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 should a tourniquet not be left on for a long time before taking blood?

  1. AIt can change the results, for example by concentrating the blood
  2. BIt makes the patient's arm grow stronger
  3. CIt makes the blood turn blue in the tube
  4. DIt stops the needle from entering the vein because the vein is too hard
2.Nursing fundamentalsHard

An elderly patient on intravenous fluids becomes breathless, with crackles in the lungs and swollen ankles. What is the most likely problem?

  1. AFluid overload
  2. BNormal response to IV fluids
  3. CDehydration
  4. DHypoglycaemia
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

During a procedure, a nurse sees that the team is about to start without a time-out. What should the nurse do?

  1. ASay nothing, because the surgeon is responsible for the procedure
  2. BWait and raise the issue after the procedure is finished
  3. CSpeak up clearly and stop the start until the time-out is done
  4. DReport it to the manager at the end of the week
5.Prioritization & delegationMedium

After handover, which patient should the nurse see first?

  1. AA patient with pneumonia, temperature 38.2 °C, who had an antipyretic 30 minutes ago
  2. BA patient two days after hip replacement with pain of 5/10
  3. CA patient with diabetes whose glucose before breakfast is 160 mg/dL (8.9 mmol/L)
  4. DA patient with asthma who is using accessory muscles and has an SpO₂ of 88%
6.Prioritization & delegationHard

On an addiction unit, which patient should the nurse assess first?

  1. ADrowsy with pinpoint pupils and a respiratory rate of 7/min
  2. BAnxious, with goose bumps, stomach cramps and loose stools
  3. CAsking for an extra blanket and a hot drink
  4. DYawning, with a runny nose and dilated pupils
7.Clinical nursingMedium

Which measure helps prevent delirium in older inpatients?

  1. AKeeping the lights on all night
  2. BMoving the patient to a different bed each night to give them a change of scene
  3. CRestricting fluids to avoid incontinence
  4. DReorientation, glasses and hearing aids in use, and good sleep and hydration
8.Clinical nursingHard

Which patient should the nurse assess first?

  1. AA patient with COPD whose SpO2 is 89% and within their target range
  2. BA patient with diabetes whose glucose is 11 mmol/L (198 mg/dL) before lunch
  3. CA patient with asthma who can only speak in single words
  4. DA postoperative patient who rates their pain as 6/10
9.Lab values & electrolytesMedium

A patient receiving chemotherapy has an ANC of 300/µL and a new temperature of 38.3 °C (100.9 °F). What should the nurse do first?

  1. AReport it at once so cultures and antibiotics start quickly
  2. BRemove extra blankets and offer a tepid sponge bath
  3. CGive acetaminophen (paracetamol) and recheck the temperature in 4 hours
  4. DEncourage oral fluids and record the fever in the chart
10.Lab values & electrolytesHard

A man of Mediterranean descent develops dark urine, jaundice and a falling hemoglobin a few days after eating fava beans. Which condition is most likely?

  1. AVitamin B12 deficiency anemia
  2. BSickle cell crisis with vaso-occlusion
  3. CIron-deficiency anemia from poor diet
  4. DG6PD deficiency with acute hemolysis
11.PharmacologyMedium

A man taking tamsulosin is planning cataract surgery. What should the nurse advise?

  1. AStop the drug for one day and no further action is needed
  2. BTake a double dose on the day of surgery
  3. CTell the eye surgeon, as it can cause floppy iris syndrome
  4. DThe drug has no link with eye surgery
12.PharmacologyHard

A patient receiving a phenylephrine infusion has a rise in blood pressure and a fall in heart rate. What is the best explanation?

  1. APhenylephrine directly blocks beta-1 receptors in the heart's conduction system
  2. BThe fall in heart rate shows phenylephrine toxicity of the AV node
  3. CAlpha-1 vasoconstriction raises blood pressure and causes reflex bradycardia
  4. DPhenylephrine stimulates muscarinic receptors
13.Med-surg: cardiovascular & respiratoryMedium

Where is the V1 electrode placed for a 12-lead ECG?

  1. AThe fifth intercostal space in the mid-axillary line
  2. BOver the left nipple
  3. CThe fourth intercostal space just right of the sternum
  4. DJust below the left collarbone
14.Med-surg: cardiovascular & respiratoryHard

After cardiac catheterisation via the radial artery, which assessment is most important?

  1. ABowel sounds and abdominal girth every hour after the test
  2. BPupil size and reaction to light every 15 minutes
  3. CCirculation, sensation and movement of the hand, and the site
  4. DUrine specific gravity every four hours
15.Med-surg: neuro, endocrine & renalMedium

How should peritoneal dialysis fluid be warmed before use?

  1. AIt should be used cold from the fridge
  2. BIn a dedicated dry-heat warmer
  3. CIn a bowl of hot tap water
  4. DIn a microwave oven
16.Med-surg: neuro, endocrine & renalHard

A patient has erratic glucose readings. The nurse finds a soft, rubbery lump where they always inject. What is the most important teaching?

  1. AKeep injecting into the lump, because it hurts less there
  2. BDouble the insulin dose because the lump blocks the insulin
  3. CMassage the lump firmly after every injection
  4. DUse healthy sites and check glucose often, as less insulin may be needed
17.Med-surg: GI, perioperative & oncologyMedium

Which patient is at highest risk of refeeding syndrome?

  1. AA healthy adult after an overnight fast for minor surgery
  2. BA patient with a normal BMI eating three meals a day
  3. CA patient who missed one lunch because of a scan
  4. DAn underweight patient who has eaten very little for 10 days
18.Med-surg: GI, perioperative & oncologyHard

In recovery, an awake and anxious patient cannot lift their head, and their breaths are shallow and weak. What is the most likely cause?

  1. AOpioid overdose with pinpoint pupils
  2. BNormal tiredness after surgery
  3. CA simple panic attack
  4. DResidual neuromuscular blockade
19.Maternity & obstetric nursingMedium

At 1 minute, a newborn's heart rate is 90/min. How many points does the heart rate receive in the APGAR score?

  1. A1
  2. B0
  3. C2
  4. D3
20.Maternity & obstetric nursingHard

Why does the foramen ovale close soon after birth?

  1. AThe umbilical vein carries more blood to the heart
  2. BProstaglandin levels rise in the newborn's blood
  3. CLeft atrial pressure rises above right atrial pressure
  4. DBlood flow to the lungs decreases after birth
21.Pediatric nursingMedium

In a child with hypovolaemic shock, which finding is usually a late sign?

  1. AProlonged capillary refill
  2. BLow blood pressure
  3. CTachycardia
  4. DCool extremities
22.Pediatric nursingHard

A few weeks after diagnosis of type 1 diabetes, a child's insulin needs fall a lot. The parents think the diabetes is cured. What should the nurse explain?

  1. AThe diagnosis was probably wrong, and insulin can be stopped
  2. BThe child has become insulin resistant and now needs tablets instead of injections
  3. CThe diabetes has turned into type 2 diabetes
  4. DThis is the temporary "honeymoon" phase; insulin is still needed
23.Mental health nursingMedium

An older man has poor concentration, memory complaints and low mood that started after his wife died. Why is careful assessment important?

  1. ADepression in older adults can look like dementia and is treatable
  2. BLow mood after the loss of a partner is always normal grief and never needs any assessment
  3. CMemory complaints in older adults are always caused by dementia
  4. DOlder adults cannot be treated for depression
24.Mental health nursingHard

A patient who takes fluoxetine in the evening says he has had trouble falling asleep since starting it. What should the nurse suggest?

  1. AStop the fluoxetine at once and tell the prescriber at his next appointment
  2. BDiscuss with the prescriber whether he can take it in the morning instead
  3. CTake a double dose at night to make him sleepy
  4. DDrink a small glass of wine or beer before bed to help him fall asleep
25.Nursing math & unit conversionsMedium
67.6580 kg? kground to 0.1 kg

Practice exercise (made-up values, not clinical guidance). A weight conversion gives 67.6580 kg. The rule in this exercise is that weights are rounded to the nearest tenth of a kilogram. What value x do you record?

67.6580 kg
x = kg
26.Nursing math & unit conversionsHard
00:0019:4008:05t = ?

Practice exercise (made-up values, not clinical guidance). An infusion starts at 19:40 and finishes at 08:05 the next morning (24-hour clock). How many hours t did it run? Give the answer in hours as a decimal, rounded to two decimal places.

19:4008:05
t = h
27.Dosage calculationsMedium
2%100 mLm = ? mg

How many milligrams of drug m are in 100 mL of a 2% (w/v) solution?

2% w/v100 mL
m = mg
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 640 micrograms. The ampoule contains 2 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

640 mcg2 mg/mL
V = mL
29.IV infusion ratesMedium
60 gtt/mL100 mL/h? gtt/min

An infusion is ordered at 100 mL/h, but no pump is available. It runs by gravity through a giving set of 60 gtt/mL. Find the drip rate R in drops per minute.

100 mL/h60 gtt/mL
R = gtt/min
30.IV infusion ratesHard
630 mLleft? mL/h3 h left

1500 mL was ordered over 8 hours. After 5 hours you find that 630 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?

1500 mL / 8 hafter 5 h: 630 mL
Δ = %
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftsoup180 mLwater240 mLjelly100 mLIV infusion80 mL/h × 8 hIV antibiotic1 × 100 mLurine325 mLurine500 mLwound drain60 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The patient weighs 79 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

79 kg8 hurine: 325 mLurine: 500 mLwound drain: 60 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
500 mL→ 60 mL/hstart 09:00ttotal​ = ? h100 mL/h × 4 h

Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 09:00 at 100 mL/h. After 4 hours the rate is changed to 60 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 mL100 mL/h · 4 h60 mL/h
t = h
33.Clinical assessment scoresMedium
S? / 4+M? / 4+A? / 4+Mob? / 4+N? / 4+F? / 3Σ?

Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: slightly limited; moisture: rarely moist; activity: walks occasionally; mobility: very limited; nutrition: excellent; friction and shear: potential problem. Find the Braden total B.

6–23
B =
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 124 kg and is 186 cm tall. Calculate the BMI and click the WHO weight category.

124 kg186 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: A · It can change the results, for example by concentrating the blood

Why this is the answer

Prolonged tourniquet time causes fluid to leave the vessel and can alter results such as potassium and protein. It is applied only as long as needed.

Answer

A · It can change the results, for example by concentrating the blood
2.Nursing fundamentals

Answer: A · Fluid overload

Why this is the answer

Breathlessness, crackles, raised respiratory rate and oedema during IV therapy suggest fluid overload. The nurse should stop or slow the infusion as appropriate, sit the patient up and escalate.

Answer

A · Fluid overload
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: C · Speak up clearly and stop the start until the time-out is done

Why this is the answer

The time-out is a key step to prevent wrong-patient, wrong-site and wrong-procedure errors. Any team member who sees it being skipped should speak up and halt the procedure until it is done.

Answer

C · Speak up clearly and stop the start until the time-out is done
5.Prioritization & delegation

Answer: D · A patient with asthma who is using accessory muscles and has an SpO₂ of 88%

Why this is the answer

Accessory muscle use and low SpO₂ in asthma show acute respiratory distress, a breathing problem. The raised glucose, moderate pain and a fever already being treated are real but less urgent.

Answer

D · A patient with asthma who is using accessory muscles and has an SpO₂ of 88%
6.Prioritization & delegation

Answer: A · Drowsy with pinpoint pupils and a respiratory rate of 7/min

Why this is the answer

Pinpoint pupils, drowsiness and slow breathing suggest opioid overdose, which can be fatal. Yawning, a runny nose, dilated pupils and cramps are signs of opioid withdrawal, which is distressing but rarely life-threatening.

Answer

A · Drowsy with pinpoint pupils and a respiratory rate of 7/min
7.Clinical nursing

Answer: D · Reorientation, glasses and hearing aids in use, and good sleep and hydration

Why this is the answer

Multicomponent prevention, including orientation, sensory aids, hydration, nutrition, mobility, sleep and avoiding unnecessary moves or drugs, reduces delirium.

Answer

D · Reorientation, glasses and hearing aids in use, and good sleep and hydration
8.Clinical nursing

Answer: C · A patient with asthma who can only speak in single words

Why this is the answer

Being unable to complete sentences is a sign of acute severe or life-threatening asthma, an airway and breathing emergency. The other patients need attention but are not immediately life-threatened.

Answer

C · A patient with asthma who can only speak in single words
9.Lab values & electrolytes

Answer: A · Report it at once so cultures and antibiotics start quickly

Why this is the answer

Neutropenic fever is a medical emergency, because infection can progress to sepsis rapidly without the usual signs of inflammation. Blood cultures are taken and broad-spectrum antibiotics are started promptly as prescribed.Checked against: Watch Out for Fever · CDC (2024); What You Need to Know: Neutropenia and Risk for Infection · CDC

Answer

A · Report it at once so cultures and antibiotics start quickly
10.Lab values & electrolytes

Answer: D · G6PD deficiency with acute hemolysis

Why this is the answer

G6PD deficiency makes red cells vulnerable to oxidative damage. Fava beans, some drugs (such as primaquine and some sulfonamides) and infections can trigger acute hemolysis, with dark urine, jaundice and anemia. Triggers are avoided.

Answer

D · G6PD deficiency with acute hemolysis
11.Pharmacology

Answer: C · Tell the eye surgeon, as it can cause floppy iris syndrome

Why this is the answer

Tamsulosin can cause intraoperative floppy iris syndrome, which complicates cataract surgery. The surgeon needs to know so that the technique can be adapted.

Answer

C · Tell the eye surgeon, as it can cause floppy iris syndrome
12.Pharmacology

Answer: C · Alpha-1 vasoconstriction raises blood pressure and causes reflex bradycardia

Why this is the answer

Phenylephrine is a pure alpha-1 agonist with little direct cardiac action. The higher blood pressure activates baroreceptors, which increase vagal tone and slow the heart.

Answer

C · Alpha-1 vasoconstriction raises blood pressure and causes reflex bradycardia
13.Med-surg: cardiovascular & respiratory

Answer: C · The fourth intercostal space just right of the sternum

Why this is the answer

V1 is placed in the fourth intercostal space at the right sternal edge, and V2 at the left sternal edge. V4 is in the fifth intercostal space in the mid-clavicular line, and V6 in the mid-axillary line at the same level. Wrong placement can mimic or hide changes.

Answer

C · The fourth intercostal space just right of the sternum
14.Med-surg: cardiovascular & respiratory

Answer: C · Circulation, sensation and movement of the hand, and the site

Why this is the answer

After radial access, the compression device and puncture site are checked for bleeding or haematoma, and the hand for colour, warmth, capillary refill, sensation and movement. Radial artery occlusion and forearm compartment syndrome are possible complications.

Answer

C · Circulation, sensation and movement of the hand, and the site
15.Med-surg: neuro, endocrine & renal

Answer: B · In a dedicated dry-heat warmer

Why this is the answer

Warming dialysate to body temperature improves comfort. A microwave heats unevenly and can create hot spots; soaking can contaminate the ports. Manufacturer-approved dry heat warmers are used.

Answer

B · In a dedicated dry-heat warmer
16.Med-surg: neuro, endocrine & renal

Answer: D · Use healthy sites and check glucose often, as less insulin may be needed

Why this is the answer

Lipohypertrophy causes poor and unpredictable absorption. When the patient switches to healthy tissue, more insulin is absorbed, so hypos can occur. Glucose is monitored closely, and doses may need to be reduced.

Answer

D · Use healthy sites and check glucose often, as less insulin may be needed
17.Med-surg: GI, perioperative & oncology

Answer: D · An underweight patient who has eaten very little for 10 days

Why this is the answer

Risk factors include a low BMI, little or no intake for over 5 days, significant weight loss, alcohol misuse and low electrolytes before feeding. These patients start nutrition slowly with electrolyte monitoring.

Answer

D · An underweight patient who has eaten very little for 10 days
18.Med-surg: GI, perioperative & oncology

Answer: D · Residual neuromuscular blockade

Why this is the answer

Remaining muscle relaxant causes weakness, poor head lift and shallow breathing in an awake patient. The nurse supports breathing, gives oxygen and calls the anaesthetist, who may give a reversal agent.

Answer

D · Residual neuromuscular blockade
19.Maternity & obstetric nursing

Answer: A · 1

Why this is the answer

Heart rate scores 0 if absent, 1 if below 100/min and 2 if 100/min or more. Each of the five APGAR signs scores 0–2, so the maximum per sign is 2.

Answer

A · 1
20.Maternity & obstetric nursing

Answer: C · Left atrial pressure rises above right atrial pressure

Why this is the answer

With the first breaths, pulmonary resistance falls and more blood returns to the left atrium, while cord clamping lowers right-sided pressure. The higher left atrial pressure pushes the flap of the foramen ovale shut.

Answer

C · Left atrial pressure rises above right atrial pressure
21.Pediatric nursing

Answer: B · Low blood pressure

Why this is the answer

Children maintain blood pressure through vasoconstriction and tachycardia until a large volume is lost. Hypotension means decompensated shock and impending collapse.

Answer

B · Low blood pressure
22.Pediatric nursing

Answer: D · This is the temporary "honeymoon" phase; insulin is still needed

Why this is the answer

After insulin treatment starts, remaining beta cells may recover partly, so insulin needs fall for weeks to months. This partial remission is temporary; insulin should continue, with doses adjusted to glucose readings.

Answer

D · This is the temporary "honeymoon" phase; insulin is still needed
23.Mental health nursing

Answer: A · Depression in older adults can look like dementia and is treatable

Why this is the answer

Depression can cause slowed thinking and poor concentration that resemble dementia, sometimes called pseudodementia. Unlike dementia, the cognitive problems usually improve when the depression is treated.

Answer

A · Depression in older adults can look like dementia and is treatable
24.Mental health nursing

Answer: B · Discuss with the prescriber whether he can take it in the morning instead

Why this is the answer

Fluoxetine can be activating and cause insomnia. Taking it in the morning, with the prescriber's agreement, often helps. Stopping suddenly or using alcohol is unsafe.

Answer

B · Discuss with the prescriber whether he can take it in the morning instead
25.Nursing math & unit conversions

Answer: x = 67.7 kg

Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.

Digit in the tenths place

67.6580 → 6

Only the next digit decides

67.6580 → 5
5 is 5 or more, so round 6 up.
The digits after it (8) are ignored: round once, never step by step.

Round

x = 67.7 kg

Answer

x = 67.7 kg
26.Nursing math & unit conversions

Answer: t = 12.42 h

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.

Before midnight

19:40 → 24:00 = 260 min

After midnight

00:00 → 08:05 = 485 min

Total

260 + 485 = 745 min
t = 745/60 = 12.42 h

Answer

t = 12.42 h
27.Dosage calculations

Answer: m = 2000 mg

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

Concentration

2% = 2 g/100 mL = 20 mg/mL

Mass of drug

m = 20·100 = 2000 mg

Answer

m = 2000 mg
28.Dosage calculations

Answer: V = 0.32 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.

Same units

2 mg/mL = 2000 mcg/mL

Volume

V = 640/2000 = 0.32 mL

Answer

V = 0.32 mL
29.IV infusion rates

Answer: R = 100 gtt/min

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

Millilitres per minute

100/60 = 1.667 mL/min

Drip rate

R = 1.667·60 = 100 gtt/min

Answer

R = 100 gtt/min

With a microdrip set (60 gtt/mL), gtt/min equals mL/h.

30.IV infusion rates

Answer: Δ = 12 %

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

Original rate

1500/8 = 187.5 mL/h

New rate

R = 630/3 = 210 mL/h

Percentage change

Δ = (210 − 187.5)/187.5·100% = 12%

Answer

Δ = 12%

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

31.IV fluids & fluid balance

Answer: U = 1.31 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

325 + 500 = 825 mL

Per kilogram per hour

U = 825/(79·8) = 1.305 ≈ 1.31 mL/kg/h

Answer

U = 1.31 mL/kg/h
32.IV fluids & fluid balance

Answer: t = 5.7 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

100·4 = 400 mL
500 − 400 = 100 mL left

Second part

100/60 = 1.667 h

Total time

t = 4 + 1.667 = 5.667 ≈ 5.7 h

Answer

t = 5.7 h

That is about 5 h 40 min, so the bag runs out at about 14:40.

33.Clinical assessment scores

Answer: B = 18

Braden scale: six subscales for pressure-injury risk. Sensory perception, moisture, activity, mobility and nutrition score 1 to 4, from the worst level (1) to no problem (4); friction and shear scores 1 to 3. The total runs from 6 to 23, and a lower total means a higher risk. Common bands: 19–23 not at risk, 15–18 mild risk, 13–14 moderate risk, 10–12 high risk and 9 or below very high risk.

Score each subscale

sensory perception: slightly limited → 3
moisture: rarely moist → 4
activity: walks occasionally → 3
mobility: very limited → 2
nutrition: excellent → 4
friction and shear: potential problem → 2

Add

Braden total = 3 + 4 + 3 + 2 + 4 + 2 = 18

Answer

B = 18
34.Clinical assessment scores

Answer: obesity class II

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 = 124/1.86² = 35.84

Category

obesity class II

Answer

obesity class II

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