Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
Prioritization & delegation
Method
Ask what will harm the patient soonest if nothing is done.
Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
Assess before you act unless it is an emergency; then choose the step the others depend on.
For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.
Lab values & electrolytes
Method
Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
Link the value to its typical signs and to the drugs and conditions that cause it.
Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.
Med-surg: cardiovascular & respiratory
Method
Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
Choose the safe first action, then escalate and reassess.
Med-surg: neuro, endocrine & renal
Method
Check the glucose in every patient with new confusion, weakness or a seizure.
Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.
Med-surg: GI, perioperative & oncology
Method
Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.
Maternity & obstetric nursing
Method
Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.
Pediatric nursing
Method
Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
Match the action to the development stage and involve the family.
Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.
Mental health nursing
Method
Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
Respect rights: the least restrictive option, consent and confidentiality with its limits.
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
falls 25, diagnosis 15, aid 15/30, IV 20, gait 10/20, mental status 15
NEWS2 risk
0–4 low; single 3 low–medium; 5–6 medium; ≥ 7 high
Mean arterial pressure
MAP = (SBP + 2·DBP)/3 = DBP + PP/3
Pulse pressure and shock index
PP = SBP − DBP, SI = HR/SBP
Body mass index
BMI = kg/m² = 703·lb/in²
Method
Find the score sheet that the question uses and its range (GCS 3–15, APGAR 0–10, Braden 6–23, Morse 0–125).
Score every item separately, matching the description to its level.
Add the item scores and check that the total lies inside the range.
Apply the cut-offs: for NEWS2 also look for any single parameter scoring 3.
For derived values use MAP = (SBP + 2·DBP)/3, PP = SBP − DBP, SI = HR/SBP and BMI = kg/m².
2Practice problems
1.Nursing fundamentalsMedium
At what angle is a subcutaneous injection usually given?
AAlways exactly 15 degrees, with the skin stretched flat
B90 degrees after stretching the skin flat
C45 to 90 degrees, depending on the amount of fat
DAlways parallel to the skin
2.Nursing fundamentalsHard
A man skips bowel cancer screening because he feels healthy and thinks cancer will not happen to him. Which Health Belief Model concept best explains this?
AHigh perceived benefits
BLow perceived susceptibility
CHigh self-efficacy
DStrong cues to action
3.Infection control & patient safetyMedium
A patient with delirium is at risk of falls and of pulling out lines. Which option is less restrictive than restraints?
AA trained sitter or video monitoring with staff nearby
BA sedative given every few hours as needed
CFour side rails raised and the door closed so the patient stays in bed
DA vest restraint applied for the whole night
4.Infection control & patient safetyHard
A patient on airborne precautions needs an urgent CT scan. Which plan is correct?
AThe scan is postponed until the patient is no longer infectious
BPatient masked, CT warned in advance, staff in respirators
CPatient goes unmasked, and the CT room is cleaned the next day
DPatient wears an N95 respirator, so staff need no protection
5.Prioritization & delegationMedium
Which patient should the RN see first after receiving a report from the night nurse?
ADay 1 after bowel surgery, new chest pain and heart rate 110/min
BDay 2 after bowel surgery, asking to start a soft diet
CDay 3 after bowel surgery, wants a shower and hair wash before breakfast
DDay 4 after bowel surgery, waiting for discharge teaching
6.Prioritization & delegationHard
A patient suddenly has severe pain in one leg. The leg is pale and cold with no pedal pulse. What does this suggest?
AChronic venous insufficiency that needs elevation
BA deep vein thrombosis that can be treated next week
CAcute arterial occlusion, which is an emergency
DA muscle cramp that will pass with stretching
7.Clinical nursingMedium
Why are patients with atrial fibrillation often given anticoagulants?
ATo lower the blood pressure
BTo reduce the risk of stroke from clots in the atria
CTo convert the rhythm back to normal
DTo slow the heart rate directly and prevent palpitations
8.Clinical nursingHard
A patient faints during cannulation, with a slow pulse and pallor, and recovers quickly when laid flat. There is no rash, wheeze or swelling. What is most likely?
AVasovagal syncope
BAnaphylaxis
CA stroke
DA hypoglycaemic coma
9.Lab values & electrolytesMedium
A healthy woman at 28 weeks of pregnancy has a mildly lower hemoglobin than before pregnancy, with a normal MCV and ferritin. What is the most likely explanation?
APlasma volume rises more than red cell mass, diluting the blood
BIron is being lost through the kidneys during the pregnancy
CPregnancy hormones stop the bone marrow from making red cells
DThe fetus is destroying the mother's red cells in the circulation
10.Lab values & electrolytesHard
A patient taking isoniazid for latent TB reports nausea, loss of appetite and dark urine. The ALT is five times the upper limit of normal. What is the best action?
AHold the isoniazid and report the findings to the prescriber at once
BReassure the patient that dark urine is a harmless drug effect
CContinue the isoniazid and give it with food to settle the stomach
DDouble the dose to finish the treatment course more quickly
11.PharmacologyMedium
A nurse realises that a patient has been given the wrong dose of a medicine. What is the first action?
AWait to see whether the patient notices
BComplete the incident report before anything else
CAssess the patient for effects of the error
DCorrect the chart so it shows the right dose
12.PharmacologyHard
Codeine is converted to morphine by CYP2D6. What happens in a patient who is a CYP2D6 ultra-rapid metaboliser?
ACodeine gives almost no pain relief because little morphine is formed
BCodeine is excreted unchanged in the urine
CCodeine is converted to an inactive compound only
DMore morphine is formed, increasing the risk of opioid toxicity
13.Med-surg: cardiovascular & respiratoryMedium
A patient with hypertension takes amlodipine. Which side effect is the nurse most likely to observe?
AAnkle swelling
BWheeze
CHyperkalaemia
DDry, tickly cough
14.Med-surg: cardiovascular & respiratoryHard
An 84-year-old with heart failure becomes breathless with new crackles and a rising blood pressure during a blood transfusion. What should the nurse suspect?
ATransfusion-associated circulatory overload
BNormal effects of the transfusion
CAn acute haemolytic reaction from wrong blood
DA mild febrile reaction
15.Med-surg: neuro, endocrine & renalMedium
Which action is part of an effective bowel programme after a spinal cord injury?
AUsing strong laxatives only when the bowel has not opened for a week
BAvoiding fibre to prevent bloating
CRestricting fluids to reduce the volume of stool
DA routine at the same time each day, often after a meal
16.Med-surg: neuro, endocrine & renalHard
A kidney transplant recipient has had vomiting and diarrhoea for two days. Why should the transplant team be contacted?
AThe patient may not be absorbing their immunosuppressants
BThe tablets will make the vomiting stop
CThe kidney will start to produce far too much urine
DVomiting proves that rejection has already happened
17.Med-surg: GI, perioperative & oncologyMedium
Which area is used as a quick estimate of 1% of body surface area for small or scattered burns?
AThe patient's palm including the fingers
BThe patient's hand and forearm
CThe patient's thumbnail
DThe examiner's palm including the fingers
18.Med-surg: GI, perioperative & oncologyHard
At the end of an operation, the final count shows one swab missing. What should happen?
ALet the patient leave and search the theatre later
BClose the wound, as the swab was probably thrown away
CTell the surgeon, search, and X-ray if it is not found
DRecord the count as correct to avoid a delay
19.Maternity & obstetric nursingMedium
Parents ask why their baby is having a pulse oximetry check on the right hand and a foot. What is the reason?
ATo measure the baby's blood pressure
BTo screen for critical congenital heart disease
CTo screen for hearing loss
DTo check the baby's blood glucose
20.Maternity & obstetric nursingHard
A woman with postpartum psychosis is being admitted with her baby to a mother and baby unit. Which statement is accurate?
AIt is the same as the baby blues and resolves without treatment
BIt usually begins several months or years after the birth
CIt is an emergency that usually starts within two weeks
DIt only occurs in women who were depressed in pregnancy
21.Pediatric nursingMedium
Which temperature is usually taken as fever in a child?
A38.0 °C (100.4 °F) or higher
B39.5 °C (103.1 °F) or higher
C37.5 °C (99.5 °F) or higher
D37.0 °C (98.6 °F) or higher
22.Pediatric nursingHard
The parents of a 9-year-old who wets the bed most nights have been punishing him. What is the best advice?
AWait, as no help is available until he is a teenager
BStop punishing him, praise dry nights and consider a bedwetting alarm
CWake him every hour through the night and make him change his own sheets
DStop all drinks after lunch and keep him in nappies
23.Mental health nursingMedium
Which activity is most suitable for a patient in an acute manic episode?
AA walk with a staff member
BA long group discussion in the day room
CA complicated board game such as chess with other patients
DA competitive team game of volleyball
24.Mental health nursingHard
A patient is pacing, has clenched fists and is shouting at staff. What is the most appropriate first approach?
ATurn your back and ignore the behaviour
BUse calm verbal de-escalation, keep a safe distance and make sure both of you have an exit
CStand close to the patient and raise your voice so that you clearly take control of the situation
DRestrain the patient immediately
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 98.9 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.
98.9 °F
T = °C
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion delivers 25 mcg/min. Express this dose rate D in mg/h.
25 mcg/min1 h = 60 min1 mg = 1000 mcg
D = mg/h
27.Dosage calculationsMedium
A dose of 50 mg is needed from a 10% (w/v) solution. What volume V contains this dose?
50 mg10% w/v
V = mL
28.Dosage calculationsHard
A patient weighs 193.6 lb. The prescription is 0.5 mg/kg as a single dose, and the stock contains 250 mg in 5 mL. Using 1 kg = 2.2 lb, what volume V do you give?
193.6 lb0.5 mg/kg250 mg/5 mL1 kg = 2.2 lb
V = mL
29.IV infusion ratesMedium
500 mL was ordered over 12 hours. After 10 hours you find that 100 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?
500 mL / 12 hafter 10 h: 100 mL
R = mL/h
30.IV infusion ratesHard
A bag contains 200 mg of a drug in 100 mL and runs at 20 mL/h. How many milligrams per hour D does the patient receive?
200 mg/100 mL20 mL/h
D = mg/h
31.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL. Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 80 mL/h. At 17:30, 250 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL250 mL infused80 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: no; secondary diagnosis: yes; ambulatory aid: none, bed rest or nurse assists; IV therapy or saline lock: no; gait: weak; mental status: knows own limits. Find the Morse total MFS.
0–125
MFS =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 69 kg and is 163 cm tall. Calculate the BMI and click the WHO weight category.
69 kg163 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
3Solutions
1.Nursing fundamentals
Answer: C · 45 to 90 degrees, depending on the amount of fat
Why this is the answer
The angle depends on needle length and body fat. A short needle at 90 degrees suits most adults; in thin patients a pinch of skin or a 45-degree angle avoids reaching muscle.
Answer
C · 45 to 90 degrees, depending on the amount of fat
2.Nursing fundamentals
Answer: B · Low perceived susceptibility
Why this is the answer
In the Health Belief Model, people act when they believe they are susceptible to a serious condition and that action will help. Low perceived susceptibility reduces the chance of screening.
Answer
B · Low perceived susceptibility
3.Infection control & patient safety
Answer: A · A trained sitter or video monitoring with staff nearby
Why this is the answer
Close observation by a sitter or video monitoring allows staff to step in quickly, without restricting the patient. It is often combined with reorientation and family presence.
Answer
A · A trained sitter or video monitoring with staff nearby
4.Infection control & patient safety
Answer: B · Patient masked, CT warned in advance, staff in respirators
Why this is the answer
Urgent tests are not delayed, but the patient wears a surgical mask to contain particles, the route is planned, and the receiving staff are informed so they can protect themselves and other patients.
Answer
B · Patient masked, CT warned in advance, staff in respirators
5.Prioritization & delegation
Answer: A · Day 1 after bowel surgery, new chest pain and heart rate 110/min
Why this is the answer
New chest pain and tachycardia after surgery could be a myocardial infarction or pulmonary embolism. This patient needs immediate assessment; the others have routine needs.
Answer
A · Day 1 after bowel surgery, new chest pain and heart rate 110/min
6.Prioritization & delegation
Answer: C · Acute arterial occlusion, which is an emergency
Why this is the answer
Sudden pain, pallor, coldness and loss of pulse suggest an embolus blocking an artery. The limb can be lost within hours, so the nurse escalates immediately.
Answer
C · Acute arterial occlusion, which is an emergency
7.Clinical nursing
Answer: B · To reduce the risk of stroke from clots in the atria
Why this is the answer
In AF the atria do not contract effectively, so blood can pool and clot, especially in the left atrial appendage. A clot can travel to the brain, so anticoagulation reduces stroke risk.
Answer
B · To reduce the risk of stroke from clots in the atria
8.Clinical nursing
Answer: A · Vasovagal syncope
Why this is the answer
Vasovagal syncope is a reflex drop in heart rate and blood pressure triggered by pain, fear or needles. Anaphylaxis would usually include skin, airway or breathing features and a fast pulse.
Answer
A · Vasovagal syncope
9.Lab values & electrolytes
Answer: A · Plasma volume rises more than red cell mass, diluting the blood
Why this is the answer
In pregnancy, plasma volume increases by more than red cell mass, so the hemoglobin falls slightly (physiologic or dilutional anemia). Iron deficiency is still common in pregnancy and is checked with the MCV and ferritin.Checked against:Anemia · StatPearls (NCBI Bookshelf) (2026)
Answer
A · Plasma volume rises more than red cell mass, diluting the blood
10.Lab values & electrolytes
Answer: A · Hold the isoniazid and report the findings to the prescriber at once
Why this is the answer
Isoniazid can cause hepatitis, which may be severe. Symptoms such as nausea, loss of appetite and dark urine with a markedly raised ALT mean the drug should be held and the prescriber informed. Patients are taught to avoid alcohol and report these symptoms early.
Answer
A · Hold the isoniazid and report the findings to the prescriber at once
11.Pharmacology
Answer: C · Assess the patient for effects of the error
Why this is the answer
The first priority is to assess and monitor the patient, then inform the prescriber so treatment can be given if needed. The error is documented factually and reported through the incident system.
Answer
C · Assess the patient for effects of the error
12.Pharmacology
Answer: D · More morphine is formed, increasing the risk of opioid toxicity
Why this is the answer
Ultra-rapid metabolisers convert more codeine to morphine, which can cause respiratory depression. Poor metabolisers form little morphine and get poor pain relief. This is a classic example of pharmacogenetics.
Answer
D · More morphine is formed, increasing the risk of opioid toxicity
13.Med-surg: cardiovascular & respiratory
Answer: A · Ankle swelling
Why this is the answer
Dihydropyridine calcium channel blockers such as amlodipine dilate arterioles, raising capillary pressure and causing peripheral oedema, flushing and headache. Dry cough is typical of ACE inhibitors, and wheeze of non-selective beta-blockers in asthma.
Answer
A · Ankle swelling
14.Med-surg: cardiovascular & respiratory
Answer: A · Transfusion-associated circulatory overload
Why this is the answer
Transfusion-associated circulatory overload causes breathlessness, crackles, raised BP and JVP during or soon after transfusion, especially in older people and those with heart or kidney disease. The transfusion is stopped or slowed, the patient sat up and given oxygen, and diuretics may be prescribed. Slow rates and single units with reassessment reduce the risk.
Answer
A · Transfusion-associated circulatory overload
15.Med-surg: neuro, endocrine & renal
Answer: D · A routine at the same time each day, often after a meal
Why this is the answer
A regular routine, timed after a meal to use the gastrocolic reflex, plus fluids, fibre and, often, suppositories or digital stimulation, helps prevent constipation and accidents. This also reduces the risk of autonomic dysreflexia.
Answer
D · A routine at the same time each day, often after a meal
16.Med-surg: neuro, endocrine & renal
Answer: A · The patient may not be absorbing their immunosuppressants
Why this is the answer
Vomiting and diarrhoea can reduce absorption of immunosuppressants, raising the risk of rejection, and dehydration can harm the graft. Tacrolimus levels can also rise with diarrhoea. The team may check levels and kidney function.
Answer
A · The patient may not be absorbing their immunosuppressants
17.Med-surg: GI, perioperative & oncology
Answer: A · The patient's palm including the fingers
Why this is the answer
The patient's palm with the fingers together is about 1% of their total body surface area. It is useful for small or patchy burns. Simple erythema (superficial burns) is not included in the total.
Answer
A · The patient's palm including the fingers
18.Med-surg: GI, perioperative & oncology
Answer: C · Tell the surgeon, search, and X-ray if it is not found
Why this is the answer
Any discrepancy is reported immediately, the wound is checked before closure, the area and waste are searched, and an X-ray is taken if the item is not found. The event is documented and reported.
Answer
C · Tell the surgeon, search, and X-ray if it is not found
19.Maternity & obstetric nursing
Answer: B · To screen for critical congenital heart disease
Why this is the answer
Pulse oximetry screening compares oxygen saturation in the right hand (pre-ductal) and a foot (post-ductal). A low reading or a significant difference can indicate critical congenital heart disease.
Answer
B · To screen for critical congenital heart disease
20.Maternity & obstetric nursing
Answer: C · It is an emergency that usually starts within two weeks
Why this is the answer
Postpartum psychosis is rare but serious, typically starting suddenly within the first two weeks with mania, confusion, hallucinations or delusions. Bipolar disorder is a major risk factor. Urgent treatment is needed to keep mother and baby safe.
Answer
C · It is an emergency that usually starts within two weeks
21.Pediatric nursing
Answer: A · 38.0 °C (100.4 °F) or higher
Why this is the answer
A temperature of 38.0 °C (100.4 °F) or higher is generally considered a fever in children. In young infants even a modest fever can signal serious infection and needs prompt assessment.
Answer
A · 38.0 °C (100.4 °F) or higher
22.Pediatric nursing
Answer: B · Stop punishing him, praise dry nights and consider a bedwetting alarm
Why this is the answer
Nocturnal enuresis is common and not deliberate; punishment worsens it. Support, reward systems for agreed behaviours, enuresis alarms and sometimes desmopressin are effective, along with normal daytime drinking and regular toileting.
Answer
B · Stop punishing him, praise dry nights and consider a bedwetting alarm
23.Mental health nursing
Answer: A · A walk with a staff member
Why this is the answer
Solitary, non-competitive physical activity helps release energy safely. Competitive games, large groups and tasks requiring long concentration can increase agitation and conflict.
Answer
A · A walk with a staff member
24.Mental health nursing
Answer: B · Use calm verbal de-escalation, keep a safe distance and make sure both of you have an exit
Why this is the answer
De-escalation uses a calm voice, simple language, active listening and offering choices, while keeping a safe distance and an exit route. Restraint is a last resort if there is imminent danger.
Answer
B · Use calm verbal de-escalation, keep a safe distance and make sure both of you have an exit
25.Nursing math & unit conversions
Answer: T = 37.2 °C
Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.
Subtract 32
98.9 − 32 = 66.9
Multiply by 5/9
T = 66.9·5/9 = 37.17 ≈ 37.2 °C
Answer
T = 37.2 °C
26.Nursing math & unit conversions
Answer: D = 1.5 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 = 25 mcg/min × (60 min/1 h) × (1 mg/1000 mcg)
Calculate
D = 25·60/1000 = 1.5 mg/h
Answer
D = 1.5 mg/h
27.Dosage calculations
Answer: V = 0.5 mL
Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.
Concentration
10% = 100 mg/mL
Volume
V = 50/100 = 0.5 mL
Answer
V = 0.5 mL
28.Dosage calculations
Answer: V = 0.88 mL
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Weight in kg
193.6/2.2 = 88 kg
Dose
0.5·88 = 44 mg
Volume
V = (44/250)·5 = 0.88 mL
Answer
V = 0.88 mL
29.IV infusion rates
Answer: R = 50 mL/h
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Original rate
500/12 = 41.67 mL/h
New rate
R = 100/2 = 50 mL/h
Answer
R = 50 mL/h
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
30.IV infusion rates
Answer: D = 40 mg/h
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Concentration
200/100 = 2 mg/mL
Dose rate
D = 2·20 = 40 mg/h
Answer
D = 40 mg/h
31.IV fluids & fluid balance
Answer: I = 1560 mL
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Add the intake
oral: 200 + 120 + 120 = 440 mL
ice chips: 240/2 = 120 mL
IV infusion: 75·12 = 900 mL
IV antibiotic: 2·50 = 100 mL
I = 1560 mL
Answer
I = 1560 mL
32.IV fluids & fluid balance
Answer: t = 3.1 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Volume left
500 − 250 = 250 mL
Time
t = 250/80 = 3.125 ≈ 3.1 h
Answer
t = 3.1 h
That is about 3 h 08 min, so the bag runs out at about 20:38.
33.Clinical assessment scores
Answer: MFS = 25
Morse fall scale: six items. History of falling: no 0, yes 25. Secondary diagnosis: no 0, yes 15. Ambulatory aid: none, bed rest or nurse assistance 0; crutches, cane or walker 15; holding on to furniture 30. IV therapy or saline lock: no 0, yes 20. Gait: normal, bed rest or wheelchair 0; weak 10; impaired 20. Mental status: knows own limits 0; overestimates or forgets limits 15. The total runs from 0 to 125. Risk cut-offs differ between hospitals; a common set is 0–24 low, 25–44 moderate and 45 or more high.
Score each item
history of falling in the last 3 months: no → 0
secondary diagnosis: yes → 15
ambulatory aid: none, bed rest or nurse assists → 0
IV therapy or saline lock: no → 0
gait: weak → 10
mental status: knows own limits → 0
Add
Morse total = 0 + 15 + 0 + 0 + 10 + 0 = 25
Answer
MFS = 25
34.Clinical assessment scores
Answer: overweight
Body mass index: BMI = weight (kg)/height (m)², with the height converted to metres first. With pounds and inches, BMI = 703 × weight (lb)/height (in)². WHO adult categories: below 18.5 underweight, 18.5–24.9 healthy weight, 25.0–29.9 overweight, 30.0–34.9 obesity class I, 35.0–39.9 obesity class II and 40 or more obesity class III.
BMI
BMI = 69/1.63² = 25.97
Category
overweight
Answer
overweight
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