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 patient tells the nurse about abuse and asks them to keep it a secret. What should the nurse say?
AThat they cannot promise secrecy if someone is at risk of harm
BThat they will tell everyone on the ward so the patient is safe
CThat they promise to keep it secret, so the patient keeps trusting them
DThat they cannot listen to this and the patient should tell a doctor
2.Nursing fundamentalsHard
Which nursing diagnosis is written in the problem–aetiology–signs (PES) format?
APneumonia related to a bacterial infection in the right lung
BImpaired skin integrity related to immobility, as shown by a sacral wound
CPain related to pain, as shown by the patient saying that it hurts a lot
DTurn the patient every two hours to protect the skin
3.Infection control & patient safetyMedium
A nurse is preparing medications for two patients. What is the safest approach?
APrepare both patients’ medications together to save time
BPrepare and give medications for one patient at a time
CPut both patients’ medications in one cup and sort them at the bedside
DAsk one patient to pass the medications to the other
4.Infection control & patient safetyHard
A patient with dementia is often found at the exit doors trying to leave the unit. Which measure is most appropriate?
AGive a sedative each time the patient goes to the door
BUse an electronic wander alert, supervise closely and offer meaningful activity
CLock the patient alone in a single room so that they cannot reach the exit doors
DKeep the patient in a chair with a vest restraint
5.Prioritization & delegationMedium
A nurse takes a telephone order from a provider. What must the nurse do?
AWrite the order down and read it back to the provider to confirm it
BAsk the ward clerk to take the order on the nurse’s behalf instead
CRemember the order and write it in the chart at the end of the shift
DCarry out the order first and ask the provider to confirm it later
6.Prioritization & delegationHard
A patient with diabetes is sweaty and confused, and no glucose meter is available. The patient can swallow. What should the nurse do?
ATreat for hypoglycemia with fast-acting oral carbohydrate
BGive a dose of rapid-acting insulin in case the glucose is high
CWithhold all food and fluids until a meter is found
DAsk the patient to lie down and sleep it off
7.Clinical nursingMedium
Which instruction is correct for taking weekly alendronic acid (alendronate)?
ATake it with an antacid to protect the stomach
BChew the tablet with breakfast and a cup of milky tea
CTake it with plain water on an empty stomach and stay upright for 30 minutes
DTake it with a glass of milk at bedtime and then lie down straight away
8.Clinical nursingHard
A patient with long-standing COPD has an arterial blood gas with pH 7.37, a raised PaCO2 and a raised bicarbonate. How is this best described?
AMixed metabolic and respiratory alkalosis
BCompensated respiratory acidosis
CUncompensated metabolic alkalosis
DAcute respiratory acidosis
9.Lab values & electrolytesMedium
Which technique is recommended for a capillary blood glucose test on an adult's finger?
APrick the side of the fingertip
BPrick the center of the fingertip
CUse the same finger every time
DSqueeze the finger very hard
10.Lab values & electrolytesHard
A patient on IV gentamicin has a trough level above the target, and the creatinine has risen since yesterday. The next dose is due. What is the best action?
AHold the dose and report the results to the prescriber
BGive the dose with extra oral fluids to protect the kidneys
CGive half of the dose and document the reason for it
DGive the dose now and recheck the levels next week
11.PharmacologyMedium
Benzathine benzylpenicillin (penicillin G benzathine) is ordered. Which route is correct?
AIntravenous push
BIntravenous infusion over 30 minutes
CDeep intramuscular only
DSubcutaneous in the abdomen
12.PharmacologyHard
Why are oral liquid medicines drawn up in dedicated oral or enteral syringes that do not fit IV connectors?
ABecause IV syringes cannot hold liquids
BTo prevent oral liquids being given intravenously by mistake
CTo keep the medicine sterile for injection
DTo make the oral dose more accurate than a dose given through an IV syringe
13.Med-surg: cardiovascular & respiratoryMedium
Why is a shock for cardioversion synchronised with the QRS complex?
ATo keep the pads from burning the skin
BTo avoid delivering the shock during the T wave
CTo make the shock less painful for the patient
DTo allow the use of a lower battery charge
14.Med-surg: cardiovascular & respiratoryHard
A patient with pneumonia has a heart rate of 118/min, BP 86/50 mmHg, RR 28/min and a high lactate. Sepsis is recognised. Which action should not be delayed?
ATake blood cultures and give IV antibiotics within the first hour
BGive oral antibiotics and reassess the next day
CWait for the sputum culture result before choosing an antibiotic
DDelay fluids until a chest X-ray has been reported
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
BA routine at the same time each day, often after a meal
CRestricting fluids to reduce the volume of stool
DAvoiding fibre to prevent bloating
16.Med-surg: neuro, endocrine & renalHard
A patient on continuous overnight enteral feeding receives insulin timed to the feed. At 02:00 the tube blocks and the feed stops. What is the main risk, and what should the nurse do?
AKetoacidosis; stop all insulin until the morning
BHypoglycaemia; check glucose often and follow the plan for glucose cover
CNo risk; the insulin will simply be stored until feeding restarts
DHyperglycaemia; give an extra dose of insulin straight away
17.Med-surg: GI, perioperative & oncologyMedium
Why is the time a surgical limb tourniquet is inflated carefully recorded?
AThe surgeon is paid per minute of use
BThe tourniquet slowly loses all its air after one minute
CLong inflation can cause nerve and muscle damage
DIt shows how long the anaesthetic gas was used
18.Med-surg: GI, perioperative & oncologyHard
Why is an SGLT2 inhibitor such as dapagliflozin usually withheld before surgery?
AIt raises the risk of ketoacidosis, even with near-normal glucose
BIt interacts with all general anaesthetic gases and stops them working
CIt makes the patient's potassium dangerously high
DIt causes the surgical wound to bleed more
19.Maternity & obstetric nursingMedium
A woman in labour has severe back pain with each contraction. The fetus is in an occiput posterior position. Which measure is most likely to help?
ASacral counterpressure and a hands-and-knees position
BLying flat on her back with her legs raised
CAvoiding movement until full dilation
DHolding her breath and pushing with each contraction
20.Maternity & obstetric nursingHard
A breastfeeding mother has a hard, tender lump in one breast without fever. She feels well. What is the most likely cause and the best advice?
AMastitis; stop feeding from that breast
BA blocked duct; keep feeding and vary positions
CA breast abscess; stop breastfeeding completely
DBreast cancer; stop breastfeeding at once
21.Pediatric nursingMedium
A child with type 1 diabetes is unconscious from hypoglycaemia at school. What should be done?
AGive glucagon and call emergency services
BGive the child's usual dose of insulin
CGive a glass of orange juice by mouth
DLet the child sleep and check again in an hour
22.Pediatric nursingHard
After surgery, a 4-year-old lies very still, grimaces, has tense legs and moans. The FLACC score is 8. What should the nurse do?
ADistract the child with a game or video and give nothing else unless the child asks
BAssume the child is tired and leave them to sleep
CWait until the child asks for pain relief
DGive the prescribed analgesia and reassess the pain after it has had time to work
23.Mental health nursingMedium
A 19-year-old has just started an antidepressant. What should the nurse monitor especially closely in the first weeks?
AChanges in eye colour
BNew or worsening suicidal thoughts or behaviour
CRapid weight gain
DHair loss
24.Mental health nursingHard
A patient is pacing, has clenched fists and is shouting at staff. What is the most appropriate first approach?
ARestrain the patient immediately
BTurn your back and ignore the behaviour
CStand close to the patient and raise your voice so that you clearly take control of the situation
DUse calm verbal de-escalation, keep a safe distance and make sure both of you have an exit
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 7:55 PM. Which entry is the same time on the 24-hour clock? Click it.
7:55 PM
119:55
207:55
318:55
420:55
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 20:10 and finishes at 03:20 the next morning (24-hour clock). How many minutes t did it run?
20:1003:20
t = min
27.Dosage calculationsMedium
A child weighing 24 kg is prescribed 10 mg/kg of a drug. The stock solution contains 40 mg/mL. Draw up the dose: what volume V do you give?
24 kg10 mg/kg40 mg/mL
V = mL
28.Dosage calculationsHard
The prescription is 940 units of a drug that comes as 1000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
940 units1000 units/mL
V = mL
29.IV infusion ratesMedium
500 mL was ordered over 6 hours. After 3 hours you find that 320 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 / 6 hafter 3 h: 320 mL
R = mL/h
30.IV infusion ratesHard
A bag contains 500 mg of a drug in 50 mL and runs at 8 mL/h. How many milligrams per hour D does the patient receive?
500 mg/50 mL8 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 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL.
water: 150 mLsoup: 180 mLjuice: 200 mLIV infusion: 50 mL/h × 8 hIV antibiotic: 2 × 100 mL
I = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 11:00 at 80 mL/h. After 4 hours the rate is changed to 200 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
500 mL80 mL/h · 4 h200 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 20/min, SpO₂ 98% on room air, blood pressure 118/70 mmHg, pulse 114/min, alert, temperature 37.7 °C. What is the NEWS2 total score?
RR 20SpO₂ 98%airSBP 118HR 114AT 37.7 °C
NEWS2 =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 95 kg and is 176 cm tall. Calculate the BMI and click the WHO weight category.
95 kg176 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
3Solutions
1.Nursing fundamentals
Answer: A · That they cannot promise secrecy if someone is at risk of harm
Why this is the answer
Nurses must not promise secrecy when there is a risk of harm. They listen, stay calm, explain what will happen, record the disclosure and follow safeguarding procedures.
Answer
A · That they cannot promise secrecy if someone is at risk of harm
2.Nursing fundamentals
Answer: B · Impaired skin integrity related to immobility, as shown by a sacral wound
Why this is the answer
A PES statement gives the nursing problem, the related cause and the defining signs. Pneumonia is a medical diagnosis, turning is an intervention, and a cause cannot repeat the problem.
Answer
B · Impaired skin integrity related to immobility, as shown by a sacral wound
3.Infection control & patient safety
Answer: B · Prepare and give medications for one patient at a time
Why this is the answer
Preparing, checking and giving medications for one patient at a time, at the bedside, reduces wrong-patient errors. Mixing medicines makes errors more likely.
Answer
B · Prepare and give medications for one patient at a time
4.Infection control & patient safety
Answer: B · Use an electronic wander alert, supervise closely and offer meaningful activity
Why this is the answer
Wander alert systems, close supervision, orientation and activity reduce the risk of elopement without restricting the patient. Seclusion, restraints and sedation used for convenience are not appropriate.
Answer
B · Use an electronic wander alert, supervise closely and offer meaningful activity
5.Prioritization & delegation
Answer: A · Write the order down and read it back to the provider to confirm it
Why this is the answer
For telephone and verbal orders, the nurse writes down the full order and reads it back so the provider can confirm it. This “read-back” prevents errors from mishearing.
Answer
A · Write the order down and read it back to the provider to confirm it
6.Prioritization & delegation
Answer: A · Treat for hypoglycemia with fast-acting oral carbohydrate
Why this is the answer
When in doubt, treat as hypoglycemia. A little sugar will not harm a patient with high glucose, but untreated hypoglycemia can cause brain injury within minutes, and insulin could be fatal.
Answer
A · Treat for hypoglycemia with fast-acting oral carbohydrate
7.Clinical nursing
Answer: C · Take it with plain water on an empty stomach and stay upright for 30 minutes
Why this is the answer
Alendronic acid must be taken with plain water before food, and the patient must stay upright to reduce oesophageal irritation. Food, milk and antacids reduce absorption.
Answer
C · Take it with plain water on an empty stomach and stay upright for 30 minutes
8.Clinical nursing
Answer: B · Compensated respiratory acidosis
Why this is the answer
Chronic CO2 retention is offset by the kidneys retaining bicarbonate, bringing the pH back to normal. A normal pH with high PaCO2 and high bicarbonate is a compensated respiratory acidosis.
Answer
B · Compensated respiratory acidosis
9.Lab values & electrolytes
Answer: A · Prick the side of the fingertip
Why this is the answer
The sides of the fingertips are less sensitive than the pads, so they are used for capillary sampling. Rotating sites reduces soreness, and hard squeezing can add tissue fluid that gives inaccurate results.
Answer
A · Prick the side of the fingertip
10.Lab values & electrolytes
Answer: A · Hold the dose and report the results to the prescriber
Why this is the answer
A high aminoglycoside trough with rising creatinine means the drug is accumulating, which increases the risk of kidney damage and hearing loss. The nurse holds the dose, reports to the prescriber and asks about hearing changes and tinnitus. Only the prescriber or pharmacist changes the regimen.Checked against:Gentamicin sulfate injection - Boxed Warning (US prescribing information) · Pfizer Medical Information (FDA label)
Answer
A · Hold the dose and report the results to the prescriber
11.Pharmacology
Answer: C · Deep intramuscular only
Why this is the answer
Benzathine penicillin is a depot suspension given deep IM. Accidental intravenous injection can cause cardiorespiratory arrest and death.
Answer
C · Deep intramuscular only
12.Pharmacology
Answer: B · To prevent oral liquids being given intravenously by mistake
Why this is the answer
Wrong-route errors, such as giving an oral liquid IV, can be fatal. Syringes with connectors that cannot fit IV lines make this error physically difficult.
Answer
B · To prevent oral liquids being given intravenously by mistake
13.Med-surg: cardiovascular & respiratory
Answer: B · To avoid delivering the shock during the T wave
Why this is the answer
A shock delivered on the T wave (the vulnerable period) can trigger ventricular fibrillation. Synchronisation times the shock to the R wave. In ventricular fibrillation there is no organised QRS, so defibrillation is unsynchronised.
Answer
B · To avoid delivering the shock during the T wave
14.Med-surg: cardiovascular & respiratory
Answer: A · Take blood cultures and give IV antibiotics within the first hour
Why this is the answer
In sepsis with shock, blood cultures, IV antibiotics within the first hour, IV fluids, lactate measurement, oxygen if hypoxic and urine output monitoring are started together. Cultures should not delay antibiotics. Persistent hypotension may need vasopressors in critical care.
Answer
A · Take blood cultures and give IV antibiotics within the first hour
15.Med-surg: neuro, endocrine & renal
Answer: B · 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
B · A routine at the same time each day, often after a meal
16.Med-surg: neuro, endocrine & renal
Answer: B · Hypoglycaemia; check glucose often and follow the plan for glucose cover
Why this is the answer
If a feed stops while insulin given to cover it is still acting, the patient can become hypoglycaemic. The nurse checks glucose frequently, informs the team, restores feeding if possible and follows the prescribed plan (for example IV glucose) until feeding restarts. Basal insulin is not simply stopped in type 1 diabetes.
Answer
B · Hypoglycaemia; check glucose often and follow the plan for glucose cover
17.Med-surg: GI, perioperative & oncology
Answer: C · Long inflation can cause nerve and muscle damage
Why this is the answer
A tourniquet creates a bloodless field but causes limb ischaemia. Inflation time and pressure are recorded and the surgeon is told at set intervals, as long inflation can damage nerves and muscle.
Answer
C · Long inflation can cause nerve and muscle damage
18.Med-surg: GI, perioperative & oncology
Answer: A · It raises the risk of ketoacidosis, even with near-normal glucose
Why this is the answer
SGLT2 inhibitors can cause euglycaemic diabetic ketoacidosis around fasting and surgery. They are usually paused before surgery as advised, and ketones are checked if the patient becomes unwell.
Answer
A · It raises the risk of ketoacidosis, even with near-normal glucose
19.Maternity & obstetric nursing
Answer: A · Sacral counterpressure and a hands-and-knees position
Why this is the answer
In occiput posterior positions the fetal head presses on the sacrum. Counterpressure on the lower back and positions such as hands-and-knees or leaning forward ease pain and may help the head rotate.
Answer
A · Sacral counterpressure and a hands-and-knees position
20.Maternity & obstetric nursing
Answer: B · A blocked duct; keep feeding and vary positions
Why this is the answer
A tender lump without fever usually means a blocked duct. Frequent feeding, varied positions and gentle care help clear it. Fever, redness and flu-like symptoms suggest mastitis, which also usually allows continued feeding.
Answer
B · A blocked duct; keep feeding and vary positions
21.Pediatric nursing
Answer: A · Give glucagon and call emergency services
Why this is the answer
An unconscious child cannot swallow safely, so glucagon is given by injection or nasal spray, the child is placed in the recovery position and emergency help is called. Once awake and able to swallow, carbohydrate is given.
Answer
A · Give glucagon and call emergency services
22.Pediatric nursing
Answer: D · Give the prescribed analgesia and reassess the pain after it has had time to work
Why this is the answer
A FLACC score of 7–10 indicates severe pain. Treat with prescribed analgesia, use comfort measures as well and reassess at the right time to check the effect.
Answer
D · Give the prescribed analgesia and reassess the pain after it has had time to work
23.Mental health nursing
Answer: B · New or worsening suicidal thoughts or behaviour
Why this is the answer
In children and young adults, antidepressants can increase suicidal thinking early in treatment. Close monitoring is needed, especially in the first weeks and after dose changes.
Answer
B · New or worsening suicidal thoughts or behaviour
24.Mental health nursing
Answer: D · 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
D · Use calm verbal de-escalation, keep a safe distance and make sure both of you have an exit
25.Nursing math & unit conversions
Answer: 19:55
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
7 PM → 7 + 12 = 19
Answer
19:55
Answer
19:55
26.Nursing math & unit conversions
Answer: t = 430 min
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
20:10 → 24:00 = 230 min
After midnight
00:00 → 03:20 = 200 min
Total
t = 230 + 200 = 430 min
Answer
t = 430 min
27.Dosage calculations
Answer: V = 6 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 = 10·24 = 240 mg
Volume
V = 240/40 = 6 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 6 mL
28.Dosage calculations
Answer: V = 0.94 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 = 940/1000 = 0.94 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.94 mL
29.IV infusion rates
Answer: R = 106.7 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
500/6 = 83.33 mL/h
New rate
R = 320/3 = 106.7 mL/h
Answer
R = 106.7 mL/h
This is more than a 25% increase: most hospitals require you to contact the prescriber instead of catching up, and to assess the patient for fluid overload.
30.IV infusion rates
Answer: D = 80 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
500/50 = 10 mg/mL
Dose rate
D = 10·8 = 80 mg/h
Answer
D = 80 mg/h
31.IV fluids & fluid balance
Answer: I = 1130 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 + 180 + 200 = 530 mL
IV infusion: 50·8 = 400 mL
IV antibiotic: 2·100 = 200 mL
I = 1130 mL
Answer
I = 1130 mL
32.IV fluids & fluid balance
Answer: t = 4.9 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.
First part
80·4 = 320 mL
500 − 320 = 180 mL left
Second part
180/200 = 0.9 h
Total time
t = 4 + 0.9 = 4.9 h
Answer
t = 4.9 h
That is about 4 h 54 min, so the bag runs out at about 15:54.
33.Clinical assessment scores
Answer: NEWS2 = 2
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 20/min → 0
SpO₂ 98% → 0
on air → 0
SBP 118 mmHg → 0
HR 114/min → 2
alert (A) → 0
T 37.7 °C → 0
Add
NEWS2 = 0 + 0 + 0 + 0 + 2 + 0 + 0 = 2
Answer
NEWS2 = 2
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 = 95/1.76² = 30.67
Category
obesity class I
Answer
obesity class I
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