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

What is informed consent?

  1. AAgreement obtained after the procedure
  2. BA signed form that removes all liability from staff for any harm caused by the procedure
  3. CVoluntary agreement by a patient with capacity, after receiving adequate information
  4. DA signature from any family member
2.Nursing fundamentalsHard

A patient spills hot tea on their forearm. What is the best immediate first aid?

  1. ACover it with butter or a greasy cream
  2. BCool the burn under cool running water for about 20 minutes
  3. CPut ice or an ice pack directly on the burn for about 10 minutes
  4. DPop any blisters to let the heat escape
3.Infection control & patient safetyMedium

Which patient has the highest risk of a burn from a heating pad?

  1. AA patient recovering from a cold
  2. BA healthy young adult with a strained muscle
  3. CA patient with diabetic peripheral neuropathy
  4. DA patient with a sprained wrist who is fully alert
4.Infection control & patient safetyHard

A patient punches a nurse during care. The nurse is not seriously hurt. What should the nurse do?

  1. ARefuse to care for any patient for the rest of the week until the patient is moved
  2. BSay nothing, because violence is part of the job
  3. CPunch the patient back in self-defense
  4. DGet medical assessment and report the assault according to policy
5.Prioritization & delegationMedium

Which medication order should the nurse question?

  1. AOral potassium chloride with food
  2. BPotassium chloride diluted in an IV bag via a pump
  3. CPotassium chloride by IV push
  4. DPotassium chloride oral solution diluted in juice
6.Prioritization & delegationHard

An adult has burns over 40% of the body with no signs of airway injury. Which treatment is the priority during the first hours?

  1. ALarge-volume IV fluids with close monitoring of urine output
  2. BApplying antibiotic cream to all the burns before anything else
  3. CGiving a high-protein meal to support healing
  4. DStarting physiotherapy to prevent contractures straight away
7.Clinical nursingMedium

Which side effects are common after high doses of salbutamol (albuterol)?

  1. AConstipation and urinary retention
  2. BBradycardia and drowsiness
  3. CHair loss and weight gain
  4. DTremor and a fast heart rate
8.Clinical nursingHard

Why might a patient with diabetes who takes a beta-blocker not notice hypoglycaemia early?

  1. ABeta-blockers stop the liver from responding to insulin
  2. BBeta-blockers make the patient sleep through the night
  3. CBeta-blockers raise blood glucose, so true hypoglycaemia cannot happen at all
  4. DBeta-blockers can mask warning signs such as tremor and a fast heart rate
9.Lab values & electrolytesMedium

When several samples are drawn at the same venipuncture, which tubes or bottles are filled first?

  1. AEDTA (complete blood count) tubes
  2. BBlood culture bottles
  3. CFluoride (glucose) tubes
  4. DCoagulation (citrate) tubes
10.Lab values & electrolytesHard

Why can a normal creatinine be misleading in a frail older adult with low muscle mass?

  1. AOlder adults always have a higher creatinine than younger adults do
  2. BA normal creatinine always proves normal kidney function
  3. CCreatinine levels do not depend on muscle mass at all
  4. DLess muscle makes less creatinine, hiding reduced kidney function
11.PharmacologyMedium

A patient with heart failure starts furosemide. Which self-monitoring instruction is most useful?

  1. ACheck the blood glucose before every meal
  2. BMeasure the temperature twice a day and record it in a diary
  3. CWeigh daily at the same time on the same scales
  4. DCount the respiratory rate each evening
12.PharmacologyHard

A patient has received a sodium nitroprusside infusion for several days. He becomes confused and develops a metabolic acidosis. What should be suspected?

  1. AHypoglycaemia from nitroprusside
  2. BHyperkalaemia from the infusion
  3. CAn allergic reaction to the plastic of the infusion bag
  4. DCyanide toxicity from nitroprusside breakdown
13.Med-surg: cardiovascular & respiratoryMedium

Which pneumonia severity score uses confusion, urea, respiratory rate, blood pressure and age?

  1. ANEWS2
  2. BCHA₂DS₂-VASc
  3. CWells score
  4. DCURB-65
14.Med-surg: cardiovascular & respiratoryHard

A ventilated patient is coughing, and the high-pressure alarm sounds. Coarse sounds are heard over the trachea. What should the nurse do first?

  1. AIncrease the tidal volume on the ventilator to overcome it
  2. BAssess the patient and suction if secretions are present
  3. CDeflate the endotracheal tube cuff fully
  4. DTurn the alarm off and reassess the patient in an hour
15.Med-surg: neuro, endocrine & renalMedium

After a change in the levothyroxine dose, when is the TSH usually rechecked?

  1. AAfter 24 hours
  2. BAfter 3 days
  3. CAfter about 6–8 weeks
  4. DAfter about 2 years of treatment
16.Med-surg: neuro, endocrine & renalHard

A student has fever, a severe headache, a spreading non-blanching rash and a BP of 85/50 mmHg. A lumbar puncture is planned. What is the priority?

  1. AWait until after the lumbar puncture before giving antibiotics
  2. BGive IV antibiotics at once and start sepsis treatment
  3. CArrange a CT scan of the head before any treatment
  4. DGive paracetamol (acetaminophen) and recheck observations in an hour
17.Med-surg: GI, perioperative & oncologyMedium

Why are many patients screened for MRSA before planned surgery?

  1. ATo check whether the patient has had a flu vaccine
  2. BTo decide which anaesthetic drug to use
  3. CSo that carriers can be decolonised to reduce infection
  4. DSo that surgery can be cancelled for all positive patients
18.Med-surg: GI, perioperative & oncologyHard

Which preoperative task can a registered nurse usually delegate to a healthcare assistant (nursing assistant)?

  1. AAssessing the patient's understanding of the surgery
  2. BRecording baseline vital signs
  3. CDeciding whether abnormal results need reporting
  4. DTeaching the patient how to use a PCA pump
19.Maternity & obstetric nursingMedium

Why is it important to do newborn bloodspot screening at the recommended time rather than in the first hours?

  1. AEarlier testing always gives false negatives for all conditions
  2. BThe heel cannot be pricked until the cord falls off
  3. CSome results, such as PKU, need milk feeds first
  4. DThe baby's blood cannot be sampled before day 3
20.Maternity & obstetric nursingHard

Fluid leaking from the vagina is tested. Which result supports rupture of the membranes?

  1. AA nitrazine test that turns yellow, showing acidic fluid
  2. BFluid that smells of ammonia
  3. CA ferning pattern on a dried slide under the microscope
  4. DFluid that contains glucose on a urine dipstick
21.Pediatric nursingMedium

At about what age does a pincer grasp (picking up small objects between thumb and index finger) typically develop?

  1. AAbout 18 months
  2. BAbout 2 years
  3. CAbout 3 months
  4. DAbout 9 to 10 months
22.Pediatric nursingHard

A 2-year-old is having a tonic–clonic seizure with a high fever. What should the nurse do first?

  1. APut the child in a cool bath
  2. BProtect the child from injury, time the seizure and turn the child onto the side
  3. CPut a spoon in the child's mouth to protect the tongue
  4. DHold the child's limbs firmly to stop the movements and prevent injury from the jerking
23.Mental health nursingMedium

A woman was assaulted 10 days ago. She has nightmares, avoids the area and feels detached. According to DSM-5, which diagnosis fits the timing best?

  1. AAdjustment disorder with anxiety
  2. BAcute stress disorder
  3. CGeneralised anxiety disorder
  4. DPost-traumatic stress disorder
24.Mental health nursingHard

A charming patient with antisocial personality disorder tells a new nurse, "The other nurses always let me smoke in my room. You're cooler than them, right?" What is the best response?

  1. A"I'll let you if you promise not to tell anyone else about it."
  2. B"Well, if the others let you, I suppose it's fine this once."
  3. C"Smoking is only allowed in the garden, and that rule is the same for everyone."
  4. D"You're lying to me. The other nurses would never let you smoke in your room, so stop trying it on."
25.Nursing math & unit conversionsMedium
1234567891011121:15 AM?02:1513:1500:1501:15

Practice exercise (made-up values, not clinical guidance). A dose is charted at 1:15 AM. Which entry is the same time on the 24-hour clock? Click it.

1:15 AM
  1. 102:15
  2. 213:15
  3. 300:15
  4. 401:15
26.Nursing math & unit conversionsHard
00:0020:3003:50t = ?

Practice exercise (made-up values, not clinical guidance). An infusion starts at 20:30 and finishes at 03:50 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.

20:3003:50
t = h
27.Dosage calculationsMedium
024681010 mL

A child weighing 16 kg is prescribed 15 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

16 kg15 mg/kg25 mg/mL
V = mL
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 0.15 mg. The ampoule contains 500 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

0.15 mg500 mcg/mL
V = mL
29.IV infusion ratesMedium
500 mL15 gtt/mL8 h? gtt/min

Infuse 500 mL over 8 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 mL8 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
600 mL60 gtt/mL42 gtt/mint = ? h

A drip runs at 42 gtt/min through a set of 60 gtt/mL. There are 600 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

42 gtt/min60 gtt/mL600 mL
t = h
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftsoup250 mLwater240 mLmilk100 mLIV infusion80 mL/h × 12 hIV antibiotic1 × 50 mLurine500 mLurine500 mLwound drain80 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.

soup: 250 mLwater: 240 mLmilk: 100 mLIV infusion: 80 mL/h × 12 hIV antibiotic: 1 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
500 mL60 mL/hstart 12:4514:15: ? mL

Practice exercise (made-up values, not clinical guidance). A 500 mL bag was started at 12:45 and runs by pump at 60 mL/h. How many mL V are left in the bag at 14:15?

500 mL60 mL/h12:45 → 14:15
V = mL
33.Clinical assessment scoresMedium
3210123RR≤89–1112–2021–24≥25SpO₂≤9192–9394–95≥96air / O₂O₂airSBP≤9091–100101–110111–219≥220HR≤4041–5051–9091–110111–130≥131ACVPUAC, V, P, UT °C≤35.035.1–36.036.1–38.038.1–39.0≥39.1

Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 10/min, SpO₂ 86% on supplemental oxygen, blood pressure 90/54 mmHg, pulse 82/min, newly confused, temperature 37.8 °C. What is the NEWS2 total score?

RR 10SpO₂ 86%O₂SBP 90HR 82CT 37.8 °C
NEWS2 =
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 89 kg and is 187 cm tall. Calculate the BMI and click the WHO weight category.

89 kg187 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: C · Voluntary agreement by a patient with capacity, after receiving adequate information

Why this is the answer

Valid consent requires a patient with capacity, enough information about risks, benefits and alternatives, and a free choice. It can be withdrawn at any time.

Answer

C · Voluntary agreement by a patient with capacity, after receiving adequate information
2.Nursing fundamentals

Answer: B · Cool the burn under cool running water for about 20 minutes

Why this is the answer

Cool running water for about 20 minutes reduces pain and depth of injury. Ice can damage tissue further, grease holds heat in, and blisters are left intact to protect the skin.

Answer

B · Cool the burn under cool running water for about 20 minutes
3.Infection control & patient safety

Answer: C · A patient with diabetic peripheral neuropathy

Why this is the answer

Reduced sensation, as in peripheral neuropathy, prevents a person from feeling heat damage. Patients with poor sensation, poor circulation or confusion need very close monitoring if heat is used at all.

Answer

C · A patient with diabetic peripheral neuropathy
4.Infection control & patient safety

Answer: D · Get medical assessment and report the assault according to policy

Why this is the answer

Workplace violence should always be reported. Reporting allows care for the injured staff member, review of risks and changes to the patient’s care plan to protect staff and other patients.

Answer

D · Get medical assessment and report the assault according to policy
5.Prioritization & delegation

Answer: C · Potassium chloride by IV push

Why this is the answer

Potassium chloride must never be given by IV push, because a rapid dose can cause cardiac arrest. It is diluted and given slowly through an infusion pump.

Answer

C · Potassium chloride by IV push
6.Prioritization & delegation

Answer: A · Large-volume IV fluids with close monitoring of urine output

Why this is the answer

Once the airway is secure, the early priority in major burns is fluid resuscitation to prevent burn shock. Urine output is a key guide to whether enough fluid is being given.

Answer

A · Large-volume IV fluids with close monitoring of urine output
7.Clinical nursing

Answer: D · Tremor and a fast heart rate

Why this is the answer

Salbutamol is a beta2-agonist and can cause tremor, tachycardia and palpitations. High doses can also lower serum potassium.

Answer

D · Tremor and a fast heart rate
8.Clinical nursing

Answer: D · Beta-blockers can mask warning signs such as tremor and a fast heart rate

Why this is the answer

Tremor, palpitations and anxiety in hypoglycaemia are driven by the sympathetic system, which beta-blockers blunt. Sweating is often still present, and patients need to monitor glucose closely.

Answer

D · Beta-blockers can mask warning signs such as tremor and a fast heart rate
9.Lab values & electrolytes

Answer: B · Blood culture bottles

Why this is the answer

Blood cultures are drawn first to reduce contamination. A standard order of draw then follows (citrate, serum, heparin, EDTA, fluoride), which prevents additives being carried from one tube into the next and distorting results.

Answer

B · Blood culture bottles
10.Lab values & electrolytes

Answer: D · Less muscle makes less creatinine, hiding reduced kidney function

Why this is the answer

Creatinine is made by muscle. A person with little muscle makes little creatinine, so the value can look normal even when kidney function is reduced. Creatinine-based eGFR can overestimate function in the same way, so a measured creatinine clearance or a cystatin C–based estimate may be used when dosing drugs cleared by the kidneys.Checked against: Creatinine blood test · MedlinePlus (NIH) (2025)

Answer

D · Less muscle makes less creatinine, hiding reduced kidney function
11.Pharmacology

Answer: C · Weigh daily at the same time on the same scales

Why this is the answer

Daily weight is the best home measure of fluid balance. A rapid gain suggests fluid retention, and a rapid loss suggests overdiuresis and dehydration, both of which should be reported.

Answer

C · Weigh daily at the same time on the same scales
12.Pharmacology

Answer: D · Cyanide toxicity from nitroprusside breakdown

Why this is the answer

Nitroprusside releases cyanide, which is normally converted to thiocyanate. With high doses, long infusions or poor organ function, cyanide and thiocyanate can accumulate; the infusion is also protected from light.

Answer

D · Cyanide toxicity from nitroprusside breakdown
13.Med-surg: cardiovascular & respiratory

Answer: D · CURB-65

Why this is the answer

CURB-65 gives one point each for Confusion, Urea >7 mmol/L, Respiratory rate ≥30/min, low Blood pressure (systolic <90 or diastolic ≤60 mmHg) and age ≥65. Higher scores mean higher mortality and the need for hospital or critical care.

Answer

D · CURB-65
14.Med-surg: cardiovascular & respiratory

Answer: B · Assess the patient and suction if secretions are present

Why this is the answer

High-pressure alarms are caused by secretions, coughing, biting the tube, kinked tubing or bronchospasm. With secretions heard, suctioning is the logical first step after a quick assessment. Low-pressure alarms suggest a leak or disconnection. Alarms must never be silenced without finding the cause.

Answer

B · Assess the patient and suction if secretions are present
15.Med-surg: neuro, endocrine & renal

Answer: C · After about 6–8 weeks

Why this is the answer

Levothyroxine has a half-life of about a week, so it takes several weeks to reach a new steady state. TSH is usually rechecked about 6–8 weeks after a dose change.

Answer

C · After about 6–8 weeks
16.Med-surg: neuro, endocrine & renal

Answer: B · Give IV antibiotics at once and start sepsis treatment

Why this is the answer

Meningococcal septicaemia can kill within hours. Antibiotics must not be delayed for a lumbar puncture or scan. Fluids and other sepsis care are started, and a lumbar puncture is often unsafe in a shocked patient.

Answer

B · Give IV antibiotics at once and start sepsis treatment
17.Med-surg: GI, perioperative & oncology

Answer: C · So that carriers can be decolonised to reduce infection

Why this is the answer

MRSA carriers have a higher risk of surgical site infection. Screening allows decolonisation with nasal ointment and skin washes, and the right antibiotic prophylaxis.

Answer

C · So that carriers can be decolonised to reduce infection
18.Med-surg: GI, perioperative & oncology

Answer: B · Recording baseline vital signs

Why this is the answer

Trained assistants can record routine observations and report them. Assessment, teaching and interpreting results need registered nurse knowledge and judgement.

Answer

B · Recording baseline vital signs
19.Maternity & obstetric nursing

Answer: C · Some results, such as PKU, need milk feeds first

Why this is the answer

Phenylalanine builds up only after the baby has had milk feeds, so very early samples can miss PKU. Programmes specify timing, and early samples may need repeating.

Answer

C · Some results, such as PKU, need milk feeds first
20.Maternity & obstetric nursing

Answer: C · A ferning pattern on a dried slide under the microscope

Why this is the answer

Amniotic fluid forms a fern-like pattern when dried and turns nitrazine paper blue because it is alkaline. Vaginal secretions and urine are usually acidic. Blood, semen and infection can give false positives on nitrazine testing.

Answer

C · A ferning pattern on a dried slide under the microscope
21.Pediatric nursing

Answer: D · About 9 to 10 months

Why this is the answer

A pincer grasp typically appears at about 9–10 months and becomes a neat, refined pincer by about 12 months. It is also why small objects become a choking risk at this age.

Answer

D · About 9 to 10 months
22.Pediatric nursing

Answer: B · Protect the child from injury, time the seizure and turn the child onto the side

Why this is the answer

During a seizure, move hard objects away, do not put anything in the mouth or restrain the child, time it and place the child on the side afterwards. Get urgent help if it lasts more than 5 minutes.

Answer

B · Protect the child from injury, time the seizure and turn the child onto the side
23.Mental health nursing

Answer: B · Acute stress disorder

Why this is the answer

Acute stress disorder lasts from 3 days to 1 month after a trauma. If symptoms last longer than 1 month, PTSD is diagnosed. ICD-11 does not have this diagnosis and describes an acute stress reaction as a normal response rather than a disorder.

Answer

B · Acute stress disorder
24.Mental health nursing

Answer: C · "Smoking is only allowed in the garden, and that rule is the same for everyone."

Why this is the answer

Patients with antisocial traits may use charm and flattery to manipulate staff. A calm, non-defensive restatement of the rule, applied consistently by all staff, avoids both being manipulated and starting a power struggle.

Answer

C · "Smoking is only allowed in the garden, and that rule is the same for everyone."
25.Nursing math & unit conversions

Answer: 01:15

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

1 AM → 01

Answer

01:15

Answer

01:15
26.Nursing math & unit conversions

Answer: t = 7.33 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

20:30 → 24:00 = 210 min

After midnight

00:00 → 03:50 = 230 min

Total

210 + 230 = 440 min
t = 440/60 = 7.333 ≈ 7.33 h

Answer

t = 7.33 h
27.Dosage calculations

Answer: V = 9.6 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 = 15·16 = 240 mg

Volume

V = 240/25 = 9.6 mL

On the syringe

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

Answer

V = 9.6 mL
28.Dosage calculations

Answer: V = 0.3 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

0.15 mg = 150 mcg

Volume

V = 150/500 = 0.3 mL

Answer

V = 0.3 mL
29.IV infusion rates

Answer: R = 16 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

8·60 = 480 min

Drip rate

R = 500·15/480 = 15.63 ≈ 16 gtt/min

Answer

R = 16 gtt/min

At the bedside you round to the nearest whole drop: 16 gtt/min.

30.IV infusion rates

Answer: t = 14.3 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

42·60/60 = 42 mL/h

Time left

t = 600/42 = 14.29 ≈ 14.3 h

Answer

t = 14.3 h
31.IV fluids & fluid balance

Answer: I = 1600 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: 250 + 240 + 100 = 590 mL
IV infusion: 80·12 = 960 mL
IV antibiotic: 1·50 = 50 mL
I = 1600 mL

Answer

I = 1600 mL
32.IV fluids & fluid balance

Answer: V = 410 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

12:45 → 14:15 = 1.5 h

Volume infused

60·1.5 = 90 mL

Volume left

V = 500 − 90 = 410 mL

Answer

V = 410 mL
33.Clinical assessment scores

Answer: NEWS2 = 12

NEWS2 (National Early Warning Score 2, Royal College of Physicians 2017): score each of the seven parameters with the chart (respiration rate, SpO₂ on scale 1, air or supplemental oxygen, systolic blood pressure, pulse, consciousness on the ACVPU scale and temperature) and add the scores. Clinical risk: 0–4 low; a score of 3 in any single parameter low–medium; 5–6 medium; 7 or more high. A total of 5 or more needs an urgent response.

Score each parameter

RR 10/min → 1
SpO₂ 86% → 3
on oxygen → 2
SBP 90 mmHg → 3
HR 82/min → 0
newly confused (C) → 3
T 37.8 °C → 0

Add

NEWS2 = 1 + 3 + 2 + 3 + 0 + 3 + 0 = 12

Answer

NEWS2 = 12
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 = 89/1.87² = 25.45

Category

overweight

Answer

overweight

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