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.

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1Formulas and methods

Infection control & patient safety

Method

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

Prioritization & delegation

Method

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

Lab values & electrolytes

Method

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

Med-surg: cardiovascular & respiratory

Method

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

Med-surg: neuro, endocrine & renal

Method

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

Med-surg: GI, perioperative & oncology

Method

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

Maternity & obstetric nursing

Method

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

Pediatric nursing

Method

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

Mental health nursing

Method

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

Nursing math & unit conversions

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

Method

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

Dosage calculations

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

Method

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

IV infusion rates

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

Method

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

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 says, "I've never seen this tablet before," as the nurse offers it. What should the nurse do?

  1. AReassure the patient that the tablet is correct and give it
  2. BStop and recheck the prescription before giving it
  3. CGive half the tablet until the doctor visits
  4. DLeave the tablet on the table for the patient to take later
2.Nursing fundamentalsHard

An older patient with diarrhoea for three days is dizzy on standing and passing small amounts of dark urine. What is the most likely problem?

  1. AFluid overload from drinking too much
  2. BNormal ageing that needs no action
  3. CDehydration from fluid loss
  4. DUrinary retention caused by a full bladder
3.Infection control & patient safetyMedium

A patient has highly contagious viral conjunctivitis. Which teaching is most important?

  1. ARub the eyes gently to remove the discharge
  2. BKeep using the same contact lenses to protect the eyes
  3. CWear a surgical mask whenever someone else is in the room
  4. DWash hands often and do not share towels, pillows or eye drops
4.Infection control & patient safetyHard

A nurse teaches new parents how to cope with an infant’s crying. Which statement shows a need for further teaching?

  1. A“I will check whether he is hungry, wet or too warm.”
  2. B“If he won’t stop crying, a quick shake will get his attention.”
  3. C“I can call a friend or family member to help when I am tired.”
  4. D“If I get frustrated, I will put him safely in the crib and take a short break.”
5.Prioritization & delegationMedium

A nurse has given rapid-acting insulin, and then learns that the patient’s meal tray will be 45 minutes late. What should the nurse do?

  1. AGive a second, smaller dose of insulin when the meal tray finally arrives
  2. BTell the patient to wait and do nothing until the tray comes
  3. CGet the patient some carbohydrate food now and check the glucose
  4. DAsk the patient to walk around the ward until the food arrives
6.Prioritization & delegationHard

A nurse is caring for four patients. Who can be safely assigned to the nursing assistant for routine care?

  1. AA patient returning from surgery who needs the first postoperative assessment
  2. BA patient with a new chest tube placed an hour ago
  3. CA patient five days after a stroke who needs help with bathing and has stable vital signs
  4. DA patient with a blood glucose of 52 mg/dL (2.9 mmol/L) who is sweating
7.Clinical nursingMedium

A patient receives IV furosemide for fluid overload. Which findings show the treatment is working?

  1. AA rise in blood pressure and a new cough
  2. BA rise in weight and more lung crackles
  3. CIncreased urine output, less breathlessness and a falling weight
  4. DFalling urine output, new ankle swelling and a rise in weight
8.Clinical nursingHard

A patient with back pain develops numbness around the anus and genitals and new difficulty passing urine. Which condition should be suspected?

  1. ACauda equina syndrome
  2. BConstipation
  3. CSimple muscle strain
  4. DKidney stones
9.Lab values & electrolytesMedium

A patient with HIV on antiretroviral therapy has an undetectable viral load. What does this mean?

  1. AThe treatment can now be stopped without any risk
  2. BThe treatment is suppressing the virus very well
  3. CThe CD4 count must now be dangerously low too
  4. DThe virus has been completely cured and removed
10.Lab values & electrolytesHard

A patient's bedside glucose meter shows "HI" (above its measuring range). The patient is drowsy. What should the nurse do?

  1. AAssume the meter is broken and give the usual insulin dose
  2. BSend a venous sample to the lab and inform the provider at once
  3. CRecord "HI" and repeat the meter test at the next scheduled time
  4. DGive oral glucose in case the reading is wrong and the patient is low
11.PharmacologyMedium

How does glyceryl trinitrate (GTN) relieve angina?

  1. AIt releases nitric oxide, mainly dilating veins and reducing cardiac workload
  2. BIt increases the force of contraction so the heart pumps blood more efficiently
  3. CIt blocks beta-1 receptors and slows the heart
  4. DIt dissolves the clot in the coronary artery
12.PharmacologyHard

A woman with chronic hypertension who takes lisinopril is now pregnant. What is the key concern?

  1. AACE inhibitors harm fetal kidneys, so a safer drug is used
  2. BLisinopril works better in pregnancy, so the dose should be increased
  3. CAll antihypertensives must be stopped in pregnancy
  4. DLisinopril has no known fetal effects and should be continued
13.Med-surg: cardiovascular & respiratoryMedium

A patient with angle-closure glaucoma needs nebulised ipratropium. What precaution is sensible?

  1. ARun it at the highest possible gas flow
  2. BMix it with an eye drop before putting it in the nebuliser
  3. CGive it only with the patient lying completely flat
  4. DUse a mouthpiece or protect the eyes from the mist
14.Med-surg: cardiovascular & respiratoryHard

Four hours after abdominal surgery, a patient's heart rate has risen from 84 to 122/min and they are restless and pale. BP is still 118/76 mmHg, and the surgical drain is filling with blood. What should the nurse conclude?

  1. AThe patient is stable because the blood pressure is normal
  2. BThe tachycardia is from pain and needs only analgesia
  3. CEarly haemorrhagic shock is likely, so escalate urgently
  4. DThe drain is working well, so no action is needed
15.Med-surg: neuro, endocrine & renalMedium

A patient with Addison's disease takes fludrocortisone as well as hydrocortisone. Why?

  1. ATo treat a low thyroid hormone level
  2. BTo replace the missing adrenaline
  3. CTo lower the blood pressure
  4. DTo replace the missing aldosterone
16.Med-surg: neuro, endocrine & renalHard

An older man has not passed urine for 10 hours, has lower abdominal pain and a bladder scan of 1100 mL. Creatinine has risen. What is the most likely cause and action?

  1. AUrinary retention; catheterise as prescribed and watch for a large diuresis
  2. BContrast nephropathy; arrange emergency haemodialysis today
  3. CDehydration; give a fluid bolus and recheck the creatinine tomorrow
  4. DDiabetes insipidus; give desmopressin and restrict fluids
17.Med-surg: GI, perioperative & oncologyMedium

Why is regular (scheduled) analgesia often preferred to "as required" doses in the first days after major surgery?

  1. AIt completely prevents all opioid side effects
  2. BIt removes the need to assess the patient's pain during the day
  3. CIt keeps drug levels steady and prevents severe peaks of pain
  4. DIt allows doses higher than the maximum daily limit to be given
18.Med-surg: GI, perioperative & oncologyHard

A patient on a long-term opioid for chronic pain is admitted for surgery. Which statement is correct?

  1. AThey should receive only paracetamol after the operation is over
  2. BAll opioids should be stopped on admission to prevent addiction
  3. CThey need lower postoperative opioid doses than opioid-naive patients
  4. DThe usual opioid is continued, plus extra analgesia, due to tolerance
19.Maternity & obstetric nursingMedium

A woman with hypothyroidism becomes pregnant. What usually happens to her levothyroxine needs?

  1. AThey decrease to zero, so she stops the drug
  2. BThey stay the same, so no monitoring is needed
  3. CThey usually rise, so levels are checked early
  4. DShe switches to iodine tablets instead
20.Maternity & obstetric nursingHard

A newborn's bilirubin is rising quickly at 30 hours despite phototherapy, and the baby is lethargic with an arched back and high-pitched cry. What does this suggest?

  1. AA normal reaction to phototherapy
  2. BMild breast milk jaundice
  3. CAcute bilirubin encephalopathy
  4. DNormal newborn reflexes
21.Pediatric nursingMedium

In acute post-streptococcal glomerulonephritis, which assessment is especially important?

  1. ASerum bilirubin
  2. BBlood glucose
  3. CPeak flow
  4. DBlood pressure
22.Pediatric nursingHard

A few weeks after diagnosis of type 1 diabetes, a child's insulin needs fall a lot. The parents think the diabetes is cured. What should the nurse explain?

  1. AThe diabetes has turned into type 2 diabetes
  2. BThis is the temporary "honeymoon" phase; insulin is still needed
  3. CThe diagnosis was probably wrong, and insulin can be stopped
  4. DThe child has become insulin resistant and now needs tablets instead of injections
23.Mental health nursingMedium

What should a patient starting zolpidem for insomnia be taught to report?

  1. AFeeling sleepy about 30 minutes after taking it at bedtime
  2. BDoing things while not fully awake, such as sleepwalking or driving, with no memory of it
  3. CFeeling slightly more rested and alert the next morning than before starting the medicine
  4. DSleeping through the night without waking up
24.Mental health nursingHard

The parent of a 16-year-old taking a stimulant for ADHD says her son's friends keep asking him for his tablets. What should the nurse teach?

  1. AGive the friends a smaller dose if they ask, so that they do not have side effects
  2. BSharing is fine as long as the friends are the same age
  3. CStore it securely and never share it, because stimulants are controlled drugs
  4. DStop the medicine so that there is no risk of sharing
25.Nursing math & unit conversionsMedium
12345678910111219:00?9:00 PM7:00 AM7:00 PM6:00 PM

Practice exercise (made-up values, not clinical guidance). A dose is charted at 19:00 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.

19:00
  1. 19:00 PM
  2. 27:00 AM
  3. 37:00 PM
  4. 46:00 PM
26.Nursing math & unit conversionsHard
1½ tsp · 4/day · 5 d? mL1 tsp = 5 mL

Practice exercise (made-up values, not clinical guidance). A prescription reads 1½ tsp of an oral suspension every 6 hours for 5 days. Using 1 tsp = 5 mL, how many mL V are needed for the whole course?

1½ tspevery 6 hours5 days1 tsp = 5 mL
V = mL
27.Dosage calculationsMedium
18 kg15 mg/kgD = ? mg

A patient weighs 18 kg and is prescribed 15 mg/kg as a single dose. Find the dose D in mg.

18 kg15 mg/kg
D = mg
28.Dosage calculationsHard
20%stockV₁ = ? mL

You must prepare 100 mL of a 0.5% (w/v) solution from a 20% (w/v) stock solution. What volume of stock V₁ do you need?

C₁ = 20%C₂ = 0.5%V₂ = 100 mL
V₁ = mL
29.IV infusion ratesMedium
500 mL20 gtt/mL3 h? gtt/min

Infuse 500 mL over 3 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

500 mL3 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
250 mg250 mL20 mL/h? mg/h

A bag contains 250 mg of a drug in 250 mL and runs at 20 mL/h. How many milligrams per hour D does the patient receive?

250 mg/250 mL20 mL/h
D = mg/h
31.Pediatric & critical-care dosingMedium
25 000 units250 mLheparin? mL/h53 kg20 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 20 units/kg/h for a patient who weighs 53 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

25 000 units/250 mL20 units/kg/h53 kg
R = mL/h
32.Pediatric & critical-care dosingHard
500 mg250 mLdobutamine? mL/h107 kg7.5 mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A bag contains dobutamine 500 mg in 250 mL. The order is 7.5 mcg/kg/min for a patient who weighs 107 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

500 mg/250 mL7.5 mcg/kg/min107 kg
R = mL/h
33.IV fluids & fluid balanceMedium
IntakeOutput8-hour shifttea240 mLjuice150 mLsoup250 mLIV infusion80 mL/h × 8 hIV antibiotic1 × 100 mLurine150 mLurine200 mLurine250 mLurine225 mLwound drain150 mLvomit150 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).

tea: 240 mLjuice: 150 mLsoup: 250 mLIV infusion: 80 mL/h × 8 hIV antibiotic: 1 × 100 mLurine: 150 mLurine: 200 mLurine: 250 mLurine: 225 mLwound drain: 150 mLvomit: 150 mL
B = mL
34.IV fluids & fluid balanceHard
1000 mL50 mL/hstart 09:0010:00: ? mL

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 09:00 and runs by pump at 50 mL/h. How many mL V are left in the bag at 10:00?

1000 mL50 mL/h09:00 → 10:00
V = mL
35.Clinical assessment scoresMedium
E4 / 4+V4 / 5+M? / 6GCS 13?

Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 13, with E4 and V4. What motor score M was recorded, and which response does it describe? Give the number.

GCS 13E4V4
M =
36.Clinical assessment scoresHard
low riskmoderate riskhigh risk

Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: yes; secondary diagnosis: yes; ambulatory aid: crutches, cane or walker; IV therapy or saline lock: yes; gait: weak; mental status: knows own limits. Using the cut-offs 0–24 low, 25–44 moderate and 45 or more high, click the fall-risk level.

  1. 1low risk
  2. 2moderate risk
  3. 3high risk
37.Arterial blood gas interpretationMedium

Practice values: Na⁺ 145 mmol/L, glucose 18.8 mmol/L and urea 17.5 mmol/L. Calculate the serum osmolality Osm = 2·Na⁺ + glucose + urea to the nearest whole number.

Na⁺ 145 mmol/Lglucose 18.8 mmol/Lurea 17.5 mmol/L
Osm = mOsm/kg
38.Arterial blood gas interpretationHard
pH7.357.457.22PaCO₂mmHg354545HCO₃⁻mmol/L222618appropriate compensationadded respiratory acidosisadded respiratory alkalosis

A practice gas shows a metabolic acidosis: pH 7.22, PaCO₂ 45 mmHg (6.0 kPa), HCO₃⁻ 18 mmol/L. Compare the measured PaCO₂ with Winter’s formula. Click your interpretation.

pH 7.22PaCO₂ 45 mmHg (6.0 kPa)HCO₃⁻ 18 mmol/L
  1. 1appropriate compensation
  2. 2added respiratory acidosis
  3. 3added respiratory alkalosis
39.ECG rhythm strip interpretationMedium
II25 mm/s · 10 mm/mVnormal sinus rhythmfirst-degree AV blockatrial fibrillationjunctional rhythm

Interpret this lead II rhythm strip. 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. 1normal sinus rhythm
  2. 2first-degree AV block
  3. 3atrial fibrillation
  4. 4junctional rhythm
40.ECG rhythm strip interpretationHard
II25 mm/s · 10 mm/mVfirst-degree AV block2:1 AV block (type undetermined)second-degree AV block type IIsecond-degree AV block type I (Wenckebach)

Interpret this lead II strip. Which interpretation can you defend from this single strip? 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. 22:1 AV block (type undetermined)
  3. 3second-degree AV block type II
  4. 4second-degree AV block type I (Wenckebach)

3Solutions

1.Nursing fundamentals

Answer: B · Stop and recheck the prescription before giving it

Why this is the answer

A patient questioning a medicine may be a sign of an error. The nurse holds the dose, checks the prescription and the drug and explains before giving it.

Answer

B · Stop and recheck the prescription before giving it
2.Nursing fundamentals

Answer: C · Dehydration from fluid loss

Why this is the answer

Diarrhoea causes loss of water and electrolytes. Postural dizziness and concentrated low-volume urine show dehydration, which needs fluid replacement, electrolyte checks and close monitoring.

Answer

C · Dehydration from fluid loss
3.Infection control & patient safety

Answer: D · Wash hands often and do not share towels, pillows or eye drops

Why this is the answer

Viral conjunctivitis spreads easily by contact with eye secretions. Hand hygiene, not touching the eyes and not sharing towels, pillows or eye products reduce spread.

Answer

D · Wash hands often and do not share towels, pillows or eye drops
4.Infection control & patient safety

Answer: B · “If he won’t stop crying, a quick shake will get his attention.”

Why this is the answer

Shaking an infant can cause bleeding in the brain, permanent disability or death. Parents are taught to put the baby down safely and step away if they feel overwhelmed, and to ask for help.

Answer

B · “If he won’t stop crying, a quick shake will get his attention.”
5.Prioritization & delegation

Answer: C · Get the patient some carbohydrate food now and check the glucose

Why this is the answer

Rapid-acting insulin starts working within minutes, so a long delay before eating risks hypoglycemia. The nurse arranges food or carbohydrate now and monitors the glucose.

Answer

C · Get the patient some carbohydrate food now and check the glucose
6.Prioritization & delegation

Answer: C · A patient five days after a stroke who needs help with bathing and has stable vital signs

Why this is the answer

A stable patient who needs help with activities of daily living is suitable for routine care by an assistant. A new chest tube, symptomatic hypoglycemia and the first postoperative assessment need a licensed nurse.

Answer

C · A patient five days after a stroke who needs help with bathing and has stable vital signs
7.Clinical nursing

Answer: C · Increased urine output, less breathlessness and a falling weight

Why this is the answer

Effective diuresis increases urine output and reduces congestion, so breathing improves and weight falls. Electrolytes, renal function and blood pressure are also monitored.

Answer

C · Increased urine output, less breathlessness and a falling weight
8.Clinical nursing

Answer: A · Cauda equina syndrome

Why this is the answer

Saddle anaesthesia, bladder or bowel dysfunction and leg symptoms with back pain suggest cauda equina syndrome. It needs an emergency MRI and surgical review to prevent permanent loss of function.

Answer

A · Cauda equina syndrome
9.Lab values & electrolytes

Answer: B · The treatment is suppressing the virus very well

Why this is the answer

An undetectable viral load shows that antiretroviral therapy is suppressing viral replication. The virus remains in the body, so treatment must continue. People with a sustained undetectable viral load do not transmit HIV sexually.

Answer

B · The treatment is suppressing the virus very well
10.Lab values & electrolytes

Answer: B · Send a venous sample to the lab and inform the provider at once

Why this is the answer

"HI" means the glucose exceeds the meter's range, so the true value is unknown and may be very high, as in DKA or HHS. A laboratory sample is sent, the provider is informed promptly, and the patient is assessed for dehydration and ketones.Checked against: Blood Glucose Test · MedlinePlus (NIH) (2024); Diabetic ketoacidosis - Medical Encyclopedia · MedlinePlus (NIH) (2025)

Answer

B · Send a venous sample to the lab and inform the provider at once
11.Pharmacology

Answer: A · It releases nitric oxide, mainly dilating veins and reducing cardiac workload

Why this is the answer

GTN is converted to nitric oxide, which relaxes vascular smooth muscle through cGMP. Venodilation lowers preload, so the heart works less and needs less oxygen.

Answer

A · It releases nitric oxide, mainly dilating veins and reducing cardiac workload
12.Pharmacology

Answer: A · ACE inhibitors harm fetal kidneys, so a safer drug is used

Why this is the answer

ACE inhibitors and ARBs cause fetal kidney damage, oligohydramnios and other problems, especially later in pregnancy. Drugs such as labetalol, nifedipine or methyldopa are used instead.

Answer

A · ACE inhibitors harm fetal kidneys, so a safer drug is used
13.Med-surg: cardiovascular & respiratory

Answer: D · Use a mouthpiece or protect the eyes from the mist

Why this is the answer

Ipratropium is an antimuscarinic bronchodilator. Mist escaping from a face mask can reach the eyes, dilate the pupil and trigger acute angle-closure glaucoma in susceptible patients. A mouthpiece or eye protection reduces the risk.

Answer

D · Use a mouthpiece or protect the eyes from the mist
14.Med-surg: cardiovascular & respiratory

Answer: C · Early haemorrhagic shock is likely, so escalate urgently

Why this is the answer

Rising heart rate, restlessness, pallor and visible bleeding are signs of compensated haemorrhagic shock. Waiting for hypotension delays treatment. The nurse escalates urgently, gives oxygen, ensures IV access and anticipates bloods, fluids or blood products and surgical review.

Answer

C · Early haemorrhagic shock is likely, so escalate urgently
15.Med-surg: neuro, endocrine & renal

Answer: D · To replace the missing aldosterone

Why this is the answer

In primary adrenal insufficiency, both cortisol and aldosterone are lacking. Hydrocortisone replaces cortisol, and fludrocortisone replaces aldosterone to keep sodium, potassium and blood pressure normal.

Answer

D · To replace the missing aldosterone
16.Med-surg: neuro, endocrine & renal

Answer: A · Urinary retention; catheterise as prescribed and watch for a large diuresis

Why this is the answer

Urinary retention, often from prostatic enlargement, can cause post-renal AKI. Relieving the obstruction with a catheter is the treatment. After drainage of a large volume, some patients have a marked post-obstructive diuresis, so fluid balance, electrolytes and blood pressure are monitored.

Answer

A · Urinary retention; catheterise as prescribed and watch for a large diuresis
17.Med-surg: GI, perioperative & oncology

Answer: C · It keeps drug levels steady and prevents severe peaks of pain

Why this is the answer

Predictable, continuous postoperative pain is best managed with regular multimodal analgesia (for example paracetamol and, where safe, an NSAID), with as-needed doses for breakthrough pain. Pain and side effects are still assessed regularly.

Answer

C · It keeps drug levels steady and prevents severe peaks of pain
18.Med-surg: GI, perioperative & oncology

Answer: D · The usual opioid is continued, plus extra analgesia, due to tolerance

Why this is the answer

Patients on long-term opioids have tolerance and physical dependence. Stopping their usual opioid risks withdrawal and uncontrolled pain. Their baseline dose is continued (or converted to another route) and multimodal analgesia added; they often need more opioid than opioid-naive patients, with careful monitoring.

Answer

D · The usual opioid is continued, plus extra analgesia, due to tolerance
19.Maternity & obstetric nursing

Answer: C · They usually rise, so levels are checked early

Why this is the answer

Levothyroxine needs usually rise in pregnancy. Thyroid function is checked as soon as pregnancy is confirmed and regularly afterwards, because untreated hypothyroidism can affect fetal brain development.

Answer

C · They usually rise, so levels are checked early
20.Maternity & obstetric nursing

Answer: C · Acute bilirubin encephalopathy

Why this is the answer

Lethargy, poor feeding, hypertonia with arching and a high-pitched cry are signs of acute bilirubin encephalopathy. An urgent exchange transfusion may be needed to prevent permanent kernicterus.

Answer

C · Acute bilirubin encephalopathy
21.Pediatric nursing

Answer: D · Blood pressure

Why this is the answer

Fluid and salt retention in glomerulonephritis often causes hypertension, which can lead to headache, visual disturbance and seizures (hypertensive encephalopathy). Blood pressure, weight, fluid balance and urine output are monitored closely.

Answer

D · Blood pressure
22.Pediatric nursing

Answer: B · This is the temporary "honeymoon" phase; insulin is still needed

Why this is the answer

After insulin treatment starts, remaining beta cells may recover partly, so insulin needs fall for weeks to months. This partial remission is temporary; insulin should continue, with doses adjusted to glucose readings.

Answer

B · This is the temporary "honeymoon" phase; insulin is still needed
23.Mental health nursing

Answer: B · Doing things while not fully awake, such as sleepwalking or driving, with no memory of it

Why this is the answer

Zolpidem and similar "Z-drugs" can cause complex sleep behaviours, such as sleep-walking, sleep-driving or cooking while not fully awake, which can cause serious injury. These must be reported and the drug stopped.

Answer

B · Doing things while not fully awake, such as sleepwalking or driving, with no memory of it
24.Mental health nursing

Answer: C · Store it securely and never share it, because stimulants are controlled drugs

Why this is the answer

Stimulants can be diverted and misused for studying or recreation. They are controlled drugs, so secure storage, monitoring the number of tablets and not sharing them are important.

Answer

C · Store it securely and never share it, because stimulants are controlled drugs
25.Nursing math & unit conversions

Answer: 7:00 PM

24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.

Convert the hour

19 − 12 = 7 → PM

Answer

7:00 PM

Answer

7:00 PM
26.Nursing math & unit conversions

Answer: V = 150 mL

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.

Volume per dose

1½ tsp = 1.5·5 = 7.5 mL

Whole course

V = 7.5 mL × 4/day × 5 = 150 mL

Answer

V = 150 mL
27.Dosage calculations

Answer: D = 270 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.

Dose

15·18 = 270 mg

Answer

D = 270 mg
28.Dosage calculations

Answer: V₁ = 2.5 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.

Volume of stock

V₁ = 0.5·100/20 = 2.5 mL

Answer

V₁ = 2.5 mL
29.IV infusion rates

Answer: R = 56 gtt/min

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

Time in minutes

3·60 = 180 min

Drip rate

R = 500·20/180 = 55.56 ≈ 56 gtt/min

Answer

R = 56 gtt/min

At the bedside you round to the nearest whole drop: 56 gtt/min.

30.IV infusion rates

Answer: D = 20 mg/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.

Concentration

250/250 = 1 mg/mL

Dose rate

D = 1·20 = 20 mg/h

Answer

D = 20 mg/h
31.Pediatric & critical-care dosing

Answer: R = 10.6 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

20·53 = 1 060 units/h

Concentration

25 000/250 = 100 units/mL

Pump rate

R = 1060/100 = 10.6 mL/h

Answer

R = 10.6 mL/h
32.Pediatric & critical-care dosing

Answer: R = 24.1 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

500 mg = 500 000 mcg
500 000/250 = 2000 mcg/mL

Dose per minute and per hour

7.5·107 = 802.5 mcg/min
802.5·60 = 48150 mcg/h

Pump rate

R = 48150/2000 = 24.07 ≈ 24.1 mL/h

Answer

R = 24.1 mL/h
33.IV fluids & fluid balance

Answer: B = 255 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: 240 + 150 + 250 = 640 mL
IV infusion: 80·8 = 640 mL
IV antibiotic: 1·100 = 100 mL
total intake = 1380 mL

Total output

150 + 200 + 250 + 225 + 150 + 150 = 1125 mL

Balance

B = 1380 − 1125 = 255 mL

Answer

B = 255 mL

Positive: more fluid went in than came out.

34.IV fluids & fluid balance

Answer: V = 950 mL

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.

Elapsed time

09:00 → 10:00 = 1 h

Volume infused

50·1 = 50 mL

Volume left

V = 1000 − 50 = 950 mL

Answer

V = 950 mL
35.Clinical assessment scores

Answer: M = 5

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.

Motor score

M = 13 − 4 − 4 = 5
M5: moves a hand to the site of pressure (localises)

Answer

M = 5
36.Clinical assessment scores

Answer: high risk

Morse fall scale: six items. History of falling: no 0, yes 25. Secondary diagnosis: no 0, yes 15. Ambulatory aid: none, bed rest or nurse assistance 0; crutches, cane or walker 15; holding on to furniture 30. IV therapy or saline lock: no 0, yes 20. Gait: normal, bed rest or wheelchair 0; weak 10; impaired 20. Mental status: knows own limits 0; overestimates or forgets limits 15. The total runs from 0 to 125. Risk cut-offs differ between hospitals; a common set is 0–24 low, 25–44 moderate and 45 or more high.

Score each item

history of falling in the last 3 months: yes → 25
secondary diagnosis: yes → 15
ambulatory aid: crutches, cane or walker → 15
IV therapy or saline lock: yes → 20
gait: weak → 10
mental status: knows own limits → 0

Add

Morse total = 25 + 15 + 15 + 20 + 10 + 0 = 85

Risk level

85 → high risk

Answer

high risk
37.Arterial blood gas interpretation

Answer: Osm = 326 mOsm/kg

Derived values: calculated serum osmolality is 2·Na⁺ + glucose + urea with all values in mmol/L (2·Na⁺ + glucose/18 + BUN/2.8 with glucose and BUN in mg/dL); normal is about 275–295 mOsm/kg. The P/F ratio is PaO₂ divided by FiO₂ as a fraction. The alveolar oxygen pressure is PAO₂ = FiO₂·(760 − 47) − PaCO₂/0.8 mmHg at sea level, and the A–a gradient is PAO₂ − PaO₂.

Calculated osmolality

Osm = 2·145 + 18.8 + 17.5 = 326.3 ≈ 326 mOsm/kg

Answer

Osm = 326 mOsm/kg
38.Arterial blood gas interpretation

Answer: added respiratory acidosis

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

1.5·18 + 8 = 35 → 33–37 mmHg

Compare

measured: 45 mmHg → added respiratory acidosis

Answer

added respiratory acidosis
39.ECG rhythm strip interpretation

Answer: junctional rhythm

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.

Five steps

1. Rate: R–R = 31 small boxes, 1500 ÷ 31 ≈ 48 per minute.
2. Rhythm: regular, every R–R is 1.24 s.
3. P waves: inverted, just after each QRS.
4. PR interval: not measurable.
5. QRS: 0.08 s, narrow (below 0.12 s).

Interpretation

junctional rhythm

Answer

junctional rhythm
40.ECG rhythm strip interpretation

Answer: 2:1 AV block (type undetermined)

2:1 AV block: with two P waves for every QRS, no two conducted P waves follow each other, so you cannot see whether the PR would lengthen (type I) or stay constant (type II) before a non-conducted P wave. From one strip it is called a 2:1 AV block; a longer strip or a change in the conduction ratio decides the type. A narrow QRS makes type I more likely and a wide QRS type II, but neither proves it.

Five steps

1. Rate: R–R = 38 small boxes, 1500 ÷ 38 ≈ 39 per minute.
2. Rhythm: regular, every R–R is 1.52 s.
3. P waves: upright and regular (P–P 0.76 s, 79 per minute), two for every QRS.
4. PR interval: constant at 0.18 s in the conducted beats.
5. QRS: 0.08 s, narrow (below 0.12 s).

Why the type stays open

Every second P wave is not conducted, so no two conducted beats follow each other and a lengthening PR could never show.
2:1 AV block (type undetermined)

Answer

2:1 AV block (type undetermined)

A narrow QRS makes type I more likely and a wide QRS type II, but only a longer strip or a change in the conduction ratio decides.

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