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

Which part of the stethoscope is best for hearing low-pitched sounds such as some heart murmurs?

  1. AThe earpieces turned backwards
  2. BThe bell, pressed firmly on the skin
  3. CThe bell, placed lightly on the skin
  4. DThe diaphragm, pressed firmly on the skin
2.Nursing fundamentalsHard

Five days after hip surgery, a patient suddenly becomes breathless with sharp chest pain and a fast heart rate. What should the nurse suspect?

  1. AAnxiety about going home
  2. BA chest infection developing slowly
  3. CA pulmonary embolism
  4. DNormal recovery after hip surgery
3.Infection control & patient safetyMedium

When should blood specimen tubes be labeled?

  1. AAt the bedside, in front of the patient, right after collection
  2. BBack at the station after all the samples are collected
  3. CBy the laboratory staff after the tubes arrive
  4. DAt the nurses’ station before going to the patient, to save time
4.Infection control & patient safetyHard

A patient with dementia is often found at the exit doors trying to leave the unit. Which measure is most appropriate?

  1. AUse an electronic wander alert, supervise closely and offer meaningful activity
  2. BLock the patient alone in a single room so that they cannot reach the exit doors
  3. CGive a sedative each time the patient goes to the door
  4. DKeep the patient in a chair with a vest restraint
5.Prioritization & delegationMedium

A patient just told they have cancer is crying, but has also vomited several times and cannot keep fluids down. What does the nurse address first?

  1. AThe vomiting and fluid loss
  2. BTeaching about chemotherapy
  3. CEmotional support about the diagnosis
  4. DContacting the hospital chaplain
6.Prioritization & delegationHard

After cardiac surgery, a patient becomes hypotensive with distended neck veins and muffled heart sounds, and chest drain output has suddenly stopped. What should the nurse suspect?

  1. ALeft-sided heart failure
  2. BCardiac tamponade
  3. CHypovolemic shock from dehydration
  4. DA blocked urinary catheter
7.Clinical nursingMedium

A patient's abdomen is rigid and board-like, and they lie very still because movement worsens the pain. What does this suggest?

  1. APeritonitis
  2. BConstipation
  3. CIndigestion
  4. DUrinary tract infection
8.Clinical nursingHard

A patient on enteral tube feeding after a long period of starvation develops low phosphate, low potassium and arrhythmias. What is most likely?

  1. ARefeeding syndrome
  2. BDumping syndrome
  3. CDiabetic ketoacidosis
  4. DHyperthyroidism
9.Lab values & electrolytesMedium

A patient with hepatic encephalopathy is receiving lactulose. Which finding best shows that the treatment is effective?

  1. ASix to eight watery stools a day with dizziness
  2. BA rising serum ammonia with a slower flapping tremor
  3. CTwo to three soft stools a day and clearer thinking
  4. DNo bowel movement for 2 days and calm sleep
10.Lab values & electrolytesHard

Ten minutes into a red cell transfusion, a patient develops fever, chills, low back pain and dark urine. After stopping the transfusion, what should the nurse do next?

  1. AFlush the remaining blood through the line with the IV fluid to finish it
  2. BRestart the transfusion more slowly after giving an antipyretic drug
  3. CKeep the IV open with normal saline using new tubing and call the provider
  4. DDiscard the blood bag and tubing in the clinical waste to stop exposure
11.PharmacologyMedium

Which is a well-known adverse effect of long-term oral corticosteroids?

  1. AOsteoporosis
  2. BLow blood pressure
  3. CWeight loss
  4. DHypoglycaemia
12.PharmacologyHard

On admission, a patient's home medicine list includes warfarin for atrial fibrillation, but warfarin is not on the admission orders. What should the nurse do?

  1. ATell the patient to stop warfarin permanently
  2. BClarify the omission with the prescriber (medication reconciliation)
  3. CGive the patient's own warfarin brought from home without an order
  4. DAssume the omission is intended and do nothing
13.Med-surg: cardiovascular & respiratoryMedium

What does a raised D-dimer result mean?

  1. AA deep vein thrombosis has been safely excluded
  2. BA pulmonary embolism or DVT has been confirmed
  3. CThe anticoagulant dose is too low and must rise
  4. DFibrin breakdown is present, but it does not prove a clot
14.Med-surg: cardiovascular & respiratoryHard

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

  1. ALymphoedema from lying in bed
  2. BA local skin allergy to the dressing
  3. CA catheter-related deep vein thrombosis
  4. DAn expected effect of the antibiotic
15.Med-surg: neuro, endocrine & renalMedium

A patient has had a calcium oxalate kidney stone. Which advice best helps prevent another?

  1. ACut all calcium out of the diet
  2. BTake extra vitamin C supplements
  3. CDrink only a little to avoid diluting the urine
  4. DDrink plenty of fluid so the urine stays pale
16.Med-surg: neuro, endocrine & renalHard

A haemodialysis patient asks why fluid between sessions must be limited. Which explanation is correct?

  1. AExcess fluid builds up, raising BP and causing breathlessness and cramps on dialysis
  2. BFluid restriction is mainly to shorten the time spent on the machine
  3. CDrinking water makes the dialysis remove too much potassium from the blood
  4. DExtra fluid weakens the fistula wall and makes it more likely to burst
17.Med-surg: GI, perioperative & oncologyMedium

How are skin staples usually removed from a healed incision?

  1. AOnly the staples at each end, leaving the others for good
  2. BAlternate staples first, then the rest if the wound holds
  3. CAll staples at once by pulling each one straight up from the skin
  4. DThe staples are left in permanently under the skin
18.Med-surg: GI, perioperative & oncologyHard

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

  1. A"I'll stop smoking because it makes reflux worse."
  2. B"I'll try to lose some weight over the next months."
  3. C"I'll keep a diary of foods that trigger my symptoms."
  4. D"Peppermint tea after dinner will settle my reflux."
19.Maternity & obstetric nursingMedium

A woman at 28 weeks is Rh-negative and has a positive antibody screen for anti-D. What does this mean?

  1. AThe result is normal and needs no further action
  2. BShe needs a double dose of anti-D immunoglobulin
  3. CHer baby is definitely Rh-negative
  4. DShe is sensitised; the fetus is watched for anaemia
20.Maternity & obstetric nursingHard

A fetal heart rate tracing shows absent baseline variability with recurrent late decelerations. How is this classified and what does it require?

  1. ACategory II: an indeterminate tracing that only needs continued routine observation and documentation
  2. BCategory I: normal, routine care
  3. CCategory III: an abnormal tracing that needs prompt intervention and preparation for expedited birth
  4. DA normal pattern during fetal sleep
21.Pediatric nursingMedium

A child's tonic–clonic seizure has lasted more than 5 minutes. What should the nurse do?

  1. AHold the child's arms and legs firmly to stop the movements
  2. BWait another 15 minutes, because most seizures stop on their own
  3. CPut a tongue depressor between the child's teeth
  4. DGive the prescribed rescue medicine and call for emergency help
22.Pediatric nursingHard

The parent of a child on chemotherapy calls to say the child has a temperature of 38.5 °C (101.3 °F). What is the correct advice?

  1. ABring the child to hospital straight away for assessment and IV antibiotics
  2. BWait until the next clinic visit, as fever is common
  3. CGive paracetamol (acetaminophen) and call back if the fever lasts more than 2 days
  4. DGive a cool bath and keep the child at home
23.Mental health nursingMedium

A patient with narcissistic personality disorder demands that only the senior doctor should speak to him, because the nurses are "beneath him". What is the best approach?

  1. ATell him that he is not as important as he thinks he is
  2. BAvoid him as much as possible, because he is rude and unpleasant to the nursing staff
  3. CRespond respectfully but firmly, and keep the same expectations as for other patients
  4. DArrange for only the senior doctor to see him from now on
24.Mental health nursingHard

A nurse is teaching a patient who has started haloperidol for schizophrenia. Which statement shows a need for further teaching?

  1. A"I can stop taking it as soon as the voices go away."
  2. B"I should tell the nurse if my neck or jaw muscles feel stiff."
  3. C"I should get up slowly if I feel dizzy."
  4. D"I'll avoid alcohol while I'm taking this medicine."
25.Nursing math & unit conversionsMedium
45.425 gtt/min? gtt/minround to 1 gtt/min

Practice exercise (made-up values, not clinical guidance). A drip-rate calculation gives 45.425 gtt/min. The rule in this exercise is that drip rates are rounded to the nearest whole drop. What value x do you record?

45.425 gtt/min
x = gtt/min
26.Nursing math & unit conversionsHard
0.5 mcg/kg/min? mg/h69 kg1 h = 60 min1 mg = 1000 mcg

Practice exercise (made-up values, not clinical guidance). An order reads 0.5 mcg/kg/min for a patient who weighs 69 kg. Express the dose rate D in mg/h. Round to two decimal places.

0.5 mcg/kg/min69 kg
D = mg/h
27.Dosage calculationsMedium
45 kg7.5 mg/kg/day2× per dayD = ? mg

A patient weighs 45 kg. The prescribed dose is 7.5 mg/kg per day, given in 2 equal doses. How many milligrams D are given per dose?

45 kg7.5 mg/kg/day2× per day
D = mg
28.Dosage calculationsHard
75 kg162 cmBSA = √(h·w/3600)50 mg/m²D = ? mg

A patient is 162 cm tall and weighs 75 kg. The prescription is 50 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.

162 cm75 kg50 mg/m²
D = mg
29.IV infusion ratesMedium
1500 mL20 gtt/mL10 h? gtt/min

Infuse 1500 mL over 10 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute.

1500 mL10 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
400 mg250 mL30 mL/h? mg/h

A bag contains 400 mg of a drug in 250 mL and runs at 30 mL/h. How many milligrams per hour D does the patient receive?

400 mg/250 mL30 mL/h
D = mg/h
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftwater250 mLjuice150 mLmilk240 mLice chips200 mLIV infusion100 mL/h × 12 hIV antibiotic2 × 50 mLurine225 mLurine400 mLurine350 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.

water: 250 mLjuice: 150 mLmilk: 240 mLice chips: 200 mLIV infusion: 100 mL/h × 12 hIV antibiotic: 2 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
500 mL100 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 100 mL/h. How many mL V are left in the bag at 14:15?

500 mL100 mL/h12:45 → 14:15
V = mL
33.Clinical assessment scoresMedium
H? / 25+D? / 15+Aid? / 30+IV? / 20+G? / 20+MS? / 15Σ?

Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: no; secondary diagnosis: no; ambulatory aid: none, bed rest or nurse assists; IV therapy or saline lock: yes; gait: weak; mental status: knows own limits. Find the Morse total MFS.

0–125
MFS =
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 97 kg and is 164 cm tall. Calculate the BMI and click the WHO weight category.

97 kg164 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 · The bell, placed lightly on the skin

Why this is the answer

The bell picks up low-pitched sounds and must be held lightly. The diaphragm, pressed firmly, is used for high-pitched sounds such as normal breath, bowel and heart sounds.

Answer

C · The bell, placed lightly on the skin
2.Nursing fundamentals

Answer: C · A pulmonary embolism

Why this is the answer

Sudden breathlessness, pleuritic chest pain and tachycardia after surgery suggest a clot from the leg has reached the lungs. This is an emergency needing urgent medical review.

Answer

C · A pulmonary embolism
3.Infection control & patient safety

Answer: A · At the bedside, in front of the patient, right after collection

Why this is the answer

Labeling tubes at the bedside, using two patient identifiers and in the patient’s presence, prevents wrong-patient specimens. Pre-labeled or later-labeled tubes are easily mixed up.

Answer

A · At the bedside, in front of the patient, right after collection
4.Infection control & patient safety

Answer: A · Use an electronic wander alert, supervise closely and offer meaningful activity

Why this is the answer

Wander alert systems, close supervision, orientation and activity reduce the risk of elopement without restricting the patient. Seclusion, restraints and sedation used for convenience are not appropriate.

Answer

A · Use an electronic wander alert, supervise closely and offer meaningful activity
5.Prioritization & delegation

Answer: A · The vomiting and fluid loss

Why this is the answer

Ongoing vomiting threatens fluid and electrolyte balance, a physiological need. Emotional support is important and should follow soon, but the physical threat is addressed first.

Answer

A · The vomiting and fluid loss
6.Prioritization & delegation

Answer: B · Cardiac tamponade

Why this is the answer

Hypotension, distended neck veins and muffled heart sounds suggest fluid compressing the heart. A sudden stop in chest drain output can mean clots are trapping blood around the heart; this is an emergency.

Answer

B · Cardiac tamponade
7.Clinical nursing

Answer: A · Peritonitis

Why this is the answer

Peritonitis, often from perforation, causes guarding, rigidity and pain worsened by movement. It is a surgical emergency.

Answer

A · Peritonitis
8.Clinical nursing

Answer: A · Refeeding syndrome

Why this is the answer

Refeeding syndrome results from rapid shifts of phosphate, potassium and magnesium into cells when feeding resumes. High-risk patients start slowly with electrolyte monitoring and thiamine.

Answer

A · Refeeding syndrome
9.Lab values & electrolytes

Answer: C · Two to three soft stools a day and clearer thinking

Why this is the answer

Lactulose acidifies the colon, traps ammonia and speeds its removal, so the goal is usually about 2–3 soft stools a day with improving mental status. Too much lactulose can cause severe diarrhea, dehydration and electrolyte loss.Checked against: Lactulose · MedlinePlus (NIH) (2024)

Answer

C · Two to three soft stools a day and clearer thinking
10.Lab values & electrolytes

Answer: C · Keep the IV open with normal saline using new tubing and call the provider

Why this is the answer

These signs suggest an acute hemolytic reaction. The transfusion is stopped, the line is kept open with normal saline through new tubing, the provider and blood bank are informed, and the bag, tubing and blood and urine samples are sent for testing as per policy.Checked against: Hemolytic transfusion reaction · MedlinePlus (NIH) (2025)

Answer

C · Keep the IV open with normal saline using new tubing and call the provider
11.Pharmacology

Answer: A · Osteoporosis

Why this is the answer

Long-term corticosteroids reduce bone formation and raise fracture risk. They also cause weight gain, high blood glucose, hypertension and a higher infection risk.

Answer

A · Osteoporosis
12.Pharmacology

Answer: B · Clarify the omission with the prescriber (medication reconciliation)

Why this is the answer

Medication reconciliation compares the patient's home medicines with current orders to find omissions, duplications and errors. The nurse raises the difference with the prescriber, who decides whether to continue, hold or change the drug.

Answer

B · Clarify the omission with the prescriber (medication reconciliation)
13.Med-surg: cardiovascular & respiratory

Answer: D · Fibrin breakdown is present, but it does not prove a clot

Why this is the answer

D-dimer is a breakdown product of fibrin. A normal result in a patient with a low clinical probability (for example a low Wells score) helps exclude DVT or PE. A raised result is common in many conditions, so imaging (duplex ultrasound or CT pulmonary angiography) is needed to confirm a clot.

Answer

D · Fibrin breakdown is present, but it does not prove a clot
14.Med-surg: cardiovascular & respiratory

Answer: C · A catheter-related deep vein thrombosis

Why this is the answer

Upper-limb DVT is a recognised complication of PICCs and other central lines. Arm swelling, pain and distended veins should be reported, and an ultrasound arranged. The line is not flushed forcefully, and treatment usually involves anticoagulation.

Answer

C · A catheter-related deep vein thrombosis
15.Med-surg: neuro, endocrine & renal

Answer: D · Drink plenty of fluid so the urine stays pale

Why this is the answer

High fluid intake is the most important measure for preventing stones. Dietary calcium is usually not restricted, because it binds oxalate in the gut. High-dose vitamin C can increase oxalate.

Answer

D · Drink plenty of fluid so the urine stays pale
16.Med-surg: neuro, endocrine & renal

Answer: A · Excess fluid builds up, raising BP and causing breathlessness and cramps on dialysis

Why this is the answer

Patients with little residual urine output accumulate fluid between sessions. Large gains cause hypertension, pulmonary oedema and heart strain, and removing large volumes quickly during dialysis causes hypotension and cramps. Restricting fluid and salt (which drives thirst) keeps gains manageable.

Answer

A · Excess fluid builds up, raising BP and causing breathlessness and cramps on dialysis
17.Med-surg: GI, perioperative & oncology

Answer: B · Alternate staples first, then the rest if the wound holds

Why this is the answer

Removing alternate staples first allows the nurse to check that the wound edges stay together. If the wound is secure, the rest are removed, and adhesive strips can be applied for support.

Answer

B · Alternate staples first, then the rest if the wound holds
18.Med-surg: GI, perioperative & oncology

Answer: D · "Peppermint tea after dinner will settle my reflux."

Why this is the answer

Peppermint can relax the lower oesophageal sphincter and may worsen reflux. Weight loss, stopping smoking and avoiding personal triggers are standard lifestyle measures.

Answer

D · "Peppermint tea after dinner will settle my reflux."
19.Maternity & obstetric nursing

Answer: D · She is sensitised; the fetus is watched for anaemia

Why this is the answer

If antibodies are already present, anti-D prophylaxis is of no use. Antibody levels are followed and the fetus is monitored for anaemia, often with Doppler of the middle cerebral artery.

Answer

D · She is sensitised; the fetus is watched for anaemia
20.Maternity & obstetric nursing

Answer: C · Category III: an abnormal tracing that needs prompt intervention and preparation for expedited birth

Why this is the answer

In the three-tier system, absent variability with recurrent late or variable decelerations, or with bradycardia, is Category III. Intrauterine resuscitation starts at once, the team is called, and birth is expedited if the pattern does not resolve.

Answer

C · Category III: an abnormal tracing that needs prompt intervention and preparation for expedited birth
21.Pediatric nursing

Answer: D · Give the prescribed rescue medicine and call for emergency help

Why this is the answer

A seizure lasting 5 minutes or more is treated as possible status epilepticus. Rescue medicine such as buccal or intranasal midazolam, or rectal or intranasal diazepam, is given according to the care plan, and emergency help is called. The child is never restrained and nothing is put in the mouth.

Answer

D · Give the prescribed rescue medicine and call for emergency help
22.Pediatric nursing

Answer: A · Bring the child to hospital straight away for assessment and IV antibiotics

Why this is the answer

Fever during chemotherapy is treated as possible neutropenic sepsis. The child needs urgent assessment, blood tests and cultures, and IV antibiotics within the target time set by local policy; delay can be fatal.

Answer

A · Bring the child to hospital straight away for assessment and IV antibiotics
23.Mental health nursing

Answer: C · Respond respectfully but firmly, and keep the same expectations as for other patients

Why this is the answer

People with narcissistic personality disorder have a fragile self-esteem beneath the grandiosity. A consistent, respectful and non-defensive approach avoids power struggles and maintains the usual boundaries.

Answer

C · Respond respectfully but firmly, and keep the same expectations as for other patients
24.Mental health nursing

Answer: A · "I can stop taking it as soon as the voices go away."

Why this is the answer

Antipsychotics are continued after symptoms improve, because stopping them early is a major cause of relapse. Any change should be discussed with the prescriber.

Answer

A · "I can stop taking it as soon as the voices go away."
25.Nursing math & unit conversions

Answer: x = 45 gtt/min

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 ones place

45.425 → 5

Only the next digit decides

45.425 → 4
4 is 4 or less, so 5 stays.
The digits after it (25) are ignored: round once, never step by step.

Round

x = 45 gtt/min

Answer

x = 45 gtt/min
26.Nursing math & unit conversions

Answer: D = 2.07 mg/h

Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.

Set up the chain

D = 0.5 mcg/kg/min × 69 kg × (60 min/1 h) × (1 mg/1000 mcg)

Calculate

D = 0.5·69·60/1000 = 2.07 mg/h

Answer

D = 2.07 mg/h
27.Dosage calculations

Answer: D = 168.8 mg

Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.

Total per day

7.5·45 = 337.5 mg

Per dose

D = 337.5/2 = 168.8 mg

Answer

D = 168.8 mg
28.Dosage calculations

Answer: D = 91.86 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).

Body surface area

BSA = √(162·75/3600) = √3.375 = 1.837 m²

Dose

D = 50·1.837 = 91.86 mg

Answer

D = 91.86 mg
29.IV infusion rates

Answer: R = 50 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

10·60 = 600 min

Drip rate

R = 1500·20/600 = 50 gtt/min

Answer

R = 50 gtt/min
30.IV infusion rates

Answer: D = 48 mg/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.

Concentration

400/250 = 1.6 mg/mL

Dose rate

D = 1.6·30 = 48 mg/h

Answer

D = 48 mg/h
31.IV fluids & fluid balance

Answer: I = 2040 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 + 150 + 240 = 640 mL
ice chips: 200/2 = 100 mL
IV infusion: 100·12 = 1200 mL
IV antibiotic: 2·50 = 100 mL
I = 2040 mL

Answer

I = 2040 mL
32.IV fluids & fluid balance

Answer: V = 350 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

100·1.5 = 150 mL

Volume left

V = 500 − 150 = 350 mL

Answer

V = 350 mL
33.Clinical assessment scores

Answer: MFS = 30

Morse fall scale: six items. History of falling: no 0, yes 25. Secondary diagnosis: no 0, yes 15. Ambulatory aid: none, bed rest or nurse assistance 0; crutches, cane or walker 15; holding on to furniture 30. IV therapy or saline lock: no 0, yes 20. Gait: normal, bed rest or wheelchair 0; weak 10; impaired 20. Mental status: knows own limits 0; overestimates or forgets limits 15. The total runs from 0 to 125. Risk cut-offs differ between hospitals; a common set is 0–24 low, 25–44 moderate and 45 or more high.

Score each item

history of falling in the last 3 months: no → 0
secondary diagnosis: no → 0
ambulatory aid: none, bed rest or nurse assists → 0
IV therapy or saline lock: yes → 20
gait: weak → 10
mental status: knows own limits → 0

Add

Morse total = 0 + 0 + 0 + 20 + 10 + 0 = 30

Answer

MFS = 30
34.Clinical assessment scores

Answer: obesity class II

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 = 97/1.64² = 36.06

Category

obesity class II

Answer

obesity class II

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