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 opens the eyes when spoken to, talks in sentences but is confused and shows as the best motor response: obeys commands. 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). A practice patient is assessed with the Braden scale: sensory perception: no impairment; moisture: rarely moist; activity: bedfast; mobility: very limited; nutrition: probably inadequate; friction and shear: no apparent 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 gas shows PaCO₂ 56 mmHg (7.5 kPa). Use the rule that in chronic respiratory acidosis HCO₃⁻ rises by 3.5 mmol/L for every 10 mmHg that PaCO₂ is above 40, starting from HCO₃⁻ 24 mmol/L, to find the expected HCO₃⁻.
According to Erikson, what is the main developmental task of older adulthood?
AIntegrity versus despair
BTrust versus mistrust
CIdentity versus role confusion
DIndustry versus inferiority
6.Nursing fundamentalsHard
Which simple measure helps reduce the risk of delirium in an older inpatient?
AMaking sure they have their glasses and hearing aids
BKeeping the lights on all night
CLimiting visits from family members
DMoving them to a different bed every night to vary their surroundings
7.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose calculation for an injection gives 7.9697 mL. The rule in this exercise is that volumes of 1 mL or more are rounded to the nearest tenth of a mL. What value x do you record?
7.9697 mL
x = mL
8.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion delivers 1.5 mg/h. Express this dose rate D in mcg/min. Round to one decimal place.
1.5 mg/h1 mg = 1000 mcg1 h = 60 min
D = mcg/min
3Solutions
1.Clinical assessment scores
Answer: mild
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: opens the eyes when spoken to → 3
V: talks in sentences but is confused → 4
M: obeys commands → 6
Add
GCS = 3 + 4 + 6 = 13
Severity
GCS 13 → mild
Answer
mild
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: rarely moist → 4
activity: bedfast → 1
mobility: very limited → 2
nutrition: probably inadequate → 2
friction and shear: no apparent problem → 3
Add
Braden total = 4 + 4 + 1 + 2 + 2 + 3 = 16
Risk level
16 → mild risk
Answer
mild risk
3.Arterial blood gas interpretation
Answer: HCO₃⁻ = 29.6 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
|56 − 40| = 16 mmHg → 1.6 × 10 mmHg
Expected HCO₃⁻
HCO₃⁻ = 24 + 3.5·1.6 = 29.6 mmol/L
Answer
HCO₃⁻ = 29.6 mmol/L
4.Arterial blood gas interpretation
Answer: AGc = 22 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.
Anion gap
AG = 134 − (104 + 10) = 20
Correction for albumin
20 + 0.25·(40 − 32) = 22 mmol/L
Answer
AGc = 22 mmol/L
Above about 12 after correction: a high anion gap.
5.Nursing fundamentals
Answer: A · Integrity versus despair
Why this is the answer
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: A · Making sure they have their glasses and hearing aids
Why this is the answer
Sensory aids, orientation, good sleep, hydration, mobility and family involvement all help prevent delirium. Frequent moves and poor sleep make it more likely.
Answer
A · Making sure they have their glasses and hearing aids
7.Nursing math & unit conversions
Answer: x = 8 mL
Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.
Digit in the tenths place
7.9697 → 9
Only the next digit decides
7.9697 → 6
6 is 5 or more, so round 9 up.
The digits after it (97) are ignored: round once, never step by step.
Round
x = 8 mL
Answer
x = 8 mL
8.Nursing math & unit conversions
Answer: D = 25 mcg/min
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.