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

A patient asks to see their own health records. What is correct in the UK?

  1. APatients can only see their records once they have been discharged
  2. BOnly doctors are allowed to see health records
  3. CPatients can see their records only with a court order
  4. DPatients have a legal right to request access to their records
2.Nursing fundamentalsHard

A nurse realises that a dose of analgesia given two hours ago was not documented. What is correct?

  1. AAsk a colleague to sign that they gave it
  2. BLeave it out, as it is now too late to record it in the notes
  3. CWrite it in the space for two hours ago as if it was recorded then
  4. DWrite it now as a late entry, stating when it was given
3.Infection control & patient safetyMedium

A child has swallowed a button battery. Why is this urgent?

  1. AIt is only harmful if several batteries are swallowed
  2. BThe only risk is poisoning from heavy metals years later
  3. CIt always passes through the gut without harm
  4. DIt can burn through the lining of the esophagus within hours
4.Infection control & patient safetyHard

A patient dies after a wrong-drug error, and the hospital carries out a root cause analysis. What is its main focus?

  1. AIdentifying which staff member made the error and should be disciplined
  2. BDeciding whether to tell the family about the error
  3. CEstimating the legal costs for the hospital
  4. DFinding the system and process weaknesses that allowed the error
5.Prioritization & delegationMedium

Which infant with gastroenteritis should the nurse see first?

  1. ATwo loose stools today, feeding well
  2. BMild diaper rash, otherwise playful
  3. CAlert, crying with tears, had a wet diaper an hour ago
  4. DLethargic, sunken fontanel, no wet diaper for 8 hours
6.Prioritization & delegationHard

A patient with diabetes takes propranolol. Which sign of hypoglycemia is most likely to still appear?

  1. ATremor
  2. BTachycardia
  3. CSweating
  4. DPalpitations
7.Clinical nursingMedium

A patient with type 2 diabetes is acutely unwell, very dehydrated and has a blood glucose of 40 mmol/L without significant ketones. What is the most likely diagnosis?

  1. ADiabetes insipidus
  2. BHyperosmolar hyperglycaemic state
  3. CHypoglycaemia
  4. DDiabetic ketoacidosis with dehydration
8.Clinical nursingHard

The fluid in an underwater seal chest drain has stopped swinging with breathing. What could this mean?

  1. AThe patient's breathing has become normal and the drain can be pulled out by the nurse
  2. BThe tube may be kinked or blocked, or the lung may have fully re-expanded
  3. CThe drain is working perfectly and needs no checks
  4. DThe water seal has been set up correctly for the first time
9.Lab values & electrolytesMedium

A patient with chronic kidney disease receives an erythropoiesis-stimulating agent such as epoetin alfa. Which assessments are most important?

  1. AHemoglobin and blood pressure
  2. BSerum amylase and lipase
  3. CSerum glucose and ketones
  4. DLiver enzymes and bilirubin
10.Lab values & electrolytesHard

Two days after bowel surgery, a patient with nasogastric suction has a distended abdomen, absent bowel sounds and muscle weakness. The potassium is 2.8 mEq/L. Which interpretation is best?

  1. AThe potassium is normal for the second day after surgery
  2. BHyperkalemia from tissue damage is causing the bowel to stop
  3. CThe low potassium is due to the patient drinking too much water
  4. DHypokalemia from gastric losses is contributing to paralytic ileus
11.PharmacologyMedium

A patient given haloperidol develops a sudden painful twisting of the neck and the eyes roll upward. Which drug is usually given?

  1. ADantrolene by mouth to relax the twisted neck muscles
  2. BAn anticholinergic such as benzatropine (benztropine)
  3. CA second dose of haloperidol
  4. DNaloxone
12.PharmacologyHard

A patient with HIV has a CD4 count below 200 cells/mm3. Which prophylaxis is usually started?

  1. ACo-trimoxazole to prevent Pneumocystis pneumonia
  2. BOseltamivir to prevent influenza
  3. CIsoniazid to prevent hepatitis B
  4. DFluconazole to prevent urinary and skin infections
13.Med-surg: cardiovascular & respiratoryMedium

Which ECG change is classically linked with hyperkalaemia?

  1. AProminent U waves
  2. BA sawtooth baseline
  3. CDelta waves before the QRS
  4. DTall, peaked T waves
14.Med-surg: cardiovascular & respiratoryHard

A patient being treated for pulmonary TB repeatedly misses doses and stops when they feel better. Which strategy is most effective?

  1. ADirectly observed therapy with support for barriers to adherence
  2. BStopping treatment, as it is clearly not working for this patient
  3. CDoubling the dose on the days the patient remembers to take it
  4. DSwitching to a single drug to make it easier
15.Med-surg: neuro, endocrine & renalMedium

Why should long-term steroid treatment not be stopped suddenly?

  1. AStopping suddenly makes the bones grow too quickly and then fracture
  2. BThe steroids build up and become toxic after they are stopped
  3. CThe suppressed adrenal glands cannot make enough cortisol at once
  4. DStopping causes the blood glucose to fall sharply
16.Med-surg: neuro, endocrine & renalHard

A patient with diabetes insipidus after head trauma needs hourly urine output measurement. Which task can be delegated to a trained healthcare assistant (nursing assistant)?

  1. AAssessing the patient's level of consciousness
  2. BDeciding whether to give the next desmopressin dose
  3. CMeasuring hourly urine and reporting results above a set amount
  4. DInterpreting the serum sodium results
17.Med-surg: GI, perioperative & oncologyMedium

Which approach to red cell transfusion in a stable patient with a GI bleed fits current evidence?

  1. ANever transfuse, whatever the haemoglobin or the symptoms
  2. BTransfuse two units routinely before every endoscopy
  3. CA restrictive threshold, often around 70 g/L, in most stable patients
  4. DTransfuse everyone to keep the haemoglobin above 150 g/L at all times
18.Med-surg: GI, perioperative & oncologyHard

On day 2 of severe acute pancreatitis, a patient becomes breathless, with SpO₂ 88% and bilateral infiltrates on chest X-ray. Which complication is most likely?

  1. ASpontaneous tension pneumothorax
  2. BAcute severe asthma attack
  3. CAcute respiratory distress syndrome (ARDS)
  4. DAspiration of a foreign body
19.Maternity & obstetric nursingMedium

Which measure helps prevent infant abduction from a maternity unit?

  1. ALetting any visitor carry the baby in the corridor
  2. BChecking staff ID before handing over a baby
  3. CPosting the baby's name and room on the door
  4. DLeaving babies in the nursery overnight
20.Maternity & obstetric nursingHard

A newborn is pale, has a heart rate of 170/min and weak pulses after a difficult vacuum birth. The scalp is boggy and swelling across the sutures is increasing. What should the nurse suspect?

  1. ACaput succedaneum
  2. BSubgaleal haemorrhage
  3. CNormal moulding
  4. DSimple cephalhaematoma
21.Pediatric nursingMedium

How should an infant with heart failure be fed?

  1. ALying flat on the back so the baby does not need to hold the head up
  2. BLarge feeds every 6 hours so the baby can rest in between
  3. CSmall, frequent feeds with rest breaks, using higher-energy milk if prescribed
  4. DStop the feed when the baby tires and wait until the next scheduled feed
22.Pediatric nursingHard

A 14-year-old has superficial cuts on her forearms. She says cutting helps her cope and that she does not want to die. What is the best nursing response?

  1. ATreat the wounds, stay calm and non-judgemental, and refer for assessment
  2. BAccept that she is not at risk because she says she does not want to die
  3. CTell her firmly that cutting is attention-seeking behaviour and that she must stop now
  4. DPromise not to tell anyone so that she keeps talking
23.Mental health nursingMedium

A patient says, "I'll take the pill, the bill, the hill, the still." What is this called?

  1. ANeologism
  2. BEcholalia
  3. CClang association
  4. DPerseveration
24.Mental health nursingHard

A nurse notices that a colleague smells of alcohol, has slurred speech and is about to give medicines. What should the nurse do?

  1. AWait until the end of the shift, then talk privately with the colleague
  2. BSay nothing, because it is not her responsibility
  3. CGive the colleague some strong coffee and let her continue with the medicine round if she says she feels fine
  4. DReport the concern immediately to the nurse in charge, following policy, to protect patients
25.Nursing math & unit conversionsMedium
94969810010210410635363738394041°F°C? °F35.3 °C

Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 35.3 °C. Convert it to degrees Fahrenheit T with °F = °C × 9/5 + 32. Round to one decimal place.

35.3 °C
T = °F
26.Nursing math & unit conversionsHard
1½ cups? mL½ tsp? mL3 fl oz? mLΣ = ? mL

Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 1½ cups of tea, ½ tsp of cough syrup, 3 fl oz of juice. Using the equivalents given, find the total oral intake V in mL.

1 cup = 8 fl oz = 240 mL1 tsp = 5 mL1 fl oz = 30 mL
V = mL
27.Dosage calculationsMedium
2%w/vV = ? mL

A dose of 60 mg is needed from a 2% (w/v) solution. What volume V contains this dose?

60 mg2% w/v
V = mL
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 3040 micrograms. The ampoule contains 4 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

3040 mcg4 mg/mL
V = mL
29.IV infusion ratesMedium
320 mLleft? mL/h3 h left

1000 mL was ordered over 12 hours. After 9 hours you find that 320 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 9 h: 320 mL
R = mL/h
30.IV infusion ratesHard
400 mLleft? mL/h2 h left

1000 mL was ordered over 6 hours. After 4 hours you find that 400 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?

1000 mL / 6 hafter 4 h: 400 mL
Δ = %
31.Pediatric & critical-care dosingMedium
25 000 units250 mLheparin? mL/h102 kg14 units/kg/h

Practice exercise (made-up values, not clinical guidance). A bag contains 25 000 units of heparin in 250 mL. The order is 14 units/kg/h for a patient who weighs 102 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

25 000 units/250 mL14 units/kg/h102 kg
R = mL/h
32.Pediatric & critical-care dosingHard
800 mg500 mLdopamine? mL/h81 kg4 mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A bag contains dopamine 800 mg in 500 mL. The order is 4 mcg/kg/min for a patient who weighs 81 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

800 mg/500 mL4 mcg/kg/min81 kg
R = mL/h
33.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftmilk100 mLjuice150 mLwater120 mLice chips120 mLIV infusion60 mL/h × 8 hIV antibiotic2 × 50 mLurine225 mLurine200 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). Count ice chips as half their volume.

milk: 100 mLjuice: 150 mLwater: 120 mLice chips: 120 mLIV infusion: 60 mL/h × 8 hIV antibiotic: 2 × 50 mLurine: 225 mLurine: 200 mL
B = mL
34.IV fluids & fluid balanceHard
1000 mL800 mL infused100 mL/h15:30t = ? h

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 100 mL/h. At 15:30, 800 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

1000 mL800 mL infused100 mL/h
t = h
35.Clinical assessment scoresMedium
S? / 4+M? / 4+A? / 4+Mob? / 4+N? / 4+F? / 3Σ?

Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: slightly limited; moisture: occasionally moist; activity: walks frequently; mobility: no limitation; nutrition: probably inadequate; friction and shear: no apparent problem. Find the Braden total B.

6–23
B =
36.Clinical assessment scoresHard
125?SBPDBPmmHgMAP = 65

Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 65 mmHg. A patient’s systolic pressure is 125 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 65 mmHg?

MAP 65 mmHgSBP 125 mmHg
DBP = mmHg
37.Arterial blood gas interpretationMedium

A practice gas shows a metabolic acidosis with HCO₃⁻ 12 mmol/L. Use Winter’s formula to find the expected PaCO₂ (the centre of the range) in mmHg.

HCO₃⁻ 12 mmol/L
PaCO₂ = mmHg
38.Arterial blood gas interpretationHard

A practice gas shows a metabolic alkalosis with HCO₃⁻ 44 mmol/L. Use expected PaCO₂ = 0.7·HCO₃⁻ + 21 to find the expected PaCO₂.

HCO₃⁻ 44 mmol/L
PaCO₂ = mmHg
39.ECG rhythm strip interpretationMedium
II25 mm/s · 10 mm/mV

Measure the QT interval and the R–R interval on this regular lead II strip, then calculate the rate-corrected QTc with Fridericia’s formula QTc = QT/∛RR (both in seconds). Give the answer in seconds to three decimals.

lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
QTc = s
40.ECG rhythm strip interpretationHard
II25 mm/s · 10 mm/mV

This lead II strip shows an AV block, so the atria and the ventricles beat at different rates. Measure the P–P interval and find the atrial rate in beats per minute (1500 method, whole number).

lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
atrial rate = bpm

3Solutions

1.Nursing fundamentals

Answer: D · Patients have a legal right to request access to their records

Why this is the answer

Under data protection law, patients can request access to their health records. The nurse explains the local process for making a request.

Answer

D · Patients have a legal right to request access to their records
2.Nursing fundamentals

Answer: D · Write it now as a late entry, stating when it was given

Why this is the answer

Late entries are clearly marked as such, showing both when care was given and when the note was written. This keeps the record accurate and prevents a second dose being given.

Answer

D · Write it now as a late entry, stating when it was given
3.Infection control & patient safety

Answer: D · It can burn through the lining of the esophagus within hours

Why this is the answer

A button battery lodged in the esophagus can cause severe chemical burns within a few hours, so the child needs emergency assessment and often removal. It should never be treated as harmless.

Answer

D · It can burn through the lining of the esophagus within hours
4.Infection control & patient safety

Answer: D · Finding the system and process weaknesses that allowed the error

Why this is the answer

A root cause analysis looks beyond the individual to the system factors, such as storage, labeling, staffing or workflow, that allowed the error. The aim is to change the system so the error cannot happen again.

Answer

D · Finding the system and process weaknesses that allowed the error
5.Prioritization & delegation

Answer: D · Lethargic, sunken fontanel, no wet diaper for 8 hours

Why this is the answer

Lethargy, a sunken fontanel and no urine for hours suggest severe dehydration, which can lead to shock in infants. The other infants are well hydrated.

Answer

D · Lethargic, sunken fontanel, no wet diaper for 8 hours
6.Prioritization & delegation

Answer: C · Sweating

Why this is the answer

Beta-blockers can hide tachycardia, palpitations and tremor during hypoglycemia. Sweating is mainly cholinergic, so it usually remains, and patients are taught to check glucose when they sweat.

Answer

C · Sweating
7.Clinical nursing

Answer: B · Hyperosmolar hyperglycaemic state

Why this is the answer

HHS usually affects people with type 2 diabetes. It develops over days with extreme hyperglycaemia, dehydration and high osmolality, but little ketosis.

Answer

B · Hyperosmolar hyperglycaemic state
8.Clinical nursing

Answer: B · The tube may be kinked or blocked, or the lung may have fully re-expanded

Why this is the answer

Loss of swing can mean a kinked, clamped or blocked tube, or re-expansion of the lung. The nurse checks the tubing and the patient and reports the finding.

Answer

B · The tube may be kinked or blocked, or the lung may have fully re-expanded
9.Lab values & electrolytes

Answer: A · Hemoglobin and blood pressure

Why this is the answer

Epoetin stimulates red cell production. Hemoglobin is monitored, because raising it too high increases the risk of hypertension, stroke and thrombosis. Blood pressure is monitored, and iron stores are checked, since iron is needed for a good response.

Answer

A · Hemoglobin and blood pressure
10.Lab values & electrolytes

Answer: D · Hypokalemia from gastric losses is contributing to paralytic ileus

Why this is the answer

Gastric suction removes potassium and causes metabolic alkalosis, which shifts more potassium into cells. Low potassium reduces smooth muscle contraction and contributes to ileus and weakness. The provider is informed and potassium is replaced as prescribed.

Answer

D · Hypokalemia from gastric losses is contributing to paralytic ileus
11.Pharmacology

Answer: B · An anticholinergic such as benzatropine (benztropine)

Why this is the answer

Acute dystonia is caused by dopamine blockade, which leaves acetylcholine activity relatively high. An IM or IV anticholinergic usually relieves it within minutes.

Answer

B · An anticholinergic such as benzatropine (benztropine)
12.Pharmacology

Answer: A · Co-trimoxazole to prevent Pneumocystis pneumonia

Why this is the answer

A low CD4 count greatly raises the risk of Pneumocystis jirovecii pneumonia. Co-trimoxazole prevents it and also reduces the risk of toxoplasmosis.

Answer

A · Co-trimoxazole to prevent Pneumocystis pneumonia
13.Med-surg: cardiovascular & respiratory

Answer: D · Tall, peaked T waves

Why this is the answer

Rising potassium causes tall, tented T waves, then a flattened P wave, a prolonged PR interval and a widening QRS that can progress to ventricular fibrillation or asystole. U waves suggest hypokalaemia; a sawtooth baseline is atrial flutter.

Answer

D · Tall, peaked T waves
14.Med-surg: cardiovascular & respiratory

Answer: A · Directly observed therapy with support for barriers to adherence

Why this is the answer

Directly observed therapy, where a health worker watches each dose, plus help with practical and social barriers, improves completion and reduces multidrug-resistant TB. Single-drug therapy or interrupted treatment breeds resistance.

Answer

A · Directly observed therapy with support for barriers to adherence
15.Med-surg: neuro, endocrine & renal

Answer: C · The suppressed adrenal glands cannot make enough cortisol at once

Why this is the answer

Long-term glucocorticoids suppress ACTH, and the adrenal glands shrink. Stopping abruptly can cause adrenal insufficiency or crisis. Doses are reduced gradually so the glands can recover.

Answer

C · The suppressed adrenal glands cannot make enough cortisol at once
16.Med-surg: neuro, endocrine & renal

Answer: C · Measuring hourly urine and reporting results above a set amount

Why this is the answer

Measuring and recording urine output with clear instructions on when to report is suitable for a trained assistant. Medication decisions, neurological assessment and interpreting results stay with the registered nurse.

Answer

C · Measuring hourly urine and reporting results above a set amount
17.Med-surg: GI, perioperative & oncology

Answer: C · A restrictive threshold, often around 70 g/L, in most stable patients

Why this is the answer

Restrictive transfusion (often at a haemoglobin of about 70 g/L, with a target of 70–90 g/L, or a higher threshold in cardiovascular disease) is associated with better outcomes in many GI bleeding patients than liberal transfusion. Massive haemorrhage is managed by major haemorrhage protocols.

Answer

C · A restrictive threshold, often around 70 g/L, in most stable patients
18.Med-surg: GI, perioperative & oncology

Answer: C · Acute respiratory distress syndrome (ARDS)

Why this is the answer

Severe pancreatitis triggers a systemic inflammatory response that can cause ARDS, AKI and shock. Hypoxaemia with bilateral infiltrates is typical. Escalation to critical care for respiratory support is needed.

Answer

C · Acute respiratory distress syndrome (ARDS)
19.Maternity & obstetric nursing

Answer: B · Checking staff ID before handing over a baby

Why this is the answer

Matching ID bands, checking staff identification and teaching parents to hand their baby only to identified staff are key. Information about the baby should not be displayed publicly.

Answer

B · Checking staff ID before handing over a baby
20.Maternity & obstetric nursing

Answer: B · Subgaleal haemorrhage

Why this is the answer

A subgaleal haemorrhage is bleeding under the scalp aponeurosis. It crosses suture lines, can grow rapidly and can cause hypovolaemic shock. It is an emergency, unlike caput or cephalhaematoma.

Answer

B · Subgaleal haemorrhage
21.Pediatric nursing

Answer: C · Small, frequent feeds with rest breaks, using higher-energy milk if prescribed

Why this is the answer

Infants with heart failure use a lot of energy and tire easily. Small, frequent feeds, rest breaks, a semi-upright position and energy-dense milk help them grow; tube feeding may be needed if they cannot take enough.

Answer

C · Small, frequent feeds with rest breaks, using higher-energy milk if prescribed
22.Pediatric nursing

Answer: A · Treat the wounds, stay calm and non-judgemental, and refer for assessment

Why this is the answer

Self-harm often helps young people manage overwhelming feelings, but it is linked to higher suicide risk. A calm, non-judgemental response, wound care, risk assessment and referral to mental health services are needed.

Answer

A · Treat the wounds, stay calm and non-judgemental, and refer for assessment
23.Mental health nursing

Answer: C · Clang association

Why this is the answer

Clang associations link words by rhyme or sound and are seen in mania and psychosis. Echolalia repeats another person's words; a neologism is a newly invented word.

Answer

C · Clang association
24.Mental health nursing

Answer: D · Report the concern immediately to the nurse in charge, following policy, to protect patients

Why this is the answer

An impaired nurse is a risk to patients. The concern is reported at once through the proper channel so the colleague can be removed from patient care and offered support through the organisation's procedures.

Answer

D · Report the concern immediately to the nurse in charge, following policy, to protect patients
25.Nursing math & unit conversions

Answer: T = 95.5 °F

Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.

Multiply by 9/5

35.3·9/5 = 63.54

Add 32

T = 63.54 + 32 = 95.54 ≈ 95.5 °F

Answer

T = 95.5 °F
26.Nursing math & unit conversions

Answer: V = 452.5 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

1½ cups = 1.5·240 = 360 mL
½ tsp = 0.5·5 = 2.5 mL
3 fl oz = 3·30 = 90 mL

Add

V = 360 + 2.5 + 90 = 452.5 mL

Answer

V = 452.5 mL
27.Dosage calculations

Answer: V = 3 mL

Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.

Concentration

2% = 20 mg/mL

Volume

V = 60/20 = 3 mL

Answer

V = 3 mL
28.Dosage calculations

Answer: V = 0.76 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.

Same units

4 mg/mL = 4000 mcg/mL

Volume

V = 3040/4000 = 0.76 mL

Answer

V = 0.76 mL
29.IV infusion rates

Answer: R = 106.7 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 = 320/3 = 106.7 mL/h

Answer

R = 106.7 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: Δ = 20 %

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

1000/6 = 166.7 mL/h

New rate

R = 400/2 = 200 mL/h

Percentage change

Δ = (200 − 166.7)/166.7·100% = 20%

Answer

Δ = 20%

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

31.Pediatric & critical-care dosing

Answer: R = 14.3 mL/h

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 per hour

14·102 = 1 428 units/h

Concentration

25 000/250 = 100 units/mL

Pump rate

R = 1428/100 = 14.28 ≈ 14.3 mL/h

Answer

R = 14.3 mL/h
32.Pediatric & critical-care dosing

Answer: R = 12.2 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

800 mg = 800 000 mcg
800 000/500 = 1600 mcg/mL

Dose per minute and per hour

4·81 = 324 mcg/min
324·60 = 19440 mcg/h

Pump rate

R = 19440/1600 = 12.15 ≈ 12.2 mL/h

Answer

R = 12.2 mL/h
33.IV fluids & fluid balance

Answer: B = 585 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: 100 + 150 + 120 = 370 mL
ice chips: 120/2 = 60 mL
IV infusion: 60·8 = 480 mL
IV antibiotic: 2·50 = 100 mL
total intake = 1010 mL

Total output

225 + 200 = 425 mL

Balance

B = 1010 − 425 = 585 mL

Answer

B = 585 mL

Positive: more fluid went in than came out.

34.IV fluids & fluid balance

Answer: t = 2 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

1000 − 800 = 200 mL

Time

t = 200/100 = 2 h

Answer

t = 2 h

That is about 2 h 00 min, so the bag runs out at about 17:30.

35.Clinical assessment scores

Answer: B = 19

Braden scale: six subscales for pressure-injury risk. Sensory perception, moisture, activity, mobility and nutrition score 1 to 4, from the worst level (1) to no problem (4); friction and shear scores 1 to 3. The total runs from 6 to 23, and a lower total means a higher risk. Common bands: 19–23 not at risk, 15–18 mild risk, 13–14 moderate risk, 10–12 high risk and 9 or below very high risk.

Score each subscale

sensory perception: slightly limited → 3
moisture: occasionally moist → 3
activity: walks frequently → 4
mobility: no limitation → 4
nutrition: probably inadequate → 2
friction and shear: no apparent problem → 3

Add

Braden total = 3 + 3 + 4 + 4 + 2 + 3 = 19

Answer

B = 19
36.Clinical assessment scores

Answer: DBP = 35 mmHg

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

Rearrange

DBP = (3·MAP − SBP)/2

Substitute

DBP = (3·65 − 125)/2 = 70/2 = 35 mmHg

Answer

DBP = 35 mmHg
37.Arterial blood gas interpretation

Answer: PaCO₂ = 26 mmHg

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.

Winter’s formula

PaCO₂ = 1.5·12 + 8 = 26 mmHg
range: 24–28 mmHg

Answer

PaCO₂ = 26 mmHg
38.Arterial blood gas interpretation

Answer: PaCO₂ = 51.8 mmHg

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.

Expected PaCO₂

0.7·44 + 21 = 51.8 mmHg

Answer

PaCO₂ = 51.8 mmHg

The rise has a limit: PaCO₂ rarely goes above about 55 mmHg from compensation alone.

39.ECG rhythm strip interpretation

Answer: QTc = 0.438 s

QT and QTc: the QT interval runs from the start of the QRS complex to the end of the T wave. It shortens as the heart rate rises, so it is corrected for rate with the R–R interval in seconds: Bazett QTc = QT/√RR and Fridericia QTc = QT/∛RR. Bazett is the formula most textbooks use; it over-corrects at fast rates, where Fridericia is preferred. Limits differ between references: a QTc above about 0.45 s in men or 0.46 s in women is usually called prolonged, and above 0.50 s markedly prolonged.

Measure

QT = 10 × 0.04 = 0.40 s
RR = 19 × 0.04 = 0.76 s

Fridericia’s formula

QTc = 0.40/∛0.76 = 0.40/0.9126 = 0.438 s

Answer

QTc = 0.438 s

Within the usual limits (about 0.45 s for men, 0.46 s for women). (438 ms)

40.ECG rhythm strip interpretation

Answer: atrial rate = 68 bpm

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.

Atrial rate

P–P = 22 small boxes = 0.88 s → 1500 ÷ 22 = 68.18 ≈ 68 per minute

Ventricular rate

R–R = 44 small boxes = 1.76 s → 1500 ÷ 44 = 34.09 ≈ 34 per minute

Answer

atrial rate = 68 bpm

Answer

atrial rate = 68 bpm

2:1 AV block: every second P wave is not conducted, so the atrial rate is twice the ventricular rate.

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