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 the main aim of "protected mealtimes" on hospital wards?

  1. ATo give staff a fixed break while the patients are eating their meals
  2. BTo make sure all patients eat the same meal at once
  3. CTo stop visitors from bringing any food into hospital
  4. DTo let patients eat without interruptions, with help where needed
2.Nursing fundamentalsHard

A severely malnourished patient is about to start feeding. Which complication is a particular risk?

  1. AImmediate allergic reaction to the feed
  2. BSudden weight gain of several kilograms of fat in the first week
  3. CRefeeding syndrome with low phosphate, potassium and magnesium
  4. DVery high blood sodium in the first hour
3.Infection control & patient safetyMedium

Which room lighting is safest at night for a patient at high risk of falls?

  1. AA low night light that lights the path to the bathroom
  2. BOnly the light from the television screen
  3. CComplete darkness so the patient sleeps more deeply
  4. DBright overhead lights left on all night in the room
4.Infection control & patient safetyHard

A nurse teaches a patient about home oxygen safety. Which statement shows a need for further teaching?

  1. A“I will keep my oxygen away from the stove.”
  2. B“I will keep my spare cylinders upright and secured.”
  3. C“I will put a ‘no smoking’ sign on my front door for visitors.”
  4. D“I can light candles at dinner if my oxygen is turned down low.”
5.Prioritization & delegationMedium

A patient taking lithium has vomiting, diarrhea and a new coarse tremor. What should the nurse do?

  1. AEncourage the patient to cut down on salt and fluids
  2. BGive the dose with food to reduce the stomach upset
  3. CHold the next dose and report for an urgent lithium level
  4. DReassure the patient that a coarse tremor is expected at first
6.Prioritization & delegationHard

A patient with MRSA in a wound is on contact precautions. Which instruction to the nursing assistant is correct?

  1. AOnly wear gloves when touching the wound itself; skin and bedding are safe
  2. BWear a gown and gloves for contact with the patient or the room, and use dedicated equipment
  3. CWear a respirator mask in the room, because MRSA in a wound spreads through the air to others
  4. DNo special precautions are needed if the wound is covered with a dressing
7.Clinical nursingMedium

Which observation is most important after giving a patient a first dose of a new antibiotic intravenously?

  1. AWhether their hair loss increases
  2. BHow much they walk that day
  3. CTheir appetite at the next meal
  4. DSigns of an allergic reaction such as rash, wheeze or swelling
8.Clinical nursingHard

Why can sepsis be missed in older adults?

  1. ABlood tests are not useful in older people
  2. BOlder adults cannot develop sepsis because their immune system is weaker
  3. CThey may have no fever and present with confusion, falls or reduced mobility
  4. DOlder adults always have a very high fever
9.Lab values & electrolytesMedium

A patient has taken hydrochlorothiazide for several years. Which laboratory change is a recognized effect of this drug?

  1. AA rise in serum uric acid
  2. BA fall in blood glucose
  3. CA fall in serum calcium
  4. DA rise in serum potassium
10.Lab values & electrolytesHard

An aPTT result is extremely high, but the nurse learns that the sample was taken from the arm where the heparin infusion runs. What is the best action?

  1. AGive protamine at once to reverse the heparin
  2. BAccept the result and halve the infusion rate
  3. CStop the heparin infusion permanently and inform the provider
  4. DRequest a new sample from the opposite arm before the dose is adjusted
11.PharmacologyMedium

How does heparin produce its anticoagulant effect?

  1. AIt blocks the vitamin K-dependent synthesis of clotting factors in the liver
  2. BIt irreversibly inhibits platelet COX-1
  3. CIt enhances antithrombin, which inactivates thrombin and factor Xa
  4. DIt breaks down fibrin in existing clots
12.PharmacologyHard

Two days after starting chemotherapy for a leukaemia with a high white cell count, a patient has reduced urine output. Which lab pattern suggests tumour lysis syndrome?

  1. AHigh sodium, high glucose and low potassium
  2. BLow potassium, low phosphate, low uric acid and high calcium
  3. CHigh potassium, high phosphate, high uric acid and low calcium
  4. DNormal electrolytes with a high haemoglobin
13.Med-surg: cardiovascular & respiratoryMedium

Where is the V1 electrode placed for a 12-lead ECG?

  1. AThe fourth intercostal space just right of the sternum
  2. BOver the left nipple
  3. CJust below the left collarbone
  4. DThe fifth intercostal space in the mid-axillary line
14.Med-surg: cardiovascular & respiratoryHard

Which task for a stable patient with heart failure can the registered nurse most appropriately delegate to a healthcare assistant (unlicensed assistive personnel)?

  1. AAssessing lung sounds for new crackles
  2. BMeasuring and recording the morning weight
  3. CTeaching the patient about a low-salt diet
  4. DDeciding whether to give the furosemide dose
15.Med-surg: neuro, endocrine & renalMedium

A patient is starting nitrofurantoin for a UTI. Which teaching point is correct?

  1. AIt turns the tears and sweat bright orange
  2. BIt may turn the urine dark yellow or brown
  3. CIt must be taken only once a week
  4. DIt should be taken on an empty stomach with milk
16.Med-surg: neuro, endocrine & renalHard

A patient with a cervical spinal cord injury is helped to sit up for the first time. They become dizzy and pale, and the BP falls from 110/70 to 78/46 mmHg. What should the nurse do?

  1. ALower the patient back towards lying, then raise them gradually later
  2. BContinue sitting them upright, because it will pass in an hour
  3. CGive a large meal and a strong coffee to raise the blood pressure
  4. DStand the patient up to improve the blood flow to the legs
17.Med-surg: GI, perioperative & oncologyMedium

Why is regular (scheduled) analgesia often preferred to "as required" doses in the first days after major surgery?

  1. AIt completely prevents all opioid side effects
  2. BIt removes the need to assess the patient's pain during the day
  3. CIt allows doses higher than the maximum daily limit to be given
  4. DIt keeps drug levels steady and prevents severe peaks of pain
18.Med-surg: GI, perioperative & oncologyHard

During a nerve block, a patient reports a metallic taste and ringing in the ears, then has a seizure. Besides calling for help and supporting the airway, which specific treatment is given?

  1. AIV lipid emulsion
  2. BIV dantrolene
  3. CIV glucose 50%
  4. DIV naloxone
19.Maternity & obstetric nursingMedium

Which substance in amniotic fluid is used to judge fetal lung maturity?

  1. ASurfactant, assessed by the lecithin/sphingomyelin (L/S) ratio
  2. BGlucose, assessed by its concentration
  3. CAlpha-fetoprotein, assessed by its level
  4. DBilirubin, assessed by its colour
20.Maternity & obstetric nursingHard

Which postpartum task can be delegated to an assistive staff member (healthcare assistant)?

  1. AEvaluating a woman for signs of postpartum depression
  2. BTaking vital signs of a stable woman
  3. CTeaching a first-time mother about breastfeeding
  4. DAssessing the fundus of a woman with heavy bleeding
21.Pediatric nursingMedium

The nurse uses a blood pressure cuff that is too small for a child's arm. What effect will this have?

  1. AThe reading will be falsely high
  2. BThe cuff will not inflate at all
  3. CThe reading will be accurate but slower to obtain
  4. DThe reading will be falsely low
22.Pediatric nursingHard

A 7-year-old with an asthma attack was wheezing loudly but is now quiet, drowsy and has very reduced air entry. What does this indicate?

  1. AA good response to the reliever inhaler, with the airways now opening up again
  2. BThe child is falling asleep normally
  3. CThe attack is resolving
  4. DA life-threatening deterioration with exhaustion and very poor air movement
23.Mental health nursingMedium

What is the Abnormal Involuntary Movement Scale (AIMS) used for?

  1. ATo screen for and monitor tardive dyskinesia
  2. BTo assess the risk of a patient becoming violent
  3. CTo rate the severity of depression
  4. DTo measure the severity of alcohol withdrawal
24.Mental health nursingHard

A patient with depression and a family history of bipolar disorder started an antidepressant 2 weeks ago. He now sleeps 3 hours a night, talks rapidly and is spending large amounts of money. What should the nurse suspect?

  1. AThe expected improvement in mood from the antidepressant
  2. BSerotonin syndrome caused by a high dose
  3. CNormal relief and extra energy now that his depression has finally lifted after the treatment
  4. DA switch into mania or hypomania triggered by the antidepressant
25.Nursing math & unit conversionsMedium
10 lb 2 oz? kg1 lb = 16 oz1 kg = 2.2 lb

Practice exercise (made-up values, not clinical guidance). A newborn weighs 10 lb 2 oz. Using 1 lb = 16 oz and 1 kg = 2.2 lb, find the weight m in kilograms. Round to two decimal places.

10 lb 2 oz1 lb = 16 oz1 kg = 2.2 lb
m = kg
26.Nursing math & unit conversionsHard
1½ tbsp? mL½ fl oz? mL3 tsp? mL½ cup? mLΣ = ? mL

Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 1½ tbsp of liquid supplement, ½ fl oz of juice, 3 tsp of cough syrup, ½ cup of tea. Using the equivalents given, find the total oral intake V in mL.

1 tbsp = 15 mL1 fl oz = 30 mL1 tsp = 5 mL1 cup = 8 fl oz = 240 mL
V = mL
27.Dosage calculationsMedium
57 kgBSA = 1.46 m²100 mg/m²D = ? mg

A patient weighing 57 kg has a body surface area of 1.46 m². The prescription is 100 mg/m². Find the dose D in mg.

57 kgBSA = 1.46 m²100 mg/m²
D = mg
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 1300 units of a drug that comes as 10000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

1300 units10000 units/mL
V = mL
29.IV infusion ratesMedium
V = ?20 gtt/mL35 gtt/min6 h

A drip runs at 35 gtt/min through a set of 20 gtt/mL. How many millilitres V does the patient receive in 6 hours?

35 gtt/min20 gtt/mL6 h
V = mL
30.IV infusion ratesHard
300 mL20 gtt/mL30 gtt/mint = ? h

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.

30 gtt/min20 gtt/mL300 mL
t = h
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shifttea200 mLmilk200 mLice chips240 mLIV infusion125 mL/h × 12 hIV antibiotic2 × 100 mLurine175 mLurine475 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 fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.

tea: 200 mLmilk: 200 mLice chips: 240 mLIV infusion: 125 mL/h × 12 hIV antibiotic: 2 × 100 mLurine: 175 mLurine: 475 mL
B = mL
32.IV fluids & fluid balanceHard
1000 mL50 mL/hstart 07:1512:45: ? mL

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 07:15 and runs by pump at 50 mL/h. How many mL V are left in the bag at 12:45?

1000 mL50 mL/h07:15 → 12:45
V = mL
33.Clinical assessment scoresMedium
S? / 4+M? / 4+A? / 4+Mob? / 4+N? / 4+F? / 3Σ?

Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: no impairment; moisture: constantly moist; activity: chairfast; mobility: completely immobile; nutrition: probably inadequate; friction and shear: no apparent problem. Find the Braden total B.

6–23
B =
34.Clinical assessment scoresHard
113?SBPDBPmmHgMAP = 65

Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 65 mmHg. A patient’s systolic pressure is 113 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 65 mmHg?

MAP 65 mmHgSBP 113 mmHg
DBP = mmHg

3Solutions

1.Nursing fundamentals

Answer: D · To let patients eat without interruptions, with help where needed

Why this is the answer

Ward rounds and tests can interrupt meals, and patients then eat less. Protected mealtimes pause non-urgent activity so staff can focus on helping patients eat.

Answer

D · To let patients eat without interruptions, with help where needed
2.Nursing fundamentals

Answer: C · Refeeding syndrome with low phosphate, potassium and magnesium

Why this is the answer

When feeding restarts after starvation, insulin release drives phosphate, potassium and magnesium into the cells. Low levels can cause heart failure and arrhythmias, so feeding starts slowly and bloods are monitored.

Answer

C · Refeeding syndrome with low phosphate, potassium and magnesium
3.Infection control & patient safety

Answer: A · A low night light that lights the path to the bathroom

Why this is the answer

A night light lets the patient see obstacles and the way to the bathroom without disturbing sleep. Many falls happen in the dark on the way to the toilet.

Answer

A · A low night light that lights the path to the bathroom
4.Infection control & patient safety

Answer: D · “I can light candles at dinner if my oxygen is turned down low.”

Why this is the answer

Oxygen supports combustion, so open flames such as candles, matches, gas stoves and cigarettes must be kept away whatever the flow rate. The other statements are correct.

Answer

D · “I can light candles at dinner if my oxygen is turned down low.”
5.Prioritization & delegation

Answer: C · Hold the next dose and report for an urgent lithium level

Why this is the answer

Vomiting, diarrhea and a coarse tremor suggest lithium toxicity. The nurse holds the dose and reports so a serum level can be checked; low salt or fluid intake raises lithium levels further.

Answer

C · Hold the next dose and report for an urgent lithium level
6.Prioritization & delegation

Answer: B · Wear a gown and gloves for contact with the patient or the room, and use dedicated equipment

Why this is the answer

MRSA spreads through direct contact and contaminated surfaces. Gown and gloves, hand hygiene and dedicated equipment prevent transmission; a respirator is not needed for contact precautions.

Answer

B · Wear a gown and gloves for contact with the patient or the room, and use dedicated equipment
7.Clinical nursing

Answer: D · Signs of an allergic reaction such as rash, wheeze or swelling

Why this is the answer

First doses carry a risk of anaphylaxis. Watch for rash, urticaria, swelling, wheeze, breathlessness and falling blood pressure.

Answer

D · Signs of an allergic reaction such as rash, wheeze or swelling
8.Clinical nursing

Answer: C · They may have no fever and present with confusion, falls or reduced mobility

Why this is the answer

Older people may have a normal or low temperature and present with delirium, falls or general decline. Early warning scores and a high index of suspicion are important.

Answer

C · They may have no fever and present with confusion, falls or reduced mobility
9.Lab values & electrolytes

Answer: A · A rise in serum uric acid

Why this is the answer

Thiazides reduce uric acid excretion and can trigger gout. They also tend to lower potassium, sodium and magnesium, raise calcium (by reducing its excretion) and raise blood glucose and lipids.Checked against: Hydrochlorothiazide · StatPearls (NCBI Bookshelf) (2026)

Answer

A · A rise in serum uric acid
10.Lab values & electrolytes

Answer: D · Request a new sample from the opposite arm before the dose is adjusted

Why this is the answer

Blood drawn from the infusion arm contains heparin from the drip, so the aPTT is falsely high. A sample from the other arm gives a true result. Changing the dose on a false result could cause clotting.Checked against: Partial Thromboplastin Time (PTT) Test · MedlinePlus (NIH) (2026)

Answer

D · Request a new sample from the opposite arm before the dose is adjusted
11.Pharmacology

Answer: C · It enhances antithrombin, which inactivates thrombin and factor Xa

Why this is the answer

Heparin binds antithrombin and greatly accelerates its inactivation of thrombin and factor Xa. Low-molecular-weight heparins act mainly on factor Xa.

Answer

C · It enhances antithrombin, which inactivates thrombin and factor Xa
12.Pharmacology

Answer: C · High potassium, high phosphate, high uric acid and low calcium

Why this is the answer

Rapid tumour cell death releases potassium, phosphate and nucleic acids (which become uric acid). Phosphate binds calcium, lowering it; prevention includes IV fluids and drugs that lower uric acid.

Answer

C · High potassium, high phosphate, high uric acid and low calcium
13.Med-surg: cardiovascular & respiratory

Answer: A · The fourth intercostal space just right of the sternum

Why this is the answer

V1 is placed in the fourth intercostal space at the right sternal edge, and V2 at the left sternal edge. V4 is in the fifth intercostal space in the mid-clavicular line, and V6 in the mid-axillary line at the same level. Wrong placement can mimic or hide changes.

Answer

A · The fourth intercostal space just right of the sternum
14.Med-surg: cardiovascular & respiratory

Answer: B · Measuring and recording the morning weight

Why this is the answer

Weighing a stable patient is a routine, measurable task that can be delegated, with the result reported to the nurse. Assessment, patient teaching and clinical decisions about medicines require the registered nurse's judgement and cannot be delegated.

Answer

B · Measuring and recording the morning weight
15.Med-surg: neuro, endocrine & renal

Answer: B · It may turn the urine dark yellow or brown

Why this is the answer

Nitrofurantoin can make urine dark yellow or brown, which is harmless. Taking it with food reduces nausea. Patients should report breathlessness, cough or tingling, which are rare but serious effects.

Answer

B · It may turn the urine dark yellow or brown
16.Med-surg: neuro, endocrine & renal

Answer: A · Lower the patient back towards lying, then raise them gradually later

Why this is the answer

Loss of sympathetic tone causes orthostatic hypotension after high spinal injuries. The patient is reclined, and later raised gradually, often with compression stockings, an abdominal binder and sometimes medicines.

Answer

A · Lower the patient back towards lying, then raise them gradually later
17.Med-surg: GI, perioperative & oncology

Answer: D · It keeps drug levels steady and prevents severe peaks of pain

Why this is the answer

Predictable, continuous postoperative pain is best managed with regular multimodal analgesia (for example paracetamol and, where safe, an NSAID), with as-needed doses for breakthrough pain. Pain and side effects are still assessed regularly.

Answer

D · It keeps drug levels steady and prevents severe peaks of pain
18.Med-surg: GI, perioperative & oncology

Answer: A · IV lipid emulsion

Why this is the answer

These are signs of local anaesthetic systemic toxicity. The injection is stopped, help is called, the airway is secured and seizures are treated. IV lipid emulsion is the specific treatment, especially if the circulation is affected.

Answer

A · IV lipid emulsion
19.Maternity & obstetric nursing

Answer: A · Surfactant, assessed by the lecithin/sphingomyelin (L/S) ratio

Why this is the answer

Surfactant reduces surface tension and keeps alveoli open. An L/S ratio of about 2:1 or more suggests the lungs are mature. Amniotic fluid testing for lung maturity is now rarely used in practice.

Answer

A · Surfactant, assessed by the lecithin/sphingomyelin (L/S) ratio
20.Maternity & obstetric nursing

Answer: B · Taking vital signs of a stable woman

Why this is the answer

Routine vital signs for a stable patient can be delegated, with the nurse interpreting results. Assessment, teaching and evaluation of unstable patients are nursing responsibilities.

Answer

B · Taking vital signs of a stable woman
21.Pediatric nursing

Answer: A · The reading will be falsely high

Why this is the answer

A cuff that is too small gives falsely high readings, and one that is too large gives falsely low readings. The bladder width should be about 40% of the arm circumference.

Answer

A · The reading will be falsely high
22.Pediatric nursing

Answer: D · A life-threatening deterioration with exhaustion and very poor air movement

Why this is the answer

A "silent chest" and drowsiness mean that too little air is moving and the child is tiring. This is an emergency: call for help, give oxygen and emergency treatment as ordered.

Answer

D · A life-threatening deterioration with exhaustion and very poor air movement
23.Mental health nursing

Answer: A · To screen for and monitor tardive dyskinesia

Why this is the answer

The AIMS is a structured examination of involuntary movements of the face, limbs and trunk. It is done at baseline and regularly during long-term antipsychotic treatment so tardive dyskinesia is detected early.

Answer

A · To screen for and monitor tardive dyskinesia
24.Mental health nursing

Answer: D · A switch into mania or hypomania triggered by the antidepressant

Why this is the answer

Antidepressants can trigger mania or hypomania in people with bipolar disorder, particularly without a mood stabiliser. The nurse reports this so the prescriber can reassess the diagnosis and treatment.

Answer

D · A switch into mania or hypomania triggered by the antidepressant
25.Nursing math & unit conversions

Answer: m = 4.6 kg

Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.

Ounces to pounds

2 oz/16 = 0.125 lb
10 + 0.125 = 10.13 lb

Pounds to kilograms

m = 10.13/2.2 = 4.602 ≈ 4.6 kg

Answer

m = 4.6 kg
26.Nursing math & unit conversions

Answer: V = 172.5 mL

Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.

Each item in mL

1½ tbsp = 1.5·15 = 22.5 mL
½ fl oz = 0.5·30 = 15 mL
3 tsp = 3·5 = 15 mL
½ cup = 0.5·240 = 120 mL

Add

V = 22.5 + 15 + 15 + 120 = 172.5 mL

Answer

V = 172.5 mL
27.Dosage calculations

Answer: D = 146 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 = 100·1.46 = 146 mg

Answer

D = 146 mg
28.Dosage calculations

Answer: V = 0.13 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.

Volume

V = 1300/10000 = 0.13 mL

On the syringe

On this 1 mL syringe every small line is 0.01 mL.

Answer

V = 0.13 mL
29.IV infusion rates

Answer: V = 630 mL

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

35·60/20 = 105 mL/h

Volume

V = 105·6 = 630 mL

Answer

V = 630 mL
30.IV infusion rates

Answer: t = 3.3 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

30·60/20 = 90 mL/h

Time left

t = 300/90 = 3.333 ≈ 3.3 h

Answer

t = 3.3 h
31.IV fluids & fluid balance

Answer: B = 1570 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.

Total intake

oral: 200 + 200 = 400 mL
ice chips: 240/2 = 120 mL
IV infusion: 125·12 = 1500 mL
IV antibiotic: 2·100 = 200 mL
total intake = 2220 mL

Total output

175 + 475 = 650 mL

Balance

B = 2220 − 650 = 1570 mL

Answer

B = 1570 mL

Positive: more fluid went in than came out.

32.IV fluids & fluid balance

Answer: V = 725 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

07:15 → 12:45 = 5.5 h

Volume infused

50·5.5 = 275 mL

Volume left

V = 1000 − 275 = 725 mL

Answer

V = 725 mL
33.Clinical assessment scores

Answer: B = 13

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: constantly moist → 1
activity: chairfast → 2
mobility: completely immobile → 1
nutrition: probably inadequate → 2
friction and shear: no apparent problem → 3

Add

Braden total = 4 + 1 + 2 + 1 + 2 + 3 = 13

Answer

B = 13
34.Clinical assessment scores

Answer: DBP = 41 mmHg

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.

Rearrange

DBP = (3·MAP − SBP)/2

Substitute

DBP = (3·65 − 113)/2 = 82/2 = 41 mmHg

Answer

DBP = 41 mmHg

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