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

Which Glasgow Coma Scale score indicates a fully alert patient?

1. A12
2. B10
3. C3
4. D15

A patient on regular morphine is very drowsy, has pinpoint pupils and is breathing 8 times a minute. What is the priority?

1. ALet the patient sleep and recheck in four hours
2. BCall for help, support breathing, withhold the opioid and prepare naloxone as per protocol
3. CGive a strong cup of coffee
4. DGive the next morphine dose as prescribed

A nurse gives part of a dose of an opioid from a vial and must discard the rest. What is correct?

1. AReturn the rest to the patient’s medication drawer
2. BDiscard it in front of a second licensed (registered) nurse, who witnesses and documents it
3. CDiscard it alone in the sink and document the amount wasted later in the shift
4. DKeep the rest for the patient’s next dose

A patient with a sealed radioactive implant reports that the implant has fallen out onto the bed. What should the nurse do?

1. ALeave it on the bed until the radiation team arrives tomorrow
2. BPick it up with gloved hands and put it in the clinical waste
3. CUse long-handled forceps to place it in the lead container
4. DAsk the patient to hold it until help arrives

A nurse takes a telephone order from a provider. What must the nurse do?

1. ACarry out the order first and ask the provider to confirm it later
2. BWrite the order down and read it back to the provider to confirm it
3. CAsk the ward clerk to take the order on the nurse’s behalf instead
4. DRemember the order and write it in the chart at the end of the shift

A medical-unit nurse is floated to intensive care and given a patient on a ventilator, which the nurse has never managed. What is the best response?

1. ARefuse to work and go home, because the assignment is unsafe
2. BLeave the intensive care unit and go back to the medical unit without telling anyone
3. CAccept the full assignment without comment to avoid conflict
4. DTell the charge nurse about the gap, accept tasks within competence and ask for support

How should a nurse communicate with a patient who has impaired hearing?

1. ATalk to the patient's relative instead of to the patient directly
2. BShout loudly from the end of the bed so they can hear
3. CSpeak very quickly to save time
4. DFace the patient, speak clearly and reduce background noise

A patient after major surgery has a falling blood pressure, rising heart rate and a swollen, tense abdomen, though the wound dressing is dry. What should you suspect?

1. ANormal postoperative swelling with no concern
2. BUrinary tract infection
3. CConstipation
4. DInternal bleeding

A patient with pneumonia had a CRP of 180 mg/L on admission and 40 mg/L after 4 days of antibiotics. What does this most likely show?

1. AThe antibiotic is causing liver damage
2. BThe inflammation is settling with treatment
3. CThe patient has developed a new infection
4. DThe infection has spread to another organ

A malnourished patient starts eating again and, on day 3, has a phosphate of 1.2 mg/dL (0.39 mmol/L) with muscle weakness and shortness of breath. What is the main risk?

1. AKidney stones from calcium released by the bones
2. BRapid weight gain, but no serious danger
3. CWeak breathing muscles and heart failure from low phosphate
4. DHyperkalemia caused by cells releasing potassium

How does sucralfate help a peptic ulcer heal?

1. AIt blocks histamine H2 receptors in the stomach
2. BIt forms a protective coating over the ulcer base
3. CIt kills Helicobacter pylori directly
4. DIt neutralises acid by releasing bicarbonate

During an alteplase infusion for acute ischaemic stroke, the patient develops a sudden severe headache and her level of consciousness falls. What is the nurse's first action?

1. ASlow the infusion to half the rate and recheck in 30 minutes
2. BStop the alteplase infusion and notify the provider urgently
3. CGive a bolus of heparin to prevent a new clot
4. DGive paracetamol for the headache and continue the infusion

A patient taking isosorbide mononitrate asks about sildenafil for erectile dysfunction. What is the main danger?

1. ABleeding from the gums
2. BSevere hypotension
3. CA very high potassium level
4. DSevere hypertension

Two days after a coronary stent, a patient on aspirin and ticagrelor has black, tarry stools and feels faint on standing. What should the nurse do?

1. AGive a laxative and repeat the observations tomorrow
2. BReassure the patient that iron tablets cause black stools
3. CCheck vital signs, report urgently and anticipate a blood count
4. DStop both antiplatelet drugs permanently on the nurse's own decision

A patient taking dapagliflozin (an SGLT2 inhibitor) is vomiting, with blood ketones of 4.5 mmol/L but a glucose of only 11 mmol/L. What should be suspected?

1. AA normal side effect needing no action
2. BHyperosmolar hyperglycaemic state
3. CEuglycaemic diabetic ketoacidosis
4. DHypoglycaemia caused by the vomiting

A patient with motor neurone disease reports morning headaches, poor sleep and sleepiness during the day. What do these symptoms suggest?

1. ALow mood, which should be treated with an antidepressant first
2. BWeak breathing at night, so a review for ventilation support
3. CNormal tiredness that needs no specific action
4. DA side effect of riluzole, which should be stopped straight away by the nurse

Which description fits a category (stage) 4 pressure ulcer?

1. AA blister filled with clear fluid over the heel or sacrum
2. BIntact skin with redness that does not blanch
3. CFull-thickness loss with exposed bone, tendon or muscle
4. DA shallow wound into the dermis only

A nurse teaches a patient after a laparoscopic fundoplication for reflux. Which statement shows a need for further teaching?

1. A"I should eat smaller meals for a while after the operation."
2. B"Fizzy drinks will help me bring up wind after meals."
3. C"I'll eat soft, moist food at first and chew it well."
4. D"Some difficulty swallowing can happen in the early weeks."

A woman at 39 weeks with a healthy pregnancy asks about walking in early labour. What is the best advice?

1. AWalking and upright positions can help progress
2. BUpright positions always make labour slower
3. CShe must stay in bed on her back for the whole labour
4. DWalking will cause the cord to prolapse

Just after delivery of the placenta, a woman suddenly has severe pain, heavy bleeding and shock. No fundus can be felt abdominally and a mass is seen at the vulva. What is most likely?

1. ACervical laceration
2. BUterine atony
3. CUterine inversion
4. DAmniotic fluid embolism

Which finding is an early sign of shock in a child?

1. AA fast heart rate with a prolonged capillary refill
2. BSlow, deep breathing with a normal heart rate
3. CA warm, flushed child with a strong, bounding pulse
4. DLow blood pressure with a slow heart rate and pauses in breathing

Which treatment is not routinely recommended for a typical infant with bronchiolitis?

1. ABronchodilators or corticosteroids
2. BHelp with feeding or fluids if intake is poor
3. CGentle nasal suction if the nose is blocked
4. DOxygen if the saturation is persistently low

Which setting is best for an initial assessment interview with a new patient?

1. AA small office with the nurse sitting behind a high desk between herself and the door
2. BA quiet, private room with chairs at the same level and easy access to the door
3. CThe corridor, so that the interview can be done quickly
4. DThe busy day room, so that the patient feels part of the ward

Which finding best helps to distinguish serotonin syndrome from neuroleptic malignant syndrome?

1. AHyperreflexia and clonus with a rapid onset suggest serotonin syndrome
2. BConfusion occurs only in neuroleptic malignant syndrome, never in serotonin syndrome
3. CSweating occurs only in neuroleptic malignant syndrome
4. DFever is present only in serotonin syndrome

Practice exercise (made-up values, not clinical guidance). A dose is charted at 5:10 AM. Which entry is the same time on the 24-hour clock? Click it.

1. 104:10
2. 205:10
3. 317:10
4. 406:10

Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 1½ fl oz of juice, 2½ tsp of cough syrup, 3 tbsp of liquid supplement, 2 cups of tea. Using the equivalents given, find the total oral intake V in mL.

A patient weighs 12 kg. The prescribed dose is 5 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?

The prescription is 4650 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

500 mL was ordered over 8 hours. After 3 hours you find that 360 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?

A bag contains 2 g of a drug in 250 mL. The order is 1.5 mg per minute. At what rate R do you set the pump, in mL/h?

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-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 1000 mL bag runs by pump at 60 mL/h. At 17:00, 300 mL have already been infused. How many hours t until the bag is 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: yes; ambulatory aid: crutches, cane or walker; IV therapy or saline lock: yes; gait: weak; 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: yes; gait: normal, bed rest or wheelchair; mental status: knows own 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