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

Which care best protects the skin of a patient with frequent urinary incontinence?

  1. AGentle cleansing after each episode and a barrier product
  2. BApplying talcum powder thickly after each episode
  3. CLeaving the skin wet so it does not dry out
  4. DScrubbing the area with soap and hot water twice a day
2.Nursing fundamentalsHard

A pulse oximeter reads 82% on a patient with cold hands who is talking in full sentences with a normal respiratory rate. What is the best first action?

  1. AIgnore the reading because the patient looks well
  2. BRemove any oxygen because the reading must be wrong
  3. CRecord the reading and recheck it at the next routine set of observations
  4. DCheck the patient and probe, then warm the hand or move the probe
3.Infection control & patient safetyMedium

A patient with delirium is at risk of falls and of pulling out lines. Which option is less restrictive than restraints?

  1. AFour side rails raised and the door closed so the patient stays in bed
  2. BA trained sitter or video monitoring with staff nearby
  3. CA sedative given every few hours as needed
  4. DA vest restraint applied for the whole night
4.Infection control & patient safetyHard

A nurse teaches new parents about safe infant sleep. Which statement shows a need for further teaching?

  1. A“We will keep the crib in our room, next to our bed, for the first months.”
  2. B“We will not smoke near the baby.”
  3. C“We will put a soft bumper pad and a blanket in the crib so the baby is cozy.”
  4. D“We will lay the baby on the back for every sleep, including naps.”
5.Prioritization & delegationMedium

A patient with a valid do-not-resuscitate order (DNR; called DNACPR in the UK) stops breathing and has no pulse. What should the nurse do?

  1. AStart CPR and stop when the family arrives
  2. BCall the cardiac arrest team and let them decide
  3. CFollow the DNR order and do not start CPR
  4. DStart chest compressions but not rescue breaths
6.Prioritization & delegationHard

An infant is choking and cannot cry or breathe. Which technique is correct?

  1. AA blind finger sweep of the mouth
  2. BBack blows and chest thrusts
  3. CHolding the infant upside down by the feet
  4. DAbdominal thrusts, as in adults
7.Clinical nursingMedium

A patient on the ward has shingles with open blisters. Which people are most at risk from contact?

  1. APregnant women and immunocompromised people who have not had chickenpox
  2. BOnly people over 80 who have already had shingles themselves
  3. CNo one, because shingles cannot spread
  4. DPeople who have already had chickenpox in childhood and are now healthy
8.Clinical nursingHard

Why must a unit of red cells be transfused within the set time limit (commonly four hours) after it leaves controlled cold storage?

  1. ABacteria can grow in the blood at room temperature
  2. BThe red cells break down and turn into plasma
  3. CThe blood group of the cells changes after a few hours
  4. DThe bag stops dripping after four hours
9.Lab values & electrolytesMedium

A patient on peritoneal dialysis notices that the drained fluid is cloudy and has abdominal pain. What should the nurse do?

  1. ARecord it as normal and continue the usual exchanges
  2. BStop dialysis for a week and recheck the fluid later
  3. CSend the fluid for cell count and culture and report it
  4. DAdd more glucose to the next bag to clear the fluid
10.Lab values & electrolytesHard

A patient with kidney stones and fatigue has a calcium of 11.6 mg/dL (2.9 mmol/L), a high parathyroid hormone (PTH) and a low phosphate. Which condition is most likely?

  1. AHypoparathyroidism
  2. BPrimary hyperparathyroidism
  3. CVitamin D deficiency
  4. DCancer-related hypercalcemia
11.PharmacologyMedium

Why should long-term oral corticosteroids not be stopped suddenly?

  1. AThe drug forms toxic metabolites when stopped
  2. BThe immune system would immediately attack the liver and adrenal glands
  3. CStopping causes a sudden rise in blood glucose
  4. DThe adrenal glands are suppressed and may not make enough cortisol
12.PharmacologyHard

A patient taking co-trimoxazole develops fever, a spreading blistering rash and painful mouth sores. What is the most likely diagnosis?

  1. AOral thrush; start an antifungal and continue the antibiotic
  2. BSunburn caused by the drug; advise sunscreen only
  3. CA mild rash that will settle; continue the drug and give moisturiser
  4. DStevens–Johnson syndrome; stop the drug and get urgent medical care
13.Med-surg: cardiovascular & respiratoryMedium

Which statement about direct oral anticoagulants such as apixaban and rivaroxaban is correct?

  1. ATheir effect is reversed by giving vitamin K
  2. BWeekly INR checks are needed, as with warfarin
  3. CNo routine INR checks, but doses depend on kidney function
  4. DMissed doses do not matter because they act for weeks
14.Med-surg: cardiovascular & respiratoryHard

Which instruction from the registered nurse to a healthcare assistant (unlicensed assistive personnel) caring for a patient with COPD is most appropriate?

  1. A"Teach him how to use his new inhaler this afternoon after his rest."
  2. B"Turn his oxygen up to whatever he needs if he looks short of breath."
  3. C"Tell me straight away if his SpO₂ is under 88% or he is more breathless."
  4. D"Listen to his chest after lunch and let me know what you can hear."
15.Med-surg: neuro, endocrine & renalMedium

A patient has acute glomerulonephritis with oedema and high blood pressure. Which nursing care is most appropriate?

  1. ACheck the weight once a week
  2. BMonitor BP, fluid balance and daily weight
  3. CEncourage a high-salt diet to balance the fluids
  4. DGive large amounts of IV fluid
16.Med-surg: neuro, endocrine & renalHard

A man with chronic urinary retention is catheterised. Over the next hours he passes very large volumes of urine. What is the main nursing concern?

  1. ARupture of the bladder from the catheter
  2. BA rise in blood glucose from the urine
  3. CA urinary infection caused by the high flow of urine
  4. DFluid and electrolyte loss from post-obstructive diuresis
17.Med-surg: GI, perioperative & oncologyMedium

Which statement about corticosteroids in inflammatory bowel disease is correct?

  1. AThey are used to induce remission, not for maintenance
  2. BThey are the best long-term maintenance treatment
  3. CThey are given only as a one-off injection
  4. DThey cure the disease after one course
18.Med-surg: GI, perioperative & oncologyHard

A nurse has a needlestick injury after taking blood from a patient with hepatitis B. What should the nurse do first?

  1. AWash the site with soap and running water, without scrubbing
  2. BFinish the shift and report it the next day
  3. CScrub the area hard with a nail brush and alcohol
  4. DSuck the wound to remove as much of the blood as possible
19.Maternity & obstetric nursingMedium

When the newborn's head is turned to one side, the arm on that side extends and the other arm flexes. Which reflex is this?

  1. AMoro reflex
  2. BPalmar grasp reflex
  3. CTonic neck reflex
  4. DRooting reflex
20.Maternity & obstetric nursingHard

After treatment for a molar pregnancy, what is the most important teaching point?

  1. ANo further follow-up is needed once the uterus is empty
  2. BTry to conceive again as soon as possible to reduce recurrence
  3. CAttend serial hCG checks and use reliable contraception during follow-up
  4. DAvoid all physical activity for 6 months
21.Pediatric nursingMedium

A medicine is prescribed at 10 mg/kg. The child weighs 18 kg and the liquid contains 120 mg in 5 mL. What volume should be given?

  1. A7.5 mL
  2. B15 mL
  3. C3.75 mL
  4. D1.5 mL
22.Pediatric nursingHard

A 9-year-old with Down syndrome has new neck pain, clumsy walking and changes in bladder control. What should the nurse suspect?

  1. AA simple urinary infection causing tiredness
  2. BAtlantoaxial instability with spinal cord compression
  3. CThe normal low muscle tone of Down syndrome getting worse with age
  4. DGrowing pains in the legs
23.Mental health nursingMedium

What should a patient taking chlorpromazine be taught about sun exposure?

  1. AUse sunscreen and protective clothing, because the skin may burn easily
  2. BSun exposure has no effect while taking this medicine
  3. CAvoid going outside at all, even in winter, for the rest of his life
  4. DSunbathe for longer each day to improve mood
24.Mental health nursingHard

A patient taking naltrexone for alcohol dependence is brought to the emergency department with a broken leg. Why should the nurse tell the team about the naltrexone?

  1. ANaltrexone makes opioids much stronger, so smaller doses must be used
  2. BIt is not relevant, because naltrexone only affects the way the body responds to alcohol
  3. CNaltrexone causes broken bones to heal more slowly
  4. DNaltrexone blocks opioid analgesics, so pain relief needs to be planned differently
25.Nursing math & unit conversionsMedium
5 lb 15 oz? kg1 lb = 16 oz1 kg = 2.2 lb

Practice exercise (made-up values, not clinical guidance). A newborn weighs 5 lb 15 oz. Using 1 lb = 16 oz and 1 kg = 2.2 lb, find the weight m in kilograms. Round to two decimal places.

5 lb 15 oz1 lb = 16 oz1 kg = 2.2 lb
m = kg
26.Nursing math & unit conversionsHard
1½ tsp · 2/day · 14 d? × 150 mL1 tsp = 5 mL

Practice exercise (made-up values, not clinical guidance). A prescription reads 1½ tsp of an oral suspension twice a day for 14 days. The suspension comes in 150 mL bottles. Using 1 tsp = 5 mL, how many whole bottles N must be supplied so the course is complete?

1½ tsptwice a day14 days150 mL1 tsp = 5 mL
N =
27.Dosage calculationsMedium
024681010 mL

A child weighing 9 kg is prescribed 4 mg/kg of a drug. The stock solution contains 10 mg/mL. Draw up the dose: what volume V do you give?

9 kg4 mg/kg10 mg/mL
V = mL
28.Dosage calculationsHard
40k units500 mL? mL/h2000 units/h

An infusion contains 40000 units of a drug in 500 mL. The prescription is 2000 units per hour. At what rate R do you set the pump, in mL/h?

40000 units/500 mL2000 units/h
R = mL/h
29.IV infusion ratesMedium
1500 mL10 gtt/mL3 h? gtt/min

Infuse 1500 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.

1500 mL3 h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
400 mg250 mL15 mL/h? mg/h

A bag contains 400 mg of a drug in 250 mL and runs at 15 mL/h. How many milligrams per hour D does the patient receive?

400 mg/250 mL15 mL/h
D = mg/h
31.Pediatric & critical-care dosingMedium
25 000 units500 mLheparin? mL/h94 kg16 units/kg/h

Practice exercise (made-up values, not clinical guidance). A bag contains 25 000 units of heparin in 500 mL. The order is 16 units/kg/h for a patient who weighs 94 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

25 000 units/500 mL16 units/kg/h94 kg
R = mL/h
32.Pediatric & critical-care dosingHard
500 mg250 mLdobutamine35 mL/h105 kg? mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A dobutamine infusion of 500 mg in 250 mL runs at 35 mL/h. The patient weighs 105 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.

500 mg/250 mL35 mL/h105 kg
D = mcg/kg/min
33.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftjuice150 mLwater150 mLsoup250 mLIV infusion80 mL/h × 8 hIV antibiotic1 × 50 mLurine200 mLurine325 mLurine425 mLurine200 mLwound drain140 mLvomit200 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The patient weighs 64 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

64 kg8 hurine: 200 mLurine: 325 mLurine: 425 mLurine: 200 mLwound drain: 140 mLvomit: 200 mL
U = mL/kg/h
34.IV fluids & fluid balanceHard
500 mL150 mL infused120 mL/h17:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 120 mL/h. At 17:00, 150 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL150 mL infused120 mL/h
t = h
35.Clinical assessment scoresMedium
12569SBPDBPmmHgHR 124/min · SI = ?

Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 124/min and a blood pressure of 125/69 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.

HR 124/minBP 125/69 mmHg
SI =
36.Clinical assessment scoresHard
low riskmoderate riskhigh risk

Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: no; secondary diagnosis: yes; ambulatory aid: crutches, cane or walker; IV therapy or saline lock: yes; gait: impaired; mental status: knows own limits. Using the cut-offs 0–24 low, 25–44 moderate and 45 or more high, click the fall-risk level.

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

A practice gas shows a metabolic acidosis with HCO₃⁻ 14 mmol/L. Use Winter’s formula to find the expected PaCO₂ (the centre of the range) in mmHg.

HCO₃⁻ 14 mmol/L
PaCO₂ = mmHg
38.Arterial blood gas interpretationHard
pH7.357.457.08PaCO₂mmHg354535HCO₃⁻mmol/L222610appropriate compensationadded respiratory acidosisadded respiratory alkalosis

A practice gas shows a metabolic acidosis: pH 7.08, PaCO₂ 35 mmHg (4.7 kPa), HCO₃⁻ 10 mmol/L. Compare the measured PaCO₂ with Winter’s formula. Click your interpretation.

pH 7.08PaCO₂ 35 mmHg (4.7 kPa)HCO₃⁻ 10 mmol/L
  1. 1appropriate compensation
  2. 2added respiratory acidosis
  3. 3added respiratory alkalosis
39.ECG rhythm strip interpretationMedium
II25 mm/s · 10 mm/mVatrial flutter, 2:1 conductionsinus arrhythmiaatrial fibrillationjunctional rhythm

Interpret this lead II rhythm strip. Which rhythm is it? Click your answer.

lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
  1. 1atrial flutter, 2:1 conduction
  2. 2sinus arrhythmia
  3. 3atrial fibrillation
  4. 4junctional rhythm
40.ECG rhythm strip interpretationHard
II25 mm/s · 10 mm/mVsinus tachycardiaasystolepulseless electrical activity (PEA)ventricular fibrillation

A monitored patient is found unresponsive and not breathing normally, and no carotid pulse can be felt. The monitor shows this organised rhythm. What is this situation called? 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 tachycardia
  2. 2asystole
  3. 3pulseless electrical activity (PEA)
  4. 4ventricular fibrillation

3Solutions

1.Nursing fundamentals

Answer: A · Gentle cleansing after each episode and a barrier product

Why this is the answer

Moisture and urine break down the skin barrier. Prompt, gentle cleansing with a pH-balanced cleanser and a barrier cream or film protects against incontinence-associated dermatitis.

Answer

A · Gentle cleansing after each episode and a barrier product
2.Nursing fundamentals

Answer: D · Check the patient and probe, then warm the hand or move the probe

Why this is the answer

Cold peripheries, movement and nail varnish can give falsely low readings. The nurse assesses the patient first, then checks the waveform and probe site; a low reading is never ignored until it is explained.

Answer

D · Check the patient and probe, then warm the hand or move the probe
3.Infection control & patient safety

Answer: B · A trained sitter or video monitoring with staff nearby

Why this is the answer

Close observation by a sitter or video monitoring allows staff to step in quickly, without restricting the patient. It is often combined with reorientation and family presence.

Answer

B · A trained sitter or video monitoring with staff nearby
4.Infection control & patient safety

Answer: C · “We will put a soft bumper pad and a blanket in the crib so the baby is cozy.”

Why this is the answer

Soft bedding, bumpers and loose blankets increase the risk of suffocation and sudden infant death. The crib should hold only a firm mattress with a fitted sheet.

Answer

C · “We will put a soft bumper pad and a blanket in the crib so the baby is cozy.”
5.Prioritization & delegation

Answer: C · Follow the DNR order and do not start CPR

Why this is the answer

A valid DNR order means CPR is not started. The nurse keeps the patient comfortable, informs the provider and supports the family.

Answer

C · Follow the DNR order and do not start CPR
6.Prioritization & delegation

Answer: B · Back blows and chest thrusts

Why this is the answer

For a choking infant, the nurse gives cycles of five back blows and five chest thrusts. Abdominal thrusts are not used in infants, and blind finger sweeps can push the object deeper.

Answer

B · Back blows and chest thrusts
7.Clinical nursing

Answer: A · Pregnant women and immunocompromised people who have not had chickenpox

Why this is the answer

Someone who has never had chickenpox can catch chickenpox from contact with shingles blisters. Non-immune pregnant and immunocompromised people are at particular risk, so lesions are covered and precautions followed.

Answer

A · Pregnant women and immunocompromised people who have not had chickenpox
8.Clinical nursing

Answer: A · Bacteria can grow in the blood at room temperature

Why this is the answer

Red cells are stored cold to limit bacterial growth. Once out of controlled storage, the transfusion must be completed within the time limit to reduce the risk of bacterial contamination and transfusion-transmitted infection.

Answer

A · Bacteria can grow in the blood at room temperature
9.Lab values & electrolytes

Answer: C · Send the fluid for cell count and culture and report it

Why this is the answer

Cloudy effluent with abdominal pain suggests peritonitis, the main serious complication of peritoneal dialysis. A sample is sent for white cell count, Gram stain and culture, and antibiotics (often given in the dialysis fluid) are started as prescribed.Checked against: Dialysis - peritoneal · MedlinePlus (NIH) (2024)

Answer

C · Send the fluid for cell count and culture and report it
10.Lab values & electrolytes

Answer: B · Primary hyperparathyroidism

Why this is the answer

In primary hyperparathyroidism, usually from an adenoma, PTH is high despite high calcium, and phosphate is low because PTH increases its excretion. Cancer-related hypercalcemia typically has a suppressed PTH.Checked against: Parathyroid Hormone (PTH) Test · MedlinePlus (NIH) (2023); Hyperparathyroidism · MedlinePlus (NIH) (2026)

Answer

B · Primary hyperparathyroidism
11.Pharmacology

Answer: D · The adrenal glands are suppressed and may not make enough cortisol

Why this is the answer

Steroid therapy suppresses the hypothalamic–pituitary–adrenal axis. Sudden withdrawal can cause an adrenal crisis, so doses are reduced gradually.

Answer

D · The adrenal glands are suppressed and may not make enough cortisol
12.Pharmacology

Answer: D · Stevens–Johnson syndrome; stop the drug and get urgent medical care

Why this is the answer

Stevens–Johnson syndrome is a severe drug reaction with skin blistering and mucosal involvement. Sulfonamides are a common cause, and the drug must be stopped immediately.

Answer

D · Stevens–Johnson syndrome; stop the drug and get urgent medical care
13.Med-surg: cardiovascular & respiratory

Answer: C · No routine INR checks, but doses depend on kidney function

Why this is the answer

DOACs have predictable effects, so routine coagulation monitoring is not required. Renal function, weight, age and interacting drugs guide dosing. Because the effect wears off within a day or two, missed doses matter. Vitamin K does not reverse them; specific reversal agents exist.

Answer

C · No routine INR checks, but doses depend on kidney function
14.Med-surg: cardiovascular & respiratory

Answer: C · "Tell me straight away if his SpO₂ is under 88% or he is more breathless."

Why this is the answer

Delegated tasks should come with specific parameters for reporting. Changing oxygen therapy, chest assessment and patient teaching need a registered nurse's knowledge and judgement. Clear reporting instructions keep the patient safe.

Answer

C · "Tell me straight away if his SpO₂ is under 88% or he is more breathless."
15.Med-surg: neuro, endocrine & renal

Answer: B · Monitor BP, fluid balance and daily weight

Why this is the answer

In acute glomerulonephritis, salt and water retention cause oedema and hypertension. Close monitoring of BP, input and output and daily weights is needed, often with salt and fluid restriction and antihypertensives.

Answer

B · Monitor BP, fluid balance and daily weight
16.Med-surg: neuro, endocrine & renal

Answer: D · Fluid and electrolyte loss from post-obstructive diuresis

Why this is the answer

After relief of chronic obstruction, the kidneys may pass large volumes of urine and salt. Hypovolaemia and electrolyte problems can follow. Strict fluid balance, blood pressure checks and electrolyte monitoring are needed.

Answer

D · Fluid and electrolyte loss from post-obstructive diuresis
17.Med-surg: GI, perioperative & oncology

Answer: A · They are used to induce remission, not for maintenance

Why this is the answer

Steroids settle flares but are not effective or safe for maintenance because of side effects such as osteoporosis, diabetes and infection. Drugs such as aminosalicylates, immunomodulators or biologics maintain remission.

Answer

A · They are used to induce remission, not for maintenance
18.Med-surg: GI, perioperative & oncology

Answer: A · Wash the site with soap and running water, without scrubbing

Why this is the answer

The site is washed with soap and running water; it may be allowed to bleed gently, but it is not scrubbed or sucked. The injury is reported immediately so that post-exposure assessment, including hepatitis B immunity and treatment if needed, can start quickly.

Answer

A · Wash the site with soap and running water, without scrubbing
19.Maternity & obstetric nursing

Answer: C · Tonic neck reflex

Why this is the answer

The asymmetric tonic neck reflex gives a "fencing" posture. It fades over the first months; persistence beyond the expected age can suggest neurological problems.

Answer

C · Tonic neck reflex
20.Maternity & obstetric nursing

Answer: C · Attend serial hCG checks and use reliable contraception during follow-up

Why this is the answer

hCG is followed until it is undetectable because persistent trophoblastic disease or choriocarcinoma can develop. A new pregnancy would raise hCG and hide this, so reliable contraception is advised during follow-up.

Answer

C · Attend serial hCG checks and use reliable contraception during follow-up
21.Pediatric nursing

Answer: A · 7.5 mL

Why this is the answer

Dose = 10 mg × 18 kg = 180 mg. Volume = 180 ÷ 120 × 5 mL = 7.5 mL. Calculations for children are checked carefully, often by a second nurse.

Answer

A · 7.5 mL
22.Pediatric nursing

Answer: B · Atlantoaxial instability with spinal cord compression

Why this is the answer

Children with Down syndrome can have instability between the first two cervical vertebrae. Neck pain, changes in gait, weakness and bladder or bowel changes suggest cord compression and need urgent assessment.

Answer

B · Atlantoaxial instability with spinal cord compression
23.Mental health nursing

Answer: A · Use sunscreen and protective clothing, because the skin may burn easily

Why this is the answer

Chlorpromazine can cause photosensitivity, leading to sunburn after short exposure. Sunscreen, hats and covering the skin reduce this risk.

Answer

A · Use sunscreen and protective clothing, because the skin may burn easily
24.Mental health nursing

Answer: D · Naltrexone blocks opioid analgesics, so pain relief needs to be planned differently

Why this is the answer

Naltrexone blocks opioid receptors, so usual opioid doses may not work, and attempts to overcome the block with high doses can be dangerous. The team needs to know so that analgesia can be planned safely.

Answer

D · Naltrexone blocks opioid analgesics, so pain relief needs to be planned differently
25.Nursing math & unit conversions

Answer: m = 2.7 kg

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.

Ounces to pounds

15 oz/16 = 0.9375 lb
5 + 0.9375 = 5.938 lb

Pounds to kilograms

m = 5.938/2.2 = 2.699 ≈ 2.7 kg

Answer

m = 2.7 kg
26.Nursing math & unit conversions

Answer: N = 2

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.

Total volume

7.5 mL × 2 × 14 = 210 mL

Bottles

210/150 = 1.4 → N = 2

Answer

N = 2
27.Dosage calculations

Answer: V = 3.6 mL

Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.

Dose from body weight

D = 4·9 = 36 mg

Volume

V = 36/10 = 3.6 mL

On the syringe

On this 10 mL syringe every small line is 0.2 mL.

Answer

V = 3.6 mL
28.Dosage calculations

Answer: R = 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

40000/500 = 80 units/mL

Pump rate

R = 2000/80 = 25 mL/h

Answer

R = 25 mL/h
29.IV infusion rates

Answer: R = 83 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 = 1500·10/180 = 83.33 ≈ 83 gtt/min

Answer

R = 83 gtt/min

At the bedside you round to the nearest whole drop: 83 gtt/min.

30.IV infusion rates

Answer: D = 24 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

400/250 = 1.6 mg/mL

Dose rate

D = 1.6·15 = 24 mg/h

Answer

D = 24 mg/h
31.Pediatric & critical-care dosing

Answer: R = 30.1 mL/h

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

Units per hour

16·94 = 1 504 units/h

Concentration

25 000/500 = 50 units/mL

Pump rate

R = 1504/50 = 30.08 ≈ 30.1 mL/h

Answer

R = 30.1 mL/h
32.Pediatric & critical-care dosing

Answer: D = 11.1 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

35·2000 = 70000 mcg/h
70000/60 = 1167 mcg/min

Per kilogram

D = 1167/105 = 11.11 ≈ 11.1 mcg/kg/min

Answer

D = 11.1 mcg/kg/min
33.IV fluids & fluid balance

Answer: U = 2.25 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

200 + 325 + 425 + 200 = 1150 mL

Per kilogram per hour

U = 1150/(64·8) = 2.246 ≈ 2.25 mL/kg/h

Answer

U = 2.25 mL/kg/h
34.IV fluids & fluid balance

Answer: t = 2.9 h

Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Volume left

500 − 150 = 350 mL

Time

t = 350/120 = 2.917 ≈ 2.9 h

Answer

t = 2.9 h

That is about 2 h 55 min, so the bag runs out at about 19:55.

35.Clinical assessment scores

Answer: SI = 0.99

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.

Shock index

SI = 124/125 = 0.992 ≈ 0.99

Answer

SI = 0.99

Above the usual 0.5–0.7.

36.Clinical assessment scores

Answer: high risk

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

Score each item

history of falling in the last 3 months: no → 0
secondary diagnosis: yes → 15
ambulatory aid: crutches, cane or walker → 15
IV therapy or saline lock: yes → 20
gait: impaired → 20
mental status: knows own limits → 0

Add

Morse total = 0 + 15 + 15 + 20 + 20 + 0 = 70

Risk level

70 → high risk

Answer

high risk
37.Arterial blood gas interpretation

Answer: PaCO₂ = 29 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 = 1.5·14 + 8 = 29 mmHg
range: 27–31 mmHg

Answer

PaCO₂ = 29 mmHg
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

1.5·10 + 8 = 23 → 21–25 mmHg

Compare

measured: 35 mmHg → added respiratory acidosis

Answer

added respiratory acidosis
39.ECG rhythm strip interpretation

Answer: atrial fibrillation

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: 9 QRS complexes in 6 s, × 10 = 90 per minute.
2. Rhythm: irregularly irregular, R–R from 0.46 to 1.02 s with no pattern.
3. P waves: none; the baseline shows small irregular fibrillatory waves.
4. PR interval: not measurable.
5. QRS: 0.08 s, narrow (below 0.12 s).

Interpretation

atrial fibrillation

Answer

atrial fibrillation
40.ECG rhythm strip interpretation

Answer: pulseless electrical activity (PEA)

Pulseless electrical activity (PEA): PEA cannot be seen on a strip. The monitor shows organised electrical activity (a rhythm other than VF, VT or asystole) but the patient has no palpable pulse, so it is recognised by checking the patient. In adult resuscitation guidelines PEA and asystole are the non-shockable cardiac arrest rhythms: high-quality CPR, epinephrine as soon as possible and a search for reversible causes (the Hs and Ts, such as hypovolaemia, hypoxia, tension pneumothorax and cardiac tamponade). VF and pulseless VT are the shockable rhythms.

What the strip shows

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: 0.06 s, narrow (below 0.12 s).
sinus tachycardia

What the patient shows

no pulse despite organised electrical activity: pulseless electrical activity (PEA), a non-shockable cardiac arrest rhythm

Answer

pulseless electrical activity (PEA)

Answer

pulseless electrical activity (PEA)

PEA is recognised at the bedside, never from the strip alone. This is exam practice, not clinical guidance.

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