NCLEX-PN-style practice questions (LPN/LVN): cram pack

Formula sheets, the key method steps for every topic and 34 practice problems, with full solutions at the back.

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1Formulas and methods

Infection control & patient safety

Method

  1. Start with standard precautions for every patient: hand hygiene, PPE for the expected exposure, safe sharps.
  2. Add precautions by route: contact (gown, gloves), droplet (surgical mask), airborne (N95, negative-pressure room).
  3. Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
  4. Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
  5. Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.

Prioritization & delegation

Method

  1. Ask what will harm the patient soonest if nothing is done.
  2. Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
  3. Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
  4. Assess before you act unless it is an emergency; then choose the step the others depend on.
  5. For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.

Lab values & electrolytes

Method

  1. Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
  2. Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
  3. Link the value to its typical signs and to the drugs and conditions that cause it.
  4. Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
  5. Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.

Med-surg: cardiovascular & respiratory

Method

  1. Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
  2. Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
  3. Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
  4. Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
  5. Choose the safe first action, then escalate and reassess.

Med-surg: neuro, endocrine & renal

Method

  1. Check the glucose in every patient with new confusion, weakness or a seizure.
  2. Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
  3. For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
  4. For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
  5. For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.

Med-surg: GI, perioperative & oncology

Method

  1. Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
  2. Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
  3. For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
  4. For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
  5. For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.

Maternity & obstetric nursing

Method

  1. Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
  2. Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
  3. Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
  4. Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.

Pediatric nursing

Method

  1. Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
  2. Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
  3. Match the action to the development stage and involve the family.
  4. Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.

Mental health nursing

Method

  1. Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
  2. Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
  3. Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
  4. Respect rights: the least restrictive option, consent and confidentiality with its limits.

Nursing math & unit conversions

Metric steps
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
Weight and length
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
Household measures
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
Temperature
°C = (°F − 32)·5/9, °F = °C·9/5 + 32
24-hour clock
PM hours 1–11: add 12; 12 AM = 00:xx; 12 PM = 12:xx
Dose rate
mcg/min × 60/1000 = mg/h
Laboratory factors
glucose 1 mmol/L = 18 mg/dL; creatinine 1 mg/dL = 88.4 µmol/L; Hb 1 g/dL = 10 g/L

Method

  1. Write the given quantity with its unit and the unit you want.
  2. Pick the equivalent: 1000 between kg, g, mg and mcg or L and mL; 1 kg = 2.2 lb; 1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 240 mL.
  3. Write it as a fraction so that the unwanted unit cancels; for a rate, use one fraction per unit that changes.
  4. Check the direction: a smaller unit gives a bigger number.
  5. Round only the final answer, to the precision the question names.

Dosage calculations

Dose from strength
volume = dose / strength
Weight-based dose
dose = mg/kg × body weight
Tablets
number = dose / tablet strength
Units
1 g = 1000 mg, 1 mg = 1000 mcg

Method

  1. Convert the ordered dose and the stock strength to the same unit.
  2. Use desired over have times quantity: (D/H) × Q.
  3. For weight-based doses, multiply by the weight in kg first, then divide the daily dose by the number of doses.
  4. Estimate first and check that the answer is reasonable.

IV infusion rates

Pump rate
mL/h = volume (mL)/time (h)
Drip rate
drops/min = volume (mL) × drop factor / time (min)
Infusion time
time (h) = volume (mL)/rate (mL/h)

Method

  1. Pump rate in mL/h: volume divided by time in hours.
  2. Drip rate in drops/min: volume × drop factor divided by time in minutes.
  3. For time remaining: volume left divided by the rate.
  4. Round as the question or the equipment requires.

IV fluids & fluid balance

Holliday–Segar per hour
4 mL/kg (first 10 kg) + 2 mL/kg (next 10 kg) + 1 mL/kg (each kg above 20)
Holliday–Segar per day
100 / 50 / 20 mL/kg for the same bands
Fluid balance
intake − output
Ice chips
count as half their volume
Urine output
mL/kg/h = mL / (kg × h)
Infusion time
time (h) = volume left (mL) / rate (mL/h)
Volume infused
mL = rate × time

Clinical assessment scores

Glasgow Coma Scale
GCS = E (1–4) + V (1–5) + M (1–6) = 3–15
APGAR
5 signs × 0–2 = 0–10; 7–10 reassuring, 4–6 moderately abnormal, 0–3 low
Braden scale
5 × (1–4) + 1 × (1–3) = 6–23; ≤ 18 at risk
Morse fall scale
falls 25, diagnosis 15, aid 15/30, IV 20, gait 10/20, mental status 15
NEWS2 risk
0–4 low; single 3 low–medium; 5–6 medium; ≥ 7 high
Mean arterial pressure
MAP = (SBP + 2·DBP)/3 = DBP + PP/3
Pulse pressure and shock index
PP = SBP − DBP, SI = HR/SBP
Body mass index
BMI = kg/m² = 703·lb/in²

Method

  1. Find the score sheet that the question uses and its range (GCS 3–15, APGAR 0–10, Braden 6–23, Morse 0–125).
  2. Score every item separately, matching the description to its level.
  3. Add the item scores and check that the total lies inside the range.
  4. Apply the cut-offs: for NEWS2 also look for any single parameter scoring 3.
  5. For derived values use MAP = (SBP + 2·DBP)/3, PP = SBP − DBP, SI = HR/SBP and BMI = kg/m².

2Practice problems

1.Nursing fundamentalsMedium

What does the Malnutrition Universal Screening Tool (MUST) assess?

  1. AThe risk of malnutrition
  2. BSwallowing ability
  3. CThe risk of falling
  4. DThe level of pain
2.Nursing fundamentalsHard

A toddler is brought in with bruises on both cheeks and the parent's explanation does not fit the injuries. What should the nurse do?

  1. AIgnore it, as children often bruise themselves
  2. BDocument accurately and follow the child safeguarding procedure
  3. CConfront the parent and ask them directly whether they hurt the child
  4. DSend the child home and phone the family next week
3.Infection control & patient safetyMedium

Why are blood cultures usually taken from two separate venipuncture sites?

  1. ABecause each site tests a different antibiotic
  2. BTo help tell a true infection from skin contamination
  3. CTo reduce the total amount of blood taken
  4. DTo make the results come back faster from the laboratory
4.Infection control & patient safetyHard

Only one airborne infection isolation room (negative pressure) is free. Which newly admitted patient should be placed in it?

  1. AA patient with an MRSA wound infection
  2. BA patient with suspected active pulmonary tuberculosis
  3. CA patient with C. difficile diarrhea
  4. DA patient with confirmed seasonal influenza and a cough
5.Prioritization & delegationMedium

The day after a total thyroidectomy, a patient reports tingling around the mouth and in the fingers. What should the nurse do first?

  1. AGive the patient’s routine oral iron supplement early
  2. BReassure the patient that this is normal after neck surgery
  3. CEncourage deep breaths into a paper bag until it passes
  4. DCheck for signs of low calcium and inform the provider
6.Prioritization & delegationHard

During an infusion of a thrombolytic drug for stroke, the patient develops a severe headache and starts vomiting. What should the nurse do first?

  1. AStop the infusion and inform the provider at once
  2. BContinue the infusion, because headache is expected
  3. CSlow the infusion and give an antiemetic as prescribed
  4. DGive a dose of aspirin for the headache
7.Clinical nursingMedium

Which advice is important for a patient on long-term oral corticosteroids?

  1. ADo not stop them suddenly
  2. BTake them only when symptoms flare
  3. CDouble the dose if a dose is missed
  4. DTake them on an empty stomach at night
8.Clinical nursingHard

A patient with several days of vomiting and diarrhoea has low blood pressure, low urine output and a rising creatinine. Which description fits best?

  1. AChronic kidney disease, treated with long-term dialysis three times a week
  2. BIntrinsic kidney injury from glomerulonephritis, treated with high-dose steroids
  3. CPre-renal acute kidney injury from poor perfusion, treated by restoring fluid volume
  4. DPost-renal acute kidney injury from obstruction, treated with a catheter
9.Lab values & electrolytesMedium

Which ECG change is linked to hypocalcemia?

  1. AA prominent delta wave
  2. BTall, peaked T waves
  3. CA prolonged QT interval
  4. DA shortened QT interval
10.Lab values & electrolytesHard

A patient’s vancomycin trough is 28 mcg/mL; the target set by the prescriber is 15–20 mcg/mL. The next dose is due now. What is the best action?

  1. AHold the dose, inform the prescriber and check kidney function
  2. BGive a double dose to finish the course faster
  3. CGive the dose over a shorter time to reduce exposure
  4. DGive the dose as scheduled and recheck the trough level in a week
11.PharmacologyMedium

Which antihypertensive class can raise blood glucose and uric acid levels, sometimes triggering gout?

  1. AThiazide diuretics
  2. BAngiotensin II receptor blockers
  3. CACE inhibitors
  4. DAlpha-1 blockers
12.PharmacologyHard

The clearance of a drug falls to half because of kidney failure, while its volume of distribution stays the same. What happens to its half-life?

  1. AIt stays the same
  2. BIt doubles
  3. CIt halves
  4. DIt increases fourfold
13.Med-surg: cardiovascular & respiratoryMedium

A patient with angle-closure glaucoma needs nebulised ipratropium. What precaution is sensible?

  1. AMix it with an eye drop before putting it in the nebuliser
  2. BUse a mouthpiece or protect the eyes from the mist
  3. CGive it only with the patient lying completely flat
  4. DRun it at the highest possible gas flow
14.Med-surg: cardiovascular & respiratoryHard

A patient with a COPD exacerbation has been on NIV for two hours. They are now more drowsy, and the pH has fallen further despite a good mask fit. What should the nurse do?

  1. AGive a sedative to help the patient tolerate the mask
  2. BEscalate urgently for review of intubation or a ceiling of care
  3. CRemove the mask and give nebulised bronchodilators only from now on
  4. DContinue NIV unchanged and repeat the blood gas tomorrow morning
15.Med-surg: neuro, endocrine & renalMedium

Why is propranolol given to a patient with hyperthyroidism?

  1. ATo ease tremor and palpitations while other treatment starts
  2. BTo stop the thyroid gland from making any more hormones
  3. CTo destroy overactive thyroid tissue over a few weeks
  4. DTo replace the hormone lost from the thyroid gland
16.Med-surg: neuro, endocrine & renalHard

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

  1. AA patient with Guillain–Barré syndrome whose vital capacity is falling
  2. BA patient with multiple sclerosis who is tired after physiotherapy
  3. CA patient with a headache after a lumbar puncture this morning
  4. DA patient with Parkinson's disease whose next dose is due in one hour
17.Med-surg: GI, perioperative & oncologyMedium

Before an anti-TNF biologic such as infliximab is started for Crohn's disease, which screening is essential?

  1. AA bone density scan
  2. BA test of colour vision
  3. CA test for coeliac disease
  4. DScreening for tuberculosis
18.Med-surg: GI, perioperative & oncologyHard

After a fall, a patient with advanced dementia is agitated, grimacing and guarding the hip, and cannot rate the pain. What should the nurse do?

  1. AUse an observational pain tool, give analgesia and reassess
  2. BWait until a relative can confirm the pain
  3. CGive a sedative to treat the agitation and avoid giving any analgesia
  4. DAssume there is no pain because none is reported
19.Maternity & obstetric nursingMedium

A woman's epidural has just been inserted. Which nursing action is a priority in the next hours?

  1. AKeep her lying flat on her back
  2. BEncourage her to walk around the room on her own
  3. CRestrict all oral and IV fluids
  4. DCheck her blood pressure and bladder often
20.Maternity & obstetric nursingHard

A woman with severe postpartum haemorrhage is being treated with uterotonics. Which additional drug, given early, can reduce death from bleeding?

  1. AHeparin
  2. BTranexamic acid
  3. CAspirin
  4. DMagnesium sulfate
21.Pediatric nursingMedium

After cleft lip repair, which nursing action protects the suture line?

  1. APosition the baby on the back or side and avoid putting objects in the mouth
  2. BClean the suture line with a dry, rough cloth to remove crusts several times a day
  3. CPlace the baby on the stomach to sleep
  4. DLet the baby suck on a dummy straight away
22.Pediatric nursingHard

After hypospadias repair, a toddler has a urinary catheter. Which nursing action has priority?

  1. AKeep the catheter draining freely and check for kinks or blockage
  2. BRemove the dressing on the first day to check the wound
  3. CLimit fluids for the first days so that less urine passes over the repair
  4. DClamp the catheter for a few hours to train the bladder
23.Mental health nursingMedium

A patient in a manic episode makes repeated sexual comments to a nurse. What is the most appropriate response?

  1. ALaugh at the comments so he does not feel rejected
  2. BCalmly say that the comments are not acceptable and redirect him
  3. CAvoid the patient for the rest of the shift
  4. DRespond with similar comments to build rapport
24.Mental health nursingHard

A child has been admitted several times with unexplained fevers that only happen when her mother is present. Staff see the mother tampering with the child's IV line. What is the priority action?

  1. ADiscuss the matter with the mother alone and ask her to stop
  2. BDischarge the child home with the mother as soon as possible
  3. CDocument the event carefully in the notes and wait to see whether it happens again before telling anyone else
  4. DEnsure the child's safety and follow child protection procedures
25.Nursing math & unit conversionsMedium
1234567891011125:05 PM?05:0516:0517:0518:05

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

5:05 PM
  1. 105:05
  2. 216:05
  3. 317:05
  4. 418:05
26.Nursing math & unit conversionsHard
1 tbsp · 2/day · 7 d? × 150 mL1 tbsp = 15 mL

Practice exercise (made-up values, not clinical guidance). A prescription reads 1 tbsp of an oral suspension every 12 hours for 7 days. The suspension comes in 150 mL bottles. Using 1 tbsp = 15 mL, how many whole bottles N must be supplied so the course is complete?

1 tbspevery 12 hours7 days150 mL1 tbsp = 15 mL
N =
27.Dosage calculationsMedium
024681010 mL

A child weighing 14 kg is prescribed 2 mg/kg of a drug. The stock solution contains 10 mg/mL. Draw up the dose: what volume V do you give?

14 kg2 mg/kg10 mg/mL
V = mL
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 2250 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

2250 units5000 units/mL
V = mL
29.IV infusion ratesMedium
300 mLleft? mL/h2 h left

1000 mL was ordered over 8 hours. After 6 hours you find that 300 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?

1000 mL / 8 hafter 6 h: 300 mL
R = mL/h
30.IV infusion ratesHard
550 mLleft? mL/h2 h left

1500 mL was ordered over 6 hours. After 4 hours you find that 550 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 / 6 hafter 4 h: 550 mL
Δ = %
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftsoup200 mLmilk100 mLice chips120 mLIV infusion75 mL/h × 8 hIV antibiotic1 × 100 mLurine275 mLurine325 mLurine325 mLurine400 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. Count ice chips as half their volume.

soup: 200 mLmilk: 100 mLice chips: 120 mLIV infusion: 75 mL/h × 8 hIV antibiotic: 1 × 100 mL
I = mL
32.IV fluids & fluid balanceHard
500 mL→ 200 mL/hstart 07:00ttotal​ = ? h75 mL/h × 4 h

Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 07:00 at 75 mL/h. After 4 hours the rate is changed to 200 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.

500 mL75 mL/h · 4 h200 mL/h
t = h
33.Clinical assessment scoresMedium
mildmoderatesevere

Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury does not open the eyes at all, makes only incomprehensible sounds such as moaning and shows as the best motor response: no movement at all. Work out the GCS and classify the head injury by it. Click your answer.

  1. 1mild
  2. 2moderate
  3. 3severe
34.Clinical assessment scoresHard
124?SBPDBPmmHgMAP = 70

Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 70 mmHg. A patient’s systolic pressure is 124 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 70 mmHg?

MAP 70 mmHgSBP 124 mmHg
DBP = mmHg

3Solutions

1.Nursing fundamentals

Answer: A · The risk of malnutrition

Why this is the answer

MUST combines body mass index, unplanned weight loss and acute disease effect into a score that shows the risk of malnutrition and guides nutritional care.

Answer

A · The risk of malnutrition
2.Nursing fundamentals

Answer: B · Document accurately and follow the child safeguarding procedure

Why this is the answer

Injuries that do not match the explanation are a warning sign. The nurse records facts, not opinions, and refers through safeguarding procedures without confronting the family.

Answer

B · Document accurately and follow the child safeguarding procedure
3.Infection control & patient safety

Answer: B · To help tell a true infection from skin contamination

Why this is the answer

If the same organism grows from both sets, it is more likely to be a true bloodstream infection. Growth in only one set may be contamination from the skin.

Answer

B · To help tell a true infection from skin contamination
4.Infection control & patient safety

Answer: B · A patient with suspected active pulmonary tuberculosis

Why this is the answer

Tuberculosis needs airborne precautions in a negative-pressure room. Influenza needs droplet precautions and MRSA and C. difficile need contact precautions, which can be given in an ordinary single room.

Answer

B · A patient with suspected active pulmonary tuberculosis
5.Prioritization & delegation

Answer: D · Check for signs of low calcium and inform the provider

Why this is the answer

Damage to the parathyroid glands during thyroid surgery can cause hypocalcemia. Tingling, muscle cramps and a positive Chvostek or Trousseau sign need prompt reporting and calcium replacement as prescribed.

Answer

D · Check for signs of low calcium and inform the provider
6.Prioritization & delegation

Answer: A · Stop the infusion and inform the provider at once

Why this is the answer

A new severe headache, vomiting or neurological decline during thrombolysis can mean intracranial bleeding. The infusion is stopped, the provider informed and an urgent scan arranged.

Answer

A · Stop the infusion and inform the provider at once
7.Clinical nursing

Answer: A · Do not stop them suddenly

Why this is the answer

Long-term steroids suppress the adrenal glands, so stopping suddenly can cause adrenal crisis. Patients should carry a steroid alert card or medical ID and follow sick-day guidance.

Answer

A · Do not stop them suddenly
8.Clinical nursing

Answer: C · Pre-renal acute kidney injury from poor perfusion, treated by restoring fluid volume

Why this is the answer

Fluid loss reduces kidney perfusion, causing pre-renal AKI. Prompt fluid replacement can restore function before the kidney tissue itself is damaged.

Answer

C · Pre-renal acute kidney injury from poor perfusion, treated by restoring fluid volume
9.Lab values & electrolytes

Answer: C · A prolonged QT interval

Why this is the answer

Low calcium prolongs the QT interval, which can lead to dangerous arrhythmias. High calcium shortens the QT interval, and peaked T waves are typical of hyperkalemia.

Answer

C · A prolonged QT interval
10.Lab values & electrolytes

Answer: A · Hold the dose, inform the prescriber and check kidney function

Why this is the answer

A trough above target means the drug is building up, which raises the risk of kidney damage. The nurse holds the dose and informs the prescriber, who will adjust the dose or interval. The kidney function is checked.

Answer

A · Hold the dose, inform the prescriber and check kidney function
11.Pharmacology

Answer: A · Thiazide diuretics

Why this is the answer

Thiazide diuretics reduce uric acid excretion and can worsen glucose tolerance. They also cause low potassium and sodium, so electrolytes are monitored.

Answer

A · Thiazide diuretics
12.Pharmacology

Answer: B · It doubles

Why this is the answer

Half-life is proportional to Vd and inversely proportional to clearance. Halving clearance doubles the half-life, so the drug accumulates and takes longer to reach steady state.

Answer

B · It doubles
13.Med-surg: cardiovascular & respiratory

Answer: B · Use a mouthpiece or protect the eyes from the mist

Why this is the answer

Ipratropium is an antimuscarinic bronchodilator. Mist escaping from a face mask can reach the eyes, dilate the pupil and trigger acute angle-closure glaucoma in susceptible patients. A mouthpiece or eye protection reduces the risk.

Answer

B · Use a mouthpiece or protect the eyes from the mist
14.Med-surg: cardiovascular & respiratory

Answer: B · Escalate urgently for review of intubation or a ceiling of care

Why this is the answer

Worsening acidosis and consciousness on NIV mean treatment is failing. Senior review is needed to decide on intubation and ventilation or, if agreed in advance, a ceiling of care. Ideally the plan for NIV failure is documented when NIV is started. Sedation would depress breathing further.

Answer

B · Escalate urgently for review of intubation or a ceiling of care
15.Med-surg: neuro, endocrine & renal

Answer: A · To ease tremor and palpitations while other treatment starts

Why this is the answer

A beta-blocker quickly controls adrenergic symptoms such as tachycardia, tremor and anxiety. It does not lower hormone production, so a thionamide, radioactive iodine or surgery is still needed.

Answer

A · To ease tremor and palpitations while other treatment starts
16.Med-surg: neuro, endocrine & renal

Answer: A · A patient with Guillain–Barré syndrome whose vital capacity is falling

Why this is the answer

A falling vital capacity and weak cough in Guillain–Barré syndrome warn of respiratory failure, which may need ventilation. The other patients have expected or less urgent problems.

Answer

A · A patient with Guillain–Barré syndrome whose vital capacity is falling
17.Med-surg: GI, perioperative & oncology

Answer: D · Screening for tuberculosis

Why this is the answer

Anti-TNF drugs suppress immunity and can reactivate latent tuberculosis. Patients are screened for TB and hepatitis B before starting and are taught to report signs of infection.

Answer

D · Screening for tuberculosis
18.Med-surg: GI, perioperative & oncology

Answer: A · Use an observational pain tool, give analgesia and reassess

Why this is the answer

In dementia, pain often appears as agitation or guarding. An observational tool supports assessment; analgesia is given and effect reassessed. The hip is also assessed for injury such as a fracture.

Answer

A · Use an observational pain tool, give analgesia and reassess
19.Maternity & obstetric nursing

Answer: D · Check her blood pressure and bladder often

Why this is the answer

Epidurals cause sympathetic block, so hypotension is common. They also reduce the urge to void, so the bladder is checked and catheterised if needed. Lateral positions avoid aortocaval compression.

Answer

D · Check her blood pressure and bladder often
20.Maternity & obstetric nursing

Answer: B · Tranexamic acid

Why this is the answer

Tranexamic acid is an antifibrinolytic. Given early, ideally within 3 hours of birth, it reduces deaths from postpartum haemorrhage. Heparin and aspirin would increase bleeding.

Answer

B · Tranexamic acid
21.Pediatric nursing

Answer: A · Position the baby on the back or side and avoid putting objects in the mouth

Why this is the answer

After a lip repair, avoid prone positioning and anything that rubs the suture line. Elbow splints may be used according to the surgeon's instructions. Feed with the method recommended by the team.

Answer

A · Position the baby on the back or side and avoid putting objects in the mouth
22.Pediatric nursing

Answer: A · Keep the catheter draining freely and check for kinks or blockage

Why this is the answer

After repair, the catheter or stent protects the new urethra while it heals. It must drain freely; blockage causes bladder spasm and pressure on the repair. Fluids are encouraged, and the dressing is managed as the surgeon directs.

Answer

A · Keep the catheter draining freely and check for kinks or blockage
23.Mental health nursing

Answer: B · Calmly say that the comments are not acceptable and redirect him

Why this is the answer

Disinhibition is common in mania. Clear, calm limit setting and redirection protect both staff and patient and maintain boundaries without punishing him.

Answer

B · Calmly say that the comments are not acceptable and redirect him
24.Mental health nursing

Answer: D · Ensure the child's safety and follow child protection procedures

Why this is the answer

This suggests factitious disorder imposed on another, which is a form of child abuse. The nurse protects the child and reports through safeguarding procedures. Confronting the parent alone can increase the risk to the child.

Answer

D · Ensure the child's safety and follow child protection procedures
25.Nursing math & unit conversions

Answer: 17:05

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 PM → 5 + 12 = 17

Answer

17:05

Answer

17:05
26.Nursing math & unit conversions

Answer: N = 2

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.

Total volume

15 mL × 2 × 7 = 210 mL

Bottles

210/150 = 1.4 → N = 2

Answer

N = 2
27.Dosage calculations

Answer: V = 2.8 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 = 2·14 = 28 mg

Volume

V = 28/10 = 2.8 mL

On the syringe

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

Answer

V = 2.8 mL
28.Dosage calculations

Answer: V = 0.45 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 = 2250/5000 = 0.45 mL

On the syringe

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

Answer

V = 0.45 mL
29.IV infusion rates

Answer: R = 150 mL/h

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

Original rate

1000/8 = 125 mL/h

New rate

R = 300/2 = 150 mL/h

Answer

R = 150 mL/h

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

30.IV infusion rates

Answer: Δ = 10 %

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

1500/6 = 250 mL/h

New rate

R = 550/2 = 275 mL/h

Percentage change

Δ = (275 − 250)/250·100% = 10%

Answer

Δ = 10%

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

31.IV fluids & fluid balance

Answer: I = 1060 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 + 100 = 300 mL
ice chips: 120/2 = 60 mL
IV infusion: 75·8 = 600 mL
IV antibiotic: 1·100 = 100 mL
I = 1060 mL

Answer

I = 1060 mL
32.IV fluids & fluid balance

Answer: t = 5 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

75·4 = 300 mL
500 − 300 = 200 mL left

Second part

200/200 = 1 h

Total time

t = 4 + 1 = 5 h

Answer

t = 5 h

That is about 5 h 00 min, so the bag runs out at about 12:00.

33.Clinical assessment scores

Answer: severe

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.

Score each area

E: does not open the eyes at all → 1
V: makes only incomprehensible sounds such as moaning → 2
M: no movement at all → 1

Add

GCS = 1 + 2 + 1 = 4

Severity

GCS 4 → severe

Answer

severe
34.Clinical assessment scores

Answer: DBP = 43 mmHg

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

Rearrange

DBP = (3·MAP − SBP)/2

Substitute

DBP = (3·70 − 124)/2 = 86/2 = 43 mmHg

Answer

DBP = 43 mmHg

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