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 behaviour shows active listening?

  1. APlanning your reply while the patient is talking
  2. BLooking at the computer screen to take notes during the conversation
  3. CParaphrasing what the patient said to check understanding
  4. DChanging the subject when emotions come up
2.Nursing fundamentalsHard

A patient wants to keep taking St John's wort, a herbal remedy, while in hospital. Why should the nurse tell the prescriber?

  1. AIt must be swapped for a prescribed antidepressant at once
  2. BIt has no effects, so it is a waste of time
  3. CIt interacts with many medicines and can reduce their effect
  4. DHerbal remedies are always banned in hospital
3.Infection control & patient safetyMedium

Why is “QD” (once daily) on The Joint Commission’s “Do Not Use” list?

  1. AIt is only allowed for intravenous medicines
  2. BIt means “every day at bedtime” in some hospitals
  3. CIt is a Latin abbreviation, and only plain English abbreviations may be used
  4. DIt can be misread as QID or QOD, so the drug is given too often or too rarely
4.Infection control & patient safetyHard

During a power cut in a US hospital, a ventilator must stay powered. Where should it be plugged in?

  1. AInto an extension cord from the corridor
  2. BInto a red outlet connected to the emergency generator
  3. CInto the outlet that is closest to the bed, whatever its color
  4. DInto any white outlet in the room
5.Prioritization & delegationMedium

Which patient is at the highest risk of falling?

  1. AA 30-year-old after an appendectomy who walks with steady steps
  2. BAn 84-year-old taking a diuretic who has fallen before and gets up at night
  3. CA 60-year-old admitted for chest pain that has since been ruled out by tests
  4. DA 45-year-old with asthma who is alert and independent
6.Prioritization & delegationHard

A marathon runner is confused, with a temperature of 41 °C and hot skin. What is the priority?

  1. AWrapping the runner in a blanket to prevent shivering
  2. BGiving an antipyretic tablet and waiting for it to work
  3. CRapid cooling while supporting airway and circulation
  4. DAsking the runner to rest in the shade and drink slowly
7.Clinical nursingMedium

In suspected sepsis, what should ideally be collected before the first dose of antibiotics, as long as it does not delay treatment?

  1. AA stool sample for occult blood
  2. BBlood cultures
  3. CA 24-hour urine collection
  4. DA fasting cholesterol level
8.Clinical nursingHard

A patient is taught to self-inject low-molecular-weight heparin. Which statement shows a need for further teaching?

  1. A"I will rub the area firmly after the injection."
  2. B"I will inject into the fatty tissue of my abdomen."
  3. C"I will report any unusual bleeding or bruising."
  4. D"I will change the injection site each time."
9.Lab values & electrolytesMedium

A patient with suspected pulmonary TB needs sputum samples for acid-fast bacilli. Which instruction is correct?

  1. AGive several samples of nasal mucus blown into a tissue
  2. BGive one sample after brushing with mouthwash so it is clean
  3. CGive several deep-cough samples, often first thing in the morning
  4. DGive one sample of saliva collected from the mouth at any time of day
10.Lab values & electrolytesHard

A patient on warfarin with an INR of 3.6 fell and hit their head an hour ago. They now report a worsening headache and drowsiness. What is the priority?

  1. AGive acetaminophen (paracetamol) and recheck the INR tomorrow
  2. BReport urgently for imaging and possible reversal
  3. CHold warfarin for one dose and observe at home
  4. DEncourage rest in a dark room to settle the pain
11.PharmacologyMedium

How does sucralfate help a peptic ulcer heal?

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

A patient who has had several courses of bleomycin develops a dry cough and worsening breathlessness. What should the nurse suspect?

  1. AAsthma caused by anxiety
  2. BA normal effect that will pass in a day
  3. CPulmonary fibrosis from bleomycin
  4. DHeart failure from bleomycin
13.Med-surg: cardiovascular & respiratoryMedium

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

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

A 74-year-old man with a known abdominal aortic aneurysm suddenly has severe back and abdominal pain. His heart rate is 128/min and BP 82/50 mmHg. What is the priority?

  1. AEncourage him to walk to ease the back pain
  2. BGive oral analgesia and reassess the pain in an hour
  3. CArrange a routine outpatient ultrasound scan of the aneurysm
  4. DCall for emergency help and prepare for urgent vascular surgery
15.Med-surg: neuro, endocrine & renalMedium

Why should antiepileptic drugs not be stopped suddenly?

  1. ASudden withdrawal can trigger seizures, including status epilepticus
  2. BThe drugs build up in the body and become toxic after stopping
  3. CStopping them suddenly causes permanent damage to the liver and kidneys
  4. DStopping them suddenly causes a dangerous rise in blood pressure
16.Med-surg: neuro, endocrine & renalHard

A patient with SIADH needs IV fluid. Which fluid is most likely to worsen the hyponatraemia?

  1. A3% saline
  2. B5% glucose (dextrose, D5W)
  3. C8.4% sodium bicarbonate
  4. D20% human albumin
17.Med-surg: GI, perioperative & oncologyMedium

Which statement about moist wound healing is correct?

  1. AA wet wound bed always prevents infection
  2. BA moist, not wet, wound bed helps cells move and heal faster
  3. CWounds heal fastest when left to dry out and form a scab
  4. DWounds should be soaked in water for hours every day
18.Med-surg: GI, perioperative & oncologyHard

A patient with a toe ulcer says the leg pain is worse at night and eases when they hang the leg over the side of the bed. What does this suggest?

  1. AArterial insufficiency
  2. BNeuropathic itching
  3. CVenous insufficiency
  4. DLymphoedema
19.Maternity & obstetric nursingMedium

A woman with hyperemesis gravidarum has been vomiting for weeks. Which vitamin is given before glucose-containing fluids to prevent Wernicke encephalopathy?

  1. APhytomenadione (vitamin K)
  2. BThiamine (vitamin B1)
  3. CVitamin D
  4. DAscorbic acid (vitamin C)
20.Maternity & obstetric nursingHard

A woman with an epidural in labour now has a temperature of 38.0 °C (100.4 °F). Which statement is most accurate?

  1. AFever in labour can be ignored if the baby is moving
  2. BFever with an epidural always means the catheter is infected
  3. CThe epidural may cause it, but infection must be ruled out
  4. DFever with an epidural is always caused by the epidural
21.Pediatric nursingMedium

Using the 100–50–20 rule, what is the daily maintenance fluid requirement for a 15 kg child?

  1. A750 mL per day
  2. B1000 mL per day
  3. C1250 mL per day
  4. D1500 mL per day
22.Pediatric nursingHard

A 4-year-old says it is wrong to hit his sister "because then I get a time-out". Which level of Kohlberg's moral development does this reflect?

  1. APostconventional level
  2. BConventional level
  3. CFormal operational level
  4. DPreconventional level
23.Mental health nursingMedium

How does repetitive transcranial magnetic stimulation (rTMS) differ from ECT?

  1. AIt is given as a daily tablet that contains tiny magnetic particles
  2. BIt involves surgically implanting electrodes deep in the brain under anaesthetic
  3. CIt needs a general anaesthetic and causes a seizure, like ECT
  4. DIt uses magnetic pulses on the scalp while the patient is awake, without causing a seizure
24.Mental health nursingHard

A patient in a manic episode starts taking off her clothes in the busy day room. What is the most appropriate action?

  1. AAsk the other patients to ignore her and carry on
  2. BCalmly cover her and guide her to her room or a quiet area
  3. CCall security to remove her from the ward
  4. DTell her loudly in front of everyone that she must stop
25.Nursing math & unit conversionsMedium
1234567891011121:00 PM?13:0012:0014:0001:00

Practice exercise (made-up values, not clinical guidance). A dose is charted at 1:00 PM. Which entry is the same time on the 24-hour clock? Click it.

1:00 PM
  1. 113:00
  2. 212:00
  3. 314:00
  4. 401:00
26.Nursing math & unit conversionsHard
50 µmol/L? mg/dL1 mg/dL = 88.4 µmol/L

Practice exercise (made-up values, not clinical guidance). A serum creatinine result is 50 µmol/L. Using 1 mg/dL = 88.4 µmol/L for creatinine, find c in mg/dL. Round to two decimal places.

50 µmol/L1 mg/dL = 88.4 µmol/L
c = mg/dL
27.Dosage calculationsMedium
024681010 mL

A child weighing 8 kg is prescribed 3 mg/kg of a drug. The stock solution contains 10 mg/mL. Draw up the dose: what volume V do you give?

8 kg3 mg/kg10 mg/mL
V = mL
28.Dosage calculationsHard
100 mg/5 mLV = ? mL

A child weighing 28 kg is prescribed 12.5 mg/kg per dose of an oral suspension that contains 100 mg in 5 mL. What volume V do you give?

28 kg12.5 mg/kg100 mg/5 mL
V = mL
29.IV infusion ratesMedium
10 gtt/mL150 mL/h? gtt/min

An infusion is ordered at 150 mL/h, but no pump is available. It runs by gravity through a giving set of 10 gtt/mL. Find the drip rate R in drops per minute.

150 mL/h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
1110 mLleft? mL/h5 h left

1500 mL was ordered over 8 hours. After 3 hours you find that 1110 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?

1500 mL / 8 hafter 3 h: 1110 mL
Δ = %
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shifttea200 mLwater300 mLjuice100 mLIV infusion100 mL/h × 8 hIV antibiotic2 × 50 mLurine225 mLurine325 mLurine350 mLurine250 mLwound drain140 mLvomit250 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL.

tea: 200 mLwater: 300 mLjuice: 100 mLIV infusion: 100 mL/h × 8 hIV antibiotic: 2 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
1000 mL50 mL/hstart 10:1513:45: ? mL

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 10:15 and runs by pump at 50 mL/h. How many mL V are left in the bag at 13:45?

1000 mL50 mL/h10:15 → 13:45
V = mL
33.Clinical assessment scoresMedium
7649SBPDBPmmHgHR 121/min · SI = ?

Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 121/min and a blood pressure of 76/49 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.

HR 121/minBP 76/49 mmHg
SI =
34.Clinical assessment scoresHard
low riskmoderate riskhigh risk

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: no; gait: normal, bed rest or wheelchair; mental status: overestimates or forgets limits. Using the cut-offs 0–24 low, 25–44 moderate and 45 or more high, click the fall-risk level.

  1. 1low risk
  2. 2moderate risk
  3. 3high risk

3Solutions

1.Nursing fundamentals

Answer: C · Paraphrasing what the patient said to check understanding

Why this is the answer

Active listening includes attention, appropriate eye contact, nodding, reflecting and paraphrasing. It helps patients feel heard and gives the nurse accurate information.

Answer

C · Paraphrasing what the patient said to check understanding
2.Nursing fundamentals

Answer: C · It interacts with many medicines and can reduce their effect

Why this is the answer

St John's wort induces liver enzymes and can lower levels of drugs such as warfarin and the contraceptive pill. All herbal and over-the-counter products are recorded and reviewed.

Answer

C · It interacts with many medicines and can reduce their effect
3.Infection control & patient safety

Answer: D · It can be misread as QID or QOD, so the drug is given too often or too rarely

Why this is the answer

“QD” and “QOD” can be confused with each other and with “QID”, leading to serious dosing errors. The word “daily” or “every other day” is written in full instead.

Answer

D · It can be misread as QID or QOD, so the drug is given too often or too rarely
4.Infection control & patient safety

Answer: B · Into a red outlet connected to the emergency generator

Why this is the answer

In US hospitals, red outlets are usually connected to the emergency generator. Life-support equipment is plugged into them, and battery backups are checked as part of emergency planning.

Answer

B · Into a red outlet connected to the emergency generator
5.Prioritization & delegation

Answer: B · An 84-year-old taking a diuretic who has fallen before and gets up at night

Why this is the answer

A previous fall is one of the strongest risk factors. Older age, diuretics and getting up at night to urinate add further risk, so this patient needs fall precautions.

Answer

B · An 84-year-old taking a diuretic who has fallen before and gets up at night
6.Prioritization & delegation

Answer: C · Rapid cooling while supporting airway and circulation

Why this is the answer

Heat stroke is an emergency in which body temperature rises and the brain is affected. Rapid cooling, for example with cold water or ice, is the priority; antipyretics do not work for heat stroke.

Answer

C · Rapid cooling while supporting airway and circulation
7.Clinical nursing

Answer: B · Blood cultures

Why this is the answer

Blood cultures taken before antibiotics are more likely to grow the organism, which allows targeted treatment later. Antibiotics should still be given promptly and must not be delayed.

Answer

B · Blood cultures
8.Clinical nursing

Answer: A · "I will rub the area firmly after the injection."

Why this is the answer

Rubbing the site after an anticoagulant injection increases bruising and is avoided. Rotating sites, injecting subcutaneously and reporting bleeding are correct.

Answer

A · "I will rub the area firmly after the injection."
9.Lab values & electrolytes

Answer: C · Give several deep-cough samples, often first thing in the morning

Why this is the answer

Usually a series of three sputum samples is collected, at least one in the early morning, when secretions have pooled overnight. The patient rinses with water (not mouthwash), takes deep breaths and coughs deeply to bring up sputum, not saliva. Airborne precautions are used.

Answer

C · Give several deep-cough samples, often first thing in the morning
10.Lab values & electrolytes

Answer: B · Report urgently for imaging and possible reversal

Why this is the answer

A head injury in an anticoagulated patient, with worsening headache and drowsiness, suggests intracranial bleeding. The provider is told at once, neurological checks are done often, urgent imaging is arranged, and warfarin reversal (vitamin K and a prothrombin complex concentrate) may be prescribed.

Answer

B · Report urgently for imaging and possible reversal
11.Pharmacology

Answer: D · It forms a protective coating over the ulcer base

Why this is the answer

Sucralfate forms a gel-like barrier that sticks to the ulcer and protects it from acid and pepsin. It is taken on an empty stomach and can reduce the absorption of other drugs taken at the same time.

Answer

D · It forms a protective coating over the ulcer base
12.Pharmacology

Answer: C · Pulmonary fibrosis from bleomycin

Why this is the answer

Bleomycin can cause pneumonitis and pulmonary fibrosis, especially at higher cumulative doses. New respiratory symptoms are reported, and lung function may be monitored.

Answer

C · Pulmonary fibrosis from bleomycin
13.Med-surg: cardiovascular & respiratory

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

Why this is the answer

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

Answer

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

Answer: D · Call for emergency help and prepare for urgent vascular surgery

Why this is the answer

Sudden abdominal or back pain with hypotension in a patient with an AAA suggests rupture, which is often fatal without urgent repair. The team is called at once, large-bore IV access and blood are arranged, and the patient goes to theatre. Fluid may be limited so the blood pressure is not pushed high (permissive hypotension), as directed by the team.

Answer

D · Call for emergency help and prepare for urgent vascular surgery
15.Med-surg: neuro, endocrine & renal

Answer: A · Sudden withdrawal can trigger seizures, including status epilepticus

Why this is the answer

Stopping antiepileptics abruptly can cause rebound seizures, which may be prolonged. Changes are made gradually under medical supervision, and missed doses should be avoided.

Answer

A · Sudden withdrawal can trigger seizures, including status epilepticus
16.Med-surg: neuro, endocrine & renal

Answer: B · 5% glucose (dextrose, D5W)

Why this is the answer

5% glucose (5% dextrose, D5W) provides free water once the glucose is metabolised. In SIADH, this water is kept, so sodium falls further. Hypotonic fluids are avoided. Hypertonic saline is used for severe symptomatic hyponatraemia.

Answer

B · 5% glucose (dextrose, D5W)
17.Med-surg: GI, perioperative & oncology

Answer: B · A moist, not wet, wound bed helps cells move and heal faster

Why this is the answer

A moist environment supports cell migration, autolytic debridement and less pain. Too much moisture causes maceration, so dressings are chosen to balance exudate.

Answer

B · A moist, not wet, wound bed helps cells move and heal faster
18.Med-surg: GI, perioperative & oncology

Answer: A · Arterial insufficiency

Why this is the answer

Rest pain eased by dependency is typical of severe peripheral arterial disease. Elevating the leg worsens pain, and compression is avoided. Vascular assessment is needed.

Answer

A · Arterial insufficiency
19.Maternity & obstetric nursing

Answer: B · Thiamine (vitamin B1)

Why this is the answer

Prolonged vomiting depletes thiamine. Giving glucose without thiamine can trigger Wernicke encephalopathy, with confusion, ataxia and eye movement problems.

Answer

B · Thiamine (vitamin B1)
20.Maternity & obstetric nursing

Answer: C · The epidural may cause it, but infection must be ruled out

Why this is the answer

Epidurals are associated with a rise in maternal temperature, but this cannot be assumed. Intra-amniotic infection must be considered, especially with prolonged rupture of membranes or fetal tachycardia.

Answer

C · The epidural may cause it, but infection must be ruled out
21.Pediatric nursing

Answer: C · 1250 mL per day

Why this is the answer

First 10 kg: 10 × 100 = 1000 mL. Next 5 kg: 5 × 50 = 250 mL. Total = 1250 mL per day, or about 52 mL per hour.

Answer

C · 1250 mL per day
22.Pediatric nursing

Answer: D · Preconventional level

Why this is the answer

At the preconventional level, typical of young children, right and wrong are judged by punishment and reward. Formal operational is one of Piaget's cognitive stages, not a Kohlberg level.

Answer

D · Preconventional level
23.Mental health nursing

Answer: D · It uses magnetic pulses on the scalp while the patient is awake, without causing a seizure

Why this is the answer

rTMS stimulates specific brain areas with a magnetic coil held on the head. It does not need anaesthesia or cause a seizure and is used for depression that has not responded to medicines.

Answer

D · It uses magnetic pulses on the scalp while the patient is awake, without causing a seizure
24.Mental health nursing

Answer: B · Calmly cover her and guide her to her room or a quiet area

Why this is the answer

Disinhibition in mania can lead to embarrassment and exploitation. The nurse protects her privacy and dignity quietly and moves her to a less stimulating environment.

Answer

B · Calmly cover her and guide her to her room or a quiet area
25.Nursing math & unit conversions

Answer: 13:00

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 PM → 1 + 12 = 13

Answer

13:00

Answer

13:00
26.Nursing math & unit conversions

Answer: c = 0.57 mg/dL

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.

Convert

c = 50/88.4 = 0.5656 ≈ 0.57 mg/dL

Answer

c = 0.57 mg/dL
27.Dosage calculations

Answer: V = 2.4 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 = 3·8 = 24 mg

Volume

V = 24/10 = 2.4 mL

On the syringe

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

Answer

V = 2.4 mL
28.Dosage calculations

Answer: V = 17.5 mL

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.

Dose from weight

12.5·28 = 350 mg

Volume

V = (350/100)·5 = 17.5 mL

Answer

V = 17.5 mL
29.IV infusion rates

Answer: R = 25 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.

Millilitres per minute

150/60 = 2.5 mL/min

Drip rate

R = 2.5·10 = 25 gtt/min

Answer

R = 25 gtt/min
30.IV infusion rates

Answer: Δ = 18.4 %

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.

Original rate

1500/8 = 187.5 mL/h

New rate

R = 1110/5 = 222 mL/h

Percentage change

Δ = (222 − 187.5)/187.5·100% = 18.4%

Answer

Δ = 18.4%

Many hospitals allow such an adjustment up to 25% without a new order; check local policy.

31.IV fluids & fluid balance

Answer: I = 1500 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: 200 + 300 + 100 = 600 mL
IV infusion: 100·8 = 800 mL
IV antibiotic: 2·50 = 100 mL
I = 1500 mL

Answer

I = 1500 mL
32.IV fluids & fluid balance

Answer: V = 825 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

10:15 → 13:45 = 3.5 h

Volume infused

50·3.5 = 175 mL

Volume left

V = 1000 − 175 = 825 mL

Answer

V = 825 mL
33.Clinical assessment scores

Answer: SI = 1.59

Blood pressure values: pulse pressure PP = SBP − DBP. Mean arterial pressure MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3, an estimate based on the heart spending about two thirds of each beat in diastole at a normal heart rate (less accurate when the heart rate is fast); a MAP of at least about 65 mmHg is a common target for organ perfusion. The shock index SI = heart rate/SBP is normally about 0.5–0.7; a value above about 1 is a warning sign of shock.

Shock index

SI = 121/76 = 1.592 ≈ 1.59

Answer

SI = 1.59

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

34.Clinical assessment scores

Answer: low risk

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: no → 0
gait: normal, bed rest or wheelchair → 0
mental status: overestimates or forgets limits → 15

Add

Morse total = 0 + 0 + 0 + 0 + 0 + 15 = 15

Risk level

15 → low risk

Answer

low risk

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