NCLEX-style practice questions (RN): cram pack

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.