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 is high-flow oxygen often humidified?

  1. ATo add medicine to the oxygen
  2. BTo cool the patient's temperature
  3. CTo stop the airways and secretions from drying out
  4. DTo make the oxygen more concentrated before it reaches the lungs
2.Nursing fundamentalsHard

A nurse uses SBAR to call a doctor about a breathless patient. Which item belongs under "Background"?

  1. A"I am calling about Mr Smith in bed 4, who is very breathless."
  2. BHis respiratory rate is 30 and his SpO₂ is 86% on 2 L of oxygen
  3. CThe patient has COPD and was admitted two days ago with pneumonia
  4. D"Please come and review him within the next 10 minutes."
3.Infection control & patient safetyMedium

Where should the drainage bag of an indwelling urinary catheter be kept?

  1. AHung on the IV pole above the patient
  2. BBelow the level of the bladder and off the floor
  3. COn the floor under the bed, where it is out of the way
  4. DOn the bed next to the patient’s hip
4.Infection control & patient safetyHard

A patient restrained because of violent behavior is now calm, oriented and following instructions. What should the nurse do?

  1. ARemove the restraints, because the reason for them has ended
  2. BKeep the restraints until the next provider visit
  3. CKeep the restraints until the order expires
  4. DRemove one restraint each day to test the patient’s behavior
5.Prioritization & delegationMedium

On a pediatric unit, which child does the nurse assess first?

  1. AA child with asthma who is now quiet with very little air movement
  2. BA child with croup who has a barking cough but no stridor at rest
  3. CA child in a new arm cast with pink, warm fingers and pain of 5/10
  4. DA child with a temperature of 38.2 °C after vaccination
6.Prioritization & delegationHard

A team has an RN, an LPN/LVN and a nursing assistant. Which task is the best one to assign to the LPN/LVN?

  1. AAssessing a patient who returned from surgery 30 minutes ago
  2. BMeasuring the vital signs and weights of every patient on the unit before breakfast
  3. CGiving a scheduled subcutaneous anticoagulant injection to a stable patient
  4. DWriting the discharge teaching plan for a patient with new diabetes
7.Clinical nursingMedium

A patient's seizure has lasted more than five minutes. What does this mean?

  1. ARestrain the limbs to stop the movements
  2. BIt should be treated as status epilepticus and emergency medication given
  3. CIt is normal and needs no treatment
  4. DPlace something in the mouth to prevent tongue biting
8.Clinical nursingHard

A nurse teaches a patient with reflux disease. Which statement shows a need for further teaching?

  1. A"I will raise the head of my bed with blocks."
  2. B"A big meal just before bed is fine if I take my tablet."
  3. C"I will try to lose some weight over the next months."
  4. D"I will cut down on alcohol."
9.Lab values & electrolytesMedium

A breathless patient in the emergency department has a BNP below 100 pg/mL. What does this suggest?

  1. AThe patient has had a myocardial infarction in the past day
  2. BHeart failure is an unlikely cause of the breathlessness
  3. CSevere heart failure is certainly the cause of the problem
  4. DThe kidneys are failing and the patient needs dialysis
10.Lab values & electrolytesHard

The nurse teaches a patient starting lithium. Which statement shows a need for further teaching?

  1. A"I will drink plenty of fluids, especially in hot weather"
  2. B"I will cut out salt from my diet completely to stay healthy"
  3. C"I will tell my doctor if I have vomiting or diarrhea"
  4. D"I will check with the pharmacist before taking ibuprofen"
11.PharmacologyMedium

Which approach is usually recommended to prevent constipation in a patient on regular opioids?

  1. AAn antidiarrhoeal drug at night to slow the gut
  2. BBulk-forming fibre alone, with fluid intake restricted
  3. CNo laxative until the patient has not opened the bowels for a week
  4. DA stimulant laxative such as senna, often with a stool softener
12.PharmacologyHard

Which drug class can cause life-threatening hyperkalaemia when combined with an ACE inhibitor?

  1. AThiazide diuretics
  2. BLoop diuretics such as high-dose intravenous furosemide
  3. CPotassium-sparing diuretics such as spironolactone
  4. DProton pump inhibitors
13.Med-surg: cardiovascular & respiratoryMedium

Analysis of a pleural effusion shows it is an exudate (high protein and LDH compared with blood). Which cause is most likely?

  1. ALiver cirrhosis with a low albumin
  2. BNephrotic syndrome with protein lost in urine
  3. CHeart failure with raised venous pressure
  4. DPneumonia or cancer affecting the pleura
14.Med-surg: cardiovascular & respiratoryHard

A patient who started an ACE inhibitor yesterday develops swelling of the lips and tongue and a hoarse voice. What should the nurse do first?

  1. AExplain that this is an expected, harmless side effect
  2. BAssess the airway, call for urgent help and hold further doses
  3. CGive the next dose early, as this will settle the swelling quickly
  4. DApply ice to the lips and review again in the morning
15.Med-surg: neuro, endocrine & renalMedium

Why might a patient bleed more from the needle sites straight after haemodialysis?

  1. ADialysis removes all the platelets from the blood
  2. BThe fistula has been damaged and must be tied off
  3. CHeparin is often used to stop the circuit from clotting
  4. DDialysis raises the blood pressure sharply for several hours
16.Med-surg: neuro, endocrine & renalHard

An 89-year-old with stage 5 CKD and severe heart failure, who has capacity, decides not to start dialysis. What is the nurse's best response?

  1. AAsk the family to change the patient's mind
  2. BTell the patient they must start dialysis by law
  3. CStop all care, because nothing more can be done
  4. DRespect the decision and support symptom-focused care
17.Med-surg: GI, perioperative & oncologyMedium

Which risk is particularly linked with tramadol?

  1. ASerotonin syndrome with some antidepressants, and seizures
  2. BHigh blood pressure that needs emergency treatment in most patients
  3. CRapid liver failure at normal doses
  4. DSevere stomach ulcers in all patients
18.Med-surg: GI, perioperative & oncologyHard

A patient has a category (stage) 2 pressure ulcer on the sacrum. Which plan is most appropriate?

  1. AMassage around the wound every hour to stimulate blood flow to the skin
  2. BLeave it uncovered and dry it with a hair dryer
  3. COffload the area, manage moisture, support nutrition and dress it
  4. DSit the patient upright in a chair for most of the day
19.Maternity & obstetric nursingMedium

Which reflex causes the newborn's toes to fan out when the sole is stroked from heel to toe?

  1. AStepping reflex
  2. BPlantar grasp reflex
  3. CMoro reflex
  4. DBabinski reflex
20.Maternity & obstetric nursingHard

Fluid leaking from the vagina is tested. Which result supports rupture of the membranes?

  1. AFluid that smells of ammonia
  2. BA ferning pattern on a dried slide under the microscope
  3. CFluid that contains glucose on a urine dipstick
  4. DA nitrazine test that turns yellow, showing acidic fluid
21.Pediatric nursingMedium

Which finding is an early sign of shock in a child?

  1. ASlow, deep breathing with a normal heart rate
  2. BA fast heart rate with a prolonged capillary refill
  3. CLow blood pressure with a slow heart rate and pauses in breathing
  4. DA warm, flushed child with a strong, bounding pulse
22.Pediatric nursingHard

Several family members, including the children, have had headaches, nausea and drowsiness all winter. They feel better when away from home. What should the nurse suspect?

  1. ASeasonal influenza
  2. BMigraine that runs in the family
  3. CCarbon monoxide poisoning
  4. DFood poisoning
23.Mental health nursingMedium

A young person who took LSD at a festival is frightened by what he is seeing. What is the most helpful nursing approach?

  1. AShine a bright light in his eyes every few minutes to check his pupils and keep him alert until it wears off
  2. BLeave him alone in a dark room so that he can sleep it off
  3. CArgue with him that what he sees is not real until he accepts it
  4. DStay with him in a calm, quiet place and reassure him that the effects are from the drug and will pass
24.Mental health nursingHard

A patient in a mental health unit asks to read his own health records. What is the correct general principle?

  1. AOnly his family can request access to his records on his behalf
  2. BPatients generally have a right of access, with limited exceptions to prevent serious harm
  3. CPsychiatric patients are never allowed to see their records
  4. DThe nurse should give him the records immediately without following any procedure
25.Nursing math & unit conversionsMedium
12345678910111209:40?9:40 AM8:40 AM11:40 AM9:40 PM

Practice exercise (made-up values, not clinical guidance). A dose is charted at 09:40 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.

09:40
  1. 19:40 AM
  2. 28:40 AM
  3. 311:40 AM
  4. 49:40 PM
26.Nursing math & unit conversionsHard
00:0017:3502:30t = ?

Practice exercise (made-up values, not clinical guidance). An infusion starts at 17:35 and finishes at 02:30 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.

17:3502:30
t = h
27.Dosage calculationsMedium
024681010 mL

A child weighing 11 kg is prescribed 4 mg/kg of a drug. The stock solution contains 20 mg/mL. Draw up the dose: what volume V do you give?

11 kg4 mg/kg20 mg/mL
V = mL
28.Dosage calculationsHard
100 mg/5 mLV = ? mL

A child weighing 8 kg is prescribed 20 mg/kg per dose of an oral suspension that contains 100 mg in 5 mL. What volume V do you give?

8 kg20 mg/kg100 mg/5 mL
V = mL
29.IV infusion ratesMedium
310 mLleft? mL/h2 h left

1000 mL was ordered over 8 hours. After 6 hours you find that 310 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?

1000 mL / 8 hafter 6 h: 310 mL
R = mL/h
30.IV infusion ratesHard
400 mL20 gtt/mL30 gtt/mint = ? h

A drip runs at 30 gtt/min through a set of 20 gtt/mL. There are 400 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

30 gtt/min20 gtt/mL400 mL
t = h
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftsoup250 mLmilk100 mLtea150 mLIV infusion60 mL/h × 8 hIV antibiotic1 × 50 mLurine375 mLurine325 mLurine325 mLwound drain100 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 62 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

62 kg8 hurine: 375 mLurine: 325 mLurine: 325 mLwound drain: 100 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
500 mL150 mL infused100 mL/h20:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 100 mL/h. At 20:00, 150 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL150 mL infused100 mL/h
t = h
33.Clinical assessment scoresMedium
7347SBPDBPmmHgHR 67/min · SI = ?

Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 67/min and a blood pressure of 73/47 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.

HR 67/minBP 73/47 mmHg
SI =
34.Clinical assessment scoresHard
low riskmoderate riskhigh risk

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: no; secondary diagnosis: no; ambulatory aid: crutches, cane or walker; IV therapy or saline lock: yes; gait: normal, bed rest or wheelchair; mental status: knows own limits. Using the cut-offs 0–24 low, 25–44 moderate and 45 or more high, click the fall-risk level.

  1. 1low risk
  2. 2moderate risk
  3. 3high risk

3Solutions

1.Nursing fundamentals

Answer: C · To stop the airways and secretions from drying out

Why this is the answer

Dry gas at high flow dries the mucous membranes and thickens secretions. Humidification keeps the airways moist and secretions easier to clear.

Answer

C · To stop the airways and secretions from drying out
2.Nursing fundamentals

Answer: C · The patient has COPD and was admitted two days ago with pneumonia

Why this is the answer

SBAR is Situation (why you are calling), Background (relevant history), Assessment (your findings) and Recommendation (what you need). Clear structure speeds up the response.

Answer

C · The patient has COPD and was admitted two days ago with pneumonia
3.Infection control & patient safety

Answer: B · Below the level of the bladder and off the floor

Why this is the answer

Keeping the bag below the bladder prevents backflow of urine into the bladder, and keeping it off the floor prevents contamination. Both reduce the risk of catheter-associated urinary tract infection.

Answer

B · Below the level of the bladder and off the floor
4.Infection control & patient safety

Answer: A · Remove the restraints, because the reason for them has ended

Why this is the answer

Restraints are used only as long as needed to keep people safe. Once the patient no longer presents a danger, the restraints are removed, even if the order has not yet expired.

Answer

A · Remove the restraints, because the reason for them has ended
5.Prioritization & delegation

Answer: A · A child with asthma who is now quiet with very little air movement

Why this is the answer

In asthma, very little air movement and a quiet child mean severe obstruction and possible respiratory failure. The other children are stable for now.

Answer

A · A child with asthma who is now quiet with very little air movement
6.Prioritization & delegation

Answer: C · Giving a scheduled subcutaneous anticoagulant injection to a stable patient

Why this is the answer

LPNs/LVNs usually give scheduled injections to stable patients. A fresh postoperative assessment and teaching plans need the RN, and routine vital signs are better given to the assistant so the LPN/LVN can use their skills.

Answer

C · Giving a scheduled subcutaneous anticoagulant injection to a stable patient
7.Clinical nursing

Answer: B · It should be treated as status epilepticus and emergency medication given

Why this is the answer

A seizure lasting five minutes or longer, or repeated seizures without recovery, is treated as status epilepticus. Protect from injury, give oxygen and give emergency anticonvulsants as prescribed.

Answer

B · It should be treated as status epilepticus and emergency medication given
8.Clinical nursing

Answer: B · "A big meal just before bed is fine if I take my tablet."

Why this is the answer

Large late meals increase reflux even when a PPI is taken. Raising the head of the bed, losing weight and reducing alcohol are correct measures.

Answer

B · "A big meal just before bed is fine if I take my tablet."
9.Lab values & electrolytes

Answer: B · Heart failure is an unlikely cause of the breathlessness

Why this is the answer

BNP is released from stretched ventricles, so a low value makes heart failure an unlikely cause of acute breathlessness. A high value supports heart failure, but BNP also rises with age, kidney disease and pulmonary embolism.Checked against: Natriuretic Peptide Tests (BNP, NT-proBNP) · MedlinePlus (NIH) (2023)

Answer

B · Heart failure is an unlikely cause of the breathlessness
10.Lab values & electrolytes

Answer: B · "I will cut out salt from my diet completely to stay healthy"

Why this is the answer

A sudden fall in sodium intake makes the kidneys keep more sodium and lithium, raising the lithium level towards toxicity. Patients keep a normal, steady salt intake, drink enough fluids, report fluid loss and avoid NSAIDs unless approved.

Answer

B · "I will cut out salt from my diet completely to stay healthy"
11.Pharmacology

Answer: D · A stimulant laxative such as senna, often with a stool softener

Why this is the answer

Opioid-induced constipation does not usually resolve with time, so a laxative is started with the opioid. Stimulant laxatives counter reduced motility; bulk-forming laxatives alone can worsen symptoms if fluid intake is low.

Answer

D · A stimulant laxative such as senna, often with a stool softener
12.Pharmacology

Answer: C · Potassium-sparing diuretics such as spironolactone

Why this is the answer

ACE inhibitors lower aldosterone and spironolactone blocks its receptor; together they reduce potassium excretion and can raise potassium dangerously.

Answer

C · Potassium-sparing diuretics such as spironolactone
13.Med-surg: cardiovascular & respiratory

Answer: D · Pneumonia or cancer affecting the pleura

Why this is the answer

Transudates form when hydrostatic or oncotic pressure changes push fluid out of vessels, as in heart failure, cirrhosis and nephrotic syndrome. Exudates form when inflammation or tumour makes the pleura leaky, so protein and LDH are high (Light's criteria). Common causes are pneumonia, cancer, TB and pulmonary embolism.

Answer

D · Pneumonia or cancer affecting the pleura
14.Med-surg: cardiovascular & respiratory

Answer: B · Assess the airway, call for urgent help and hold further doses

Why this is the answer

Angioedema is a rare but potentially life-threatening reaction to ACE inhibitors, caused by bradykinin accumulation. Airway compromise is the priority: call for emergency help, monitor airway and breathing closely, and stop the drug permanently. It can occur even after years of use.

Answer

B · Assess the airway, call for urgent help and hold further doses
15.Med-surg: neuro, endocrine & renal

Answer: C · Heparin is often used to stop the circuit from clotting

Why this is the answer

Heparin is commonly used during haemodialysis to prevent clotting in the circuit. Its effect can cause prolonged bleeding from puncture sites, so procedures such as IM injections may be timed with care.

Answer

C · Heparin is often used to stop the circuit from clotting
16.Med-surg: neuro, endocrine & renal

Answer: D · Respect the decision and support symptom-focused care

Why this is the answer

A competent patient can refuse dialysis. The nurse makes sure the choice is informed, respects it and supports conservative kidney management, with symptom control, advance care planning and palliative care input.

Answer

D · Respect the decision and support symptom-focused care
17.Med-surg: GI, perioperative & oncology

Answer: A · Serotonin syndrome with some antidepressants, and seizures

Why this is the answer

Tramadol is a weak opioid that also inhibits serotonin and noradrenaline reuptake. It can lower the seizure threshold and cause serotonin syndrome with SSRIs and other serotonergic drugs.

Answer

A · Serotonin syndrome with some antidepressants, and seizures
18.Med-surg: GI, perioperative & oncology

Answer: C · Offload the area, manage moisture, support nutrition and dress it

Why this is the answer

Offloading the sacrum, keeping the skin clean and dry, ensuring adequate protein and calories, and choosing a dressing that keeps a moist healing environment all support healing. Long periods sitting increase sacral pressure.

Answer

C · Offload the area, manage moisture, support nutrition and dress it
19.Maternity & obstetric nursing

Answer: D · Babinski reflex

Why this is the answer

The Babinski reflex, fanning of the toes with dorsiflexion of the big toe, is normal in infants until about 1 year. Pressing the sole near the toes gives the plantar grasp instead.

Answer

D · Babinski reflex
20.Maternity & obstetric nursing

Answer: B · A ferning pattern on a dried slide under the microscope

Why this is the answer

Amniotic fluid forms a fern-like pattern when dried and turns nitrazine paper blue because it is alkaline. Vaginal secretions and urine are usually acidic. Blood, semen and infection can give false positives on nitrazine testing.

Answer

B · A ferning pattern on a dried slide under the microscope
21.Pediatric nursing

Answer: B · A fast heart rate with a prolonged capillary refill

Why this is the answer

Children maintain their blood pressure until late in shock. Early signs include tachycardia, prolonged capillary refill, cool peripheries, reduced urine output and changes in behaviour.

Answer

B · A fast heart rate with a prolonged capillary refill
22.Pediatric nursing

Answer: C · Carbon monoxide poisoning

Why this is the answer

Carbon monoxide from faulty heaters or boilers causes headache, nausea, dizziness and drowsiness that improve away from the source. Pulse oximetry can look falsely normal. Treatment is removal from the source and high-flow oxygen; the appliance must be checked.

Answer

C · Carbon monoxide poisoning
23.Mental health nursing

Answer: D · Stay with him in a calm, quiet place and reassure him that the effects are from the drug and will pass

Why this is the answer

For a frightening hallucinogen experience, a calm setting, a supportive person and simple reassurance usually help. The nurse also monitors vital signs and watches for injury or other substances.

Answer

D · Stay with him in a calm, quiet place and reassure him that the effects are from the drug and will pass
24.Mental health nursing

Answer: B · Patients generally have a right of access, with limited exceptions to prevent serious harm

Why this is the answer

Data protection and health records laws in many countries give patients a right to access their records. Requests follow a formal procedure, and information may be withheld only in limited cases, for example if it could cause serious harm.

Answer

B · Patients generally have a right of access, with limited exceptions to prevent serious harm
25.Nursing math & unit conversions

Answer: 9:40 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

09 → 9 AM

Answer

9:40 AM

Answer

9:40 AM
26.Nursing math & unit conversions

Answer: t = 8.92 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

17:35 → 24:00 = 385 min

After midnight

00:00 → 02:30 = 150 min

Total

385 + 150 = 535 min
t = 535/60 = 8.917 ≈ 8.92 h

Answer

t = 8.92 h
27.Dosage calculations

Answer: V = 2.2 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 = 4·11 = 44 mg

Volume

V = 44/20 = 2.2 mL

On the syringe

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

Answer

V = 2.2 mL
28.Dosage calculations

Answer: V = 8 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.

Dose from weight

20·8 = 160 mg

Volume

V = (160/100)·5 = 8 mL

Answer

V = 8 mL
29.IV infusion rates

Answer: R = 155 mL/h

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

Original rate

1000/8 = 125 mL/h

New rate

R = 310/2 = 155 mL/h

Answer

R = 155 mL/h

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

30.IV infusion rates

Answer: t = 4.4 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

30·60/20 = 90 mL/h

Time left

t = 400/90 = 4.444 ≈ 4.4 h

Answer

t = 4.4 h
31.IV fluids & fluid balance

Answer: U = 2.07 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

375 + 325 + 325 = 1025 mL

Per kilogram per hour

U = 1025/(62·8) = 2.067 ≈ 2.07 mL/kg/h

Answer

U = 2.07 mL/kg/h
32.IV fluids & fluid balance

Answer: t = 3.5 h

Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Volume left

500 − 150 = 350 mL

Time

t = 350/100 = 3.5 h

Answer

t = 3.5 h

That is about 3 h 30 min, so the bag runs out at about 23:30.

33.Clinical assessment scores

Answer: SI = 0.92

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

Shock index

SI = 67/73 = 0.9178 ≈ 0.92

Answer

SI = 0.92

Above the usual 0.5–0.7.

34.Clinical assessment scores

Answer: moderate risk

Morse fall scale: six items. History of falling: no 0, yes 25. Secondary diagnosis: no 0, yes 15. Ambulatory aid: none, bed rest or nurse assistance 0; crutches, cane or walker 15; holding on to furniture 30. IV therapy or saline lock: no 0, yes 20. Gait: normal, bed rest or wheelchair 0; weak 10; impaired 20. Mental status: knows own limits 0; overestimates or forgets limits 15. The total runs from 0 to 125. Risk cut-offs differ between hospitals; a common set is 0–24 low, 25–44 moderate and 45 or more high.

Score each item

history of falling in the last 3 months: no → 0
secondary diagnosis: no → 0
ambulatory aid: crutches, cane or walker → 15
IV therapy or saline lock: yes → 20
gait: normal, bed rest or wheelchair → 0
mental status: knows own limits → 0

Add

Morse total = 0 + 0 + 15 + 20 + 0 + 0 = 35

Risk level

35 → moderate risk

Answer

moderate risk

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