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 chart records GCS 15, with E4 and V5. What motor score M was recorded, and which response does it describe? Give the number.
GCS 15E4V5
M =
2.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: no impairment; moisture: constantly moist; activity: chairfast; mobility: slightly limited; nutrition: adequate; friction and shear: potential problem. Use the bands 19–23 not at risk, 15–18 mild, 13–14 moderate, 10–12 high and 9 or below very high. Click the risk level.
1not at risk
2mild risk
3moderate risk
4high risk
5very high risk
3.Arterial blood gas interpretationMedium
A practice arterial blood gas shows pH 7.59, PaCO₂ 39 mmHg (5.2 kPa) and HCO₃⁻ 36 mmol/L. The primary disorder is metabolic alkalosis. How far is it compensated? Click your answer.
pH 7.59PaCO₂ 39 mmHg (5.2 kPa)HCO₃⁻ 36 mmol/L
1uncompensated
2partially compensated
3fully compensated
4.Arterial blood gas interpretationHard
A practice gas shows a respiratory acidosis: pH 7.32, PaCO₂ 66 mmHg (8.8 kPa), HCO₃⁻ 33 mmol/L. Use the rules ‘HCO₃⁻ rises 1 mmol/L per 10 mmHg (acute) or 3.5 mmol/L per 10 mmHg (chronic)’ to classify it. Click your answer.
pH 7.32PaCO₂ 66 mmHg (8.8 kPa)HCO₃⁻ 33 mmol/L
1acute
2chronic
3acute on chronic
5.Nursing fundamentalsMedium
Where in the eye should eye drops be placed?
ADirectly onto the centre of the cornea
BInto the inner corner of the eye only
CInto the pocket of the lower eyelid
DOnto the upper eyelid while the eye is shut
6.Nursing fundamentalsHard
A patient going home on warfarin has been taught about the drug. Which statement shows a need for further teaching?
A"I'll keep my appointments for blood tests."
B"I'll try to keep the amount of green vegetables I eat steady."
C"I'll report any blood in my urine or black stools."
D"I'll stop eating all green vegetables from now on."
7.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient is 5 ft 9 in tall. Using 1 ft = 12 in and 1 in = 2.54 cm, find the height h in centimetres, to the nearest whole centimetre.
5 ft 9 in1 ft = 12 in1 in = 2.54 cm
h = cm
8.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A prescription reads 1 tbsp of an oral suspension three times a day for 5 days. Using 1 tbsp = 15 mL, how many mL V are needed for the whole course?
1 tbspthree times a day5 days1 tbsp = 15 mL
V = mL
3Solutions
1.Clinical assessment scores
Answer: M = 6
Glasgow Coma Scale: add the best response in three areas. Eye opening E: 4 spontaneous, 3 to sound or speech, 2 to pressure, 1 none. Verbal V: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Motor M: 6 obeys commands, 5 localises, 4 normal flexion (withdraws), 3 abnormal flexion, 2 extension, 1 none. The total runs from 3 to 15. After a head injury, 13–15 is usually called mild, 9–12 moderate and 3–8 severe.
Motor score
M = 15 − 4 − 5 = 6
M6: obeys commands
Answer
M = 6
2.Clinical assessment scores
Answer: mild risk
Braden scale: six subscales for pressure-injury risk. Sensory perception, moisture, activity, mobility and nutrition score 1 to 4, from the worst level (1) to no problem (4); friction and shear scores 1 to 3. The total runs from 6 to 23, and a lower total means a higher risk. Common bands: 19–23 not at risk, 15–18 mild risk, 13–14 moderate risk, 10–12 high risk and 9 or below very high risk.
Score each subscale
sensory perception: no impairment → 4
moisture: constantly moist → 1
activity: chairfast → 2
mobility: slightly limited → 3
nutrition: adequate → 3
friction and shear: potential problem → 2
Add
Braden total = 4 + 1 + 2 + 3 + 3 + 2 = 15
Risk level
15 → mild risk
Answer
mild risk
3.Arterial blood gas interpretation
Answer: uncompensated
Reading a blood gas (ROME): first the pH: below 7.35 is acidaemia, above 7.45 alkalaemia. Then find the value that explains it. PaCO₂ (normal 35–45 mmHg, 4.7–6.0 kPa) is the respiratory part and moves Opposite to the pH in a respiratory disorder; HCO₃⁻ (normal 22–26 mmol/L) is the metabolic part and moves in the same direction as the pH (Respiratory Opposite, Metabolic Equal). The other value shows the compensation: normal means uncompensated; abnormal in the direction that pulls the pH back while the pH is still abnormal means partially compensated; a normal pH with both values abnormal means fully compensated. Ranges differ slightly between laboratories; these are practice values.
ROME, value by value
pH 7.59: alkalaemia (above 7.45)
PaCO₂ 39 mmHg: normal (35–45)
HCO₃⁻ 36 mmol/L: high (22–26)
Compensation
Clinically, also check the expected compensation: for a metabolic alkalosis PaCO₂ ≈ 0.7·HCO₃⁻ + 21 = 44.2–48.2 mmHg, so the measured 39 mmHg points to an additional respiratory alkalosis (a mixed disorder). The answer above is the ROME exam classification.
uncompensated
Answer
uncompensated
4.Arterial blood gas interpretation
Answer: chronic
Expected compensation: in metabolic acidosis Winter’s formula predicts PaCO₂ = 1.5·HCO₃⁻ + 8 ± 2 mmHg; a measured value above that range points to an additional respiratory acidosis, below it to an additional respiratory alkalosis. The anion gap AG = Na⁺ − (Cl⁻ + HCO₃⁻), normally about 8–12 mmol/L, separates high-gap from normal-gap metabolic acidosis; low albumin hides a high gap (add 2.5 per g/dL that albumin is below 4.0). The delta ratio (AG − 12)/(24 − HCO₃⁻) between about 0.8 and 2 fits a pure high-gap acidosis (some texts use 1 instead of 0.8), below that an added normal-gap acidosis, and above 2 an added metabolic alkalosis.
Expected HCO₃⁻
acute: 24 + 1·2.6 = 26.6 mmol/L
chronic: 24 + 3.5·2.6 = 33.1 mmol/L
Compare
measured: 33 mmol/L → chronic
Answer
chronic
5.Nursing fundamentals
Answer: C · Into the pocket of the lower eyelid
Why this is the answer
Drops go into the lower conjunctival sac, which is less sensitive than the cornea. Pressing gently on the inner corner afterwards reduces drainage into the nose.
Answer
C · Into the pocket of the lower eyelid
6.Nursing fundamentals
Answer: D · "I'll stop eating all green vegetables from now on."
Why this is the answer
Vitamin K in green vegetables opposes warfarin, so a stable intake keeps the INR steady. Cutting them out suddenly can make the INR rise; bleeding signs and blood tests are correct points.
Answer
D · "I'll stop eating all green vegetables from now on."
7.Nursing math & unit conversions
Answer: h = 175 cm
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.
Height in inches
5·12 + 9 = 69 in
Inches to centimetres
h = 69·2.54 = 175.3 ≈ 175 cm
Answer
h = 175 cm
8.Nursing math & unit conversions
Answer: V = 225 mL
Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.