NCLEX-PN-style practice questions (LPN/LVN): cram pack

Formula sheets, the key method steps for every topic and 34 practice problems, with full solutions at the back.

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1Formulas and methods

Infection control & patient safety

Method

  1. Start with standard precautions for every patient: hand hygiene, PPE for the expected exposure, safe sharps.
  2. Add precautions by route: contact (gown, gloves), droplet (surgical mask), airborne (N95, negative-pressure room).
  3. Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
  4. Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
  5. Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.

Prioritization & delegation

Method

  1. Ask what will harm the patient soonest if nothing is done.
  2. Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
  3. Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
  4. Assess before you act unless it is an emergency; then choose the step the others depend on.
  5. For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.

Lab values & electrolytes

Method

  1. Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
  2. Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
  3. Link the value to its typical signs and to the drugs and conditions that cause it.
  4. Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
  5. Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.

Med-surg: cardiovascular & respiratory

Method

  1. Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
  2. Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
  3. Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
  4. Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
  5. Choose the safe first action, then escalate and reassess.

Med-surg: neuro, endocrine & renal

Method

  1. Check the glucose in every patient with new confusion, weakness or a seizure.
  2. Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
  3. For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
  4. For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
  5. For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.

Med-surg: GI, perioperative & oncology

Method

  1. Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
  2. Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
  3. For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
  4. For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
  5. For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.

Maternity & obstetric nursing

Method

  1. Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
  2. Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
  3. Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
  4. Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.

Pediatric nursing

Method

  1. Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
  2. Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
  3. Match the action to the development stage and involve the family.
  4. Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.

Mental health nursing

Method

  1. Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
  2. Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
  3. Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
  4. Respect rights: the least restrictive option, consent and confidentiality with its limits.

Nursing math & unit conversions

Metric steps
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
Weight and length
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
Household measures
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
Temperature
°C = (°F − 32)·5/9, °F = °C·9/5 + 32
24-hour clock
PM hours 1–11: add 12; 12 AM = 00:xx; 12 PM = 12:xx
Dose rate
mcg/min × 60/1000 = mg/h
Laboratory factors
glucose 1 mmol/L = 18 mg/dL; creatinine 1 mg/dL = 88.4 µmol/L; Hb 1 g/dL = 10 g/L

Method

  1. Write the given quantity with its unit and the unit you want.
  2. Pick the equivalent: 1000 between kg, g, mg and mcg or L and mL; 1 kg = 2.2 lb; 1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 240 mL.
  3. Write it as a fraction so that the unwanted unit cancels; for a rate, use one fraction per unit that changes.
  4. Check the direction: a smaller unit gives a bigger number.
  5. Round only the final answer, to the precision the question names.

Dosage calculations

Dose from strength
volume = dose / strength
Weight-based dose
dose = mg/kg × body weight
Tablets
number = dose / tablet strength
Units
1 g = 1000 mg, 1 mg = 1000 mcg

Method

  1. Convert the ordered dose and the stock strength to the same unit.
  2. Use desired over have times quantity: (D/H) × Q.
  3. For weight-based doses, multiply by the weight in kg first, then divide the daily dose by the number of doses.
  4. Estimate first and check that the answer is reasonable.

IV infusion rates

Pump rate
mL/h = volume (mL)/time (h)
Drip rate
drops/min = volume (mL) × drop factor / time (min)
Infusion time
time (h) = volume (mL)/rate (mL/h)

Method

  1. Pump rate in mL/h: volume divided by time in hours.
  2. Drip rate in drops/min: volume × drop factor divided by time in minutes.
  3. For time remaining: volume left divided by the rate.
  4. Round as the question or the equipment requires.

IV fluids & fluid balance

Holliday–Segar per hour
4 mL/kg (first 10 kg) + 2 mL/kg (next 10 kg) + 1 mL/kg (each kg above 20)
Holliday–Segar per day
100 / 50 / 20 mL/kg for the same bands
Fluid balance
intake − output
Ice chips
count as half their volume
Urine output
mL/kg/h = mL / (kg × h)
Infusion time
time (h) = volume left (mL) / rate (mL/h)
Volume infused
mL = rate × time

Clinical assessment scores

Glasgow Coma Scale
GCS = E (1–4) + V (1–5) + M (1–6) = 3–15
APGAR
5 signs × 0–2 = 0–10; 7–10 reassuring, 4–6 moderately abnormal, 0–3 low
Braden scale
5 × (1–4) + 1 × (1–3) = 6–23; ≤ 18 at risk
Morse fall scale
falls 25, diagnosis 15, aid 15/30, IV 20, gait 10/20, mental status 15
NEWS2 risk
0–4 low; single 3 low–medium; 5–6 medium; ≥ 7 high
Mean arterial pressure
MAP = (SBP + 2·DBP)/3 = DBP + PP/3
Pulse pressure and shock index
PP = SBP − DBP, SI = HR/SBP
Body mass index
BMI = kg/m² = 703·lb/in²

Method

  1. Find the score sheet that the question uses and its range (GCS 3–15, APGAR 0–10, Braden 6–23, Morse 0–125).
  2. Score every item separately, matching the description to its level.
  3. Add the item scores and check that the total lies inside the range.
  4. Apply the cut-offs: for NEWS2 also look for any single parameter scoring 3.
  5. For derived values use MAP = (SBP + 2·DBP)/3, PP = SBP − DBP, SI = HR/SBP and BMI = kg/m².

2Practice problems

1.Nursing fundamentalsMedium

Before fitting anti-embolism stockings, what should the nurse do?

  1. AFit them over existing bandages or wounds
  2. BFit the tightest size available so the stockings give the best effect
  3. CChoose a size by looking at the patient's shoe size and weight
  4. DMeasure the legs to get the right size and check for arterial disease
2.Nursing fundamentalsHard

An elderly patient on intravenous fluids becomes breathless, with crackles in the lungs and swollen ankles. What is the most likely problem?

  1. AFluid overload
  2. BDehydration
  3. CNormal response to IV fluids
  4. DHypoglycaemia
3.Infection control & patient safetyMedium

A child has swallowed a button battery. Why is this urgent?

  1. AIt is only harmful if several batteries are swallowed
  2. BIt can burn through the lining of the esophagus within hours
  3. CIt always passes through the gut without harm
  4. DThe only risk is poisoning from heavy metals years later
4.Infection control & patient safetyHard

A child with chickenpox is admitted. Which staff member is the best choice to care for the child?

  1. AA nurse who has never had chickenpox or the vaccine
  2. BA student nurse with unknown immunity
  3. CA nurse who is pregnant and unsure of her immunity
  4. DA nurse with documented immunity to varicella
5.Prioritization & delegationMedium

A nurse teaches a patient who uses crutches. Which statement shows a need for further teaching?

  1. A“I will keep the crutch tips in good condition.”
  2. B“I will remove loose rugs from the floor at home.”
  3. C“I will take my weight on my hands, not on my armpits.”
  4. D“I will lean on the crutch pads under my arms to rest.”
6.Prioritization & delegationHard

A marathon runner is confused, with a temperature of 41 °C and hot skin. What is the priority?

  1. AGiving an antipyretic tablet and waiting for it to work
  2. BWrapping the runner in a blanket to prevent shivering
  3. CAsking the runner to rest in the shade and drink slowly
  4. DRapid cooling while supporting airway and circulation
7.Clinical nursingMedium

Which drug is first-line in an acute asthma attack?

  1. AAn oral antihistamine such as cetirizine taken every few hours
  2. BA nebulised or inhaled short-acting beta2-agonist (salbutamol/albuterol)
  3. CA long-acting inhaled corticosteroid, used alone at a higher dose
  4. DAn oral beta-blocker
8.Clinical nursingHard

A few hours after cardiac surgery, a patient has low blood pressure, a raised jugular venous pressure and quiet, muffled heart sounds. What should be suspected?

  1. ACardiac tamponade
  2. BPneumonia
  3. CHyperkalaemia
  4. DHypovolaemia from dehydration
9.Lab values & electrolytesMedium

A patient has started parenteral nutrition (PN) through a central line. Which test is monitored most frequently in the first days?

  1. AHemoglobin A1c
  2. BSerum lipase
  3. CThyroid hormones
  4. DBlood glucose
10.Lab values & electrolytesHard

An 82-year-old woman without a catheter has a urine culture growing bacteria, but no fever, urinary symptoms or change in mental state. What is the best interpretation?

  1. AA urinary tract infection that needs urgent IV antibiotics
  2. BContamination, so the culture must be repeated every week
  3. CAsymptomatic bacteriuria, usually not treated with antibiotics
  4. DPyelonephritis, which needs admission and IV fluids today
11.PharmacologyMedium

A child is starting methylphenidate for ADHD. Which advice is appropriate?

  1. AGive the drug only at weekends
  2. BExpect weight gain as the main side effect
  3. CGive doses early in the day and monitor appetite and growth
  4. DGive the last dose at bedtime to help the child sleep
12.PharmacologyHard

An older patient with coronary artery disease is starting levothyroxine for hypothyroidism. Why is a low starting dose used?

  1. AFast replacement raises cardiac oxygen demand and can cause angina
  2. BOlder patients absorb levothyroxine much better, so small doses are all they need
  3. CHigh starting doses cause permanent hypothyroidism
  4. DLevothyroxine causes severe hypoglycaemia in older patients
13.Med-surg: cardiovascular & respiratoryMedium

A patient uses a salbutamol (albuterol) inhaler and a steroid inhaler at the same times each day. Which order is usually taught?

  1. AThe order makes no difference to either drug
  2. BSalbutamol first, then the steroid after a short wait
  3. CBoth inhalers puffed together in one breath
  4. DSteroid first, then salbutamol straight afterwards
14.Med-surg: cardiovascular & respiratoryHard

A patient with a tracheostomy suddenly becomes distressed, and a suction catheter will not pass down the tube. What should the nurse do first?

  1. ARemove the inner cannula
  2. BIncrease the oxygen and wait
  3. CInflate the cuff with more air
  4. DGive a nebulised bronchodilator
15.Med-surg: neuro, endocrine & renalMedium

Which urine finding best distinguishes diabetes insipidus from SIADH?

  1. ADI gives dilute urine; SIADH gives concentrated urine
  2. BDI gives concentrated urine; SIADH gives dilute urine
  3. CDI gives glucose in the urine; SIADH gives protein
  4. DBoth conditions give very concentrated urine
16.Med-surg: neuro, endocrine & renalHard

A large pituitary tumour presses on the optic chiasm. Which visual field defect is most typical?

  1. ALoss of the inner half of the field in both eyes
  2. BLoss of central vision in both eyes
  3. CComplete blindness in one eye only
  4. DLoss of the outer half of the field in both eyes
17.Med-surg: GI, perioperative & oncologyMedium

Which pain pattern classically suggests a duodenal rather than a gastric ulcer?

  1. APain straight after eating that is worsened by food
  2. BPain in the right lower abdomen with fever and vomiting
  3. CPain 2–3 hours after meals and at night, eased by eating
  4. DPain only on deep breathing that eases when sitting forwards
18.Med-surg: GI, perioperative & oncologyHard

A patient with lung cancer develops facial swelling, distended neck veins and breathlessness that worsens when lying down. Which emergency is likely?

  1. AHypercalcaemia of malignancy
  2. BSuperior vena cava obstruction
  3. CSpinal cord compression
  4. DMassive pulmonary embolism
19.Maternity & obstetric nursingMedium

Which factor most increases a postnatal woman's risk of venous thromboembolism?

  1. ABreastfeeding
  2. BNormal blood loss
  3. CCaesarean birth
  4. DEarly walking after birth
20.Maternity & obstetric nursingHard

Which newborn finding should prompt checks for kidney and other anomalies?

  1. AMild moulding of the head
  2. BMilia on the nose
  3. CA single umbilical artery
  4. DAcrocyanosis in the first hours
21.Pediatric nursingMedium

How is threadworm (pinworm) infection usually confirmed?

  1. AA blood test for worm antibodies taken an hour after an evening meal
  2. BA tape test on the skin around the anus first thing in the morning
  3. CA urine sample collected in the evening
  4. DAn abdominal X-ray to look for the worms in the gut
22.Pediatric nursingHard

A child with nephrotic syndrome is on high-dose corticosteroids. Which instruction is most important for the family?

  1. AStop the steroids suddenly when the oedema goes
  2. BReport fever or signs of infection promptly
  3. CGive live vaccines during treatment
  4. DEncourage a high-salt diet
23.Mental health nursingMedium

A patient uses the word "glimpotrance" and explains that it means the force that controls his thoughts. What is this?

  1. AA neologism
  2. BEcholalia
  3. CCircumstantiality
  4. DA clang association
24.Mental health nursingHard

A teenager says she cuts herself "to feel better, not to die." Which statement about this is correct?

  1. ASelf-injury without suicidal intent shows that she has no mental health problems that need any treatment
  2. BNon-suicidal self-injury still increases the long-term risk of suicide, so risk is assessed each time
  3. CSelf-injury without suicidal intent never needs any assessment
  4. DShe should be told that cutting is only attention-seeking behaviour
25.Nursing math & unit conversionsMedium
12345678910111211:40?1:40 AM11:40 PM10:40 AM11:40 AM

Practice exercise (made-up values, not clinical guidance). A dose is charted at 11:40 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.

11:40
  1. 11:40 AM
  2. 211:40 PM
  3. 310:40 AM
  4. 411:40 AM
26.Nursing math & unit conversionsHard
½ tsp? mL1 tbsp? mL¾ cup? mL1½ fl oz? mLΣ = ? mL

Practice exercise (made-up values, not clinical guidance). During a shift a patient takes ½ tsp of cough syrup, 1 tbsp of liquid supplement, ¾ cup of tea, 1½ fl oz of juice. Using the equivalents given, find the total oral intake V in mL.

1 tsp = 5 mL1 tbsp = 15 mL1 cup = 8 fl oz = 240 mL1 fl oz = 30 mL
V = mL
27.Dosage calculationsMedium
30 kg7.5 mg/kgD = ? mg

A patient weighs 30 kg and is prescribed 7.5 mg/kg as a single dose. Find the dose D in mg.

30 kg7.5 mg/kg
D = mg
28.Dosage calculationsHard
74 kg178 cmBSA = √(h·w/3600)60 mg/m²D = ? mg

A patient is 178 cm tall and weighs 74 kg. The prescription is 60 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.

178 cm74 kg60 mg/m²
D = mg
29.IV infusion ratesMedium
15 gtt/mL120 mL/h? gtt/min

An infusion is ordered at 120 mL/h, but no pump is available. It runs by gravity through a giving set of 15 gtt/mL. Find the drip rate R in drops per minute.

120 mL/h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
1000 mg250 mL60 gtt/mL240 mg/h? gtt/min

1000 mg of a drug is diluted in 250 mL and given by gravity through a set of 60 gtt/mL. The order is 240 mg per hour. Find the drip rate R in drops per minute.

1000 mg/250 mL240 mg/h60 gtt/mL
R = gtt/min
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shifttea240 mLwater300 mLice chips120 mLIV infusion75 mL/h × 8 hIV antibiotic1 × 50 mLurine425 mLurine250 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL. Count ice chips as half their volume.

tea: 240 mLwater: 300 mLice chips: 120 mLIV infusion: 75 mL/h × 8 hIV antibiotic: 1 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
500 mL300 mL infused125 mL/h18:30t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 125 mL/h. At 18:30, 300 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL300 mL infused125 mL/h
t = h
33.Clinical assessment scoresMedium
H? / 25+D? / 15+Aid? / 30+IV? / 20+G? / 20+MS? / 15Σ?

Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: no; secondary diagnosis: no; ambulatory aid: holds on to furniture; IV therapy or saline lock: yes; gait: normal, bed rest or wheelchair; mental status: knows own limits. Find the Morse total MFS.

0–125
MFS =
34.Clinical assessment scoresHard
106?SBPDBPmmHgMAP = 70

Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 70 mmHg. A patient’s systolic pressure is 106 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 70 mmHg?

MAP 70 mmHgSBP 106 mmHg
DBP = mmHg

3Solutions

1.Nursing fundamentals

Answer: D · Measure the legs to get the right size and check for arterial disease

Why this is the answer

Wrong-sized stockings can cause skin damage or a tourniquet effect. They are not used in significant peripheral arterial disease, and the skin is checked daily.

Answer

D · Measure the legs to get the right size and check for arterial disease
2.Nursing fundamentals

Answer: A · Fluid overload

Why this is the answer

Breathlessness, crackles, raised respiratory rate and oedema during IV therapy suggest fluid overload. The nurse should stop or slow the infusion as appropriate, sit the patient up and escalate.

Answer

A · Fluid overload
3.Infection control & patient safety

Answer: B · It can burn through the lining of the esophagus within hours

Why this is the answer

A button battery lodged in the esophagus can cause severe chemical burns within a few hours, so the child needs emergency assessment and often removal. It should never be treated as harmless.

Answer

B · It can burn through the lining of the esophagus within hours
4.Infection control & patient safety

Answer: D · A nurse with documented immunity to varicella

Why this is the answer

Staff with proven immunity, from vaccination or past infection, should care for patients with varicella. Non-immune staff, especially pregnant staff, risk infection and can spread the virus to other patients.

Answer

D · A nurse with documented immunity to varicella
5.Prioritization & delegation

Answer: D · “I will lean on the crutch pads under my arms to rest.”

Why this is the answer

Leaning on the axillary pads can compress the nerves in the armpit. Weight should be taken through the hands, and the home should be made safe from trip hazards.

Answer

D · “I will lean on the crutch pads under my arms to rest.”
6.Prioritization & delegation

Answer: D · Rapid cooling while supporting airway and circulation

Why this is the answer

Heat stroke is an emergency in which body temperature rises and the brain is affected. Rapid cooling, for example with cold water or ice, is the priority; antipyretics do not work for heat stroke.

Answer

D · Rapid cooling while supporting airway and circulation
7.Clinical nursing

Answer: B · A nebulised or inhaled short-acting beta2-agonist (salbutamol/albuterol)

Why this is the answer

Short-acting beta2-agonists relieve bronchospasm within minutes. Oxygen to target, steroids and other treatments are added according to severity.

Answer

B · A nebulised or inhaled short-acting beta2-agonist (salbutamol/albuterol)
8.Clinical nursing

Answer: A · Cardiac tamponade

Why this is the answer

Hypotension, raised JVP and muffled heart sounds (Beck's triad) suggest cardiac tamponade. Blood in the pericardial space compresses the heart and needs urgent drainage.

Answer

A · Cardiac tamponade
9.Lab values & electrolytes

Answer: D · Blood glucose

Why this is the answer

PN contains concentrated dextrose, so hyperglycemia is common, especially at the start; glucose is checked frequently and insulin may be needed. Electrolytes, including phosphate, magnesium and potassium, are also monitored for refeeding syndrome.

Answer

D · Blood glucose
10.Lab values & electrolytes

Answer: C · Asymptomatic bacteriuria, usually not treated with antibiotics

Why this is the answer

Asymptomatic bacteriuria is common in older adults and usually should not be treated, because treatment brings adverse effects and resistance without benefit. Exceptions include pregnancy and some urological procedures.Checked against: Asymptomatic Bacteriuria · StatPearls (NCBI Bookshelf) (2023)

Answer

C · Asymptomatic bacteriuria, usually not treated with antibiotics
11.Pharmacology

Answer: C · Give doses early in the day and monitor appetite and growth

Why this is the answer

Stimulants can cause insomnia, so doses are given in the morning and early afternoon. Reduced appetite can slow growth, so height and weight are tracked.

Answer

C · Give doses early in the day and monitor appetite and growth
12.Pharmacology

Answer: A · Fast replacement raises cardiac oxygen demand and can cause angina

Why this is the answer

Thyroid hormone increases metabolic rate, heart rate and contractility. In older people and those with heart disease, the dose is started low and increased slowly to avoid ischaemia and arrhythmias.

Answer

A · Fast replacement raises cardiac oxygen demand and can cause angina
13.Med-surg: cardiovascular & respiratory

Answer: B · Salbutamol first, then the steroid after a short wait

Why this is the answer

Using the bronchodilator first opens the airways so the inhaled corticosteroid can reach the smaller airways. A short wait between inhalers and a mouth rinse after the steroid are also taught.

Answer

B · Salbutamol first, then the steroid after a short wait
14.Med-surg: cardiovascular & respiratory

Answer: A · Remove the inner cannula

Why this is the answer

Tracheostomy emergency guidance is to remove the inner cannula first, because it may be blocked with secretions. If the patient does not improve, the cuff is deflated and the tube may need to be removed. Oxygen is applied to the face and the stoma, and emergency help is called.

Answer

A · Remove the inner cannula
15.Med-surg: neuro, endocrine & renal

Answer: A · DI gives dilute urine; SIADH gives concentrated urine

Why this is the answer

In DI, lack of ADH effect causes large volumes of dilute urine (specific gravity often below 1.005) with high serum sodium. In SIADH, excess ADH causes low urine output with concentrated urine and low serum sodium.

Answer

A · DI gives dilute urine; SIADH gives concentrated urine
16.Med-surg: neuro, endocrine & renal

Answer: D · Loss of the outer half of the field in both eyes

Why this is the answer

The chiasm carries crossing fibres from the nasal retinas, which see the temporal (outer) fields. Compression causes a bitemporal hemianopia. Patients may bump into objects at their sides.

Answer

D · Loss of the outer half of the field in both eyes
17.Med-surg: GI, perioperative & oncology

Answer: C · Pain 2–3 hours after meals and at night, eased by eating

Why this is the answer

Classically, duodenal ulcer pain occurs when the stomach is empty and at night, and food or antacids ease it. Gastric ulcer pain is often brought on by eating. Patterns overlap, so endoscopy makes the diagnosis.

Answer

C · Pain 2–3 hours after meals and at night, eased by eating
18.Med-surg: GI, perioperative & oncology

Answer: B · Superior vena cava obstruction

Why this is the answer

A tumour can compress or invade the superior vena cava, causing facial and arm swelling, dilated chest veins, headache and breathlessness. The patient is sat up and urgently reviewed; treatment includes steroids, stenting and radiotherapy or chemotherapy.

Answer

B · Superior vena cava obstruction
19.Maternity & obstetric nursing

Answer: C · Caesarean birth

Why this is the answer

Pregnancy and the postpartum period are hypercoagulable. Caesarean birth, immobility, obesity, older age and previous VTE add to the risk. Early walking and, where indicated, prophylaxis reduce it.

Answer

C · Caesarean birth
20.Maternity & obstetric nursing

Answer: C · A single umbilical artery

Why this is the answer

A two-vessel cord can be associated with renal, cardiac and other anomalies. Milia, moulding and acrocyanosis are normal findings.

Answer

C · A single umbilical artery
21.Pediatric nursing

Answer: B · A tape test on the skin around the anus first thing in the morning

Why this is the answer

Clear adhesive tape pressed against the perianal skin on waking, before washing, picks up eggs that can be seen under a microscope. Parents may also see the small white worms around the anus at night.

Answer

B · A tape test on the skin around the anus first thing in the morning
22.Pediatric nursing

Answer: B · Report fever or signs of infection promptly

Why this is the answer

Children with nephrotic syndrome on steroids are prone to serious infections such as peritonitis and cellulitis. Steroids must be tapered, not stopped suddenly, and live vaccines are deferred during high-dose treatment.

Answer

B · Report fever or signs of infection promptly
23.Mental health nursing

Answer: A · A neologism

Why this is the answer

Neologisms are invented words, or real words given a private meaning, and are a sign of disorganised thinking.

Answer

A · A neologism
24.Mental health nursing

Answer: B · Non-suicidal self-injury still increases the long-term risk of suicide, so risk is assessed each time

Why this is the answer

Self-harm is a strong predictor of later suicide, even when the person does not intend to die. Each episode needs a compassionate assessment of risk, triggers and the function of the behaviour.

Answer

B · Non-suicidal self-injury still increases the long-term risk of suicide, so risk is assessed each time
25.Nursing math & unit conversions

Answer: 11:40 AM

24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.

Convert the hour

11 → 11 AM

Answer

11:40 AM

Answer

11:40 AM
26.Nursing math & unit conversions

Answer: V = 242.5 mL

Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.

Each item in mL

½ tsp = 0.5·5 = 2.5 mL
1 tbsp = 1·15 = 15 mL
¾ cup = 0.75·240 = 180 mL
1½ fl oz = 1.5·30 = 45 mL

Add

V = 2.5 + 15 + 180 + 45 = 242.5 mL

Answer

V = 242.5 mL
27.Dosage calculations

Answer: D = 225 mg

Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.

Dose

7.5·30 = 225 mg

Answer

D = 225 mg
28.Dosage calculations

Answer: D = 114.8 mg

Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).

Body surface area

BSA = √(178·74/3600) = √3.659 = 1.913 m²

Dose

D = 60·1.913 = 114.8 mg

Answer

D = 114.8 mg
29.IV infusion rates

Answer: R = 30 gtt/min

Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.

Millilitres per minute

120/60 = 2 mL/min

Drip rate

R = 2·15 = 30 gtt/min

Answer

R = 30 gtt/min
30.IV infusion rates

Answer: R = 60 gtt/min

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

Concentration

1000/250 = 4 mg/mL

Volume per hour

240/4 = 60 mL/h

Drip rate

R = 60·60/60 = 60 gtt/min

Answer

R = 60 gtt/min
31.IV fluids & fluid balance

Answer: I = 1250 mL

Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Add the intake

oral: 240 + 300 = 540 mL
ice chips: 120/2 = 60 mL
IV infusion: 75·8 = 600 mL
IV antibiotic: 1·50 = 50 mL
I = 1250 mL

Answer

I = 1250 mL
32.IV fluids & fluid balance

Answer: t = 1.6 h

Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Volume left

500 − 300 = 200 mL

Time

t = 200/125 = 1.6 h

Answer

t = 1.6 h

That is about 1 h 36 min, so the bag runs out at about 20:06.

33.Clinical assessment scores

Answer: MFS = 50

Morse fall scale: six items. History of falling: no 0, yes 25. Secondary diagnosis: no 0, yes 15. Ambulatory aid: none, bed rest or nurse assistance 0; crutches, cane or walker 15; holding on to furniture 30. IV therapy or saline lock: no 0, yes 20. Gait: normal, bed rest or wheelchair 0; weak 10; impaired 20. Mental status: knows own limits 0; overestimates or forgets limits 15. The total runs from 0 to 125. Risk cut-offs differ between hospitals; a common set is 0–24 low, 25–44 moderate and 45 or more high.

Score each item

history of falling in the last 3 months: no → 0
secondary diagnosis: no → 0
ambulatory aid: holds on to furniture → 30
IV therapy or saline lock: yes → 20
gait: normal, bed rest or wheelchair → 0
mental status: knows own limits → 0

Add

Morse total = 0 + 0 + 30 + 20 + 0 + 0 = 50

Answer

MFS = 50
34.Clinical assessment scores

Answer: DBP = 52 mmHg

Blood pressure values: pulse pressure PP = SBP − DBP. Mean arterial pressure MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3, an estimate based on the heart spending about two thirds of each beat in diastole at a normal heart rate (less accurate when the heart rate is fast); a MAP of at least about 65 mmHg is a common target for organ perfusion. The shock index SI = heart rate/SBP is normally about 0.5–0.7; a value above about 1 is a warning sign of shock.

Rearrange

DBP = (3·MAP − SBP)/2

Substitute

DBP = (3·70 − 106)/2 = 104/2 = 52 mmHg

Answer

DBP = 52 mmHg

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