Read the pH: below 7.35 is acidosis, above 7.45 alkalosis.
Find the value that explains it: PaCO₂ moving opposite to the pH is respiratory, HCO₃⁻ moving with the pH is metabolic.
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.
In a metabolic acidosis, compare PaCO₂ with Winter’s formula, 1.5·HCO₃⁻ + 8 ± 2, and calculate the anion gap Na⁺ − (Cl⁻ + HCO₃⁻).
Check a high anion gap with the delta ratio and, when albumin is low, with the corrected gap.
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
Write the given quantity with its unit and the unit you want.
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.
Write it as a fraction so that the unwanted unit cancels; for a rate, use one fraction per unit that changes.
Check the direction: a smaller unit gives a bigger number.
Round only the final answer, to the precision the question names.
2Practice problems
1.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury does not open the eyes at all, makes only incomprehensible sounds such as moaning and shows as the best motor response: abnormal flexion of the arms (decorticate posture). Work out the GCS and classify the head injury by it. Click your answer.
1mild
2moderate
3severe
2.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 60 mmHg. A patient’s systolic pressure is 106 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 60 mmHg?
MAP 60 mmHgSBP 106 mmHg
DBP = mmHg
3.Arterial blood gas interpretationMedium
A practice gas shows PaCO₂ 26 mmHg (3.5 kPa). Use the rule that in chronic respiratory alkalosis HCO₃⁻ falls by 5 mmol/L for every 10 mmHg that PaCO₂ is below 40, starting from HCO₃⁻ 24 mmol/L, to find the expected HCO₃⁻.
At sea level, a practice gas taken on 21% oxygen shows PaO₂ 71 mmHg (9.5 kPa) and PaCO₂ 39 mmHg (5.2 kPa). Use PAO₂ = FiO₂·(760 − 47) − PaCO₂/0.8 to find the A–a gradient.
According to Erikson, what is the main developmental task of older adulthood?
AIntegrity versus despair
BIdentity versus role confusion
CIndustry versus inferiority
DTrust versus mistrust
6.Nursing fundamentalsHard
A dying patient's breathing gets deeper and faster, then shallower, followed by a pause with no breathing, in a repeating cycle. What is this pattern called?
ABiot's breathing
BCheyne–Stokes breathing
CParadoxical breathing
DKussmaul breathing
7.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient is 187 cm tall. Using 1 in = 2.54 cm, find the height h in inches. Round to one decimal place.
187 cm1 in = 2.54 cm
h = in
8.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 18:45 and finishes at 08:25 the next morning (24-hour clock). How many minutes t did it run?
18:4508:25
t = min
3Solutions
1.Clinical assessment scores
Answer: severe
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.
Score each area
E: does not open the eyes at all → 1
V: makes only incomprehensible sounds such as moaning → 2
M: abnormal flexion of the arms (decorticate posture) → 3
Add
GCS = 1 + 2 + 3 = 6
Severity
GCS 6 → severe
Answer
severe
2.Clinical assessment scores
Answer: DBP = 37 mmHg
Blood pressure values: pulse pressure PP = SBP − DBP. Mean arterial pressure MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3, an estimate based on the heart spending about two thirds of each beat in diastole at a normal heart rate (less accurate when the heart rate is fast); a MAP of at least about 65 mmHg is a common target for organ perfusion. The shock index SI = heart rate/SBP is normally about 0.5–0.7; a value above about 1 is a warning sign of shock.
Rearrange
DBP = (3·MAP − SBP)/2
Substitute
DBP = (3·60 − 106)/2 = 74/2 = 37 mmHg
Answer
DBP = 37 mmHg
3.Arterial blood gas interpretation
Answer: HCO₃⁻ = 17 mmol/L
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.
Change in PaCO₂
|26 − 40| = 14 mmHg → 1.4 × 10 mmHg
Expected HCO₃⁻
HCO₃⁻ = 24 − 5·1.4 = 17 mmol/L
Answer
HCO₃⁻ = 17 mmol/L
4.Arterial blood gas interpretation
Answer: A–a gradient = 29.98 mmHg
Derived values: calculated serum osmolality is 2·Na⁺ + glucose + urea with all values in mmol/L (2·Na⁺ + glucose/18 + BUN/2.8 with glucose and BUN in mg/dL); normal is about 275–295 mOsm/kg. The P/F ratio is PaO₂ divided by FiO₂ as a fraction. The alveolar oxygen pressure is PAO₂ = FiO₂·(760 − 47) − PaCO₂/0.8 mmHg at sea level, and the A–a gradient is PAO₂ − PaO₂.
In late adulthood people review their lives. A sense of meaning brings integrity, while regret can lead to despair. Reminiscence can support this stage.
Answer
A · Integrity versus despair
6.Nursing fundamentals
Answer: B · Cheyne–Stokes breathing
Why this is the answer
Cheyne–Stokes breathing is a cyclical rise and fall in depth with periods of apnoea. It is common near the end of life and in severe heart failure or brain injury.
Answer
B · Cheyne–Stokes breathing
7.Nursing math & unit conversions
Answer: h = 73.6 in
Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.
Centimetres to inches
h = 187/2.54 = 73.62 ≈ 73.6 in
Answer
h = 73.6 in
8.Nursing math & unit conversions
Answer: t = 820 min
24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.