NCLEX-style practice questions (RN): cram pack

Formula sheets, the key method steps for every topic and 40 practice problems, with full solutions at the back.

New problemsBack to the course

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

1Formulas and methods

Infection control & patient safety

Method

  1. Start with standard precautions for every patient: hand hygiene, PPE for the expected exposure, safe sharps.
  2. Add precautions by route: contact (gown, gloves), droplet (surgical mask), airborne (N95, negative-pressure room).
  3. Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
  4. Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
  5. Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.

Prioritization & delegation

Method

  1. Ask what will harm the patient soonest if nothing is done.
  2. Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
  3. Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
  4. Assess before you act unless it is an emergency; then choose the step the others depend on.
  5. For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.

Lab values & electrolytes

Method

  1. Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
  2. Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
  3. Link the value to its typical signs and to the drugs and conditions that cause it.
  4. Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
  5. Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.

Med-surg: cardiovascular & respiratory

Method

  1. Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
  2. Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
  3. Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
  4. Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
  5. Choose the safe first action, then escalate and reassess.

Med-surg: neuro, endocrine & renal

Method

  1. Check the glucose in every patient with new confusion, weakness or a seizure.
  2. Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
  3. For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
  4. For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
  5. For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.

Med-surg: GI, perioperative & oncology

Method

  1. Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
  2. Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
  3. For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
  4. For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
  5. For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.

Maternity & obstetric nursing

Method

  1. Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
  2. Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
  3. Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
  4. Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.

Pediatric nursing

Method

  1. Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
  2. Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
  3. Match the action to the development stage and involve the family.
  4. Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.

Mental health nursing

Method

  1. Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
  2. Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
  3. Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
  4. Respect rights: the least restrictive option, consent and confidentiality with its limits.

Nursing math & unit conversions

Metric steps
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
Weight and length
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
Household measures
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
Temperature
°C = (°F − 32)·5/9, °F = °C·9/5 + 32
24-hour clock
PM hours 1–11: add 12; 12 AM = 00:xx; 12 PM = 12:xx
Dose rate
mcg/min × 60/1000 = mg/h
Laboratory factors
glucose 1 mmol/L = 18 mg/dL; creatinine 1 mg/dL = 88.4 µmol/L; Hb 1 g/dL = 10 g/L

Method

  1. Write the given quantity with its unit and the unit you want.
  2. Pick the equivalent: 1000 between kg, g, mg and mcg or L and mL; 1 kg = 2.2 lb; 1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 240 mL.
  3. Write it as a fraction so that the unwanted unit cancels; for a rate, use one fraction per unit that changes.
  4. Check the direction: a smaller unit gives a bigger number.
  5. Round only the final answer, to the precision the question names.

Dosage calculations

Dose from strength
volume = dose / strength
Weight-based dose
dose = mg/kg × body weight
Tablets
number = dose / tablet strength
Units
1 g = 1000 mg, 1 mg = 1000 mcg

Method

  1. Convert the ordered dose and the stock strength to the same unit.
  2. Use desired over have times quantity: (D/H) × Q.
  3. For weight-based doses, multiply by the weight in kg first, then divide the daily dose by the number of doses.
  4. Estimate first and check that the answer is reasonable.

IV infusion rates

Pump rate
mL/h = volume (mL)/time (h)
Drip rate
drops/min = volume (mL) × drop factor / time (min)
Infusion time
time (h) = volume (mL)/rate (mL/h)

Method

  1. Pump rate in mL/h: volume divided by time in hours.
  2. Drip rate in drops/min: volume × drop factor divided by time in minutes.
  3. For time remaining: volume left divided by the rate.
  4. Round as the question or the equipment requires.

Pediatric & critical-care dosing

Daily dose
mg/day = mg/kg/day × weight (kg)
Doses per day
number = 24 h / dosing interval (h)
Pounds to kilograms
kg = lb / 2.2
Infusion concentration
units/mL = units in bag / bag volume
Pump rate
mL/h = dose per hour / concentration
Titrated drip
mL/h = mcg/kg/min × kg × 60 / (mcg/mL)
Dose from pump rate
mcg/kg/min = mL/h × (mcg/mL) / (60 × kg)
Units
1 mg = 1000 mcg

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.

Arterial blood gas interpretation

Normal ranges
pH 7.35–7.45, PaCO₂ 35–45 mmHg (4.7–6.0 kPa), HCO₃⁻ 22–26 mmol/L
ROME
Respiratory: PaCO₂ opposite to pH; Metabolic: HCO₃⁻ equal to pH
Winter’s formula
PaCO₂ = 1.5·HCO₃⁻ + 8 ± 2
Metabolic alkalosis
PaCO₂ ≈ 0.7·HCO₃⁻ + 21
Anion gap
AG = Na⁺ − (Cl⁻ + HCO₃⁻) ≈ 8–12
Albumin-corrected gap
AG + 2.5·(4.0 − alb g/dL) = AG + 0.25·(40 − alb g/L)
Delta ratio
(AG − 12)/(24 − HCO₃⁻)
P/F ratio
PaO₂/FiO₂
Alveolar gas equation
PAO₂ = FiO₂·(760 − 47) − PaCO₂/0.8
Serum osmolality
2·Na⁺ + glucose + urea (2·Na⁺ + glucose/18 + BUN/2.8)

Method

  1. Read the pH: below 7.35 is acidosis, above 7.45 alkalosis.
  2. Find the value that explains it: PaCO₂ moving opposite to the pH is respiratory, HCO₃⁻ moving with the pH is metabolic.
  3. Look at the other value: normal means uncompensated, abnormal in the compensating direction means partial compensation, and a normal pH with both abnormal means full compensation.
  4. In a metabolic acidosis, compare PaCO₂ with Winter’s formula, 1.5·HCO₃⁻ + 8 ± 2, and calculate the anion gap Na⁺ − (Cl⁻ + HCO₃⁻).
  5. Check a high anion gap with the delta ratio and, when albumin is low, with the corrected gap.

ECG rhythm strip interpretation

Paper (25 mm/s, 10 mm/mV)
1 small box = 0.04 s, 1 large box = 0.20 s, 10 mm = 1 mV
Heart rate, regular rhythm
300 ÷ large boxes = 1500 ÷ small boxes = 60 ÷ RR (s)
Heart rate, irregular rhythm
QRS complexes in 6 s × 10
Normal PR interval
0.12–0.20 s
Normal QRS duration
< 0.12 s
QTc (Bazett)
QT/√RR
QTc (Fridericia)
QT/∛RR
QTc (Framingham)
QT + 154·(1 − RR)
Sinus rates
bradycardia < 60, normal 60–100, tachycardia > 100 /min
Escape rates
junctional 40–60, ventricular 20–40 /min
Fast rhythms
SVT 150–250 /min (narrow), VT > 100 /min (wide)

Method

  1. Rate: for a regular rhythm divide 300 by the large boxes or 1500 by the small boxes between two R waves; for an irregular rhythm count the QRS complexes in 6 seconds and multiply by 10.
  2. Rhythm: compare the R–R intervals. Equal is regular; a repeating pattern is regularly irregular; no pattern at all is irregularly irregular.
  3. P waves: is there an upright P wave in lead II before every QRS, all alike? Look for fibrillatory or sawtooth waves, inverted P waves and P waves without a QRS.
  4. PR interval: from the start of P to the start of the QRS, normally 0.12–0.20 s and constant. Watch whether it lengthens, stays fixed before a dropped beat, or varies at random.
  5. QRS duration: below 0.12 s is narrow; 0.12 s or more is wide. Then name the rhythm, and for the QT use QTc = QT/√RR (Bazett) with times in seconds.

2Practice problems

1.Nursing fundamentalsMedium

Why are patients with a new ileostomy at risk of dehydration?

  1. AThe colon removes too much water from the stool
  2. BThe stoma absorbs water from the body
  3. CThey are not allowed to drink for several weeks after surgery
  4. DThe output is liquid and contains a lot of water and salt
2.Nursing fundamentalsHard

Three days after abdominal surgery, a patient coughs and the wound opens with bowel visible. What should the nurse do first?

  1. ASit the patient fully upright and ask them to cough again
  2. BPush the bowel gently back into the abdomen, then apply a firm bandage over it
  3. CCover it with sterile saline-soaked dressings and call for urgent help
  4. DLeave the wound uncovered so the surgeon can see it
3.Infection control & patient safetyMedium

What is the main aim of purposeful hourly rounding?

  1. ATo check pain, toileting, position and personal items before the patient needs to ask
  2. BTo count the patient’s medications every hour and check that none are missing
  3. CTo wake the patient every hour to check orientation
  4. DTo replace the need for a call light
4.Infection control & patient safetyHard

A patient with active pulmonary tuberculosis asks visitors to come in. What is the best response?

  1. AAllow any visitor in without any precautions, to support the patient
  2. BExplain the risk, limit visits and teach visitors to use the protection provided
  3. CAsk visitors to stand in the open doorway instead of entering the room
  4. DBan all contact permanently, including phone calls
5.Prioritization & delegationMedium

Which scheduled medication is the most time-critical?

  1. AA daily multivitamin tablet due at 08:00
  2. BRapid-acting insulin due with a breakfast tray that has arrived
  3. CA daily stool softener due with breakfast
  4. DA daily cholesterol-lowering statin tablet due with breakfast at 08:00
6.Prioritization & delegationHard

Using ESI, a stable adult with abdominal pain will need blood tests and a CT scan, but has a heart rate of 130/min. Which statement is correct?

  1. AThe patient is level 5 because the pain is not severe
  2. BThe nurse should consider level 2 because of the danger-zone vital sign
  3. CVital signs never change the ESI level
  4. DThe patient is level 4 because the blood tests and the scan count as one resource
7.Clinical nursingMedium

How is Helicobacter pylori infection usually treated?

  1. ASurgery to remove the stomach
  2. BA single dose of paracetamol and a bland diet for a week
  3. CAntacids alone, taken after every meal for a month
  4. DA combination of antibiotics with a proton pump inhibitor
8.Clinical nursingHard

Shortly after starting a transfusion, a patient becomes breathless, wheezy and hypotensive with facial swelling. What should the nurse do first?

  1. AFinish the unit quickly so the exposure time is as short as possible
  2. BGive paracetamol and an antihistamine and continue the transfusion
  3. CSlow the transfusion rate and recheck the observations in an hour
  4. DStop the transfusion, keep IV access and call for urgent help
9.Lab values & electrolytesMedium

A nurse completed the hepatitis B vaccine series. Which result shows protective immunity?

  1. AAnti-HBs of 10 mIU/mL or more
  2. BA raised ALT level
  3. CA positive HBsAg test
  4. DA positive IgM anti-HBc
10.Lab values & electrolytesHard

A patient on clozapine reports a sore throat and fever. The ANC is 400/µL (0.4 × 10⁹/L). What should the nurse do?

  1. AGive the dose with food to protect the stomach
  2. BHold the clozapine and report the result at once
  3. CHalve the dose and give it with a throat lozenge
  4. DGive the next dose and recheck the ANC next month
11.PharmacologyMedium

Which serious but rare adverse effect of statins should patients report straight away?

  1. AA dry cough
  2. BAnkle swelling
  3. CA metallic taste
  4. DUnexplained muscle pain or weakness
12.PharmacologyHard

A patient on rifampicin, isoniazid, pyrazinamide and ethambutol develops a painful swollen big toe. Which drug is most likely responsible?

  1. ARifampicin
  2. BIsoniazid
  3. CEthambutol
  4. DPyrazinamide
13.Med-surg: cardiovascular & respiratoryMedium

After an acute coronary syndrome, a patient with a normal cholesterol level is prescribed a high-intensity statin. Why?

  1. AStatins work as painkillers for chest pain
  2. BStatins reduce further events whatever the starting cholesterol
  3. CStatins are given after an ACS mainly to lower the blood pressure
  4. DStatins are needed only if the cholesterol level is very high
14.Med-surg: cardiovascular & respiratoryHard

Three hours after femoral cardiac catheterisation, a patient has new lower back and flank pain, a heart rate of 112/min and BP 92/60 mmHg. The groin looks normal. What should the nurse suspect?

  1. ARetroperitoneal bleeding
  2. BA urinary tract infection
  3. CAn allergic reaction to the contrast
  4. DNormal back ache from lying flat
15.Med-surg: neuro, endocrine & renalMedium

A stroke patient understands what is said but struggles to find words and speaks in short, effortful phrases. What type of aphasia is this?

  1. AGlobal aphasia with no understanding
  2. BReceptive (Wernicke's) aphasia
  3. CDysarthria from weak facial muscles
  4. DExpressive (Broca's) aphasia
16.Med-surg: neuro, endocrine & renalHard

Six weeks after a kidney transplant, a patient has a fever, tenderness over the graft, less urine and a rising creatinine. What is most likely?

  1. AA side effect of sun exposure
  2. BDehydration that needs only more oral fluids and rest
  3. CA normal finding as the kidney settles in
  4. DAcute rejection, needing urgent transplant team review
17.Med-surg: GI, perioperative & oncologyMedium

What is achalasia?

  1. AFailure of the lower oesophageal sphincter to relax on swallowing
  2. BWeakness of the lower oesophageal sphincter that allows reflux
  3. CInflammation of the oesophagus caused by a fungal infection
  4. DA tear at the junction of the oesophagus and the stomach
18.Med-surg: GI, perioperative & oncologyHard

While a central line is disconnected, a patient suddenly becomes breathless with chest pain and hypotension. Air embolism is suspected. What should the nurse do first?

  1. AClamp the line, lie the patient left side down, head low; give oxygen
  2. BRemove the central line straight away and leave the site open to the air
  3. CSit the patient fully upright and flush the line
  4. DGive the patient a drink and observe for an hour
19.Maternity & obstetric nursingMedium

Why must the fetal heart rate be monitored before and after external cephalic version?

  1. AIt is needed only to record the baby's position for billing
  2. BThe procedure can cause cord compression or abruption
  3. CIt is used to diagnose gestational diabetes
  4. DIt confirms the baby's sex
20.Maternity & obstetric nursingHard

Women with pre-eclampsia can develop complications after birth. Which statement in discharge teaching is correct?

  1. AAll risk ends once the placenta has been delivered
  2. BSeizures cannot happen after the baby and placenta are born
  3. CIt can still develop after birth, so report headache or visual changes
  4. DBlood pressure always returns to normal within 1 hour of birth
21.Pediatric nursingMedium

Which finding at an 18-month check requires referral for developmental assessment?

  1. AThe child plays alongside other children rather than with them
  2. BThe child is not yet walking independently
  3. CThe child is afraid of strangers
  4. DThe child says only a few words
22.Pediatric nursingHard

The mother of a 6-week-old says the baby cries for hours and she fears she might lose control. What is the best advice?

  1. AShake the baby gently for a few seconds to stop the crying and calm him
  2. BGive the baby a little honey on a dummy to settle him at night
  3. CHold the baby face down on her lap until he falls asleep, however long it takes
  4. DPut the baby safely in the cot, take a few minutes' break and ask for support
23.Mental health nursingMedium

A patient taking valproate is starting lamotrigine. Why must lamotrigine be increased especially slowly?

  1. AThe two drugs together cause severe hair growth
  2. BLamotrigine will lower the valproate level until it has no effect
  3. CValproate raises lamotrigine levels, which increases the risk of a serious rash
  4. DValproate makes lamotrigine work faster, so the dose must be increased quickly
24.Mental health nursingHard

An 80-year-old surgical patient becomes confused overnight, with fluctuating attention and pulling at his IV line. He was well oriented on admission. What is the most appropriate interpretation?

  1. ANormal ageing that needs no action
  2. BBad behaviour that needs restraint immediately
  3. CProbable delirium: look for an underlying physical cause and inform the team
  4. DRapid progression of dementia that cannot be treated, so no further tests are needed
25.Nursing math & unit conversionsMedium
0.39279 mL? mLround to 0.01 mL

Practice exercise (made-up values, not clinical guidance). A dose calculation for a small injection gives 0.39279 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?

0.39279 mL
x = mL
26.Nursing math & unit conversionsHard
8 mcg/min? mg/h1 h = 60 min1 mg = 1000 mcg

Practice exercise (made-up values, not clinical guidance). An infusion delivers 8 mcg/min. Express this dose rate D in mg/h.

8 mcg/min1 h = 60 min1 mg = 1000 mcg
D = mg/h
27.Dosage calculationsMedium
25 kg20 mg/kg/day4× per dayD = ? mg

A patient weighs 25 kg. The prescribed dose is 20 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?

25 kg20 mg/kg/day4× per day
D = mg
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 3400 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

3400 units5000 units/mL
V = mL
29.IV infusion ratesMedium
760 mLleft? mL/h7 h left

1000 mL was ordered over 12 hours. After 5 hours you find that 760 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 / 12 hafter 5 h: 760 mL
R = mL/h
30.IV infusion ratesHard
750 mL20 gtt/mL28 gtt/mint = ? h

A drip runs at 28 gtt/min through a set of 20 gtt/mL. There are 750 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

28 gtt/min20 gtt/mL750 mL
t = h
31.Pediatric & critical-care dosingMedium
heparin 1 000 units/mL70 units/kg · 89 kg → V = ? mL

Practice exercise (made-up values, not clinical guidance). A practice protocol calls for a heparin bolus of 70 units/kg for a patient who weighs 89 kg. The vial contains 1 000 units/mL. What volume V do you draw up? Round to one decimal place.

70 units/kg89 kg1 000 units/mL
V = mL
32.Pediatric & critical-care dosingHard
400 mg250 mLdopamine? mL/h85 kg5 mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A bag contains dopamine 400 mg in 250 mL. The order is 5 mcg/kg/min for a patient who weighs 85 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

400 mg/250 mL5 mcg/kg/min85 kg
R = mL/h
33.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftsoup180 mLjuice120 mLjelly120 mLIV infusion80 mL/h × 12 hIV antibiotic2 × 50 mLurine500 mLurine175 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-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).

soup: 180 mLjuice: 120 mLjelly: 120 mLIV infusion: 80 mL/h × 12 hIV antibiotic: 2 × 50 mLurine: 500 mLurine: 175 mL
B = mL
34.IV fluids & fluid balanceHard
500 mL100 mL infused80 mL/h09:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 80 mL/h. At 09:00, 100 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL100 mL infused80 mL/h
t = h
35.Clinical assessment scoresMedium
mildmoderatesevere

Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury does not open the eyes at all, makes only incomprehensible sounds such as moaning and shows as the best motor response: extension of the arms and legs (abnormal extension). Work out the GCS and classify the head injury by it. Click your answer.

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

Practice exercise (made-up values, not clinical guidance). An adult weighs 136 kg and is 171 cm tall. Calculate the BMI and click the WHO weight category.

136 kg171 cm
  1. 1underweight
  2. 2healthy weight
  3. 3overweight
  4. 4obesity class I
  5. 5obesity class II
  6. 6obesity class III
37.Arterial blood gas interpretationMedium
pH7.357.457.38PaCO₂mmHg354526HCO₃⁻mmol/L222615uncompensatedpartially compensatedfully compensated

A practice arterial blood gas shows pH 7.38, PaCO₂ 26 mmHg (3.5 kPa) and HCO₃⁻ 15 mmol/L. The primary disorder is metabolic acidosis. How far is it compensated? Click your answer.

pH 7.38PaCO₂ 26 mmHg (3.5 kPa)HCO₃⁻ 15 mmol/L
  1. 1uncompensated
  2. 2partially compensated
  3. 3fully compensated
38.Arterial blood gas interpretationHard

Practice values: Na⁺ 135, Cl⁻ 105, HCO₃⁻ 16 mmol/L and albumin 36 g/L. Find the albumin-corrected anion gap AGc = AG + 0.25·(40 − albumin).

Na⁺ 135 mmol/LCl⁻ 105 mmol/LHCO₃⁻ 16 mmol/Lalbumin 36 g/L
AGc = mmol/L
39.ECG rhythm strip interpretationMedium
II25 mm/s · 10 mm/mV

This lead II strip shows atrial flutter with a fixed conduction ratio. Find the ventricular rate in beats per minute.

lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
ventricular rate = bpm
40.ECG rhythm strip interpretationHard
II25 mm/s · 10 mm/mVfirst-degree AV blocksecond-degree AV block type I (Wenckebach)second-degree AV block type IIsinus bradycardia

This lead II strip shows a conduction problem between the atria and the ventricles. Which rhythm is it? Click your answer.

lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
  1. 1first-degree AV block
  2. 2second-degree AV block type I (Wenckebach)
  3. 3second-degree AV block type II
  4. 4sinus bradycardia

3Solutions

1.Nursing fundamentals

Answer: D · The output is liquid and contains a lot of water and salt

Why this is the answer

The colon normally reabsorbs water and salt. An ileostomy bypasses it, so high output can quickly cause dehydration and low sodium; output is monitored and fluids encouraged.

Answer

D · The output is liquid and contains a lot of water and salt
2.Nursing fundamentals

Answer: C · Cover it with sterile saline-soaked dressings and call for urgent help

Why this is the answer

Evisceration is a surgical emergency. The nurse stays with the patient, covers the bowel with sterile moist dressings, positions them to reduce tension on the wound and calls for urgent surgical review.

Answer

C · Cover it with sterile saline-soaked dressings and call for urgent help
3.Infection control & patient safety

Answer: A · To check pain, toileting, position and personal items before the patient needs to ask

Why this is the answer

Regular, planned rounding that addresses pain, toileting, positioning and possessions within reach reduces falls and call-light use. The call light stays within reach as well.

Answer

A · To check pain, toileting, position and personal items before the patient needs to ask
4.Infection control & patient safety

Answer: B · Explain the risk, limit visits and teach visitors to use the protection provided

Why this is the answer

Visits are limited and supported with education and protection according to policy, while the patient remains in a closed negative-pressure room. Visiting at an open door defeats the negative pressure.

Answer

B · Explain the risk, limit visits and teach visitors to use the protection provided
5.Prioritization & delegation

Answer: B · Rapid-acting insulin due with a breakfast tray that has arrived

Why this is the answer

Rapid-acting insulin is given with a meal; giving it late or without food can cause high or low blood glucose. The other daily medicines can be given a little later without harm.

Answer

B · Rapid-acting insulin due with a breakfast tray that has arrived
6.Prioritization & delegation

Answer: B · The nurse should consider level 2 because of the danger-zone vital sign

Why this is the answer

In ESI, a patient who needs two or more resources is level 3, but danger-zone vital signs such as a very fast heart rate should make the nurse consider level 2.

Answer

B · The nurse should consider level 2 because of the danger-zone vital sign
7.Clinical nursing

Answer: D · A combination of antibiotics with a proton pump inhibitor

Why this is the answer

Eradication therapy combines a PPI with two antibiotics for a set course. Completing the course is important for success.

Answer

D · A combination of antibiotics with a proton pump inhibitor
8.Clinical nursing

Answer: D · Stop the transfusion, keep IV access and call for urgent help

Why this is the answer

Severe transfusion reactions, including anaphylaxis, require immediately stopping the transfusion, keeping venous access, following the ABCDE approach and treating anaphylaxis with IM adrenaline.

Answer

D · Stop the transfusion, keep IV access and call for urgent help
9.Lab values & electrolytes

Answer: A · Anti-HBs of 10 mIU/mL or more

Why this is the answer

An anti-HBs level of at least 10 mIU/mL after vaccination indicates protection. HBsAg and IgM anti-HBc indicate infection, not immunity. Health care workers are often tested after vaccination.

Answer

A · Anti-HBs of 10 mIU/mL or more
10.Lab values & electrolytes

Answer: B · Hold the clozapine and report the result at once

Why this is the answer

An ANC below 500/µL is severe neutropenia, and with fever and sore throat it suggests a serious infection. Clozapine is held, the provider is told immediately, and infection is assessed and treated. A nurse never changes a dose without a prescription.

Answer

B · Hold the clozapine and report the result at once
11.Pharmacology

Answer: D · Unexplained muscle pain or weakness

Why this is the answer

Statins can cause myopathy, which rarely progresses to rhabdomyolysis with kidney damage. Unexplained muscle pain should be checked, for example with a creatine kinase level.

Answer

D · Unexplained muscle pain or weakness
12.Pharmacology

Answer: D · Pyrazinamide

Why this is the answer

Pyrazinamide reduces uric acid excretion and can cause hyperuricaemia and gout. It is also hepatotoxic, like isoniazid and rifampicin.

Answer

D · Pyrazinamide
13.Med-surg: cardiovascular & respiratory

Answer: B · Statins reduce further events whatever the starting cholesterol

Why this is the answer

After ACS, high-intensity statin therapy reduces recurrent MI, stroke and death regardless of baseline cholesterol, partly by stabilising plaques. It is part of standard secondary prevention with antiplatelets, beta-blockers, ACE inhibitors and lifestyle change.

Answer

B · Statins reduce further events whatever the starting cholesterol
14.Med-surg: cardiovascular & respiratory

Answer: A · Retroperitoneal bleeding

Why this is the answer

A high femoral puncture can bleed into the retroperitoneal space without visible groin swelling. Back or flank pain with tachycardia and hypotension is a warning sign. The nurse calls for urgent help, assesses for shock and expects bloods and imaging.

Answer

A · Retroperitoneal bleeding
15.Med-surg: neuro, endocrine & renal

Answer: D · Expressive (Broca's) aphasia

Why this is the answer

Expressive aphasia, from damage to Broca's area in the frontal lobe, causes non-fluent, effortful speech with relatively preserved understanding. Receptive aphasia causes fluent but meaningless speech and poor comprehension. Dysarthria is a motor speech problem with intact language.

Answer

D · Expressive (Broca's) aphasia
16.Med-surg: neuro, endocrine & renal

Answer: D · Acute rejection, needing urgent transplant team review

Why this is the answer

Fever, graft tenderness, falling urine output and rising creatinine suggest acute rejection, although infection must also be ruled out. Early treatment, often with high-dose steroids, can save the graft, so the transplant team is contacted urgently.

Answer

D · Acute rejection, needing urgent transplant team review
17.Med-surg: GI, perioperative & oncology

Answer: A · Failure of the lower oesophageal sphincter to relax on swallowing

Why this is the answer

In achalasia, peristalsis is lost and the lower oesophageal sphincter does not relax, causing dysphagia to both solids and liquids, regurgitation and weight loss. Treatments include dilatation and surgical myotomy.

Answer

A · Failure of the lower oesophageal sphincter to relax on swallowing
18.Med-surg: GI, perioperative & oncology

Answer: A · Clamp the line, lie the patient left side down, head low; give oxygen

Why this is the answer

Air can enter an open central line. Clamping stops more air entering; the left lateral, head-down position may keep air in the right heart away from the pulmonary outflow. High-flow oxygen and emergency help are given.

Answer

A · Clamp the line, lie the patient left side down, head low; give oxygen
19.Maternity & obstetric nursing

Answer: B · The procedure can cause cord compression or abruption

Why this is the answer

External cephalic version turns a breech fetus to cephalic. It can cause fetal bradycardia, cord problems, abruption and fetomaternal bleeding, so the fetus is monitored and anti-D given to Rh-negative women.

Answer

B · The procedure can cause cord compression or abruption
20.Maternity & obstetric nursing

Answer: C · It can still develop after birth, so report headache or visual changes

Why this is the answer

Pre-eclampsia and eclampsia can occur up to about 6 weeks after birth, most often in the first days. Women should report severe headache, visual disturbance, upper abdominal pain or shortness of breath.

Answer

C · It can still develop after birth, so report headache or visual changes
21.Pediatric nursing

Answer: B · The child is not yet walking independently

Why this is the answer

Not walking by about 18 months is a red flag. A few words, parallel play and stranger wariness are typical at this age.

Answer

B · The child is not yet walking independently
22.Pediatric nursing

Answer: D · Put the baby safely in the cot, take a few minutes' break and ask for support

Why this is the answer

Crying peaks at about 6–8 weeks and can be very stressful. Parents are taught that it is safe to put the baby down and take a break, never to shake a baby, and how to get help from partners, family or health services.

Answer

D · Put the baby safely in the cot, take a few minutes' break and ask for support
23.Mental health nursing

Answer: C · Valproate raises lamotrigine levels, which increases the risk of a serious rash

Why this is the answer

Valproate inhibits the metabolism of lamotrigine, roughly doubling its levels. Because lamotrigine rash, including Stevens-Johnson syndrome, is linked to rapid dose increases, a slower titration is used.

Answer

C · Valproate raises lamotrigine levels, which increases the risk of a serious rash
24.Mental health nursing

Answer: C · Probable delirium: look for an underlying physical cause and inform the team

Why this is the answer

Acute, fluctuating confusion suggests delirium, often caused by infection, pain, drugs, dehydration, urinary retention or hypoxia. It is a medical emergency; the cause is treated and the patient is kept safe with non-drug measures first.

Answer

C · Probable delirium: look for an underlying physical cause and inform the team
25.Nursing math & unit conversions

Answer: x = 0.39 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

0.39279 → 9

Only the next digit decides

0.39279 → 2
2 is 4 or less, so 9 stays.
The digits after it (79) are ignored: round once, never step by step.

Round

x = 0.39 mL

Answer

x = 0.39 mL
26.Nursing math & unit conversions

Answer: D = 0.48 mg/h

Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.

Set up the chain

D = 8 mcg/min × (60 min/1 h) × (1 mg/1000 mcg)

Calculate

D = 8·60/1000 = 0.48 mg/h

Answer

D = 0.48 mg/h
27.Dosage calculations

Answer: D = 125 mg

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

Total per day

20·25 = 500 mg

Per dose

D = 500/4 = 125 mg

Answer

D = 125 mg
28.Dosage calculations

Answer: V = 0.68 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.

Volume

V = 3400/5000 = 0.68 mL

On the syringe

On this 1 mL syringe every small line is 0.01 mL.

Answer

V = 0.68 mL
29.IV infusion rates

Answer: R = 108.6 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

1000/12 = 83.33 mL/h

New rate

R = 760/7 = 108.6 mL/h

Answer

R = 108.6 mL/h

This is more than a 25% increase: most hospitals require you to contact the prescriber instead of catching up, and to assess the patient for fluid overload.

30.IV infusion rates

Answer: t = 8.9 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

28·60/20 = 84 mL/h

Time left

t = 750/84 = 8.929 ≈ 8.9 h

Answer

t = 8.9 h
31.Pediatric & critical-care dosing

Answer: V = 6.2 mL

Heparin and insulin infusions: concentration = units in the bag/bag volume (units/mL). Pump rate (mL/h) = units per hour/concentration, and units per hour = mL/h × concentration. For a weight-based order, units/h = units/kg/h × weight first. A bolus volume = units needed/vial strength. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Units needed

70·89 = 6 230 units

Volume

V = 6230/1000 = 6.23 ≈ 6.2 mL

Answer

V = 6.2 mL
32.Pediatric & critical-care dosing

Answer: R = 15.9 mL/h

Titrated drips: first find the concentration in mcg/mL (mg × 1000/mL). For a weight-based order, mcg/min = mcg/kg/min × weight. Then mL/h = mcg/min × 60/concentration. Working backwards, mcg/kg/min = mL/h × concentration/(60 × weight). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Concentration

400 mg = 400 000 mcg
400 000/250 = 1600 mcg/mL

Dose per minute and per hour

5·85 = 425 mcg/min
425·60 = 25500 mcg/h

Pump rate

R = 25500/1600 = 15.94 ≈ 15.9 mL/h

Answer

R = 15.9 mL/h
33.IV fluids & fluid balance

Answer: B = 805 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: 180 + 120 + 120 = 420 mL
IV infusion: 80·12 = 960 mL
IV antibiotic: 2·50 = 100 mL
total intake = 1480 mL

Total output

500 + 175 = 675 mL

Balance

B = 1480 − 675 = 805 mL

Answer

B = 805 mL

Positive: more fluid went in than came out.

34.IV fluids & fluid balance

Answer: t = 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 − 100 = 400 mL

Time

t = 400/80 = 5 h

Answer

t = 5 h

That is about 5 h 00 min, so the bag runs out at about 14:00.

35.Clinical assessment scores

Answer: severe

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: does not open the eyes at all → 1
V: makes only incomprehensible sounds such as moaning → 2
M: extension of the arms and legs (abnormal extension) → 2

Add

GCS = 1 + 2 + 2 = 5

Severity

GCS 5 → severe

Answer

severe
36.Clinical assessment scores

Answer: obesity class III

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

BMI

BMI = 136/1.71² = 46.51

Category

obesity class III

Answer

obesity class III
37.Arterial blood gas interpretation

Answer: fully compensated

Reading a blood gas (ROME): first the pH: below 7.35 is acidaemia, above 7.45 alkalaemia. Then find the value that explains it. PaCO₂ (normal 35–45 mmHg, 4.7–6.0 kPa) is the respiratory part and moves Opposite to the pH in a respiratory disorder; HCO₃⁻ (normal 22–26 mmol/L) is the metabolic part and moves in the same direction as the pH (Respiratory Opposite, Metabolic Equal). The other value shows the compensation: normal means uncompensated; abnormal in the direction that pulls the pH back while the pH is still abnormal means partially compensated; a normal pH with both values abnormal means fully compensated. Ranges differ slightly between laboratories; these are practice values.

ROME, value by value

pH 7.38: within 7.35–7.45
PaCO₂ 26 mmHg: low (35–45)
HCO₃⁻ 15 mmol/L: low (22–26)

Compensation

Clinically, also check the expected compensation: Winter’s formula expects PaCO₂ 28.5–32.5 mmHg, so the measured 26 mmHg points to an additional respiratory alkalosis (a mixed disorder). The answer above is the ROME exam classification.

fully compensated

Answer

fully compensated
38.Arterial blood gas interpretation

Answer: AGc = 15 mmol/L

Expected compensation: in metabolic acidosis Winter’s formula predicts PaCO₂ = 1.5·HCO₃⁻ + 8 ± 2 mmHg; a measured value above that range points to an additional respiratory acidosis, below it to an additional respiratory alkalosis. The anion gap AG = Na⁺ − (Cl⁻ + HCO₃⁻), normally about 8–12 mmol/L, separates high-gap from normal-gap metabolic acidosis; low albumin hides a high gap (add 2.5 per g/dL that albumin is below 4.0). The delta ratio (AG − 12)/(24 − HCO₃⁻) between about 0.8 and 2 fits a pure high-gap acidosis (some texts use 1 instead of 0.8), below that an added normal-gap acidosis, and above 2 an added metabolic alkalosis.

Anion gap

AG = 135 − (105 + 16) = 14

Correction for albumin

14 + 0.25·(40 − 36) = 15 mmol/L

Answer

AGc = 15 mmol/L

Above about 12 after correction: a high anion gap.

39.ECG rhythm strip interpretation

Answer: ventricular rate = 100 bpm

Rhythm criteria (lead II): sinus rhythm has an upright P wave before every QRS, a constant PR of 0.12–0.20 s and a narrow QRS: normal sinus rhythm at 60–100/min, sinus bradycardia below 60, sinus tachycardia above 100. Atrial fibrillation: no P waves, a fibrillatory baseline and an irregularly irregular R–R. Atrial flutter: sawtooth flutter waves at about 250–350/min with a fixed conduction ratio such as 2:1 or 4:1. First-degree AV block: sinus rhythm with a constant PR above 0.20 s. Junctional rhythm: narrow QRS at 40–60/min with absent or inverted P waves (PR below 0.12 s, or P after the QRS). A PVC is an early, wide (0.12 s or more), bizarre QRS without a P wave, with the T wave in the opposite direction and usually a full compensatory pause; in bigeminy every second beat is a PVC.

Flutter waves

F–F = 5 small boxes = 0.20 s → 1500 ÷ 5 = 300 per minute

QRS complexes

R–R = 15 small boxes = 0.60 s → 1500 ÷ 15 = 100 per minute
conduction ratio = 300 ÷ 100 = 3:1

Answer

ventricular rate = 100 bpm
40.ECG rhythm strip interpretation

Answer: second-degree AV block type II

AV blocks: march out the P waves and check which ones are followed by a QRS. First-degree: every P conducted, PR constant and above 0.20 s. Second-degree type I (Mobitz I, Wenckebach): the PR lengthens from beat to beat until one P wave is not conducted, then the cycle starts again (group beating). Second-degree type II (Mobitz II): the PR of the conducted beats stays constant, and P waves are suddenly not conducted; the QRS is often wide. Third-degree (complete) block: P waves and QRS complexes are each regular but independent, the PR varies at random and the atrial rate is faster than the escape rate (junctional 40–60/min with a narrow QRS, ventricular 20–40/min with a wide QRS). A 2:1 block cannot be called type I or type II from one strip.

Five steps

1. Rate: 6 QRS complexes in 6 s, × 10 = 60 per minute.
2. Rhythm: the P waves are regular; R–R is regular except for a long pause where a QRS is missing.
3. P waves: upright and regular (P–P 0.88 s, 68 per minute); one P in every 4 is not followed by a QRS.
4. PR interval: constant at 0.20 s in the conducted beats.
5. QRS: 0.14 s, wide (0.12 s or more).

Interpretation

second-degree AV block type II

Answer

second-degree AV block type II

Type II and third-degree blocks are the ones that can suddenly progress, so textbooks rank them as more serious than type I.

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