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 with expressive aphasia after a stroke understands speech but struggles to find words. Which approach helps most?

  1. ASpeak louder and more slowly than usual
  2. BAsk simple yes/no questions and allow plenty of time
  3. CFinish their sentences quickly for them to save them frustration
  4. DTalk to the family instead of the patient
2.Nursing fundamentalsHard

A healthcare assistant (nursing assistant) has recorded a blood pressure of 82/50 mmHg during routine observations but did not report it. What should the registered nurse do first?

  1. AComplete an incident report
  2. BTalk to the healthcare assistant about reporting
  3. CAssess the patient straight away
  4. DRepeat the observations at the next routine time
3.Infection control & patient safetyMedium

Where should the dispersive (grounding) pad for electrosurgery be placed?

  1. AOver an area with scar tissue or a tattoo, so that the pad does not slip
  2. BOver a bony prominence such as the hip bone
  3. COn skin that is wet with antiseptic prep
  4. DOn clean, dry skin over a well-perfused muscle, close to the surgical site
4.Infection control & patient safetyHard

Minutes after the first IV dose of an antibiotic starts, the patient develops wheezing, hives and low blood pressure. What should the nurse do first?

  1. AStop the infusion
  2. BRecord the new allergy in the chart
  3. CSlow the infusion rate
  4. DGive an oral antihistamine
5.Prioritization & delegationMedium

After handover, which patient should the nurse see first?

  1. AA patient with diabetes whose glucose before breakfast is 160 mg/dL (8.9 mmol/L)
  2. BA patient two days after hip replacement with pain of 5/10
  3. CA patient with asthma who is using accessory muscles and has an SpO₂ of 88%
  4. DA patient with pneumonia, temperature 38.2 °C, who had an antipyretic 30 minutes ago
6.Prioritization & delegationHard

A patient in acute mania paces constantly, has lost weight and will not sit down to eat. Which intervention is most helpful?

  1. AInsist that the patient sits at the table until the meal is finished
  2. BLeave meals in the room and let the patient eat whenever and whatever they choose
  3. CWait until the mania settles before worrying about nutrition
  4. DOffer high-calorie finger foods and drinks the patient can take while moving
7.Clinical nursingMedium

Which oxygen device delivers a precise, fixed concentration of oxygen?

  1. ASimple face mask
  2. BNasal cannula
  3. CVenturi mask
  4. DNon-rebreathe mask
8.Clinical nursingHard

A nurse phones a doctor about a deteriorating patient using SBAR. Which statement belongs in the "R" section?

  1. A"I am calling about Mr Smith, who is breathless."
  2. B"Please review him within the next 15 minutes."
  3. C"He was admitted three days ago with pneumonia."
  4. D"His blood pressure is 85/50 and he is confused."
9.Lab values & electrolytesMedium

A young adult with new diabetes has a very low C-peptide level. What does this suggest?

  1. AThe kidneys are excreting all of the patient's insulin in urine
  2. BThe patient has high insulin resistance, as in type 2 diabetes
  3. CThe pancreas is making very little insulin, as in type 1 diabetes
  4. DThe patient is injecting too much insulin and needs a lower dose
10.Lab values & electrolytesHard

Which patient’s result should the nurse report first?

  1. ATotal cholesterol slightly above target
  2. BGlucose 42 mg/dL (2.3 mmol/L) in a patient who is sweating and confused
  3. CHbA1c 7.4% (57 mmol/mol) in a patient with type 2 diabetes
  4. DCreatinine 1.6 mg/dL (141 µmol/L) in a patient with known stable CKD
11.PharmacologyMedium

A patient has oral mucositis after chemotherapy. Which advice is appropriate?

  1. AUse a soft toothbrush and rinse with saline or a bland mouthwash
  2. BUse an alcohol-based mouthwash several times a day to kill germs
  3. CEat spicy and acidic foods to stimulate healing
  4. DBrush hard with a firm toothbrush to remove debris
12.PharmacologyHard

A patient receives high-dose IV aciclovir for herpes encephalitis. Which nursing action reduces the main risk to the kidneys?

  1. ARestrict oral and IV fluids to prevent brain swelling
  2. BGive a loop diuretic before each dose
  3. CGive the infusion as a rapid push
  4. DKeep the patient well hydrated and give the infusion slowly
13.Med-surg: cardiovascular & respiratoryMedium

How does intermittent pneumatic compression help prevent DVT?

  1. AIt keeps the legs completely still to protect the veins
  2. BIt warms the legs gently so the blood becomes thinner and flows faster
  3. CIt squeezes the legs in cycles to push venous blood towards the heart
  4. DIt breaks up and dissolves clots that have already formed in the veins
14.Med-surg: cardiovascular & respiratoryHard

A patient is going home after a spontaneous pneumothorax treated with a chest drain. Which advice is correct?

  1. AStop smoking and do not fly until a doctor confirms full resolution
  2. BTake up scuba diving to strengthen the lungs
  3. CFly home as soon as possible so they can recover in comfort there
  4. DExpect it never to happen again, so no follow-up is needed
15.Med-surg: neuro, endocrine & renalMedium

A seizure has lasted five minutes and is continuing. What is the usual first-line drug treatment?

  1. AAn IV loading dose of phenytoin before anything else
  2. BA benzodiazepine such as IV lorazepam or buccal midazolam
  3. CIM adrenaline into the outer thigh
  4. DIV glucose 50% in every patient, then reassess
16.Med-surg: neuro, endocrine & renalHard

A drowsy patient's glucose meter shows "HI". What should the nurse do?

  1. AGive glucose gel in case the reading is wrong
  2. BTreat it as very high, check ketones and escalate
  3. CAssume the meter is broken and recheck tomorrow
  4. DRecord "normal" in the notes because no number appears
17.Med-surg: GI, perioperative & oncologyMedium

Aspirate from a nasogastric tube has a pH of 7. What should the nurse do?

  1. AFlush with 50 mL of air and start the feed
  2. BGive the medicines but not the feed
  3. CDo not use it; re-test later or arrange an X-ray as per policy
  4. DStart the feed slowly and watch the patient closely for coughing
18.Med-surg: GI, perioperative & oncologyHard

After a fall, a patient with advanced dementia is agitated, grimacing and guarding the hip, and cannot rate the pain. What should the nurse do?

  1. AGive a sedative to treat the agitation and avoid giving any analgesia
  2. BAssume there is no pain because none is reported
  3. CWait until a relative can confirm the pain
  4. DUse an observational pain tool, give analgesia and reassess
19.Maternity & obstetric nursingMedium

The fundus is boggy, above the umbilicus and displaced to the right. What is the most likely cause?

  1. AA normal finding on day 1
  2. BRetained placental tissue on the left
  3. CA tear in the perineum
  4. DA full bladder
20.Maternity & obstetric nursingHard

A large for gestational age newborn of a mother with diabetes is also very red and has a high haematocrit. Which complication of this finding should the nurse watch for?

  1. ADehydration caused by vomiting
  2. BNeural tube defects
  3. CHypothermia caused by sweating
  4. DJaundice
21.Pediatric nursingMedium

A child with tetralogy of Fallot suddenly becomes very blue and breathless while crying. Which position helps?

  1. AHead-down tilt
  2. BSitting with the legs hanging down
  3. CKnee–chest position (or squatting)
  4. DFlat on the back
22.Pediatric nursingHard

A child with a head injury now has rising blood pressure, a falling heart rate and irregular breathing. What does this indicate?

  1. AA late sign of raised intracranial pressure; an emergency
  2. BDehydration that needs more fluids
  3. CNormal recovery after a head injury
  4. DPain from the injury that needs stronger, regular analgesia
23.Mental health nursingMedium

A young person who took LSD at a festival is frightened by what he is seeing. What is the most helpful nursing approach?

  1. ALeave him alone in a dark room so that he can sleep it off
  2. BArgue with him that what he sees is not real until he accepts it
  3. CShine a bright light in his eyes every few minutes to check his pupils and keep him alert until it wears off
  4. DStay with him in a calm, quiet place and reassure him that the effects are from the drug and will pass
24.Mental health nursingHard

During a session, a patient says he intends to seriously harm a named neighbour. What is the correct general principle?

  1. AThe nurse should personally go and warn the neighbour without telling the team
  2. BThe risk to an identifiable person must be shared with the team and may need to be disclosed to protect that person, following the law and policy
  3. CConfidentiality means nothing can be shared
  4. DThe threat should be ignored because patients often say things they don't mean
25.Nursing math & unit conversionsMedium
1234567891011122:50 PM?15:5013:5002:5014:50

Practice exercise (made-up values, not clinical guidance). A dose is charted at 2:50 PM. Which entry is the same time on the 24-hour clock? Click it.

2:50 PM
  1. 115:50
  2. 213:50
  3. 302:50
  4. 414:50
26.Nursing math & unit conversionsHard
1 tbsp · 2/day · 7 d? mL1 tbsp = 15 mL

Practice exercise (made-up values, not clinical guidance). A prescription reads 1 tbsp of an oral suspension every 12 hours for 7 days. Using 1 tbsp = 15 mL, how many mL V are needed for the whole course?

1 tbspevery 12 hours7 days1 tbsp = 15 mL
V = mL
27.Dosage calculationsMedium
80 kg7.5 mg/kg/day2× per dayD = ? mg

A patient weighs 80 kg. The prescribed dose is 7.5 mg/kg per day, given in 2 equal doses. How many milligrams D are given per dose?

80 kg7.5 mg/kg/day2× per day
D = mg
28.Dosage calculationsHard
50k units250 mL? mL/h1250 units/h

An infusion contains 50000 units of a drug in 250 mL. The prescription is 1250 units per hour. At what rate R do you set the pump, in mL/h?

50000 units/250 mL1250 units/h
R = mL/h
29.IV infusion ratesMedium
190 mLleft? mL/h2 h left

500 mL was ordered over 6 hours. After 4 hours you find that 190 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?

500 mL / 6 hafter 4 h: 190 mL
R = mL/h
30.IV infusion ratesHard
320 mLleft? mL/h2 h left

1000 mL was ordered over 8 hours. After 6 hours you find that 320 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?

1000 mL / 8 hafter 6 h: 320 mL
Δ = %
31.Pediatric & critical-care dosingMedium
heparin 5 000 units/mL60 units/kg · 50 kg → V = ? mL

Practice exercise (made-up values, not clinical guidance). A practice protocol calls for a heparin bolus of 60 units/kg for a patient who weighs 50 kg. The vial contains 5 000 units/mL. What volume V do you draw up? Round to two decimal places.

60 units/kg50 kg5 000 units/mL
V = mL
32.Pediatric & critical-care dosingHard
500 mg250 mLdobutamine22 mL/h84 kg? mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A dobutamine infusion of 500 mg in 250 mL runs at 22 mL/h. The patient weighs 84 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.

500 mg/250 mL22 mL/h84 kg
D = mcg/kg/min
33.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftjuice120 mLtea200 mLice chips100 mLIV infusion125 mL/h × 12 hIV antibiotic2 × 50 mLurine475 mLurine250 mLurine300 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The patient weighs 73 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

73 kg12 hurine: 475 mLurine: 250 mLurine: 300 mL
U = mL/kg/h
34.IV fluids & fluid balanceHard
1000 mL120 mL/hstart 12:1513:45: ? mL

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 12:15 and runs by pump at 120 mL/h. How many mL V are left in the bag at 13:45?

1000 mL120 mL/h12:15 → 13:45
V = mL
35.Clinical assessment scoresMedium
mildmoderatesevere

Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury opens the eyes when spoken to, talks in sentences but is confused and shows as the best motor response: withdraws the limb from pressure (normal flexion). Work out the GCS and classify the head injury by it. Click your answer.

  1. 1mild
  2. 2moderate
  3. 3severe
36.Clinical assessment scoresHard
117?SBPDBPmmHgMAP = 65

Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 65 mmHg. A patient’s systolic pressure is 117 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 65 mmHg?

MAP 65 mmHgSBP 117 mmHg
DBP = mmHg
37.Arterial blood gas interpretationMedium

A practice gas shows a metabolic acidosis with HCO₃⁻ 10 mmol/L. Use Winter’s formula to find the expected PaCO₂ (the centre of the range) in mmHg.

HCO₃⁻ 10 mmol/L
PaCO₂ = mmHg
38.Arterial blood gas interpretationHard
pH7.357.457.20PaCO₂mmHg354521HCO₃⁻mmol/L22268added normal-gap acidosispure high-gap acidosisadded metabolic alkalosis

A practice gas shows pH 7.20, PaCO₂ 21 mmHg (2.8 kPa) and HCO₃⁻ 8 mmol/L, with Na⁺ 137 and Cl⁻ 90 mmol/L. Use the anion gap and the delta ratio to click the best interpretation.

pH 7.20PaCO₂ 21 mmHg (2.8 kPa)HCO₃⁻ 8 mmol/LNa⁺ 137 mmol/LCl⁻ 90 mmol/L
  1. 1added normal-gap acidosis
  2. 2pure high-gap acidosis
  3. 3added metabolic alkalosis
39.ECG rhythm strip interpretationMedium
II25 mm/s · 10 mm/mVatrial fibrillationsupraventricular tachycardia (SVT)sinus tachycardiaatrial flutter, 2:1 conduction

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. 1atrial fibrillation
  2. 2supraventricular tachycardia (SVT)
  3. 3sinus tachycardia
  4. 4atrial flutter, 2:1 conduction
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 · Ask simple yes/no questions and allow plenty of time

Why this is the answer

Short questions that can be answered with yes, no or a gesture, picture boards and patience let the patient communicate. Hearing is not the problem, so shouting does not help.

Answer

B · Ask simple yes/no questions and allow plenty of time
2.Nursing fundamentals

Answer: C · Assess the patient straight away

Why this is the answer

A low blood pressure may mean deterioration, so the nurse assesses the patient at once and escalates if needed. Feedback to the assistant and reporting follow afterwards.

Answer

C · Assess the patient straight away
3.Infection control & patient safety

Answer: D · On clean, dry skin over a well-perfused muscle, close to the surgical site

Why this is the answer

The pad returns the current safely. Good contact over a well-perfused muscle prevents burns, while bony areas, scars, hair and moisture reduce contact and can cause burns at the pad site.

Answer

D · On clean, dry skin over a well-perfused muscle, close to the surgical site
4.Infection control & patient safety

Answer: A · Stop the infusion

Why this is the answer

These are signs of anaphylaxis. The nurse stops the infusion at once, calls for help and supports the airway, and intramuscular epinephrine (adrenaline) is the first-line treatment. Documentation comes later.

Answer

A · Stop the infusion
5.Prioritization & delegation

Answer: C · A patient with asthma who is using accessory muscles and has an SpO₂ of 88%

Why this is the answer

Accessory muscle use and low SpO₂ in asthma show acute respiratory distress, a breathing problem. The raised glucose, moderate pain and a fever already being treated are real but less urgent.

Answer

C · A patient with asthma who is using accessory muscles and has an SpO₂ of 88%
6.Prioritization & delegation

Answer: D · Offer high-calorie finger foods and drinks the patient can take while moving

Why this is the answer

Patients in mania may be too active to sit and eat. Portable high-calorie foods and fluids help meet physiological needs, which are a priority.

Answer

D · Offer high-calorie finger foods and drinks the patient can take while moving
7.Clinical nursing

Answer: C · Venturi mask

Why this is the answer

A Venturi mask entrains a set amount of room air, giving a fixed oxygen percentage regardless of the patient's breathing pattern. This makes it useful for patients at risk of hypercapnia.

Answer

C · Venturi mask
8.Clinical nursing

Answer: B · "Please review him within the next 15 minutes."

Why this is the answer

In SBAR, R is the recommendation or request, such as a review within a time frame. The other statements belong to Assessment, Background and Situation.

Answer

B · "Please review him within the next 15 minutes."
9.Lab values & electrolytes

Answer: C · The pancreas is making very little insulin, as in type 1 diabetes

Why this is the answer

C-peptide is cleaved from proinsulin when insulin is made, so it reflects the body's own insulin production. A very low level suggests beta-cell loss, as in type 1 diabetes; in type 2 diabetes it is often normal or high early on.

Answer

C · The pancreas is making very little insulin, as in type 1 diabetes
10.Lab values & electrolytes

Answer: B · Glucose 42 mg/dL (2.3 mmol/L) in a patient who is sweating and confused

Why this is the answer

Symptomatic hypoglycemia can quickly lead to seizures and brain injury, so it is treated straight away according to protocol. The other results are chronic or stable and can be discussed later.

Answer

B · Glucose 42 mg/dL (2.3 mmol/L) in a patient who is sweating and confused
11.Pharmacology

Answer: A · Use a soft toothbrush and rinse with saline or a bland mouthwash

Why this is the answer

Chemotherapy damages rapidly dividing mucosal cells. Gentle oral care, saline rinses and avoiding alcohol, spicy and acidic foods reduce pain and infection risk.

Answer

A · Use a soft toothbrush and rinse with saline or a bland mouthwash
12.Pharmacology

Answer: D · Keep the patient well hydrated and give the infusion slowly

Why this is the answer

Aciclovir can crystallise in the tubules and cause acute kidney injury. Good hydration, slow infusion and monitoring of kidney function reduce this risk.

Answer

D · Keep the patient well hydrated and give the infusion slowly
13.Med-surg: cardiovascular & respiratory

Answer: C · It squeezes the legs in cycles to push venous blood towards the heart

Why this is the answer

Inflatable sleeves around the calves or feet inflate and deflate in cycles, increasing venous return and reducing stasis. They are used when anticoagulation is unsuitable or alongside it. They are not used on a leg with a known DVT or severe arterial disease.

Answer

C · It squeezes the legs in cycles to push venous blood towards the heart
14.Med-surg: cardiovascular & respiratory

Answer: A · Stop smoking and do not fly until a doctor confirms full resolution

Why this is the answer

Patients should not fly until the pneumothorax has resolved on X-ray, often with an extra waiting period. Diving is usually avoided permanently unless definitive surgery has been done. Smoking increases recurrence, which is common, so patients learn to seek help for new breathlessness or chest pain.

Answer

A · Stop smoking and do not fly until a doctor confirms full resolution
15.Med-surg: neuro, endocrine & renal

Answer: B · A benzodiazepine such as IV lorazepam or buccal midazolam

Why this is the answer

A seizure lasting five minutes or more (or repeated seizures without recovery) is treated as status epilepticus. A benzodiazepine is given first (IV lorazepam if access is available; buccal or intranasal midazolam or rectal diazepam if not), then a second-line antiseizure drug such as levetiracetam, phenytoin or valproate if the seizure continues. Glucose is checked and given only if low.

Answer

B · A benzodiazepine such as IV lorazepam or buccal midazolam
16.Med-surg: neuro, endocrine & renal

Answer: B · Treat it as very high, check ketones and escalate

Why this is the answer

"HI" means the glucose is above the meter's upper range. In a drowsy patient this may be DKA or HHS. A laboratory glucose, ketones, observations and urgent medical review are needed.

Answer

B · Treat it as very high, check ketones and escalate
17.Med-surg: GI, perioperative & oncology

Answer: C · Do not use it; re-test later or arrange an X-ray as per policy

Why this is the answer

A pH above 5.5 may mean the tube is in the lung or oesophagus, or the stomach acid is reduced by drugs or feed. Nothing is given until position is confirmed according to local policy.

Answer

C · Do not use it; re-test later or arrange an X-ray as per policy
18.Med-surg: GI, perioperative & oncology

Answer: D · Use an observational pain tool, give analgesia and reassess

Why this is the answer

In dementia, pain often appears as agitation or guarding. An observational tool supports assessment; analgesia is given and effect reassessed. The hip is also assessed for injury such as a fracture.

Answer

D · Use an observational pain tool, give analgesia and reassess
19.Maternity & obstetric nursing

Answer: D · A full bladder

Why this is the answer

A full bladder lifts and displaces the uterus, usually to the right, and stops it contracting well. Helping the woman to empty her bladder usually lets the fundus return to the midline and firm up.

Answer

D · A full bladder
20.Maternity & obstetric nursing

Answer: D · Jaundice

Why this is the answer

Polycythaemia is common in infants of diabetic mothers and SGA babies. Breakdown of the extra red cells raises bilirubin, and high viscosity can cause poor feeding, lethargy or thrombosis.

Answer

D · Jaundice
21.Pediatric nursing

Answer: C · Knee–chest position (or squatting)

Why this is the answer

Bringing the knees to the chest raises systemic vascular resistance, so less blood shunts from right to left and more flows to the lungs. Keep the child calm, give oxygen and call for help.

Answer

C · Knee–chest position (or squatting)
22.Pediatric nursing

Answer: A · A late sign of raised intracranial pressure; an emergency

Why this is the answer

Hypertension with a widening pulse pressure, bradycardia and irregular respirations is Cushing's triad, a late sign of raised intracranial pressure and possible brain herniation. Immediate emergency treatment is needed.

Answer

A · A late sign of raised intracranial pressure; an emergency
23.Mental health nursing

Answer: D · Stay with him in a calm, quiet place and reassure him that the effects are from the drug and will pass

Why this is the answer

For a frightening hallucinogen experience, a calm setting, a supportive person and simple reassurance usually help. The nurse also monitors vital signs and watches for injury or other substances.

Answer

D · Stay with him in a calm, quiet place and reassure him that the effects are from the drug and will pass
24.Mental health nursing

Answer: B · The risk to an identifiable person must be shared with the team and may need to be disclosed to protect that person, following the law and policy

Why this is the answer

A serious threat against an identifiable person overrides confidentiality. The nurse informs the team, documents the threat and follows the legal and policy procedures for protecting the person.

Answer

B · The risk to an identifiable person must be shared with the team and may need to be disclosed to protect that person, following the law and policy
25.Nursing math & unit conversions

Answer: 14:50

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

2 PM → 2 + 12 = 14

Answer

14:50

Answer

14:50
26.Nursing math & unit conversions

Answer: V = 210 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

1 tbsp = 1·15 = 15 mL

Whole course

V = 15 mL × 2/day × 7 = 210 mL

Answer

V = 210 mL
27.Dosage calculations

Answer: D = 300 mg

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

Total per day

7.5·80 = 600 mg

Per dose

D = 600/2 = 300 mg

Answer

D = 300 mg
28.Dosage calculations

Answer: R = 6.25 mL/h

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.

Concentration

50000/250 = 200 units/mL

Pump rate

R = 1250/200 = 6.25 mL/h

Answer

R = 6.25 mL/h
29.IV infusion rates

Answer: R = 95 mL/h

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

Original rate

500/6 = 83.33 mL/h

New rate

R = 190/2 = 95 mL/h

Answer

R = 95 mL/h

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

30.IV infusion rates

Answer: Δ = 28 %

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

Original rate

1000/8 = 125 mL/h

New rate

R = 320/2 = 160 mL/h

Percentage change

Δ = (160 − 125)/125·100% = 28%

Answer

Δ = 28%

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

31.Pediatric & critical-care dosing

Answer: V = 0.6 mL

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

Units needed

60·50 = 3 000 units

Volume

V = 3000/5000 = 0.6 mL

Answer

V = 0.6 mL
32.Pediatric & critical-care dosing

Answer: D = 8.7 mcg/kg/min

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

500 000/250 = 2000 mcg/mL

Micrograms per minute

22·2000 = 44000 mcg/h
44000/60 = 733.3 mcg/min

Per kilogram

D = 733.3/84 = 8.73 ≈ 8.7 mcg/kg/min

Answer

D = 8.7 mcg/kg/min
33.IV fluids & fluid balance

Answer: U = 1.17 mL/kg/h

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 urine

475 + 250 + 300 = 1025 mL

Per kilogram per hour

U = 1025/(73·12) = 1.17 mL/kg/h

Answer

U = 1.17 mL/kg/h
34.IV fluids & fluid balance

Answer: V = 820 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

12:15 → 13:45 = 1.5 h

Volume infused

120·1.5 = 180 mL

Volume left

V = 1000 − 180 = 820 mL

Answer

V = 820 mL
35.Clinical assessment scores

Answer: moderate

Glasgow Coma Scale: add the best response in three areas. Eye opening E: 4 spontaneous, 3 to sound or speech, 2 to pressure, 1 none. Verbal V: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Motor M: 6 obeys commands, 5 localises, 4 normal flexion (withdraws), 3 abnormal flexion, 2 extension, 1 none. The total runs from 3 to 15. After a head injury, 13–15 is usually called mild, 9–12 moderate and 3–8 severe.

Score each area

E: opens the eyes when spoken to → 3
V: talks in sentences but is confused → 4
M: withdraws the limb from pressure (normal flexion) → 4

Add

GCS = 3 + 4 + 4 = 11

Severity

GCS 11 → moderate

Answer

moderate
36.Clinical assessment scores

Answer: DBP = 39 mmHg

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

Rearrange

DBP = (3·MAP − SBP)/2

Substitute

DBP = (3·65 − 117)/2 = 78/2 = 39 mmHg

Answer

DBP = 39 mmHg
37.Arterial blood gas interpretation

Answer: PaCO₂ = 23 mmHg

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

Winter’s formula

PaCO₂ = 1.5·10 + 8 = 23 mmHg
range: 21–25 mmHg

Answer

PaCO₂ = 23 mmHg
38.Arterial blood gas interpretation

Answer: pure high-gap 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.

Anion gap

AG = 137 − (90 + 8) = 39

Delta ratio

(39 − 12)/(24 − 8) = 1.688
pure high-gap acidosis

Answer

pure high-gap acidosis
39.ECG rhythm strip interpretation

Answer: supraventricular tachycardia (SVT)

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. Narrow-complex tachycardia and pauses: supraventricular tachycardia (SVT) is a regular tachycardia at about 150–250/min with narrow QRS complexes; the P waves are usually not visible because they are hidden in the QRS complex or the T wave. Sinus tachycardia in an adult at rest is usually below about 150/min and has a visible P wave before every QRS; atrial flutter with 2:1 conduction often runs at about 150/min and shows sawtooth waves. In sinus arrest the sinus node stops firing for a moment: a pause with no P wave and no QRS whose length is not a whole number of P–P cycles (a pause of exactly two or three cycles points to sinus exit block instead).

Five steps

1. Rate: R–R = 10 small boxes, 1500 ÷ 10 ≈ 150 per minute.
2. Rhythm: regular, every R–R is 0.40 s.
3. P waves: none visible; at this rate they are hidden in the QRS complexes or the T waves.
4. PR interval: not measurable.
5. QRS: 0.08 s, narrow (below 0.12 s), so the rhythm starts above the ventricles.

Interpretation

supraventricular tachycardia (SVT)

Answer

supraventricular tachycardia (SVT)
40.ECG rhythm strip interpretation

Answer: rate

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 = 31 small boxes, 1500 ÷ 31 ≈ 48 per minute.
2. Rhythm: regular, every R–R is 1.24 s.
3. P waves: upright, one before every QRS, all alike.
4. PR interval: 0.20 s, constant, within 0.12–0.20 s.
5. QRS: 0.08 s, narrow (below 0.12 s).

First abnormal step

rate → sinus bradycardia

Answer

rate

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