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

How should a patient receiving tube feeding be positioned to reduce the risk of aspiration?

  1. ALying on the stomach
  2. BIn the head-down position
  3. CWith the head of the bed raised to about 30–45 degrees
  4. DLying completely flat
2.Nursing fundamentalsHard

In the SBAR communication tool, what does the "A" stand for?

  1. AAction
  2. BAssessment
  3. CAdmission
  4. DAllergies
3.Infection control & patient safetyMedium

Which information must be documented when a patient is restrained?

  1. AOnly the time the restraint was put on and the time it was taken off
  2. BThe reason, alternatives tried, type of restraint, times and regular assessments
  3. COnly the name of the nurse who applied it and the unit where it happened
  4. DOnly whether the family agreed to the restraint
4.Infection control & patient safetyHard

A patient with dementia is often found at the exit doors trying to leave the unit. Which measure is most appropriate?

  1. AKeep the patient in a chair with a vest restraint
  2. BGive a sedative each time the patient goes to the door
  3. CUse an electronic wander alert, supervise closely and offer meaningful activity
  4. DLock the patient alone in a single room so that they cannot reach the exit doors
5.Prioritization & delegationMedium

A patient is receiving a blood transfusion. Which task can the nurse delegate to a nursing assistant?

  1. AStarting the transfusion once the blood arrives
  2. BDeciding whether to stop the transfusion if the patient has chills
  3. CMeasuring and reporting vital signs at the times set by the nurse
  4. DAssessing the patient for signs of a transfusion reaction
6.Prioritization & delegationHard

A nurse returns to the station to find four messages. Which one is answered first?

  1. AThe laboratory is calling with a critical potassium result of 2.6 mEq/L
  2. BA family member wants an update on their father’s progress
  3. CThe pharmacy asks when the next delivery should be scheduled
  4. DA colleague asks to swap shifts with them next week because of a family wedding
7.Clinical nursingMedium

An older patient is at high risk of falls on the ward. Which nursing action is most appropriate?

  1. AKeep the call bell and belongings within reach and review medicines that cause drowsiness
  2. BUse bed rails for every patient automatically
  3. CRemove the patient's glasses to prevent breakage
  4. DRestrict the patient to bed at all times
8.Clinical nursingHard

Why are early surgery and early mobilisation recommended for older patients with a hip fracture?

  1. AThey mainly reduce the cost of the operation
  2. BThey allow the bone to heal fully without any need for pain relief
  3. CThey reduce complications such as pneumonia, pressure ulcers and delirium
  4. DThey make physiotherapy and rehabilitation unnecessary after discharge
9.Lab values & electrolytesMedium

A patient starts high-dose prednisone. Which laboratory change should the nurse expect?

  1. AA rise in blood glucose
  2. BA fall in serum sodium
  3. CA fall in the white cell count
  4. DA rise in serum potassium
10.Lab values & electrolytesHard

A patient with a large, fast-growing lymphoma will start chemotherapy tomorrow. Which plan best prevents tumor lysis syndrome?

  1. ANo special measures, because the risk starts only after a week
  2. BIV hydration, a uric acid-lowering drug and frequent electrolytes
  3. CFluid restriction and a high-potassium diet before the treatment
  4. DCalcium supplements and a high-phosphate diet during treatment
11.PharmacologyMedium

Why is ketorolac given only for a short course?

  1. AIt quickly loses all its pain-relieving effect because of tolerance
  2. BIt causes respiratory depression after a few days
  3. CGI bleeding and kidney injury become more likely with longer use
  4. DIt is a strong opioid that causes addiction
12.PharmacologyHard

Which strategy is most effective at preventing errors with IV insulin infusions?

  1. AUsing insulin syringes to measure large IV volumes
  2. BWriting "U" for units on the order
  3. CPreparing insulin infusions in advance and leaving them unlabelled
  4. DAn independent double check and a smart pump with a drug library
13.Med-surg: cardiovascular & respiratoryMedium

Which investigation is usually used to confirm a deep vein thrombosis in the leg?

  1. AA lung function test
  2. BAn exercise ECG
  3. CCompression duplex ultrasound
  4. DA plain chest X-ray and an ECG
14.Med-surg: cardiovascular & respiratoryHard

A nurse has four cardiac patients. Which one should be seen first?

  1. AA patient with AF and a heart rate of 86/min who is due an apixaban dose this morning
  2. BA patient with heart failure whose weight is 0.3 kg up on yesterday's morning weight
  3. CA patient after a radial angiogram asking when they can eat
  4. DA patient with angina whose chest pain has not eased with rest and who is sweating
15.Med-surg: neuro, endocrine & renalMedium

A patient has confirmed meningococcal meningitis. What is usually offered to their close household contacts?

  1. APreventive antibiotics
  2. BA full course of IV antibiotics in hospital
  3. CNo action unless they develop symptoms
  4. DA lumbar puncture to check for infection
16.Med-surg: neuro, endocrine & renalHard

On the first day after a kidney transplant, urine output suddenly falls from 200 mL/h to 10 mL/h. What should the nurse check first?

  1. AThat the catheter is not blocked or kinked
  2. BWhether the patient has eaten
  3. CThe patient's blood glucose level
  4. DThe patient's temperature and pulse
17.Med-surg: GI, perioperative & oncologyMedium

Which dressing is generally suitable for a wound with heavy exudate?

  1. ADry gauze changed weekly
  2. BAn alginate or foam
  3. CA hydrogel sheet
  4. DA thin transparent film
18.Med-surg: GI, perioperative & oncologyHard

During burn resuscitation, a 70 kg adult's urine output has been 120 mL/h for 3 hours, and the face and limbs are very oedematous. What should the nurse do?

  1. ADiscuss reducing the fluid rate with the team
  2. BGive a diuretic without discussing it
  3. CStop all IV fluids completely and remove the catheter
  4. DIncrease the fluid rate to keep the output high
19.Maternity & obstetric nursingMedium

What do accelerations of the fetal heart rate usually indicate?

  1. AFetal sleep
  2. BThe fetus is well oxygenated
  3. CCompression of the umbilical cord
  4. DPlacental insufficiency
20.Maternity & obstetric nursingHard

A woman at 11 weeks has heavy bleeding, cramping and an open cervical os, and she has passed some tissue. Which type of miscarriage is this?

  1. AMissed miscarriage
  2. BComplete miscarriage
  3. CIncomplete miscarriage
  4. DThreatened miscarriage
21.Pediatric nursingMedium

Which daily monitoring is most useful for a child with nephrotic syndrome?

  1. AWeight and urine dipstick for protein
  2. BBlood glucose before and after every meal
  3. CPeak flow and oxygen saturation every morning
  4. DHead circumference and fontanelle tension
22.Pediatric nursingHard

The parents of a child who is being resuscitated ask to stay in the room. What is the best response?

  1. AAllow them to stay only if they help with the compressions
  2. BAllow them to stay if they wish, with a staff member to support and explain
  3. CAsk them to leave, because their presence always harms the team's work
  4. DTell them to wait outside in the corridor until the resuscitation is over
23.Mental health nursingMedium

Which US legal case is associated with the duty of mental health professionals to protect people who are threatened by a patient?

  1. ABrown v Board of Education
  2. BMiranda v Arizona
  3. CTarasoff v Regents of the University of California
  4. DRoe v Wade
24.Mental health nursingHard

Two days after surgery, a 79-year-old woman is quiet and drowsy, stares into space and gives muddled answers that vary through the day. Her daughter says she was sharp before. What is most likely?

  1. ADepression after surgery
  2. BHypoactive delirium
  3. CNormal tiredness after anaesthesia
  4. DAdvanced dementia
25.Nursing math & unit conversionsMedium
10 lb 5 oz? kg1 lb = 16 oz1 kg = 2.2 lb

Practice exercise (made-up values, not clinical guidance). A newborn weighs 10 lb 5 oz. Using 1 lb = 16 oz and 1 kg = 2.2 lb, find the weight m in kilograms. Round to two decimal places.

10 lb 5 oz1 lb = 16 oz1 kg = 2.2 lb
m = kg
26.Nursing math & unit conversionsHard
00:0017:2508:35t = ?

Practice exercise (made-up values, not clinical guidance). An infusion starts at 17:25 and finishes at 08:35 the next morning (24-hour clock). How many minutes t did it run?

17:2508:35
t = min
27.Dosage calculationsMedium
024681010 mL

A child weighing 25 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?

25 kg10 mg/kg50 mg/mL
V = mL
28.Dosage calculationsHard
50k units250 mL? mL/h2000 units/h

An infusion contains 50000 units of a drug in 250 mL. The prescription is 2000 units per hour. At what rate R do you set the pump, in mL/h?

50000 units/250 mL2000 units/h
R = mL/h
29.IV infusion ratesMedium
500 mL60 gtt/mL6 h? gtt/min

Infuse 500 mL over 6 hours with a giving set of 60 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

500 mL6 h60 gtt/mL
R = gtt/min
30.IV infusion ratesHard
1000 mg250 mL15 gtt/mL400 mg/h? gtt/min

1000 mg of a drug is diluted in 250 mL and given by gravity through a set of 15 gtt/mL. The order is 400 mg per hour. Find the drip rate R in drops per minute.

1000 mg/250 mL400 mg/h15 gtt/mL
R = gtt/min
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftjuice120 mLwater240 mLmilk240 mLice chips120 mLIV infusion75 mL/h × 12 hIV antibiotic2 × 50 mLurine225 mLurine375 mLurine225 mLurine300 mLvomit200 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The patient weighs 81 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

81 kg12 hurine: 225 mLurine: 375 mLurine: 225 mLurine: 300 mLvomit: 200 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
500 mL200 mL infused100 mL/h10:30t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 100 mL/h. At 10:30, 200 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL200 mL infused100 mL/h
t = h
33.Clinical assessment scoresMedium
H? / 25+D? / 15+Aid? / 30+IV? / 20+G? / 20+MS? / 15Σ?

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: crutches, cane or walker; IV therapy or saline lock: no; gait: weak; mental status: knows own limits. Find the Morse total MFS.

0–125
MFS =
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 55 kg and is 179 cm tall. Calculate the BMI and click the WHO weight category.

55 kg179 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: C · With the head of the bed raised to about 30–45 degrees

Why this is the answer

Raising the head of the bed during and after feeding helps prevent reflux and aspiration into the lungs.

Answer

C · With the head of the bed raised to about 30–45 degrees
2.Nursing fundamentals

Answer: B · Assessment

Why this is the answer

SBAR: Situation, Background, Assessment (your clinical judgement of the problem) and Recommendation (what you need).

Answer

B · Assessment
3.Infection control & patient safety

Answer: B · The reason, alternatives tried, type of restraint, times and regular assessments

Why this is the answer

Restraint documentation includes the behavior that made it necessary, less restrictive measures tried, the order, the type used, the times applied and released, and ongoing checks of circulation, skin, needs and mental state.

Answer

B · The reason, alternatives tried, type of restraint, times and regular assessments
4.Infection control & patient safety

Answer: C · Use an electronic wander alert, supervise closely and offer meaningful activity

Why this is the answer

Wander alert systems, close supervision, orientation and activity reduce the risk of elopement without restricting the patient. Seclusion, restraints and sedation used for convenience are not appropriate.

Answer

C · Use an electronic wander alert, supervise closely and offer meaningful activity
5.Prioritization & delegation

Answer: C · Measuring and reporting vital signs at the times set by the nurse

Why this is the answer

An assistant can measure vital signs and report them. Assessing for a reaction, starting the transfusion and deciding to stop it need the nurse’s judgement.

Answer

C · Measuring and reporting vital signs at the times set by the nurse
6.Prioritization & delegation

Answer: A · The laboratory is calling with a critical potassium result of 2.6 mEq/L

Why this is the answer

A critical potassium of 2.6 mEq/L can cause life-threatening arrhythmias, so it is acted on first: the nurse assesses the patient and informs the provider. The other calls can wait.

Answer

A · The laboratory is calling with a critical potassium result of 2.6 mEq/L
7.Clinical nursing

Answer: A · Keep the call bell and belongings within reach and review medicines that cause drowsiness

Why this is the answer

Falls prevention includes assessing risk factors, reviewing sedating drugs, providing glasses, footwear and walking aids, keeping essentials in reach and supporting toileting.

Answer

A · Keep the call bell and belongings within reach and review medicines that cause drowsiness
8.Clinical nursing

Answer: C · They reduce complications such as pneumonia, pressure ulcers and delirium

Why this is the answer

Delayed surgery and immobility increase the risk of chest infection, VTE, pressure ulcers, delirium and loss of independence. Guidelines recommend surgery within about 24–48 hours of admission (UK guidance: the day of or day after) and mobilisation soon after.

Answer

C · They reduce complications such as pneumonia, pressure ulcers and delirium
9.Lab values & electrolytes

Answer: A · A rise in blood glucose

Why this is the answer

Glucocorticoids raise blood glucose by increasing glucose production and reducing insulin sensitivity. They also tend to lower potassium, retain sodium and raise the white cell count by releasing neutrophils into the blood.Checked against: Blood Glucose Test · MedlinePlus (NIH) (2024)

Answer

A · A rise in blood glucose
10.Lab values & electrolytes

Answer: B · IV hydration, a uric acid-lowering drug and frequent electrolytes

Why this is the answer

Prevention includes aggressive IV hydration, drugs such as allopurinol or rasburicase to lower uric acid, and frequent monitoring of potassium, phosphate, calcium, uric acid and creatinine. Tumor lysis usually begins within 1–3 days of starting treatment.Checked against: Uric Acid Test · MedlinePlus (NIH) (2026)

Answer

B · IV hydration, a uric acid-lowering drug and frequent electrolytes
11.Pharmacology

Answer: C · GI bleeding and kidney injury become more likely with longer use

Why this is the answer

Ketorolac is a potent NSAID used for short-term moderate to severe pain. Its risks of GI bleeding, kidney injury and bleeding are high, so treatment is limited to a few days.

Answer

C · GI bleeding and kidney injury become more likely with longer use
12.Pharmacology

Answer: D · An independent double check and a smart pump with a drug library

Why this is the answer

Independent double checks, standard concentrations and smart pumps with dose limits reduce insulin errors. "U" for units is avoided because it can be misread as a zero.

Answer

D · An independent double check and a smart pump with a drug library
13.Med-surg: cardiovascular & respiratory

Answer: C · Compression duplex ultrasound

Why this is the answer

Compression ultrasound shows whether a deep vein is compressible and whether flow is normal; a vein containing clot does not compress. A low clinical probability with a negative D-dimer can rule out DVT without imaging.

Answer

C · Compression duplex ultrasound
14.Med-surg: cardiovascular & respiratory

Answer: D · A patient with angina whose chest pain has not eased with rest and who is sweating

Why this is the answer

Chest pain that does not settle with rest, especially with sweating, suggests an acute coronary syndrome and needs immediate assessment and a 12-lead ECG. A controlled heart rate in AF, a very small weight change and a question about eating are not urgent.

Answer

D · A patient with angina whose chest pain has not eased with rest and who is sweating
15.Med-surg: neuro, endocrine & renal

Answer: A · Preventive antibiotics

Why this is the answer

Close contacts, such as people living in the same household, are offered chemoprophylaxis, for example with ciprofloxacin or rifampicin (rifampin), to clear carriage. Public health teams usually coordinate this.

Answer

A · Preventive antibiotics
16.Med-surg: neuro, endocrine & renal

Answer: A · That the catheter is not blocked or kinked

Why this is the answer

A sudden drop in output after transplant may be caused by a blocked catheter, often from clots. The nurse checks the tubing and may flush the catheter per protocol, and then escalates urgently, because vascular thrombosis or rejection are also possible.

Answer

A · That the catheter is not blocked or kinked
17.Med-surg: GI, perioperative & oncology

Answer: B · An alginate or foam

Why this is the answer

Alginates and foams absorb large amounts of exudate. Hydrogels add moisture to dry wounds, films suit superficial wounds with little exudate and dry gauze sticks to the wound bed. The surrounding skin is protected from maceration.

Answer

B · An alginate or foam
18.Med-surg: GI, perioperative & oncology

Answer: A · Discuss reducing the fluid rate with the team

Why this is the answer

An output of about 1.7 mL/kg/h suggests over-resuscitation. Excess fluid ("fluid creep") worsens oedema and can cause pulmonary oedema and compartment syndromes, so the rate is reviewed and reduced under the burn protocol.

Answer

A · Discuss reducing the fluid rate with the team
19.Maternity & obstetric nursing

Answer: B · The fetus is well oxygenated

Why this is the answer

Accelerations are abrupt rises above the baseline (at term at least 15 bpm for at least 15 seconds). They are a reassuring sign of a well-oxygenated fetus with an intact nervous system.

Answer

B · The fetus is well oxygenated
20.Maternity & obstetric nursing

Answer: C · Incomplete miscarriage

Why this is the answer

An open os with some tissue passed and continued bleeding is an incomplete miscarriage. Retained tissue can cause haemorrhage and infection, so it is usually managed medically or surgically.

Answer

C · Incomplete miscarriage
21.Pediatric nursing

Answer: A · Weight and urine dipstick for protein

Why this is the answer

Daily weights show changes in fluid retention, and urine dipsticks show whether protein loss is improving or relapsing. Abdominal girth and blood pressure are also often monitored.

Answer

A · Weight and urine dipstick for protein
22.Pediatric nursing

Answer: B · Allow them to stay if they wish, with a staff member to support and explain

Why this is the answer

Many families want to be present, and guidelines support offering this with a dedicated staff member to explain and support them. Family presence can help with grief and does not generally interfere with resuscitation.

Answer

B · Allow them to stay if they wish, with a staff member to support and explain
23.Mental health nursing

Answer: C · Tarasoff v Regents of the University of California

Why this is the answer

In Tarasoff (California, 1976), the court held that therapists have a duty to take reasonable steps to protect an identifiable person from a serious threat made by a patient. Similar principles exist in many jurisdictions.

Answer

C · Tarasoff v Regents of the University of California
24.Mental health nursing

Answer: B · Hypoactive delirium

Why this is the answer

Hypoactive delirium presents with drowsiness, slowness and reduced activity, and is often missed or mistaken for depression. Acute onset, fluctuating course and inattention point to delirium.

Answer

B · Hypoactive delirium
25.Nursing math & unit conversions

Answer: m = 4.69 kg

Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.

Ounces to pounds

5 oz/16 = 0.3125 lb
10 + 0.3125 = 10.31 lb

Pounds to kilograms

m = 10.31/2.2 = 4.688 ≈ 4.69 kg

Answer

m = 4.69 kg
26.Nursing math & unit conversions

Answer: t = 910 min

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

17:25 → 24:00 = 395 min

After midnight

00:00 → 08:35 = 515 min

Total

t = 395 + 515 = 910 min

Answer

t = 910 min
27.Dosage calculations

Answer: V = 5 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 = 10·25 = 250 mg

Volume

V = 250/50 = 5 mL

On the syringe

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

Answer

V = 5 mL
28.Dosage calculations

Answer: R = 10 mL/h

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.

Concentration

50000/250 = 200 units/mL

Pump rate

R = 2000/200 = 10 mL/h

Answer

R = 10 mL/h
29.IV infusion rates

Answer: R = 83 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

6·60 = 360 min

Drip rate

R = 500·60/360 = 83.33 ≈ 83 gtt/min

Answer

R = 83 gtt/min

At the bedside you round to the nearest whole drop: 83 gtt/min.

30.IV infusion rates

Answer: R = 25 gtt/min

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

1000/250 = 4 mg/mL

Volume per hour

400/4 = 100 mL/h

Drip rate

R = 100·15/60 = 25 gtt/min

Answer

R = 25 gtt/min
31.IV fluids & fluid balance

Answer: U = 1.16 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 + 375 + 225 + 300 = 1125 mL

Per kilogram per hour

U = 1125/(81·12) = 1.157 ≈ 1.16 mL/kg/h

Answer

U = 1.16 mL/kg/h
32.IV fluids & fluid balance

Answer: t = 3 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 − 200 = 300 mL

Time

t = 300/100 = 3 h

Answer

t = 3 h

That is about 3 h 00 min, so the bag runs out at about 13:30.

33.Clinical assessment scores

Answer: MFS = 65

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: yes → 25
secondary diagnosis: yes → 15
ambulatory aid: crutches, cane or walker → 15
IV therapy or saline lock: no → 0
gait: weak → 10
mental status: knows own limits → 0

Add

Morse total = 25 + 15 + 15 + 0 + 10 + 0 = 65

Answer

MFS = 65
34.Clinical assessment scores

Answer: underweight

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 = 55/1.79² = 17.17

Category

underweight

Answer

underweight

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