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

At what angle is a subcutaneous injection usually given?

1. A90 degrees after stretching the skin flat
2. BAlways exactly 15 degrees, with the skin stretched flat
3. CAlways parallel to the skin
4. D45 to 90 degrees, depending on the amount of fat

A patient has been taught breathing exercises before surgery. Which statement shows a need for further teaching?

1. A"I'll hold a pillow over the wound when I cough."
2. B"I'll ask for pain relief if pain stops me breathing deeply."
3. C"I'll take some slow deep breaths every hour."
4. D"I'll avoid coughing so I don't hurt my stitches."

Which IV fluid can be given with packed red blood cells in the same line?

1. ALactated Ringer’s (Hartmann’s) solution
2. B5% dextrose in water
3. C5% dextrose in 0.45% sodium chloride
4. D0.9% sodium chloride

A patient is receiving a high-alert drug by continuous infusion. At handover, which practice is safest?

1. AThe incoming nurse checks it at the end of the shift
2. BBoth nurses check the pump and bag against the prescription
3. CThe outgoing nurse says that “the pump is fine” at the desk
4. DOnly the rate is checked, not the drug or concentration

A nurse teaches foot care to a patient with diabetes. Which statement shows a need for further teaching?

1. A“I will check the soles of my feet every day with a mirror.”
2. B“I will dry well between my toes after washing.”
3. C“I will wear shoes that fit well, even at home.”
4. D“I will soak my feet in hot water every evening.”

A child is admitted with a suspected Wilms tumor (nephroblastoma). Which instruction is most important for all staff?

1. AGive a warm bath with abdominal massage
2. BMeasure abdominal girth by pressing firmly
3. CDo not palpate the abdomen
4. DEncourage the child to play contact sports

Which blood result often rises in an upper GI bleed because blood is digested in the gut?

1. AGlucose
2. BUrea (blood urea nitrogen)
3. CSodium
4. DCalcium

Which finding most strongly suggests a pulmonary embolism in a postoperative patient?

1. ASudden breathlessness and pleuritic chest pain with tachycardia
2. BGradual onset of cough with yellow sputum and mild fever over a week
3. CWheeze that improves with salbutamol
4. DSlow heart rate with high blood pressure

Which laboratory value best reflects the cause of confusion in a patient with severe liver disease and a flapping tremor?

1. AA low serum potassium only
2. BA raised troponin
3. CA raised serum ammonia
4. DA low serum lipase

A patient's total calcium is 7.6 mg/dL and the albumin is 2.0 g/dL. Using the common correction (add 0.8 mg/dL for each 1 g/dL that albumin is below 4.0), what is the corrected calcium?

1. A7.6 mg/dL, below the normal range
2. B11.6 mg/dL, above the normal range
3. C9.2 mg/dL, within the normal range
4. D6.0 mg/dL, well below the normal range

How should a topical corticosteroid cream usually be applied?

1. AOn broken, infected skin to speed healing
2. BAs a thin layer to the affected area only, as directed
3. CUnder a tight plastic dressing every night without advice
4. DAs a thick layer over the whole body

An older patient with coronary artery disease is starting levothyroxine for hypothyroidism. Why is a low starting dose used?

1. AOlder patients absorb levothyroxine much better, so small doses are all they need
2. BLevothyroxine causes severe hypoglycaemia in older patients
3. CHigh starting doses cause permanent hypothyroidism
4. DFast replacement raises cardiac oxygen demand and can cause angina

A patient uses a salbutamol (albuterol) inhaler and a steroid inhaler at the same times each day. Which order is usually taught?

1. AThe order makes no difference to either drug
2. BSteroid first, then salbutamol straight afterwards
3. CBoth inhalers puffed together in one breath
4. DSalbutamol first, then the steroid after a short wait

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

1. AUrine specific gravity every four hours
2. BPupil size and reaction to light every 15 minutes
3. CCirculation, sensation and movement of the hand, and the site
4. DBowel sounds and abdominal girth every hour after the test

A routine blood test shows a potassium of 6.4 mmol/L. The lab reports that the sample was haemolysed. The patient feels well. What should the nurse do?

1. AInform the doctor and arrange an urgent repeat sample
2. BIgnore it, because haemolysis always gives a normal result
3. CStart dialysis as soon as possible
4. DGive oral potassium supplements straight away

Which of these patients with acute ischaemic stroke is least likely to be eligible for IV thrombolysis?

1. AA patient whose blood pressure is 170/95 mmHg
2. BA patient whose symptoms began 90 minutes ago
3. CA patient who had major abdominal surgery five days ago
4. DA patient whose CT scan shows no sign of any intracranial bleeding

Which statement about multimodal analgesia is correct?

1. AIt is a method used only for long-term chronic pain
2. BDrugs with different actions are combined to reduce opioid needs
3. COnly one analgesic should ever be given at any one time
4. DSeveral different opioids are combined for a stronger overall effect

A patient with three fractured ribs is taking shallow breaths because of pain. Why is effective analgesia a priority?

1. AGood analgesia makes rib fractures heal fully within a few days
2. BShallow breathing can lead to atelectasis and pneumonia
3. CPain relief is only needed for the patient's comfort
4. DRib pain always means the heart is damaged

What is a "reactive" non-stress test?

1. ALate decelerations with every contraction
2. BAt least 2 fetal heart rate accelerations within 20 minutes
3. CNo accelerations of the fetal heart rate within 40 minutes
4. DA baseline heart rate above 160 bpm

Which statement by a woman with postnatal depression shows that the nurse's teaching has been effective?

1. A"Depression after birth means I am a bad mother."
2. B"I should keep my feelings to myself so I don't worry my family."
3. C"I will tell my midwife or doctor if I have thoughts of harming myself."
4. D"If I take medicine I can never breastfeed again."

How should the nurse measure the heart rate of a 9-month-old?

1. ARead it from the pulse oximeter only
2. BCount the radial pulse for 15 seconds and multiply by 4
3. CCount the carotid pulse for 30 seconds and multiply by 2
4. DCount the apical pulse for a full minute

On day 5 of chickenpox, a child has a fever again, and one area of skin around some spots has become red, hot, swollen and very painful. What should the nurse suspect?

1. ANormal healing of chickenpox spots
2. BAn allergy to calamine lotion
3. CA second attack of chickenpox caused by a different strain
4. DA secondary bacterial skin infection

Which side effects should the nurse monitor for in a patient starting donepezil?

1. ATremor, thirst and passing large amounts of urine
2. BWeight gain and high blood glucose
3. CDry mouth, constipation and urinary retention
4. DNausea, diarrhoea and a slow heart rate

The day before discharge, a patient with depression says, "Soon I'll finally be at peace and won't be a burden to anyone." What should the nurse do?

1. ASay she will feel better at home
2. BAsk directly whether she is thinking of suicide and inform the team before discharge goes ahead
3. CNote the remark in her record and let the discharge go ahead as planned, without any further action
4. DAssume she means she is relieved about going home

Practice exercise (made-up values, not clinical guidance). A dose is charted at 10:45 PM. Which entry is the same time on the 24-hour clock? Click it.

1. 122:45
2. 223:45
3. 321:45
4. 410:45

Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 1 tbsp of liquid supplement, 3 tsp of cough syrup, 3 cups of tea, 3 fl oz of juice. Using the equivalents given, find the total oral intake V in mL.

A child weighing 37 kg is prescribed 10 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?

The prescription is 550 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?

Infuse 250 mL over 4 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

1500 mL was ordered over 8 hours. After 4 hours you find that 930 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?

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 fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 08:45 and runs by pump at 120 mL/h. How many mL V are left in the bag at 13:45?

Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: yes; secondary diagnosis: yes; ambulatory aid: holds on to furniture; IV therapy or saline lock: yes; gait: normal, bed rest or wheelchair; mental status: knows own limits. Find the Morse total MFS.

Practice exercise (made-up values, not clinical guidance). At 5 minutes after birth, a practice newborn has a pink body with blue hands and feet, a heart rate of 65/min, a grimace when stimulated, some flexion of the arms and legs and slow, irregular breathing with a weak cry. Score the APGAR and click how the score is interpreted.

1. 1reassuring
2. 2moderately abnormal
3. 3low