Free practice questions · NCLEX-PN · Dosage calculation
NCLEX-PN dosage calculation practice questions.
Tablets and liquids, weight-based doses, infusion and drip rates, worked the way the exam asks. Ten questions from the Lumen Nursing NCLEX-PN bank, written to the LPN and LVN scope. Answer each one and check it; the rationale explains the key and every other option.
1Multiple choice, single answerFundamentals
A client is prescribed 1000 mL of lactated Ringer's to run over 12 hours with a set delivering 15 drops per milliliter. The nurse counts the rate at 35 drops per minute. Which of the following actions should the nurse take?
Slow the infusion to the calculated rate and continue to monitor it
Leave the rate as it is, because it is running correctly
Report an infiltration to the registered nurse (RN)
Increase the rate so the infusion finishes on time
Answer it, then check it.
Answer and rationale
Answer
- A: Slow the infusion to the calculated rate and continue to monitor it
The key, and why
Work out what it should be before deciding whether 35 is wrong.
Each distractor
Option B. It is not running correctly. It is running about 70 percent fast.
Option C. Nothing here describes an infiltration, which would show as swelling, coolness and pain at the site with a slowing rather than a fast rate.
Option D. Increasing it makes the problem worse.
The teaching point
Work out what the rate SHOULD be before you judge what it IS. Volume × drop factor ÷ minutes. Too FAST → look for FLUID OVERLOAD. Crackles, breathlessness, distended neck veins, rising pressure. Too SLOW → the client misses the fluid, and the line may be positional or blocked. Calculating and MONITORING the rate is a PN activity.
2Multiple choice, single answerLeadership and Management
During a 0700 bedside handoff on a medical unit, the off-going nurse reports that the peripheral IV in the left forearm of a 70-year-old client is infusing 0.9% sodium chloride at 75 mL/hr and "looks fine." At the bedside, the nurse finds the skin around the IV site swollen, cool and pale, and the client says the arm feels tight. Which action should the nurse take first?
Start a new peripheral IV in the right arm so that the infusion is not interrupted
Tell the off-going nurse that the IV site was not checked before the report
Stop the infusion at the pump and clamp the IV tubing
Elevate the left arm on a pillow and recheck the IV site in 30 minutes
Answer it, then check it.
Answer and rationale
Answer
- C: Stop the infusion at the pump and clamp the IV tubing
The key, and why
Swelling, coolness, pallor and tightness around an IV site are the signs of infiltration. The catheter has slipped out of the vein or through its wall, and the fluid is running into the tissue instead of the bloodstream. The skin is cool because the fluid is at room temperature, and pale because the swelling presses on the small vessels. Every minute the pump keeps running adds more fluid under the skin, so the first action is to stop the infusion.
After that the nurse removes the catheter, which is within LPN/VN scope, elevates the arm to help the fluid reabsorb, measures and records the area, and reports to the registered nurse (RN) so the RN can place a new IV. This is the reason handoff is done at the bedside: the oncoming nurse sees the client and the equipment while the off-going nurse is still there. The conversation about the missed check comes after the client is safe.
Each distractor
Option A is the right idea for the client. It is just not an LPN/VN task. Starting a new IV belongs to the RN, so the nurse reports the need rather than placing the catheter.
Option B matters, and the nurse will raise it, but talking about the report does not stop fluid entering the tissue.
Option D elevates the arm while the pump keeps pushing fluid into the infiltrated tissue. Elevation helps only after the infusion is stopped.
The teaching point
Infiltration = swollen, COOL, PALE, tight. STOP the infusion first, then remove the catheter and elevate. Bedside handoff = both nurses SEE the client and the equipment. Starting an IV = the RN. Removing a peripheral IV = the nurse.
3Fill in the blank, calculationPharmacology
A 54-year-old client at an ambulatory surgery center is scheduled for an open inguinal hernia repair with mesh. The primary health care provider prescribes cefazolin 2 g in 100 mL of 0.9% sodium chloride IV piggyback over 30 minutes, to be completed no more than 60 minutes before the incision. How many mL/hr should the nurse set the IV infusion pump to deliver? Record your answer using a whole number.
Type your answer. Use CALCULATOR on the bottom bar if you need it.
Answer it, then check it.
Answer and rationale
Answer
- 200
The key, and why
A prophylactic antibiotic before surgery is one of the most effective ways to prevent a surgical site infection, and it matters even more when a foreign body such as mesh is left in the wound. Cefazolin, a first-generation cephalosporin, covers the skin bacteria most likely to enter an incision. It works only if a therapeutic level is already in the tissue when the skin is cut, so the infusion is completed within the 60 minutes before the incision.
An infusion pump is always set in mL/hr. When a volume is to run over less than an hour, convert the time to hours first, or work out how much would run in a full hour at the same speed. The answer is 200 mL/hr.
The teaching point
mL/hr = VOLUME ÷ TIME IN HOURS. 30 minutes = 0.5 hour. Prophylactic antibiotic before surgery = finished WITHIN 60 minutes before the incision.
4Fill in the blank, calculationFundamentals
In the procedure area of an outpatient liver clinic, 7 L of ascitic fluid is removed from a client with cirrhosis during a paracentesis. The health care provider prescribes albumin 25% IV at a dose of 8 g for each liter of fluid removed, and the registered nurse (RN) asks the nurse to check the volume before the infusion is started. How many mL of albumin 25% will the client receive? Record your answer using a whole number.
Type your answer. Use CALCULATOR on the bottom bar if you need it.
Answer it, then check it.
Answer and rationale
Answer
- 224
The key, and why
Albumin is a protein that holds fluid inside the blood vessels by its oncotic pull. When a large volume of ascites is drained, fluid shifts from the vessels into the abdomen to refill it, and the client can become hypotensive, and kidney injury can follow. Albumin given after a large-volume paracentesis keeps fluid in the circulation. A common dose is 6 to 8 g for every liter removed when more than 5 L is drained.
A 25% solution means 25 g of albumin in every 100 mL, which is 0.25 g in each mL. This client needs 56 g, which is 224 mL of the 25% solution. Albumin is made from pooled donor plasma, and in most facilities the RN starts it. Checking the calculation and then watching the BP, the pulse, and the breathing during the infusion are part of the nurse's role.
The teaching point
PERCENT solution = grams in 100 mL. 25% = 25 g in 100 mL. LARGE-VOLUME paracentesis (over 5 L) = ALBUMIN to prevent HYPOTENSION and KIDNEY injury. Albumin = the RN starts it, the nurse checks the math and watches the client.
5Fill in the blank, calculationFundamentals
A 76-year-old resident of a skilled nursing facility who weighs 70 kg has developed a deep vein thrombosis in the right leg after 6 days of bed rest. The health care provider prescribes enoxaparin 1 mg/kg subcutaneously every 12 hours. The pharmacy supplies enoxaparin 80 mg/0.8 mL in a prefilled syringe. How many mL should the nurse administer? Record your answer using 1 decimal place.
Type your answer. Use CALCULATOR on the bottom bar if you need it.
Answer it, then check it.
Answer and rationale
Answer
- 0.7 or .7
The key, and why
Treatment doses of enoxaparin are based on weight, 1 mg for each kilogram every 12 hours, which is higher than the fixed dose used to prevent a clot. This resident weighs 70 kg, so each dose is 70 mg.
The prefilled syringe holds 80 mg in 0.8 mL, a concentration of 100 mg in each mL. To give 70 mg, the nurse expels the excess medication from the syringe down to the 0.7 mL mark before the injection, and then gives it into the abdomen without expelling any remaining air bubble. The nurse watches the platelet count and for signs of bleeding, because low-molecular-weight heparins can cause both.
The teaching point
TREATMENT enoxaparin = 1 mg/kg every 12 HOURS. PREVENTION = fixed dose (30 mg every 12 hours or 40 mg daily). mL = dose ÷ concentration. Watch PLATELETS and BLEEDING.
6Fill in the blank, calculationFundamentals
A 70-year-old client receiving hospice care at home has a prescription for morphine oral solution 5 mg sublingually every 2 hours as needed for dyspnea. The oral solution on hand contains 20 mg/mL. How many mL should the nurse administer? Record your answer using 2 decimal places.
Type your answer. Use CALCULATOR on the bottom bar if you need it.
Answer it, then check it.
Answer and rationale
Answer
- 0.25 or .25
The key, and why
Morphine relieves dyspnea at the end of life by lowering the brain's sensitivity to carbon dioxide and by easing the anxiety of breathlessness. Small doses are used, and the concentrated oral solution lets a small volume be placed under the tongue or in the cheek of a client who can no longer swallow well.
The concentrated solution is 20 mg in every 1 mL, which is 5 to 10 times stronger than the usual oral morphine solutions. Errors with it have caused deaths, so the nurse uses the calibrated oral syringe supplied with the bottle, confirms the concentration on the label, and has a second nurse check the dose if the agency requires it. The dose needed here is 0.25 mL.
The teaching point
20 mg/mL = the CONCENTRATED oral MORPHINE solution. Tiny VOLUMES, so use the calibrated ORAL syringe. Always confirm the CONCENTRATION on the label before measuring.
Safety note
Mixing up mg and mL gives 20 times the intended dose of the concentrated morphine solution. Check the concentration and measure with the oral syringe supplied with the bottle.
7Fill in the blank, calculationFundamentals
A 57-year-old client at a wellness visit started smoking at age 17 and smoked 1.5 packs of cigarettes a day until quitting 8 years ago. The nurse calculates the client's smoking history before reporting it to the health care provider. How many pack-years has the client smoked? Record your answer using a whole number.
Type your answer. Use CALCULATOR on the bottom bar if you need it.
Answer it, then check it.
Answer and rationale
Answer
- 48
The key, and why
A pack-year is a way of measuring how much a person has smoked over a lifetime. It is the number of packs smoked each day multiplied by the number of years the person smoked. It is used to decide who qualifies for lung cancer screening.
The client is 57 and quit 8 years ago, so the client stopped smoking at age 49. From age 17 to 49 is 32 years. At 1.5 packs a day for 32 years, the client has a 48 pack-year history.
This client is 57, has 48 pack-years, and quit within the past 15 years, so the client meets all three criteria for a yearly low-dose CT scan of the chest, and the nurse passes that on to the provider.
The teaching point
PACK-YEARS = PACKS per day × YEARS smoked. Find the years smoked FIRST = age quit minus age started. Screening (USPSTF) = AGE 50 to 80 + 20 PACK-YEARS + smoking now OR quit within 15 YEARS.
8Trend questionFundamentals
Measure | 0800 | 1200 | 1600
Heart rate | 72/min | 80/min | 88/min
Blood pressure | 104/64 mm Hg | 110/68 mm Hg | 116/70 mm Hg
Respiratory rate | 16/min | 22/min | 28/min
SpO2 | 98% | 97% | 96%
A 74-year-old client with a history of heart failure is admitted with pneumonia and dehydration and is receiving 0.9% sodium chloride at 150 mL/hr. The nurse reviews the vital signs recorded during the first 8 hours of the infusion. Which of the following findings should the nurse report to the registered nurse (RN)?
Heart rate increased from 72/min to 88/min
Respiratory rate increased from 16/min to 28/min
SpO2 decreased from 98% to 96%
Blood pressure increased from 104/64 mm Hg to 116/70 mm Hg
Answer it, then check it.
Answer and rationale
Answer
- B: Respiratory rate increased from 16/min to 28/min
The key, and why
Fluid volume excess from IV therapy happens when fluid is given faster than the heart and kidneys can handle it. Older adults and clients with heart failure are at the highest risk, because a weak left ventricle cannot move the extra volume forward, so it backs up into the lungs.
One of the earliest signs is a rising respiratory rate. Fluid stiffens the lungs before it is enough to drop the SpO2 below normal or produce loud crackles, and the client breathes faster to compensate. A rise from 16 to 28/min in 8 hours on a 150 mL/hr infusion is the finding to act on. The nurse raises the head of the bed, listens for crackles, checks the neck veins and the work of breathing, and reports the trend to the RN, because the infusion rate needs the provider's review. Monitoring the flow rate and the client's response to IV fluids is part of the nurse's daily work.
Each distractor
Option A, a heart rate rising from 72 to 88/min, stays inside 60 to 100/min and fits a client who is febrile and being rehydrated.
Option C, an SpO2 of 96% to 98%, stays normal. Oxygen saturation often falls later in fluid overload than the respiratory rate rises, which is why a normal reading here does not rule it out.
Option D rises as the client is rehydrated from a low-normal reading and stays within the normal range.
The teaching point
FLUID OVERLOAD early → RESPIRATORY RATE UP, then crackles, dyspnea, distended neck veins, falling SpO2. High risk = OLDER ADULT + HEART FAILURE + running IV fluids. NORMAL = respiratory rate 12 to 20/min, heart rate 60 to 100/min, SpO2 95% to 100%.
9Select all that applyLeadership and Management
A 76-year-old resident of a long-term care facility receives a continuous tube feeding at 60 mL/hr through a gastrostomy tube. The nurse watches the unlicensed assistive personnel (UAP) give morning care. Which of the following actions by the UAP require follow-up?
Tells the nurse that the skin around the tube looks redder than yesterday
Turns off the feeding pump because the alarm keeps sounding during the bath
Lowers the head of the bed flat to change the bottom sheet while the feeding is running
Cleans the resident's teeth and gums with a soft toothbrush and a small amount of water
Washes the skin around the tube with soap and water and pats it dry
Answer it, then check it.
Answer and rationale
Answer
- B: Turns off the feeding pump because the alarm keeps sounding during the bath
- C: Lowers the head of the bed flat to change the bottom sheet while the feeding is running
The key, and why
A tube feeding fills the stomach continuously, and lying flat lets formula flow back up the esophagus and into the airway. The head of the bed stays at 30 degrees or higher while the feeding runs and for at least 30 to 60 minutes after it stops. If the resident has to lie flat for a linen change, the nurse pauses the feeding first and restarts it afterward.
The pump belongs to the nurse. An alarm usually means a blocked tube, an empty bag or air in the line, which the nurse has to check. When a UAP switches the pump off to stop the noise, the resident misses formula and the cause goes unchecked.
Each distractor
Option A is correct. The UAP is reporting a change around the stoma, which the nurse then checks for infection or leakage.
Option D is correct care. A resident who takes nothing by mouth still needs mouth care, because a dry mouth grows bacteria that can be aspirated.
Option E is correct care. Gentle cleaning with soap and water and drying the skin keep the stoma site from breaking down.
The teaching point
Tube feeding = head of bed 30 DEGREES or higher. PAUSE the feeding before lying flat. Pump alarm = NURSE checks the cause. A UAP never turns the pump off. NPO still needs MOUTH CARE.
10Multiple choice, single answerNutrition
On the third day after transsphenoidal removal of a pituitary adenoma, a 45-year-old client has central diabetes insipidus. Since 0600 the urine output has been 200 to 250 mL/hr, the urine specific gravity is 1.004, and the serum sodium is 147 mEq/L. The client is alert and reports intense thirst. The nurse reviews the new prescriptions. Which of the following prescriptions should the nurse question?
Serum sodium every 6 hours
Desmopressin 0.1 mg orally now
Fluid restriction of 1,000 mL in 24 hours
Hourly urine output with strict intake and output
Answer it, then check it.
Answer and rationale
Answer
- C: Fluid restriction of 1,000 mL in 24 hours
The key, and why
Diabetes insipidus is a lack of antidiuretic hormone, and it is a known complication of pituitary surgery because the posterior pituitary stores the hormone. Without it, the kidneys cannot concentrate urine and pour out large volumes of dilute urine. The urine output of 200 to 250 mL/hr, a specific gravity of 1.004, a sodium of 147 mEq/L, and intense thirst all fit.
The client is losing free water faster than the body can spare it, and thirst is the body asking for it back. Restricting fluid would leave the client to dehydrate, and the sodium would keep climbing toward confusion, seizures, and hypovolemic shock. Checking that each prescription fits the client is part of the nurse's role in processing orders, so the nurse holds this one and clarifies it with the provider. The client needs free access to water, and the provider may add IV fluid if oral intake cannot keep up.
Each distractor
Option A is appropriate. The sodium shows whether water losses are being replaced and must be followed closely after pituitary surgery.
Option B is appropriate. Desmopressin replaces the missing hormone and lets the kidneys hold water again.
Option D is appropriate. Hourly output shows how fast the client is losing water and whether desmopressin is working.
The teaching point
DIABETES INSIPIDUS = no ADH = LARGE DILUTE urine, HIGH sodium, THIRST. Give WATER and DESMOPRESSIN. SIADH = too much ADH = LOW sodium, CONCENTRATED urine. RESTRICT fluids. Restricting fluid in DI is the OPPOSITE treatment.
Safety note
A fluid restriction in a client with diabetes insipidus can cause severe dehydration and hypernatremia within hours.
Want to know where you stand, not just the answers?
The free readiness exam is 85 questions on one fixed form, built to the current NCSBN test plan, with a readiness band by section emailed to you. No card. Or open the bank with 30 free practice questions.
More free sets
NCLEX-RN, all formatsTen questions across the NGN formats, mixed sectionsNCLEX-PNTen questions written to the LPN and LVN scopeNursing schoolTen questions across the course bank, A&P to Nursing ResearchNCLEX-PN · CardiacHeart failure, MI, dysrhythmias, cardiac drugsNCLEX-PN · EndocrineDiabetes, insulin, thyroid, adrenal disordersNCLEX-PN · RespiratoryCOPD, asthma, pneumonia, oxygen, chest tubesNCLEX-PN · PediatricsGrowth, development, pediatric presentationsNCLEX-PN · MaternityAntepartum, labor, postpartum, newbornNCLEX-PN · Mental healthCommunication, crisis, substance use, psych medsNCLEX-PN · Lab valuesElectrolytes, CBC, coagulation, renal valuesNCLEX-PN · Infection controlPrecautions, isolation, PPE, asepsisNCLEX-PN · Case studiesTwo six-step cases with the client record