Free Prometric exam questions for nurses with answers

Answer: B. These patients already have neuropathy, so the aim is to reduce disability and limb loss. This is tertiary prevention, which limits complications and supports rehabilitation in established disease.

• A. Detecting undiagnosed disease is secondary prevention; these patients are already diagnosed.
• C. Preventing onset in healthy adults is primary prevention.
• D. Policy change on sugar intake is a population-level primary or primordial measure.

Key point: Tertiary prevention reduces complications and disability in established disease.

Based on: IDF Clinical Practice Recommendations on the Diabetic Foot; Stanhope & Lancaster, Public Health Nursing, 10th ed.

Answer: C. His statement shows low perceived susceptibility. Personalised data on his own risk factors makes the threat concrete and relevant. The Health Belief Model says action needs perceived susceptibility and severity that outweigh barriers.

• A. Benefits information targets perceived benefits; his main barrier is that he does not see himself at risk.
• B. General statistics are impersonal and do not change perceived personal susceptibility.
• D. Cost and cooking skill are perceived barriers to action, which he has not raised.

Key point: Match the intervention to the Health Belief Model construct that is lacking.

Based on: Glanz, Rimer & Viswanath, Health Behavior: Theory, Research, and Practice, 5th ed.

Answer: D. Sensitivity = true positives ÷ all with disease = 170 ÷ (170 + 30) = 170 ÷ 200 = 85%. It describes how well the test finds people who have the disease.

• A. 95% is the specificity (760 ÷ 800), the ability to identify people without disease.
• B. 15% is the false-negative proportion (30 ÷ 200), the opposite of sensitivity.
• C. 81% is the positive predictive value (170 ÷ 210), which depends on prevalence.

Key point: Sensitivity = TP ÷ (TP + FN); specificity = TN ÷ (TN + FP).

Based on: Gordis Epidemiology, 6th ed., screening and test validity

Answer: C. Fever and respiratory symptoms with animal exposure to camels match the MERS-CoV case definition. Early masking and isolation at triage prevents spread to other patients and staff. The others do not fit the respiratory-exposure profile.

• A. Chronic cough without fever and exposure suggests a chronic cause, so this is lower risk.
• B. Gastroenteritis needs contact precautions but not a respiratory case definition.
• D. Possible deep vein thrombosis needs assessment but is not infectious.

Key point: Screen for fever, respiratory symptoms and exposure at triage, and isolate before assessment.

Based on: WHO Case Definition for MERS-CoV; WHO IPC for MERS-CoV

Answer: B. Central shelves keep the most stable 2 to 8 °C range. Boxes should be spaced for circulation, and no food, drink or specimens should be stored in the same unit.

• A. The door has the greatest temperature variation each time it opens.
• C. The back wall and bottom can be too cold or hold moisture, and packing against walls blocks air flow.
• D. Proximity to the freezer compartment risks freezing.

Key point: Store vaccines centrally, spaced apart, never in the door or near the freezer.

Based on: WHO Vaccine Management Handbook; CDC Vaccine Storage and Handling Toolkit

Answer: D. Preparedness covers planning, training, drills and stockpiling before an event. Response happens during and immediately after, and recovery follows.

• A. Treating casualties belongs to the response phase.
• B. Rebuilding is part of the recovery phase.
• C. Counselling survivors belongs to recovery.

Key point: Preparedness is what you do before the event.

Based on: WHO Health Emergency and Disaster Risk Management Framework (2019); ICN Core Competencies in Disaster Nursing v2.0

Answer: C. Accurate readings need rest, a supported back, the arm at heart level and no caffeine, smoking or exercise within 30 minutes. Two readings a minute apart are usually recorded.

• A. Exertion raises the reading.
• B. The arm should be supported at heart level; hanging gives a falsely high reading.
• D. Caffeine raises blood pressure for 30 minutes or more.

Key point: Rest 5 minutes, back supported, arm at heart level, no caffeine beforehand.

Based on: ESH 2023 Guidelines for the Management of Arterial Hypertension; WHO Hypertension Guideline (2021)

Answer: B. The incubation period of MERS-CoV is up to 14 days, so contacts are monitored for 14 days after the last unprotected exposure and must report symptoms promptly to occupational health or infection control.

• A. The incubation period can be up to 14 days.
• C. This is shorter than the incubation period.
• D. This exceeds the recommended period of 14 days.

Key point: MERS-CoV contacts are monitored for 14 days after last exposure.

Based on: WHO MERS-CoV infection prevention and control guidance

Answer: C. In START, perfusion is checked after respiratory rate. Capillary refill over 2 seconds or absent radial pulse indicates shock and places the patient in the immediate category.

• A. Delayed is for patients with normal perfusion and mental status.
• B. Green applies to patients able to walk.
• D. The patient is breathing, so expectant does not apply.

Key point: START: breathing, perfusion, mental status; delayed refill means immediate.

Based on: START Triage (Newport Beach); WHO mass casualty management

Answer: D. 225 / 500 = 45%, which is in the red zone. Red zone indicates severe airway narrowing and needs reliever and urgent help.

• A. This is too slow for red-zone readings.
• B. Delay is unsafe.
• C. Red-zone readings need action now.

Key point: Calculate peak flow as a percentage of personal best.

Based on: GINA Global Strategy for Asthma Management and Prevention

Answer: A. After confirming unresponsiveness and absent or abnormal breathing, the rescuer shouts for help and activates the emergency response system so that a defibrillator and team arrive quickly. A pulse check of up to 10 seconds is done at the same time, and compressions start immediately if no definite pulse is felt.

• B. Starting with breaths delays recognition of arrest and activation of the team; compressions take priority in adults.
• C. Equipment and monitoring are secondary and delay help and compressions.
• D. Code status should be known by the team, but a delay to check the chart is not appropriate in an unresponsive, non-breathing patient unless a valid DNAR is already known.

Key point: Activate the emergency response and get the defibrillator early; start compressions without delay if there is no definite pulse.

Based on: AHA 2025 Guidelines for CPR and ECC

Answer: B. For adults, the target is a depth of at least 5 cm but not more than 6 cm, a rate of 100 to 120 per minute, full recoil, and minimal interruptions. Leaning on the chest stops the heart refilling between compressions.

• A. This is too shallow and too slow to generate adequate coronary and cerebral perfusion.
• C. The depth is right but rates above 120 per minute reduce filling time and compression quality.
• D. This depth is too shallow for an adult, and leaning on the chest prevents full recoil and reduces venous return.

Key point: Adult CPR: 5 to 6 cm, 100 to 120/min, full recoil, minimal pauses.

Based on: AHA 2025 Guidelines for CPR and ECC

Answer: C. Ventricular fibrillation and pulseless ventricular tachycardia are shockable. Early defibrillation with the shortest possible peri-shock pause gives the best chance of survival, so compressions continue during charging and restart immediately after the shock.

• A. Pausing during charging increases hands-off time and lowers the chance of a successful shock.
• B. In a shockable rhythm, defibrillation is the priority; drugs do not replace the shock.
• D. Compressions resume at once after the shock; the rhythm and pulse are reassessed after two minutes of CPR.

Key point: Minimise hands-off time: compress while charging, shock, restart compressions at once.

Based on: AHA 2025 Guidelines for CPR and ECC

Answer: D. For non-shockable rhythms such as asystole and PEA, adrenaline 1 mg should be given as early as possible, followed by every 3 to 5 minutes, together with continuous high-quality CPR and treatment of reversible causes.

• A. Asystole is a non-shockable rhythm; a shock does not help and wastes time.
• B. Atropine is no longer recommended in asystole or pulseless electrical activity.
• C. Amiodarone is used for shock-refractory VF or pulseless VT, not asystole.

Key point: Non-shockable rhythm: CPR plus early adrenaline, no shock.

Based on: AHA 2025 Guidelines for CPR and ECC

Answer: B. Amiodarone 300 mg is the first-line antiarrhythmic for VF or pulseless VT that persists after defibrillation, followed by 150 mg if needed. Lidocaine is an accepted alternative if amiodarone is unavailable.

• A. Adenosine treats supraventricular tachycardia with a pulse, not VF.
• C. Atropine is for symptomatic bradycardia, not VF.
• D. Calcium is not given routinely in arrest; it is reserved for specific causes such as hyperkalaemia.

Key point: Refractory VF/pVT: amiodarone 300 mg, then 150 mg.

Based on: AHA 2025 Guidelines for CPR and ECC

Answer: A. Intramuscular adrenaline 0.5 mg (0.5 mL of 1 mg/mL) in the adult mid-outer thigh is the first-line treatment and should not be delayed. Antihistamines and corticosteroids are adjuncts only.

• B. Antihistamines treat skin symptoms but do not reverse airway obstruction or shock.
• C. Corticosteroids act too slowly to treat acute anaphylaxis.
• D. Salbutamol treats bronchospasm only and does not address airway oedema or hypotension.

Key point: Anaphylaxis: IM adrenaline first, in the mid-thigh.

Based on: World Allergy Organization Anaphylaxis Guidance 2020; Resuscitation Council UK anaphylaxis guideline

Answer: A. Opioid toxicity kills through hypoventilation. Oxygenation and ventilation come first; naloxone is then titrated in small doses to restore adequate breathing rather than full consciousness. Transdermal patches should be removed.

• B. Gastric lavage is not indicated and risks aspiration in an unprotected airway.
• C. Flumazenil is a benzodiazepine antagonist and can precipitate seizures.
• D. Hypoxia must be corrected first; large bolus doses can cause severe withdrawal and pulmonary oedema.

Key point: Opioid poisoning: ventilate first, then titrate naloxone.

Based on: AHA 2025 Guidelines for CPR and ECC (opioid-associated emergencies)

Answer: B. Dark urine with very high creatine kinase indicates rhabdomyolysis. Early high-volume isotonic fluids maintain urine output and protect the kidneys; potassium, calcium and renal function are monitored closely.

• A. Rhabdomyolysis needs aggressive fluids to prevent pigment-induced kidney injury.
• C. NSAIDs are nephrotoxic and should be avoided in rhabdomyolysis.
• D. Potassium is released from damaged muscle; hyperkalaemia is the risk.

Key point: Rhabdomyolysis: fluids, avoid nephrotoxins, monitor potassium.

Based on: Wilderness Medical Society Clinical Practice Guidelines: Heat Illness; KDIGO AKI guideline

Answer: D. Pelvic fractures can bleed many litres. A binder or sheet placed at the level of the greater trochanters reduces pelvic volume and tamponades venous bleeding. Examination by manipulation of the pelvis is avoided because it can disturb clots.

• A. Springing or rocking the pelvis can dislodge clots and worsen bleeding.
• B. A binder placed too high does not close the pelvic ring and is less effective.
• C. Repeated movement can worsen bleeding; a single controlled log roll is done only when necessary.

Key point: Pelvic binder at the greater trochanters; do not spring the pelvis.

Based on: ATLS 10th ed., ACS Committee on Trauma

Answer: A. The nurse stays with the patient, starts oxygen per protocol titrated to the target saturation, attaches monitoring and prepares an SBAR with the latest observations, medicines, results, allergies and resuscitation status.

• B. Leaving a deteriorating patient is unsafe.
• C. Transferring an unstable patient is risky and should follow stabilisation.
• D. Oxygen can be started as an emergency intervention under protocols.

Key point: Stay, support and prepare SBAR information.

Based on: Australian Commission on Safety and Quality in Health Care, Recognising and Responding to Acute Deterioration; British Thoracic Society Oxygen Guideline 2017

Answer: D. Tuberculosis is spread by small airborne droplet nuclei, so the patient needs an airborne infection isolation room (negative pressure, door closed) and staff need a fit-tested particulate respirator. Isolation starts on suspicion, before confirmation.

• A. Surgical masks do not filter airborne droplet nuclei and the door must stay closed.
• B. Positive pressure would push contaminated air out into the corridor; gown and gloves do not protect against inhalation.
• C. Standard precautions are not enough for suspected TB; a bay shares air with other patients.

Key point: Suspected TB, measles or varicella: airborne precautions, negative-pressure room and N95 respirator.

Based on: CDC Guideline for Isolation Precautions (2007, updated); WHO guidelines on TB infection prevention and control (2019)

Answer: D. Immediate first aid is to wash the puncture wound with soap and water without scrubbing or squeezing; mucous membranes are flushed with water. The nurse should then report the incident promptly so source and baseline testing, follow-up and any post-exposure prophylaxis can be arranged.

• A. Squeezing or milking the wound can damage tissue and is not recommended.
• B. Scrubbing or using bleach or strong antiseptics damages the skin and does not reduce risk.
• C. Reporting is essential but follows immediate first aid of the wound.

Key point: After a sharps injury: wash with soap and water first, then report immediately.

Based on: WHO Guidelines on post-exposure prophylaxis and occupational exposure; CDC guidance on occupational exposure to bloodborne pathogens

Answer: A. Falls prevention targets the cause: he is getting up to void. Scheduled toileting, a low bed and an accessible call bell address the need and lessen the injury risk. Interventions should be individualised, and restraints or bed rails are not appropriate falls prevention measures.

• B. Full rails raise the height of a fall and he may climb over them; they do not meet his toileting need.
• C. Restraints increase agitation and injury and do not address the cause.
• D. Untreated pain causes restlessness and harms recovery; the dose should be reviewed, not withheld.

Key point: Prevent falls by meeting the patient's need (toileting, pain, mobility) rather than restricting movement.

Based on: WHO Step Safely: Strategies for preventing and managing falls (2007); Joint Commission/JCI National Patient Safety Goals; Potter & Perry Fundamentals of Nursing, safety chapter

Answer: B. Medication should not be given until the patient's identity is reliably verified. The nurse should check the theatre handover and notes with a second nurse as per policy, apply a new wristband with the correct identifiers, and then give the dose.

• A. Bed number is not a patient identifier and a mismatch of patients is possible.
• C. A drowsy patient may answer incorrectly, so self-report alone is unreliable.
• D. Giving the drug before identity is verified and banded defeats the purpose of identification.

Key point: No band, no drug: verify identity with a second person and re-band before giving medicines.

Based on: Joint Commission International Patient Safety Goal 1; WHO High 5s Patient Identification SOP

Answer: B. Floating the heels removes pressure completely, with the knee slightly flexed to avoid popliteal vein pressure. It is the recommended technique for preventing and treating heel pressure injury.

• A. Ring cushions concentrate pressure on surrounding tissue and reduce blood flow.
• C. Massage of reddened skin can damage already compromised capillaries and is not recommended.
• D. A tight bandage adds pressure and can reduce circulation.

Key point: Offload the heels by floating them, not by ring cushions or massage.

Based on: NPIAP/EPUAP/PPPIA International Guideline: Prevention and Treatment of Pressure Ulcers/Injuries (2019)

Answer: D. Manual lifting of dependent patients causes musculoskeletal injury to staff and shear to the patient. Slide sheets, hoists and enough staff make the move safe, and the assessment guides the equipment.

• A. Even with good posture, manually lifting a dependent patient risks staff injury, and lifting under the arms can injure the patient's shoulders.
• B. Relatives are not trained in safe handling, and a draw-sheet lift still means manually lifting the patient's weight.
• C. The patient cannot assist, so the nurse would end up taking the weight.

Key point: Use equipment and a handling plan instead of lifting dependent patients.

Based on: WHO Patient Safety Curriculum Guide; Potter & Perry, Fundamentals of Nursing, 10th ed., safe patient handling

Answer: B. Granulation tissue is made of new capillaries and connective tissue and appears beefy red, moist and granular. It fills the wound from the base up.

• A. This is slough, a sign of devitalised tissue that needs removal.
• C. This indicates likely infection.
• D. This is eschar, dead tissue that delays healing.

Key point: Healthy granulation tissue is moist, red and bumpy.

Based on: Wound, Ostomy and Continence Nurses Society wound care guidance; Potter & Perry, Fundamentals of Nursing, 10th ed.

Answer: D. Documentation should be factual, objective, timed and include the patient's own words, observations and the actions taken. It should avoid opinion, labels and blame.

• A. This is subjective, judgemental, and does not include assessment.
• B. This is an assumption not based on assessment.
• C. Blame and speculation do not belong in the record; incident reporting is separate.

Key point: Chart facts, observations and actions, not opinions.

Based on: Potter & Perry, Fundamentals of Nursing, 10th ed., documentation; JCI Accreditation Standards for Hospitals, management of information

Answer: A. Cylinders must be secured upright in a holder or trolley to prevent falling, valve damage and sudden gas release. The nurse should also check there is enough content for the journey.

• B. A loose cylinder can roll, fall or be knocked, and may injure the patient.
• C. The regulator is not designed to bear the weight and the pole may become unstable.
• D. Hand carrying risks dropping the cylinder, and valve damage can cause a violent gas release.

Key point: Always secure oxygen cylinders upright in a holder; never leave them loose or carry them by the regulator.

Based on: BTS Guideline for Oxygen Use in Adults (2017); WHO Oxygen Therapy for Children manual

Answer: B. Active bleeding with haemodynamic changes is an emergency, and continuing suction will increase blood loss. The device is stopped, the dressing is left in place and pressure applied while urgent help is summoned.

• A. Restarting suction, even at a lower pressure, can worsen haemorrhage.
• C. Removing the dressing in the ward can increase bleeding and delay the emergency response.
• D. A delay until the next round is unsafe for a patient showing signs of shock.

Key point: Stop negative pressure therapy at once for brisk bleeding and call for urgent help.

Based on: FDA Safety Communication on NPWT (2011); manufacturer instructions for use

Answer: C. Sudden focal neurological deficit within the thrombolysis window suggests acute stroke, where each minute of delay causes loss of brain tissue. Acute, new, potentially life- or function-threatening problems outrank stable chronic ones.

• A. A stable chronic wound can wait until the acute problem has been assessed.
• B. Chronic pain with a known pattern is less urgent than a new neurological deficit.
• D. An isolated, asymptomatic mildly raised glucose is not an emergency.

Key point: Acute and unstable problems take priority over chronic and stable ones, and time-critical conditions such as stroke come first.

Based on: Marquis & Huston, Leadership Roles and Management Functions in Nursing, 10th ed.

Answer: B. Delegation transfers the task but not accountability. The nurse must choose an appropriate person, give clear instructions, supervise, and evaluate the outcome and the patient's response.

• A. Repeating the task wastes resources and signals lack of trust; supervision and follow-up are sufficient.
• C. Documentation must show who performed the care; recording it as one's own is inaccurate.
• D. The nurse delegates the task but remains accountable for the decision to delegate and for outcomes.

Key point: You can delegate the task, but you remain accountable for the decision to delegate and for supervising the result.

Based on: Marquis & Huston, Leadership Roles and Management Functions in Nursing, 10th ed.

Answer: A. Stable patients with predictable needs and routine tasks are suited to practical nurses. Unstable patients, new admissions needing assessment, and patients needing frequent judgement-based monitoring are assigned to the registered nurse.

• B. A recently post-procedure patient needs ongoing assessment for bleeding and arrhythmias by the registered nurse.
• C. Initial assessment and care planning are registered nurse responsibilities.
• D. A patient with new, unexplained changes is unstable and needs registered nurse assessment.

Key point: Match assignments to scope and competence: stable and predictable for the practical nurse, unstable or undiagnosed for the registered nurse.

Based on: Marquis & Huston, Leadership Roles and Management Functions in Nursing, 10th ed.

Answer: D. Confidentiality yields when there is serious risk to identifiable others, but disclosure must follow law and policy rather than individual decision. The nurse escalates to the physician, who counsels the patient and, if needed, makes any permitted or required report.

• A. Confidentiality is not absolute when a serious, foreseeable risk to others exists.
• B. Disclosing to an employer on the nurse's own initiative bypasses the physician and the lawful disclosure process.
• C. Nurses cannot make discharge conditional on a promise or detain a competent patient.

Key point: Confidentiality has limits for serious risk to others, but disclosure goes through the team and policy, not unilateral action.

Based on: ICN Code of Ethics for Nurses (2021); Beauchamp & Childress, Principles of Biomedical Ethics, 8th ed.

Answer: C. Nurses are accountable for working within their competence. They should communicate limits, accept appropriate assignments, and request orientation or supervision for others.

• A. Accepting beyond competence endangers patients and breaches professional standards.
• B. Refusing all work is unnecessary when appropriate tasks can be assigned.
• D. Asking for help after the fact is too late for unsafe acts.

Key point: Work within your competence and speak up before accepting an unsafe assignment.

Based on: ICN Code of Ethics for Nurses (2021); Marquis & Huston, Leadership Roles and Management Functions in Nursing, 10th ed.

Answer: C. Physiological needs such as pain relief, oxygen, food and fluid must be met before higher needs. Pain relief also allows the patient to take part in discussing her concerns later.

• A. Safety and security needs are higher than physiological needs, so they follow.
• B. Belonging needs are higher in the hierarchy.
• D. Self-esteem is a higher-level need.

Key point: Meet physiological needs first, then safety, belonging, esteem and self-actualisation.

Based on: Maslow's hierarchy of needs as applied in Potter & Perry, Fundamentals of Nursing

Answer: A. Sensitive health information should be shared only with those who need it and in settings where it cannot be overheard. A private room is the safest option.

• B. Others may overhear in the corridor.
• C. Visitors could overhear the information.
• D. Public places are unsuitable for any identifiable patient information.

Key point: Discuss patient information only in private and with those who need to know.

Based on: International Council of Nurses, Code of Ethics for Nurses (2021)

Answer: B. Patient safety comes first: check the glucose, monitor for hypoglycaemia and obtain medical orders. Then disclose the error honestly and complete an incident report with facts only.

• A. The report is required but follows the patient's care.
• C. Disclosure is required, but treatment comes first and is led with the team.
• D. Altering the record is inappropriate; any correction must be a transparent addendum after care.

Key point: Care for the patient first, then report and disclose honestly.

Based on: WHO Patient Safety Curriculum Guide (2011), reporting and learning

Answer: D. PICO stands for Population, Intervention, Comparison and Outcome. The comparison is the alternative to the intervention, here the standard soap and water bath.

• A. This is the population.
• B. This is the intervention.
• C. This is the outcome.

Key point: PICO: Population, Intervention, Comparison, Outcome.

Based on: Melnyk & Fineout-Overholt, Evidence-Based Practice in Nursing & Healthcare, 4th ed.

Answer: D. Patients have the right to be free from unnecessary restraint. The nurse assesses causes such as pain, hypoxia, infection or a full bladder, and uses the least restrictive alternatives first.

• A. Restraint is a last resort and requires an order and assessment.
• B. This is unsafe, unreliable and may be unsuitable for the family.
• C. Stopping prescribed therapy needs the doctor's decision.

Key point: Use the least restrictive measure and treat the cause of confusion.

Based on: Joint Commission International Accreditation Standards, Patient and Family Rights

Answer: A. Respiratory rate under 12 breaths/min with absent reflexes signals toxicity. The infusion is stopped, senior help is called, airway and breathing are supported, and 10% calcium gluconate (1 g, 10 mL) is given by slow intravenous injection if ordered.

• B. Halving the rate is inadequate when respiratory depression is already present.
• C. Oxygen helps but continuing the drug allows toxicity to worsen.
• D. Naloxone reverses opioids; the antidote for magnesium is calcium gluconate.

Key point: Respiratory depression on magnesium: stop the drug, get help, calcium gluconate is the antidote.

Based on: ACOG Practice Bulletin 222 (2020); WHO recommendations for pre-eclampsia and eclampsia (2011)

Answer: D. Engorgement is relieved by frequent, effective milk removal. Softening the areola by hand expression or reverse pressure helps the baby attach, and cold compresses after feeds ease discomfort.

• A. Stopping milk removal worsens engorgement and risks mastitis.
• B. Tight binding and fluid restriction are not recommended.
• C. Restricting feeds increases engorgement.

Key point: Engorgement: keep removing milk frequently.

Based on: WHO Infant and young child feeding counselling; Academy of Breastfeeding Medicine Protocol 36 (2022)

Answer: D. A boggy fundus is uterine atony, the leading cause of PPH. Firm massage with a hand cupped over the fundus stimulates contraction while uterotonics are arranged.

• A. A cold pack does not contract the uterus.
• B. Ambulation is unsafe during active bleeding.
• C. Temperature is not the priority during haemorrhage.

Key point: Boggy uterus and bleeding: massage the fundus first.

Based on: WHO recommendations on postpartum haemorrhage (2012); Williams Obstetrics, postpartum haemorrhage chapter

Answer: B. Oxytocin 10 IU IM is the uterotonic of choice for preventing postpartum haemorrhage. It is given within one minute of birth, once a second baby is excluded, followed by delayed cord clamping and controlled cord traction by a trained provider.

• A. Early cord clamping is not advised, and cord traction is done only after a uterotonic is given.
• C. Uterine massage is not a substitute for a uterotonic in prevention.
• D. Oxytocin should not wait for placental signs.

Key point: Give oxytocin 10 IU IM within one minute of birth to prevent postpartum haemorrhage.

Based on: WHO recommendations for the prevention and treatment of postpartum haemorrhage (2012, updated 2018)

Answer: C. One missed combined pill (less than 48 hours late) needs no extra precautions as long as the pill is taken as soon as remembered and the rest are taken on time.

• A. Skipping a pill without taking the missed tablet reduces protection.
• B. Stopping the pack is unnecessary and creates a gap.
• D. Condoms for 7 days are needed only when two or more pills are missed, and doubling future doses is not a recommended regimen.

Key point: One missed pill: take it now and continue; extra protection is for two or more.

Based on: FSRH Combined Hormonal Contraception guideline (2019, amended 2023); WHO Family Planning Handbook

Answer: D. Classic signs of placental separation are a small gush of blood, lengthening of the cord at the vulva, and the fundus becoming firm, rounded and rising in the abdomen as the placenta enters the lower segment.

• A. After separation the fundus becomes firm and globular and rises; a soft, flat uterus suggests atony.
• B. Sudden severe pain with collapse suggests uterine inversion or rupture, not separation.
• C. The cord lengthens as the placenta descends; it does not retract.

Key point: Placenta separated: cord lengthens, gush of blood, uterus firm and globular.

Based on: Myles Textbook for Midwives, third stage of labour; WHO recommendations on postpartum haemorrhage (2012)

Answer: D. Obesity (body mass index above 30 kg/m²) and a previous macrosomic baby (4.5 kg or more) are major risk factors for gestational diabetes, so she is the priority for early testing. A previous miscarriage, a vegetarian diet and a body mass index of 22 to 26 kg/m² without other risk factors do not place a woman in the high-risk group.

• A. A normal body mass index in a first pregnancy carries no major risk factor.
• B. A previous miscarriage does not raise the risk of gestational diabetes.
• C. A body mass index of 26 kg/m² with no other risk factor and a vegetarian diet carry much lower risk than option D.

Key point: Previous macrosomia and obesity prompt early screening for gestational diabetes.

Based on: NICE guideline NG3: Diabetes in pregnancy (2015, updated 2020); ADA Standards of Care in Diabetes, Management of diabetes in pregnancy (2026)

Answer: C. The first hour after birth is the period of highest risk for postpartum haemorrhage. Frequent checks of uterine tone, bleeding and vital signs at about 15-minute intervals detect early haemorrhage, with later intervals extended if stable.

• A. Two-hour gaps would miss rapid blood loss.
• B. Four-hourly checks suit later postnatal care, not the first hour.
• D. A single check does not detect developing bleeding.

Key point: Monitor the mother every 15 minutes in the first hour after birth.

Based on: WHO recommendations on prevention and treatment of postpartum haemorrhage (2012); Myles Textbook for Midwives, 17th ed.

Answer: B. Rh-negative women with an ectopic pregnancy can be sensitised by fetal cells entering the maternal blood during bleeding or surgery. Anti-D is given within 72 hours of the sensitising event.

• A. A non-viable pregnancy can still sensitise.
• C. Rupture is not required; surgery and bleeding can sensitise.
• D. Waiting for a future pregnancy leaves the risk of sensitisation unaddressed.

Key point: Rh-negative women need anti-D after ectopic pregnancy.

Based on: NICE guideline NG126: Ectopic pregnancy and miscarriage (2019, updated 2023); RCOG Green-top Guideline 21 (2016)

Answer: D. Sudden bleeding at membrane rupture with fetal bradycardia and a stable mother suggests ruptured vasa praevia, in which fetal vessels bleed. The fetus loses blood rapidly, so immediate delivery is required.

• A. Examination wastes time and may disrupt vessels further.
• B. Observation allows fetal exsanguination.
• C. Continuing labour risks fetal death.

Key point: Bleeding at rupture with fetal bradycardia: suspect vasa praevia and deliver immediately.

Based on: RCOG Green-top Guideline 27b: Placenta praevia, placenta accreta and vasa praevia (2018)

Answer: C. A gain of more than 2 kg in 3 days, new oedema and orthopnoea indicate worsening congestion. The prescriber needs to review her diuretic dose and look for a cause. Self-adjusting diuretics without advice is unsafe.

• A. Changing the dose without prescriber advice risks electrolyte disturbance and kidney injury.
• B. Rapid gain over days is fluid, not normal fluctuation; ignoring it delays treatment.
• D. Increasing fluid intake would worsen congestion in a patient who is already overloaded.

Key point: A weight gain above 2 kg in 3 days in heart failure should be reported promptly.

Based on: ESC 2021 Guidelines for Acute and Chronic Heart Failure

Answer: D. Tachycardia with hypotension, reduced consciousness and chest pain is haemodynamic instability (adverse features). Unstable tachyarrhythmia is treated with synchronised cardioversion under sedation, so help must be called and equipment prepared at once.

• A. An oral beta-blocker acts too slowly and may worsen hypotension in an unstable patient.
• B. Delaying treatment for review is unsafe when adverse features are present.
• C. Unsynchronised shocks are for pulseless VT/VF; shocking a conscious patient with a pulse must be synchronised.

Key point: Unstable tachycardia with a pulse needs synchronised cardioversion, not drugs and delay.

Based on: ERC Guidelines 2021 and AHA Adult Tachycardia with a Pulse algorithm (ACLS)

Answer: C. Dose = 18 units/kg/h x 70 kg = 1260 units/h. Concentration = 25 000 units / 500 mL = 50 units/mL. Rate = 1260 / 50 = 25.2 mL/h. Always check the calculation independently with a second nurse because heparin is a high-alert medicine.

• A. Halves the correct rate; this results from using 100 units/mL.
• B. 18.0 mL/h delivers only 900 units/h (about 12.9 units/kg/h); it comes from entering the dose figure as the pump rate.
• D. Doubles the correct rate; this results from using 25 units/mL.

Key point: Dose per hour divided by concentration per mL gives the pump rate.

Based on: Institute for Safe Medication Practices (ISMP) List of High-Alert Medications; Lewis's Medical-Surgical Nursing, 12th ed.

Answer: A. A silent chest with drowsiness and hypoxia despite oxygen signals life-threatening asthma: airflow is so low that wheeze disappears. She needs immediate senior or critical care help while bronchodilator and oxygen continue.

• B. Loss of wheeze here means minimal airflow, not improvement.
• C. Lying flat worsens breathing; she needs upright positioning and urgent help.
• D. Delaying escalation for an hour is unsafe in life-threatening asthma.

Key point: A silent chest in a severe asthmatic is an ominous sign; escalate immediately.

Based on: GINA Global Strategy for Asthma Management and Prevention, 2024; BTS/NICE/SIGN Asthma Guideline, 2024

Answer: A. Raised PaCO2 with a pH on the acid side of 7.40 indicates a primary respiratory acidosis. The raised bicarbonate shows renal compensation over days, bringing the pH back to the low-normal range, so it is chronic and fully compensated.

• B. PaCO2 and HCO3 are both markedly abnormal; only the pH has normalised through compensation.
• C. If acute and uncompensated, the pH would be low and the bicarbonate near normal.
• D. pH below 7.40 points to an acid primary problem; high bicarbonate is the compensation, not the cause.

Key point: Compare the pH with 7.40 to decide the primary disorder; the opposite change is compensation.

Based on: Lewis's Medical-Surgical Nursing, 12th ed., acid-base imbalances

Answer: C. Insulin must continue until ketones clear and acidosis resolves, even though glucose is falling. When glucose falls below about 14 mmol/L, a glucose infusion (10% in UK JBDS guidance, 5% in the ADA consensus) is added alongside the sodium chloride so that insulin can keep suppressing ketone production without causing hypoglycaemia.

• A. Stopping insulin allows ketosis to continue.
• B. Subcutaneous insulin is for after ketones have resolved and the patient is eating.
• D. Isotonic fluid is continued to maintain circulation.

Key point: In DKA, continue insulin and add glucose when glucose falls below 14 mmol/L.

Based on: JBDS-IP Management of DKA in Adults 2023; ADA/EASD/JBDS/AACE consensus report on hyperglycaemic crises in adults 2024

Answer: C. Abrupt withdrawal of a beta-blocker can cause rebound tachycardia, hypertension and angina or MI because of receptor up-regulation. Hypertension is often symptom-free, so the patient must continue treatment and any change should be tapered by the prescriber.

• A. A resting pulse of 70 to 80 is normal on a beta-blocker; the threshold for contacting the team is much lower (about 50 to 60), and stopping is not the patient's decision.
• B. Intermittent use gives unstable BP control and repeated withdrawal effects.
• D. Self-adjusting the dose risks bradycardia and hypotension.

Key point: Never stop a beta-blocker suddenly: rebound tachycardia, hypertension and angina can follow.

Based on: Lewis Medical-Surgical Nursing, 12th ed., hypertension drug therapy

Answer: C. A platelet fall of more than 50% between days 5 and 10 of heparin, with skin necrosis, strongly suggests HIT, a prothrombotic immune reaction. All heparin including flushes and LMWH must be stopped and a non-heparin anticoagulant started on medical order.

• A. Continuing heparin in suspected HIT greatly increases the risk of arterial and venous thrombosis.
• B. Reducing the dose still exposes the patient to heparin and the immune reaction continues.
• D. Low molecular weight heparin cross-reacts and is also contraindicated in HIT.

Key point: Platelets falling after 5 to 10 days of heparin: suspect HIT, stop all heparin and escalate.

Based on: ASH 2018 Guidelines for Heparin-Induced Thrombocytopenia

Answer: D. Most serious reactions, such as ABO incompatibility, occur early. Starting slowly with close observation limits harm if a reaction occurs. Each unit should be completed within 4 hours of leaving controlled storage.

• A. Running it fast removes the chance to recognise an early reaction; the 4 hour limit does not require 1 hour.
• B. Reactions can start within minutes, so interval observations during the transfusion are essential.
• C. Glucose causes red cell clumping and haemolysis; only 0.9% sodium chloride is used.

Key point: Start the transfusion slowly and observe closely for the first 15 minutes.

Based on: BSH Guideline on the Administration of Blood Components / WHO Clinical Transfusion Practice

Answer: B. Rising end-tidal CO2 with tachycardia, masseter rigidity and fever suggests malignant hyperthermia, a hypermetabolic crisis triggered by volatile agents and suxamethonium. Dantrolene stops the calcium release.

• A. Cooling helps later, but the trigger must be stopped and dantrolene given first.
• C. Deepening the volatile agent worsens the crisis because the agent is the trigger.
• D. Neostigmine does not treat this condition and can cause bradycardia.

Key point: Malignant hyperthermia: stop triggers, 100% oxygen, dantrolene, then cool.

Based on: MHAUS Emergency Therapy / AAGBI Malignant Hyperthermia Guideline

Answer: C. Reflecting the feeling and inviting the patient to describe the situation shows acceptance and encourages exploration without confirming or arguing with the perception. It builds trust and gives the nurse the information needed to assess for low mood, paranoia or real conflict.

• A. Flatly disagreeing and giving false reassurance dismisses her feelings and makes her feel unheard.
• B. 'Why' questions can feel accusatory and invite defensiveness rather than exploration.
• D. Changing the subject blocks communication and tells the patient her concern is unimportant.

Key point: Reflect feelings and use open exploration; avoid false reassurance, 'why' questions and changing the subject.

Based on: Videbeck, Psychiatric-Mental Health Nursing, therapeutic communication techniques chapter

Answer: D. A specific plan, access to the means, a chosen time and preparation (saving tablets, arranging for others to be absent) indicate imminent risk. These elements move a patient from ideation to intent and require immediate protective action.

• A. This is passive ideation without plan or intent, which needs assessment but is lower risk.
• B. A strong protective factor is described, so risk is lower.
• C. This describes self-harm used to cope, without suicidal intent.

Key point: A specific plan, available means and a set time signal high imminent risk.

Based on: Videbeck, Psychiatric-Mental Health Nursing, suicide chapter

Answer: B. ECT is performed under brief general anaesthesia with a muscle relaxant, so preparation follows pre-anaesthetic principles: fasting, an empty bladder, removal of dentures and jewellery, and checking consent and prescribed medicine instructions.

• A. Food before general anaesthesia increases the risk of aspiration.
• C. Benzodiazepines raise the seizure threshold and can reduce seizure quality, so the prescriber decides whether they are held.
• D. A muscle relaxant is given with the anaesthetic, so restraints are not used.

Key point: Prepare for ECT as for anaesthesia: fasting, empty bladder and no dentures or jewellery.

Based on: Videbeck, Psychiatric-Mental Health Nursing; Royal College of Psychiatrists ECT Handbook

Answer: C. Maintenance lithium levels are usually 0.4 to 1.0 mmol/L, with 0.6 to 0.8 mmol/L the common target, measured about 12 hours after the last dose. Levels above about 1.5 mmol/L are associated with toxicity.

• A. This level is subtherapeutic.
• B. This level is above the therapeutic range and may be associated with toxicity.
• D. This level is in the range of serious toxicity.

Key point: Maintenance lithium range is about 0.6 to 0.8 mmol/L taken 12 hours after the dose.

Based on: NICE CG185 Bipolar disorder; Maudsley Prescribing Guidelines in Psychiatry

Answer: C. Ataxia, confusion and ophthalmoplegia suggest Wernicke encephalopathy. Glucose metabolism depends on thiamine, so thiamine must be given first or with glucose to avoid precipitating or worsening the condition.

• A. Glucose given before thiamine can worsen Wernicke encephalopathy by consuming remaining thiamine.
• B. Folic acid does not treat the suspected condition and should not delay thiamine.
• D. Delay and oral administration risk irreversible brain injury; high-dose parenteral thiamine is required.

Key point: Give IV thiamine before or with glucose in alcohol-dependent, malnourished patients.

Based on: NICE CG100 Alcohol-use disorders: physical complications; EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy (Galvin et al., 2010)

Answer: D. Supervision during and after meals prevents food avoidance, hiding food and purging while providing support. The nurse stays matter-of-fact and neutral and avoids bargaining about food.

• A. Eating alone allows hiding, discarding food and later purging.
• B. Negotiating meals reinforces control over food; the plan should be consistent.
• C. Discussing weight and shape during meals increases anxiety and focuses on the illness.

Key point: Supervise meals and the period afterwards calmly and consistently.

Based on: NICE NG69 Eating disorders; Videbeck, Psychiatric-Mental Health Nursing

Answer: C. Therapeutic silence gives the patient time to gather thoughts and feel accepted. Staying present shows respect and lets her lead when she is ready.

• A. Changing the subject interrupts her processing and signals discomfort with her feelings.
• B. Telling her not to feel sad dismisses her emotions and is non-therapeutic.
• D. Leaving for an hour abandons a distressed patient who needs presence.

Key point: Comfortable silence with the nurse present is a therapeutic communication technique.

Based on: Stuart, Principles and Practice of Psychiatric Nursing, 11th ed., therapeutic communication chapter

Answer: B. Lithium is handled by the kidney like sodium. Low sodium or dehydration makes the kidney retain lithium, raising levels toward toxicity. Intake should remain consistent.

• A. Salt restriction raises lithium levels.
• C. Fluid restriction risks dehydration and toxicity.
• D. Patients must not self-adjust doses; with heavy sweating they should drink more fluid and tell the team.

Key point: Keep sodium and fluids steady while on lithium.

Based on: Stahl's Essential Psychopharmacology; Videbeck, Psychiatric-Mental Health Nursing, 9th ed.

Answer: D. Nicotine replacement with behavioural support improves quit success and manages withdrawal in hospitalised patients.

• A. Admission is a good opportunity to quit with support; delaying misses it.
• B. Using smoking as a reward reinforces dependence and undermines quitting.
• C. Unsupported abrupt cessation has lower success.

Key point: Combine nicotine replacement with counselling.

Based on: WHO Clinical treatment guideline for tobacco cessation in adults (2024)

Answer: C. Acute fluctuating confusion is delirium, a medical emergency with an underlying cause, here probably a urinary tract infection. Prompt medical assessment is required.

• A. Dementia progresses over months to years, not hours.
• B. Sedation masks the cause and can worsen delirium.
• D. Observation alone delays treatment.

Key point: Sudden change in cognition in an older adult is delirium until proven otherwise.

Based on: NICE CG103 Delirium; Lewis, Medical-Surgical Nursing, 12th ed.

Answer: A. By 9 months an infant normally babbles with consonant sounds (for example 'ba-ba') and turns toward familiar voices. Absence of both suggests a possible hearing or language problem and needs audiology and developmental referral. The other findings are within normal limits.

• B. Independent walking is expected at about 12–15 months, so this is normal at 9 months.
• C. Stranger anxiety is a typical social milestone from about 6–9 months.
• D. A raking grasp is typical at this age; the pincer grasp develops at about 9–12 months.

Key point: Lack of babbling and of response to name at 9 months is a red flag for hearing or developmental delay.

Based on: CDC/AAP 'Learn the Signs. Act Early.' developmental milestones (2022 revision); Hockenberry & Wilson, Wong's Nursing Care of Infants and Children, 11th ed.

Answer: B. Preschoolers use magical thinking and often believe that illness or procedures are punishment. The nurse should correct this misconception in short concrete terms, be honest about brief discomfort, and use play with real equipment. This reduces fear and supports cooperation.

• A. Detailed physiological explanation suits school-age children; a preschooler cannot process it and is likely to be more frightened.
• C. This is dishonest and destroys trust when he feels pain; honesty about brief discomfort is recommended.
• D. Preschoolers need a short, honest explanation just before the procedure; giving none increases fear and fantasies.

Key point: Preschoolers think magically; reassure that procedures are not punishment and use play with a doll or equipment.

Based on: Wong's Nursing Care of Infants and Children, 11th ed., chapters on cognitive development and preparation for procedures

Answer: D. The findings classify him as having some dehydration (irritable, sunken eyes, thirsty, slow skin pinch). Working: 75 mL/kg × 9 kg = 675 mL over 4 hours, about 170 mL per hour, given in small frequent sips, then reassess.

• A. This uses 50 mL/kg, which is not the volume specified by the protocol.
• B. This uses 100 mL/kg, the Plan C IV volume for severe dehydration, which is too high for Plan B.
• C. This is only 25 mL/kg and would under-treat his deficit.

Key point: Some dehydration: WHO Plan B is 75 mL/kg ORS over 4 hours, then reassess.

Based on: WHO The Treatment of Diarrhoea: A Manual for Physicians and Other Senior Health Workers

Answer: A. Small volumes directed along the inside of the cheek with the infant held semi-upright allow the infant to swallow safely and reduce choking. Using a syringe also ensures an accurate dose, and the infant should be praised and comforted afterwards.

• B. The infant may not finish the feed and so receive an incomplete dose.
• C. Lying flat and squirting to the back of the throat increases the risk of aspiration and choking.
• D. This risks aspiration and distress and is not an acceptable technique.

Key point: Give oral liquids slowly into the cheek pocket with the infant semi-upright; never mix a whole dose in a full feed.

Based on: Wong's Nursing Care of Infants and Children, 11th ed., administration of medication

Answer: B. Immunisation schedules do not restart after a delay. Previous valid doses count, the missed dose is given as soon as possible, and later doses follow at the minimum intervals.

• A. Extending the interval does not reduce the effect of earlier doses.
• C. Valid earlier doses are never discarded because of a delay.
• D. One dose of a multi-dose series does not give full or lasting protection.

Key point: Never restart a vaccine series because of a delay; continue from where it stopped.

Based on: WHO Immunization in Practice; CDC catch-up immunization principles

Answer: C. Weight loss = 8.0 - 7.2 = 0.8 kg. Percentage dehydration = loss divided by pre-illness weight: 0.8 / 8.0 x 100 = 10%. A deficit of about 10% (about 100 mL/kg) is at the severe end of dehydration and needs urgent clinical assessment.

• A. 8% results from using the loss in kilograms as a percentage.
• B. 11% results from dividing by the current weight (0.8 / 7.2) instead of the pre-illness weight.
• D. 1% is a decimal-place error.

Key point: Percentage dehydration = (pre-illness weight - current weight) / pre-illness weight x 100.

Based on: WHO Pocket Book of Hospital Care for Children, 2nd ed., dehydration; Nelson Textbook of Pediatrics

Answer: A. In hypernatraemia, brain cells adapt by increasing their solute content. If plasma sodium falls too fast, water is drawn into the cells, leading to cerebral oedema, seizures and possible death. Slow, controlled correction avoids this.

• B. Potassium is not the concern in this correction rate.
• C. Renal excretion is not the limiting factor; brain osmotic shifts are.
• D. Heart failure is not a universal risk and is not the reason for the slow rate.

Key point: Correct hypernatraemia slowly to avoid cerebral oedema.

Based on: Nelson Textbook of Pediatrics, hypernatraemic dehydration; APLS: The Pediatric Emergency Medicine Course

Answer: A. Symmetrical, sharply demarcated burns with spared flexed areas indicate forced immersion in hot water and are not consistent with accidental splashes. The nurse should report the concern to the child protection team.

• B. Splash burns on the upper body match a plausible accident history.
• C. Palm burns from a hot door match a plausible mechanism.
• D. Sunburn is explained by exposure and is a neglect issue at most.

Key point: Symmetrical immersion-type burns with clear borders are red flags for abuse.

Based on: WHO Preventing Child Maltreatment guide; RCPCH child protection evidence review on burns

Answer: C. Locking up medicines and chemicals in original labelled containers is the most effective prevention. Child-resistant caps slow but do not stop children.

• A. Caps are not child-proof and a low drawer is accessible.
• B. Ipecac is no longer recommended and can cause harm.
• D. Calling medicine sweets encourages children to take it.

Key point: Lock away medicines and chemicals; know the poison centre number.

Based on: Hockenberry & Wilson, Wong's Essentials of Pediatric Nursing, 11th ed.

Answer: A. Aspirin in viral illnesses like influenza or varicella is linked with Reye syndrome, a serious liver and brain disease.

• B. Food does not remove the risk.
• C. Reduced dose does not remove the risk.
• D. Aspirin should not be used as a second option.

Key point: Avoid aspirin for children with viral illness.

Based on: WHO and AAP guidance on Reye syndrome

Answer: D. Rate (mL/h) = total volume / time in hours = 500 / 6 = 83.3, which rounds to 83 mL/h.

• A. This would finish the infusion in 5 hours.
• B. This would take 10 hours.
• C. This would finish in 3 hours.

Key point: mL/h = total volume divided by hours.

Based on: Potter & Perry Fundamentals of Nursing, IV therapy chapter

Answer: A. Drops/min = (volume x drop factor) / time in minutes = (1000 x 20) / 600 = 33.3, rounded to 33 drops/min.

• B. 100 is the rate in mL/h, not drops per minute.
• C. This uses a 15 drops/mL set.
• D. This uses a 30 drops/mL set.

Key point: Convert hours to minutes and use the drop factor printed on the set.

Based on: Potter & Perry Fundamentals of Nursing, IV therapy chapter

Answer: C. Dose = 18 kg x 15 mg/kg = 270 mg. Volume = (270 / 120) x 5 mL = 11.25 mL, which rounds to 11.3 mL. This is within the usual paediatric single-dose limits.

• A. This uses 12 mg/kg (216 mg) instead of the ordered 15 mg/kg.
• B. This forgets to multiply by the 5 mL volume.
• D. This multiplies by 10 mL rather than 5 mL.

Key point: Calculate the mg dose from weight first, then the volume from the concentration.

Based on: BNF for Children, paracetamol monograph / Harriet Lane Handbook

Answer: B. Concentration = 25,000 / 500 = 50 units/mL. Rate = 1,200 units/h / 50 units/mL = 24 mL/h.

• A. This assumes 100 units/mL instead of 50 units/mL.
• C. This is a decimal error.
• D. This assumes 25 units/mL.

Key point: Work out units per mL first, then divide the hourly dose by it.

Based on: ISMP high-alert medication guidance / Gahart's Intravenous Medications

Answer: A. Methotrexate for rheumatoid arthritis is given once weekly. Daily administration has caused fatal bone marrow suppression, so the nurse must stop and clarify.

• B. Daily dosing can cause fatal toxicity even at small doses.
• C. Altering the dose without prescriber clarification is outside nursing practice.
• D. Folic acid does not make daily dosing safe.

Key point: Query any daily methotrexate order for non-cancer use.

Based on: ISMP high-alert medications list / BNF methotrexate monograph

Answer: B. Tinnitus suggests ototoxicity and low urine output suggests nephrotoxicity, both serious dose-related adverse effects of gentamicin requiring review of the dose and drug levels.

• A. Mild nausea is common and not specific to aminoglycoside toxicity.
• C. A minor site reaction needs monitoring but is not urgent here.
• D. This suggests a response to treatment.

Key point: Monitor renal function, hearing and drug levels with aminoglycosides.

Based on: BNF gentamicin monograph / Lewis Medical-Surgical Nursing

Answer: C. Opioid-induced respiratory depression is life-threatening. Stimulate, support airway and breathing, call for help and give naloxone titrated to restore breathing.

• A. This delays treatment of respiratory depression.
• B. Oxygen alone does not reverse hypoventilation.
• D. Flumazenil reverses benzodiazepines, not opioids.

Key point: Reversal is by naloxone titrated in small doses, with continuous monitoring.

Based on: Lewis Medical-Surgical Nursing / ISMP opioid safety guidance

Answer: C. Acetylcysteine replenishes glutathione and prevents hepatotoxicity in paracetamol overdose, and is most effective when given early.

• A. Naloxone reverses opioids.
• B. Flumazenil reverses benzodiazepines.
• D. Protamine reverses heparin.

Key point: Paracetamol overdose: acetylcysteine.

Based on: Lewis Medical-Surgical Nursing / BNF paracetamol poisoning guidance

Answer: C. Stopping the infusion limits further tissue injury. The cannula is left in place briefly so residual drug can be aspirated before removal, and the prescriber is notified so the antidote (phentolamine, infiltrated subcutaneously around the site) can be given per protocol.

• A. Flushing pushes more drug into the tissue.
• B. Removing the cannula first loses the chance to aspirate residual drug from the tissue.
• D. Continuing the infusion worsens tissue damage.

Key point: On suspected extravasation: stop, aspirate, do not flush.

Based on: Infusion Nurses Society, Infusion Therapy Standards of Practice (2024)

Answer: B. NSAIDs inhibit gastric prostaglandins and platelet function, so they are contraindicated in active peptic ulcer and gastrointestinal bleeding.

• A. A tension headache is a standard indication.
• C. Musculoskeletal pain is a standard indication.
• D. Dental pain is a standard indication.

Key point: Avoid NSAIDs in active GI bleeding.

Based on: BNF ibuprofen monograph / Lewis Medical-Surgical Nursing