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 is getting up for the first time after several days in bed. What should the nurse do first?
AAsk the patient to walk to the bathroom alone
BHave the patient sit on the edge of the bed for a short time before standing
CGive the patient a large drink of water while standing
DHelp the patient stand up quickly, so that the dizziness has less time to start
2.Nursing fundamentalsHard
A patient has a generalised tonic-clonic seizure in bed. What should the nurse do?
APut a spoon between the teeth to stop tongue biting
BGive a drink of water as soon as the jerking starts
CHold the arms and legs firmly so that the jerking movements stop more quickly
DProtect the head, move objects away, time it and do not restrain
3.Infection control & patient safetyMedium
A patient is on suicide precautions. Which room safety measure is appropriate?
ARemove items that could be used for self-harm, such as belts and cords
BLet the patient keep a personal razor for shaving, as long as staff are told
CAllow glass bottles if the patient seems calm
DKeep the door closed at all times so the patient has privacy
4.Infection control & patient safetyHard
Which action by a nurse shows that the five moments of hand hygiene are being followed?
AShe cleans her hands only when they look dirty
BShe wears the same gloves between two patients
CShe cleans her hands only at the start and end of the shift
DShe cleans her hands after touching the bed rail
5.Prioritization & delegationMedium
Which task should the nurse delegate to a nursing assistant for a patient on fall precautions?
AHelping the patient to the toilet every 2 hours as planned
BTeaching the family how to prevent falls at home
CAssessing and recording the patient’s fall risk score each morning
DDeciding whether the bed alarm is still needed
6.Prioritization & delegationHard
An adult has burns over 40% of the body with no signs of airway injury. Which treatment is the priority during the first hours?
ALarge-volume IV fluids with close monitoring of urine output
BStarting physiotherapy to prevent contractures straight away
CGiving a high-protein meal to support healing
DApplying antibiotic cream to all the burns before anything else
7.Clinical nursingMedium
What is the main benefit of pulmonary rehabilitation for patients with COPD?
ANo further need for inhalers
BA cure for the disease within months
CBetter exercise capacity and quality of life
DReversal of the lung damage caused by smoking
8.Clinical nursingHard
Which finding suggests hypocalcaemia?
ASevere thirst with a large urine output and constipation
BA flapping tremor of the outstretched hands
CA slow, irregular pulse with nausea and yellow-tinged vision
DSpasm of the hand when a blood pressure cuff is inflated on the arm
9.Lab values & electrolytesMedium
A patient receives repeated nebulized albuterol (salbutamol) for severe asthma. Which laboratory change should the nurse watch for?
AA fall in blood glucose
BA rise in serum calcium
CA fall in serum potassium
DA rise in serum sodium
10.Lab values & electrolytesHard
Why can a normal creatinine be misleading in a frail older adult with low muscle mass?
AOlder adults always have a higher creatinine than younger adults do
BCreatinine levels do not depend on muscle mass at all
CLess muscle makes less creatinine, hiding reduced kidney function
DA normal creatinine always proves normal kidney function
11.PharmacologyMedium
A patient with a peanut allergy is taught to use an adrenaline auto-injector. Which statement is correct?
AUse it only if the antihistamine has not worked after an hour
BThere is no need to see a doctor if the swelling goes down
CKeep it at home so it is not lost
DCall emergency services after using it, even if symptoms improve
12.PharmacologyHard
Which heart failure drug improves symptoms and reduces hospital admissions but has not been shown to reduce mortality?
AA mineralocorticoid receptor antagonist such as spironolactone
BA beta blocker such as bisoprolol
CDigoxin
DAn ACE inhibitor
13.Med-surg: cardiovascular & respiratoryMedium
Shortly after a permanent pacemaker is inserted via the subclavian vein, the patient becomes breathless with reduced breath sounds on that side. What complication should be suspected?
APulmonary oedema
BPericarditis
CAsthma
DPneumothorax
14.Med-surg: cardiovascular & respiratoryHard
On day 2 after a surgical tracheostomy, the tube falls out. The patient is breathing but distressed. What should the nurse do first?
ACall for expert help and give oxygen to both the face and the stoma
BCover the stoma completely with a sealed dressing and wait for help
CForce the tube back through the stoma immediately with firm pressure
DLeave the patient alone while fetching a new tube
15.Med-surg: neuro, endocrine & renalMedium
Which long-term risk should a kidney transplant recipient be taught to reduce with sun protection?
AHair loss
BKidney stones
CSkin cancer
DGout
16.Med-surg: neuro, endocrine & renalHard
A patient with renal colic has normal kidney function and no other contraindications. Which drug is usually the first choice for pain?
AAn oral antihistamine such as cetirizine
BAn NSAID such as diclofenac
COral paracetamol (acetaminophen) alone
DA benzodiazepine such as diazepam
17.Med-surg: GI, perioperative & oncologyMedium
A patient takes co-codamol at home (a combination tablet sold under different names in different countries). Why should the nurse check this before giving regular paracetamol (acetaminophen)?
ACo-codamol must be stopped a week before any paracetamol
BIt already contains paracetamol, so overdose could occur
CParacetamol and codeine cause a severe allergic reaction when combined
DCo-codamol stops paracetamol from working
18.Med-surg: GI, perioperative & oncologyHard
Why is naloxone usually given in small, repeated doses to a postoperative patient with opioid-induced respiratory depression?
ATo make the opioid work faster and more strongly
BBecause large doses of naloxone have no extra effect at all
CBecause high doses of naloxone cause respiratory depression
DTo restore breathing without causing severe pain and withdrawal
19.Maternity & obstetric nursingMedium
Why is the hearing of newborns screened before discharge or soon after birth?
AIt detects congenital heart disease
BHearing loss can be cured with a single injection
CEarly support improves language development
DIt is required before vitamin K can be given
20.Maternity & obstetric nursingHard
A woman with active genital herpes lesions is admitted in early labour with intact membranes. What should the nurse expect?
AA fetal scalp electrode for close monitoring
BRupture of the membranes to speed up labour
CA vaginal birth with no special precautions
DA caesarean birth to reduce the risk of neonatal herpes
21.Pediatric nursingMedium
How should the nurse measure the heart rate of a 9-month-old?
ACount the radial pulse for 15 seconds and multiply by 4
BRead it from the pulse oximeter only
CCount the carotid pulse for 30 seconds and multiply by 2
DCount the apical pulse for a full minute
22.Pediatric nursingHard
A parent asks why the HPV vaccine is offered in early adolescence (at about 11 to 13 years, depending on the country). Which answer is best?
AIt works best before any exposure to the virus, and young adolescents respond strongly
BIt is only effective if given in the first year of secondary school, before exams start
CChildren of this age are already likely to have the virus, so it treats the infection
DIt is given at this age because it prevents chickenpox in adolescence
23.Mental health nursingMedium
The wife of a man with alcohol dependence organises her life around his drinking, hides it from others and neglects her own needs. What does this pattern suggest?
ALearned helplessness in the patient
BDelirium tremens
CEnabling by the healthcare team
DCodependency
24.Mental health nursingHard
A patient with an anxiety disorder speaks so quickly about her worries that the nurse cannot follow. Which response is most helpful?
A"Let's slow down and talk about one thing at a time. What worries you most right now?"
B"There's really nothing to worry about, so just try to relax."
C"You're talking too fast, so we'll have to stop for today."
D"Let me tell you what I think your problem is, and then we can talk."
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose calculation for an injection gives 13.6333 mL. The rule in this exercise is that volumes of 1 mL or more are rounded to the nearest tenth of a mL. What value x do you record?
13.6333 mL
x = mL
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 3 tsp of cough syrup, 1 fl oz of juice, 1 tbsp of liquid supplement, ½ cup of tea. Using the equivalents given, find the total oral intake V in mL.
1 tsp = 5 mL1 fl oz = 30 mL1 tbsp = 15 mL1 cup = 8 fl oz = 240 mL
V = mL
27.Dosage calculationsMedium
A patient weighs 90 kg. The prescribed dose is 2 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?
90 kg2 mg/kg/day3× per day
D = mg
28.Dosage calculationsHard
An infusion contains 20000 units of a drug in 1000 mL. The prescription is 1000 units per hour. At what rate R do you set the pump, in mL/h?
20000 units/1000 mL1000 units/h
R = mL/h
29.IV infusion ratesMedium
An infusion is ordered at 150 mL/h, but no pump is available. It runs by gravity through a giving set of 20 gtt/mL. Find the drip rate R in drops per minute.
150 mL/h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 200 mg of a drug in 500 mL and runs at 30 mL/h. How many milligrams per hour D does the patient receive?
200 mg/500 mL30 mL/h
D = mg/h
31.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL. Count ice chips as half their volume.
water: 200 mLjuice: 150 mLice chips: 200 mLIV infusion: 50 mL/h × 12 hIV antibiotic: 2 × 100 mL
I = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 08:00 at 80 mL/h. After 2 hours the rate is changed to 100 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
1000 mL80 mL/h · 2 h100 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: no; secondary diagnosis: yes; ambulatory aid: none, bed rest or nurse assists; IV therapy or saline lock: no; gait: impaired; mental status: knows own limits. Find the Morse total MFS.
0–125
MFS =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). At 5 minutes after birth, a practice newborn has a pink body with blue hands and feet, a heart rate of 110/min, a cry, cough or sneeze when stimulated, active movement and good breathing with a strong cry. Score the APGAR and click how the score is interpreted.
1reassuring
2moderately abnormal
3low
3Solutions
1.Nursing fundamentals
Answer: B · Have the patient sit on the edge of the bed for a short time before standing
Why this is the answer
After bed rest blood pressure may drop on standing. Sitting on the edge of the bed first, with the feet on the floor, lets the body adjust and lowers the risk of fainting and falls.
Answer
B · Have the patient sit on the edge of the bed for a short time before standing
2.Nursing fundamentals
Answer: D · Protect the head, move objects away, time it and do not restrain
Why this is the answer
During a seizure the nurse keeps the patient safe, notes the time and the features, and never puts anything in the mouth. Afterwards the patient is placed in the recovery position and the airway checked.
Answer
D · Protect the head, move objects away, time it and do not restrain
3.Infection control & patient safety
Answer: A · Remove items that could be used for self-harm, such as belts and cords
Why this is the answer
Patients at risk of suicide need a safe environment, with belts, cords, sharp objects and glass removed, and observation at the level ordered. Privacy is secondary to safety in this situation.
Answer
A · Remove items that could be used for self-harm, such as belts and cords
4.Infection control & patient safety
Answer: D · She cleans her hands after touching the bed rail
Why this is the answer
Touching the patient’s surroundings, such as rails and tables, contaminates the hands, so hand hygiene is needed afterwards. Gloves are changed between patients, and hand hygiene is needed whether or not the hands look dirty.
Answer
D · She cleans her hands after touching the bed rail
5.Prioritization & delegation
Answer: A · Helping the patient to the toilet every 2 hours as planned
Why this is the answer
A scheduled toileting round is a routine task that follows the care plan. Scoring fall risk, deciding on interventions and teaching need nursing judgement.
Answer
A · Helping the patient to the toilet every 2 hours as planned
6.Prioritization & delegation
Answer: A · Large-volume IV fluids with close monitoring of urine output
Why this is the answer
Once the airway is secure, the early priority in major burns is fluid resuscitation to prevent burn shock. Urine output is a key guide to whether enough fluid is being given.
Answer
A · Large-volume IV fluids with close monitoring of urine output
7.Clinical nursing
Answer: C · Better exercise capacity and quality of life
Why this is the answer
Pulmonary rehabilitation improves breathlessness, exercise tolerance and well-being, and reduces hospital admissions. It does not reverse the underlying lung damage.
Answer
C · Better exercise capacity and quality of life
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 · A fall in serum potassium
Why this is the answer
Beta-2 agonists push potassium into cells and can cause hypokalemia, especially at high doses; they also raise blood glucose. For this reason nebulized albuterol is sometimes used as an extra treatment for hyperkalemia.
Answer
C · A fall in serum potassium
10.Lab values & electrolytes
Answer: C · Less muscle makes less creatinine, hiding reduced kidney function
Why this is the answer
Creatinine is made by muscle. A person with little muscle makes little creatinine, so the value can look normal even when kidney function is reduced. Creatinine-based eGFR can overestimate function in the same way, so a measured creatinine clearance or a cystatin C–based estimate may be used when dosing drugs cleared by the kidneys.Checked against:Creatinine blood test · MedlinePlus (NIH) (2025)
Answer
C · Less muscle makes less creatinine, hiding reduced kidney function
11.Pharmacology
Answer: D · Call emergency services after using it, even if symptoms improve
Why this is the answer
Anaphylaxis can recur after the adrenaline wears off (a biphasic reaction). The person always calls for help after using it, carries two auto-injectors and uses adrenaline early.
Answer
D · Call emergency services after using it, even if symptoms improve
12.Pharmacology
Answer: C · Digoxin
Why this is the answer
ACE inhibitors (or ARBs/ARNI), beta blockers, mineralocorticoid antagonists and SGLT2 inhibitors reduce mortality in heart failure with reduced ejection fraction. Digoxin improves symptoms and reduces admissions without reducing mortality.
Answer
C · Digoxin
13.Med-surg: cardiovascular & respiratory
Answer: D · Pneumothorax
Why this is the answer
Subclavian puncture can injure the pleura and cause a pneumothorax. A chest X-ray is usually taken after implantation. Other complications include haematoma, lead displacement and infection.
Answer
D · Pneumothorax
14.Med-surg: cardiovascular & respiratory
Answer: A · Call for expert help and give oxygen to both the face and the stoma
Why this is the answer
In the first days after a tracheostomy, the tract is immature and the tube can easily be misplaced into the tissues. Emergency guidance is to call for an airway expert, apply oxygen to face and stoma and assess breathing. Reinsertion is done only by trained staff.
Answer
A · Call for expert help and give oxygen to both the face and the stoma
15.Med-surg: neuro, endocrine & renal
Answer: C · Skin cancer
Why this is the answer
Transplant recipients have a much higher risk of skin cancers, especially squamous cell carcinoma, because of immunosuppression. Sun protection and regular skin checks are important.
Answer
C · Skin cancer
16.Med-surg: neuro, endocrine & renal
Answer: B · An NSAID such as diclofenac
Why this is the answer
NSAIDs are recommended first line for renal colic in suitable patients because they reduce prostaglandin-driven pain and ureteric spasm. Opioids are added if needed. NSAIDs are avoided in kidney impairment.
Answer
B · An NSAID such as diclofenac
17.Med-surg: GI, perioperative & oncology
Answer: B · It already contains paracetamol, so overdose could occur
Why this is the answer
Co-codamol combines codeine and paracetamol. Giving extra paracetamol can exceed the maximum daily dose and cause liver damage, so all sources of paracetamol are counted.
Answer
B · It already contains paracetamol, so overdose could occur
18.Med-surg: GI, perioperative & oncology
Answer: D · To restore breathing without causing severe pain and withdrawal
Why this is the answer
A large bolus can abruptly reverse analgesia, causing severe pain, agitation, hypertension, pulmonary oedema and arrhythmias. Titrating small doses restores adequate breathing. Because naloxone's effect can be shorter than the opioid's, monitoring and repeat doses or an infusion may be needed.
Answer
D · To restore breathing without causing severe pain and withdrawal
19.Maternity & obstetric nursing
Answer: C · Early support improves language development
Why this is the answer
Early detection of hearing loss allows hearing aids, cochlear implants or other support in the first months, which greatly improves language outcomes.
Answer
C · Early support improves language development
20.Maternity & obstetric nursing
Answer: D · A caesarean birth to reduce the risk of neonatal herpes
Why this is the answer
Active genital lesions or prodromal symptoms at the onset of labour are an indication for caesarean birth because neonatal herpes can be severe. Invasive procedures such as scalp electrodes are avoided.
Answer
D · A caesarean birth to reduce the risk of neonatal herpes
21.Pediatric nursing
Answer: D · Count the apical pulse for a full minute
Why this is the answer
In infants and children under about 2 years, the apical pulse is counted with a stethoscope for a full minute. Their rates are fast and may vary with breathing, so short counts are inaccurate.
Answer
D · Count the apical pulse for a full minute
22.Pediatric nursing
Answer: A · It works best before any exposure to the virus, and young adolescents respond strongly
Why this is the answer
HPV is passed on through sexual contact, so vaccination is most effective before any exposure. Younger adolescents also produce a strong antibody response. The vaccine protects against HPV types that cause cervical and other cancers and genital warts.
Answer
A · It works best before any exposure to the virus, and young adolescents respond strongly
23.Mental health nursing
Answer: D · Codependency
Why this is the answer
Codependency describes a family member whose life becomes centred on the other person's addiction, often with caretaking, covering up and neglect of self. Support groups such as Al-Anon can help.
Answer
D · Codependency
24.Mental health nursing
Answer: A · "Let's slow down and talk about one thing at a time. What worries you most right now?"
Why this is the answer
Focusing directs the conversation to one main concern, which reduces overwhelm and makes the problem easier to work on. A calm, slow pace from the nurse also helps lower anxiety.
Answer
A · "Let's slow down and talk about one thing at a time. What worries you most right now?"
25.Nursing math & unit conversions
Answer: x = 13.6 mL
Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.
Digit in the tenths place
13.6333 → 6
Only the next digit decides
13.6333 → 3
3 is 4 or less, so 6 stays.
The digits after it (33) are ignored: round once, never step by step.
Round
x = 13.6 mL
Answer
x = 13.6 mL
26.Nursing math & unit conversions
Answer: V = 180 mL
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.
Each item in mL
3 tsp = 3·5 = 15 mL
1 fl oz = 1·30 = 30 mL
1 tbsp = 1·15 = 15 mL
½ cup = 0.5·240 = 120 mL
Add
V = 15 + 30 + 15 + 120 = 180 mL
Answer
V = 180 mL
27.Dosage calculations
Answer: D = 60 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.
Total per day
2·90 = 180 mg
Per dose
D = 180/3 = 60 mg
Answer
D = 60 mg
28.Dosage calculations
Answer: R = 50 mL/h
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.
Concentration
20000/1000 = 20 units/mL
Pump rate
R = 1000/20 = 50 mL/h
Answer
R = 50 mL/h
29.IV infusion rates
Answer: R = 50 gtt/min
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Millilitres per minute
150/60 = 2.5 mL/min
Drip rate
R = 2.5·20 = 50 gtt/min
Answer
R = 50 gtt/min
30.IV infusion rates
Answer: D = 12 mg/h
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Concentration
200/500 = 0.4 mg/mL
Dose rate
D = 0.4·30 = 12 mg/h
Answer
D = 12 mg/h
31.IV fluids & fluid balance
Answer: I = 1250 mL
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Add the intake
oral: 200 + 150 = 350 mL
ice chips: 200/2 = 100 mL
IV infusion: 50·12 = 600 mL
IV antibiotic: 2·100 = 200 mL
I = 1250 mL
Answer
I = 1250 mL
32.IV fluids & fluid balance
Answer: t = 10.4 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
80·2 = 160 mL
1000 − 160 = 840 mL left
Second part
840/100 = 8.4 h
Total time
t = 2 + 8.4 = 10.4 h
Answer
t = 10.4 h
That is about 10 h 24 min, so the bag runs out at about 18:24.
33.Clinical assessment scores
Answer: MFS = 35
Morse fall scale: six items. History of falling: no 0, yes 25. Secondary diagnosis: no 0, yes 15. Ambulatory aid: none, bed rest or nurse assistance 0; crutches, cane or walker 15; holding on to furniture 30. IV therapy or saline lock: no 0, yes 20. Gait: normal, bed rest or wheelchair 0; weak 10; impaired 20. Mental status: knows own limits 0; overestimates or forgets limits 15. The total runs from 0 to 125. Risk cut-offs differ between hospitals; a common set is 0–24 low, 25–44 moderate and 45 or more high.
Score each item
history of falling in the last 3 months: no → 0
secondary diagnosis: yes → 15
ambulatory aid: none, bed rest or nurse assists → 0
IV therapy or saline lock: no → 0
gait: impaired → 20
mental status: knows own limits → 0
Add
Morse total = 0 + 15 + 0 + 0 + 20 + 0 = 35
Answer
MFS = 35
34.Clinical assessment scores
Answer: reassuring
APGAR score: five signs, each scored 0, 1 or 2, checked at 1 and 5 minutes after birth. Appearance (colour): blue or pale 0, pink body with blue extremities 1, pink all over 2. Pulse: absent 0, below 100/min 1, 100/min or more 2. Grimace (reflex irritability): none 0, grimace 1, cry, cough or sneeze 2. Activity (tone): limp 0, some flexion 1, active movement 2. Respiration: absent 0, slow or irregular with a weak cry 1, good with a strong cry 2. A total of 7–10 is reassuring, 4–6 moderately abnormal and 0–3 low.
Score each sign
Appearance: a pink body with blue hands and feet → 1
Pulse: 110/min → 2
Grimace: a cry, cough or sneeze when stimulated → 2
Activity: active movement → 2
Respiration: good breathing with a strong cry → 2
Add
APGAR = 1 + 2 + 2 + 2 + 2 = 9
Interpretation
9 → reassuring
Answer
reassuring
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