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
When using a metered-dose inhaler without a spacer, what should the patient do straight after inhaling the dose?
ABreathe out hard through the mouthpiece
BHold their breath for about 10 seconds
CRinse the mouth before breathing in
DTake another dose at once without pausing
2.Nursing fundamentalsHard
A patient with capacity tells the nurse they do not want the operation their family keeps pushing for. What is the nurse's best action?
ASay nothing to avoid a conflict with the family
BSupport the patient to tell the team their wishes
CLet the family decide, as they know the patient best
DTell the patient to follow the family's advice
3.Infection control & patient safetyMedium
A nurse who never had BCG vaccine has a positive tuberculin skin test for the first time. The chest x-ray is clear and there are no symptoms. What does this most likely mean?
ALatent TB infection, which is not contagious
BA failed test that must be repeated next year
CActive TB, which needs airborne isolation
DImmunity to TB from a past exposure
4.Infection control & patient safetyHard
A visitor is receiving an electric shock from a faulty lamp and is still touching it. What should the nurse do first?
ASwitch off the power or unplug the lamp without touching the person
BPull the visitor away from the lamp by the arm as quickly as possible
CThrow water over the lamp to stop the current
DStart chest compressions straight away
5.Prioritization & delegationMedium
A swimmer is found unresponsive after diving into shallow water. Which method should the nurse use to open the airway?
ARaising the chin while bending the neck forward
BJaw thrust, keeping the head and neck in line
CHead-tilt, chin-lift with full neck extension
DTurning the head to the side to drain water
6.Prioritization & delegationHard
A patient with an upper GI bleed has a heart rate of 128/min and a blood pressure of 84/50 mmHg. All of these are prescribed. Which does the nurse start first?
AOral iron tablets
BBooking the diagnostic endoscopy for the next morning
CIV fluid or blood through large-bore cannulas
DAn IV proton pump inhibitor infusion
7.Clinical nursingMedium
A patient receives IV furosemide for fluid overload. Which findings show the treatment is working?
AIncreased urine output, less breathlessness and a falling weight
BFalling urine output, new ankle swelling and a rise in weight
CA rise in weight and more lung crackles
DA rise in blood pressure and a new cough
8.Clinical nursingHard
A patient's blood test shows potassium 6.8 mmol/L and the ECG shows peaked T waves. Which treatment protects the heart most quickly?
AFurosemide tablets the next day
BA low-potassium diet only
CIV calcium gluconate
DOral potassium supplements
9.Lab values & electrolytesMedium
A patient taking a statin reports new, unexplained muscle pain and weakness. Which laboratory test would the nurse expect to be ordered?
ASerum ammonia
BCreatine kinase (CK)
CCardiac troponin
DSerum lipase
10.Lab values & electrolytesHard
An older adult with type 2 diabetes is drowsy and very dehydrated. Glucose 920 mg/dL (51 mmol/L), serum osmolality 350 mOsm/kg, pH 7.36, urine ketones negative or trace. Which condition fits best?
ADiabetic ketoacidosis (DKA)
BMetformin-related lactic acidosis
CHyperosmolar hyperglycemic state (HHS)
DSyndrome of inappropriate ADH (SIADH)
11.PharmacologyMedium
Besides lithium levels, which blood tests are monitored in long-term lithium treatment?
AINR and fibrinogen
BTroponin and CK-MB
CLiver enzymes, serum amylase and lipase
DKidney function and thyroid function
12.PharmacologyHard
A patient starting sertraline is taught about the drug. Which statement shows a need for further teaching?
A"I may have some nausea at first."
B"It may take a few weeks to feel the full effect."
C"I will tell someone if I have thoughts of harming myself."
D"If I feel better after a week, I can stop taking it."
13.Med-surg: cardiovascular & respiratoryMedium
How should a patient breathe in when using a dry powder inhaler?
AQuickly and deeply, after breathing out away from the device
BSlowly and gently over about ten seconds
CThrough the nose with the mouthpiece in the mouth
DSeveral times, breathing out into the device between breaths
14.Med-surg: cardiovascular & respiratoryHard
A nurse teaches a patient who is starting warfarin. Which statement shows a need for further teaching?
A"If I miss a dose, I will take two the next day."
B"I will check before taking any new medicines or herbal remedies."
C"I will have regular INR blood tests."
D"I will tell my dentist that I take warfarin."
15.Med-surg: neuro, endocrine & renalMedium
A patient who has had type 1 diabetes for 30 years says they no longer feel the warning signs of a hypo. What is this called?
AHypoglycaemia unawareness
BDiabetic ketoacidosis
CInsulin resistance
DThe dawn phenomenon
16.Med-surg: neuro, endocrine & renalHard
A patient with hypothyroidism who has missed medication for weeks is admitted hypothermic and drowsy, with a pulse of 46/min, low sodium and a raised PaCO₂. Which condition is most likely?
AHeat stroke
BAdrenal crisis
CMyxoedema coma
DThyroid storm
17.Med-surg: GI, perioperative & oncologyMedium
Which advice may help reduce the risk of a parastomal hernia after stoma surgery?
AStrain hard on the toilet each day to strengthen the abdominal muscles
BDo intensive sit-ups from the first week
CAvoid heavy lifting early on and use support garments as advised
DKeep the stoma bag as full as possible
18.Med-surg: GI, perioperative & oncologyHard
A patient with bowel obstruction develops constant severe pain (no longer colicky), fever, a heart rate of 120/min and a rigid, tender abdomen. What does this suggest?
ANormal progress that only needs regular simple analgesia
BThe obstruction is resolving as the bowel starts to move
CConstipation that should be treated with a stimulant laxative
DStrangulation or perforation needing urgent surgical review
19.Maternity & obstetric nursingMedium
How can a cephalhaematoma be told apart from caput succedaneum?
AA cephalhaematoma is a soft swelling of the scalp skin only
BA cephalhaematoma does not cross the suture lines
CA cephalhaematoma crosses the midline of the skull
DA cephalhaematoma is present at birth and disappears within a few days
20.Maternity & obstetric nursingHard
A multiparous woman arrives with strong contractions and the baby is born within an hour of their onset. What should the nurse monitor closely afterwards?
AUterine tone, bleeding and newborn injury
BOnly the newborn's blood glucose
COnly the mother's temperature
DThe mother's ability to walk alone
21.Pediatric nursingMedium
Using the 100–50–20 rule, what is the daily maintenance fluid requirement for a 15 kg child?
A1000 mL per day
B1500 mL per day
C750 mL per day
D1250 mL per day
22.Pediatric nursingHard
Two children with cystic fibrosis are admitted to the same ward. Which precaution is important?
APut them in the same room so they can support each other
BLet them share airway clearance equipment to save resources
CKeep them apart, not sharing rooms, equipment or play areas
DAsk them to do their daily physiotherapy sessions together in the playroom
23.Mental health nursingMedium
A newly admitted patient asks, "Do you think I'm crazy?" Which response is most therapeutic?
A"Everyone here is a bit crazy in some way, so there's really nothing for you to worry about."
B"You seem worried about what being here means. Can you tell me more?"
C"Yes, but you're in the right place now."
D"Of course not. Only crazy people would ask that."
24.Mental health nursingHard
A patient who is stable on lithium tells the nurse she has started taking ibuprofen every day for back pain. What should the nurse do?
ATell her it is fine, because ibuprofen is sold without a prescription and is safe
BInform the prescriber, because ibuprofen can raise lithium to toxic levels
CAdvise her to double her lithium dose
DTell her to also take a diuretic for the swelling
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A newborn weighs 6 lb 8 oz. Using 1 lb = 16 oz and 1 kg = 2.2 lb, find the weight m in kilograms. Round to two decimal places.
6 lb 8 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 delivers 3 mg/h. Express this dose rate D in mcg/min. Round to one decimal place.
3 mg/h1 mg = 1000 mcg1 h = 60 min
D = mcg/min
27.Dosage calculationsMedium
A child weighing 30 kg is prescribed 2 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?
30 kg2 mg/kg50 mg/mL
V = mL
28.Dosage calculationsHard
A patient weighs 83.6 lb. The prescription is 1 mg/kg as a single dose, and the stock contains 50 mg in 1 mL. Using 1 kg = 2.2 lb, what volume V do you give?
83.6 lb1 mg/kg50 mg/1 mL1 kg = 2.2 lb
V = mL
29.IV infusion ratesMedium
Infuse 500 mL over 2 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 mL2 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 50 gtt/min through a set of 60 gtt/mL. There are 600 mL left in the bag. How many hours t until it is empty?
50 gtt/min60 gtt/mL600 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 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 150 mL/h. At 20:00, 50 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL50 mL infused150 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 12, with E3 and V4. What motor score M was recorded, and which response does it describe? Give the number.
GCS 12E3V4
M =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 12/min, SpO₂ 94% on supplemental oxygen, blood pressure 102/62 mmHg, pulse 110/min, alert, temperature 35.8 °C. Which clinical risk group does the patient fall into? Click it.
RR 12SpO₂ 94%O₂SBP 102HR 110AT 35.8 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: B · Hold their breath for about 10 seconds
Why this is the answer
The patient breathes out, seals the lips round the mouthpiece, presses as they start a slow deep breath in, then holds the breath for about 10 seconds or as long as is comfortable.
Answer
B · Hold their breath for about 10 seconds
2.Nursing fundamentals
Answer: B · Support the patient to tell the team their wishes
Why this is the answer
As an advocate the nurse makes sure the patient's own wishes are heard. A competent adult decides about their treatment, and the family's views do not override this.
Answer
B · Support the patient to tell the team their wishes
3.Infection control & patient safety
Answer: A · Latent TB infection, which is not contagious
Why this is the answer
A positive skin test with no symptoms and a normal chest x-ray suggests latent TB infection. The person cannot spread TB but should be evaluated for treatment to prevent active disease later.
Answer
A · Latent TB infection, which is not contagious
4.Infection control & patient safety
Answer: A · Switch off the power or unplug the lamp without touching the person
Why this is the answer
The rescuer must not touch someone still in contact with live current. The power is switched off or the plug pulled first, then the person is assessed and resuscitation is started if needed.
Answer
A · Switch off the power or unplug the lamp without touching the person
5.Prioritization & delegation
Answer: B · Jaw thrust, keeping the head and neck in line
Why this is the answer
A diving injury may damage the cervical spine. A jaw thrust opens the airway with little neck movement; if it fails, the airway still takes priority.
Answer
B · Jaw thrust, keeping the head and neck in line
6.Prioritization & delegation
Answer: C · IV fluid or blood through large-bore cannulas
Why this is the answer
Tachycardia and hypotension show hypovolemic shock, so restoring the circulating volume comes first, with fluids or blood products as prescribed and close monitoring. Acid suppression and endoscopy follow once resuscitation is under way, and oral iron belongs to later recovery.
Answer
C · IV fluid or blood through large-bore cannulas
7.Clinical nursing
Answer: A · Increased urine output, less breathlessness and a falling weight
Why this is the answer
Effective diuresis increases urine output and reduces congestion, so breathing improves and weight falls. Electrolytes, renal function and blood pressure are also monitored.
Answer
A · Increased urine output, less breathlessness and a falling weight
8.Clinical nursing
Answer: C · IV calcium gluconate
Why this is the answer
IV calcium stabilises the myocardium within minutes. Insulin with glucose then shifts potassium into cells, and other measures remove it from the body.
Answer
C · IV calcium gluconate
9.Lab values & electrolytes
Answer: B · Creatine kinase (CK)
Why this is the answer
Statins can cause myopathy and, rarely, rhabdomyolysis. A raised CK confirms muscle injury, and the provider may stop the statin. The nurse also asks about dark urine, which can signal myoglobin in the urine.Checked against:Creatine Kinase · MedlinePlus (NIH) (2023)
Answer
B · Creatine kinase (CK)
10.Lab values & electrolytes
Answer: C · Hyperosmolar hyperglycemic state (HHS)
Why this is the answer
HHS causes extreme hyperglycemia and high osmolality with severe dehydration, but enough insulin is present to prevent significant ketosis, so the pH is near normal. DKA has ketones and acidosis; SIADH has low osmolality.Checked against:Ketoacidosis · StatPearls (NCBI Bookshelf) (2023); Osmolality blood test · MedlinePlus (NIH) (2025)
Answer
C · Hyperosmolar hyperglycemic state (HHS)
11.Pharmacology
Answer: D · Kidney function and thyroid function
Why this is the answer
Lithium can impair kidney function and cause hypothyroidism. Kidney function, thyroid function and calcium are checked regularly, along with lithium levels.
Answer
D · Kidney function and thyroid function
12.Pharmacology
Answer: D · "If I feel better after a week, I can stop taking it."
Why this is the answer
Antidepressants are continued for months after improvement to prevent relapse, and are tapered when stopped. Early nausea, delayed benefit and monitoring for suicidal thoughts are correct points.
Answer
D · "If I feel better after a week, I can stop taking it."
13.Med-surg: cardiovascular & respiratory
Answer: A · Quickly and deeply, after breathing out away from the device
Why this is the answer
Dry powder inhalers have no propellant, so a fast, deep inhalation is needed to disperse the powder. The patient breathes out away from the device first, because moist breath can clump the powder. Very weak or breathless patients may not manage this.
Answer
A · Quickly and deeply, after breathing out away from the device
14.Med-surg: cardiovascular & respiratory
Answer: A · "If I miss a dose, I will take two the next day."
Why this is the answer
Doubling up after a missed dose can cause over-anticoagulation and bleeding. Patients are usually told to take a missed dose the same day if they remember, or skip it and record it, then seek advice. Regular INR checks, telling other clinicians and checking interactions are correct.
Answer
A · "If I miss a dose, I will take two the next day."
15.Med-surg: neuro, endocrine & renal
Answer: A · Hypoglycaemia unawareness
Why this is the answer
Long duration of diabetes and frequent hypos reduce the adrenaline response, so warning symptoms are lost. This greatly increases the risk of severe hypos. Strict avoidance of hypos for some weeks can partly restore awareness, and glucose sensors with alarms help.
Answer
A · Hypoglycaemia unawareness
16.Med-surg: neuro, endocrine & renal
Answer: C · Myxoedema coma
Why this is the answer
Myxoedema coma presents with reduced consciousness, hypothermia, bradycardia, hypoventilation, hyponatraemia and hypoglycaemia, often triggered by infection or missed treatment. It needs critical care, IV thyroid hormone, steroid cover until adrenal insufficiency is excluded, passive rewarming and great care with sedatives.
Answer
C · Myxoedema coma
17.Med-surg: GI, perioperative & oncology
Answer: C · Avoid heavy lifting early on and use support garments as advised
Why this is the answer
Avoiding heavy lifting in the early months, supporting the abdomen when coughing, gentle core exercises as advised by the stoma team and a healthy weight may reduce risk.
Answer
C · Avoid heavy lifting early on and use support garments as advised
18.Med-surg: GI, perioperative & oncology
Answer: D · Strangulation or perforation needing urgent surgical review
Why this is the answer
A change from colicky to constant pain, with fever, tachycardia, peritonism or raised lactate, suggests ischaemia (strangulation) or perforation. This is a surgical emergency. Laxatives are contraindicated in mechanical obstruction.
Answer
D · Strangulation or perforation needing urgent surgical review
19.Maternity & obstetric nursing
Answer: B · A cephalhaematoma does not cross the suture lines
Why this is the answer
Caput is oedema of the scalp, present at birth, crossing sutures and resolving within days. A cephalhaematoma is a subperiosteal bleed limited by the sutures; it appears after birth, lasts weeks and can increase jaundice.
Answer
B · A cephalhaematoma does not cross the suture lines
20.Maternity & obstetric nursing
Answer: A · Uterine tone, bleeding and newborn injury
Why this is the answer
Precipitous labour increases the risk of cervical and perineal tears, uterine atony and haemorrhage, and of newborn injuries such as bruising or intracranial bleeding.
Answer
A · Uterine tone, bleeding and newborn injury
21.Pediatric nursing
Answer: D · 1250 mL per day
Why this is the answer
First 10 kg: 10 × 100 = 1000 mL. Next 5 kg: 5 × 50 = 250 mL. Total = 1250 mL per day, or about 52 mL per hour.
Answer
D · 1250 mL per day
22.Pediatric nursing
Answer: C · Keep them apart, not sharing rooms, equipment or play areas
Why this is the answer
People with CF can pass bacteria such as Pseudomonas aeruginosa and Burkholderia cepacia to each other, worsening lung disease. Children with CF are kept apart in hospital and clinics, and equipment is not shared.
Answer
C · Keep them apart, not sharing rooms, equipment or play areas
23.Mental health nursing
Answer: B · "You seem worried about what being here means. Can you tell me more?"
Why this is the answer
The question often hides fear or shame about being in a mental health setting. Exploring the concern shows acceptance, while labelling or false reassurance does not help.
Answer
B · "You seem worried about what being here means. Can you tell me more?"
24.Mental health nursing
Answer: B · Inform the prescriber, because ibuprofen can raise lithium to toxic levels
Why this is the answer
NSAIDs reduce lithium excretion, so levels can rise into the toxic range. The prescriber should review the pain treatment and lithium monitoring.
Answer
B · Inform the prescriber, because ibuprofen can raise lithium to toxic levels
25.Nursing math & unit conversions
Answer: m = 2.95 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
8 oz/16 = 0.5 lb
6 + 0.5 = 6.5 lb
Pounds to kilograms
m = 6.5/2.2 = 2.955 ≈ 2.95 kg
Answer
m = 2.95 kg
26.Nursing math & unit conversions
Answer: D = 50 mcg/min
Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.
Set up the chain
D = 3 mg/h × (1000 mcg/1 mg) × (1 h/60 min)
Calculate
D = 3000/60 = 50 mcg/min
Answer
D = 50 mcg/min
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 = 2·30 = 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 = 0.76 mL
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Weight in kg
83.6/2.2 = 38 kg
Dose
1·38 = 38 mg
Volume
V = (38/50)·1 = 0.76 mL
Answer
V = 0.76 mL
29.IV infusion rates
Answer: R = 63 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
2·60 = 120 min
Drip rate
R = 500·15/120 = 62.5 ≈ 63 gtt/min
Answer
R = 63 gtt/min
At the bedside you round to the nearest whole drop: 63 gtt/min.
30.IV infusion rates
Answer: t = 12 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
50·60/60 = 50 mL/h
Time left
t = 600/50 = 12 h
Answer
t = 12 h
31.IV fluids & fluid balance
Answer: B = 605 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.
Total intake
oral: 100 + 120 + 250 = 470 mL
ice chips: 120/2 = 60 mL
IV infusion: 50·12 = 600 mL
IV antibiotic: 2·100 = 200 mL
total intake = 1330 mL
Total output
250 + 150 + 175 + 150 = 725 mL
Balance
B = 1330 − 725 = 605 mL
Answer
B = 605 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: t = 3 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 = 450/150 = 3 h
Answer
t = 3 h
That is about 3 h 00 min, so the bag runs out at about 23:00.
33.Clinical assessment scores
Answer: M = 5
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 = 12 − 3 − 4 = 5
M5: moves a hand to the site of pressure (localises)
Answer
M = 5
34.Clinical assessment scores
Answer: medium
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 12/min → 0
SpO₂ 94% → 1
on oxygen → 2
SBP 102 mmHg → 1
HR 110/min → 1
alert (A) → 0
T 35.8 °C → 1
Total and red scores
NEWS2 = 0 + 1 + 2 + 1 + 1 + 0 + 1 = 6
No parameter scores 3.
Risk group
medium
Answer
medium
A total of 5 or more calls for an urgent clinical response.
This is independent practice material. ExamProblems is not affiliated with or endorsed by the organisation that runs this exam, and the exam name is used only to describe the content. NCLEX®, NCLEX-RN® and NCLEX-PN® are trademarks of the National Council of State Boards of Nursing, Inc. (NCSBN), which is not affiliated with ExamProblems and does not endorse it or vouch for its accuracy.