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

A patient is getting up for the first time after several days in bed. What should the nurse do first?

  1. AHelp the patient stand up quickly, so that the dizziness has less time to start
  2. BHave the patient sit on the edge of the bed for a short time before standing
  3. CAsk the patient to walk to the bathroom alone
  4. DGive the patient a large drink of water while standing
2.Nursing fundamentalsHard

A patient has a generalised tonic-clonic seizure in bed. What should the nurse do?

  1. AGive a drink of water as soon as the jerking starts
  2. BProtect the head, move objects away, time it and do not restrain
  3. CHold the arms and legs firmly so that the jerking movements stop more quickly
  4. DPut a spoon between the teeth to stop tongue biting
3.Infection control & patient safetyMedium

A small fire starts in a waste bin in a patient’s room while the patient is in bed. What does the nurse do first?

  1. ARemove the patient from immediate danger
  2. BGo and look for the nearest fire extinguisher
  3. CPhone the manager to report the fire
  4. DOpen the windows to clear the smoke
4.Infection control & patient safetyHard

An IV bag from the pharmacy holds the correct drug, but the label shows another patient’s name. What should the nurse do?

  1. ACross out the name and write in the correct patient’s name
  2. BAsk the patient whether it is fine to use the bag
  3. CHang it, because the drug and dose are correct
  4. DNot hang it, and get a correctly labeled bag from the pharmacy
5.Prioritization & delegationMedium

A patient has heart failure. Which instruction about daily weights is best to give the nursing assistant?

  1. A“Weigh him at any time today, on whichever scale is free.”
  2. B“Weigh him after lunch, fully dressed, with his shoes on.”
  3. C“Only weigh him if his ankles look more swollen than they did yesterday afternoon.”
  4. D“Weigh him each morning before breakfast, on the same scale, and tell me the result.”
6.Prioritization & delegationHard

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

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

Which is a major risk factor for Clostridioides difficile infection?

  1. AA diet high in fibre and fresh fruit
  2. BRecent broad-spectrum antibiotic use
  3. CRegular exercise
  4. DTaking regular paracetamol
8.Clinical nursingHard

A patient on an unfractionated heparin infusion is also started on warfarin. Which tests are used to monitor each drug?

  1. APlatelet count for both drugs
  2. BINR for heparin and APTT for warfarin
  3. CAPTT for heparin and INR for warfarin
  4. DD-dimer for both drugs
9.Lab values & electrolytesMedium

A 55-year-old has a positive fecal immunochemical test (FIT) during routine screening. What is the usual next step?

  1. ANo action if there are no symptoms
  2. BReferral for colonoscopy
  3. CStart an iron supplement only
  4. DRepeat the test in 10 years
10.Lab values & electrolytesHard

A patient with schizophrenia drinks very large amounts of water each day. Sodium is 121 mEq/L, and the urine is very dilute (urine osmolality 70 mOsm/kg). Which explanation fits best?

  1. ASyndrome of inappropriate ADH
  2. BPrimary (psychogenic) polydipsia
  3. CHyperosmolar hyperglycemic state
  4. DCentral diabetes insipidus
11.PharmacologyMedium

Which early signs suggest systemic toxicity from a local anaesthetic?

  1. APinpoint pupils and slow, shallow breathing
  2. BNumbness around the mouth, metallic taste and tinnitus
  3. CHeavy sweating, salivation and diarrhoea
  4. DItchy rash and swelling only at the injection site
12.PharmacologyHard

Which statement correctly contrasts donepezil and memantine in Alzheimer's disease?

  1. ABoth drugs are dopamine agonists that differ only in their half-lives
  2. BDonepezil inhibits cholinesterase; memantine blocks NMDA receptors
  3. CBoth drugs remove amyloid plaques from the brain
  4. DDonepezil blocks NMDA receptors; memantine inhibits acetylcholinesterase
13.Med-surg: cardiovascular & respiratoryMedium

A young patient with hypertrophic cardiomyopathy asks why they are told to avoid dehydration. What is the best explanation?

  1. ALow blood volume can worsen obstruction of blood leaving the heart
  2. BFluids dissolve the extra muscle in the heart wall
  3. CDehydration makes the heart muscle grow thicker within a few hours
  4. DDehydration is the cause of the inherited condition
14.Med-surg: cardiovascular & respiratoryHard

After a faulty gas heater was found at home, a patient has headache, nausea and confusion. SpO₂ is 99% on air. What is the priority treatment?

  1. AReassurance, because the oxygen saturation is normal
  2. BParacetamol (acetaminophen) and observation only
  3. COxygen at 1 L/min via nasal cannula
  4. DHigh-concentration oxygen via a non-rebreather mask
15.Med-surg: neuro, endocrine & renalMedium

A patient takes levodopa for Parkinson's disease. Which teaching point is correct?

  1. ALarge high-protein meals can reduce how well the drug works
  2. BThe drug cures the disease if taken for a full year
  3. CThe tablets work best taken with a large steak dinner
  4. DStop the drug for a day each week to avoid tolerance
16.Med-surg: neuro, endocrine & renalHard

The nurse has four urology patients. Which one needs to be seen first?

  1. AA patient with a suprapubic catheter due for a routine change
  2. BA patient after TURP with light pink drainage and mild discomfort
  3. CA patient with stress incontinence asking about pelvic floor exercises
  4. DA patient with a nephrostomy who has rigors and a BP of 86/50 mmHg
17.Med-surg: GI, perioperative & oncologyMedium

Which advice helps a patient with haemorrhoids?

  1. AEat less fibre so that stools are smaller
  2. BTake a codeine-based painkiller every day
  3. CEat more fibre, drink enough fluid and avoid straining
  4. DSit on the toilet for long periods to empty fully
18.Med-surg: GI, perioperative & oncologyHard

On the day after a Hartmann's procedure, the end colostomy is dark purple to black. What should the nurse do?

  1. AReport it urgently, as the stoma may be necrotic
  2. BRecord it as normal postoperative bruising and recheck it next week
  3. CRub the stoma to improve its colour
  4. DCut a smaller hole in the pouch
19.Maternity & obstetric nursingMedium

Low-dose aspirin may be prescribed from early pregnancy to a woman with a high risk of:

  1. APre-eclampsia
  2. BGestational diabetes
  3. CHyperemesis gravidarum
  4. DPlacenta praevia
20.Maternity & obstetric nursingHard

A newborn is pale, has a heart rate of 170/min and weak pulses after a difficult vacuum birth. The scalp is boggy and swelling across the sutures is increasing. What should the nurse suspect?

  1. ANormal moulding
  2. BCaput succedaneum
  3. CSubgaleal haemorrhage
  4. DSimple cephalhaematoma
21.Pediatric nursingMedium

Which finding is an early sign of shock in a child?

  1. AA fast heart rate with a prolonged capillary refill
  2. BSlow, deep breathing with a normal heart rate
  3. CLow blood pressure with a slow heart rate and pauses in breathing
  4. DA warm, flushed child with a strong, bounding pulse
22.Pediatric nursingHard

An 8-year-old tells the nurse that her uncle touches her in a way she does not like and asks the nurse to keep it secret. What is the best response?

  1. APromise to keep the secret, so that she keeps trusting the nurse and tells more later
  2. BPhone the uncle straight away to ask for his side of the story before reporting anything
  3. CListen calmly, praise her for telling, explain it must be shared, and follow safeguarding
  4. DAsk detailed, leading questions to find out exactly what happened
23.Mental health nursingMedium

Which monitoring is especially important for patients on second-generation antipsychotics such as olanzapine?

  1. AHearing and eyesight only, as these are most affected by the drug
  2. BWeight, waist circumference, blood glucose and lipids
  3. CBone density only
  4. DPlatelet count only
24.Mental health nursingHard

Immediately after an ECT treatment, a patient is drowsy in the recovery area. What is the nursing priority?

  1. AGive a large breakfast straight away
  2. BTest the patient's long-term memory in detail to check for any lasting damage
  3. CAsk the patient to walk back to the ward alone
  4. DMaintain the airway, place the patient on the side and monitor vital signs
25.Nursing math & unit conversionsMedium
6 lb 14 oz? kg1 lb = 16 oz1 kg = 2.2 lb

Practice exercise (made-up values, not clinical guidance). A newborn weighs 6 lb 14 oz. Using 1 lb = 16 oz and 1 kg = 2.2 lb, find the weight m in kilograms. Round to two decimal places.

6 lb 14 oz1 lb = 16 oz1 kg = 2.2 lb
m = kg
26.Nursing math & unit conversionsHard
156 g/L? g/dL1 L = 10 dL

Practice exercise (made-up values, not clinical guidance). A haemoglobin result is 156 g/L. Express it in g/dL Hb.

156 g/L1 L = 10 dL
Hb = g/dL
27.Dosage calculationsMedium
1:10 000ampouleV = ? mL

A prefilled syringe of epinephrine (adrenaline) is labelled 1:10 000 (0.1 mg/mL). The prescription is 1 mg IV in cardiac arrest. What volume V do you give?

1:10 0001 mg
V = mL
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 5800 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?

5800 units10000 units/mL
V = mL
29.IV infusion ratesMedium
250 mL10 gtt/mL2 h? gtt/min

Infuse 250 mL over 2 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

250 mL2 h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
400 mg500 mL10 mL/h? mcg/min

An infusion of 400 mg in 500 mL runs at 10 mL/h. How many micrograms per minute D does the patient receive?

400 mg/500 mL10 mL/h
D = mcg/min
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftwater300 mLjuice120 mLice chips200 mLIV infusion100 mL/h × 8 hIV antibiotic1 × 50 mLurine300 mLurine325 mLurine450 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 patient weighs 70 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

70 kg8 hurine: 300 mLurine: 325 mLurine: 450 mLvomit: 250 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
500 mL50 mL/hstart 06:1514:15: ? mL

Practice exercise (made-up values, not clinical guidance). A 500 mL bag was started at 06:15 and runs by pump at 50 mL/h. How many mL V are left in the bag at 14:15?

500 mL50 mL/h06:15 → 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: holds on to furniture; IV therapy or saline lock: no; gait: impaired; mental status: overestimates or forgets 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 51 kg and is 184 cm tall. Calculate the BMI and click the WHO weight category.

51 kg184 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: B · Have the patient sit on the edge of the bed for a short time before standing

Why this is the answer

After bed rest blood pressure may drop on standing. Sitting on the edge of the bed first, with the feet on the floor, lets the body adjust and lowers the risk of fainting and falls.

Answer

B · Have the patient sit on the edge of the bed for a short time before standing
2.Nursing fundamentals

Answer: B · Protect the head, move objects away, time it and do not restrain

Why this is the answer

During a seizure the nurse keeps the patient safe, notes the time and the features, and never puts anything in the mouth. Afterwards the patient is placed in the recovery position and the airway checked.

Answer

B · Protect the head, move objects away, time it and do not restrain
3.Infection control & patient safety

Answer: A · Remove the patient from immediate danger

Why this is the answer

Rescue comes first: move the patient away from the fire. Then raise the alarm, contain the fire by closing doors, and extinguish it if safe. Opening windows feeds the fire with oxygen.

Answer

A · Remove the patient from immediate danger
4.Infection control & patient safety

Answer: D · Not hang it, and get a correctly labeled bag from the pharmacy

Why this is the answer

A label with another patient’s name means the bag may be meant for someone else or may differ in other ways. The nurse does not use it, returns it and reports the issue so the error can be investigated.

Answer

D · Not hang it, and get a correctly labeled bag from the pharmacy
5.Prioritization & delegation

Answer: D · “Weigh him each morning before breakfast, on the same scale, and tell me the result.”

Why this is the answer

Daily weights are measured at the same time, on the same scale and in similar clothing so that changes show real fluid gain. A quick rise in weight can be an early sign of worsening heart failure.

Answer

D · “Weigh him each morning before breakfast, on the same scale, and tell me the result.”
6.Prioritization & delegation

Answer: B · 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

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

Answer: B · Recent broad-spectrum antibiotic use

Why this is the answer

Broad-spectrum antibiotics disrupt normal gut flora, letting C. difficile overgrow. Older age, hospital stay and proton pump inhibitors also increase the risk.

Answer

B · Recent broad-spectrum antibiotic use
8.Clinical nursing

Answer: C · APTT for heparin and INR for warfarin

Why this is the answer

The APTT reflects the intrinsic pathway and is used to adjust heparin infusions. Warfarin is monitored by the INR, a standardised prothrombin time. Platelets are also checked on heparin to detect HIT.

Answer

C · APTT for heparin and INR for warfarin
9.Lab values & electrolytes

Answer: B · Referral for colonoscopy

Why this is the answer

A positive FIT means hidden blood in the stool, which may come from a polyp, cancer or other lesion, so a colonoscopy is needed to find the source. A positive screening test is never ignored, even without symptoms.Checked against: Fecal Occult Blood Test (FOBT) · MedlinePlus (NIH) (2024)

Answer

B · Referral for colonoscopy
10.Lab values & electrolytes

Answer: B · Primary (psychogenic) polydipsia

Why this is the answer

In primary polydipsia, ADH is appropriately suppressed, so the kidneys make very dilute urine, but the intake exceeds what they can excrete. In SIADH the urine is inappropriately concentrated. Fluid restriction and close sodium monitoring are needed.Checked against: Osmolality urine test · MedlinePlus (NIH) (2025); Syndrome of inappropriate antidiuretic hormone secretion · MedlinePlus (NIH) (2025)

Answer

B · Primary (psychogenic) polydipsia
11.Pharmacology

Answer: B · Numbness around the mouth, metallic taste and tinnitus

Why this is the answer

Local anaesthetic toxicity starts with central nervous system signs such as perioral numbness, metallic taste, tinnitus and agitation. It can progress to seizures, arrhythmias and cardiac arrest.

Answer

B · Numbness around the mouth, metallic taste and tinnitus
12.Pharmacology

Answer: B · Donepezil inhibits cholinesterase; memantine blocks NMDA receptors

Why this is the answer

Donepezil raises acetylcholine levels, while memantine reduces excitotoxic glutamate activity at NMDA receptors. Both give symptomatic benefit only.

Answer

B · Donepezil inhibits cholinesterase; memantine blocks NMDA receptors
13.Med-surg: cardiovascular & respiratory

Answer: A · Low blood volume can worsen obstruction of blood leaving the heart

Why this is the answer

In hypertrophic cardiomyopathy, a thickened septum can obstruct the left ventricular outflow tract, and the obstruction worsens when the ventricle is underfilled. Dehydration, vasodilators and strenuous exertion can trigger symptoms or arrhythmias. It is a cause of sudden cardiac death in young people.

Answer

A · Low blood volume can worsen obstruction of blood leaving the heart
14.Med-surg: cardiovascular & respiratory

Answer: D · High-concentration oxygen via a non-rebreather mask

Why this is the answer

Carbon monoxide binds haemoglobin far more strongly than oxygen, causing tissue hypoxia, while pulse oximetry can look normal. High-concentration oxygen speeds CO removal. Carboxyhaemoglobin is measured on a blood gas, and others in the home may also be at risk.

Answer

D · High-concentration oxygen via a non-rebreather mask
15.Med-surg: neuro, endocrine & renal

Answer: A · Large high-protein meals can reduce how well the drug works

Why this is the answer

Protein-rich meals can compete with levodopa for absorption and entry into the brain, which reduces its effect. Patients are often advised to take doses at consistent times relative to meals. Levodopa controls symptoms but does not stop the disease.

Answer

A · Large high-protein meals can reduce how well the drug works
16.Med-surg: neuro, endocrine & renal

Answer: D · A patient with a nephrostomy who has rigors and a BP of 86/50 mmHg

Why this is the answer

Rigors and hypotension in a patient with a nephrostomy suggest urosepsis, which needs immediate assessment and treatment. Light pink drainage after TURP is expected. The other patients are stable.

Answer

D · A patient with a nephrostomy who has rigors and a BP of 86/50 mmHg
17.Med-surg: GI, perioperative & oncology

Answer: C · Eat more fibre, drink enough fluid and avoid straining

Why this is the answer

Soft stools reduce straining and pressure on the anal cushions. Long sitting on the toilet and constipating drugs such as codeine should be avoided.

Answer

C · Eat more fibre, drink enough fluid and avoid straining
18.Med-surg: GI, perioperative & oncology

Answer: A · Report it urgently, as the stoma may be necrotic

Why this is the answer

A dark or black stoma suggests poor blood supply and necrosis, which can extend below the skin. The surgical team must assess it urgently, as further surgery may be needed.

Answer

A · Report it urgently, as the stoma may be necrotic
19.Maternity & obstetric nursing

Answer: A · Pre-eclampsia

Why this is the answer

Low-dose aspirin started around 12 weeks reduces the risk of pre-eclampsia in women at high risk, such as those with previous pre-eclampsia, chronic hypertension or kidney disease.

Answer

A · Pre-eclampsia
20.Maternity & obstetric nursing

Answer: C · Subgaleal haemorrhage

Why this is the answer

A subgaleal haemorrhage is bleeding under the scalp aponeurosis. It crosses suture lines, can grow rapidly and can cause hypovolaemic shock. It is an emergency, unlike caput or cephalhaematoma.

Answer

C · Subgaleal haemorrhage
21.Pediatric nursing

Answer: A · A fast heart rate with a prolonged capillary refill

Why this is the answer

Children maintain their blood pressure until late in shock. Early signs include tachycardia, prolonged capillary refill, cool peripheries, reduced urine output and changes in behaviour.

Answer

A · A fast heart rate with a prolonged capillary refill
22.Pediatric nursing

Answer: C · Listen calmly, praise her for telling, explain it must be shared, and follow safeguarding

Why this is the answer

The nurse listens without showing shock, reassures the child, avoids leading questions, records her words accurately and explains that people who can help need to know. The concern is reported at once through the safeguarding procedure.

Answer

C · Listen calmly, praise her for telling, explain it must be shared, and follow safeguarding
23.Mental health nursing

Answer: B · Weight, waist circumference, blood glucose and lipids

Why this is the answer

Many second-generation antipsychotics cause weight gain, insulin resistance and dyslipidaemia. Metabolic monitoring is done at baseline and regularly during treatment.

Answer

B · Weight, waist circumference, blood glucose and lipids
24.Mental health nursing

Answer: D · Maintain the airway, place the patient on the side and monitor vital signs

Why this is the answer

After ECT, the priority is airway and breathing until the patient is fully awake, with monitoring of vital signs and orientation. Food and walking come after the patient is alert and swallowing safely.

Answer

D · Maintain the airway, place the patient on the side and monitor vital signs
25.Nursing math & unit conversions

Answer: m = 3.13 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

14 oz/16 = 0.875 lb
6 + 0.875 = 6.875 lb

Pounds to kilograms

m = 6.875/2.2 = 3.125 ≈ 3.13 kg

Answer

m = 3.13 kg
26.Nursing math & unit conversions

Answer: Hb = 15.6 g/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

Hb = 156 g/L × (1 L/10 dL) = 15.6 g/dL

Answer

Hb = 15.6 g/dL
27.Dosage calculations

Answer: V = 10 mL

Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.

Concentration

1:10 000 = 1 g/10000 mL = 0.1 mg/mL

Volume

V = 1/0.1 = 10 mL

Answer

V = 10 mL

US labels now state mg/mL (1 mg/mL = 1:1000; 0.1 mg/mL = 1:10 000). Never give 1 mg/mL epinephrine IV push.

28.Dosage calculations

Answer: V = 0.58 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 = 5800/10000 = 0.58 mL

On the syringe

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

Answer

V = 0.58 mL
29.IV infusion rates

Answer: R = 21 gtt/min

Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.

Time in minutes

2·60 = 120 min

Drip rate

R = 250·10/120 = 20.83 ≈ 21 gtt/min

Answer

R = 21 gtt/min

At the bedside you round to the nearest whole drop: 21 gtt/min.

30.IV infusion rates

Answer: D = 133.3 mcg/min

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

Concentration

400000 mcg/500 mL = 800 mcg/mL

Dose per hour

10·800 = 8000 mcg/h

Dose per minute

D = 8000/60 = 133.3 mcg/min

Answer

D = 133.3 mcg/min
31.IV fluids & fluid balance

Answer: U = 1.92 mL/kg/h

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 urine

300 + 325 + 450 = 1075 mL

Per kilogram per hour

U = 1075/(70·8) = 1.92 mL/kg/h

Answer

U = 1.92 mL/kg/h
32.IV fluids & fluid balance

Answer: V = 100 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

06:15 → 14:15 = 8 h

Volume infused

50·8 = 400 mL

Volume left

V = 500 − 400 = 100 mL

Answer

V = 100 mL
33.Clinical assessment scores

Answer: MFS = 65

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: holds on to furniture → 30
IV therapy or saline lock: no → 0
gait: impaired → 20
mental status: overestimates or forgets limits → 15

Add

Morse total = 0 + 0 + 30 + 0 + 20 + 15 = 65

Answer

MFS = 65
34.Clinical assessment scores

Answer: underweight

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 = 51/1.84² = 15.06

Category

underweight

Answer

underweight

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