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

Why must a respirator such as an FFP3 or N95 mask be fit-tested?

  1. AFit-testing makes the mask reusable for a week
  2. BFit-testing checks whether the patient is still infectious
  3. CIt only protects if it seals closely to the wearer's face
  4. DIt must be tested to check it is the right colour
2.Nursing fundamentalsHard

During a handover the nurse notices a colleague is sharing patient details loudly in a busy corridor. What should the nurse do?

  1. AJoin in to finish the handover more quickly
  2. BSuggest moving the handover to a private place
  3. CIgnore it, as handover is part of care
  4. DReport the colleague to the police
3.Infection control & patient safetyMedium

A family member will visit a patient on contact precautions. What should the nurse do?

  1. AAsk them to wear an N95 respirator only, with no gown or gloves
  2. BTell them visits are not allowed at all
  3. CTell them precautions only apply to staff
  4. DShow them how to use the gown and gloves and how to clean their hands
4.Infection control & patient safetyHard

A handwritten order reads “10U regular insulin subcut now”. What is the nurse’s best action?

  1. AGive 100 units, as the order seems to say
  2. BGive 10 units without question, as written
  3. CAsk a nursing assistant to interpret the handwriting
  4. DClarify the order, because “U” can be misread
5.Prioritization & delegationMedium

A patient uses patient-controlled analgesia (PCA) after surgery. Which statement by a family member shows a need for further teaching?

  1. A“The pump has limits set by the nurse so she cannot get too much at once.”
  2. B“Only she should press the button when she needs pain relief.”
  3. C“I will tell the nurse if she becomes very sleepy or hard to wake.”
  4. D“I will press the button for her while she is asleep so she stays comfortable.”
6.Prioritization & delegationHard

An RN has five patients and a nursing assistant. One patient has just become short of breath. Which task should the RN delegate so that the RN can go to that patient?

  1. AMorning vital signs on the four stable patients
  2. BGiving the breathless patient’s IV furosemide
  3. CExplaining the new diagnosis to the breathless patient’s family
  4. DAssessing the breathless patient’s lung sounds
7.Clinical nursingMedium

Which blood results are typical of Addison's disease (primary adrenal insufficiency)?

  1. AHigh sodium and low potassium
  2. BHigh glucose and high calcium
  3. CLow haemoglobin and high platelets
  4. DLow sodium and high potassium
8.Clinical nursingHard

A patient with a COPD exacerbation remains acidotic with a high PaCO2 despite optimal medical treatment and controlled oxygen. Which treatment is usually considered next?

  1. A15 L/min oxygen via a non-rebreathe mask
  2. BSedation to slow the breathing
  3. CNon-invasive ventilation
  4. DStopping all oxygen therapy
9.Lab values & electrolytesMedium

A patient on warfarin for atrial fibrillation has a target INR of 2.0–3.0. How does the usual target for a patient with a mechanical mitral valve compare?

  1. AMuch higher, about 5.0–6.0
  2. BHigher, about 2.5–3.5
  3. CThe same, 2.0–3.0
  4. DLower, about 1.0–1.5
10.Lab values & electrolytesHard

A patient with advanced chronic kidney disease has a mildly raised troponin that has stayed the same on several tests over months. There is no chest pain and the ECG is unchanged. What is the best interpretation?

  1. AA laboratory error, because troponin is never raised in kidney disease
  2. BA chronic stable rise; infarction needs a rising or falling pattern
  3. CProof of an acute myocardial infarction that needs emergency treatment now
  4. DA sign of skeletal muscle injury, because troponin comes from all muscles
11.PharmacologyMedium

A patient uses a salbutamol (albuterol) inhaler and a corticosteroid inhaler at the same time of day. Which order is usually taught?

  1. AUse the salbutamol first, wait a few minutes, then use the steroid
  2. BThe order does not matter and no waiting is needed
  3. CUse the steroid first, then the salbutamol right after without any gap
  4. DUse both in the same breath to save time
12.PharmacologyHard

Before starting rituximab, patients are tested for hepatitis B. Why?

  1. ARituximab can reactivate hepatitis B and cause liver failure
  2. BRituximab is made from the hepatitis B virus
  3. CHepatitis B infection makes rituximab completely ineffective
  4. DRituximab is a vaccine against hepatitis B
13.Med-surg: cardiovascular & respiratoryMedium

A patient uses a glyceryl trinitrate (nitroglycerin) patch for angina. Why is it usually removed for several hours each day?

  1. AThe skin needs a break to absorb a larger dose
  2. BA nitrate-free interval prevents tolerance
  3. CIt lowers the risk of a high potassium level
  4. DThe patch works only during the night
14.Med-surg: cardiovascular & respiratoryHard

A 25-year-old non-smoker has wheeze and cough that come and go, worse at night and after exercise. Spirometry improves markedly after a bronchodilator. Which diagnosis is most likely?

  1. AAsthma
  2. BHeart failure
  3. CIdiopathic pulmonary fibrosis
  4. DCOPD
15.Med-surg: neuro, endocrine & renalMedium

A patient with a right-hemisphere stroke ignores food on the left side of the plate. What is this called?

  1. ADysphagia
  2. BLeft-sided neglect
  3. CExpressive aphasia
  4. DCerebellar ataxia
16.Med-surg: neuro, endocrine & renalHard

Three days after a stroke, a patient with dysphagia on a modified diet has a temperature of 38.2 °C (100.8 °F), a respiratory rate of 24/min and crackles at the right lung base. What should the nurse do?

  1. AEncourage more fluids by mouth to treat the fever
  2. BGive paracetamol (acetaminophen) and continue the modified diet as before
  3. CRecord the findings and recheck them at the next routine observation
  4. DSuspect aspiration pneumonia, stop oral intake and escalate for review
17.Med-surg: GI, perioperative & oncologyMedium

In the SBAR communication tool, what belongs under "A"?

  1. AThe patient's admission date only
  2. BA list of the patient's allergies only
  3. CThe nurse's assessment of what the problem is
  4. DThe address and phone number of the patient's next of kin
18.Med-surg: GI, perioperative & oncologyHard

A patient with known oesophageal varices is vomiting large amounts of fresh blood. Which treatments should the nurse anticipate before endoscopy?

  1. AOral NSAID for pain and a high-protein meal
  2. BAn urgent barium swallow before any drug treatment
  3. COctreotide or terlipressin, plus IV antibiotics, during resuscitation
  4. DRapid saline infusion to a high blood pressure
19.Maternity & obstetric nursingMedium

Why are pregnant women at increased risk of urinary tract infection and pyelonephritis?

  1. AProgesterone dilates the ureters and slows the flow of urine
  2. BPregnancy greatly reduces the production of urine
  3. CThe bladder empties more completely in pregnancy
  4. DThe urine becomes more acidic in pregnancy
20.Maternity & obstetric nursingHard

A preterm baby's parents are being taught about breast milk. Which statement shows they understand its special benefit for preterm babies?

  1. A"Breast milk means our baby will not need any oxygen."
  2. B"Breast milk removes the need for eye screening."
  3. C"Breast milk stops jaundice from ever developing."
  4. D"Breast milk lowers the risk of necrotising enterocolitis."
21.Pediatric nursingMedium

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

  1. A1000 mL per day
  2. B1250 mL per day
  3. C750 mL per day
  4. D1500 mL per day
22.Pediatric nursingHard

A teenager with severe anorexia nervosa starts nutritional rehabilitation. Which blood result is most important to watch in the first days?

  1. ACholesterol
  2. BBilirubin
  3. CPhosphate
  4. DAmylase
23.Mental health nursingMedium

Which behaviour is a warning sign of possible suicidal intent in a depressed patient?

  1. AAsking for help with a job application for after discharge
  2. BMaking plans for a family holiday
  3. CGiving away valued possessions and suddenly seeming calm
  4. DTalking about their favourite music
24.Mental health nursingHard

A patient tells the nurse, "You're the only one I can talk to. You're much better than the other nurses." What is the most appropriate response?

  1. A"The other nurses are not as experienced as I am, so it makes sense that you prefer talking to me."
  2. B"You shouldn't compare nurses. That's not fair to them, and it's rude."
  3. C"Thank you. I'll make sure I'm always the one assigned to you from now on."
  4. D"I'm glad our talks help. All the staff here are working with you, and it's important that you can talk to them too."
25.Nursing math & unit conversionsMedium
1234567891011125:05 AM?17:0506:0505:0504:05

Practice exercise (made-up values, not clinical guidance). A dose is charted at 5:05 AM. Which entry is the same time on the 24-hour clock? Click it.

5:05 AM
  1. 117:05
  2. 206:05
  3. 305:05
  4. 404:05
26.Nursing math & unit conversionsHard
5 mcg/kg/min? mg/h75 kg1 h = 60 min1 mg = 1000 mcg

Practice exercise (made-up values, not clinical guidance). An order reads 5 mcg/kg/min for a patient who weighs 75 kg. Express the dose rate D in mg/h. Round to two decimal places.

5 mcg/kg/min75 kg
D = mg/h
27.Dosage calculationsMedium
024681010 mL

A child weighing 32 kg is prescribed 7.5 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?

32 kg7.5 mg/kg50 mg/mL
V = mL
28.Dosage calculationsHard
10%stockV₁ = ? mL

You must prepare 1000 mL of a 2% (w/v) solution from a 10% (w/v) stock solution. What volume of stock V₁ do you need?

C₁ = 10%C₂ = 2%V₂ = 1000 mL
V₁ = mL
29.IV infusion ratesMedium
V = ?60 gtt/mL100 gtt/min8 h

A drip runs at 100 gtt/min through a set of 60 gtt/mL. How many millilitres V does the patient receive in 8 hours?

100 gtt/min60 gtt/mL8 h
V = mL
30.IV infusion ratesHard
500 mg500 mL60 gtt/mL20 mg/h? gtt/min

500 mg of a drug is diluted in 500 mL and given by gravity through a set of 60 gtt/mL. The order is 20 mg per hour. Find the drip rate R in drops per minute.

500 mg/500 mL20 mg/h60 gtt/mL
R = gtt/min
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftwater250 mLsoup180 mLjelly100 mLIV infusion125 mL/h × 12 hIV antibiotic1 × 100 mLurine375 mLurine175 mLwound drain60 mLvomit200 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The patient weighs 89 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

89 kg12 hurine: 375 mLurine: 175 mLwound drain: 60 mLvomit: 200 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
1000 mL→ 150 mL/hstart 13:30ttotal​ = ? h125 mL/h × 4 h

Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 13:30 at 125 mL/h. After 4 hours the rate is changed to 150 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.

1000 mL125 mL/h · 4 h150 mL/h
t = h
33.Clinical assessment scoresMedium
E4 / 4+V5 / 5+M? / 6GCS 15?

Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 15, with E4 and V5. What motor score M was recorded, and which response does it describe? Give the number.

GCS 15E4V5
M =
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 121 kg and is 150 cm tall. Calculate the BMI and click the WHO weight category.

121 kg150 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 · It only protects if it seals closely to the wearer's face

Why this is the answer

A respirator filters tiny airborne particles only if air passes through the filter, not around a gap. Fit-testing and a fit-check every time it is worn make sure it seals.

Answer

C · It only protects if it seals closely to the wearer's face
2.Nursing fundamentals

Answer: B · Suggest moving the handover to a private place

Why this is the answer

Information shared for care must still be protected from people who do not need it. Moving to a private area or speaking quietly at the bedside protects patient confidentiality.

Answer

B · Suggest moving the handover to a private place
3.Infection control & patient safety

Answer: D · Show them how to use the gown and gloves and how to clean their hands

Why this is the answer

Visitors are taught how to put on and remove PPE as required by the policy and how to perform hand hygiene, so they protect themselves and other patients.

Answer

D · Show them how to use the gown and gloves and how to clean their hands
4.Infection control & patient safety

Answer: D · Clarify the order, because “U” can be misread

Why this is the answer

“10U” can be read as 100 or 104 units, a potentially fatal overdose. The nurse clarifies the order and asks for “units” to be written in full. Guessing is never acceptable for insulin.

Answer

D · Clarify the order, because “U” can be misread
5.Prioritization & delegation

Answer: D · “I will press the button for her while she is asleep so she stays comfortable.”

Why this is the answer

PCA is safe because a sleepy patient cannot press the button. If someone else presses it, the patient can receive too much opioid and develop respiratory depression.

Answer

D · “I will press the button for her while she is asleep so she stays comfortable.”
6.Prioritization & delegation

Answer: A · Morning vital signs on the four stable patients

Why this is the answer

Routine vital signs on stable patients can be delegated, freeing the RN to assess and treat the unstable patient. Assessment, IV medication and explaining a new diagnosis stay with the RN.

Answer

A · Morning vital signs on the four stable patients
7.Clinical nursing

Answer: D · Low sodium and high potassium

Why this is the answer

Without aldosterone, the kidneys lose sodium and retain potassium. Patients may also have low blood pressure, low glucose and increased skin pigmentation.

Answer

D · Low sodium and high potassium
8.Clinical nursing

Answer: C · Non-invasive ventilation

Why this is the answer

In hypercapnic respiratory failure from COPD that persists despite treatment, non-invasive ventilation (bilevel positive pressure) supports ventilation and lowers PaCO2. Stopping oxygen would cause dangerous hypoxia.

Answer

C · Non-invasive ventilation
9.Lab values & electrolytes

Answer: B · Higher, about 2.5–3.5

Why this is the answer

Mechanical heart valves, especially in the mitral position, have a high risk of thrombosis, so the INR target is usually higher, about 2.5–3.5. An INR of 5 or more carries a high bleeding risk.

Answer

B · Higher, about 2.5–3.5
10.Lab values & electrolytes

Answer: B · A chronic stable rise; infarction needs a rising or falling pattern

Why this is the answer

Troponin is often chronically raised in CKD and other conditions. Acute infarction is diagnosed by a rise and/or fall in troponin together with symptoms or ECG changes, so serial results are compared with the patient's baseline.

Answer

B · A chronic stable rise; infarction needs a rising or falling pattern
11.Pharmacology

Answer: A · Use the salbutamol first, wait a few minutes, then use the steroid

Why this is the answer

The bronchodilator opens the airways so that the inhaled steroid can reach further into the lungs. A short wait between the inhalers is usually advised.

Answer

A · Use the salbutamol first, wait a few minutes, then use the steroid
12.Pharmacology

Answer: A · Rituximab can reactivate hepatitis B and cause liver failure

Why this is the answer

Rituximab destroys CD20-positive B cells, weakening control of latent hepatitis B. Reactivation can cause fulminant hepatitis, so carriers receive monitoring or antiviral prophylaxis.

Answer

A · Rituximab can reactivate hepatitis B and cause liver failure
13.Med-surg: cardiovascular & respiratory

Answer: B · A nitrate-free interval prevents tolerance

Why this is the answer

Continuous nitrate use leads to tolerance within days. A daily nitrate-free period (often overnight, when angina is least likely) keeps the drug effective. Patients are taught to rotate patch sites.

Answer

B · A nitrate-free interval prevents tolerance
14.Med-surg: cardiovascular & respiratory

Answer: A · Asthma

Why this is the answer

Asthma typically causes variable symptoms with reversible airflow obstruction. COPD usually affects older people with a smoking history and causes persistent, poorly reversible obstruction. Fibrosis gives a restrictive pattern.

Answer

A · Asthma
15.Med-surg: neuro, endocrine & renal

Answer: B · Left-sided neglect

Why this is the answer

Right-hemisphere strokes commonly cause neglect of the left side of space and the body. The nurse may need to prompt the patient to scan to the left, and the environment should be arranged safely. Aphasia is typical of left-hemisphere damage.

Answer

B · Left-sided neglect
16.Med-surg: neuro, endocrine & renal

Answer: D · Suspect aspiration pneumonia, stop oral intake and escalate for review

Why this is the answer

These signs suggest aspiration pneumonia, which is a common and serious complication of dysphagia. The patient needs medical review, chest assessment, oxygen if needed, and reassessment of their swallow before eating again.

Answer

D · Suspect aspiration pneumonia, stop oral intake and escalate for review
17.Med-surg: GI, perioperative & oncology

Answer: C · The nurse's assessment of what the problem is

Why this is the answer

SBAR is Situation, Background, Assessment and Recommendation. Under Assessment, the nurse gives the findings and their interpretation, for example "I think the patient may be bleeding".

Answer

C · The nurse's assessment of what the problem is
18.Med-surg: GI, perioperative & oncology

Answer: C · Octreotide or terlipressin, plus IV antibiotics, during resuscitation

Why this is the answer

In suspected variceal bleeding, a vasoactive drug (octreotide in the US, or terlipressin where it is licensed) reduces portal pressure, and prophylactic antibiotics such as ceftriaxone reduce infection and mortality in cirrhosis. Resuscitation is cautious to avoid raising portal pressure. Endoscopic band ligation is the definitive treatment.

Answer

C · Octreotide or terlipressin, plus IV antibiotics, during resuscitation
19.Maternity & obstetric nursing

Answer: A · Progesterone dilates the ureters and slows the flow of urine

Why this is the answer

Progesterone relaxes and dilates the ureters, and the growing uterus compresses them, so urine stasis occurs. This makes ascending infection easier, which is why asymptomatic bacteriuria is screened for and treated.

Answer

A · Progesterone dilates the ureters and slows the flow of urine
20.Maternity & obstetric nursing

Answer: D · "Breast milk lowers the risk of necrotising enterocolitis."

Why this is the answer

Human milk, including expressed or donor milk, reduces the risk of necrotising enterocolitis and infection in preterm babies. It does not remove the need for other monitoring.

Answer

D · "Breast milk lowers the risk of necrotising enterocolitis."
21.Pediatric nursing

Answer: B · 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

B · 1250 mL per day
22.Pediatric nursing

Answer: C · Phosphate

Why this is the answer

When feeding restarts after starvation, insulin drives phosphate, potassium and magnesium into cells. Low phosphate can cause heart failure, arrhythmias and confusion, so electrolytes are checked often and feeds are increased gradually.

Answer

C · Phosphate
23.Mental health nursing

Answer: C · Giving away valued possessions and suddenly seeming calm

Why this is the answer

Warning signs include talk of death, giving away possessions, saying goodbye, a sudden improvement in mood after deep depression, and searching for means.

Answer

C · Giving away valued possessions and suddenly seeming calm
24.Mental health nursing

Answer: D · "I'm glad our talks help. All the staff here are working with you, and it's important that you can talk to them too."

Why this is the answer

Accepting the role of the "only" helper encourages dependence and splitting. The nurse acknowledges the patient's feeling and encourages trust in the whole team, which keeps care consistent.

Answer

D · "I'm glad our talks help. All the staff here are working with you, and it's important that you can talk to them too."
25.Nursing math & unit conversions

Answer: 05:05

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

5 AM → 05

Answer

05:05

Answer

05:05
26.Nursing math & unit conversions

Answer: D = 22.5 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 = 5 mcg/kg/min × 75 kg × (60 min/1 h) × (1 mg/1000 mcg)

Calculate

D = 5·75·60/1000 = 22.5 mg/h

Answer

D = 22.5 mg/h
27.Dosage calculations

Answer: V = 4.8 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 = 7.5·32 = 240 mg

Volume

V = 240/50 = 4.8 mL

On the syringe

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

Answer

V = 4.8 mL
28.Dosage calculations

Answer: V₁ = 200 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.

Volume of stock

V₁ = 2·1000/10 = 200 mL

Answer

V₁ = 200 mL
29.IV infusion rates

Answer: V = 800 mL

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

Rate in mL/h

100·60/60 = 100 mL/h

Volume

V = 100·8 = 800 mL

Answer

V = 800 mL
30.IV infusion rates

Answer: R = 20 gtt/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

500/500 = 1 mg/mL

Volume per hour

20/1 = 20 mL/h

Drip rate

R = 20·60/60 = 20 gtt/min

Answer

R = 20 gtt/min
31.IV fluids & fluid balance

Answer: U = 0.51 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

375 + 175 = 550 mL

Per kilogram per hour

U = 550/(89·12) = 0.515 ≈ 0.51 mL/kg/h

Answer

U = 0.51 mL/kg/h
32.IV fluids & fluid balance

Answer: t = 7.3 h

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.

First part

125·4 = 500 mL
1000 − 500 = 500 mL left

Second part

500/150 = 3.333 h

Total time

t = 4 + 3.333 = 7.333 ≈ 7.3 h

Answer

t = 7.3 h

That is about 7 h 20 min, so the bag runs out at about 20:50.

33.Clinical assessment scores

Answer: M = 6

Glasgow Coma Scale: add the best response in three areas. Eye opening E: 4 spontaneous, 3 to sound or speech, 2 to pressure, 1 none. Verbal V: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Motor M: 6 obeys commands, 5 localises, 4 normal flexion (withdraws), 3 abnormal flexion, 2 extension, 1 none. The total runs from 3 to 15. After a head injury, 13–15 is usually called mild, 9–12 moderate and 3–8 severe.

Motor score

M = 15 − 4 − 5 = 6
M6: obeys commands

Answer

M = 6
34.Clinical assessment scores

Answer: obesity class III

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 = 121/1.5² = 53.78

Category

obesity class III

Answer

obesity class III

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