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.

New problemsBack to the course

In the print window, choose “Save as PDF” to keep a copy on your device.

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

At what angle is an intramuscular injection given?

  1. A15 degrees
  2. B90 degrees
  3. C30 degrees
  4. D45 degrees
2.Nursing fundamentalsHard

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

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

A patient has fallen, and the nurse completes an incident report. Which statement about this report is correct?

  1. AA copy of it is placed in the patient’s chart so all staff know about the fall
  2. BIt is only needed when the patient is injured
  3. CIt replaces the need to document the fall in the patient’s record
  4. DIt is written factually and does not replace documenting the fall in the patient’s record
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. AExplain the risks, notify the provider and follow the policy for leaving against advice
  2. BHide the patient’s clothes and belongings so that they cannot leave the ward
  3. CApply wrist restraints until the provider arrives to speak with the patient
  4. DLock the doors so the patient cannot leave
5.Prioritization & delegationMedium

Which practice makes a shift handover safest?

  1. ALeaving a sticky note on the computer screen for the next nurse
  2. BA structured format, such as SBAR, with time for questions
  3. CA quick chat in the corridor with no notes taken
  4. DHanding over only the patients who had problems during the shift
6.Prioritization & delegationHard

A patient with MRSA in a wound is on contact precautions. Which instruction to the nursing assistant is correct?

  1. ANo special precautions are needed if the wound is covered with a dressing
  2. BWear a gown and gloves for contact with the patient or the room, and use dedicated equipment
  3. COnly wear gloves when touching the wound itself; skin and bedding are safe
  4. DWear a respirator mask in the room, because MRSA in a wound spreads through the air to others
7.Clinical nursingMedium

A patient taking a statin reports unexplained muscle pain and weakness. What should the nurse do?

  1. AReassure them that this is a sign the drug is working
  2. BAdvise more vigorous exercise to work through it
  3. CTell them to double the dose
  4. DReport it, as statins can cause muscle damage
8.Clinical nursingHard

A healthcare assistant reports four observations. Which one needs the nurse's immediate action?

  1. A"Ms Ali has walked to the bathroom on her own."
  2. B"Mrs Jones would like a cup of tea and her glasses cleaned."
  3. C"Mr Patel's breathing rate is 8 a minute and he's hard to wake."
  4. D"Mr Chen's blood pressure is 128/80 as usual."
9.Lab values & electrolytesMedium

A patient had a total gastrectomy. Which long-term therapy is needed to prevent anemia?

  1. AMonthly transfusions of red blood cells
  2. BLifelong oral folic acid tablets only
  3. CWeekly doses of oral vitamin K tablets
  4. DLifelong vitamin B12 replacement
10.Lab values & electrolytesHard

A patient has painless jaundice, itching, dark urine and pale stools. ALP is markedly raised, conjugated (direct) bilirubin is high and ALT is only mildly raised. What is the most likely cause?

  1. AAcute viral hepatitis with widespread liver cell damage
  2. BGilbert syndrome, a harmless inherited bilirubin disorder
  3. CBlockage of bile flow, for example by a tumor in the bile duct
  4. DIncreased breakdown of red blood cells (hemolytic anemia)
11.PharmacologyMedium

A patient starting niacin (nicotinic acid) complains of flushing and warmth after doses. Which advice may reduce this?

  1. ATake the niacin with a hot drink so that it dissolves and acts faster
  2. BTake aspirin 30 minutes before the niacin, if the prescriber agrees
  3. CDouble the dose to build tolerance faster
  4. DTake it on an empty stomach in a hot bath
12.PharmacologyHard

Which heart failure drug improves symptoms and reduces hospital admissions but has not been shown to reduce mortality?

  1. AA mineralocorticoid receptor antagonist such as spironolactone
  2. BDigoxin
  3. CAn ACE inhibitor
  4. DA beta blocker such as bisoprolol
13.Med-surg: cardiovascular & respiratoryMedium

Why must anti-embolism stockings be measured and fitted correctly?

  1. ALoose stockings make the patient's legs too warm at night
  2. BTight stockings work better, so the smallest size is always best
  3. CPoorly fitting stockings can cause pressure damage
  4. DCorrect fit is needed only to improve the appearance
14.Med-surg: cardiovascular & respiratoryHard

After hip surgery, a patient suddenly becomes breathless and anxious with a heart rate of 124/min, SpO₂ 86% on air and sharp pain on breathing. The chest sounds clear. What should the nurse do first?

  1. AGive oxygen, sit them up, call for urgent review and stay
  2. BWalk the patient round the ward to improve breathing
  3. CLie the patient flat and raise both legs on pillows
  4. DGive a sedative for the anxiety and recheck in an hour
15.Med-surg: neuro, endocrine & renalMedium

Which CSF result is most typical of bacterial meningitis?

  1. ACloudy fluid, many neutrophils, low glucose and high protein
  2. BClear fluid with normal cells, glucose and protein
  3. CClear fluid, many lymphocytes, normal glucose and slightly raised protein
  4. DBlood-stained fluid that clears in later tubes
16.Med-surg: neuro, endocrine & renalHard

During a TURP, a patient becomes confused and nauseated, with a slow pulse and a raised BP. The sodium is 121 mmol/L. What is most likely?

  1. AHypoglycaemia from fasting for many hours before surgery
  2. BTURP syndrome from absorbed irrigation fluid
  3. CA normal reaction to the spinal anaesthetic
  4. DAn allergic reaction to the catheter
17.Med-surg: GI, perioperative & oncologyMedium

A day after a spinal anaesthetic, a patient has a headache that is worse when sitting up and better when lying flat. What is the most likely cause?

  1. APost-dural puncture headache
  2. BRaised blood pressure from pain
  3. CA side effect of the antibiotic
  4. DMigraine caused by hospital lighting
18.Med-surg: GI, perioperative & oncologyHard

An immobile patient on opioids drinks very little. Which laxative choice is least appropriate?

  1. AA stimulant laxative taken regularly
  2. BAn osmotic laxative such as a macrogol
  3. CA stool softener with a stimulant laxative
  4. DA bulk-forming laxative used on its own
19.Maternity & obstetric nursingMedium

Why is indomethacin generally not used as a tocolytic after about 32 weeks?

  1. AIt can close the fetal ductus arteriosus too early
  2. BIt causes severe maternal hypertension
  3. CIt triggers maternal hypoglycaemia
  4. DIt stimulates stronger contractions late in pregnancy
20.Maternity & obstetric nursingHard

A labouring woman has had an epidural for 3 hours. The fundus is displaced and a bulge is seen above the pubic bone. What should the nurse do?

  1. ACheck for bladder distension and empty the bladder
  2. BStart an oxytocin infusion
  3. CIncrease the rate of the epidural
  4. DPrepare her for an emergency caesarean
21.Pediatric nursingMedium

Which approach best helps a 4-year-old during a vaccination?

  1. ATell the child the injection will not hurt at all
  2. BPromise a reward only if the child stays completely still and does not cry
  3. CHold the child upright on a parent's lap and use distraction, such as blowing bubbles
  4. DHave staff hold the child flat on the couch so the injection is quick
22.Pediatric nursingHard

A toddler swallowed a button battery 30 minutes ago and seems well. What is the correct action?

  1. AGive a glass of milk and observe at home
  2. BWait for the battery to pass naturally and check the nappies for several days
  3. CMake the toddler vomit
  4. DArrange immediate transfer to emergency care for imaging and removal
23.Mental health nursingMedium

An 86-year-old nursing home resident becomes acutely confused over two days. Which cause should be considered first?

  1. AA sudden onset of Alzheimer's disease
  2. BAn infection such as a urinary tract infection, or a medicine side effect
  3. CThe normal ageing process
  4. DA first episode of schizophrenia caused by moving into the home
24.Mental health nursingHard

Five days after starting haloperidol, a patient has a temperature of 40 °C, rigid limbs, confusion, fluctuating blood pressure and sweating. What should the nurse do first?

  1. AGive paracetamol for the fever and recheck the observations in 4 hours
  2. BEncourage him to exercise to reduce stiffness
  3. CWithhold the antipsychotic and get urgent medical help
  4. DGive another dose of haloperidol to calm him
25.Nursing math & unit conversionsMedium
12345678910111211:25?11:25 PM10:25 AM11:25 AM1:25 AM

Practice exercise (made-up values, not clinical guidance). A dose is charted at 11:25 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.

11:25
  1. 111:25 PM
  2. 210:25 AM
  3. 311:25 AM
  4. 41:25 AM
26.Nursing math & unit conversionsHard
00:0021:2007:45t = ?

Practice exercise (made-up values, not clinical guidance). An infusion starts at 21:20 and finishes at 07:45 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.

21:2007:45
t = h
27.Dosage calculationsMedium
30 kg15 mg/kg/day4× per dayD = ? mg

A patient weighs 30 kg. The prescribed dose is 15 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?

30 kg15 mg/kg/day4× per day
D = mg
28.Dosage calculationsHard
200 mg/5 mLV = ? mL

A patient weighs 68.2 lb. The prescription is 5 mg/kg as a single dose, and the stock contains 200 mg in 5 mL. Using 1 kg = 2.2 lb, what volume V do you give? Round to one decimal place.

68.2 lb5 mg/kg200 mg/5 mL1 kg = 2.2 lb
V = mL
29.IV infusion ratesMedium
250 mL20 gtt/mL3 h? gtt/min

Infuse 250 mL over 3 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

250 mL3 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
2 g500 mL? mL/h4 mg/min

A bag contains 2 g of a drug in 500 mL. The order is 4 mg per minute. At what rate R do you set the pump, in mL/h?

2 g/500 mL4 mg/min
R = mL/h
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftwater240 mLjuice100 mLjelly100 mLice chips100 mLIV infusion125 mL/h × 8 hIV antibiotic1 × 100 mLurine225 mLurine150 mLurine200 mLwound drain30 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 75 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

75 kg8 hurine: 225 mLurine: 150 mLurine: 200 mLwound drain: 30 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
1000 mL→ 200 mL/hstart 16:30ttotal​ = ? h100 mL/h × 2 h

Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 16:30 at 100 mL/h. After 2 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.

1000 mL100 mL/h · 2 h200 mL/h
t = h
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 16/min, SpO₂ 86% on supplemental oxygen, blood pressure 150/90 mmHg, pulse 92/min, alert, temperature 38.4 °C. What is the NEWS2 total score?

RR 16SpO₂ 86%O₂SBP 150HR 92AT 38.4 °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 108 kg and is 163 cm tall. Calculate the BMI and click the WHO weight category.

108 kg163 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: B · 90 degrees

Why this is the answer

Intramuscular injections are given at 90 degrees so the needle passes through the skin and fat into the muscle. Intradermal injections use about 10–15 degrees.

Answer

B · 90 degrees
2.Nursing fundamentals

Answer: B · "I'll avoid coughing so I don't hurt my stitches."

Why this is the answer

Avoiding coughing lets secretions collect and raises the risk of chest infection. Splinting the wound, deep breathing and good pain control are correct.

Answer

B · "I'll avoid coughing so I don't hurt my stitches."
3.Infection control & patient safety

Answer: D · It is written factually and does not replace documenting the fall in the patient’s record

Why this is the answer

The nurse documents the facts of the fall, the assessment and the care given in the patient’s record. The incident report is a separate quality-improvement document and is not filed in the chart. Policies differ on whether the record notes that a report was made: many US facilities advise against it, while many UK services record the report reference. Falls are reported whether or not there is an injury.

Answer

D · It is written factually and does not replace documenting the fall in the patient’s record
4.Infection control & patient safety

Answer: A · 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

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

Answer: B · A structured format, such as SBAR, with time for questions

Why this is the answer

Handover is a high-risk moment for errors. A structured format and the chance to ask questions help the next nurse understand each patient’s condition and priorities.

Answer

B · A structured format, such as SBAR, with time for questions
6.Prioritization & delegation

Answer: B · Wear a gown and gloves for contact with the patient or the room, and use dedicated equipment

Why this is the answer

MRSA spreads through direct contact and contaminated surfaces. Gown and gloves, hand hygiene and dedicated equipment prevent transmission; a respirator is not needed for contact precautions.

Answer

B · Wear a gown and gloves for contact with the patient or the room, and use dedicated equipment
7.Clinical nursing

Answer: D · Report it, as statins can cause muscle damage

Why this is the answer

Statins can cause myopathy and, rarely, rhabdomyolysis. Unexplained muscle symptoms should be reported so creatine kinase can be checked and the drug reviewed.

Answer

D · Report it, as statins can cause muscle damage
8.Clinical nursing

Answer: C · "Mr Patel's breathing rate is 8 a minute and he's hard to wake."

Why this is the answer

A low respiratory rate with reduced consciousness suggests respiratory depression, for example from opioids. It needs immediate assessment and escalation.

Answer

C · "Mr Patel's breathing rate is 8 a minute and he's hard to wake."
9.Lab values & electrolytes

Answer: D · Lifelong vitamin B12 replacement

Why this is the answer

Intrinsic factor from the stomach is needed to absorb vitamin B12 in the ileum. After a total gastrectomy, B12 must be replaced for life, usually by injection, to prevent macrocytic anemia and nerve damage.Checked against: Vitamin B12 or folate deficiency anaemia - Causes · NHS (2023); Vitamin B12 deficiency anemia · MedlinePlus (NIH) (2026)

Answer

D · Lifelong vitamin B12 replacement
10.Lab values & electrolytes

Answer: C · Blockage of bile flow, for example by a tumor in the bile duct

Why this is the answer

In obstruction, conjugated bilirubin backs up into the blood and is passed in the urine, making it dark, while stools are pale and ALP rises. Hemolysis and Gilbert syndrome raise unconjugated bilirubin; hepatitis raises ALT much more.Checked against: Bilirubin in Urine · MedlinePlus (NIH) (2024)

Answer

C · Blockage of bile flow, for example by a tumor in the bile duct
11.Pharmacology

Answer: B · Take aspirin 30 minutes before the niacin, if the prescriber agrees

Why this is the answer

Niacin causes prostaglandin-mediated vasodilation and flushing. Aspirin beforehand, taking it with food and avoiding hot drinks and alcohol reduce this effect.

Answer

B · Take aspirin 30 minutes before the niacin, if the prescriber agrees
12.Pharmacology

Answer: B · Digoxin

Why this is the answer

ACE inhibitors (or ARBs/ARNI), beta blockers, mineralocorticoid antagonists and SGLT2 inhibitors reduce mortality in heart failure with reduced ejection fraction. Digoxin improves symptoms and reduces admissions without reducing mortality.

Answer

B · Digoxin
13.Med-surg: cardiovascular & respiratory

Answer: C · Poorly fitting stockings can cause pressure damage

Why this is the answer

Stockings that are the wrong size or that roll down can act like a tourniquet and cause skin and pressure damage. They are measured to the leg, checked daily, and avoided in significant peripheral arterial disease, severe neuropathy or leg skin damage.

Answer

C · Poorly fitting stockings can cause pressure damage
14.Med-surg: cardiovascular & respiratory

Answer: A · Give oxygen, sit them up, call for urgent review and stay

Why this is the answer

Sudden breathlessness, tachycardia, pleuritic pain and hypoxaemia after orthopaedic surgery suggest pulmonary embolism. Immediate actions are supportive: oxygen to target saturation, upright positioning if blood pressure allows, urgent escalation and continuous monitoring, followed by investigations and anticoagulation as prescribed. Sedation could mask deterioration and depress breathing.

Answer

A · Give oxygen, sit them up, call for urgent review and stay
15.Med-surg: neuro, endocrine & renal

Answer: A · Cloudy fluid, many neutrophils, low glucose and high protein

Why this is the answer

Bacterial meningitis usually gives turbid CSF with raised neutrophils and protein and low glucose. Viral meningitis typically shows clear fluid with lymphocytes and normal glucose.

Answer

A · Cloudy fluid, many neutrophils, low glucose and high protein
16.Med-surg: neuro, endocrine & renal

Answer: B · TURP syndrome from absorbed irrigation fluid

Why this is the answer

In TURP syndrome, irrigating fluid is absorbed into the blood, causing fluid overload and dilutional hyponatraemia. Signs include confusion, nausea, bradycardia, hypertension and, if severe, seizures. It needs urgent medical treatment.

Answer

B · TURP syndrome from absorbed irrigation fluid
17.Med-surg: GI, perioperative & oncology

Answer: A · Post-dural puncture headache

Why this is the answer

CSF leaking through the dural puncture lowers pressure and causes a positional headache. Fluids, simple analgesia and caffeine may help, and the anaesthetist is informed; an epidural blood patch is sometimes needed.

Answer

A · Post-dural puncture headache
18.Med-surg: GI, perioperative & oncology

Answer: D · A bulk-forming laxative used on its own

Why this is the answer

Bulk-forming laxatives need good fluid intake and mobility and can worsen constipation or cause obstruction without them. They do not counter the effect of opioids on gut movement, so stimulant or osmotic laxatives are preferred.

Answer

D · A bulk-forming laxative used on its own
19.Maternity & obstetric nursing

Answer: A · It can close the fetal ductus arteriosus too early

Why this is the answer

Indomethacin inhibits prostaglandin synthesis. In the fetus this can cause premature closure of the ductus arteriosus and reduced fetal urine output with oligohydramnios, risks that increase with gestational age.

Answer

A · It can close the fetal ductus arteriosus too early
20.Maternity & obstetric nursing

Answer: A · Check for bladder distension and empty the bladder

Why this is the answer

Epidurals block bladder sensation, so the bladder can overfill. A full bladder can slow descent of the fetus and cause injury. The nurse should encourage voiding or catheterise per protocol.

Answer

A · Check for bladder distension and empty the bladder
21.Pediatric nursing

Answer: C · Hold the child upright on a parent's lap and use distraction, such as blowing bubbles

Why this is the answer

Upright comfort positions with a parent and distraction reduce fear and pain. Honest, simple explanations build trust; saying it won't hurt or making a reward depend on not crying increases distress.

Answer

C · Hold the child upright on a parent's lap and use distraction, such as blowing bubbles
22.Pediatric nursing

Answer: D · Arrange immediate transfer to emergency care for imaging and removal

Why this is the answer

Button batteries in the oesophagus can cause severe burns within 2 hours. Even a well-looking child needs urgent X-ray and, if the battery is in the oesophagus, endoscopic removal.

Answer

D · Arrange immediate transfer to emergency care for imaging and removal
23.Mental health nursing

Answer: B · An infection such as a urinary tract infection, or a medicine side effect

Why this is the answer

Acute confusion in an older adult suggests delirium, which has an underlying cause. Common causes include infections, medicines (especially anticholinergics and sedatives), dehydration, hypoxia, pain and urinary retention.

Answer

B · An infection such as a urinary tract infection, or a medicine side effect
24.Mental health nursing

Answer: C · Withhold the antipsychotic and get urgent medical help

Why this is the answer

These findings suggest neuroleptic malignant syndrome. Stop the antipsychotic, call for urgent medical review, start cooling and supportive care, and monitor vital signs, kidney function and CK.

Answer

C · Withhold the antipsychotic and get urgent medical help
25.Nursing math & unit conversions

Answer: 11:25 AM

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

11 → 11 AM

Answer

11:25 AM

Answer

11:25 AM
26.Nursing math & unit conversions

Answer: t = 10.42 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

21:20 → 24:00 = 160 min

After midnight

00:00 → 07:45 = 465 min

Total

160 + 465 = 625 min
t = 625/60 = 10.42 h

Answer

t = 10.42 h
27.Dosage calculations

Answer: D = 112.5 mg

Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.

Total per day

15·30 = 450 mg

Per dose

D = 450/4 = 112.5 mg

Answer

D = 112.5 mg
28.Dosage calculations

Answer: V = 3.9 mL

Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.

Weight in kg

68.2/2.2 = 31 kg

Dose

5·31 = 155 mg

Volume

V = (155/200)·5 = 3.875 ≈ 3.9 mL

Answer

V = 3.9 mL
29.IV infusion rates

Answer: R = 28 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.

Time in minutes

3·60 = 180 min

Drip rate

R = 250·20/180 = 27.78 ≈ 28 gtt/min

Answer

R = 28 gtt/min

At the bedside you round to the nearest whole drop: 28 gtt/min.

30.IV infusion rates

Answer: R = 60 mL/h

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

Concentration

2000 mg/500 mL = 4 mg/mL

Dose per hour

4·60 = 240 mg/h

Pump rate

R = 240/4 = 60 mL/h

Answer

R = 60 mL/h
31.IV fluids & fluid balance

Answer: U = 0.96 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

225 + 150 + 200 = 575 mL

Per kilogram per hour

U = 575/(75·8) = 0.9583 ≈ 0.96 mL/kg/h

Answer

U = 0.96 mL/kg/h
32.IV fluids & fluid balance

Answer: t = 6 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

100·2 = 200 mL
1000 − 200 = 800 mL left

Second part

800/200 = 4 h

Total time

t = 2 + 4 = 6 h

Answer

t = 6 h

That is about 6 h 00 min, so the bag runs out at about 22:30.

33.Clinical assessment scores

Answer: NEWS2 = 7

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 16/min → 0
SpO₂ 86% → 3
on oxygen → 2
SBP 150 mmHg → 0
HR 92/min → 1
alert (A) → 0
T 38.4 °C → 1

Add

NEWS2 = 0 + 3 + 2 + 0 + 1 + 0 + 1 = 7

Answer

NEWS2 = 7
34.Clinical assessment scores

Answer: obesity class III

Body mass index: BMI = weight (kg)/height (m)², with the height converted to metres first. With pounds and inches, BMI = 703 × weight (lb)/height (in)². WHO adult categories: below 18.5 underweight, 18.5–24.9 healthy weight, 25.0–29.9 overweight, 30.0–34.9 obesity class I, 35.0–39.9 obesity class II and 40 or more obesity class III.

BMI

BMI = 108/1.63² = 40.65

Category

obesity class III

Answer

obesity class III

This is independent practice material. ExamProblems is not affiliated with or endorsed by the organisation that runs this exam, and the exam name is used only to describe the content. NCLEX®, NCLEX-RN® and NCLEX-PN® are trademarks of the National Council of State Boards of Nursing, Inc. (NCSBN), which is not affiliated with ExamProblems and does not endorse it or vouch for its accuracy.

ExamProblems · examproblems.com/courses/nclex-pn-practice-questions