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 should a liquid medicine be measured in a medicine cup?

  1. AAt eye level, reading the lowest point of the curved surface
  2. BBy filling the cup to the very top
  3. CBy pouring until it looks about right
  4. DFrom above, reading the highest point at the edge of the liquid
2.Nursing fundamentalsHard

Which postoperative finding should be reported most urgently?

  1. APain score of 4/10 at the wound site when moving
  2. BUrine output of 50 mL in the last hour
  3. CRespiratory rate 8/min and difficult to rouse
  4. DTemperature 37.4 °C on the first day
3.Infection control & patient safetyMedium

A nurse cleans an IV pump with a disinfectant wipe. What must happen for the disinfectant to work?

  1. AThe surface stays wet for the contact time on the product label
  2. BThe wipe is used on many pumps to save product
  3. CThe surface is dried with a clean towel right after wiping
  4. DThe surface is wiped once lightly without pressure
4.Infection control & patient safetyHard

In a US hospital (CMS rules), a patient keeps pulling at an endotracheal tube, and alternatives have failed. The nurse applies wrist restraints in an emergency. What must happen next?

  1. AAsk the family to sign a consent form instead of an order
  2. BKeep the restraints on without an order until the patient is calm
  3. CAsk the provider for a PRN restraint order to use as needed
  4. DObtain a time-limited order for the restraint promptly, following policy
5.Prioritization & delegationMedium

A patient is receiving continuous tube feeds. Which action best reduces the risk of aspiration?

  1. AKeep the head of the bed raised to at least 30 degrees
  2. BTurn the feed off only while the patient is asleep at night
  3. CIncrease the feed rate so the stomach empties sooner
  4. DLay the patient flat for an hour after each bag is hung
6.Prioritization & delegationHard

A chemical cleaning fluid splashes into a patient’s eye. What should the nurse do first?

  1. ARub the eye gently with a clean tissue to remove the chemical
  2. BGive antibiotic eye drops first
  3. CFlush the eye with plenty of water or saline straight away
  4. DCover the eye with a dry patch and wait for the provider
7.Clinical nursingMedium

What does HbA1c measure?

  1. ABlood glucose at the moment of testing
  2. BThe amount of ketones in the urine
  3. CInsulin levels after a meal
  4. DAverage blood glucose over roughly the previous two to three months
8.Clinical nursingHard

A nurse notices that a wrong dose of a drug was prepared but was caught before it was given. What should be done?

  1. ASay nothing, because no harm reached the patient
  2. BDiscipline the nurse who prepared it on the spot in front of colleagues
  3. CTell only the patient's family
  4. DReport it as a near miss through the incident reporting system
9.Lab values & electrolytesMedium

Why must a low total calcium be interpreted with care in a patient with a low serum albumin?

  1. AMuch calcium is bound to albumin, so total calcium falls even if ionized calcium is normal
  2. BLow albumin makes every calcium test inaccurate and useless
  3. CAlbumin and calcium are measured with the same chemical reaction, so they always fall together
  4. DLow albumin always causes true, symptomatic hypocalcemia
10.Lab values & electrolytesHard

A patient with sepsis has the following new results. Which set best shows organ dysfunction?

  1. ACalcium 9.4 mg/dL, phosphate 3.5 mg/dL, magnesium 1.9 mEq/L
  2. BPlatelets 70 × 10³/µL, creatinine doubled, bilirubin raised
  3. CHemoglobin 12.5 g/dL, sodium 138 mEq/L, glucose 105 mg/dL
  4. DWBC 11.5 × 10³/µL, potassium 4.2 mEq/L, albumin 3.8 g/dL
11.PharmacologyMedium

How should a topical corticosteroid cream usually be applied?

  1. AAs a thin layer to the affected area only, as directed
  2. BUnder a tight plastic dressing every night without advice
  3. COn broken, infected skin to speed healing
  4. DAs a thick layer over the whole body
12.PharmacologyHard

A patient with diabetic ketoacidosis is about to start an IV insulin infusion. Serum potassium is 3.1 mmol/L (mEq/L). Why is this a concern?

  1. APotassium has no link with insulin, so the infusion is started as planned
  2. BLow potassium makes insulin ineffective, so a higher dose is needed
  3. CInsulin moves potassium into cells, so the level can fall dangerously low
  4. DInsulin raises potassium further and can cause cardiac arrest, so the infusion is given faster
13.Med-surg: cardiovascular & respiratoryMedium

Why should a beta-blocker not be stopped suddenly in a patient with ischaemic heart disease?

  1. ARebound tachycardia and hypertension can trigger angina or MI
  2. BThe drug stays stored in the tissues for several months afterwards
  3. CSudden stopping causes severe and prolonged hypoglycaemia
  4. DThe heart rate becomes permanently slow afterwards
14.Med-surg: cardiovascular & respiratoryHard

A patient with severe sepsis becomes increasingly breathless over 24 hours. SpO₂ stays low despite high-flow oxygen, and the chest X-ray shows bilateral infiltrates. The heart function is normal. Which condition is most likely?

  1. AAcute left ventricular failure after an MI
  2. BSpontaneous pneumothorax
  3. CAcute respiratory distress syndrome
  4. DAn acute asthma attack
15.Med-surg: neuro, endocrine & renalMedium

Why is an ACE inhibitor often given to a patient with diabetes and albumin in the urine?

  1. AIt raises potassium to protect the heart
  2. BIt stops the kidneys from passing so much urine at night
  3. CIt lowers the blood glucose to normal
  4. DIt protects the kidneys and reduces albumin loss
16.Med-surg: neuro, endocrine & renalHard

A patient who had pituitary surgery has fatigue and feels cold. TSH is low, and free T4 is low. What is the most likely cause?

  1. AOver-replacement with levothyroxine
  2. BSecondary hypothyroidism
  3. CHyperthyroidism from Graves' disease
  4. DPrimary hypothyroidism from thyroid failure
17.Med-surg: GI, perioperative & oncologyMedium

Which is a common side effect of opioids, especially when given by epidural or spinal route?

  1. AIncreased hunger
  2. BRinging in the ears
  3. CItching
  4. DHair growth
18.Med-surg: GI, perioperative & oncologyHard

A nurse teaches a patient with a new ileostomy. Which statement shows a need for further teaching?

  1. A"I'll chew my food well to avoid blockages."
  2. B"I'll watch for dizziness and dark urine."
  3. C"I'll drink less so my bag fills more slowly."
  4. D"I'll report if my output becomes very watery and high."
19.Maternity & obstetric nursingMedium

Which finding points to postpartum depression rather than the baby blues?

  1. ACrying spells and mood swings on day 3 that settle within a few days without treatment
  2. BFeeling tired after a night with a crying baby
  3. CLow mood and loss of interest lasting more than 2 weeks and affecting daily life
  4. DFeeling emotional when visitors leave
20.Maternity & obstetric nursingHard

A woman has just been diagnosed with gestational diabetes at 26 weeks. What is the usual first step in management?

  1. ANo follow-up is needed until after birth
  2. BStart insulin or an oral sulfonylurea straight away for every woman, whatever her blood glucose readings show
  3. CNutrition advice, physical activity and blood glucose monitoring, with medication if targets are not met
  4. DStop eating all carbohydrates
21.Pediatric nursingMedium

Which treatment is commonly used for a child with moderate croup?

  1. AChest physiotherapy
  2. BA cough suppressant
  3. CA course of oral antibiotics such as amoxicillin for 5 to 7 days
  4. DA single dose of an oral corticosteroid such as dexamethasone
22.Pediatric nursingHard

A 6-year-old with haemophilia falls and has a swollen, painful knee. What is the priority?

  1. AEncourage the child to walk on the knee to keep the joint mobile and prevent stiffness
  2. BGive aspirin for the pain
  3. CGive factor replacement as prescribed and rest, ice, compress and elevate the joint
  4. DApply heat to the knee
23.Mental health nursingMedium

Which risk applies when antipsychotics are used in older people with dementia?

  1. AA guaranteed cure of the dementia
  2. BAn increased risk of stroke and death
  3. CA lower risk of falls than with no medicine at all
  4. DImproved memory within a few days
24.Mental health nursingHard

A patient in a manic episode is interrupting other patients and becoming louder in the day room. What is the most appropriate nursing action?

  1. ATurn up the music to distract the group
  2. BEncourage a competitive group game to use up energy
  3. CCalmly guide the patient to a quieter area with less stimulation and set clear, simple limits
  4. DArgue with the patient about the behaviour in front of everyone until the patient agrees to stop
25.Nursing math & unit conversionsMedium
0.38912 mL? mLround to 0.01 mL

Practice exercise (made-up values, not clinical guidance). A dose calculation for a small injection gives 0.38912 mL. The rule in this exercise is that volumes below 1 mL are rounded to the nearest hundredth of a mL. What value x do you record?

0.38912 mL
x = mL
26.Nursing math & unit conversionsHard
00:0020:1002:25t = ?

Practice exercise (made-up values, not clinical guidance). An infusion starts at 20:10 and finishes at 02:25 the next morning (24-hour clock). How many hours t did it run? Give the answer in hours as a decimal, rounded to two decimal places.

20:1002:25
t = h
27.Dosage calculationsMedium
024681010 mL

A child weighing 24 kg is prescribed 7.5 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?

24 kg7.5 mg/kg50 mg/mL
V = mL
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 3480 micrograms. The ampoule contains 4 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

3480 mcg4 mg/mL
V = mL
29.IV infusion ratesMedium
500 mL15 gtt/mL2 h? gtt/min

Infuse 500 mL over 2 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

500 mL2 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
1000 mg500 mL60 gtt/mL60 mg/h? gtt/min

1000 mg of a drug is diluted in 500 mL and given by gravity through a set of 60 gtt/mL. The order is 60 mg per hour. Find the drip rate R in drops per minute.

1000 mg/500 mL60 mg/h60 gtt/mL
R = gtt/min
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shifttea240 mLmilk100 mLjuice150 mLice chips200 mLIV infusion50 mL/h × 12 hIV antibiotic2 × 50 mLurine225 mLurine400 mLurine300 mLwound drain140 mL

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 total intake I in mL. Count ice chips as half their volume.

tea: 240 mLmilk: 100 mLjuice: 150 mLice chips: 200 mLIV infusion: 50 mL/h × 12 hIV antibiotic: 2 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
500 mL250 mL infused125 mL/h08:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 125 mL/h. At 08:00, 250 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL250 mL infused125 mL/h
t = h
33.Clinical assessment scoresMedium
9662SBPDBPmmHgHR 122/min · SI = ?

Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 122/min and a blood pressure of 96/62 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.

HR 122/minBP 96/62 mmHg
SI =
34.Clinical assessment scoresHard
not at riskmild riskmoderate riskhigh riskvery high risk

Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: no impairment; moisture: very moist; activity: walks frequently; mobility: completely immobile; nutrition: adequate; friction and shear: no apparent problem. Use the bands 19–23 not at risk, 15–18 mild, 13–14 moderate, 10–12 high and 9 or below very high. Click the risk level.

  1. 1not at risk
  2. 2mild risk
  3. 3moderate risk
  4. 4high risk
  5. 5very high risk

3Solutions

1.Nursing fundamentals

Answer: A · At eye level, reading the lowest point of the curved surface

Why this is the answer

The cup is placed on a flat surface and read at eye level at the bottom of the meniscus. An oral syringe is more accurate for small volumes.

Answer

A · At eye level, reading the lowest point of the curved surface
2.Nursing fundamentals

Answer: C · Respiratory rate 8/min and difficult to rouse

Why this is the answer

A low respiratory rate with reduced consciousness may mean opioid toxicity or deterioration and threatens the airway. The other findings are common after surgery and can be managed routinely.

Answer

C · Respiratory rate 8/min and difficult to rouse
3.Infection control & patient safety

Answer: A · The surface stays wet for the contact time on the product label

Why this is the answer

Each disinfectant has a contact (dwell) time during which the surface must stay visibly wet. Drying it early or spreading one wipe over many items reduces its effect.

Answer

A · The surface stays wet for the contact time on the product label
4.Infection control & patient safety

Answer: D · Obtain a time-limited order for the restraint promptly, following policy

Why this is the answer

Under US CMS rules, a nurse may apply a restraint first in an emergency, but an order from a licensed provider must be obtained promptly according to policy. PRN restraint orders are not allowed, and family consent does not replace an order. Other countries use different legal frameworks, but restraint is always a last resort that must be authorized, reviewed and documented.

Answer

D · Obtain a time-limited order for the restraint promptly, following policy
5.Prioritization & delegation

Answer: A · Keep the head of the bed raised to at least 30 degrees

Why this is the answer

Raising the head of the bed to at least 30 degrees during and after feeding lowers the risk of reflux and aspiration. Lying flat greatly increases the risk.

Answer

A · Keep the head of the bed raised to at least 30 degrees
6.Prioritization & delegation

Answer: C · Flush the eye with plenty of water or saline straight away

Why this is the answer

Chemical eye injuries are treated by immediate, continuous irrigation with large amounts of water or saline. Delay, rubbing or a patch allows more damage.

Answer

C · Flush the eye with plenty of water or saline straight away
7.Clinical nursing

Answer: D · Average blood glucose over roughly the previous two to three months

Why this is the answer

HbA1c reflects glycation of haemoglobin over the life of red cells, giving an estimate of long-term glucose control.

Answer

D · Average blood glucose over roughly the previous two to three months
8.Clinical nursing

Answer: D · Report it as a near miss through the incident reporting system

Why this is the answer

Near misses are reported so that causes can be studied and systems improved. A just, open culture encourages reporting without blame.

Answer

D · Report it as a near miss through the incident reporting system
9.Lab values & electrolytes

Answer: A · Much calcium is bound to albumin, so total calcium falls even if ionized calcium is normal

Why this is the answer

About 40% of calcium is bound to albumin. When albumin is low, total calcium falls although ionized calcium may be normal. A corrected calcium or a measured ionized calcium gives the true picture.

Answer

A · Much calcium is bound to albumin, so total calcium falls even if ionized calcium is normal
10.Lab values & electrolytes

Answer: B · Platelets 70 × 10³/µL, creatinine doubled, bilirubin raised

Why this is the answer

In sepsis, falling platelets (coagulation), a rising creatinine (kidney) and a raised bilirubin (liver) show organ dysfunction, which indicates severe disease. The other sets are normal or near normal.

Answer

B · Platelets 70 × 10³/µL, creatinine doubled, bilirubin raised
11.Pharmacology

Answer: A · As a thin layer to the affected area only, as directed

Why this is the answer

Thin application to affected skin limits systemic absorption and skin atrophy. Occlusive dressings increase absorption and are used only when prescribed.

Answer

A · As a thin layer to the affected area only, as directed
12.Pharmacology

Answer: C · Insulin moves potassium into cells, so the level can fall dangerously low

Why this is the answer

Insulin drives potassium into cells, so a low starting level can become life-threatening hypokalaemia with arrhythmias. Potassium is replaced and monitored closely; the 2024 international consensus (ADA and others) delays insulin until potassium is above 3.5 mmol/L, while UK JBDS guidance adds potassium to the fluids and asks for senior review.

Answer

C · Insulin moves potassium into cells, so the level can fall dangerously low
13.Med-surg: cardiovascular & respiratory

Answer: A · Rebound tachycardia and hypertension can trigger angina or MI

Why this is the answer

Long-term beta-blockade increases the number and sensitivity of beta receptors. Abrupt withdrawal exposes them to normal adrenaline levels, which can cause rebound tachycardia, hypertension and myocardial ischaemia. Doses are tapered.

Answer

A · Rebound tachycardia and hypertension can trigger angina or MI
14.Med-surg: cardiovascular & respiratory

Answer: C · Acute respiratory distress syndrome

Why this is the answer

ARDS is acute, non-cardiogenic pulmonary oedema caused by widespread inflammation, triggered by sepsis, pneumonia, trauma or pancreatitis. It causes severe hypoxaemia that responds poorly to oxygen, with bilateral infiltrates not explained by heart failure. Treatment includes lung-protective ventilation and often prone positioning.

Answer

C · Acute respiratory distress syndrome
15.Med-surg: neuro, endocrine & renal

Answer: D · It protects the kidneys and reduces albumin loss

Why this is the answer

ACE inhibitors and ARBs reduce glomerular pressure, lower albuminuria and slow the progression of diabetic kidney disease, as well as treating blood pressure. Potassium and creatinine are checked after starting them.

Answer

D · It protects the kidneys and reduces albumin loss
16.Med-surg: neuro, endocrine & renal

Answer: B · Secondary hypothyroidism

Why this is the answer

When the pituitary cannot make enough TSH, the thyroid is not stimulated, so both TSH and free T4 are low. In primary thyroid failure, TSH is high. In secondary hypothyroidism, free T4, not TSH, is used to guide the dose.

Answer

B · Secondary hypothyroidism
17.Med-surg: GI, perioperative & oncology

Answer: C · Itching

Why this is the answer

Pruritus is common with neuraxial opioids. Other common effects include nausea, urinary retention, constipation and sedation; respiratory depression is the most serious.

Answer

C · Itching
18.Med-surg: GI, perioperative & oncology

Answer: C · "I'll drink less so my bag fills more slowly."

Why this is the answer

Restricting fluids increases dehydration risk with an ileostomy. Patients drink enough, add salt as advised, chew well and report high output or signs of dehydration.

Answer

C · "I'll drink less so my bag fills more slowly."
19.Maternity & obstetric nursing

Answer: C · Low mood and loss of interest lasting more than 2 weeks and affecting daily life

Why this is the answer

Postpartum depression lasts longer than 2 weeks and interferes with caring for herself or the baby. Screening, for example with the Edinburgh Postnatal Depression Scale, and referral are needed.

Answer

C · Low mood and loss of interest lasting more than 2 weeks and affecting daily life
20.Maternity & obstetric nursing

Answer: C · Nutrition advice, physical activity and blood glucose monitoring, with medication if targets are not met

Why this is the answer

First-line management is medical nutrition therapy, activity and self-monitoring of glucose. If targets are not met, medication such as insulin is added. Glucose is tested again after birth because the risk of type 2 diabetes is raised.

Answer

C · Nutrition advice, physical activity and blood glucose monitoring, with medication if targets are not met
21.Pediatric nursing

Answer: D · A single dose of an oral corticosteroid such as dexamethasone

Why this is the answer

Corticosteroids reduce airway swelling in croup. Nebulised epinephrine is added for severe stridor at rest. Croup is viral, so antibiotics do not help.

Answer

D · A single dose of an oral corticosteroid such as dexamethasone
22.Pediatric nursing

Answer: C · Give factor replacement as prescribed and rest, ice, compress and elevate the joint

Why this is the answer

Early factor replacement stops the bleed. Rest, cold, gentle compression and elevation reduce swelling. Aspirin and heat would increase bleeding. Repeated joint bleeds damage the joint.

Answer

C · Give factor replacement as prescribed and rest, ice, compress and elevate the joint
23.Mental health nursing

Answer: B · An increased risk of stroke and death

Why this is the answer

Antipsychotics in older people with dementia are linked to increased rates of stroke and death. They are used only when non-drug approaches have failed and distress or risk is severe, at the lowest dose for the shortest time.

Answer

B · An increased risk of stroke and death
24.Mental health nursing

Answer: C · Calmly guide the patient to a quieter area with less stimulation and set clear, simple limits

Why this is the answer

Patients with mania benefit from a calm, low-stimulus environment, firm and consistent limits and simple, non-competitive activities.

Answer

C · Calmly guide the patient to a quieter area with less stimulation and set clear, simple limits
25.Nursing math & unit conversions

Answer: x = 0.39 mL

Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.

Digit in the hundredths place

0.38912 → 8

Only the next digit decides

0.38912 → 9
9 is 5 or more, so round 8 up.
The digits after it (12) are ignored: round once, never step by step.

Round

x = 0.39 mL

Answer

x = 0.39 mL
26.Nursing math & unit conversions

Answer: t = 6.25 h

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.

Before midnight

20:10 → 24:00 = 230 min

After midnight

00:00 → 02:25 = 145 min

Total

230 + 145 = 375 min
t = 375/60 = 6.25 h

Answer

t = 6.25 h
27.Dosage calculations

Answer: V = 3.6 mL

Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.

Dose from body weight

D = 7.5·24 = 180 mg

Volume

V = 180/50 = 3.6 mL

On the syringe

On this 10 mL syringe every small line is 0.2 mL.

Answer

V = 3.6 mL
28.Dosage calculations

Answer: V = 0.87 mL

Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.

Same units

4 mg/mL = 4000 mcg/mL

Volume

V = 3480/4000 = 0.87 mL

Answer

V = 0.87 mL
29.IV infusion rates

Answer: R = 63 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.

Time in minutes

2·60 = 120 min

Drip rate

R = 500·15/120 = 62.5 ≈ 63 gtt/min

Answer

R = 63 gtt/min

At the bedside you round to the nearest whole drop: 63 gtt/min.

30.IV infusion rates

Answer: R = 30 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

1000/500 = 2 mg/mL

Volume per hour

60/2 = 30 mL/h

Drip rate

R = 30·60/60 = 30 gtt/min

Answer

R = 30 gtt/min
31.IV fluids & fluid balance

Answer: I = 1290 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 + 100 + 150 = 490 mL
ice chips: 200/2 = 100 mL
IV infusion: 50·12 = 600 mL
IV antibiotic: 2·50 = 100 mL
I = 1290 mL

Answer

I = 1290 mL
32.IV fluids & fluid balance

Answer: t = 2 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 − 250 = 250 mL

Time

t = 250/125 = 2 h

Answer

t = 2 h

That is about 2 h 00 min, so the bag runs out at about 10:00.

33.Clinical assessment scores

Answer: SI = 1.27

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 = 122/96 = 1.271 ≈ 1.27

Answer

SI = 1.27

1 or more: a warning sign of shock in this practice case.

34.Clinical assessment scores

Answer: mild risk

Braden scale: six subscales for pressure-injury risk. Sensory perception, moisture, activity, mobility and nutrition score 1 to 4, from the worst level (1) to no problem (4); friction and shear scores 1 to 3. The total runs from 6 to 23, and a lower total means a higher risk. Common bands: 19–23 not at risk, 15–18 mild risk, 13–14 moderate risk, 10–12 high risk and 9 or below very high risk.

Score each subscale

sensory perception: no impairment → 4
moisture: very moist → 2
activity: walks frequently → 4
mobility: completely immobile → 1
nutrition: adequate → 3
friction and shear: no apparent problem → 3

Add

Braden total = 4 + 2 + 4 + 1 + 3 + 3 = 17

Risk level

17 → mild risk

Answer

mild risk

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