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 cannot stand to be measured for the MUST screening tool. How can their height be estimated?

  1. AFrom the length of the bed
  2. BFrom the length of the forearm (ulna)
  3. CFrom the size of the patient's shoes
  4. DBy asking a visitor to guess
2.Nursing fundamentalsHard

A competent adult patient asks the nurse not to tell their family about their cancer diagnosis. What should the nurse do?

  1. ATell the family, because relatives have a right to know about a serious diagnosis
  2. BAsk the doctor to tell the family anyway
  3. CTell the family only if they ask directly
  4. DRespect the request and not share the information with the family
3.Infection control & patient safetyMedium

How should a nurse handle soiled bed linen?

  1. APut it on the floor until the bed is made
  2. BShake it out first to check for lost items
  3. CHold it away from the uniform and place it straight into a linen bag
  4. DCarry it bundled against the body to the soiled utility room down the hall
4.Infection control & patient safetyHard

Which action best prevents a wrong-route error with an epidural infusion?

  1. ATape all the lines together to keep them tidy
  2. BUse a free IV port if the epidural port becomes blocked
  3. CLabel the epidural line and keep it on its own dedicated pump
  4. DUse the same pump type and tubing for all of the patient’s infusions
5.Prioritization & delegationMedium

Four hours after thyroid surgery, which patient finding should the nurse act on first?

  1. AA request to sit up to drink
  2. BPain at the incision of 4/10
  3. CA small amount of serous drainage visible on the neck dressing
  4. DA voice that is getting hoarser, with new noisy breathing
6.Prioritization & delegationHard

A patient has central chest pain that started 30 minutes ago at rest and has not eased with rest or nitroglycerin. What does this suggest?

  1. AIndigestion that is best treated with an antacid and a glass of milk
  2. BMuscle strain that needs a warm compress
  3. CStable angina that will pass without treatment
  4. DA possible myocardial infarction that needs urgent action
7.Clinical nursingMedium

How is Helicobacter pylori infection usually treated?

  1. AA single dose of paracetamol and a bland diet for a week
  2. BA combination of antibiotics with a proton pump inhibitor
  3. CAntacids alone, taken after every meal for a month
  4. DSurgery to remove the stomach
8.Clinical nursingHard

A patient after a total hip replacement suddenly has severe hip pain, a shortened leg and the leg is rotated. What is the most likely complication?

  1. AWound infection
  2. BUrinary retention
  3. CDeep vein thrombosis in the calf
  4. DDislocation of the prosthesis
9.Lab values & electrolytesMedium

A patient taking empagliflozin (an SGLT2 inhibitor) has glucose in the urine but a normal blood glucose. What is the best interpretation?

  1. AUncontrolled diabetes needing insulin
  2. BA sign of kidney failure
  3. CA urinary tract infection
  4. DAn expected effect of the drug
10.Lab values & electrolytesHard

The nurse teaches a patient with chronic kidney disease about a potassium-restricted diet. Which statement shows a need for further teaching?

  1. A"Dried apricots and raisins will be a good snack for me now"
  2. B"I can leach potatoes by soaking them before cooking them"
  3. C"I'll limit bananas, oranges and potatoes in my meals"
  4. D"I'll check food labels and ask my dietitian about portion sizes"
11.PharmacologyMedium

Bethanechol may be used for non-obstructive urinary retention. How does it work?

  1. AIt increases urine production in the kidney
  2. BIt stimulates muscarinic receptors and contracts the bladder muscle
  3. CIt blocks muscarinic receptors and relaxes the bladder wall muscle
  4. DIt shrinks the prostate gland
12.PharmacologyHard

A patient taking azathioprine is prescribed allopurinol for gout. What is the main danger?

  1. ALiver enzyme induction, making azathioprine ineffective
  2. BSevere bone marrow suppression, because azathioprine breakdown is reduced
  3. CSevere hypertension from the combination
  4. DGout becomes worse because allopurinol is inactivated by azathioprine
13.Med-surg: cardiovascular & respiratoryMedium

Why are beta-blockers often started after a myocardial infarction?

  1. AThey reduce cholesterol in the blood
  2. BThey raise the heart rate to improve blood flow to the muscle
  3. CThey dissolve the clot that is blocking the coronary artery
  4. DThey lower the heart's oxygen demand and reduce arrhythmias
14.Med-surg: cardiovascular & respiratoryHard

On the first day after abdominal surgery, a patient has a temperature of 37.8 °C, SpO₂ 93% on air and reduced breath sounds at both bases. They have stayed in bed because of pain. What is the most likely cause and response?

  1. AWound infection: open the wound fully and swab it for culture
  2. BAtelectasis: give analgesia, deep breathing and mobilisation
  3. CNormal recovery; no action is needed
  4. DPulmonary oedema: restrict all oral fluids and give a diuretic
15.Med-surg: neuro, endocrine & renalMedium

An 82-year-old taking apixaban fell three weeks ago. Since then their family has noticed increasing confusion and headaches. Which condition is most likely?

  1. ANormal ageing with mild memory loss
  2. BSubarachnoid haemorrhage from an aneurysm
  3. CAcute extradural haematoma
  4. DChronic subdural haematoma
16.Med-surg: neuro, endocrine & renalHard

Which patient on a stroke unit is most at risk of falling?

  1. AA patient with mild dysarthria who walks steadily with a frame
  2. BA patient with a right-hemisphere stroke who is impulsive and denies having weakness
  3. CA patient with a left-hemisphere stroke who has expressive aphasia and waits for help
  4. DA patient with a TIA whose symptoms resolved completely yesterday
17.Med-surg: GI, perioperative & oncologyMedium

Why is the Lund and Browder chart preferred to the rule of nines for children?

  1. AIt adjusts for body proportions that change with age
  2. BIt is faster to use than any other method of estimation
  3. CIt counts superficial burns as well
  4. DIt is used only for burns of the hands
18.Med-surg: GI, perioperative & oncologyHard

A nurse teaches a patient after a colonoscopy with polyp removal. Which statement shows a need for further teaching?

  1. A"I should report a fever or a swollen, painful abdomen."
  2. B"Some wind and bloating today is expected."
  3. C"Severe abdominal pain is normal for a week afterwards."
  4. D"I'll report heavy bleeding from my bottom."
19.Maternity & obstetric nursingMedium

What does the acronym HELLP stand for?

  1. AHaemolysis, elevated liver enzymes, low platelets
  2. BHyperglycaemia, elevated lactate, low potassium
  3. CHypertension, elevated lipids, low protein
  4. DHaemorrhage, eclampsia, low pressure
20.Maternity & obstetric nursingHard

A non-stress test at 36 weeks shows no accelerations in 40 minutes. What is the most appropriate next step?

  1. AFurther testing, such as a biophysical profile
  2. BImmediately start oxytocin to induce labour
  3. CRecord the result as reactive and reassuring
  4. DSend her home and repeat the test in a month
21.Pediatric nursingMedium

Which non-drug technique suits a 5-year-old during a cannula insertion?

  1. AReading a detailed leaflet about the procedure
  2. BBlowing bubbles or looking at a pop-up book
  3. CDoing slow breathing exercises with a numeric scale
  4. DBeing left alone so the child can concentrate
22.Pediatric nursingHard

A 14-year-old has superficial cuts on her forearms. She says cutting helps her cope and that she does not want to die. What is the best nursing response?

  1. APromise not to tell anyone so that she keeps talking
  2. BTell her firmly that cutting is attention-seeking behaviour and that she must stop now
  3. CTreat the wounds, stay calm and non-judgemental, and refer for assessment
  4. DAccept that she is not at risk because she says she does not want to die
23.Mental health nursingMedium

A patient taking phenelzine, an MAOI, is being taught before discharge. Which statement shows a need for further teaching?

  1. A"I'll avoid aged cheese and cured meats."
  2. B"A sudden severe headache is a reason to get help straight away."
  3. C"I can take any cold and flu remedy from the pharmacy."
  4. D"I'll tell any new doctor or dentist that I take an MAOI."
24.Mental health nursingHard

Which finding best helps to distinguish serotonin syndrome from neuroleptic malignant syndrome?

  1. AHyperreflexia and clonus with a rapid onset suggest serotonin syndrome
  2. BSweating occurs only in neuroleptic malignant syndrome
  3. CConfusion occurs only in neuroleptic malignant syndrome, never in serotonin syndrome
  4. DFever is present only in serotonin syndrome
25.Nursing math & unit conversionsMedium
94969810010210410635363738394041°F°C? °F40.1 °C

Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 40.1 °C. Convert it to degrees Fahrenheit T with °F = °C × 9/5 + 32. Round to one decimal place.

40.1 °C
T = °F
26.Nursing math & unit conversionsHard
22.2 mmol/L? mg/dL1 mmol/L = 18 mg/dL

Practice exercise (made-up values, not clinical guidance). A blood glucose result is 22.2 mmol/L. Using 1 mmol/L = 18 mg/dL for glucose, find c in mg/dL to the nearest whole number.

22.2 mmol/L1 mmol/L = 18 mg/dL
c = mg/dL
27.Dosage calculationsMedium
024681010 mL

A child weighing 10 kg is prescribed 4 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

10 kg4 mg/kg25 mg/mL
V = mL
28.Dosage calculationsHard
64 kg170 cmBSA = √(h·w/3600)175 mg/m²D = ? mg

A patient is 170 cm tall and weighs 64 kg. The prescription is 175 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.

170 cm64 kg175 mg/m²
D = mg
29.IV infusion ratesMedium
60 gtt/mL25 mL/h? gtt/min

An infusion is ordered at 25 mL/h, but no pump is available. It runs by gravity through a giving set of 60 gtt/mL. Find the drip rate R in drops per minute.

25 mL/h60 gtt/mL
R = gtt/min
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
12 500 units250 mLheparin? mL/h95 kg12 units/kg/h

Practice exercise (made-up values, not clinical guidance). A bag contains 12 500 units of heparin in 250 mL. The order is 12 units/kg/h for a patient who weighs 95 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

12 500 units/250 mL12 units/kg/h95 kg
R = mL/h
32.Pediatric & critical-care dosingHard
500 mg250 mLdobutamine20 mL/h107 kg? mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A dobutamine infusion of 500 mg in 250 mL runs at 20 mL/h. The patient weighs 107 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.

500 mg/250 mL20 mL/h107 kg
D = mcg/kg/min
33.IV fluids & fluid balanceMedium
IntakeOutput12-hour shifttea150 mLwater150 mLsoup250 mLice chips100 mLIV infusion50 mL/h × 12 hIV antibiotic2 × 50 mLurine500 mLurine300 mLurine300 mLwound drain30 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.

tea: 150 mLwater: 150 mLsoup: 250 mLice chips: 100 mLIV infusion: 50 mL/h × 12 hIV antibiotic: 2 × 50 mLurine: 500 mLurine: 300 mLurine: 300 mLwound drain: 30 mL
B = mL
34.IV fluids & fluid balanceHard
500 mL→ 200 mL/hstart 07:00ttotal​ = ? h80 mL/h × 4 h

Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 07:00 at 80 mL/h. After 4 hours the rate is changed to 200 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.

500 mL80 mL/h · 4 h200 mL/h
t = h
35.Clinical assessment scoresMedium
E2 / 4+V2 / 5+M? / 6GCS 5?

Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 5, with E2 and V2. What motor score M was recorded, and which response does it describe? Give the number.

GCS 5E2V2
M =
36.Clinical assessment scoresHard
3210123RR≤89–1112–2021–24≥25SpO₂≤9192–9394–95≥96air / O₂O₂airSBP≤9091–100101–110111–219≥220HR≤4041–5051–9091–110111–130≥131ACVPUAC, V, P, UT °C≤35.035.1–36.036.1–38.038.1–39.0≥39.1lowlow–mediummediumhigh

Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 7/min, SpO₂ 96% on room air, blood pressure 124/74 mmHg, pulse 76/min, alert, temperature 36.0 °C. Which clinical risk group does the patient fall into? Click it.

RR 7SpO₂ 96%airSBP 124HR 76AT 36.0 °C
  1. 1low
  2. 2low–medium
  3. 3medium
  4. 4high
37.Arterial blood gas interpretationMedium
pH7.357.457.56PaCO₂mmHg354549HCO₃⁻mmol/L222642uncompensatedpartially compensatedfully compensated

A practice arterial blood gas shows pH 7.56, PaCO₂ 49 mmHg (6.5 kPa) and HCO₃⁻ 42 mmol/L. The primary disorder is metabolic alkalosis. How far is it compensated? Click your answer.

pH 7.56PaCO₂ 49 mmHg (6.5 kPa)HCO₃⁻ 42 mmol/L
  1. 1uncompensated
  2. 2partially compensated
  3. 3fully compensated
38.Arterial blood gas interpretationHard
pH7.357.457.32PaCO₂mmHg354567HCO₃⁻mmol/L222633acutechronicacute on chronic

A practice gas shows a respiratory acidosis: pH 7.32, PaCO₂ 67 mmHg (8.9 kPa), HCO₃⁻ 33 mmol/L. Use the rules ‘HCO₃⁻ rises 1 mmol/L per 10 mmHg (acute) or 3.5 mmol/L per 10 mmHg (chronic)’ to classify it. Click your answer.

pH 7.32PaCO₂ 67 mmHg (8.9 kPa)HCO₃⁻ 33 mmol/L
  1. 1acute
  2. 2chronic
  3. 3acute on chronic
39.ECG rhythm strip interpretationMedium
II25 mm/s · 10 mm/mVsinus bradycardiaatrial fibrillationsinus arrhythmiasinus rhythm with PVCs

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

lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
  1. 1sinus bradycardia
  2. 2atrial fibrillation
  3. 3sinus arrhythmia
  4. 4sinus rhythm with PVCs
40.ECG rhythm strip interpretationHard
II25 mm/s · 10 mm/mVfirst-degree AV block2:1 AV block (type undetermined)second-degree AV block type I (Wenckebach)second-degree AV block type II

Interpret this lead II strip. Which interpretation can you defend from this single strip? Click your answer.

lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
  1. 1first-degree AV block
  2. 22:1 AV block (type undetermined)
  3. 3second-degree AV block type I (Wenckebach)
  4. 4second-degree AV block type II

3Solutions

1.Nursing fundamentals

Answer: B · From the length of the forearm (ulna)

Why this is the answer

MUST includes tables that estimate height from ulna length when the patient cannot stand. Self-reported height can also be used if it is reliable.

Answer

B · From the length of the forearm (ulna)
2.Nursing fundamentals

Answer: D · Respect the request and not share the information with the family

Why this is the answer

A patient with capacity decides who may receive their health information. The nurse can explore the patient's reasons and offer support, but must respect the wish.

Answer

D · Respect the request and not share the information with the family
3.Infection control & patient safety

Answer: C · Hold it away from the uniform and place it straight into a linen bag

Why this is the answer

Soiled linen is rolled up, held away from the uniform and placed directly into a laundry bag at the bedside. Shaking linen spreads organisms into the air, and the floor is a contaminated surface.

Answer

C · Hold it away from the uniform and place it straight into a linen bag
4.Infection control & patient safety

Answer: C · Label the epidural line and keep it on its own dedicated pump

Why this is the answer

Labeling lines at the connection end, using distinct (non-Luer) connectors and separate, clearly marked pumps make wrong-route connections much less likely. Lines are traced from the patient to the source before connecting.

Answer

C · Label the epidural line and keep it on its own dedicated pump
5.Prioritization & delegation

Answer: D · A voice that is getting hoarser, with new noisy breathing

Why this is the answer

Increasing hoarseness and noisy breathing can mean swelling, bleeding or nerve injury affecting the airway. This must be assessed at once and escalated. Mild pain and a small amount of serous drainage are expected.

Answer

D · A voice that is getting hoarser, with new noisy breathing
6.Prioritization & delegation

Answer: D · A possible myocardial infarction that needs urgent action

Why this is the answer

Chest pain that lasts and is not relieved by rest or nitroglycerin suggests acute coronary syndrome, possibly a heart attack. The nurse acts at once: ECG, escalation and prescribed treatment.

Answer

D · A possible myocardial infarction that needs urgent action
7.Clinical nursing

Answer: B · A combination of antibiotics with a proton pump inhibitor

Why this is the answer

Eradication therapy combines a PPI with two antibiotics for a set course. Completing the course is important for success.

Answer

B · A combination of antibiotics with a proton pump inhibitor
8.Clinical nursing

Answer: D · Dislocation of the prosthesis

Why this is the answer

Hip dislocation after arthroplasty causes sudden pain, shortening and rotation. It needs urgent review and reduction; patients are taught movement precautions.

Answer

D · Dislocation of the prosthesis
9.Lab values & electrolytes

Answer: D · An expected effect of the drug

Why this is the answer

SGLT2 inhibitors block glucose reabsorption in the proximal tubule, so glycosuria is expected even with normal blood glucose. Urine glucose cannot be used to monitor control in these patients. The drugs also raise the risk of genital infections and DKA.Checked against: Ketones blood test · MedlinePlus (NIH) (2025)

Answer

D · An expected effect of the drug
10.Lab values & electrolytes

Answer: A · "Dried apricots and raisins will be a good snack for me now"

Why this is the answer

Dried fruits such as apricots and raisins are very high in potassium and should be limited in kidney disease with hyperkalemia. Limiting high-potassium foods, leaching vegetables and reading labels are correct strategies.Checked against: Potassium in diet · MedlinePlus (NIH) (2026); Spironolactone · MedlinePlus (NIH) (2018)

Answer

A · "Dried apricots and raisins will be a good snack for me now"
11.Pharmacology

Answer: B · It stimulates muscarinic receptors and contracts the bladder muscle

Why this is the answer

Bethanechol mimics acetylcholine at muscarinic receptors, contracting the detrusor muscle. It must not be used if there is mechanical obstruction to outflow.

Answer

B · It stimulates muscarinic receptors and contracts the bladder muscle
12.Pharmacology

Answer: B · Severe bone marrow suppression, because azathioprine breakdown is reduced

Why this is the answer

Azathioprine is converted to mercaptopurine, which is partly inactivated by xanthine oxidase. Allopurinol blocks this enzyme, so levels rise and dangerous myelosuppression can occur unless the dose is greatly reduced or the combination avoided.

Answer

B · Severe bone marrow suppression, because azathioprine breakdown is reduced
13.Med-surg: cardiovascular & respiratory

Answer: D · They lower the heart's oxygen demand and reduce arrhythmias

Why this is the answer

Beta-blockers slow the heart and reduce contractility, lowering myocardial oxygen demand, and protect against arrhythmias. They are particularly beneficial when the ejection fraction is reduced. They are used cautiously in heart block, severe bradycardia, acute heart failure and asthma.

Answer

D · They lower the heart's oxygen demand and reduce arrhythmias
14.Med-surg: cardiovascular & respiratory

Answer: B · Atelectasis: give analgesia, deep breathing and mobilisation

Why this is the answer

Atelectasis is common in the first days after surgery, especially upper abdominal surgery, due to pain, shallow breathing and immobility. It can cause a low-grade fever and reduced basal breath sounds. Good analgesia, deep breathing exercises, coughing with wound support and early mobilisation reverse it and prevent pneumonia.

Answer

B · Atelectasis: give analgesia, deep breathing and mobilisation
15.Med-surg: neuro, endocrine & renal

Answer: D · Chronic subdural haematoma

Why this is the answer

Older people have brain atrophy that stretches the bridging veins, and anticoagulants increase bleeding. A slow venous bleed can cause gradual confusion, headache or weakness over weeks. A CT scan is needed.

Answer

D · Chronic subdural haematoma
16.Med-surg: neuro, endocrine & renal

Answer: B · A patient with a right-hemisphere stroke who is impulsive and denies having weakness

Why this is the answer

Right-hemisphere strokes often cause left-sided neglect, poor judgement, impulsivity and denial of the deficit. These patients may try to get up alone. Patients with left-hemisphere strokes are often more cautious.

Answer

B · A patient with a right-hemisphere stroke who is impulsive and denies having weakness
17.Med-surg: GI, perioperative & oncology

Answer: A · It adjusts for body proportions that change with age

Why this is the answer

The Lund and Browder chart gives different percentages for the head and legs at different ages, so it is more accurate in children and is also widely used in adults.

Answer

A · It adjusts for body proportions that change with age
18.Med-surg: GI, perioperative & oncology

Answer: C · "Severe abdominal pain is normal for a week afterwards."

Why this is the answer

Mild bloating and cramps from the air used are expected. Severe or worsening pain, fever, a distended abdomen or heavy rectal bleeding can mean perforation or haemorrhage and must be reported straight away.

Answer

C · "Severe abdominal pain is normal for a week afterwards."
19.Maternity & obstetric nursing

Answer: A · Haemolysis, elevated liver enzymes, low platelets

Why this is the answer

HELLP syndrome is a serious complication of pre-eclampsia. Right upper quadrant or epigastric pain, nausea and malaise are typical, and blood pressure is not always very high.

Answer

A · Haemolysis, elevated liver enzymes, low platelets
20.Maternity & obstetric nursing

Answer: A · Further testing, such as a biophysical profile

Why this is the answer

A non-reactive NST may reflect a fetal sleep cycle or drugs, but it can also indicate hypoxia. A biophysical profile or contraction stress test is used to clarify fetal wellbeing.

Answer

A · Further testing, such as a biophysical profile
21.Pediatric nursing

Answer: B · Blowing bubbles or looking at a pop-up book

Why this is the answer

Distraction that suits the child's age, such as bubbles, books, toys or videos, reduces pain and distress. Blowing bubbles also encourages slow, deep breathing. Parents are encouraged to stay and help.

Answer

B · Blowing bubbles or looking at a pop-up book
22.Pediatric nursing

Answer: C · Treat the wounds, stay calm and non-judgemental, and refer for assessment

Why this is the answer

Self-harm often helps young people manage overwhelming feelings, but it is linked to higher suicide risk. A calm, non-judgemental response, wound care, risk assessment and referral to mental health services are needed.

Answer

C · Treat the wounds, stay calm and non-judgemental, and refer for assessment
23.Mental health nursing

Answer: C · "I can take any cold and flu remedy from the pharmacy."

Why this is the answer

Decongestants such as pseudoephedrine are sympathomimetics and can cause a hypertensive crisis with MAOIs. Patients should check any new medicine, including over-the-counter remedies, with a pharmacist or prescriber.

Answer

C · "I can take any cold and flu remedy from the pharmacy."
24.Mental health nursing

Answer: A · Hyperreflexia and clonus with a rapid onset suggest serotonin syndrome

Why this is the answer

Both can cause fever, confusion and autonomic instability. Serotonin syndrome starts within hours and causes neuromuscular excitation (hyperreflexia, clonus). NMS develops over days with "lead-pipe" rigidity and slowed reflexes.

Answer

A · Hyperreflexia and clonus with a rapid onset suggest serotonin syndrome
25.Nursing math & unit conversions

Answer: T = 104.2 °F

Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.

Multiply by 9/5

40.1·9/5 = 72.18

Add 32

T = 72.18 + 32 = 104.2 °F

Answer

T = 104.2 °F
26.Nursing math & unit conversions

Answer: c = 400 mg/dL

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.

Convert

c = 22.2·18 = 399.6 ≈ 400 mg/dL

Answer

c = 400 mg/dL
27.Dosage calculations

Answer: V = 1.6 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 = 4·10 = 40 mg

Volume

V = 40/25 = 1.6 mL

On the syringe

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

Answer

V = 1.6 mL
28.Dosage calculations

Answer: D = 304.2 mg

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

Body surface area

BSA = √(170·64/3600) = √3.022 = 1.738 m²

Dose

D = 175·1.738 = 304.2 mg

Answer

D = 304.2 mg
29.IV infusion rates

Answer: R = 25 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.

Millilitres per minute

25/60 = 0.4167 mL/min

Drip rate

R = 0.4167·60 = 25 gtt/min

Answer

R = 25 gtt/min

With a microdrip set (60 gtt/mL), gtt/min equals mL/h.

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: R = 22.8 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

12·95 = 1 140 units/h

Concentration

12 500/250 = 50 units/mL

Pump rate

R = 1140/50 = 22.8 mL/h

Answer

R = 22.8 mL/h
32.Pediatric & critical-care dosing

Answer: D = 6.2 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

20·2000 = 40000 mcg/h
40000/60 = 666.7 mcg/min

Per kilogram

D = 666.7/107 = 6.231 ≈ 6.2 mcg/kg/min

Answer

D = 6.2 mcg/kg/min
33.IV fluids & fluid balance

Answer: B = 170 mL

Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Total intake

oral: 150 + 150 + 250 = 550 mL
ice chips: 100/2 = 50 mL
IV infusion: 50·12 = 600 mL
IV antibiotic: 2·50 = 100 mL
total intake = 1300 mL

Total output

500 + 300 + 300 + 30 = 1130 mL

Balance

B = 1300 − 1130 = 170 mL

Answer

B = 170 mL

Positive: more fluid went in than came out.

34.IV fluids & fluid balance

Answer: t = 4.9 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.

First part

80·4 = 320 mL
500 − 320 = 180 mL left

Second part

180/200 = 0.9 h

Total time

t = 4 + 0.9 = 4.9 h

Answer

t = 4.9 h

That is about 4 h 54 min, so the bag runs out at about 11:54.

35.Clinical assessment scores

Answer: M = 1

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

Motor score

M = 5 − 2 − 2 = 1
M1: no movement at all

Answer

M = 1
36.Clinical assessment scores

Answer: low–medium

NEWS2 (National Early Warning Score 2, Royal College of Physicians 2017): score each of the seven parameters with the chart (respiration rate, SpO₂ on scale 1, air or supplemental oxygen, systolic blood pressure, pulse, consciousness on the ACVPU scale and temperature) and add the scores. Clinical risk: 0–4 low; a score of 3 in any single parameter low–medium; 5–6 medium; 7 or more high. A total of 5 or more needs an urgent response.

Score each parameter

RR 7/min → 3
SpO₂ 96% → 0
on air → 0
SBP 124 mmHg → 0
HR 76/min → 0
alert (A) → 0
T 36.0 °C → 1

Total and red scores

NEWS2 = 3 + 0 + 0 + 0 + 0 + 0 + 1 = 4
At least one parameter scores 3.

Risk group

low–medium

Answer

low–medium

A single score of 3 needs an urgent review even when the total is low.

37.Arterial blood gas interpretation

Answer: partially compensated

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

ROME, value by value

pH 7.56: alkalaemia (above 7.45)
PaCO₂ 49 mmHg: high (35–45)
HCO₃⁻ 42 mmol/L: high (22–26)

Compensation

partially compensated

Answer

partially compensated
38.Arterial blood gas interpretation

Answer: chronic

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 HCO₃⁻

acute: 24 + 1·2.7 = 26.7 mmol/L
chronic: 24 + 3.5·2.7 = 33.45 mmol/L

Compare

measured: 33 mmol/L → chronic

Answer

chronic
39.ECG rhythm strip interpretation

Answer: sinus arrhythmia

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: 7 QRS complexes in 6 s, × 10 = 70 per minute.
2. Rhythm: irregular, R–R from 0.76 to 1.10 s, lengthening and shortening gradually.
3. P waves: upright, one before every QRS, all alike.
4. PR interval: 0.18 s, constant, within 0.12–0.20 s.
5. QRS: 0.08 s, narrow (below 0.12 s).

Interpretation

sinus arrhythmia

Answer

sinus arrhythmia
40.ECG rhythm strip interpretation

Answer: 2:1 AV block (type undetermined)

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

Five steps

1. Rate: R–R = 36 small boxes, 1500 ÷ 36 ≈ 42 per minute.
2. Rhythm: regular, every R–R is 1.44 s.
3. P waves: upright and regular (P–P 0.72 s, 83 per minute), two for every QRS.
4. PR interval: constant at 0.16 s in the conducted beats.
5. QRS: 0.10 s, narrow (below 0.12 s).

Why the type stays open

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

Answer

2:1 AV block (type undetermined)

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

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