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

How is body mass index (BMI) calculated?

  1. AHeight in centimetres divided by weight in kilograms
  2. BWeight in kilograms multiplied by height in metres squared
  3. CWaist size divided by hip size
  4. DWeight in kilograms divided by height in metres squared
2.Nursing fundamentalsHard

Which task is most appropriate for a registered nurse to delegate to a healthcare assistant (nursing assistant)?

  1. AEvaluating a patient who has just fallen
  2. BAssessing a newly admitted patient's falls risk
  3. CHelping a stable patient walk to the bathroom
  4. DTeaching a patient how to use crutches
3.Infection control & patient safetyMedium

Which nurse should not be assigned to a patient with a sealed radioactive implant?

  1. AA nurse trained in radiation safety
  2. BA nurse who is pregnant
  3. CA nurse who has worked on the unit for two years
  4. DA nurse wearing a dosimeter badge
4.Infection control & patient safetyHard

Which action by a nurse shows that the five moments of hand hygiene are being followed?

  1. AShe cleans her hands after touching the bed rail
  2. BShe wears the same gloves between two patients
  3. CShe cleans her hands only when they look dirty
  4. DShe cleans her hands only at the start and end of the shift
5.Prioritization & delegationMedium

A conscious patient with hypoglycemia drank juice 15 minutes ago. The glucose is now 62 mg/dL (3.4 mmol/L). What should the nurse do next?

  1. AGive the next scheduled dose of rapid-acting insulin with the meal
  2. BGive another serving of fast-acting carbohydrate and recheck in 15 minutes
  3. CRecord the result and recheck the glucose at the usual time before the evening meal
  4. DWait another hour, because juice can take a long time to work
6.Prioritization & delegationHard

A patient on a cardiac monitor suddenly becomes unresponsive, and the monitor shows ventricular fibrillation. What is the priority once help has been called?

  1. ACheck the blood potassium level before any shock is considered
  2. BRecord a full 12-lead ECG to confirm the rhythm before doing anything else at all
  3. CDefibrillate as soon as the defibrillator is available, with CPR until then
  4. DGive an oral antiarrhythmic tablet and recheck the rhythm in five minutes
7.Clinical nursingMedium

Under the Mental Capacity Act 2005 (England and Wales), which principle applies?

  1. AA diagnosis of dementia means the person lacks capacity for all decisions
  2. BEveryone over 75 is assumed to lack capacity
  3. CCapacity is decided by the next of kin, who must sign a form for every decision
  4. DA person must be assumed to have capacity unless it is shown that they lack it
8.Clinical nursingHard

A patient with an acute GI bleed has a heart rate of 120/min and blood pressure 90/60 mmHg. What is the nursing priority after calling for help?

  1. AGive a large meal to restore energy
  2. BSecure large-bore IV access and prepare for fluid or blood replacement
  3. CDelay action until the stool colour is checked
  4. DEncourage walking to the bathroom alone
9.Lab values & electrolytesMedium

Why do patients with chronic kidney disease often have anemia?

  1. AHigh potassium in kidney disease breaks down red cells
  2. BThe kidneys make less erythropoietin, which drives red cell production
  3. CThe damaged kidneys filter out and destroy red blood cells
  4. DUremic toxins make the bone marrow produce white cells instead of red cells
10.Lab values & electrolytesHard

A patient’s total calcium is 7.9 mg/dL (2.0 mmol/L), with an albumin of 2.4 g/dL (24 g/L) and no symptoms. Which test would best clarify whether true hypocalcemia is present?

  1. AAn HbA1c
  2. BA urine specific gravity
  3. CAn ionized calcium
  4. DA serum sodium
11.PharmacologyMedium

Which is a well-known adverse effect of long-term oral corticosteroids?

  1. AHypoglycaemia
  2. BOsteoporosis
  3. CLow blood pressure
  4. DWeight loss
12.PharmacologyHard

A non-competitive (irreversible) antagonist changes a dose–response curve by:

  1. ALowering the maximum response
  2. BMaking the curve steeper without other changes
  3. CShifting the curve to the right with the same maximum
  4. DShifting the curve to the left
13.Med-surg: cardiovascular & respiratoryMedium

A 70 kg patient has passed 20 mL of urine per hour for the last three hours. How should this be interpreted?

  1. ABelow 0.5 mL/kg/h, suggesting poor kidney perfusion
  2. BHigh, suggesting fluid overload that needs a diuretic
  3. CNormal, because the target is 0.1 mL/kg/h
  4. DNormal, because any measurable urine output is reassuring
14.Med-surg: cardiovascular & respiratoryHard

A patient receiving noradrenaline (norepinephrine) through a peripheral cannula has pale, cold skin around the site. What should the nurse do?

  1. AStop it at that site, inform the team and follow the extravasation policy
  2. BMassage the area firmly to spread the drug out into the surrounding tissue
  3. CIncrease the rate so the drug enters the vein faster and leaks less
  4. DContinue the infusion, as this is expected
15.Med-surg: neuro, endocrine & renalMedium

A woman who takes the combined contraceptive pill is starting carbamazepine. What should she be taught?

  1. AShe should take both at the same time so they are absorbed together
  2. BCarbamazepine can make the pill less effective, so other contraception is needed
  3. CThe pill makes carbamazepine toxic, so she must stop the pill
  4. DThere is no interaction between these two medicines
16.Med-surg: neuro, endocrine & renalHard

A patient's potassium is 7.1 mmol/L, and the ECG shows peaked T waves and broad QRS complexes. What is the first treatment?

  1. AIV calcium gluconate
  2. BOral sodium bicarbonate
  3. CIV furosemide
  4. DOral potassium binder
17.Med-surg: GI, perioperative & oncologyMedium

Which complication is more typical of Crohn's disease than of ulcerative colitis?

  1. AFistulas between the bowel and other organs
  2. BBleeding only from the rectum
  3. CInflammation limited to the rectal lining
  4. DDisease that is cured by removing the colon
18.Med-surg: GI, perioperative & oncologyHard

Which safety rule applies to vincristine?

  1. AIt is usually given intrathecally with other spinal drugs
  2. BIt can be given by whichever route the prescriber prefers
  3. CIt is best given as a fast IV push into a small vein
  4. DNever intrathecal; supplied in a minibag for IV use only
19.Maternity & obstetric nursingMedium

A woman's cultural practice involves eating only warm foods after birth. How should the nurse respond?

  1. AInsist that she eat the standard hospital diet
  2. BRespect it and offer suitable warm foods
  3. CIgnore her requests to save time
  4. DTell her the practice is harmful and must stop
20.Maternity & obstetric nursingHard

A nurse is teaching a mother how to prevent shaken baby syndrome. Which statement shows a need for further teaching?

  1. A"If I get too frustrated, I will put him in his cot and step away for a few minutes."
  2. B"Crying often increases in the first weeks, and that can be normal."
  3. C"I can call someone to help when I feel overwhelmed."
  4. D"If I feel very angry, it is fine to shake him a little to stop the crying."
21.Pediatric nursingMedium

A parent asks how to care for a child with mild croup at home. Which advice is correct?

  1. AHold the child over a bowl of hot, steaming water to loosen the cough
  2. BLay the child flat in a cool room so the airway can relax
  3. CGive an over-the-counter cough syrup every hour until the barking cough stops
  4. DKeep the child calm and upright, and get urgent help if there is noisy breathing at rest
22.Pediatric nursingHard

A 2-year-old has swallowed several of his mother's iron tablets. Why is this treated as an emergency even if he looks well?

  1. AIron tablets dissolve to form a gas that blocks the airway
  2. BIron poisoning causes only constipation, which needs an enema
  3. CIron tablets cause an immediate allergic reaction in young children
  4. DIron poisoning can cause gut bleeding, shock and liver failure hours later
23.Mental health nursingMedium

In DSM-5-TR, prolonged grief disorder in adults requires that at least how long has passed since the death?

  1. A3 years
  2. B6 weeks
  3. C2 weeks
  4. D12 months
24.Mental health nursingHard

The daughter of a man with moderate dementia says she is exhausted, is not sleeping and feels guilty for getting angry with him. What is the most helpful nursing response?

  1. AAdvise her to take on more responsibility for his care so that she feels less guilty
  2. BAcknowledge her strain and discuss support such as respite care and carers' groups
  3. CSuggest that she stops visiting him for a few months so that she can rest and forget about her guilt
  4. DTell her that good daughters do not get angry with their parents
25.Nursing math & unit conversionsMedium
94969810010210410635363738394041°F°C98.2 °F? °C

Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 98.2 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.

98.2 °F
T = °C
26.Nursing math & unit conversionsHard
2 mcg/kg/min? mg/h94 kg1 h = 60 min1 mg = 1000 mcg

Practice exercise (made-up values, not clinical guidance). An order reads 2 mcg/kg/min for a patient who weighs 94 kg. Express the dose rate D in mg/h. Round to two decimal places.

2 mcg/kg/min94 kg
D = mg/h
27.Dosage calculationsMedium
43 kgBSA = 1.32 m²375 mg/m²D = ? mg

A patient weighing 43 kg has a body surface area of 1.32 m². The prescription is 375 mg/m². Find the dose D in mg.

43 kgBSA = 1.32 m²375 mg/m²
D = mg
28.Dosage calculationsHard
200 mg/5 mLV = ? mL

A child weighing 14 kg is prescribed 15 mg/kg per dose of an oral suspension that contains 200 mg in 5 mL. What volume V do you give? Round to one decimal place.

14 kg15 mg/kg200 mg/5 mL
V = mL
29.IV infusion ratesMedium
450 mLleft? mL/h4 h left

1000 mL was ordered over 10 hours. After 6 hours you find that 450 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?

1000 mL / 10 hafter 6 h: 450 mL
R = mL/h
30.IV infusion ratesHard
200 mL60 gtt/mL40 gtt/mint = ? h

A drip runs at 40 gtt/min through a set of 60 gtt/mL. There are 200 mL left in the bag. How many hours t until it is empty?

40 gtt/min60 gtt/mL200 mL
t = h
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shifttea240 mLmilk240 mLjuice150 mLIV infusion80 mL/h × 12 hIV antibiotic1 × 50 mLurine325 mLurine200 mLurine250 mLurine350 mLwound drain110 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The patient weighs 105 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

105 kg12 hurine: 325 mLurine: 200 mLurine: 250 mLurine: 350 mLwound drain: 110 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
1000 mL150 mL/hstart 14:0019:30: ? mL

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 14:00 and runs by pump at 150 mL/h. How many mL V are left in the bag at 19:30?

1000 mL150 mL/h14:00 → 19:30
V = mL
33.Clinical assessment scoresMedium
160104SBPDBPmmHgHR 144/min · SI = ?

Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 144/min and a blood pressure of 160/104 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.

HR 144/minBP 160/104 mmHg
SI =
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 80 kg and is 169 cm tall. Calculate the BMI and click the WHO weight category.

80 kg169 cm
  1. 1underweight
  2. 2healthy weight
  3. 3overweight
  4. 4obesity class I
  5. 5obesity class II
  6. 6obesity class III

3Solutions

1.Nursing fundamentals

Answer: D · Weight in kilograms divided by height in metres squared

Why this is the answer

BMI = weight (kg) ÷ height² (m²). For example, 70 kg and 1.75 m gives about 22.9 kg/m². It is a screening measure and does not show body composition.

Answer

D · Weight in kilograms divided by height in metres squared
2.Nursing fundamentals

Answer: C · Helping a stable patient walk to the bathroom

Why this is the answer

Routine help with care for a stable patient can be delegated. Assessment, teaching and evaluation need registered nurse judgement.

Answer

C · Helping a stable patient walk to the bathroom
3.Infection control & patient safety

Answer: B · A nurse who is pregnant

Why this is the answer

Pregnant staff and visitors are not assigned to patients with radioactive implants. Other staff limit the time spent with the patient, keep their distance, use shielding and wear a dosimeter.

Answer

B · A nurse who is pregnant
4.Infection control & patient safety

Answer: A · She cleans her hands after touching the bed rail

Why this is the answer

Touching the patient’s surroundings, such as rails and tables, contaminates the hands, so hand hygiene is needed afterwards. Gloves are changed between patients, and hand hygiene is needed whether or not the hands look dirty.

Answer

A · She cleans her hands after touching the bed rail
5.Prioritization & delegation

Answer: B · Give another serving of fast-acting carbohydrate and recheck in 15 minutes

Why this is the answer

If the glucose is still below the hypoglycemia threshold after treatment (70 mg/dL in US guidance, 4.0 mmol/L in UK guidance), the fast-acting carbohydrate is repeated and the glucose rechecked. Once it is normal, a snack or meal helps keep it stable.

Answer

B · Give another serving of fast-acting carbohydrate and recheck in 15 minutes
6.Prioritization & delegation

Answer: C · Defibrillate as soon as the defibrillator is available, with CPR until then

Why this is the answer

Ventricular fibrillation is a shockable cardiac arrest rhythm. Early defibrillation, with high-quality CPR until the shock is given, is the most important treatment.

Answer

C · Defibrillate as soon as the defibrillator is available, with CPR until then
7.Clinical nursing

Answer: D · A person must be assumed to have capacity unless it is shown that they lack it

Why this is the answer

The Act begins by presuming capacity. Capacity is decision-specific and time-specific, and people must be given all practicable help to make their own decision.

Answer

D · A person must be assumed to have capacity unless it is shown that they lack it
8.Clinical nursing

Answer: B · Secure large-bore IV access and prepare for fluid or blood replacement

Why this is the answer

Tachycardia and hypotension suggest significant blood loss. ABCDE assessment, wide-bore IV access, bloods including cross-match and resuscitation come first, followed by endoscopy.

Answer

B · Secure large-bore IV access and prepare for fluid or blood replacement
9.Lab values & electrolytes

Answer: B · The kidneys make less erythropoietin, which drives red cell production

Why this is the answer

Diseased kidneys produce less erythropoietin, so the marrow makes fewer red cells. Treatment can include erythropoiesis-stimulating agents and iron.Checked against: Anemia · MedlinePlus (NIH) (2026); Erythropoietin test · MedlinePlus (NIH) (2025)

Answer

B · The kidneys make less erythropoietin, which drives red cell production
10.Lab values & electrolytes

Answer: C · An ionized calcium

Why this is the answer

Low albumin lowers total calcium without necessarily lowering the active, ionized calcium. Measuring ionized calcium directly is the most reliable way to decide whether treatment is needed.Checked against: Calcium - ionized · MedlinePlus (NIH) (2025); Calcium Blood Test · MedlinePlus (NIH) (2024)

Answer

C · An ionized calcium
11.Pharmacology

Answer: B · Osteoporosis

Why this is the answer

Long-term corticosteroids reduce bone formation and raise fracture risk. They also cause weight gain, high blood glucose, hypertension and a higher infection risk.

Answer

B · Osteoporosis
12.Pharmacology

Answer: A · Lowering the maximum response

Why this is the answer

A competitive antagonist shifts the curve to the right but higher agonist doses reach the same maximum. A non-competitive antagonist reduces the maximum response.

Answer

A · Lowering the maximum response
13.Med-surg: cardiovascular & respiratory

Answer: A · Below 0.5 mL/kg/h, suggesting poor kidney perfusion

Why this is the answer

A urine output below about 0.5 mL/kg/h (35 mL/h for 70 kg) for several hours is oliguria and may indicate hypovolaemia, shock or acute kidney injury. It should be reported along with the other observations, and the catheter checked for blockage.

Answer

A · Below 0.5 mL/kg/h, suggesting poor kidney perfusion
14.Med-surg: cardiovascular & respiratory

Answer: A · Stop it at that site, inform the team and follow the extravasation policy

Why this is the answer

Extravasated noradrenaline causes intense local vasoconstriction and tissue necrosis. The infusion is stopped at that site (with a plan to continue elsewhere, since the patient depends on it), the team is informed and the local extravasation protocol is followed. Vasopressors are given through a central line where possible.

Answer

A · Stop it at that site, inform the team and follow the extravasation policy
15.Med-surg: neuro, endocrine & renal

Answer: B · Carbamazepine can make the pill less effective, so other contraception is needed

Why this is the answer

Carbamazepine is a strong liver enzyme inducer, so it lowers hormone levels from the pill and can lead to an unplanned pregnancy. Contraception that is not affected, such as an IUD, is usually advised.

Answer

B · Carbamazepine can make the pill less effective, so other contraception is needed
16.Med-surg: neuro, endocrine & renal

Answer: A · IV calcium gluconate

Why this is the answer

ECG changes mean the heart is at risk. IV calcium is given first to stabilise the myocardium, followed by insulin with glucose (and often nebulised salbutamol) to shift potassium into cells. Binders or dialysis then remove it.

Answer

A · IV calcium gluconate
17.Med-surg: GI, perioperative & oncology

Answer: A · Fistulas between the bowel and other organs

Why this is the answer

Transmural inflammation in Crohn's disease can create fistulas, abscesses and strictures. Ulcerative colitis is mucosal, and removing the colon and rectum is curative.

Answer

A · Fistulas between the bowel and other organs
18.Med-surg: GI, perioperative & oncology

Answer: D · Never intrathecal; supplied in a minibag for IV use only

Why this is the answer

Intrathecal vincristine is almost always fatal. To prevent wrong-route errors, it is diluted in a minibag for IV use, labelled "for intravenous use only, fatal if given by other routes" and kept separate from intrathecal drugs.

Answer

D · Never intrathecal; supplied in a minibag for IV use only
19.Maternity & obstetric nursing

Answer: B · Respect it and offer suitable warm foods

Why this is the answer

Many cultures have postnatal dietary customs, such as warm foods. When a practice is not harmful, the nurse respects it and adapts care, which builds trust and supports recovery.

Answer

B · Respect it and offer suitable warm foods
20.Maternity & obstetric nursing

Answer: D · "If I feel very angry, it is fine to shake him a little to stop the crying."

Why this is the answer

Shaking a baby can cause brain injury, retinal haemorrhages and death. Parents are taught that crying is normal, to put the baby down safely and step away when frustrated, and to ask for help.

Answer

D · "If I feel very angry, it is fine to shake him a little to stop the crying."
21.Pediatric nursing

Answer: D · Keep the child calm and upright, and get urgent help if there is noisy breathing at rest

Why this is the answer

Calm and comfort reduce distress and airway narrowing. Steam inhalation is not effective and risks scalds. Parents should seek urgent help for stridor at rest, retractions, drooling, blue colour or drowsiness.

Answer

D · Keep the child calm and upright, and get urgent help if there is noisy breathing at rest
22.Pediatric nursing

Answer: D · Iron poisoning can cause gut bleeding, shock and liver failure hours later

Why this is the answer

Iron overdose damages the gut lining and disrupts cell metabolism, leading to vomiting, bleeding, shock, acidosis and liver failure, sometimes after a period when the child seems better. Urgent assessment is needed; deferoxamine is used for serious poisoning.

Answer

D · Iron poisoning can cause gut bleeding, shock and liver failure hours later
23.Mental health nursing

Answer: D · 12 months

Why this is the answer

In adults, prolonged grief disorder requires at least 12 months since the loss (6 months for children and adolescents), with intense yearning or preoccupation that impairs functioning. ICD-11 uses a shorter minimum of 6 months.

Answer

D · 12 months
24.Mental health nursing

Answer: B · Acknowledge her strain and discuss support such as respite care and carers' groups

Why this is the answer

Caregiver strain is common and can affect both the carer and the patient. Recognising it, and offering respite, practical support and carers' groups, helps the carer continue safely.

Answer

B · Acknowledge her strain and discuss support such as respite care and carers' groups
25.Nursing math & unit conversions

Answer: T = 36.8 °C

Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.

Subtract 32

98.2 − 32 = 66.2

Multiply by 5/9

T = 66.2·5/9 = 36.78 ≈ 36.8 °C

Answer

T = 36.8 °C
26.Nursing math & unit conversions

Answer: D = 11.28 mg/h

Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.

Set up the chain

D = 2 mcg/kg/min × 94 kg × (60 min/1 h) × (1 mg/1000 mcg)

Calculate

D = 2·94·60/1000 = 11.28 mg/h

Answer

D = 11.28 mg/h
27.Dosage calculations

Answer: D = 495 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).

Dose

D = 375·1.32 = 495 mg

Answer

D = 495 mg
28.Dosage calculations

Answer: V = 5.3 mL

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 from weight

15·14 = 210 mg

Volume

V = (210/200)·5 = 5.25 ≈ 5.3 mL

Answer

V = 5.3 mL
29.IV infusion rates

Answer: R = 112.5 mL/h

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.

Original rate

1000/10 = 100 mL/h

New rate

R = 450/4 = 112.5 mL/h

Answer

R = 112.5 mL/h

Many hospitals allow such an adjustment up to 25% without a new order; check local policy.

30.IV infusion rates

Answer: t = 5 h

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.

Rate in mL/h

40·60/60 = 40 mL/h

Time left

t = 200/40 = 5 h

Answer

t = 5 h
31.IV fluids & fluid balance

Answer: U = 0.89 mL/kg/h

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.

Total urine

325 + 200 + 250 + 350 = 1125 mL

Per kilogram per hour

U = 1125/(105·12) = 0.8929 ≈ 0.89 mL/kg/h

Answer

U = 0.89 mL/kg/h
32.IV fluids & fluid balance

Answer: V = 175 mL

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.

Elapsed time

14:00 → 19:30 = 5.5 h

Volume infused

150·5.5 = 825 mL

Volume left

V = 1000 − 825 = 175 mL

Answer

V = 175 mL
33.Clinical assessment scores

Answer: SI = 0.9

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.

Shock index

SI = 144/160 = 0.9

Answer

SI = 0.9

Above the usual 0.5–0.7.

34.Clinical assessment scores

Answer: overweight

Body mass index: BMI = weight (kg)/height (m)², with the height converted to metres first. With pounds and inches, BMI = 703 × weight (lb)/height (in)². WHO adult categories: below 18.5 underweight, 18.5–24.9 healthy weight, 25.0–29.9 overweight, 30.0–34.9 obesity class I, 35.0–39.9 obesity class II and 40 or more obesity class III.

BMI

BMI = 80/1.69² = 28.01

Category

overweight

Answer

overweight

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