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
A smoker says, "I know I should stop, and I'm thinking about it some time in the next few months." Which stage of change is this?
APrecontemplation
BContemplation
CPreparation
DMaintenance
2.Nursing fundamentalsHard
A patient opens their eyes only to pain, makes incomprehensible sounds and withdraws from a painful stimulus. What is the Glasgow Coma Scale score?
A8
B6
C11
D9
3.Infection control & patient safetyMedium
A patient with diabetes will use lancets and insulin needles at home. Which teaching about disposal is correct?
APut them loose in the household trash bag, as long as the bag is tied shut
BFlush the used lancets and needles down the toilet
CRecap each needle with two hands before putting it in the kitchen trash
DPut them in a puncture-resistant container with a lid and follow local disposal rules
4.Infection control & patient safetyHard
A patient’s WBC is 4,000/mm3, with 30% neutrophils and 5% bands. What is the absolute neutrophil count (ANC)?
A1,400/mm3
B1,200/mm3
C140/mm3
D3,500/mm3
5.Prioritization & delegationMedium
Before giving a medication to a child, which check is especially important?
AThat the parent agrees with the time it is given
BThat the child likes the taste of the drug
CThat the medicine cup is the child’s favorite color
DThat the dose is correct for the child’s weight
6.Prioritization & delegationHard
An 85-year-old resident becomes newly confused and is falling, but has no fever. Which cause should the nurse consider first?
AA sudden worsening of long-standing dementia that needs no tests
BBoredom from not having enough activities
CAn infection, such as a urinary tract infection, presenting atypically
DNormal aging that needs no assessment
7.Clinical nursingMedium
Which is a recognised risk factor for postoperative nausea and vomiting?
ABeing a smoker
BA short operation under local anaesthetic
CUse of opioids after surgery
DBeing male
8.Clinical nursingHard
Why can sepsis be missed in older adults?
ABlood tests are not useful in older people
BOlder adults cannot develop sepsis because their immune system is weaker
CThey may have no fever and present with confusion, falls or reduced mobility
DOlder adults always have a very high fever
9.Lab values & electrolytesMedium
A patient's potassium is unexpectedly 5.8 mEq/L. The sample was taken after the tourniquet was on for several minutes while the patient pumped their fist. What is the best interpretation?
AThe result confirms true hyperkalemia and needs no further checking
BThe result may be falsely high and should be repeated with better technique
CTourniquet time affects only the glucose result, not the potassium
DFist pumping lowers potassium, so the true level is even higher
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?
AReassure the patient that dark urine is a harmless drug effect
BContinue the isoniazid and give it with food to settle the stomach
CDouble the dose to finish the treatment course more quickly
DHold the isoniazid and report the findings to the prescriber at once
11.PharmacologyMedium
A partial agonist is given together with a high dose of a full agonist. What happens to the response?
AIt doubles, because both drugs activate the receptor
BIt rises above the maximum of the full agonist
CIt falls, because the partial agonist competes for the receptors
DIt stays exactly the same as with the high dose of full agonist alone
12.PharmacologyHard
A patient taking sertraline starts St John's wort for low mood. What is the main concern?
ASevere low blood pressure from blocked alpha receptors
BBleeding from vitamin K deficiency
CA hypertensive crisis from tyramine
DSerotonin syndrome from combined serotonergic effects
13.Med-surg: cardiovascular & respiratoryMedium
Suspected pulmonary TB is being investigated. How are sputum samples usually collected?
ASeveral samples, ideally including early-morning sputum
BA single sample after the first week of treatment
CA swab from the nose only
DOne sample of saliva collected at any time of the day
14.Med-surg: cardiovascular & respiratoryHard
A patient with COPD on a 28% Venturi mask (SpO₂ 90%) wants to eat a meal. What is the most appropriate plan?
ARemove all oxygen during the meal and replace it afterwards
BSwitch to nasal cannula at low flow, keeping SpO₂ at 88–92%
CChange to a non-rebreather mask at 15 L/min during the meal
DKeep the Venturi mask on and give only liquids through a straw
15.Med-surg: neuro, endocrine & renalMedium
After transsphenoidal pituitary surgery, which advice should the patient follow?
ALie completely flat for at least a week after surgery
BAvoid blowing the nose, straining and bending forward
CDrink through a straw to keep the nose clean
DBlow the nose often to clear any clots
16.Med-surg: neuro, endocrine & renalHard
A nurse teaches a patient about peritoneal dialysis. Which statement shows a need for further teaching?
A"If the fluid is cloudy, I'll see if it clears next time."
B"I will wash my hands carefully before each exchange."
C"I will check my exit site every day."
D"I will weigh myself daily and record my fluid balance."
17.Med-surg: GI, perioperative & oncologyMedium
Which nursing care helps a new skin graft take?
ARemoving the dressing every hour to look at it
BMassaging the graft firmly several times a day
CKeeping the area still and avoiding shearing forces
DEncouraging the patient to exercise the area straight away
18.Med-surg: GI, perioperative & oncologyHard
A sacral wound has heavy exudate, and the surrounding skin is white, soft and wrinkled. What should the nurse do?
AUse a dressing that adds even more moisture
BProtect the skin edges and use a more absorbent dressing
CApply a tight plastic film directly over the wound
DLeave the same dressing in place for a week so the wound is not disturbed
19.Maternity & obstetric nursingMedium
Which measure helps prevent infant abduction from a maternity unit?
AChecking staff ID before handing over a baby
BLetting any visitor carry the baby in the corridor
CPosting the baby's name and room on the door
DLeaving babies in the nursery overnight
20.Maternity & obstetric nursingHard
A woman at 12 weeks has light bleeding and mild cramping. The cervix is closed and fetal heart activity is seen on ultrasound. How is this classified?
AThreatened miscarriage
BIncomplete miscarriage
CInevitable miscarriage
DMissed miscarriage
21.Pediatric nursingMedium
A medicine is prescribed at 10 mg/kg. The child weighs 18 kg and the liquid contains 120 mg in 5 mL. What volume should be given?
A1.5 mL
B3.75 mL
C15 mL
D7.5 mL
22.Pediatric nursingHard
Only one negative-pressure room is available. Which child should be placed in it?
AA child with RSV bronchiolitis
BA child with suspected measles
CA child with norovirus gastroenteritis and vomiting
DA child with impetigo
23.Mental health nursingMedium
A 78-year-old woman who started citalopram two weeks ago is newly confused and drowsy. Which laboratory result would best explain this?
AA low serum cholesterol
BA low serum sodium
CA high serum potassium
DA high haemoglobin
24.Mental health nursingHard
A patient is found unresponsive with a respiratory rate of 6/min and pinpoint pupils. What should the nurse do first?
AGive flumazenil
BPlace the patient in the recovery position and wait for the patient to wake up naturally before calling anyone
CCall for help, open the airway and support breathing, and give naloxone as prescribed or per protocol
DGive a large glass of water
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 95.1 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.
95.1 °F
T = °C
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 23:45 and finishes at 06:30 the next morning (24-hour clock). How many hours t did it run? Give the answer in hours as a decimal, rounded to two decimal places.
23:4506:30
t = h
27.Dosage calculationsMedium
A child weighing 15 kg is prescribed 4 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?
15 kg4 mg/kg50 mg/mL
V = mL
28.Dosage calculationsHard
The prescription is 4300 units of a drug that comes as 10000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
4300 units10000 units/mL
V = mL
29.IV infusion ratesMedium
An infusion is ordered at 200 mL/h, but no pump is available. It runs by gravity through a giving set of 15 gtt/mL. Find the drip rate R in drops per minute.
200 mL/h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 20 gtt/min through a set of 20 gtt/mL. There are 750 mL left in the bag. How many hours t until it is empty?
20 gtt/min20 gtt/mL750 mL
t = 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 8-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.
tea: 150 mLjelly: 120 mLice chips: 240 mLIV infusion: 50 mL/h × 8 hIV antibiotic: 2 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 60 mL/h. At 17:30, 50 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL50 mL infused60 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: no; ambulatory aid: none, bed rest or nurse assists; IV therapy or saline lock: yes; gait: normal, bed rest or wheelchair; mental status: overestimates or forgets limits. Find the Morse total MFS.
0–125
MFS =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 84 kg and is 157 cm tall. Calculate the BMI and click the WHO weight category.
84 kg157 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
3Solutions
1.Nursing fundamentals
Answer: B · Contemplation
Why this is the answer
In the stages-of-change model, contemplation means considering change within about six months without a firm plan. Precontemplation means not thinking about change yet.
Answer
B · Contemplation
2.Nursing fundamentals
Answer: A · 8
Why this is the answer
Eyes to pain score 2, incomprehensible sounds score 2 and withdrawal from pain scores 4, giving 8. A GCS of 8 or less suggests the patient may not be able to protect their airway.
Answer
A · 8
3.Infection control & patient safety
Answer: D · Put them in a puncture-resistant container with a lid and follow local disposal rules
Why this is the answer
Home sharps go into a puncture-resistant container, such as an approved sharps container or a rigid plastic bottle if local rules allow, which is closed and disposed of according to local guidance.
Answer
D · Put them in a puncture-resistant container with a lid and follow local disposal rules
4.Infection control & patient safety
Answer: A · 1,400/mm3
Why this is the answer
ANC = 4,000 × (0.30 + 0.05) = 1,400/mm3. This is below normal (neutropenia), so the patient has a raised risk of infection.
Answer
A · 1,400/mm3
5.Prioritization & delegation
Answer: D · That the dose is correct for the child’s weight
Why this is the answer
Pediatric doses are usually calculated by weight, and errors can cause serious harm. The nurse checks the dose against the child’s weight and the safe range before giving it.
Answer
D · That the dose is correct for the child’s weight
6.Prioritization & delegation
Answer: C · An infection, such as a urinary tract infection, presenting atypically
Why this is the answer
Older adults often present with confusion or falls rather than fever when they have an infection. New confusion is a change that needs assessment for causes such as infection, dehydration or medication.
Answer
C · An infection, such as a urinary tract infection, presenting atypically
7.Clinical nursing
Answer: C · Use of opioids after surgery
Why this is the answer
Known risk factors include opioids, female sex, being a non-smoker, previous PONV or motion sickness and longer general anaesthetics. High-risk patients may be given preventive antiemetics.
Answer
C · Use of opioids after surgery
8.Clinical nursing
Answer: C · They may have no fever and present with confusion, falls or reduced mobility
Why this is the answer
Older people may have a normal or low temperature and present with delirium, falls or general decline. Early warning scores and a high index of suspicion are important.
Answer
C · They may have no fever and present with confusion, falls or reduced mobility
9.Lab values & electrolytes
Answer: B · The result may be falsely high and should be repeated with better technique
Why this is the answer
Repeated fist clenching and a long tourniquet time release potassium from muscle and can cause hemolysis, both of which give a falsely high potassium. The patient is assessed and the test is repeated with correct technique; true hyperkalemia must not be missed.Checked against:Potassium Blood Test · MedlinePlus (NIH) (2024); Potassium test · MedlinePlus (NIH) (2025)
Answer
B · The result may be falsely high and should be repeated with better technique
10.Lab values & electrolytes
Answer: D · 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
D · Hold the isoniazid and report the findings to the prescriber at once
11.Pharmacology
Answer: C · It falls, because the partial agonist competes for the receptors
Why this is the answer
A partial agonist has lower efficacy. When it displaces a full agonist from receptors, the total response drops. Buprenorphine can precipitate withdrawal in people using full opioid agonists for this reason.
Answer
C · It falls, because the partial agonist competes for the receptors
12.Pharmacology
Answer: D · Serotonin syndrome from combined serotonergic effects
Why this is the answer
St John's wort has serotonergic effects, so it can cause serotonin syndrome with SSRIs. It also induces liver enzymes and can reduce levels of drugs such as the combined pill, warfarin and ciclosporin.
Answer
D · Serotonin syndrome from combined serotonergic effects
13.Med-surg: cardiovascular & respiratory
Answer: A · Several samples, ideally including early-morning sputum
Why this is the answer
Usually three sputum samples, including an early-morning sample, are sent for smear microscopy, culture and molecular testing. Deep coughed sputum, not saliva, is needed. Samples are collected before treatment where possible and in a way that limits exposure to others.
Answer
A · Several samples, ideally including early-morning sputum
14.Med-surg: cardiovascular & respiratory
Answer: B · Switch to nasal cannula at low flow, keeping SpO₂ at 88–92%
Why this is the answer
Oxygen is prescribed to a target range and should not be stopped for meals in a patient who needs it. Nasal cannulae allow eating and talking; the flow (for example 1–2 L/min) is titrated to keep the saturation in the target range. High-concentration oxygen risks hypercapnia.
Answer
B · Switch to nasal cannula at low flow, keeping SpO₂ at 88–92%
15.Med-surg: neuro, endocrine & renal
Answer: B · Avoid blowing the nose, straining and bending forward
Why this is the answer
Raised pressure in the head can open the repair and cause a CSF leak. Patients avoid nose blowing, straining, coughing hard and bending forward, and sneeze with the mouth open. Straws may also be avoided.
Answer
B · Avoid blowing the nose, straining and bending forward
16.Med-surg: neuro, endocrine & renal
Answer: A · "If the fluid is cloudy, I'll see if it clears next time."
Why this is the answer
Cloudy effluent may be the first sign of peritonitis and must be reported to the PD unit straight away, keeping the bag for testing. Waiting can allow a serious infection to develop.
Answer
A · "If the fluid is cloudy, I'll see if it clears next time."
17.Med-surg: GI, perioperative & oncology
Answer: C · Keeping the area still and avoiding shearing forces
Why this is the answer
Grafts need close contact with the wound bed to gain a new blood supply. Immobilisation, careful dressings and avoiding friction, shearing and collections under the graft help it take.
Answer
C · Keeping the area still and avoiding shearing forces
18.Med-surg: GI, perioperative & oncology
Answer: B · Protect the skin edges and use a more absorbent dressing
Why this is the answer
Maceration shows that exudate is not being managed. A barrier film or cream protects the surrounding skin, and a more absorbent dressing or more frequent changes are used. The cause of high exudate is reviewed.
Answer
B · Protect the skin edges and use a more absorbent dressing
19.Maternity & obstetric nursing
Answer: A · Checking staff ID before handing over a baby
Why this is the answer
Matching ID bands, checking staff identification and teaching parents to hand their baby only to identified staff are key. Information about the baby should not be displayed publicly.
Answer
A · Checking staff ID before handing over a baby
20.Maternity & obstetric nursing
Answer: A · Threatened miscarriage
Why this is the answer
Bleeding with a closed cervix and a viable pregnancy is a threatened miscarriage; many continue normally. An open cervix means an inevitable or incomplete miscarriage, and a missed miscarriage has no fetal heart activity.
Answer
A · Threatened miscarriage
21.Pediatric nursing
Answer: D · 7.5 mL
Why this is the answer
Dose = 10 mg × 18 kg = 180 mg. Volume = 180 ÷ 120 × 5 mL = 7.5 mL. Calculations for children are checked carefully, often by a second nurse.
Answer
D · 7.5 mL
22.Pediatric nursing
Answer: B · A child with suspected measles
Why this is the answer
Negative-pressure rooms are for airborne infections such as measles, chickenpox and tuberculosis. RSV mainly needs contact (and often droplet) precautions, impetigo contact precautions and norovirus contact precautions with strict hand hygiene.
Answer
B · A child with suspected measles
23.Mental health nursing
Answer: B · A low serum sodium
Why this is the answer
SSRIs can cause hyponatraemia through SIADH, especially in older adults. Confusion, falls and drowsiness after starting an SSRI should prompt a sodium check.
Answer
B · A low serum sodium
24.Mental health nursing
Answer: C · Call for help, open the airway and support breathing, and give naloxone as prescribed or per protocol
Why this is the answer
Airway and breathing support come first, with naloxone given to reverse opioid effects. The patient is monitored closely because naloxone may wear off before the opioid.
Answer
C · Call for help, open the airway and support breathing, and give naloxone as prescribed or per protocol
25.Nursing math & unit conversions
Answer: T = 35.1 °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
95.1 − 32 = 63.1
Multiply by 5/9
T = 63.1·5/9 = 35.06 ≈ 35.1 °C
Answer
T = 35.1 °C
26.Nursing math & unit conversions
Answer: t = 6.75 h
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.
Before midnight
23:45 → 24:00 = 15 min
After midnight
00:00 → 06:30 = 390 min
Total
15 + 390 = 405 min
t = 405/60 = 6.75 h
Answer
t = 6.75 h
27.Dosage calculations
Answer: V = 1.2 mL
Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.
Dose from body weight
D = 4·15 = 60 mg
Volume
V = 60/50 = 1.2 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 1.2 mL
28.Dosage calculations
Answer: V = 0.43 mL
Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.
Volume
V = 4300/10000 = 0.43 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.43 mL
29.IV infusion rates
Answer: R = 50 gtt/min
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.
Millilitres per minute
200/60 = 3.333 mL/min
Drip rate
R = 3.333·15 = 50 gtt/min
Answer
R = 50 gtt/min
30.IV infusion rates
Answer: t = 12.5 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.
Rate in mL/h
20·60/20 = 60 mL/h
Time left
t = 750/60 = 12.5 h
Answer
t = 12.5 h
31.IV fluids & fluid balance
Answer: I = 890 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: 150 + 120 = 270 mL
ice chips: 240/2 = 120 mL
IV infusion: 50·8 = 400 mL
IV antibiotic: 2·50 = 100 mL
I = 890 mL
Answer
I = 890 mL
32.IV fluids & fluid balance
Answer: t = 7.5 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 − 50 = 450 mL
Time
t = 450/60 = 7.5 h
Answer
t = 7.5 h
That is about 7 h 30 min, so the bag runs out at about 01:00.
33.Clinical assessment scores
Answer: MFS = 35
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: no → 0
ambulatory aid: none, bed rest or nurse assists → 0
IV therapy or saline lock: yes → 20
gait: normal, bed rest or wheelchair → 0
mental status: overestimates or forgets limits → 15
Add
Morse total = 0 + 0 + 0 + 20 + 0 + 15 = 35
Answer
MFS = 35
34.Clinical assessment scores
Answer: obesity class I
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 = 84/1.57² = 34.08
Category
obesity class I
Answer
obesity class I
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