NCLEX-style practice questions (RN): cram pack

How should dentures be cleaned to avoid breaking them?

1. AWith an abrasive cleaning powder to remove stains
2. BBy soaking them in very hot water to sterilise them
3. COver a sink lined with a towel or partly filled with water
4. DOver an empty, hard sink so they can be seen clearly

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

1. AAsk the patient to drink less to avoid swelling
2. BRefer to the dietitian and support protein and energy intake
3. CWait until the ulcer heals before addressing nutrition
4. DGive extra salt to stimulate the appetite

Why are independent double checks used for some medicines, such as insulin and heparin infusions?

1. ATo share responsibility between two nurses if an error happens
2. BTo make the preparation process faster
3. CBecause these drugs are very expensive to waste
4. DA second person checking separately catches missed errors

Before the wound is closed, the sponge count does not match the starting count. What should happen?

1. ATell the surgeon and team, search for the item, and image the patient per policy if it is not found
2. BClose the wound to avoid a long anesthetic and recount the sponges after surgery
3. CChange the count on the record so that it matches, then close the wound as planned
4. DAssume that the first count was wrong and continue

One day after surgery, a patient walked safely with the RN this morning. The RN now asks a nursing assistant to walk her again. Which instruction is most important?

1. A“Stop and call me at once if she feels dizzy or short of breath.”
2. B“Try to finish the walk before the lunch trays arrive.”
3. C“Make sure she wears her own slippers if she has them.”
4. D“Walk her to the end of the corridor and back twice before lunch.”

During a busy shift, four tasks are due. Which should the nurse do first?

1. AHelp a stable patient fill in tomorrow’s menu card
2. BUpdate the nursing care plan before the managers’ audit
3. CGive a routine daily vitamin tablet that is due at the same time
4. DFirst dose of IV antibiotic for a patient with suspected sepsis

After a total hip replacement through a posterior approach, which movement should the patient usually avoid in the early weeks?

1. AWalking short distances with a frame and a physiotherapist
2. BBending the hip beyond 90 degrees or crossing the legs
3. CDoing gentle ankle exercises
4. DLying on their back

A nurse is unsure whether a prescribed dose of a high-risk drug is correct. What is the safest action?

1. AWithhold it and check with the prescriber or pharmacist first
2. BGive the dose because the doctor has signed the prescription
3. CAsk the patient whether the dose looks the same as usual and give it
4. DGive half the dose as a compromise until the doctor is available

A patient is starting atorvastatin. Which laboratory test is usually checked at baseline?

1. ALiver enzymes
2. BThyroid antibodies
3. CBlood cultures
4. DSerum lipase

A patient's low calcium does not improve despite several days of calcium replacement. Which other electrolyte should be checked and corrected?

1. AMagnesium
2. BChloride
3. CSodium
4. DBicarbonate

During an infusion of a vesicant chemotherapy drug, the patient reports burning, and the site is swollen. What should the nurse do first?

1. AStop the infusion, leave the cannula in and follow the protocol
2. BIncrease the infusion rate to finish quickly
3. CFlush the line with a large volume of saline
4. DRemove the cannula at once and massage the area firmly

A patient on methadone is also prescribed diazepam for anxiety. What is the main safety concern?

1. ASevere hypertension from the combination
2. BDiazepam blocks the effect of methadone completely
3. CMethadone causes diazepam to be excreted very quickly
4. DAdditive sedation and respiratory depression

Which statement about a spacer for a metered-dose inhaler is correct?

1. AIt is designed to be used with dry-powder inhalers
2. BLess coordination is needed, and more drug reaches the lungs
3. CIt means the steroid preventer inhaler can be stopped altogether
4. DIt makes each puff of the drug stronger than usual

After four days of antibiotics for pneumonia, a patient still has fever and pleuritic pain. There is dullness and reduced breath sounds at the right base. What complication should be suspected?

1. AA parapneumonic effusion or empyema
2. BAn allergic reaction to the antibiotic
3. CNormal recovery from pneumonia
4. DAsthma triggered by the infection

Why are insulin and glucose given together to treat hyperkalaemia?

1. AInsulin makes the kidneys pass more potassium in the urine
2. BInsulin protects the heart muscle cells from the potassium
3. CGlucose binds the potassium in the blood and removes it
4. DInsulin moves potassium into cells; glucose prevents a hypo

A patient with acute ischaemic stroke is not a thrombolysis candidate. On day 1 the BP is 190/100 mmHg with no other emergency. What is generally appropriate?

1. AGive nitrate spray every 5 minutes until below 120 mmHg
2. BAvoid aggressive lowering and follow the stroke team's targets
3. CLower it rapidly to 110/70 mmHg with IV drugs
4. DLie the patient flat and give a large fluid bolus

How does sucralfate help a peptic ulcer heal?

1. AIt speeds up emptying of the stomach
2. BIt forms a protective coating over the ulcer base
3. CIt kills H. pylori in the stomach lining
4. DIt blocks histamine receptors on parietal cells

An adult weighing 70 kg has 40% total body surface area burns. Using the Parkland formula, how is the first 24 hours' crystalloid usually divided?

1. AHalf in the first 8 hours from the time of the burn, half over the next 16 hours
2. BEqual hourly amounts over 24 hours, counted from arrival at hospital
3. CAll of it in the first hour, then oral fluids only for the rest of the day
4. DOne quarter in the first 8 hours from arrival, the rest over 16 hours

How does a port-wine stain differ from a "stork bite" (salmon patch)?

1. AA port-wine stain always disappears within a year
2. BA stork bite is a raised tumour that grows quickly
3. CA stork bite only occurs in preterm babies
4. DA port-wine stain does not fade with time

Ten days after birth, a woman phones to say her bleeding has suddenly become heavy and bright red with clots, with lower abdominal pain and a temperature of 38.2 °C (100.8 °F). Which response is most appropriate?

1. ATell her it is probably her first period and needs no action
2. BAdvise her to use tampons so the blood loss is easier to measure
3. CReassure her that lochia rubra often returns and review at 6 weeks
4. DAsk her to come in now; retained tissue or infection is possible

A 3-year-old who used to speak in short sentences has stopped talking and no longer responds to her name. What is the most important point?

1. AIt means the child is tired and should be seen in a year
2. BLoss of previously gained skills at any age needs prompt assessment
3. CIt is normal regression at this age
4. DLanguage develops in sudden spurts, so this is expected

A large baby born to a mother with diabetes becomes jittery at 1 hour of age. What should the nurse check first?

1. AThe baby's haemoglobin
2. BThe baby's blood glucose
3. CThe baby's blood group
4. DThe baby's serum bilirubin

Which signs are typical of opioid withdrawal?

1. ADeep sleep and constipation
2. BYawning, a runny nose, dilated pupils, goosebumps and diarrhoea
3. CHigh fever, lead-pipe rigidity and confusion within a day of the last dose
4. DPinpoint pupils and slow breathing

A patient with OCD performs a long hand-washing ritual and misses breakfast. What is the best initial approach?

1. AStop the ritual by force
2. BAllow time for the ritual, plan the schedule around it and gradually limit it with the patient
3. CLock the bathroom
4. DPoint out how pointless the ritual is and insist that the patient stops it at once before breakfast

Practice exercise (made-up values, not clinical guidance). A dose is charted at 19:30 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.

1. 19:30 PM
2. 26:30 PM
3. 37:30 PM
4. 47:30 AM

Practice exercise (made-up values, not clinical guidance). An infusion starts at 17:30 and finishes at 02:20 the next morning (24-hour clock). How many hours t did it run? Give the answer in hours as a decimal, rounded to two decimal places.

A patient weighs 25 kg and is prescribed 15 mg/kg as a single dose. Find the dose D in mg.

The prescription is 3520 micrograms. The ampoule contains 4 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

An infusion is ordered at 120 mL/h, but no pump is available. It runs by gravity through a giving set of 10 gtt/mL. Find the drip rate R in drops per minute.

An infusion of 400 mg in 500 mL runs at 20 mL/h. How many micrograms per minute D does the patient receive?

Practice exercise (made-up values, not clinical guidance). An infusion contains 100 units of regular insulin in 100 mL. The order is 1.5 units/h. Find the pump rate R in mL/h. Round to one decimal place.

Practice exercise (made-up values, not clinical guidance). A bag contains dopamine 400 mg in 250 mL. The order is 3 mcg/kg/min for a patient who weighs 70 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

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 88 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

Practice exercise (made-up values, not clinical guidance). A 500 mL bag was started at 13:00 and runs by pump at 80 mL/h. How many mL V are left in the bag at 14:30?

Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 10, with E3 and V4. What motor score M was recorded, and which response does it describe? Give the number.

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: none, bed rest or nurse assists; IV therapy or saline lock: no; gait: weak; mental status: overestimates or forgets 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

A practice arterial blood gas shows pH 7.15, PaCO₂ 42 mmHg (5.6 kPa) and HCO₃⁻ 14 mmol/L. The primary disorder is metabolic acidosis. How far is it compensated? Click your answer.

1. 1uncompensated
2. 2partially compensated
3. 3fully compensated

A practice gas shows a metabolic acidosis: pH 7.34, PaCO₂ 31 mmHg (4.1 kPa), HCO₃⁻ 16 mmol/L. Compare the measured PaCO₂ with Winter’s formula. Click your interpretation.

1. 1appropriate compensation
2. 2added respiratory acidosis
3. 3added respiratory alkalosis

Measure the QT interval and the R–R interval on this regular lead II strip, then calculate the rate-corrected QTc with Fridericia’s formula QTc = QT/∛RR (both in seconds). Give the answer in seconds to three decimals.

This patient has a pacemaker. Interpret the lead II strip. Click your answer.

1. 1junctional rhythm
2. 2paced rhythm, failure to capture
3. 3dual-chamber (AV) paced rhythm
4. 4sinus rhythm with wide QRS