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
How can nurses help patients sleep better on a hospital ward at night?
AKeep the main lights on so staff can see clearly
BGive every patient a sleeping tablet
CDo routine tasks such as bed changes at midnight while it is quiet
DGroup care and observations so patients are disturbed less often
2.Nursing fundamentalsHard
According to the gate control theory, why can rubbing a bumped elbow ease the pain?
ARubbing makes the elbow numb by stopping its blood supply
BRubbing removes the damaged tissue from the elbow
CTouch signals reduce pain signals passing up the spinal cord
DRubbing increases the release of pain chemicals so the nerves tire out
3.Infection control & patient safetyMedium
A confused patient keeps pulling at an IV line. Which is a less restrictive option to consider before wrist restraints?
ATying both arms to the bed frame
BCovering the site with a sleeve or using hand mitts with supervision
CUsing a vest restraint in the chair so that the patient’s hands stay down
DGiving a sedative every few hours
4.Infection control & patient safetyHard
A patient receiving chemotherapy has an absolute neutrophil count of 400/mm3 (0.4 × 109/L) and a new temperature of 38.3 °C (100.9 °F). What should the nurse do?
AEncourage oral fluids and record the result in the chart
BRecheck the temperature in four hours before calling anyone about it
CReport it at once, because fever with severe neutropenia is an emergency
DGive an antipyretic and reassess at the next routine round
5.Prioritization & delegationMedium
A nurse delegates routine vital signs to a nursing assistant for a patient whose blood pressure has been falling for the past hour. Which right of delegation is not met?
ARight directions and communication
BRight circumstance
CRight task, because vital signs can never be delegated
DRight person
6.Prioritization & delegationHard
In an emergency department, which patient should go straight to a treatment room?
AA 45-year-old asking for a repeat prescription
BA 60-year-old with chest pressure, sweating and nausea for 20 minutes
CA 25-year-old with a sprained wrist and normal vital signs
DA 30-year-old with a sore throat for two days and a temperature of 38.0 °C
7.Clinical nursingMedium
A patient with COPD and known carbon dioxide retention needs a nebulised bronchodilator. How should it usually be given?
ADriven by high-flow oxygen at 15 L/min for as long as possible
BOnly with the patient lying flat
CWithout monitoring oxygen saturation
DDriven by compressed air, with oxygen given separately if needed
8.Clinical nursingHard
A patient with central chest pain has ST elevation on the 12-lead ECG. What is the main aim of urgent treatment?
AStarting a cholesterol-lowering drug before any other treatment is given
BWaiting for the troponin result before taking any action
CStrict bed rest for several days before deciding on treatment
DRestoring blood flow through the blocked coronary artery quickly
9.Lab values & electrolytesMedium
A patient taking spironolactone asks about using a salt substitute. What should the nurse explain?
AMost salt substitutes contain potassium and can raise the level too high
BSalt substitutes protect against the potassium loss caused by this drug
CSalt substitutes are safe because they contain only sodium chloride
DSalt substitutes are fine as long as the patient drinks more water
10.Lab values & electrolytesHard
After a crush injury, a patient's urine dipstick is strongly positive for blood, but microscopy shows almost no red cells. CK is very high. What best explains this?
AA kidney stone is scraping the ureter lining
BBleeding is coming from the bladder lining
CThe sample was contaminated with menstrual blood
DMyoglobin from damaged muscle is in the urine
11.PharmacologyMedium
A child weighing 20 kg is prescribed a drug at 15 mg/kg per dose. What is the dose?
A150 mg
B3000 mg
C300 mg
D35 mg
12.PharmacologyHard
A man taking doxazosin for hypertension starts sildenafil for erectile dysfunction. What is the main risk?
ASevere hypertension and a pounding headache
BHyperkalaemia
CSymptomatic low blood pressure and fainting
DBronchospasm
13.Med-surg: cardiovascular & respiratoryMedium
A patient with an implantable cardioverter-defibrillator asks what to do if it fires. Which teaching is correct?
AOne shock and well: contact the device clinic; repeated shocks or unwell: call emergency services
BRemove the device battery at home if it fires more than once
CDrive straight to hospital alone after any shock so the device can be checked by the team
DIgnore any shock at all, because the device is designed to fire every day and needs no follow-up
14.Med-surg: cardiovascular & respiratoryHard
Which instruction from the registered nurse to a healthcare assistant (unlicensed assistive personnel) caring for a patient with COPD is most appropriate?
A"Tell me straight away if his SpO₂ is under 88% or he is more breathless."
B"Teach him how to use his new inhaler this afternoon after his rest."
C"Listen to his chest after lunch and let me know what you can hear."
D"Turn his oxygen up to whatever he needs if he looks short of breath."
15.Med-surg: neuro, endocrine & renalMedium
A conscious patient with a glucose of 3.1 mmol/L (56 mg/dL) can swallow safely. Which is the best first treatment?
AA dose of rapid-acting insulin with a sandwich
BA chocolate bar and a cup of tea with milk
CA glass of milk and two plain biscuits
DGlucose tablets or a small glass of fruit juice
16.Med-surg: neuro, endocrine & renalHard
Which nursing care is important for a patient receiving mannitol for raised intracranial pressure?
AClamping the catheter to keep fluid in the body
BClose monitoring of urine output, sodium and osmolality
CStopping the fluid balance chart during treatment
DGiving the drug orally with meals to reduce nausea
17.Med-surg: GI, perioperative & oncologyMedium
Which task for a stable patient with an established ileostomy can usually be delegated to a trained healthcare assistant (nursing assistant)?
AAssessing the stoma for signs of necrosis
BTeaching the patient about high-output risks
CEmptying the pouch and measuring the output
DDeciding whether IV fluids are needed
18.Med-surg: GI, perioperative & oncologyHard
A patient's platelet count is 18 × 109/L (18,000/µL). Which order should the nurse question?
AOral paracetamol for headache
BDaily full blood count
CA soft diet with mouthwashes
DAn intramuscular injection
19.Maternity & obstetric nursingMedium
Which measure helps prevent infant abduction from a maternity unit?
AChecking staff ID before handing over a baby
BPosting the baby's name and room on the door
CLeaving babies in the nursery overnight
DLetting any visitor carry the baby in the corridor
20.Maternity & obstetric nursingHard
A woman with gestational diabetes on insulin asks about her baby after birth. Which statement by the nurse is accurate?
AThe baby must not be breastfed in the first week
BThe baby's glucose will be checked for hypoglycaemia
CThe baby will be born with diabetes
DThe baby will need insulin for the first days
21.Pediatric nursingMedium
A 3-year-old who used to speak in short sentences has stopped talking and no longer responds to her name. What is the most important point?
ALoss of previously gained skills at any age needs prompt assessment
BLanguage develops in sudden spurts, so this is expected
CIt means the child is tired and should be seen in a year
DIt is normal regression at this age
22.Pediatric nursingHard
How is pain best assessed in a 10-year-old with severe cerebral palsy who cannot speak?
AWith a behavioural tool such as revised FLACC, using the parents' knowledge of usual cues
BPain cannot be assessed, so analgesia is given only on request
COnly by checking whether the heart rate is above normal
DWith a 0–10 numerical scale, by asking the child to point to a number on a printed chart
23.Mental health nursingMedium
A student avoids eating in the canteen and speaking in seminars because she fears others will judge her or see her blush. Which disorder does this suggest?
AAgoraphobia
BGeneralised anxiety disorder
CSocial anxiety disorder
DObsessive-compulsive disorder
24.Mental health nursingHard
A patient who took a high-dose benzodiazepine daily for a year tells you she stopped it suddenly 2 days ago. What is the main risk?
AWithdrawal seizures
BHair loss
CWeight gain
DHypoglycaemia
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A weight conversion gives 78.1803 kg. The rule in this exercise is that weights are rounded to the nearest tenth of a kilogram. What value x do you record?
78.1803 kg
x = kg
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion delivers 12 mg/h. Express this dose rate D in mcg/min. Round to one decimal place.
12 mg/h1 mg = 1000 mcg1 h = 60 min
D = mcg/min
27.Dosage calculationsMedium
A patient weighs 90 kg. The prescribed dose is 20 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?
90 kg20 mg/kg/day4× per day
D = mg
28.Dosage calculationsHard
The prescription is 3300 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
3300 units5000 units/mL
V = mL
29.IV infusion ratesMedium
Infuse 250 mL over 12 hours with a giving set of 60 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
250 mL12 h60 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 200 mg of a drug in 250 mL and runs at 10 mL/h. How many milligrams per hour D does the patient receive?
200 mg/250 mL10 mL/h
D = mg/h
31.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss).
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 125 mL/h. At 07:00, 400 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL400 mL infused125 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 6, with E2 and V1. What motor score M was recorded, and which response does it describe? Give the number.
GCS 6E2V1
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 16/min, SpO₂ 97% on room air, blood pressure 150/90 mmHg, pulse 58/min, alert, temperature 39.2 °C. Which clinical risk group does the patient fall into? Click it.
RR 16SpO₂ 97%airSBP 150HR 58AT 39.2 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: D · Group care and observations so patients are disturbed less often
Why this is the answer
Clustering care, dimming lights, reducing noise and offering eye masks or earplugs improve sleep. Sedatives carry risks and are not routine.
Answer
D · Group care and observations so patients are disturbed less often
2.Nursing fundamentals
Answer: C · Touch signals reduce pain signals passing up the spinal cord
Why this is the answer
The gate control theory proposes that input from touch fibres "closes the gate" in the dorsal horn of the spinal cord, reducing pain transmission. This underlies massage and TENS.
Answer
C · Touch signals reduce pain signals passing up the spinal cord
3.Infection control & patient safety
Answer: B · Covering the site with a sleeve or using hand mitts with supervision
Why this is the answer
Covering the line, keeping it out of view and using mitts while observing the patient can stop pulling without fully restricting movement. Restraints and sedation are used only if these fail.
Answer
B · Covering the site with a sleeve or using hand mitts with supervision
4.Infection control & patient safety
Answer: C · Report it at once, because fever with severe neutropenia is an emergency
Why this is the answer
Febrile neutropenia can progress to sepsis quickly. The nurse reports it immediately so cultures can be taken and antibiotics started without delay.
Answer
C · Report it at once, because fever with severe neutropenia is an emergency
5.Prioritization & delegation
Answer: B · Right circumstance
Why this is the answer
Vital signs are normally delegable, but this patient is unstable, so the circumstances are not right. A deteriorating patient needs the RN to assess and interpret the findings in person.
Answer
B · Right circumstance
6.Prioritization & delegation
Answer: B · A 60-year-old with chest pressure, sweating and nausea for 20 minutes
Why this is the answer
Chest pressure with sweating and nausea may be a heart attack, so the patient needs an ECG within minutes. The other patients are stable and can safely wait.
Answer
B · A 60-year-old with chest pressure, sweating and nausea for 20 minutes
7.Clinical nursing
Answer: D · Driven by compressed air, with oxygen given separately if needed
Why this is the answer
Nebulisers driven by high-flow oxygen can raise PaCO2 in patients at risk. Air-driven nebulisers are used, with supplementary oxygen via nasal cannulae to keep saturation in the target range.
Answer
D · Driven by compressed air, with oxygen given separately if needed
8.Clinical nursing
Answer: D · Restoring blood flow through the blocked coronary artery quickly
Why this is the answer
ST-elevation myocardial infarction means a coronary artery is usually completely blocked. Urgent reperfusion by primary PCI, or thrombolysis if PCI is not available in time, limits the amount of heart muscle that dies.
Answer
D · Restoring blood flow through the blocked coronary artery quickly
9.Lab values & electrolytes
Answer: A · Most salt substitutes contain potassium and can raise the level too high
Why this is the answer
Spironolactone blocks aldosterone, so the kidneys keep potassium. Many salt substitutes are made of potassium chloride, and combining them with spironolactone can cause dangerous hyperkalemia, especially with kidney disease or ACE inhibitors.Checked against:Spironolactone · MedlinePlus (NIH) (2018); High potassium level · MedlinePlus (NIH) (2025)
Answer
A · Most salt substitutes contain potassium and can raise the level too high
10.Lab values & electrolytes
Answer: D · Myoglobin from damaged muscle is in the urine
Why this is the answer
The dipstick blood test detects heme, which is present in both hemoglobin and myoglobin. Positive "blood" without red cells, together with a very high CK, indicates myoglobinuria from rhabdomyolysis, which can damage the kidneys. IV fluids and close monitoring of urine output and potassium are needed.Checked against:Myoglobin urine test · MedlinePlus (NIH) (2025); Rhabdomyolysis · MedlinePlus (NIH) (2025); Creatine Kinase · MedlinePlus (NIH) (2023)
Answer
D · Myoglobin from damaged muscle is in the urine
11.Pharmacology
Answer: C · 300 mg
Why this is the answer
20 kg × 15 mg/kg = 300 mg. The result is also checked against the safe dose range and the adult maximum.
Answer
C · 300 mg
12.Pharmacology
Answer: C · Symptomatic low blood pressure and fainting
Why this is the answer
Alpha blockers and PDE5 inhibitors both cause vasodilation, so together they can cause marked hypotension. Patients should be stable on the alpha blocker, and the PDE5 inhibitor is started at a low dose.
Answer
C · Symptomatic low blood pressure and fainting
13.Med-surg: cardiovascular & respiratory
Answer: A · One shock and well: contact the device clinic; repeated shocks or unwell: call emergency services
Why this is the answer
A single shock with full recovery usually needs a call to the device team. Several shocks in a short time, or a shock with chest pain, breathlessness or collapse, needs emergency help. Patients should not drive themselves after a shock.
Answer
A · One shock and well: contact the device clinic; repeated shocks or unwell: call emergency services
14.Med-surg: cardiovascular & respiratory
Answer: A · "Tell me straight away if his SpO₂ is under 88% or he is more breathless."
Why this is the answer
Delegated tasks should come with specific parameters for reporting. Changing oxygen therapy, chest assessment and patient teaching need a registered nurse's knowledge and judgement. Clear reporting instructions keep the patient safe.
Answer
A · "Tell me straight away if his SpO₂ is under 88% or he is more breathless."
15.Med-surg: neuro, endocrine & renal
Answer: D · Glucose tablets or a small glass of fruit juice
Why this is the answer
About 15–20 g of fast-acting carbohydrate, such as glucose tablets or juice, raises glucose quickly. Chocolate and milk contain fat, which slows absorption. Glucose is rechecked after about 15 minutes.
Answer
D · Glucose tablets or a small glass of fruit juice
16.Med-surg: neuro, endocrine & renal
Answer: B · 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
B · Close monitoring of urine output, sodium and osmolality
17.Med-surg: GI, perioperative & oncology
Answer: C · Emptying the pouch and measuring the output
Why this is the answer
Emptying and measuring output is a routine task. Assessment of the stoma, teaching and decisions about treatment remain with the registered nurse, who reviews the recorded output.
Answer
C · Emptying the pouch and measuring the output
18.Med-surg: GI, perioperative & oncology
Answer: D · An intramuscular injection
Why this is the answer
IM injections can cause haematomas in severe thrombocytopenia. Rectal procedures, NSAIDs and aspirin are also avoided. The nurse checks with the prescriber and the oral or IV route is used where possible.
Answer
D · An intramuscular injection
19.Maternity & obstetric nursing
Answer: A · Checking staff ID before handing over a baby
Why this is the answer
Matching ID bands, checking staff identification and teaching parents to hand their baby only to identified staff are key. Information about the baby should not be displayed publicly.
Answer
A · Checking staff ID before handing over a baby
20.Maternity & obstetric nursing
Answer: B · The baby's glucose will be checked for hypoglycaemia
Why this is the answer
Babies of mothers with diabetes may have high insulin levels after birth, causing hypoglycaemia. Early, frequent feeding, often skin-to-skin, and glucose monitoring per protocol are standard.
Answer
B · The baby's glucose will be checked for hypoglycaemia
21.Pediatric nursing
Answer: A · Loss of previously gained skills at any age needs prompt assessment
Why this is the answer
Regression, the loss of language, social or motor skills, is always a red flag and needs prompt developmental and medical assessment.
Answer
A · Loss of previously gained skills at any age needs prompt assessment
22.Pediatric nursing
Answer: A · With a behavioural tool such as revised FLACC, using the parents' knowledge of usual cues
Why this is the answer
Children with cognitive impairment are assessed with behavioural tools such as the revised FLACC, which can include the child's individual pain behaviours. Parents know the child's baseline and are key partners in pain assessment.
Answer
A · With a behavioural tool such as revised FLACC, using the parents' knowledge of usual cues
23.Mental health nursing
Answer: C · Social anxiety disorder
Why this is the answer
Social anxiety disorder is a marked fear of social situations in which the person may be scrutinised, with fear of embarrassment or negative judgement, leading to avoidance or intense distress.
Answer
C · Social anxiety disorder
24.Mental health nursing
Answer: A · Withdrawal seizures
Why this is the answer
Abrupt withdrawal after long-term high-dose use can cause severe anxiety, tremor, perceptual disturbances and seizures. The prescriber should be informed and a supervised taper considered.
Answer
A · Withdrawal seizures
25.Nursing math & unit conversions
Answer: x = 78.2 kg
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
78.1803 → 1
Only the next digit decides
78.1803 → 8
8 is 5 or more, so round 1 up.
The digits after it (03) are ignored: round once, never step by step.
Round
x = 78.2 kg
Answer
x = 78.2 kg
26.Nursing math & unit conversions
Answer: D = 200 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 = 12 mg/h × (1000 mcg/1 mg) × (1 h/60 min)
Calculate
D = 12000/60 = 200 mcg/min
Answer
D = 200 mcg/min
27.Dosage calculations
Answer: D = 450 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
20·90 = 1800 mg
Per dose
D = 1800/4 = 450 mg
Answer
D = 450 mg
28.Dosage calculations
Answer: V = 0.66 mL
Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.
Volume
V = 3300/5000 = 0.66 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.66 mL
29.IV infusion rates
Answer: R = 21 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
12·60 = 720 min
Drip rate
R = 250·60/720 = 20.83 ≈ 21 gtt/min
Answer
R = 21 gtt/min
At the bedside you round to the nearest whole drop: 21 gtt/min.
30.IV infusion rates
Answer: D = 8 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
200/250 = 0.8 mg/mL
Dose rate
D = 0.8·10 = 8 mg/h
Answer
D = 8 mg/h
31.IV fluids & fluid balance
Answer: B = −585 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: 150 + 240 + 150 = 540 mL
IV infusion: 60·8 = 480 mL
IV antibiotic: 1·100 = 100 mL
total intake = 1120 mL
Total output
450 + 200 + 500 + 325 + 30 + 200 = 1705 mL
Balance
B = 1120 − 1705 = −585 mL
Answer
B = −585 mL
Negative: the patient lost more fluid than went in.
32.IV fluids & fluid balance
Answer: t = 4.8 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 − 400 = 600 mL
Time
t = 600/125 = 4.8 h
Answer
t = 4.8 h
That is about 4 h 48 min, so the bag runs out at about 11:48.
33.Clinical assessment scores
Answer: M = 3
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 = 6 − 2 − 1 = 3
M3: abnormal flexion of the arms (decorticate posture)
Answer
M = 3
34.Clinical assessment scores
Answer: low
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 16/min → 0
SpO₂ 97% → 0
on air → 0
SBP 150 mmHg → 0
HR 58/min → 0
alert (A) → 0
T 39.2 °C → 2
Total and red scores
NEWS2 = 0 + 0 + 0 + 0 + 0 + 0 + 2 = 2
No parameter scores 3.
Risk group
low
Answer
low
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