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

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

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1Formulas and methods

Infection control & patient safety

Method

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

Prioritization & delegation

Method

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

Lab values & electrolytes

Method

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

Med-surg: cardiovascular & respiratory

Method

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

Med-surg: neuro, endocrine & renal

Method

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

Med-surg: GI, perioperative & oncology

Method

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

Maternity & obstetric nursing

Method

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

Pediatric nursing

Method

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

Mental health nursing

Method

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

Nursing math & unit conversions

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

Method

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

Dosage calculations

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

Method

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

IV infusion rates

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

Method

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

IV fluids & fluid balance

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

Clinical assessment scores

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

Method

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

2Practice problems

1.Nursing fundamentalsMedium

Which combination of signs suggests a wound infection?

  1. AA dry scab with no pain
  2. BMild itching as the edges close
  3. CPink granulation tissue, mild serous fluid and a shrinking wound
  4. DIncreasing redness, warmth, swelling, pain and pus
2.Nursing fundamentalsHard

For a healthy adult having planned surgery, until how long before anaesthesia can water usually still be taken?

  1. AUp to 12 hours before
  2. BWater is not allowed from the day before
  3. CUp to 24 hours before
  4. DUp to 2 hours before
3.Infection control & patient safetyMedium

A patient with poorly controlled seizures asks about activities at home. Which advice is most important?

  1. ASleep sitting up in a chair
  2. BNever swim or bathe alone
  3. CAvoid drinking water before bed
  4. DAvoid all forms of exercise
4.Infection control & patient safetyHard

A competent adult patient with pneumonia wants to leave the hospital against medical advice. What should the nurse do?

  1. AApply wrist restraints until the provider arrives to speak with the patient
  2. BLock the doors so the patient cannot leave
  3. CHide the patient’s clothes and belongings so that they cannot leave the ward
  4. DExplain the risks, notify the provider and follow the policy for leaving against advice
5.Prioritization & delegationMedium

Using the Emergency Severity Index, which patient receives the highest acuity level?

  1. AA patient with a possible ankle fracture
  2. BA patient with chest pain and normal vital signs
  3. CAn unresponsive patient with gasping, irregular breaths
  4. DA patient with a sore throat for three days and normal vital signs
6.Prioritization & delegationHard

On a cardiac unit, which patient should the nurse see first?

  1. AA patient with heart failure who has gained 0.3 kg since yesterday
  2. BA patient taking digoxin with a pulse of 48/min, nausea and a potassium of 3.0 mEq/L
  3. CA patient who has been asked to fast before a scan tomorrow
  4. DA patient with atrial fibrillation whose heart rate is 88/min and irregular, as before
7.Clinical nursingMedium

A patient started on an ACE inhibitor develops a persistent dry cough. What is the likely cause?

  1. AA recognised side effect of the ACE inhibitor
  2. BPulmonary embolism
  3. CAsthma caused by a beta-blocker
  4. DAn allergic reaction to a recently given penicillin
8.Clinical nursingHard

Which finding suggests hypocalcaemia?

  1. ASevere thirst with a large urine output and constipation
  2. BA flapping tremor of the outstretched hands
  3. CA slow, irregular pulse with nausea and yellow-tinged vision
  4. DSpasm of the hand when a blood pressure cuff is inflated on the arm
9.Lab values & electrolytesMedium

Why must a low total calcium be interpreted with care in a patient with a low serum albumin?

  1. AAlbumin and calcium are measured with the same chemical reaction, so they always fall together
  2. BMuch calcium is bound to albumin, so total calcium falls even if ionized calcium is normal
  3. CLow albumin makes every calcium test inaccurate and useless
  4. DLow albumin always causes true, symptomatic hypocalcemia
10.Lab values & electrolytesHard

A patient on a stable dose of levothyroxine now has a TSH of 9.8 mIU/L. She recently started taking her calcium and iron supplements with her morning levothyroxine. What is the most likely explanation?

  1. AThe supplements are causing an overactive thyroid gland
  2. BThe TSH is low, showing that the dose is now too high
  3. CThe result is normal for a person on levothyroxine therapy
  4. DThe supplements are reducing levothyroxine absorption
11.PharmacologyMedium

How does metformin mainly lower blood glucose?

  1. AIt reduces glucose production by the liver
  2. BIt blocks glucose absorption in the kidney
  3. CIt replaces missing insulin
  4. DIt stimulates insulin release from the pancreas
12.PharmacologyHard

A woman using the combined oral contraceptive pill starts carbamazepine for epilepsy. What is the main concern?

  1. ACarbamazepine toxicity because the pill strongly blocks its metabolism
  2. BSevere hypoglycaemia from the combination
  3. CContraceptive failure because the hormones are metabolised faster
  4. DNo concern, because the drugs do not interact
13.Med-surg: cardiovascular & respiratoryMedium

How does varenicline help people stop smoking?

  1. AIt speeds the clearance of nicotine by the liver
  2. BIt replaces nicotine through the skin, like a nicotine patch
  3. CIt partly stimulates and partly blocks nicotine receptors
  4. DIt makes cigarettes taste of metal so smoking feels unpleasant
14.Med-surg: cardiovascular & respiratoryHard

A nurse teaches a patient who is starting warfarin. Which statement shows a need for further teaching?

  1. A"I will have regular INR blood tests."
  2. B"If I miss a dose, I will take two the next day."
  3. C"I will check before taking any new medicines or herbal remedies."
  4. D"I will tell my dentist that I take warfarin."
15.Med-surg: neuro, endocrine & renalMedium

Which approach helps most when talking to a patient with expressive aphasia?

  1. ASpeak louder, because the patient cannot hear well
  2. BFinish their sentences quickly to save them effort
  3. CAvoid talking to them until their speech has recovered
  4. DAsk questions that can be answered with yes, no or a gesture
16.Med-surg: neuro, endocrine & renalHard

Which task can the registered nurse delegate to a trained healthcare assistant (nursing assistant)?

  1. ADeciding the dose of correction insulin from the glucose result
  2. BChecking pre-meal glucose and reporting results out of range
  3. CAssessing a confused patient whose glucose is 2.6 mmol/L (47 mg/dL)
  4. DTeaching a new patient how to inject insulin
17.Med-surg: GI, perioperative & oncologyMedium

Why is pethidine (meperidine) generally avoided for regular pain relief?

  1. AIt has no pain-relieving effect at all in adults
  2. BIt can only be given by mouth
  3. CA metabolite can build up and cause seizures
  4. DIt always causes severe diarrhoea
18.Med-surg: GI, perioperative & oncologyHard

A surgical patient's MUST score is 3 and the wound is healing slowly. What is the most appropriate action?

  1. ARestrict protein to help the kidneys
  2. BRefer to the dietitian, start a nutrition plan and monitor intake
  3. CEncourage fasting to reduce wound exudate and the size of the dressing
  4. DRepeat the score in three months' time
19.Maternity & obstetric nursingMedium

Why are afterpains often stronger in multiparous women?

  1. AThey produce no oxytocin after birth
  2. BTheir uterus is always infected
  3. CTheir uterus contracts and relaxes more irregularly
  4. DThey have a smaller uterus than first-time mothers
20.Maternity & obstetric nursingHard

A woman 5 hours after birth had a large blood loss and now has a heart rate of 128/min, blood pressure of 88/50 mmHg and cold hands. Which action is most important?

  1. AEncourage her to breastfeed to contract the uterus
  2. BCall for urgent help and start fluid resuscitation
  3. CGive her a hot drink and recheck in an hour
  4. DAsk her to walk to improve circulation
21.Pediatric nursingMedium

The nurse uses a blood pressure cuff that is too small for a child's arm. What effect will this have?

  1. AThe cuff will not inflate at all
  2. BThe reading will be falsely high
  3. CThe reading will be falsely low
  4. DThe reading will be accurate but slower to obtain
22.Pediatric nursingHard

A child has suspected septic shock. Which action is the most time-critical?

  1. AGiving IV antibiotics as soon as possible, ideally within the first hour
  2. BStarting antibiotics after the fever has been present for 24 hours
  3. CWaiting for the blood culture results before starting any antibiotic treatment
  4. DGiving oral antibiotics and reviewing the child again in the morning
23.Mental health nursingMedium

A patient taking fluoxetine says she has started taking St John's wort to feel even better. What is the main risk?

  1. ASerotonin syndrome
  2. BAgranulocytosis
  3. CLithium toxicity
  4. DHypertensive crisis from tyramine
24.Mental health nursingHard

A voluntary patient asks to leave the ward now. While talking, he says he plans to jump from a bridge on the way home. What should the nurse do?

  1. ATell him to go home now and come back tomorrow morning when he feels calmer and safer
  2. BAsk him to promise that he will not jump, and then let him go home on his own
  3. CStay with him and inform the team at once, so he can be urgently assessed under mental health law
  4. DLet him leave, because voluntary patients can always go when they want
25.Nursing math & unit conversionsMedium
94969810010210410635363738394041°F°C? °F40.2 °C

Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 40.2 °C. Convert it to degrees Fahrenheit T with °F = °C × 9/5 + 32. Round to one decimal place.

40.2 °C
T = °F
26.Nursing math & unit conversionsHard
1.5 mg/h? mcg/min1 mg = 1000 mcg1 h = 60 min

Practice exercise (made-up values, not clinical guidance). An infusion delivers 1.5 mg/h. Express this dose rate D in mcg/min. Round to one decimal place.

1.5 mg/h1 mg = 1000 mcg1 h = 60 min
D = mcg/min
27.Dosage calculationsMedium
024681010 mL

A child weighing 24 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?

24 kg7.5 mg/kg50 mg/mL
V = mL
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 860 units of a drug that comes as 1000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

860 units1000 units/mL
V = mL
29.IV infusion ratesMedium
V = ?60 gtt/mL100 gtt/min2 h

A drip runs at 100 gtt/min through a set of 60 gtt/mL. How many millilitres V does the patient receive in 2 hours?

100 gtt/min60 gtt/mL2 h
V = mL
30.IV infusion ratesHard
200 mL15 gtt/mL42 gtt/mint = ? h

A drip runs at 42 gtt/min through a set of 15 gtt/mL. There are 200 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

42 gtt/min15 gtt/mL200 mL
t = h
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftmilk200 mLjuice200 mLsoup180 mLIV infusion60 mL/h × 12 hIV antibiotic2 × 100 mLurine475 mLurine200 mLurine175 mLurine350 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 48 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

48 kg12 hurine: 475 mLurine: 200 mLurine: 175 mLurine: 350 mLvomit: 200 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
500 mL80 mL/hstart 06:0007:30: ? mL

Practice exercise (made-up values, not clinical guidance). A 500 mL bag was started at 06:00 and runs by pump at 80 mL/h. How many mL V are left in the bag at 07:30?

500 mL80 mL/h06:00 → 07:30
V = mL
33.Clinical assessment scoresMedium
3210123RR≤89–1112–2021–24≥25SpO₂≤9192–9394–95≥96air / O₂O₂airSBP≤9091–100101–110111–219≥220HR≤4041–5051–9091–110111–130≥131ACVPUAC, V, P, UT °C≤35.035.1–36.036.1–38.038.1–39.0≥39.1

Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 18/min, SpO₂ 92% on room air, blood pressure 88/52 mmHg, pulse 130/min, alert, temperature 39.6 °C. What is the NEWS2 total score?

RR 18SpO₂ 92%airSBP 88HR 130AT 39.6 °C
NEWS2 =
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 71 kg and is 194 cm tall. Calculate the BMI and click the WHO weight category.

71 kg194 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: D · Increasing redness, warmth, swelling, pain and pus

Why this is the answer

Spreading redness, heat, swelling, pain, pus or an unpleasant smell suggest infection, sometimes with fever. Pink granulation tissue and itching are signs of normal healing.

Answer

D · Increasing redness, warmth, swelling, pain and pus
2.Nursing fundamentals

Answer: D · Up to 2 hours before

Why this is the answer

Standard guidance allows clear fluids up to 2 hours and food up to 6 hours before elective anaesthesia. Long fasting causes thirst, dehydration and discomfort without added safety.

Answer

D · Up to 2 hours before
3.Infection control & patient safety

Answer: B · Never swim or bathe alone

Why this is the answer

People with uncontrolled seizures are advised not to swim alone, to shower rather than bathe and to follow local laws on driving. Most normal activities can continue with sensible precautions.

Answer

B · Never swim or bathe alone
4.Infection control & patient safety

Answer: D · Explain the risks, notify the provider and follow the policy for leaving against advice

Why this is the answer

Holding a competent adult against their will can be false imprisonment. The nurse explains the risks, informs the provider, asks the patient to sign the against-advice form if they agree and documents the discussion.

Answer

D · Explain the risks, notify the provider and follow the policy for leaving against advice
5.Prioritization & delegation

Answer: C · An unresponsive patient with gasping, irregular breaths

Why this is the answer

An unresponsive patient with agonal breathing needs immediate airway and breathing support, which is ESI level 1. Chest pain with normal vital signs is high risk (level 2), and the others are lower levels.

Answer

C · An unresponsive patient with gasping, irregular breaths
6.Prioritization & delegation

Answer: B · A patient taking digoxin with a pulse of 48/min, nausea and a potassium of 3.0 mEq/L

Why this is the answer

Bradycardia and nausea in a patient taking digoxin suggest toxicity, and low potassium makes it more likely and more dangerous. A small weight change and controlled, known atrial fibrillation are stable.

Answer

B · A patient taking digoxin with a pulse of 48/min, nausea and a potassium of 3.0 mEq/L
7.Clinical nursing

Answer: A · A recognised side effect of the ACE inhibitor

Why this is the answer

Dry cough is a common side effect of ACE inhibitors such as ramipril. An angiotensin II receptor blocker is often substituted.

Answer

A · A recognised side effect of the ACE inhibitor
8.Clinical nursing

Answer: D · Spasm of the hand when a blood pressure cuff is inflated on the arm

Why this is the answer

Trousseau's sign, carpal spasm during cuff inflation, and Chvostek's sign, facial twitching on tapping the facial nerve, indicate neuromuscular irritability from low calcium.

Answer

D · Spasm of the hand when a blood pressure cuff is inflated on the arm
9.Lab values & electrolytes

Answer: B · Much calcium is bound to albumin, so total calcium falls even if ionized calcium is normal

Why this is the answer

About 40% of calcium is bound to albumin. When albumin is low, total calcium falls although ionized calcium may be normal. A corrected calcium or a measured ionized calcium gives the true picture.

Answer

B · Much calcium is bound to albumin, so total calcium falls even if ionized calcium is normal
10.Lab values & electrolytes

Answer: D · The supplements are reducing levothyroxine absorption

Why this is the answer

Calcium, iron and antacids bind levothyroxine in the gut and reduce absorption, so the TSH rises. Levothyroxine is taken on an empty stomach, usually 30–60 minutes before breakfast, separated from these supplements by about 4 hours.

Answer

D · The supplements are reducing levothyroxine absorption
11.Pharmacology

Answer: A · It reduces glucose production by the liver

Why this is the answer

Metformin mainly reduces hepatic gluconeogenesis and improves insulin sensitivity. Because it does not stimulate insulin release, hypoglycaemia is rare when used alone.

Answer

A · It reduces glucose production by the liver
12.Pharmacology

Answer: C · Contraceptive failure because the hormones are metabolised faster

Why this is the answer

Carbamazepine induces CYP3A4, speeding up the breakdown of oestrogen and progestogen. Contraceptive levels fall and pregnancy can occur, so another method is advised.

Answer

C · Contraceptive failure because the hormones are metabolised faster
13.Med-surg: cardiovascular & respiratory

Answer: C · It partly stimulates and partly blocks nicotine receptors

Why this is the answer

Varenicline is a partial agonist at nicotinic acetylcholine receptors. It reduces cravings and withdrawal and makes smoking less rewarding. Nausea is common, and patients are asked to report mood changes.

Answer

C · It partly stimulates and partly blocks nicotine receptors
14.Med-surg: cardiovascular & respiratory

Answer: B · "If I miss a dose, I will take two the next day."

Why this is the answer

Doubling up after a missed dose can cause over-anticoagulation and bleeding. Patients are usually told to take a missed dose the same day if they remember, or skip it and record it, then seek advice. Regular INR checks, telling other clinicians and checking interactions are correct.

Answer

B · "If I miss a dose, I will take two the next day."
15.Med-surg: neuro, endocrine & renal

Answer: D · Ask questions that can be answered with yes, no or a gesture

Why this is the answer

In expressive aphasia, comprehension is largely preserved. Short, closed questions, extra time, gestures and picture or word boards help. Shouting does not help, and constantly finishing sentences can frustrate the patient.

Answer

D · Ask questions that can be answered with yes, no or a gesture
16.Med-surg: neuro, endocrine & renal

Answer: B · Checking pre-meal glucose and reporting results out of range

Why this is the answer

Trained assistants can measure and record glucose and report abnormal results. Dose decisions, teaching and the assessment of an unstable patient need the registered nurse.

Answer

B · Checking pre-meal glucose and reporting results out of range
17.Med-surg: GI, perioperative & oncology

Answer: C · A metabolite can build up and cause seizures

Why this is the answer

Pethidine's metabolite norpethidine accumulates with repeated doses or kidney impairment and can cause agitation, tremor and seizures. Other opioids are preferred.

Answer

C · A metabolite can build up and cause seizures
18.Med-surg: GI, perioperative & oncology

Answer: B · Refer to the dietitian, start a nutrition plan and monitor intake

Why this is the answer

A MUST score of 2 or more indicates high risk of malnutrition. Poor nutrition delays healing, so the nurse refers to the dietitian, starts a care plan with food charts and supplements as advised, and rescreens regularly.

Answer

B · Refer to the dietitian, start a nutrition plan and monitor intake
19.Maternity & obstetric nursing

Answer: C · Their uterus contracts and relaxes more irregularly

Why this is the answer

In multiparas, and after overdistension such as twins, the uterus relaxes and contracts intermittently, causing stronger afterpains. Breastfeeding increases them through oxytocin.

Answer

C · Their uterus contracts and relaxes more irregularly
20.Maternity & obstetric nursing

Answer: B · Call for urgent help and start fluid resuscitation

Why this is the answer

Tachycardia, hypotension and cool peripheries indicate hypovolaemic shock. Help is called, IV access secured, fluids and blood given as prescribed, and the cause of bleeding treated.

Answer

B · Call for urgent help and start fluid resuscitation
21.Pediatric nursing

Answer: B · The reading will be falsely high

Why this is the answer

A cuff that is too small gives falsely high readings, and one that is too large gives falsely low readings. The bladder width should be about 40% of the arm circumference.

Answer

B · The reading will be falsely high
22.Pediatric nursing

Answer: A · Giving IV antibiotics as soon as possible, ideally within the first hour

Why this is the answer

In septic shock, IV antibiotics are given as soon as possible, ideally within an hour of recognition, after cultures are taken if this does not cause delay. Fluid resuscitation and close monitoring are started at the same time.

Answer

A · Giving IV antibiotics as soon as possible, ideally within the first hour
23.Mental health nursing

Answer: A · Serotonin syndrome

Why this is the answer

St John's wort has serotonergic effects, so combining it with an SSRI can cause serotonin syndrome. It also induces liver enzymes and interacts with many other drugs, so patients should tell the prescriber about herbal products.

Answer

A · Serotonin syndrome
24.Mental health nursing

Answer: C · Stay with him and inform the team at once, so he can be urgently assessed under mental health law

Why this is the answer

A voluntary patient who shows immediate serious risk may need urgent assessment under mental health legislation, which often includes short-term holding powers for nurses. The nurse acts quickly to keep him safe.

Answer

C · Stay with him and inform the team at once, so he can be urgently assessed under mental health law
25.Nursing math & unit conversions

Answer: T = 104.4 °F

Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.

Multiply by 9/5

40.2·9/5 = 72.36

Add 32

T = 72.36 + 32 = 104.4 °F

Answer

T = 104.4 °F
26.Nursing math & unit conversions

Answer: D = 25 mcg/min

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 = 1.5 mg/h × (1000 mcg/1 mg) × (1 h/60 min)

Calculate

D = 1500/60 = 25 mcg/min

Answer

D = 25 mcg/min
27.Dosage calculations

Answer: V = 3.6 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 = 7.5·24 = 180 mg

Volume

V = 180/50 = 3.6 mL

On the syringe

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

Answer

V = 3.6 mL
28.Dosage calculations

Answer: V = 0.86 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 = 860/1000 = 0.86 mL

On the syringe

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

Answer

V = 0.86 mL
29.IV infusion rates

Answer: V = 200 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 = 100·2 = 200 mL

Answer

V = 200 mL
30.IV infusion rates

Answer: t = 1.2 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.

Rate in mL/h

42·60/15 = 168 mL/h

Time left

t = 200/168 = 1.19 ≈ 1.2 h

Answer

t = 1.2 h
31.IV fluids & fluid balance

Answer: U = 2.08 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

475 + 200 + 175 + 350 = 1200 mL

Per kilogram per hour

U = 1200/(48·12) = 2.083 ≈ 2.08 mL/kg/h

Answer

U = 2.08 mL/kg/h
32.IV fluids & fluid balance

Answer: V = 380 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

06:00 → 07:30 = 1.5 h

Volume infused

80·1.5 = 120 mL

Volume left

V = 500 − 120 = 380 mL

Answer

V = 380 mL
33.Clinical assessment scores

Answer: NEWS2 = 9

NEWS2 (National Early Warning Score 2, Royal College of Physicians 2017): score each of the seven parameters with the chart (respiration rate, SpO₂ on scale 1, air or supplemental oxygen, systolic blood pressure, pulse, consciousness on the ACVPU scale and temperature) and add the scores. Clinical risk: 0–4 low; a score of 3 in any single parameter low–medium; 5–6 medium; 7 or more high. A total of 5 or more needs an urgent response.

Score each parameter

RR 18/min → 0
SpO₂ 92% → 2
on air → 0
SBP 88 mmHg → 3
HR 130/min → 2
alert (A) → 0
T 39.6 °C → 2

Add

NEWS2 = 0 + 2 + 0 + 3 + 2 + 0 + 2 = 9

Answer

NEWS2 = 9
34.Clinical assessment scores

Answer: healthy weight

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 = 71/1.94² = 18.86

Category

healthy weight

Answer

healthy weight

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