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). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 16/min, SpO₂ 99% on supplemental oxygen, blood pressure 112/68 mmHg, pulse 104/min, alert, temperature 36.9 °C. What is the NEWS2 total score?
RR 16SpO₂ 99%O₂SBP 112HR 104AT 36.9 °C
NEWS2 =
2.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). At 5 minutes after birth, a practice newborn has a pink body with blue hands and feet, a heart rate of 80/min, a grimace when stimulated, some flexion of the arms and legs and no breathing. Score the APGAR and click how the score is interpreted.
1reassuring
2moderately abnormal
3low
3.Arterial blood gas interpretationMedium
A practice arterial blood gas shows pH 7.44, PaCO₂ 55 mmHg (7.3 kPa) and HCO₃⁻ 36 mmol/L. The primary disorder is metabolic alkalosis. How far is it compensated? Click your answer.
pH 7.44PaCO₂ 55 mmHg (7.3 kPa)HCO₃⁻ 36 mmol/L
1uncompensated
2partially compensated
3fully compensated
4.Arterial blood gas interpretationHard
A practice gas shows a metabolic acidosis: pH 7.05, PaCO₂ 34 mmHg (4.5 kPa), HCO₃⁻ 9 mmol/L. Compare the measured PaCO₂ with Winter’s formula. Click your interpretation.
pH 7.05PaCO₂ 34 mmHg (4.5 kPa)HCO₃⁻ 9 mmol/L
1appropriate compensation
2added respiratory acidosis
3added respiratory alkalosis
5.Nursing fundamentalsMedium
During a manual blood pressure measurement in an adult, which point is usually recorded as the diastolic pressure?
AWhen the sounds become loudest
BWhen the first clear tapping sound is heard
CWhen the cuff is fully deflated
DWhen the sounds disappear completely
6.Nursing fundamentalsHard
A small fire starts in a patient's room. What is the first action?
ATry to put out the fire with water
BGo and find the fire safety officer to ask what should be done
COpen the windows to let out the smoke
DMove the patient away from immediate danger
7.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 01:30 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.
01:30
112:30 AM
23:30 AM
31:30 AM
41:30 PM
8.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An order reads 2 mcg/kg/min for a patient who weighs 108 kg. Express the dose rate D in mg/h. Round to two decimal places.
2 mcg/kg/min108 kg
D = mg/h
3Solutions
1.Clinical assessment scores
Answer: NEWS2 = 3
NEWS2 (National Early Warning Score 2, Royal College of Physicians 2017): score each of the seven parameters with the chart (respiration rate, SpO₂ on scale 1, air or supplemental oxygen, systolic blood pressure, pulse, consciousness on the ACVPU scale and temperature) and add the scores. Clinical risk: 0–4 low; a score of 3 in any single parameter low–medium; 5–6 medium; 7 or more high. A total of 5 or more needs an urgent response.
Score each parameter
RR 16/min → 0
SpO₂ 99% → 0
on oxygen → 2
SBP 112 mmHg → 0
HR 104/min → 1
alert (A) → 0
T 36.9 °C → 0
Add
NEWS2 = 0 + 0 + 2 + 0 + 1 + 0 + 0 = 3
Answer
NEWS2 = 3
2.Clinical assessment scores
Answer: moderately abnormal
APGAR score: five signs, each scored 0, 1 or 2, checked at 1 and 5 minutes after birth. Appearance (colour): blue or pale 0, pink body with blue extremities 1, pink all over 2. Pulse: absent 0, below 100/min 1, 100/min or more 2. Grimace (reflex irritability): none 0, grimace 1, cry, cough or sneeze 2. Activity (tone): limp 0, some flexion 1, active movement 2. Respiration: absent 0, slow or irregular with a weak cry 1, good with a strong cry 2. A total of 7–10 is reassuring, 4–6 moderately abnormal and 0–3 low.
Score each sign
Appearance: a pink body with blue hands and feet → 1
Pulse: 80/min → 1
Grimace: a grimace when stimulated → 1
Activity: some flexion of the arms and legs → 1
Respiration: no breathing → 0
Add
APGAR = 1 + 1 + 1 + 1 + 0 = 4
Interpretation
4 → moderately abnormal
Answer
moderately abnormal
Below 7 at 5 minutes, the score is usually repeated every 5 minutes up to 20 minutes.
3.Arterial blood gas interpretation
Answer: fully compensated
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 7.44: within 7.35–7.45
PaCO₂ 55 mmHg: high (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 55 mmHg points to an additional respiratory acidosis (a mixed disorder). The answer above is the ROME exam classification.
fully compensated
Answer
fully compensated
4.Arterial blood gas interpretation
Answer: added respiratory acidosis
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 PaCO₂
1.5·9 + 8 = 21.5 → 19.5–23.5 mmHg
Compare
measured: 34 mmHg → added respiratory acidosis
Answer
added respiratory acidosis
5.Nursing fundamentals
Answer: D · When the sounds disappear completely
Why this is the answer
The first clear sound marks the systolic pressure; in adults the point at which the sounds disappear (phase 5) is recorded as diastolic.
Answer
D · When the sounds disappear completely
6.Nursing fundamentals
Answer: D · Move the patient away from immediate danger
Why this is the answer
The first priority is to rescue anyone in immediate danger, then raise the alarm, contain the fire by closing doors and only then try to extinguish it if safe. Opening windows feeds a fire with oxygen.
Answer
D · Move the patient away from immediate danger
7.Nursing math & unit conversions
Answer: 1:30 AM
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.
Convert the hour
01 → 1 AM
Answer
1:30 AM
Answer
1:30 AM
8.Nursing math & unit conversions
Answer: D = 12.96 mg/h
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.
Set up the chain
D = 2 mcg/kg/min × 108 kg × (60 min/1 h) × (1 mg/1000 mcg)