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
Why are many modern wound dressings designed to keep the wound moist?
AMoisture kills all bacteria in the wound
BDry wounds never become infected
CMoist dressings never need changing
DA moist environment supports faster healing
2.Nursing fundamentalsHard
Which nursing diagnosis is written in the problem–aetiology–signs (PES) format?
ATurn the patient every two hours to protect the skin
BPain related to pain, as shown by the patient saying that it hurts a lot
CPneumonia related to a bacterial infection in the right lung
DImpaired skin integrity related to immobility, as shown by a sacral wound
3.Infection control & patient safetyMedium
A patient with a respiratory infection has a raised procalcitonin level. What does this most suggest?
ADehydration from poor intake
BA bacterial rather than a viral infection
CA purely viral illness
DAn allergic reaction to a recent medication
4.Infection control & patient safetyHard
A patient with suspected pertussis needs to stay in a shared bay because no single room is free. What is the most appropriate arrangement while infection control is contacted?
AUse airborne precautions with an N95 respirator for everyone
BPlace the patient next to an immunocompromised patient
CCurtains drawn, over 1 meter (3 feet) of space, masks for close contact
DUse no precautions at all until a single room becomes free
5.Prioritization & delegationMedium
A nurse asks a nursing assistant to use a mechanical lift. The assistant says they have never been trained to use it. Which right of delegation would be violated if the nurse insisted?
ARight directions and communication
BRight person
CRight supervision and evaluation
DRight task
6.Prioritization & delegationHard
A patient had sudden difficulty speaking 45 minutes ago. Which action has the highest priority?
AWait until the neurologist can assess the patient on the morning ward round
BGive aspirin by mouth straight away to limit the clot
CActivate the stroke team for urgent imaging, noting when last known well
DGive water so the patient can take the usual morning medicines
7.Clinical nursingMedium
A patient with sickle cell disease is admitted with a painful crisis. What is a key early nursing priority?
ARestricting oral fluids
BGiving prompt, effective analgesia
CDelaying pain relief until a diagnosis is confirmed
DApplying cold packs to the painful areas
8.Clinical nursingHard
Which finding suggests hypocalcaemia?
ASevere thirst with a large urine output and constipation
BA slow, irregular pulse with nausea and yellow-tinged vision
CA flapping tremor of the outstretched hands
DSpasm of the hand when a blood pressure cuff is inflated on the arm
9.Lab values & electrolytesMedium
A patient with sepsis has a lactate of 2.1 mmol/L on admission and 4.3 mmol/L two hours later, despite IV fluids. What does this suggest?
AExpected muscle activity from shivering in fever
BA normal response to IV fluids in the first hours
CWorsening tissue perfusion that needs urgent reporting
DImproving circulation as the fluids start to work
10.Lab values & electrolytesHard
The nurse prepares a patient for a 2-hour oral glucose tolerance test tomorrow morning. Which statement shows a need for further teaching?
A"I'll avoid smoking until the test is over"
B"I'll fast overnight but can drink plain water"
C"I can have a light breakfast before the test"
D"I'll stay seated during the test if I can"
11.PharmacologyMedium
Which teaching about antiepileptic drugs is most important?
ADo not stop the drug suddenly, as this can trigger severe seizures
BAlcohol has no effect on seizure control
CStop the drug when you have had no seizures for one whole week
DTake a double dose if you feel a seizure coming
12.PharmacologyHard
Why is pyridoxine (vitamin B6) often given together with isoniazid for tuberculosis?
ATo reduce bacterial resistance
BTo prevent liver damage from isoniazid
CTo prevent peripheral neuropathy
DTo increase the absorption of isoniazid
13.Med-surg: cardiovascular & respiratoryMedium
Why is a beta-blocker started at a low dose and increased slowly in heart failure?
AIt works only if the dose is never changed after the first day
BIt can briefly worsen symptoms before long-term benefit appears
CIt is safe only at the highest possible dose from the very start
DIt must be stopped as soon as symptoms improve
14.Med-surg: cardiovascular & respiratoryHard
Ten days after cardiac surgery, a patient has a fever, a red sternal wound with discharge and a clicking feeling in the chest when coughing. What should the nurse suspect?
ASternal wound infection with an unstable sternum
BPericarditis from the operation
CNormal wound healing with some expected discharge
DCostochondritis caused by forceful coughing
15.Med-surg: neuro, endocrine & renalMedium
Which statement about hyperosmolar hyperglycaemic state (HHS) is correct?
AIt mainly affects older people with type 2 diabetes, over days
BIt develops within minutes and is less dangerous than DKA
CIt always causes high blood ketones and a severe metabolic acidosis
DIt is seen mainly in young children with type 1 diabetes
16.Med-surg: neuro, endocrine & renalHard
Which nursing care is important for a patient receiving mannitol for raised intracranial pressure?
AGiving the drug orally with meals to reduce nausea
BClamping the catheter to keep fluid in the body
CClose monitoring of urine output, sodium and osmolality
DStopping the fluid balance chart during treatment
17.Med-surg: GI, perioperative & oncologyMedium
Which nursing care helps a new skin graft take?
AKeeping the area still and avoiding shearing forces
BEncouraging the patient to exercise the area straight away
CRemoving the dressing every hour to look at it
DMassaging the graft firmly several times a day
18.Med-surg: GI, perioperative & oncologyHard
A patient with three fractured ribs is taking shallow breaths because of pain. Why is effective analgesia a priority?
AShallow breathing can lead to atelectasis and pneumonia
BGood analgesia makes rib fractures heal fully within a few days
CPain relief is only needed for the patient's comfort
DRib pain always means the heart is damaged
19.Maternity & obstetric nursingMedium
A woman whose first language is not English is in labour. Which action best ensures informed consent for a caesarean?
AAsk her 10-year-old child to interpret
BUse a professional interpreter
CAsk her partner to sign for her
DUse gestures and simple English only
20.Maternity & obstetric nursingHard
A woman at 26 weeks receiving terbutaline for preterm contractions has a heart rate of 132/min and chest tightness. What should the nurse do?
AGive the next dose early to stop contractions
BIncrease her IV fluids rapidly to lower her heart rate
CWithhold the next dose and report the findings
DReassure her that this is expected and continue
21.Pediatric nursingMedium
What is the main purpose of medical play with a doll and real equipment before surgery?
ATo teach the child how the surgeons will do the operation
BTo keep the child busy so the nurse can do other work
CTo test the child's intelligence
DTo let the child express fears and gain a sense of control
22.Pediatric nursingHard
A toddler swallowed a button battery 30 minutes ago and seems well. What is the correct action?
AMake the toddler vomit
BArrange immediate transfer to emergency care for imaging and removal
CWait for the battery to pass naturally and check the nappies for several days
DGive a glass of milk and observe at home
23.Mental health nursingMedium
A 7-year-old with autism is admitted to a children's ward. Which nursing action is most helpful?
AKeep to his usual routines where possible and prepare him for any changes
BAvoid his parents' advice, because staff know best how to care for him
CChange his daily routine often, to help him get used to change
DPut him in a busy bay with lots of noise and activity to keep him stimulated
24.Mental health nursingHard
A patient says, "My boss didn't say hello this morning, so she must think I'm useless." Which cognitive distortion is shown, and what is a helpful nursing response?
AAll-or-nothing thinking; agree that the boss is being unfair
BPersonalisation; advise the patient to ask for a new manager
CCatastrophising; tell the patient that she will definitely not be fired
DMind reading; ask what other reasons there might be for the boss's behaviour
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A newborn weighs 4 lb 6 oz. Using 1 lb = 16 oz and 1 kg = 2.2 lb, find the weight m in kilograms. Round to two decimal places.
4 lb 6 oz1 lb = 16 oz1 kg = 2.2 lb
m = kg
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 21:25 and finishes at 00:50 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.
21:2500:50
t = h
27.Dosage calculationsMedium
A patient weighs 15 kg and is prescribed 10 mg/kg as a single dose. Find the dose D in mg.
15 kg10 mg/kg
D = mg
28.Dosage calculationsHard
A patient is 173 cm tall and weighs 90 kg. The prescription is 60 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.
173 cm90 kg60 mg/m²
D = mg
29.IV infusion ratesMedium
Infuse 500 mL over 10 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
500 mL10 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 25 gtt/min through a set of 15 gtt/mL. There are 200 mL left in the bag. How many hours t until it is empty?
25 gtt/min15 gtt/mL200 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 patient weighs 92 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 125 mL/h. At 06:00, 250 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL250 mL infused125 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 4, with E2 and V1. What motor score M was recorded, and which response does it describe? Give the number.
GCS 4E2V1
M =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 72 kg and is 164 cm tall. Calculate the BMI and click the WHO weight category.
72 kg164 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
3Solutions
1.Nursing fundamentals
Answer: D · A moist environment supports faster healing
Why this is the answer
Moist wound healing helps epithelial cells migrate and reduces scab formation and pain. The dressing should still manage excess exudate to protect the surrounding skin.
Answer
D · A moist environment supports faster healing
2.Nursing fundamentals
Answer: D · 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
D · Impaired skin integrity related to immobility, as shown by a sacral wound
3.Infection control & patient safety
Answer: B · A bacterial rather than a viral infection
Why this is the answer
Procalcitonin rises mainly in bacterial infections and much less in viral ones. It is used with clinical judgement to help decide when antibiotics are needed or can be stopped.
Answer
B · A bacterial rather than a viral infection
4.Infection control & patient safety
Answer: C · Curtains drawn, over 1 meter (3 feet) of space, masks for close contact
Why this is the answer
Droplet precautions focus on distance, masks and barriers. A single room is preferred, so infection control is contacted. Placing the patient near a vulnerable patient would be dangerous.
Answer
C · Curtains drawn, over 1 meter (3 feet) of space, masks for close contact
5.Prioritization & delegation
Answer: B · Right person
Why this is the answer
Right person means the delegate has the training and competence for the task. Using a lift is normally a delegable task, but not to someone who has not been trained. The nurse should arrange training or do the task with help.
Answer
B · Right person
6.Prioritization & delegation
Answer: C · Activate the stroke team for urgent imaging, noting when last known well
Why this is the answer
Thrombolysis is time-dependent and needs imaging first to rule out a bleed. The time last known well decides eligibility. Aspirin is not given before imaging, and nothing is given by mouth until swallowing has been screened.
Answer
C · Activate the stroke team for urgent imaging, noting when last known well
7.Clinical nursing
Answer: B · Giving prompt, effective analgesia
Why this is the answer
A sickle cell crisis needs rapid analgesia, often opioids, within a short target time, plus hydration, oxygen if hypoxic, warmth and monitoring for complications. Cold can trigger more sickling.
Answer
B · Giving prompt, effective analgesia
8.Clinical nursing
Answer: D · Spasm of the hand when a blood pressure cuff is inflated on the arm
Why this is the answer
Trousseau's sign, carpal spasm during cuff inflation, and Chvostek's sign, facial twitching on tapping the facial nerve, indicate neuromuscular irritability from low calcium.
Answer
D · Spasm of the hand when a blood pressure cuff is inflated on the arm
9.Lab values & electrolytes
Answer: C · Worsening tissue perfusion that needs urgent reporting
Why this is the answer
A rising lactate despite fluids suggests ongoing tissue hypoperfusion and worsening sepsis or septic shock. The nurse reports it at once; further fluids, vasopressors and source control may be needed, and lactate is remeasured.Checked against:Lactate Test · MedlinePlus (NIH) (2024); Septic shock · MedlinePlus (NIH) (2025)
Answer
C · Worsening tissue perfusion that needs urgent reporting
10.Lab values & electrolytes
Answer: C · "I can have a light breakfast before the test"
Why this is the answer
The OGTT is done after an overnight fast of at least 8 hours; water is allowed. Eating before the test makes the results invalid. Patients rest during the test and avoid smoking, which can affect glucose.Checked against:Blood Glucose Test · MedlinePlus (NIH) (2024); Glucose tolerance test - non-pregnant · MedlinePlus (NIH) (2025)
Answer
C · "I can have a light breakfast before the test"
11.Pharmacology
Answer: A · Do not stop the drug suddenly, as this can trigger severe seizures
Why this is the answer
Abrupt withdrawal of antiepileptic drugs can cause rebound seizures and even status epilepticus. Any change is made gradually under medical supervision.
Answer
A · Do not stop the drug suddenly, as this can trigger severe seizures
12.Pharmacology
Answer: C · To prevent peripheral neuropathy
Why this is the answer
Isoniazid causes pyridoxine deficiency, which can lead to peripheral neuropathy. The risk is greater in slow acetylators, malnourished patients and people with diabetes or alcohol dependence.
Answer
C · To prevent peripheral neuropathy
13.Med-surg: cardiovascular & respiratory
Answer: B · It can briefly worsen symptoms before long-term benefit appears
Why this is the answer
Beta-blockers improve survival in heart failure with reduced ejection fraction, but they can cause tiredness, low blood pressure, bradycardia and fluid retention when first started. They are therefore started low and increased gradually in stable patients, with monitoring of weight, pulse and BP.
Answer
B · It can briefly worsen symptoms before long-term benefit appears
14.Med-surg: cardiovascular & respiratory
Answer: A · Sternal wound infection with an unstable sternum
Why this is the answer
Deep sternal wound infection and sternal dehiscence are serious complications, more common with diabetes, obesity and COPD. Signs include fever, wound discharge, redness and an unstable or clicking sternum. Urgent surgical review, wound swabs, blood cultures and antibiotics are needed.
Answer
A · Sternal wound infection with an unstable sternum
15.Med-surg: neuro, endocrine & renal
Answer: A · It mainly affects older people with type 2 diabetes, over days
Why this is the answer
HHS develops over days, often triggered by infection, with extreme hyperglycaemia, very high osmolality and profound dehydration, frequently with confusion. Enough insulin is present to prevent marked ketosis. Mortality is higher than in DKA, and there is a high risk of thrombosis.
Answer
A · It mainly affects older people with type 2 diabetes, over days
16.Med-surg: neuro, endocrine & renal
Answer: C · Close monitoring of urine output, sodium and osmolality
Why this is the answer
Mannitol draws water out of the brain into the blood and is excreted by the kidneys, causing a large diuresis. Monitoring for dehydration, hypotension, electrolyte disturbance and high osmolality is required, and a urinary catheter is usually needed.
Answer
C · Close monitoring of urine output, sodium and osmolality
17.Med-surg: GI, perioperative & oncology
Answer: A · 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
A · Keeping the area still and avoiding shearing forces
18.Med-surg: GI, perioperative & oncology
Answer: A · Shallow breathing can lead to atelectasis and pneumonia
Why this is the answer
Uncontrolled chest wall pain prevents deep breaths and coughing, leading to atelectasis, sputum retention and pneumonia, particularly in older adults. Multimodal analgesia, sometimes with regional blocks, and physiotherapy are used.
Answer
A · Shallow breathing can lead to atelectasis and pneumonia
19.Maternity & obstetric nursing
Answer: B · Use a professional interpreter
Why this is the answer
Professional interpreters ensure accurate, confidential communication. Children and family members may not translate accurately and should not be used for consent. The woman herself must give consent if she has capacity.
Answer
B · Use a professional interpreter
20.Maternity & obstetric nursing
Answer: C · Withhold the next dose and report the findings
Why this is the answer
Terbutaline can cause maternal tachycardia, palpitations, chest pain, pulmonary oedema and hyperglycaemia, so it is used only short term. A maternal heart rate above about 120/min or chest pain means the drug should be held and the provider informed.
Answer
C · Withhold the next dose and report the findings
21.Pediatric nursing
Answer: D · To let the child express fears and gain a sense of control
Why this is the answer
Therapeutic or medical play lets children explore equipment, act out procedures and show feelings they cannot put into words. It reduces anxiety and helps staff correct misunderstandings.
Answer
D · To let the child express fears and gain a sense of control
22.Pediatric nursing
Answer: B · Arrange immediate transfer to emergency care for imaging and removal
Why this is the answer
Button batteries in the oesophagus can cause severe burns within 2 hours. Even a well-looking child needs urgent X-ray and, if the battery is in the oesophagus, endoscopic removal.
Answer
B · Arrange immediate transfer to emergency care for imaging and removal
23.Mental health nursing
Answer: A · Keep to his usual routines where possible and prepare him for any changes
Why this is the answer
Predictability reduces distress. Nurses keep routines, use clear and concrete language, reduce sensory stimulation, use visual supports and work closely with the parents, who know the child best.
Answer
A · Keep to his usual routines where possible and prepare him for any changes
24.Mental health nursing
Answer: D · Mind reading; ask what other reasons there might be for the boss's behaviour
Why this is the answer
Mind reading is assuming others' thoughts without evidence. Exploring alternative explanations, such as the boss being busy, helps the patient test the thought and reduce distress.
Answer
D · Mind reading; ask what other reasons there might be for the boss's behaviour
25.Nursing math & unit conversions
Answer: m = 1.99 kg
Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.
Ounces to pounds
6 oz/16 = 0.375 lb
4 + 0.375 = 4.375 lb
Pounds to kilograms
m = 4.375/2.2 = 1.989 ≈ 1.99 kg
Answer
m = 1.99 kg
26.Nursing math & unit conversions
Answer: t = 3.42 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
21:25 → 24:00 = 155 min
After midnight
00:00 → 00:50 = 50 min
Total
155 + 50 = 205 min
t = 205/60 = 3.417 ≈ 3.42 h
Answer
t = 3.42 h
27.Dosage calculations
Answer: D = 150 mg
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.
Dose
10·15 = 150 mg
Answer
D = 150 mg
28.Dosage calculations
Answer: D = 124.8 mg
Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).
Body surface area
BSA = √(173·90/3600) = √4.325 = 2.08 m²
Dose
D = 60·2.08 = 124.8 mg
Answer
D = 124.8 mg
29.IV infusion rates
Answer: R = 13 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.
Time in minutes
10·60 = 600 min
Drip rate
R = 500·15/600 = 12.5 ≈ 13 gtt/min
Answer
R = 13 gtt/min
At the bedside you round to the nearest whole drop: 13 gtt/min.
30.IV infusion rates
Answer: t = 2 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
25·60/15 = 100 mL/h
Time left
t = 200/100 = 2 h
Answer
t = 2 h
31.IV fluids & fluid balance
Answer: U = 1.19 mL/kg/h
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.
Total urine
425 + 175 + 275 = 875 mL
Per kilogram per hour
U = 875/(92·8) = 1.189 ≈ 1.19 mL/kg/h
Answer
U = 1.19 mL/kg/h
32.IV fluids & fluid balance
Answer: t = 6 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
1000 − 250 = 750 mL
Time
t = 750/125 = 6 h
Answer
t = 6 h
That is about 6 h 00 min, so the bag runs out at about 12:00.
33.Clinical assessment scores
Answer: M = 1
Glasgow Coma Scale: add the best response in three areas. Eye opening E: 4 spontaneous, 3 to sound or speech, 2 to pressure, 1 none. Verbal V: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Motor M: 6 obeys commands, 5 localises, 4 normal flexion (withdraws), 3 abnormal flexion, 2 extension, 1 none. The total runs from 3 to 15. After a head injury, 13–15 is usually called mild, 9–12 moderate and 3–8 severe.
Motor score
M = 4 − 2 − 1 = 1
M1: no movement at all
Answer
M = 1
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 = 72/1.64² = 26.77
Category
overweight
Answer
overweight
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