Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
Prioritization & delegation
Method
Ask what will harm the patient soonest if nothing is done.
Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
Assess before you act unless it is an emergency; then choose the step the others depend on.
For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.
Lab values & electrolytes
Method
Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
Link the value to its typical signs and to the drugs and conditions that cause it.
Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.
Med-surg: cardiovascular & respiratory
Method
Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
Choose the safe first action, then escalate and reassess.
Med-surg: neuro, endocrine & renal
Method
Check the glucose in every patient with new confusion, weakness or a seizure.
Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.
Med-surg: GI, perioperative & oncology
Method
Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.
Maternity & obstetric nursing
Method
Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.
Pediatric nursing
Method
Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
Match the action to the development stage and involve the family.
Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.
Mental health nursing
Method
Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
Respect rights: the least restrictive option, consent and confidentiality with its limits.
Nursing math & unit conversions
Metric steps
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
Weight and length
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
Household measures
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
falls 25, diagnosis 15, aid 15/30, IV 20, gait 10/20, mental status 15
NEWS2 risk
0–4 low; single 3 low–medium; 5–6 medium; ≥ 7 high
Mean arterial pressure
MAP = (SBP + 2·DBP)/3 = DBP + PP/3
Pulse pressure and shock index
PP = SBP − DBP, SI = HR/SBP
Body mass index
BMI = kg/m² = 703·lb/in²
Method
Find the score sheet that the question uses and its range (GCS 3–15, APGAR 0–10, Braden 6–23, Morse 0–125).
Score every item separately, matching the description to its level.
Add the item scores and check that the total lies inside the range.
Apply the cut-offs: for NEWS2 also look for any single parameter scoring 3.
For derived values use MAP = (SBP + 2·DBP)/3, PP = SBP − DBP, SI = HR/SBP and BMI = kg/m².
2Practice problems
1.Nursing fundamentalsMedium
Why is nail varnish or false nails often removed before surgery?
AThey can catch fire from the electrical equipment used in theatre
BThey can affect pulse oximetry and checking skin colour
CThey make the anaesthetic work less well
DThey are a common cause of wound infection
2.Nursing fundamentalsHard
Two days after surgery a patient has a temperature of 37.9 °C and reduced breath sounds at the lung bases. What is the most helpful nursing action, alongside reporting it?
AKeep the patient lying flat in bed so they can rest and save energy
BStop all pain relief so the patient stays alert
CEncourage deep breathing, coughing and getting out of bed
DRestrict all fluids to dry the secretions
3.Infection control & patient safetyMedium
A nurse finds an unlabeled syringe of clear fluid on the medication counter. What should the nurse do?
AGive it to the patient whose medication is due
BDiscard it, because its contents cannot be confirmed
CLabel it with the most likely drug name
DAsk nearby staff and use it if someone recognizes it
4.Infection control & patient safetyHard
Two look-alike vials of different drugs are stored next to each other, and a nurse almost picks the wrong one. Which response best reflects a just culture?
AReport it and fix the system, for example by separating the vials
BTell the nurse to be more careful and do nothing else
CKeep the incident quiet to protect the unit’s reputation
DDiscipline the nurse who nearly picked the wrong vial
5.Prioritization & delegationMedium
A nurse asks a nursing assistant to use a mechanical lift. The assistant says they have never been trained to use it. Which right of delegation would be violated if the nurse insisted?
ARight task
BRight supervision and evaluation
CRight person
DRight directions and communication
6.Prioritization & delegationHard
Which assignment by the charge nurse should be changed?
AAn LPN/LVN is assigned to give oral medications to stable patients
BAn LPN/LVN is assigned to admit a new patient from the emergency department
CAn RN is assigned to a patient receiving a blood transfusion
DA nursing assistant is assigned to help several stable patients with their meals
7.Clinical nursingMedium
A patient with anaphylaxis is hypotensive but has no breathing difficulty. How should they be positioned?
ALying flat, with the legs raised
BStanding up and walking around
CSitting upright with the legs dangling
DLying face down
8.Clinical nursingHard
An older patient's blood pressure is 142/80 mmHg lying and 116/72 mmHg after standing for three minutes, and they feel dizzy. What does this show?
AHypertensive emergency
BWhite coat hypertension
CPostural hypotension
DNormal blood pressure variation
9.Lab values & electrolytesMedium
A patient receives subcutaneous enoxaparin (a low-molecular-weight heparin). Which statement about monitoring is correct?
AThe INR is used to adjust each dose, as with warfarin
BThe aPTT must be checked every 6 hours to adjust the dose
CNo routine aPTT; platelets and kidney function are checked instead
DNo blood tests of any kind are ever needed
10.Lab values & electrolytesHard
A patient has marked generalized edema. Results show heavy proteinuria, serum albumin 1.8 g/dL (18 g/L) and total cholesterol 340 mg/dL (8.8 mmol/L). Which condition fits best?
APrerenal kidney injury
BNephrotic syndrome
CLiver cirrhosis only
DAcute pyelonephritis
11.PharmacologyMedium
Which antihypertensive class can raise blood glucose and uric acid levels, sometimes triggering gout?
AAlpha-1 blockers
BAngiotensin II receptor blockers
CACE inhibitors
DThiazide diuretics
12.PharmacologyHard
Why should a dose never be written as "5.0 mg" on a medication order?
AThe pharmacy cannot supply doses that contain a decimal point
BThe decimal point may be missed, and the dose read as 50 mg
CIt is too precise for most drugs
DIt means the dose must be given five times
13.Med-surg: cardiovascular & respiratoryMedium
Why does a large, rapidly forming pericardial effusion lower the blood pressure?
AIt compresses the heart and stops the ventricles filling
BIt makes the heart muscle contract too strongly and too fast
CIt dilates the arteries throughout the body
DIt causes the aortic valve to leak backwards into the ventricle
14.Med-surg: cardiovascular & respiratoryHard
A patient with severe chronic kidney disease needs therapeutic anticoagulation for a DVT. Why might unfractionated heparin be chosen instead of a low-molecular-weight heparin?
AUnfractionated heparin has no bleeding risk at all
BLMWH is cleared by the kidneys and can accumulate
CLMWH cannot be given to anyone over 60
DUnfractionated heparin is taken by mouth
15.Med-surg: neuro, endocrine & renalMedium
A woman who takes the combined contraceptive pill is starting carbamazepine. What should she be taught?
ACarbamazepine can make the pill less effective, so other contraception is needed
BThe pill makes carbamazepine toxic, so she must stop the pill
CThere is no interaction between these two medicines
DShe should take both at the same time so they are absorbed together
16.Med-surg: neuro, endocrine & renalHard
A patient is being assessed for brain death (brainstem death). Which condition must be excluded before testing?
AA haemoglobin of 110 g/L (11 g/dL)
BA history of high blood pressure
CA previous episode of migraine
DEffects of sedative drugs or severe hypothermia
17.Med-surg: GI, perioperative & oncologyMedium
A patient with an ileal conduit (urostomy) is worried about mucus in the urine. What is the correct explanation?
AIt is a sign of a kidney stone and must be reported today
BIt is normal, as the conduit is made from small bowel
CIt means the stoma is failing and needs surgery
DIt shows a bowel obstruction is developing
18.Med-surg: GI, perioperative & oncologyHard
A patient who had a coronary stent placed two months ago, on aspirin and clopidogrel, presents with melaena and is now stable. What is the most appropriate approach to the antiplatelet drugs?
ADouble both doses, because bleeding means the stent is at greater risk of clotting
BContinue both drugs unchanged and do not mention the bleeding to the team
CStop both drugs permanently, because any bleeding means they are no longer safe
DReport the bleed; the team decides with cardiology input, balancing bleeding against stent thrombosis
19.Maternity & obstetric nursingMedium
Which behaviour shows positive early bonding between mother and newborn?
AAsking staff to keep the baby in the nursery at all times
BFace-to-face eye contact and talking to the baby
CAvoiding holding the baby during the first day
DCalling the baby "it" and not looking at it
20.Maternity & obstetric nursingHard
Which finding is a sign that the placenta is separating in the third stage of labour?
AThe uterus becomes soft and wide
BA gush of blood and lengthening of the cord
CImmediate fall in maternal blood pressure
DSudden severe abdominal pain
21.Pediatric nursingMedium
How are feeds usually restarted after a pyloromyotomy for pyloric stenosis?
AWithin hours, increasing gradually as per protocol; some vomiting can be expected
BOnly by nasogastric tube for the first month at home
CWith large, full-volume feeds straight away to make up for the weight lost
DNot until 10 days after surgery, when the wound has healed
22.Pediatric nursingHard
A 4-month-old is brought in drowsy and vomiting, with no visible injuries. Retinal haemorrhages are found. What should the nurse suspect?
AAbusive head trauma
BMigraine
CViral gastroenteritis
DNormal newborn retinal changes
23.Mental health nursingMedium
Which item is part of a safety plan for a person experiencing domestic violence?
AKeeping all important documents in the shared house
BAvoiding contact with friends and support services so as not to provoke him
CKeeping an emergency bag with documents, money and keys somewhere safe
DTelling the abuser about plans to leave so that he can prepare
24.Mental health nursingHard
A nurse realises she has given a patient another patient's olanzapine dose. What should she do first?
AAssess the patient, including his vital signs and level of sedation
BSay nothing, because one dose will not cause harm
CFill in an incident report before checking the patient
DGive the patient his own prescribed medicine as well, to stay on schedule
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 15:15 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.
15:15
13:15 AM
23:15 PM
35:15 PM
42:15 PM
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 17:05 and finishes at 01:40 the next morning (24-hour clock). How many minutes t did it run?
17:0501:40
t = min
27.Dosage calculationsMedium
A patient weighs 12 kg and is prescribed 20 mg/kg as a single dose. Find the dose D in mg.
12 kg20 mg/kg
D = mg
28.Dosage calculationsHard
A child weighing 14 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 200 mg in 5 mL. What volume V do you give?
14 kg10 mg/kg200 mg/5 mL
V = mL
29.IV infusion ratesMedium
Infuse 1000 mL over 2 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
1000 mL2 h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
1500 mL was ordered over 10 hours. After 7 hours you find that 510 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?
1500 mL / 10 hafter 7 h: 510 mL
Δ = %
31.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL. Count ice chips as half their volume.
milk: 200 mLsoup: 180 mLice chips: 240 mLIV infusion: 80 mL/h × 8 hIV antibiotic: 2 × 100 mL
I = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 500 mL bag was started at 13:15 and runs by pump at 80 mL/h. How many mL V are left in the bag at 17:45?
500 mL80 mL/h13:15 → 17:45
V = mL
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: yes; secondary diagnosis: yes; ambulatory aid: holds on to furniture; IV therapy or saline lock: no; gait: normal, bed rest or wheelchair; mental status: overestimates or forgets limits. Find the Morse total MFS.
0–125
MFS =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). At 1 minute after birth, a practice newborn has blue or pale skin all over, no heartbeat, no response to stimulation, limp limbs with no muscle tone and no breathing. Score the APGAR and click how the score is interpreted.
1reassuring
2moderately abnormal
3low
3Solutions
1.Nursing fundamentals
Answer: B · They can affect pulse oximetry and checking skin colour
Why this is the answer
Dark varnish or false nails can block the oximeter's light and hide nail-bed colour. Clear access to the nails helps monitor oxygenation and circulation.
Answer
B · They can affect pulse oximetry and checking skin colour
2.Nursing fundamentals
Answer: C · Encourage deep breathing, coughing and getting out of bed
Why this is the answer
These signs suggest atelectasis or early chest infection. Deep breathing, coughing, adequate pain relief and mobilisation help re-expand the lungs.
Answer
C · Encourage deep breathing, coughing and getting out of bed
3.Infection control & patient safety
Answer: B · Discard it, because its contents cannot be confirmed
Why this is the answer
An unlabeled syringe could contain any drug or dose. It is discarded, and syringes are labeled straight away whenever they are not given immediately.
Answer
B · Discard it, because its contents cannot be confirmed
4.Infection control & patient safety
Answer: A · Report it and fix the system, for example by separating the vials
Why this is the answer
A just culture recognizes that human errors are often caused by system design. Separating look-alike drugs, using labels and Tall Man lettering prevents repeats. Blaming the person alone leaves the hazard in place.
Answer
A · Report it and fix the system, for example by separating the vials
5.Prioritization & delegation
Answer: C · Right person
Why this is the answer
Right person means the delegate has the training and competence for the task. Using a lift is normally a delegable task, but not to someone who has not been trained. The nurse should arrange training or do the task with help.
Answer
C · Right person
6.Prioritization & delegation
Answer: B · An LPN/LVN is assigned to admit a new patient from the emergency department
Why this is the answer
Admitting a new patient includes the initial assessment and plan of care, which belong to the RN. The other assignments match each staff member’s role.
Answer
B · An LPN/LVN is assigned to admit a new patient from the emergency department
7.Clinical nursing
Answer: A · Lying flat, with the legs raised
Why this is the answer
Lying flat with the legs raised supports circulation in anaphylactic shock. Patients with breathing difficulty may prefer to sit up, but should not stand or walk, as this can cause collapse.
Answer
A · Lying flat, with the legs raised
8.Clinical nursing
Answer: C · Postural hypotension
Why this is the answer
A fall in systolic pressure of 20 mmHg or more (here 26 mmHg) on standing, especially with symptoms, indicates postural hypotension. Causes include medicines, dehydration and autonomic problems.
Answer
C · Postural hypotension
9.Lab values & electrolytes
Answer: C · No routine aPTT; platelets and kidney function are checked instead
Why this is the answer
Enoxaparin has a predictable effect, so the aPTT is not used to monitor it. Platelet counts help detect heparin-induced thrombocytopenia, and kidney function matters because the drug is cleared by the kidneys. Anti-Xa levels may be used in pregnancy, obesity or kidney disease.
Answer
C · No routine aPTT; platelets and kidney function are checked instead
10.Lab values & electrolytes
Answer: B · Nephrotic syndrome
Why this is the answer
Nephrotic syndrome is heavy proteinuria with low albumin, edema and high lipids. Low albumin reduces oncotic pressure, causing edema, and the liver increases lipoprotein production. There is also a higher risk of clots and infection.Checked against:Nephrotic syndrome · MedlinePlus (NIH) (2025)
Answer
B · Nephrotic syndrome
11.Pharmacology
Answer: D · Thiazide diuretics
Why this is the answer
Thiazide diuretics reduce uric acid excretion and can worsen glucose tolerance. They also cause low potassium and sodium, so electrolytes are monitored.
Answer
D · Thiazide diuretics
12.Pharmacology
Answer: B · The decimal point may be missed, and the dose read as 50 mg
Why this is the answer
Trailing zeros (5.0) and missing leading zeros (.5) are well-known causes of tenfold errors. Safe practice is to write 5 mg and 0.5 mg.
Answer
B · The decimal point may be missed, and the dose read as 50 mg
13.Med-surg: cardiovascular & respiratory
Answer: A · It compresses the heart and stops the ventricles filling
Why this is the answer
The pericardial sac is fairly inelastic, so fluid that collects quickly raises the pressure around the heart. The ventricles cannot fill in diastole, stroke volume falls and the blood pressure drops. This is cardiac tamponade, treated by pericardiocentesis.
Answer
A · It compresses the heart and stops the ventricles filling
14.Med-surg: cardiovascular & respiratory
Answer: B · LMWH is cleared by the kidneys and can accumulate
Why this is the answer
Low-molecular-weight heparins are mainly renally excreted, so they accumulate in severe renal impairment and increase bleeding risk. Unfractionated heparin is cleared mainly by other routes, has a short half-life and can be monitored with aPTT and reversed with protamine.
Answer
B · LMWH is cleared by the kidneys and can accumulate
15.Med-surg: neuro, endocrine & renal
Answer: A · Carbamazepine can make the pill less effective, so other contraception is needed
Why this is the answer
Carbamazepine is a strong liver enzyme inducer, so it lowers hormone levels from the pill and can lead to an unplanned pregnancy. Contraception that is not affected, such as an IUD, is usually advised.
Answer
A · Carbamazepine can make the pill less effective, so other contraception is needed
16.Med-surg: neuro, endocrine & renal
Answer: D · Effects of sedative drugs or severe hypothermia
Why this is the answer
Before brain death (brainstem) testing, reversible causes of coma must be excluded, including sedatives and neuromuscular blockers, hypothermia, and severe metabolic or endocrine disturbance. Only then can absent reflexes be interpreted reliably.
Answer
D · Effects of sedative drugs or severe hypothermia
17.Med-surg: GI, perioperative & oncology
Answer: B · It is normal, as the conduit is made from small bowel
Why this is the answer
An ileal conduit uses a segment of ileum, which continues to produce mucus. Patients are encouraged to drink well to keep the urine flowing. Cloudy, offensive urine with fever, however, suggests infection.
Answer
B · It is normal, as the conduit is made from small bowel
18.Med-surg: GI, perioperative & oncology
Answer: D · Report the bleed; the team decides with cardiology input, balancing bleeding against stent thrombosis
Why this is the answer
Early after coronary stenting, stopping dual antiplatelet therapy carries a high risk of stent thrombosis and MI, while continuing increases bleeding. Decisions are made by the medical team, ideally with cardiology and gastroenterology input; often aspirin is continued and the second agent paused briefly or continued depending on bleeding severity and endoscopic findings.
Answer
D · Report the bleed; the team decides with cardiology input, balancing bleeding against stent thrombosis
19.Maternity & obstetric nursing
Answer: B · Face-to-face eye contact and talking to the baby
Why this is the answer
En face positioning, touching, talking in a high-pitched voice and calling the baby by name are positive bonding behaviours. Persistent avoidance needs further assessment and support.
Answer
B · Face-to-face eye contact and talking to the baby
20.Maternity & obstetric nursing
Answer: B · A gush of blood and lengthening of the cord
Why this is the answer
Signs of placental separation include a gush of blood, lengthening of the cord at the vulva, and a uterus that rises and becomes firm and globular. Severe pain or collapse suggests a complication such as inversion.
Answer
B · A gush of blood and lengthening of the cord
21.Pediatric nursing
Answer: A · Within hours, increasing gradually as per protocol; some vomiting can be expected
Why this is the answer
After pyloromyotomy, feeding normally restarts within hours and is increased to full feeds as tolerated. Mild vomiting in the first day is common; the nurse monitors intake, weight and the wound.
Answer
A · Within hours, increasing gradually as per protocol; some vomiting can be expected
22.Pediatric nursing
Answer: A · Abusive head trauma
Why this is the answer
Abusive head trauma (shaken baby syndrome) often shows subdural haemorrhage and retinal haemorrhages with few external injuries. The infant needs urgent medical care, and the nurse follows the safeguarding procedure.
Answer
A · Abusive head trauma
23.Mental health nursing
Answer: C · Keeping an emergency bag with documents, money and keys somewhere safe
Why this is the answer
A safety plan includes an escape bag, important documents, a safe place to go, emergency numbers and a code word with trusted people. The time of leaving can be the most dangerous period.
Answer
C · Keeping an emergency bag with documents, money and keys somewhere safe
24.Mental health nursing
Answer: A · Assess the patient, including his vital signs and level of sedation
Why this is the answer
After a medicine error, the first step is to assess and monitor the patient for any effects. The nurse then informs the prescriber and the nurse in charge, follows instructions, documents and reports the incident.
Answer
A · Assess the patient, including his vital signs and level of sedation
25.Nursing math & unit conversions
Answer: 3:15 PM
24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.
Convert the hour
15 − 12 = 3 → PM
Answer
3:15 PM
Answer
3:15 PM
26.Nursing math & unit conversions
Answer: t = 515 min
24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.
Before midnight
17:05 → 24:00 = 415 min
After midnight
00:00 → 01:40 = 100 min
Total
t = 415 + 100 = 515 min
Answer
t = 515 min
27.Dosage calculations
Answer: D = 240 mg
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Dose
20·12 = 240 mg
Answer
D = 240 mg
28.Dosage calculations
Answer: V = 3.5 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.
Dose from weight
10·14 = 140 mg
Volume
V = (140/200)·5 = 3.5 mL
Answer
V = 3.5 mL
29.IV infusion rates
Answer: R = 83 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 = 1000·10/120 = 83.33 ≈ 83 gtt/min
Answer
R = 83 gtt/min
At the bedside you round to the nearest whole drop: 83 gtt/min.
30.IV infusion rates
Answer: Δ = 13.33 %
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Original rate
1500/10 = 150 mL/h
New rate
R = 510/3 = 170 mL/h
Percentage change
Δ = (170 − 150)/150·100% = 13.33%
Answer
Δ = 13.33%
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
31.IV fluids & fluid balance
Answer: I = 1340 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 + 180 = 380 mL
ice chips: 240/2 = 120 mL
IV infusion: 80·8 = 640 mL
IV antibiotic: 2·100 = 200 mL
I = 1340 mL
Answer
I = 1340 mL
32.IV fluids & fluid balance
Answer: V = 140 mL
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.
Elapsed time
13:15 → 17:45 = 4.5 h
Volume infused
80·4.5 = 360 mL
Volume left
V = 500 − 360 = 140 mL
Answer
V = 140 mL
33.Clinical assessment scores
Answer: MFS = 85
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: yes → 25
secondary diagnosis: yes → 15
ambulatory aid: holds on to furniture → 30
IV therapy or saline lock: no → 0
gait: normal, bed rest or wheelchair → 0
mental status: overestimates or forgets limits → 15
Add
Morse total = 25 + 15 + 30 + 0 + 0 + 15 = 85
Answer
MFS = 85
34.Clinical assessment scores
Answer: low
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: blue or pale skin all over → 0
Pulse: 0 → 0
Grimace: no response to stimulation → 0
Activity: limp limbs with no muscle tone → 0
Respiration: no breathing → 0
Add
APGAR = 0 + 0 + 0 + 0 + 0 = 0
Interpretation
0 → low
Answer
low
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