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

How is pitting oedema checked?

1. APress over a bony area such as the shin for a few seconds and look for a dent
2. BPress on the nail bed and time the return of colour
3. CPinch the skin on the back of the hand and see how fast it falls back
4. DMeasure the width of both calves with a tape measure once a week and compare them

An AED is about to deliver a shock. What must the rescuer do?

1. AKeep doing chest compressions during the shock
2. BMake sure no one is touching the patient
3. CRemove the pads and place them again
4. DHold the patient's hand to reassure them

How tight should a wrist restraint be?

1. ATight enough to slow the pulse at the wrist
2. BLoose enough for the patient’s hand to slip out
3. CAs tight as possible so the patient cannot move the arm
4. DLoose enough to fit two fingers between the restraint and the skin

A nurse caring for a patient with influenza on droplet precautions will assist with an aerosol-generating procedure, such as bronchoscopy. What change in PPE is needed?

1. AWear gloves only, because the procedure is short
2. BNo change, because influenza only needs droplet precautions
3. CWear a fit-tested respirator (N95 or FFP3) and eye protection instead of a surgical mask
4. DWear two surgical masks, one on top of the other, for the length of the procedure

A patient’s peripheral IV site is swollen, pale and cool, and the infusion has slowed. What should the nurse do first?

1. AFlush the cannula hard to clear the blockage
2. BStop the infusion and remove the cannula
3. CApply a tight bandage over the site to reduce swelling
4. DIncrease the infusion rate to overcome the resistance

An 85-year-old resident becomes newly confused and is falling, but has no fever. Which cause should the nurse consider first?

1. AAn infection, such as a urinary tract infection, presenting atypically
2. BNormal aging that needs no assessment
3. CBoredom from not having enough activities
4. DA sudden worsening of long-standing dementia that needs no tests

Why can a very low serum albumin contribute to oedema?

1. AIt increases the number of red cells
2. BIt makes the kidneys retain potassium
3. CIt raises the blood pressure in the capillaries and pushes fluid out
4. DIt lowers the oncotic pressure that holds fluid in the blood vessels

A seriously ill patient asks the nurse, "Am I dying?" What is the best initial response?

1. AChange the subject quickly to keep them cheerful and avoid upsetting them
2. BGently explore what the patient understands and what has prompted the question
3. CTell the patient not to think about such things and to stay positive
4. DLeave and send the doctor without saying anything

A patient with type 1 diabetes has the flu, is eating little and has a glucose of 290 mg/dL (16.1 mmol/L). Which advice is correct?

1. AWait 3 days before checking the glucose again
2. BDrink only water and avoid all carbohydrate foods
3. CStop all insulin until you are eating normally again
4. DKeep taking insulin and check blood or urine ketones

A patient with right upper abdominal pain from gallstones now has jaundice, a total bilirubin of 4.8 mg/dL (82 µmol/L) and a raised ALP. What is the most likely cause?

1. AGilbert syndrome triggered by pain
2. BHemolysis caused by the gallstones
3. CA stone blocking the common bile duct
4. DUncomplicated gallbladder inflammation

Which technique is correct when giving subcutaneous enoxaparin from a prefilled syringe?

1. AMassage the site well for one minute after the injection
2. BInject into a vein on the back of the hand
3. CExpel the air bubble from the syringe first, then inject into the deltoid muscle
4. DInject into the abdomen away from the navel and do not rub the site afterwards

Which statement correctly contrasts donepezil and memantine in Alzheimer's disease?

1. ABoth drugs remove amyloid plaques from the brain
2. BDonepezil inhibits cholinesterase; memantine blocks NMDA receptors
3. CDonepezil blocks NMDA receptors; memantine inhibits acetylcholinesterase
4. DBoth drugs are dopamine agonists that differ only in their half-lives

A 34-year-old has hypertension that is hard to control and a low serum potassium without taking diuretics. Which cause should be considered?

1. AIron-deficiency anaemia
2. BEssential hypertension of ageing
3. CPrimary hyperaldosteronism
4. DHypothyroidism

A patient receiving weeks of IV antibiotics through a PICC line in the left arm develops swelling and aching of that arm and neck veins that look fuller on the left. What should the nurse suspect?

1. AA catheter-related deep vein thrombosis
2. BA local skin allergy to the dressing
3. CLymphoedema from lying in bed
4. DAn expected effect of the antibiotic

How should peritoneal dialysis fluid be warmed before use?

1. AIn a microwave oven
2. BIn a bowl of hot tap water
3. CIt should be used cold from the fridge
4. DIn a dedicated dry-heat warmer

A patient with suspected meningitis has a GCS of 9 and pupils that have become unequal. A doctor plans an immediate lumbar puncture. What is the main concern?

1. AThe patient is too confused to stay still, so it is not needed
2. BThere is no concern, because the lumbar puncture lowers pressure safely
3. CRaised pressure in the skull, so the procedure could cause herniation
4. DA lumbar puncture would spread the infection to the blood

How is an uncomplicated sigmoid volvulus often first treated?

1. AA barium meal given by mouth to untwist the bowel slowly
2. BEating a large high-fibre meal
3. CHigh-dose laxatives taken by mouth
4. DDecompression with a flexible sigmoidoscope and flatus tube

A patient with a toe ulcer says the leg pain is worse at night and eases when they hang the leg over the side of the bed. What does this suggest?

1. AVenous insufficiency
2. BLymphoedema
3. CArterial insufficiency
4. DNeuropathic itching

A woman with a normal pre-pregnancy BMI asks how much weight she should gain. Which range do the widely used US Institute of Medicine guidelines recommend?

1. AAbout 5 to 9 kg
2. BAbout 18 to 23 kg
3. CAbout 2 to 4 kg
4. DAbout 11.5 to 16 kg

Over the last hour, a labour tracing shows variable decelerations that are becoming deeper and longer, a baseline rising from 135 to 165 bpm and falling variability. How should the nurse interpret this?

1. AEvolving fetal hypoxia; escalate for urgent obstetric review
2. BBenign head compression; continue routine monitoring
3. CA sign of fetal well-being; no action is needed
4. DA normal fetal sleep cycle; recheck in an hour

If the MMR and varicella vaccines are not given on the same day, what is the general rule?

1. ANever give both vaccines in the same year
2. BSeparate them by at least 1 week
3. CSeparate them by at least 4 weeks
4. DGive the second within 24 hours of the first

A child is receiving IV potassium chloride. The nurse finds the cannula site swollen and pale and the child crying. What should the nurse do first?

1. AIncrease the infusion rate to finish faster
2. BStop the infusion and assess the site
3. CApply a tight bandage over the site
4. DReassure the child and continue the infusion

A patient with psychosis says, "There's a man standing in the corner." The nurse sees no one there. Which response uses presenting reality?

1. A"The man will go away if you ignore him."
2. B"I don't see anyone in the corner, but I know it seems real to you."
3. C"That's just your illness talking, so there's nothing to worry about. Try to think of something else."
4. D"What does the man in the corner look like?"

A patient with borderline personality disorder and frequent self-harm says, "I'm going to kill myself tonight," after an argument on the phone. A colleague says, "She always says that." What should the nurse do?

1. AAgree with the colleague and take no action at all
2. BTell the patient she is only seeking attention
3. CCarry out a full suicide risk assessment, as with any patient who expresses suicidal intent
4. DWait until the next morning to see if she still feels the same once the argument has settled down

Practice exercise (made-up values, not clinical guidance). A dose calculation for an injection gives 11.4664 mL. The rule in this exercise is that volumes of 1 mL or more are rounded to the nearest tenth of a mL. What value x do you record?

Practice exercise (made-up values, not clinical guidance). A blood glucose result is 424 mg/dL. Using 1 mmol/L = 18 mg/dL for glucose, find c in mmol/L. Round to one decimal place.

A child weighing 40 kg is prescribed 2 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

The prescription is 0.85 mg. The ampoule contains 1000 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

Infuse 250 mL over 3 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

A drip runs at 30 gtt/min through a set of 20 gtt/mL. There are 300 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

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 fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.

Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 15:00 at 120 mL/h. After 3 hours the rate is changed to 125 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.

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: yes; secondary diagnosis: no; ambulatory aid: none, bed rest or nurse assists; IV therapy or saline lock: no; gait: normal, bed rest or wheelchair; mental status: overestimates or forgets limits. Find the Morse total MFS.

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: yes; ambulatory aid: none, bed rest or nurse assists; IV therapy or saline lock: no; gait: normal, bed rest or wheelchair; mental status: overestimates or forgets limits. Using the cut-offs 0–24 low, 25–44 moderate and 45 or more high, click the fall-risk level.

1. 1low risk
2. 2moderate risk
3. 3high risk