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

The skin along a peripheral IV cannula is red, painful and swollen. What is the appropriate action?

  1. AFlush the cannula harder to clear it
  2. BRemove the cannula and document it, then resite if still needed
  3. CIncrease the infusion rate
  4. DCover it with a fresh dressing and continue the infusion as prescribed
2.Nursing fundamentalsHard

Which newly started medication most increases an older patient's risk of falling?

  1. AA night-time sedative such as a benzodiazepine
  2. BRegular paracetamol (acetaminophen) for back pain
  3. CA vitamin D supplement
  4. DAn emollient cream for dry skin
3.Infection control & patient safetyMedium

Which dressing waste should be disposed of in clinical (biohazard) waste?

  1. AA dressing soaked with fluid from an infected wound
  2. BA clean paper towel used to dry hands
  3. CAn unused, still-sealed dressing past its date
  4. DThe outer paper wrapping of a sterile dressing pack
4.Infection control & patient safetyHard

During a disaster, the hospital needs to free beds quickly. Which patient is the best candidate for early discharge?

  1. AA patient on an IV heparin infusion that is still being adjusted
  2. BA patient on a ventilator in the intensive care unit who is slowly improving
  3. CA patient admitted overnight for observation who is now stable with normal tests
  4. DA patient with ongoing chest pain awaiting cardiac tests
5.Prioritization & delegationMedium

Which patient on an addiction unit should the nurse see first?

  1. ALast drink one week ago; asking about support groups
  2. BLast drink two days ago; now shaking, sweating, heart rate 124/min and seeing insects
  3. CIn recovery for a year; came to the clinic today for a routine check and a repeat prescription
  4. DLast drink this morning; asking when lunch will arrive
6.Prioritization & delegationHard

During START triage, an adult is not breathing. The airway is repositioned and the victim still does not breathe. What is the correct category?

  1. ABlack (deceased or expectant)
  2. BRed, because no breathing is the most urgent finding
  3. CRed, and start CPR at once
  4. DYellow, and come back later
7.Clinical nursingMedium

What should a patient be told before using sublingual glyceryl trinitrate (GTN, nitroglycerin) spray for angina?

  1. AUse it only after the pain has lasted over an hour, with the patient lying flat
  2. BTake it with a large glass of milk to protect the stomach lining
  3. CSwallow the spray rather than leaving it under the tongue
  4. DSit down before using it, as it can cause dizziness and low blood pressure
8.Clinical nursingHard

A patient faints during cannulation, with a slow pulse and pallor, and recovers quickly when laid flat. There is no rash, wheeze or swelling. What is most likely?

  1. AVasovagal syncope
  2. BA hypoglycaemic coma
  3. CA stroke
  4. DAnaphylaxis
9.Lab values & electrolytesMedium

Which group of findings fits hypercalcemia?

  1. ATetany, muscle cramps and a positive Chvostek’s sign
  2. BConstipation, fatigue, confusion and kidney stones
  3. CThirst with very dilute urine as the only signs
  4. DPeaked T waves and muscle weakness only
10.Lab values & electrolytesHard

A patient with SIADH is on fluid restriction. Which task can the RN delegate to unlicensed assistive personnel (UAP), such as a nursing or healthcare assistant?

  1. ATeaching the reasons for fluid restriction
  2. BAssessing the patient for new confusion
  3. CMeasuring and recording intake and output
  4. DDeciding when to recheck the sodium level
11.PharmacologyMedium

A patient refuses a prescribed oral medicine. What should the nurse do?

  1. AHide the tablet in the patient's food
  2. BLeave the tablet on the bedside table for later
  3. CExplore the reason, respect the decision, document and inform the prescriber
  4. DRecord the medicine as given, so that the chart stays complete for the next shift
12.PharmacologyHard

A breastfeeding mother needs a mild analgesic. Which drug is generally considered compatible with breastfeeding?

  1. AParacetamol (acetaminophen)
  2. BCodeine (as co-codamol)
  3. CAspirin
  4. DPethidine (meperidine)
13.Med-surg: cardiovascular & respiratoryMedium

A patient with peripheral arterial disease has leg pain at night. Which position may ease it?

  1. AWrapping the legs in compression bandages
  2. BApplying a hot water bottle directly to the feet
  3. CHanging the legs down over the side of the bed
  4. DRaising the legs on pillows above heart level
14.Med-surg: cardiovascular & respiratoryHard

A patient with squamous cell lung cancer becomes confused, thirsty and constipated, with abdominal pain. Which electrolyte disturbance is most likely?

  1. AHypomagnesaemia
  2. BHypercalcaemia
  3. CHyponatraemia
  4. DHypokalaemia
15.Med-surg: neuro, endocrine & renalMedium

The day after a thyroidectomy, a patient reports tingling around the mouth and in the fingers. Why might this happen?

  1. AThe patient is breathing too slowly after the operation
  2. BThe anaesthetic has caused an allergic reaction
  3. CThe parathyroid glands may have been damaged, lowering calcium
  4. DThe thyroid hormone level has risen too high after surgery
16.Med-surg: neuro, endocrine & renalHard

A patient with renal colic has normal kidney function and no other contraindications. Which drug is usually the first choice for pain?

  1. AAn oral antihistamine such as cetirizine
  2. BAn NSAID such as diclofenac
  3. COral paracetamol (acetaminophen) alone
  4. DA benzodiazepine such as diazepam
17.Med-surg: GI, perioperative & oncologyMedium

Why is thiamine given to patients with alcohol dependence admitted to hospital?

  1. ATo prevent Wernicke's encephalopathy
  2. BTo prevent bleeding from varices
  3. CTo reduce the craving for alcohol
  4. DTo treat the cirrhosis directly
18.Med-surg: GI, perioperative & oncologyHard

On day 3 after surgery, a patient has a temperature of 38.6 °C, respiratory rate 24/min, pulse 118/min, BP 92/58 mmHg and new confusion. What should the nurse do?

  1. AGive paracetamol and recheck in four hours
  2. BRecord the observations and continue routine care
  3. CEscalate urgently and start the sepsis pathway
  4. DEncourage oral fluids and wait for the doctor's round
19.Maternity & obstetric nursingMedium

A woman is 5 days after birth. She cries often, sleeps poorly when the baby sleeps and feels she is a bad mother. What should the nurse do?

  1. ATell her partner to take over all baby care
  2. BAdvise her to stop breastfeeding to rest
  3. CScreen further for depression and self-harm
  4. DTell her this is the baby blues and will pass
20.Maternity & obstetric nursingHard

A large for gestational age newborn of a mother with diabetes is also very red and has a high haematocrit. Which complication of this finding should the nurse watch for?

  1. ANeural tube defects
  2. BDehydration caused by vomiting
  3. CJaundice
  4. DHypothermia caused by sweating
21.Pediatric nursingMedium

Which finding at a 2-year check most needs a speech and language referral?

  1. AThe child says "no" to most suggestions
  2. BThe child uses about 50 words or more
  3. CThe child is not yet combining any two words
  4. DThe child prefers to play beside other toddlers
22.Pediatric nursingHard

A parent refuses a recommended vaccine for their infant because of fears about side effects. What is the best initial nursing approach?

  1. AGive the vaccine anyway while the parent is distracted
  2. BAvoid the topic at future visits
  3. CTell the parent that the child can no longer be treated at the clinic unless the vaccine is given
  4. DListen to the concerns, give clear evidence-based information and document the discussion
23.Mental health nursingMedium

A man taking risperidone reports breast enlargement and his partner says he has lost interest in sex. Which effect is the most likely cause?

  1. ARaised prolactin
  2. BRaised blood calcium
  3. CLow thyroid hormone
  4. DLow blood sodium
24.Mental health nursingHard

A patient in a manic episode starts taking off her clothes in the busy day room. What is the most appropriate action?

  1. ACall security to remove her from the ward
  2. BAsk the other patients to ignore her and carry on
  3. CTell her loudly in front of everyone that she must stop
  4. DCalmly cover her and guide her to her room or a quiet area
25.Nursing math & unit conversionsMedium
0.45618 mL? mLround to 0.01 mL

Practice exercise (made-up values, not clinical guidance). A dose calculation for a small injection gives 0.45618 mL. The rule in this exercise is that volumes below 1 mL are rounded to the nearest hundredth of a mL. What value x do you record?

0.45618 mL
x = mL
26.Nursing math & unit conversionsHard
½ cup? mL2 fl oz? mL½ tsp? mLΣ = ? mL

Practice exercise (made-up values, not clinical guidance). During a shift a patient takes ½ cup of tea, 2 fl oz of juice, ½ tsp of cough syrup. Using the equivalents given, find the total oral intake V in mL.

1 cup = 8 fl oz = 240 mL1 fl oz = 30 mL1 tsp = 5 mL
V = mL
27.Dosage calculationsMedium
024681010 mL

A child weighing 35 kg is prescribed 4 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

35 kg4 mg/kg25 mg/mL
V = mL
28.Dosage calculationsHard
250 mg/5 mLV = ? mL

A child weighing 10 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 250 mg in 5 mL. What volume V do you give?

10 kg10 mg/kg250 mg/5 mL
V = mL
29.IV infusion ratesMedium
1500 mL15 gtt/mL10 h? gtt/min

Infuse 1500 mL over 10 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

1500 mL10 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
1220 mLleft? mL/h7 h left

1500 mL was ordered over 10 hours. After 3 hours you find that 1220 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?

1500 mL / 10 hafter 3 h: 1220 mL
Δ = %
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftwater350 mLsoup200 mLmilk200 mLIV infusion125 mL/h × 8 hIV antibiotic2 × 50 mLurine500 mLurine500 mLurine275 mLurine475 mLwound drain130 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss).

water: 350 mLsoup: 200 mLmilk: 200 mLIV infusion: 125 mL/h × 8 hIV antibiotic: 2 × 50 mLurine: 500 mLurine: 500 mLurine: 275 mLurine: 475 mLwound drain: 130 mL
B = mL
32.IV fluids & fluid balanceHard
500 mL250 mL infused80 mL/h18:30t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 80 mL/h. At 18:30, 250 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL250 mL infused80 mL/h
t = h
33.Clinical assessment scoresMedium
mildmoderatesevere

Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury opens the eyes when spoken to, says inappropriate, random words and shows as the best motor response: abnormal flexion of the arms (decorticate posture). Work out the GCS and classify the head injury by it. Click your answer.

  1. 1mild
  2. 2moderate
  3. 3severe
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 104 kg and is 178 cm tall. Calculate the BMI and click the WHO weight category.

104 kg178 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 · Remove the cannula and document it, then resite if still needed

Why this is the answer

Phlebitis is inflammation of the vein. The cannula should be removed, the site recorded and monitored, and a new cannula placed elsewhere only if it is still needed.

Answer

B · Remove the cannula and document it, then resite if still needed
2.Nursing fundamentals

Answer: A · A night-time sedative such as a benzodiazepine

Why this is the answer

Sedatives cause drowsiness, slowed reactions and unsteadiness, especially at night and in older adults. Diuretics and drugs that lower blood pressure also raise falls risk.

Answer

A · A night-time sedative such as a benzodiazepine
3.Infection control & patient safety

Answer: A · A dressing soaked with fluid from an infected wound

Why this is the answer

Items contaminated with blood or infectious body fluids go into clinical waste according to local rules. Clean packaging goes into general or recycling waste, so the volume of clinical waste stays as small as possible.

Answer

A · A dressing soaked with fluid from an infected wound
4.Infection control & patient safety

Answer: C · A patient admitted overnight for observation who is now stable with normal tests

Why this is the answer

In a surge, stable patients who could be safely cared for at home are discharged first. Patients who are unstable or need close monitoring or titrated infusions must stay.

Answer

C · A patient admitted overnight for observation who is now stable with normal tests
5.Prioritization & delegation

Answer: B · Last drink two days ago; now shaking, sweating, heart rate 124/min and seeing insects

Why this is the answer

Hallucinations, tremor, sweating and tachycardia two to three days after the last drink suggest severe withdrawal and possible delirium tremens, which can be fatal. This patient needs prompt assessment and treatment.

Answer

B · Last drink two days ago; now shaking, sweating, heart rate 124/min and seeing insects
6.Prioritization & delegation

Answer: A · Black (deceased or expectant)

Why this is the answer

In START, a victim who does not breathe after the airway is repositioned is tagged black. CPR for one person would take rescuers away from many others who could survive. If breathing starts after repositioning, the victim is red.

Answer

A · Black (deceased or expectant)
7.Clinical nursing

Answer: D · Sit down before using it, as it can cause dizziness and low blood pressure

Why this is the answer

GTN causes vasodilation, which can lead to headache, flushing, dizziness and hypotension. Patients should sit, and seek emergency help if the pain does not settle after the advised doses.

Answer

D · Sit down before using it, as it can cause dizziness and low blood pressure
8.Clinical nursing

Answer: A · Vasovagal syncope

Why this is the answer

Vasovagal syncope is a reflex drop in heart rate and blood pressure triggered by pain, fear or needles. Anaphylaxis would usually include skin, airway or breathing features and a fast pulse.

Answer

A · Vasovagal syncope
9.Lab values & electrolytes

Answer: B · Constipation, fatigue, confusion and kidney stones

Why this is the answer

High calcium reduces nerve and muscle excitability, causing fatigue, constipation, confusion, bone pain and kidney stones. Tetany and Chvostek’s sign are signs of low calcium.Checked against: Calcium Blood Test · MedlinePlus (NIH) (2024)

Answer

B · Constipation, fatigue, confusion and kidney stones
10.Lab values & electrolytes

Answer: C · Measuring and recording intake and output

Why this is the answer

UAP can measure and record intake and output and weigh the patient, then report the values to the RN. Assessing mental status, teaching and making decisions about laboratory monitoring need nursing judgment and remain with the RN.

Answer

C · Measuring and recording intake and output
11.Pharmacology

Answer: C · Explore the reason, respect the decision, document and inform the prescriber

Why this is the answer

Competent patients may refuse treatment. The nurse explores concerns, explains the purpose and risks, documents the refusal and informs the prescriber; covert administration needs formal legal and clinical procedures.

Answer

C · Explore the reason, respect the decision, document and inform the prescriber
12.Pharmacology

Answer: A · Paracetamol (acetaminophen)

Why this is the answer

Paracetamol passes into milk in small amounts and is widely regarded as safe. Codeine can cause dangerous opioid levels in babies of ultra-rapid metaboliser mothers, aspirin carries a Reye's risk and pethidine's metabolite accumulates in infants.

Answer

A · Paracetamol (acetaminophen)
13.Med-surg: cardiovascular & respiratory

Answer: C · Hanging the legs down over the side of the bed

Why this is the answer

Ischaemic rest pain is often relieved by lowering the legs, which improves arterial flow by gravity. Elevation worsens ischaemia. Compression is contraindicated in significant arterial disease, and direct heat can burn insensitive, ischaemic skin.

Answer

C · Hanging the legs down over the side of the bed
14.Med-surg: cardiovascular & respiratory

Answer: B · Hypercalcaemia

Why this is the answer

Squamous cell lung cancer can secrete PTH-related protein, and bone metastases can release calcium. Hypercalcaemia causes confusion, thirst, polyuria, constipation, abdominal pain and arrhythmias ("bones, stones, groans and psychiatric overtones"). Treatment includes IV fluids and bisphosphonates.

Answer

B · Hypercalcaemia
15.Med-surg: neuro, endocrine & renal

Answer: C · The parathyroid glands may have been damaged, lowering calcium

Why this is the answer

The parathyroid glands lie behind the thyroid and can be damaged or removed during surgery. Low PTH leads to hypocalcaemia, causing tingling, cramps and, if severe, tetany or arrhythmias. Calcium is checked after surgery.

Answer

C · The parathyroid glands may have been damaged, lowering calcium
16.Med-surg: neuro, endocrine & renal

Answer: B · An NSAID such as diclofenac

Why this is the answer

NSAIDs are recommended first line for renal colic in suitable patients because they reduce prostaglandin-driven pain and ureteric spasm. Opioids are added if needed. NSAIDs are avoided in kidney impairment.

Answer

B · An NSAID such as diclofenac
17.Med-surg: GI, perioperative & oncology

Answer: A · To prevent Wernicke's encephalopathy

Why this is the answer

Thiamine deficiency is common in alcohol dependence and can cause Wernicke's encephalopathy (confusion, ataxia, eye signs). Thiamine is given early, ideally before or with glucose, as glucose can worsen deficiency.

Answer

A · To prevent Wernicke's encephalopathy
18.Med-surg: GI, perioperative & oncology

Answer: C · Escalate urgently and start the sepsis pathway

Why this is the answer

These findings suggest sepsis with poor perfusion. Urgent medical review and a sepsis bundle, including blood cultures, antibiotics within an hour, lactate, fluids and urine output monitoring, improve survival.

Answer

C · Escalate urgently and start the sepsis pathway
19.Maternity & obstetric nursing

Answer: C · Screen further for depression and self-harm

Why this is the answer

Insomnia even when the baby sleeps and feelings of worthlessness can point to depression. The nurse should screen further, including asking directly about self-harm, and arrange follow-up.

Answer

C · Screen further for depression and self-harm
20.Maternity & obstetric nursing

Answer: C · Jaundice

Why this is the answer

Polycythaemia is common in infants of diabetic mothers and SGA babies. Breakdown of the extra red cells raises bilirubin, and high viscosity can cause poor feeding, lethargy or thrombosis.

Answer

C · Jaundice
21.Pediatric nursing

Answer: C · The child is not yet combining any two words

Why this is the answer

By 2 years most children use at least about 50 words and combine two words. Not combining words at 2 years needs assessment, including a hearing test. Saying "no" and parallel play are normal toddler behaviour.

Answer

C · The child is not yet combining any two words
22.Pediatric nursing

Answer: D · Listen to the concerns, give clear evidence-based information and document the discussion

Why this is the answer

Exploring the parent's specific concerns and giving balanced, accurate information is the most effective approach. Vaccination needs informed consent; the decision and the discussion are documented, and the topic can be revisited later.

Answer

D · Listen to the concerns, give clear evidence-based information and document the discussion
23.Mental health nursing

Answer: A · Raised prolactin

Why this is the answer

Blocking dopamine in the tuberoinfundibular pathway raises prolactin. This can cause gynaecomastia, galactorrhoea, menstrual problems and sexual dysfunction; risperidone and first-generation antipsychotics commonly cause it.

Answer

A · Raised prolactin
24.Mental health nursing

Answer: D · Calmly cover her and guide her to her room or a quiet area

Why this is the answer

Disinhibition in mania can lead to embarrassment and exploitation. The nurse protects her privacy and dignity quietly and moves her to a less stimulating environment.

Answer

D · Calmly cover her and guide her to her room or a quiet area
25.Nursing math & unit conversions

Answer: x = 0.46 mL

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

Digit in the hundredths place

0.45618 → 5

Only the next digit decides

0.45618 → 6
6 is 5 or more, so round 5 up.
The digits after it (18) are ignored: round once, never step by step.

Round

x = 0.46 mL

Answer

x = 0.46 mL
26.Nursing math & unit conversions

Answer: V = 182.5 mL

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.

Each item in mL

½ cup = 0.5·240 = 120 mL
2 fl oz = 2·30 = 60 mL
½ tsp = 0.5·5 = 2.5 mL

Add

V = 120 + 60 + 2.5 = 182.5 mL

Answer

V = 182.5 mL
27.Dosage calculations

Answer: V = 5.6 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 = 4·35 = 140 mg

Volume

V = 140/25 = 5.6 mL

On the syringe

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

Answer

V = 5.6 mL
28.Dosage calculations

Answer: V = 2 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

10·10 = 100 mg

Volume

V = (100/250)·5 = 2 mL

Answer

V = 2 mL
29.IV infusion rates

Answer: R = 38 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

10·60 = 600 min

Drip rate

R = 1500·15/600 = 37.5 ≈ 38 gtt/min

Answer

R = 38 gtt/min

At the bedside you round to the nearest whole drop: 38 gtt/min.

30.IV infusion rates

Answer: Δ = 16.19 %

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

Original rate

1500/10 = 150 mL/h

New rate

R = 1220/7 = 174.3 mL/h

Percentage change

Δ = (174.3 − 150)/150·100% = 16.19%

Answer

Δ = 16.19%

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

31.IV fluids & fluid balance

Answer: B = −30 mL

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 intake

oral: 350 + 200 + 200 = 750 mL
IV infusion: 125·8 = 1000 mL
IV antibiotic: 2·50 = 100 mL
total intake = 1850 mL

Total output

500 + 500 + 275 + 475 + 130 = 1880 mL

Balance

B = 1850 − 1880 = −30 mL

Answer

B = −30 mL

Negative: the patient lost more fluid than went in.

32.IV fluids & fluid balance

Answer: t = 3.1 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 − 250 = 250 mL

Time

t = 250/80 = 3.125 ≈ 3.1 h

Answer

t = 3.1 h

That is about 3 h 08 min, so the bag runs out at about 21:38.

33.Clinical assessment scores

Answer: moderate

Glasgow Coma Scale: add the best response in three areas. Eye opening E: 4 spontaneous, 3 to sound or speech, 2 to pressure, 1 none. Verbal V: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Motor M: 6 obeys commands, 5 localises, 4 normal flexion (withdraws), 3 abnormal flexion, 2 extension, 1 none. The total runs from 3 to 15. After a head injury, 13–15 is usually called mild, 9–12 moderate and 3–8 severe.

Score each area

E: opens the eyes when spoken to → 3
V: says inappropriate, random words → 3
M: abnormal flexion of the arms (decorticate posture) → 3

Add

GCS = 3 + 3 + 3 = 9

Severity

GCS 9 → moderate

Answer

moderate
34.Clinical assessment scores

Answer: obesity class I

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 = 104/1.78² = 32.82

Category

obesity class I

Answer

obesity class I

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