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

How should a patient collect a midstream urine sample?

  1. ACollect urine from the toilet bowl after passing it
  2. BPass the first part into the toilet, then catch the middle part in the pot
  3. CCollect the last few drops after the bladder is empty
  4. DCollect the very first part of the stream in the pot, then pass the rest into the toilet
2.Nursing fundamentalsHard

A patient with a slow-healing leg ulcer is eating less than half of their meals. What is the most helpful nursing action?

  1. AWait until the ulcer heals before addressing nutrition
  2. BGive extra salt to stimulate the appetite
  3. CRefer to the dietitian and support protein and energy intake
  4. DAsk the patient to drink less to avoid swelling
3.Infection control & patient safetyMedium

A patient has received oral radioactive iodine therapy. Which precaution is usually taken?

  1. APlace the patient on droplet precautions with a surgical mask
  2. BLimit time close to the patient and handle body fluids per radiation policy
  3. CLet the patient share a bathroom with other patients
  4. DEncourage pregnant visitors to sit close to the patient to give emotional support
4.Infection control & patient safetyHard

A confused patient in wrist restraints has cool, pale fingers on one hand and a weak radial pulse on that side. What should the nurse do first?

  1. ADocument the findings carefully and recheck in two hours
  2. BLoosen that restraint and assess the hand’s circulation
  3. CTighten the other restraint to stop the patient pulling
  4. DRaise the hand on a pillow, leaving the restraint as it is
5.Prioritization & delegationMedium

On a mixed medical unit, which patient should the nurse see first?

  1. AA patient asking for written information about tomorrow’s discharge
  2. BA patient with depression who has given away his belongings and has a suicide plan
  3. CA patient with a mild tension headache who is asking for acetaminophen
  4. DA patient with hypertension whose blood pressure is 136/84 mmHg
6.Prioritization & delegationHard

Which patient needs the nurse’s attention first?

  1. AA patient with chronic back pain asking for a heat pack
  2. BA patient who says this is “the worst headache of my life” that started suddenly, with a blood pressure of 170/100 mmHg
  3. CA patient with long-standing hypertension whose blood pressure is 158/94 mmHg and who has no symptoms
  4. DA patient with known migraines who has a headache like their usual ones
7.Clinical nursingMedium

Which signs suggest a blood transfusion reaction in the first minutes?

  1. AImproved colour and energy
  2. BFever, chills, back pain and low blood pressure
  3. CMild hunger
  4. DSlow, steady rise in haemoglobin over the next day
8.Clinical nursingHard

A patient going home with a leg cast is taught about cast care. Which statement shows a need for further teaching?

  1. A"I will keep the cast dry."
  2. B"I will keep my leg raised on pillows for the first few days."
  3. C"I can push a knitting needle down the cast to scratch an itch."
  4. D"I will come back if my toes go numb or turn blue."
9.Lab values & electrolytesMedium

Apart from the lithium level, which tests are monitored regularly in long-term lithium therapy?

  1. AKidney function and thyroid function
  2. BINR and the platelet count
  3. CLiver enzymes and serum amylase
  4. DTroponin and creatine kinase (CK)
10.Lab values & electrolytesHard

A 5-year-old has new bruising and petechiae two weeks after a viral illness. Platelets are 12 × 10³/µL; hemoglobin, white cell count and clotting times are normal. Which condition is most likely?

  1. AAcute leukemia
  2. BImmune thrombocytopenia (ITP)
  3. CDisseminated intravascular coagulation
  4. DHemophilia A
11.PharmacologyMedium

Which rule applies to intravenous potassium chloride?

  1. AIt is mixed into blood products to save time
  2. BIt may be given intramuscularly if there is no IV access
  3. CIt must be diluted and given as an infusion, never as an IV push
  4. DIt is given as a rapid IV push to correct low levels quickly
12.PharmacologyHard

A patient with type 2 diabetes starts a high dose of prednisolone for a flare of COPD. Which change should the nurse expect?

  1. ANo change in glucose, as steroids act only in the lungs
  2. BLower potassium only, with no effect on glucose
  3. CHigher blood glucose, so more frequent glucose checks are needed
  4. DLower blood glucose, so the diabetes medicines should be stopped
13.Med-surg: cardiovascular & respiratoryMedium

After thrombolysis for a myocardial infarction, which complication is the nurse most concerned to detect?

  1. AA skin rash appearing at the sites of the ECG electrodes
  2. BBleeding, including a sudden change in neurological status
  3. CConstipation from bed rest
  4. DA high blood glucose caused by the thrombolytic drug itself
14.Med-surg: cardiovascular & respiratoryHard

A patient with heart failure has gained 2.5 kg in three days, has new crackles at both bases and now sleeps on four pillows. BP 138/84 mmHg, SpO₂ 93% on air. What is the priority?

  1. ARecord the weight and check it again at the end of the next week
  2. BEncourage extra oral fluids to protect the kidneys
  3. CSit the patient up, assess fully and report the fluid overload
  4. DLay the patient flat to rest the heart and lower demand
15.Med-surg: neuro, endocrine & renalMedium

Why is intermittent self-catheterisation often taught after a spinal cord injury?

  1. AIt trains the bladder to grow gradually larger over time
  2. BIt removes all risk of a urinary tract infection completely
  3. CIt is mainly used to measure the urine output accurately
  4. DThe bladder may not empty, and regular emptying protects the kidneys
16.Med-surg: neuro, endocrine & renalHard

A patient with hypothyroidism who has missed medication for weeks is admitted hypothermic and drowsy, with a pulse of 46/min, low sodium and a raised PaCO₂. Which condition is most likely?

  1. AAdrenal crisis
  2. BThyroid storm
  3. CHeat stroke
  4. DMyxoedema coma
17.Med-surg: GI, perioperative & oncologyMedium

Which lung problem is a known toxicity of bleomycin?

  1. AAsthma from pollen
  2. BLung cancer within weeks
  3. CPulmonary fibrosis
  4. DPneumothorax from coughing
18.Med-surg: GI, perioperative & oncologyHard

A nurse teaches a patient after a laparoscopic fundoplication for reflux. Which statement shows a need for further teaching?

  1. A"I should eat smaller meals for a while after the operation."
  2. B"I'll eat soft, moist food at first and chew it well."
  3. C"Fizzy drinks will help me bring up wind after meals."
  4. D"Some difficulty swallowing can happen in the early weeks."
19.Maternity & obstetric nursingMedium

At 32 weeks the fundal height is 37 cm. Which explanation should be considered?

  1. AFetal growth restriction
  2. BToo little amniotic fluid
  3. CA multiple pregnancy or excess amniotic fluid
  4. DThe fetus has dropped into the pelvis
20.Maternity & obstetric nursingHard

A woman at 10 weeks has been vomiting for days, has ketones in her urine, has lost 6% of her body weight and feels dizzy on standing. What is the priority?

  1. ATell her it will pass by itself after the first trimester and no follow-up is needed
  2. BAdvise her to eat three large meals a day
  3. CCorrect the dehydration with IV fluids and electrolytes as prescribed
  4. DStart a weight-loss diet
21.Pediatric nursingMedium

How should a 4-month-old be protected from the sun?

  1. AApply a thick layer of high-factor sunscreen and allow full sun
  2. BKeep the baby out of direct sun, in the shade, with light clothing and a hat
  3. CExpose the baby to midday sun for vitamin D, then cover up
  4. DUse a sunbed for a few minutes to build a protective tan
22.Pediatric nursingHard

An infant with a large VSD now breathes faster, sweats during feeds and has gained 300 g overnight with puffy eyelids. What does this most likely indicate?

  1. AWorsening heart failure with fluid retention
  2. BGood growth thanks to improved feeding
  3. CDehydration due to sweating during feeds
  4. DAn allergic reaction to the new high-energy formula started yesterday
23.Mental health nursingMedium

A patient with borderline personality disorder praises one nurse as "the only one who understands me" and calls the others useless. What is the best team response?

  1. AAgree on consistent rules and responses across the whole team
  2. BLet the favoured nurse make all decisions for this patient
  3. CAvoid the patient
  4. DTell the patient that the other nurses are also useless
24.Mental health nursingHard

A resident with Alzheimer's disease becomes very agitated and hits out when staff try to help him bathe. What is the best approach?

  1. AStop, try again later or in a different way, and explain each step calmly
  2. BGet more staff to hold him so the bath can be finished quickly
  3. CAsk the doctor for a sedative to be given before every bath so that he stays calm and cooperative
  4. DSkip bathing for the rest of his stay
25.Nursing math & unit conversionsMedium
5 ft 1 in1 ft = 12 in1 in = 2.54 cmh = ? cm

Practice exercise (made-up values, not clinical guidance). A patient is 5 ft 1 in tall. Using 1 ft = 12 in and 1 in = 2.54 cm, find the height h in centimetres, to the nearest whole centimetre.

5 ft 1 in1 ft = 12 in1 in = 2.54 cm
h = cm
26.Nursing math & unit conversionsHard
½ cup? mL1½ tbsp? mL½ fl oz? mL½ tsp? mLΣ = ? mL

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

1 cup = 8 fl oz = 240 mL1 tbsp = 15 mL1 fl oz = 30 mL1 tsp = 5 mL
V = mL
27.Dosage calculationsMedium
33 kgBSA = 1.15 m²100 mg/m²D = ? mg

A patient weighing 33 kg has a body surface area of 1.15 m². The prescription is 100 mg/m². Find the dose D in mg.

33 kgBSA = 1.15 m²100 mg/m²
D = mg
28.Dosage calculationsHard
125 mg/5 mLV = ? mL

A child weighing 10 kg is prescribed 5 mg/kg per dose of an oral suspension that contains 125 mg in 5 mL. What volume V do you give?

10 kg5 mg/kg125 mg/5 mL
V = mL
29.IV infusion ratesMedium
500 mL10 gtt/mL3 h? gtt/min

Infuse 500 mL over 3 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

500 mL3 h10 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
250 units250 mLregular insulin? mL/h3 units/h

Practice exercise (made-up values, not clinical guidance). An infusion contains 250 units of regular insulin in 250 mL. The order is 3 units/h. Find the pump rate R in mL/h. Round to one decimal place.

250 units/250 mL3 units/h
R = mL/h
32.Pediatric & critical-care dosingHard
4 mg250 mLnorepinephrine? mL/h60 kg12 mcg/min

Practice exercise (made-up values, not clinical guidance). A patient who weighs 60 kg has an order for norepinephrine at 12 mcg/min. The bag contains 4 mg in 250 mL. Find the pump rate R in mL/h. Round to one decimal place.

4 mg/250 mL12 mcg/min60 kg
R = mL/h
33.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftmilk200 mLtea150 mLice chips200 mLIV infusion125 mL/h × 8 hIV antibiotic2 × 100 mLurine175 mLurine275 mLwound drain30 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 total intake I in mL. Count ice chips as half their volume.

milk: 200 mLtea: 150 mLice chips: 200 mLIV infusion: 125 mL/h × 8 hIV antibiotic: 2 × 100 mL
I = mL
34.IV fluids & fluid balanceHard
1000 mL60 mL/hstart 08:0012:00: ? mL

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 08:00 and runs by pump at 60 mL/h. How many mL V are left in the bag at 12:00?

1000 mL60 mL/h08:00 → 12:00
V = mL
35.Clinical assessment scoresMedium
E4 / 4+V3 / 5+M? / 6GCS 13?

Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 13, with E4 and V3. What motor score M was recorded, and which response does it describe? Give the number.

GCS 13E4V3
M =
36.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 88 kg and is 180 cm tall. Calculate the BMI and click the WHO weight category.

88 kg180 cm
  1. 1underweight
  2. 2healthy weight
  3. 3overweight
  4. 4obesity class I
  5. 5obesity class II
  6. 6obesity class III
37.Arterial blood gas interpretationMedium
pH7.357.457.36PaCO₂mmHg354533HCO₃⁻mmol/L222618uncompensatedpartially compensatedfully compensated

A practice arterial blood gas shows pH 7.36, PaCO₂ 33 mmHg (4.4 kPa) and HCO₃⁻ 18 mmol/L. The primary disorder is metabolic acidosis. How far is it compensated? Click your answer.

pH 7.36PaCO₂ 33 mmHg (4.4 kPa)HCO₃⁻ 18 mmol/L
  1. 1uncompensated
  2. 2partially compensated
  3. 3fully compensated
38.Arterial blood gas interpretationHard
pH7.357.457.27PaCO₂mmHg354541HCO₃⁻mmol/L222618appropriate compensationadded respiratory acidosisadded respiratory alkalosis

A practice gas shows a metabolic acidosis: pH 7.27, PaCO₂ 41 mmHg (5.5 kPa), HCO₃⁻ 18 mmol/L. Compare the measured PaCO₂ with Winter’s formula. Click your interpretation.

pH 7.27PaCO₂ 41 mmHg (5.5 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/mVsinus bradycardiaatrial fibrillationnormal sinus rhythmsinus tachycardia

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. 1sinus bradycardia
  2. 2atrial fibrillation
  3. 3normal sinus rhythm
  4. 4sinus tachycardia
40.ECG rhythm strip interpretationHard
II25 mm/s · 10 mm/mVraterhythmP wavesPR intervalQRS duration

Interpret this lead II strip with the five steps in order: rate, rhythm, P waves, PR interval, QRS duration. At which step do you find the first abnormal finding? Click it.

lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
  1. 1rate
  2. 2rhythm
  3. 3P waves
  4. 4PR interval
  5. 5QRS duration

3Solutions

1.Nursing fundamentals

Answer: B · Pass the first part into the toilet, then catch the middle part in the pot

Why this is the answer

After cleaning, the first stream flushes bacteria from the urethra, so the midstream part is collected in a sterile container. This reduces contamination.

Answer

B · Pass the first part into the toilet, then catch the middle part in the pot
2.Nursing fundamentals

Answer: C · Refer to the dietitian and support protein and energy intake

Why this is the answer

Poor intake delays healing. Screening, dietitian referral, food charts and support with meals, including protein and energy supplements if needed, help the wound heal.

Answer

C · Refer to the dietitian and support protein and energy intake
3.Infection control & patient safety

Answer: B · Limit time close to the patient and handle body fluids per radiation policy

Why this is the answer

Radioactive iodine is excreted in urine, sweat and saliva, so the patient is usually in a private room with their own bathroom. Staff limit time near them, use distance and follow policy for body fluids and waste.

Answer

B · Limit time close to the patient and handle body fluids per radiation policy
4.Infection control & patient safety

Answer: B · Loosen that restraint and assess the hand’s circulation

Why this is the answer

Signs of poor circulation distal to a restraint require immediate release and assessment. The restraint is then reapplied correctly only if still needed, with the two-finger check, and the findings are reported and documented.

Answer

B · Loosen that restraint and assess the hand’s circulation
5.Prioritization & delegation

Answer: B · A patient with depression who has given away his belongings and has a suicide plan

Why this is the answer

Giving away belongings and having a plan are warning signs of suicide, an immediate safety threat. The other patients are stable and their needs can wait.

Answer

B · A patient with depression who has given away his belongings and has a suicide plan
6.Prioritization & delegation

Answer: B · A patient who says this is “the worst headache of my life” that started suddenly, with a blood pressure of 170/100 mmHg

Why this is the answer

A sudden, severe “thunderclap” headache can mean a bleed in the brain, such as a subarachnoid hemorrhage, and is an emergency. The other patients have known, stable problems that match their history.

Answer

B · A patient who says this is “the worst headache of my life” that started suddenly, with a blood pressure of 170/100 mmHg
7.Clinical nursing

Answer: B · Fever, chills, back pain and low blood pressure

Why this is the answer

An acute haemolytic or febrile reaction can cause fever, rigors, loin or back pain, breathlessness and hypotension. Stop the transfusion and call for help.

Answer

B · Fever, chills, back pain and low blood pressure
8.Clinical nursing

Answer: C · "I can push a knitting needle down the cast to scratch an itch."

Why this is the answer

Pushing objects under a cast can injure the skin and cause infection or pressure sores. Elevation, keeping the cast dry and reporting numbness, colour change or increasing pain are correct.

Answer

C · "I can push a knitting needle down the cast to scratch an itch."
9.Lab values & electrolytes

Answer: A · Kidney function and thyroid function

Why this is the answer

Long-term lithium can cause hypothyroidism and impair kidney function, including nephrogenic diabetes insipidus. Creatinine/eGFR and TSH are therefore checked regularly, together with sodium and the lithium level.Checked against: Hypothyroidism · MedlinePlus (NIH) (2024)

Answer

A · Kidney function and thyroid function
10.Lab values & electrolytes

Answer: B · Immune thrombocytopenia (ITP)

Why this is the answer

ITP is immune destruction of platelets, often after a viral infection in children. It causes isolated thrombocytopenia with normal other counts and clotting tests. Leukemia usually affects other cell lines, DIC prolongs clotting times and hemophilia prolongs the aPTT.Checked against: Immune thrombocytopenic purpura (ITP) · MedlinePlus (NIH) (2026)

Answer

B · Immune thrombocytopenia (ITP)
11.Pharmacology

Answer: C · It must be diluted and given as an infusion, never as an IV push

Why this is the answer

Concentrated potassium given as a bolus can cause fatal cardiac arrhythmias. It is always diluted and given at a controlled rate, usually with an infusion pump.

Answer

C · It must be diluted and given as an infusion, never as an IV push
12.Pharmacology

Answer: C · Higher blood glucose, so more frequent glucose checks are needed

Why this is the answer

Glucocorticoids raise blood glucose by increasing liver glucose production and insulin resistance. Glucose is monitored more often, and diabetes treatment may need to be increased during the course.

Answer

C · Higher blood glucose, so more frequent glucose checks are needed
13.Med-surg: cardiovascular & respiratory

Answer: B · Bleeding, including a sudden change in neurological status

Why this is the answer

The main risk of thrombolysis is bleeding, from puncture sites, gums or the gut, and most seriously intracranial haemorrhage. The nurse monitors puncture sites, vital signs and neurological status and minimises invasive procedures. Reperfusion arrhythmias are also common.

Answer

B · Bleeding, including a sudden change in neurological status
14.Med-surg: cardiovascular & respiratory

Answer: C · Sit the patient up, assess fully and report the fluid overload

Why this is the answer

Rapid weight gain with crackles and orthopnoea indicates fluid overload and worsening heart failure. Sitting upright reduces venous return and eases breathing. The nurse completes an assessment (oxygen trend, fluid balance, oedema) and escalates so the prescriber can adjust diuretics. More fluid or lying flat would worsen congestion.

Answer

C · Sit the patient up, assess fully and report the fluid overload
15.Med-surg: neuro, endocrine & renal

Answer: D · The bladder may not empty, and regular emptying protects the kidneys

Why this is the answer

Spinal cord injury often causes neurogenic bladder. Clean intermittent catheterisation at regular intervals empties the bladder, prevents high pressures, reduces infection and kidney damage and avoids triggering autonomic dysreflexia.

Answer

D · The bladder may not empty, and regular emptying protects the kidneys
16.Med-surg: neuro, endocrine & renal

Answer: D · Myxoedema coma

Why this is the answer

Myxoedema coma presents with reduced consciousness, hypothermia, bradycardia, hypoventilation, hyponatraemia and hypoglycaemia, often triggered by infection or missed treatment. It needs critical care, IV thyroid hormone, steroid cover until adrenal insufficiency is excluded, passive rewarming and great care with sedatives.

Answer

D · Myxoedema coma
17.Med-surg: GI, perioperative & oncology

Answer: C · Pulmonary fibrosis

Why this is the answer

Bleomycin can cause pneumonitis and pulmonary fibrosis, especially at higher cumulative doses, in older patients and with high oxygen concentrations. Breathlessness or a new cough must be reported.

Answer

C · Pulmonary fibrosis
18.Med-surg: GI, perioperative & oncology

Answer: C · "Fizzy drinks will help me bring up wind after meals."

Why this is the answer

Fundoplication wraps the stomach around the lower oesophagus, so belching may be hard and gas bloat is common; fizzy drinks make it worse. Soft food, small meals and good chewing help while early swelling settles.

Answer

C · "Fizzy drinks will help me bring up wind after meals."
19.Maternity & obstetric nursing

Answer: C · A multiple pregnancy or excess amniotic fluid

Why this is the answer

A fundal height larger than dates suggests a multiple pregnancy, polyhydramnios, a large fetus or wrong dates. Growth restriction, oligohydramnios and descent of the fetus make the measurement smaller.

Answer

C · A multiple pregnancy or excess amniotic fluid
20.Maternity & obstetric nursing

Answer: C · Correct the dehydration with IV fluids and electrolytes as prescribed

Why this is the answer

These are signs of hyperemesis gravidarum with dehydration. IV fluids, electrolyte replacement, antiemetics and vitamin supplements such as thiamine as prescribed are the priority.

Answer

C · Correct the dehydration with IV fluids and electrolytes as prescribed
21.Pediatric nursing

Answer: B · Keep the baby out of direct sun, in the shade, with light clothing and a hat

Why this is the answer

Babies under about 6 months should be kept out of direct sunlight, protected by shade, clothing and hats. Sunscreen is mainly for older infants and children, on skin that cannot be covered.

Answer

B · Keep the baby out of direct sun, in the shade, with light clothing and a hat
22.Pediatric nursing

Answer: A · Worsening heart failure with fluid retention

Why this is the answer

A sudden overnight weight gain with periorbital oedema, tachypnoea and sweating suggests fluid retention from worsening heart failure. Daily weights on the same scale are a key way to monitor fluid status in these infants.

Answer

A · Worsening heart failure with fluid retention
23.Mental health nursing

Answer: A · Agree on consistent rules and responses across the whole team

Why this is the answer

Splitting divides staff into "all good" and "all bad". A consistent team approach, clear boundaries and good communication between staff prevent manipulation of the team and help the patient.

Answer

A · Agree on consistent rules and responses across the whole team
24.Mental health nursing

Answer: A · Stop, try again later or in a different way, and explain each step calmly

Why this is the answer

Bathing can feel frightening or undignified. Changing the timing, approach or method, for example a bed bath or shower, giving simple explanations and keeping him covered and warm often reduces distress without force.

Answer

A · Stop, try again later or in a different way, and explain each step calmly
25.Nursing math & unit conversions

Answer: h = 155 cm

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.

Height in inches

5·12 + 1 = 61 in

Inches to centimetres

h = 61·2.54 = 154.9 ≈ 155 cm

Answer

h = 155 cm
26.Nursing math & unit conversions

Answer: V = 160 mL

Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.

Each item in mL

½ cup = 0.5·240 = 120 mL
1½ tbsp = 1.5·15 = 22.5 mL
½ fl oz = 0.5·30 = 15 mL
½ tsp = 0.5·5 = 2.5 mL

Add

V = 120 + 22.5 + 15 + 2.5 = 160 mL

Answer

V = 160 mL
27.Dosage calculations

Answer: D = 115 mg

Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).

Dose

D = 100·1.15 = 115 mg

Answer

D = 115 mg
28.Dosage calculations

Answer: V = 2 mL

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

Dose from weight

5·10 = 50 mg

Volume

V = (50/125)·5 = 2 mL

Answer

V = 2 mL
29.IV infusion rates

Answer: R = 28 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 = 500·10/180 = 27.78 ≈ 28 gtt/min

Answer

R = 28 gtt/min

At the bedside you round to the nearest whole drop: 28 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 = 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.

Concentration

250/250 = 1 units/mL

Pump rate

R = 3/1 = 3 mL/h

Answer

R = 3 mL/h
32.Pediatric & critical-care dosing

Answer: R = 45 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

4 000/250 = 16 mcg/mL

Dose per hour

The order is per minute for the whole patient, so the weight is not needed.

12·60 = 720 mcg/h

Pump rate

R = 720/16 = 45 mL/h

Answer

R = 45 mL/h
33.IV fluids & fluid balance

Answer: I = 1650 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.

Add the intake

oral: 200 + 150 = 350 mL
ice chips: 200/2 = 100 mL
IV infusion: 125·8 = 1000 mL
IV antibiotic: 2·100 = 200 mL
I = 1650 mL

Answer

I = 1650 mL
34.IV fluids & fluid balance

Answer: V = 760 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

08:00 → 12:00 = 4 h

Volume infused

60·4 = 240 mL

Volume left

V = 1000 − 240 = 760 mL

Answer

V = 760 mL
35.Clinical assessment scores

Answer: M = 6

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 − 3 = 6
M6: obeys commands

Answer

M = 6
36.Clinical assessment scores

Answer: overweight

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

BMI

BMI = 88/1.8² = 27.16

Category

overweight

Answer

overweight
37.Arterial blood gas interpretation

Answer: fully compensated

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

ROME, value by value

pH 7.36: within 7.35–7.45
PaCO₂ 33 mmHg: low (35–45)
HCO₃⁻ 18 mmol/L: low (22–26)

Compensation

fully compensated

Answer

fully compensated
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: 41 mmHg → added respiratory acidosis

Answer

added respiratory acidosis
39.ECG rhythm strip interpretation

Answer: sinus tachycardia

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 = 14 small boxes, 1500 ÷ 14 ≈ 107 per minute.
2. Rhythm: regular, every R–R is 0.56 s.
3. P waves: upright, one before every QRS, all alike.
4. PR interval: 0.14 s, constant, within 0.12–0.20 s.
5. QRS: 0.08 s, narrow (below 0.12 s).

Interpretation

sinus tachycardia

Answer

sinus tachycardia
40.ECG rhythm strip interpretation

Answer: PR interval

Five steps for every strip: 1. rate (300 or 1500 method, or the 6-second method if irregular); 2. rhythm: are the R–R intervals equal; 3. P waves: present, upright in lead II, one before every QRS and all alike; 4. PR interval: 0.12–0.20 s and constant; 5. QRS duration: below 0.12 s. Only after the five steps name the rhythm. Normal sinus rhythm passes all five: 60–100/min, regular, upright P before every QRS, PR 0.12–0.20 s, QRS below 0.12 s.

Five steps

1. Rate: R–R = 23 small boxes, 1500 ÷ 23 ≈ 65 per minute.
2. Rhythm: regular, every R–R is 0.92 s.
3. P waves: upright, one before every QRS, all alike.
4. PR interval: 0.36 s, constant, longer than 0.20 s.
5. QRS: 0.10 s, narrow (below 0.12 s).

First abnormal step

PR interval → first-degree AV block

Answer

PR interval

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