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
In adult basic life support, how long should the rescuer take to check for normal breathing?
ANo more than 10 seconds
BAbout 30 seconds
CAt least one minute
DAs long as it takes to be certain
2.Nursing fundamentalsHard
A patient standing for the first time after surgery becomes pale, sweaty and dizzy. What should the nurse do first?
AEncourage the patient to keep walking to build strength
BHelp the patient sit or lie down safely
CGive the patient a sugary drink while standing
DLeave the patient standing and fetch the blood pressure machine
3.Infection control & patient safetyMedium
Which practice makes shift handoff safer?
AGiving handoff in a busy corridor so that the outgoing nurse can leave on time
BUsing a standard format such as SBAR or I-PASS, with time for questions
CGiving handoff from memory without any structure
DLeaving written notes only, without a chance for questions
4.Infection control & patient safetyHard
A nurse finds an unknown liquid leaking from a container in the utility room, with a strong smell. What should the nurse do first?
AMove closer and smell it carefully to identify what the substance is
BPour water over it to dilute it
CMop it up with paper towels
DLeave the area, keep others out and alert the trained response team
5.Prioritization & delegationMedium
A woman calls to say her husband suddenly has a drooping face and slurred speech. What should the nurse advise?
ADrive him to the hospital yourself after he has eaten dinner
BCall emergency services now and note the time it started
CLet him lie down and see if it improves
DBook an appointment with his doctor next week
6.Prioritization & delegationHard
An adult choking on food is coughing forcefully and can speak a little. What should the nurse do?
AGive the patient water to wash the food down
BSweep the mouth blindly with a finger
CEncourage the patient to keep coughing and stay with them
DGive abdominal thrusts straight away until the food comes out
7.Clinical nursingMedium
Which observation is most important after giving a patient a first dose of a new antibiotic intravenously?
AWhether their hair loss increases
BTheir appetite at the next meal
CHow much they walk that day
DSigns of an allergic reaction such as rash, wheeze or swelling
8.Clinical nursingHard
During a general anaesthetic, a patient develops a rapidly rising temperature, muscle rigidity and rising carbon dioxide levels. What should be suspected?
AA normal response to surgery
BMalignant hyperthermia
CPostoperative infection
DNeuroleptic malignant syndrome from antipsychotics
9.Lab values & electrolytesMedium
A patient with hyperkalemia is prescribed an oral potassium binder such as patiromer or sodium zirconium cyclosilicate. How does this drug lower potassium?
AIt protects the heart muscle against high potassium levels
BIt stops the kidneys from absorbing water in the tubules
CIt binds potassium in the gut so it leaves in the stool
DIt moves potassium into cells in the next few minutes
10.Lab values & electrolytesHard
Which patient should the nurse assess first?
AHypertension with a potassium of 3.6 mEq/L on a thiazide
BChest pain with troponin rising from the first to the second sample
CHeart failure with a BNP lower than the result on admission
DStable angina with a total cholesterol of 245 mg/dL (6.3 mmol/L)
11.PharmacologyMedium
After instilling eye drops, why should the patient press gently on the inner corner of the eye for a minute or two?
ATo stop the eye from producing tears for about an hour
BTo spread the drop evenly over the eyelid
CTo reduce drainage into the nose and absorption into blood
DTo make the pupil dilate faster
12.PharmacologyHard
A patient taking co-trimoxazole develops fever, a spreading blistering rash and painful mouth sores. What is the most likely diagnosis?
AStevens–Johnson syndrome; stop the drug and get urgent medical care
BOral thrush; start an antifungal and continue the antibiotic
CSunburn caused by the drug; advise sunscreen only
DA mild rash that will settle; continue the drug and give moisturiser
13.Med-surg: cardiovascular & respiratoryMedium
What is the purpose of cardiac resynchronisation therapy (a biventricular pacemaker)?
ATo make both ventricles contract together and more efficiently
BTo deliver a shock whenever the heart rate exceeds 100/min
CTo slow the atrial rate in patients with atrial fibrillation
DTo replace a damaged heart valve
14.Med-surg: cardiovascular & respiratoryHard
After intubation, breath sounds are heard on the right side of the chest but not the left. What is the most likely cause?
AThe left lung has completely filled with fluid
BThe tube has entered the oesophagus
CThe tube has entered the right main bronchus
DThe tube cuff has burst during insertion
15.Med-surg: neuro, endocrine & renalMedium
Why is an ACE inhibitor often given to a patient with diabetes and albumin in the urine?
AIt lowers the blood glucose to normal
BIt protects the kidneys and reduces albumin loss
CIt stops the kidneys from passing so much urine at night
DIt raises potassium to protect the heart
16.Med-surg: neuro, endocrine & renalHard
Which of these patients with acute ischaemic stroke is least likely to be eligible for IV thrombolysis?
AA patient whose blood pressure is 170/95 mmHg
BA patient who had major abdominal surgery five days ago
CA patient whose symptoms began 90 minutes ago
DA patient whose CT scan shows no sign of any intracranial bleeding
17.Med-surg: GI, perioperative & oncologyMedium
Which rule about the sterile field is correct?
AIf sterility is in doubt, the item is treated as contaminated
BSterile items can be passed across a non-sterile area freely
CA sterile pack stays sterile even when it is wet
DThe area below a gowned person's waist is sterile
18.Med-surg: GI, perioperative & oncologyHard
On day 5 after bowel resection, a patient has a fever, tachycardia and worsening abdominal pain, and the drain contains brown, faeculent fluid. What is most likely?
APostoperative constipation
BAn anastomotic leak
CA normal day 5 recovery
DA urinary tract infection
19.Maternity & obstetric nursingMedium
Which feature best distinguishes true labour from false labour?
AContractions that stop when the woman walks around
BContractions that are felt only in the lower abdomen
CDiscomfort that eases with a warm bath and rest
DProgressive dilation and effacement of the cervix
20.Maternity & obstetric nursingHard
A nurse is teaching a mother how to prevent shaken baby syndrome. Which statement shows a need for further teaching?
A"Crying often increases in the first weeks, and that can be normal."
B"If I get too frustrated, I will put him in his cot and step away for a few minutes."
C"I can call someone to help when I feel overwhelmed."
D"If I feel very angry, it is fine to shake him a little to stop the crying."
21.Pediatric nursingMedium
At about what age does a pincer grasp (picking up small objects between thumb and index finger) typically develop?
AAbout 3 months
BAbout 9 to 10 months
CAbout 2 years
DAbout 18 months
22.Pediatric nursingHard
A child has had many hospital admissions with unexplained symptoms. They occur only when the mother is present and stop when the child is apart from her. What should the nurse consider?
AA rare genetic disorder that needs more tests at once
BFabricated or induced illness; follow safeguarding procedures
CThe ward environment or hospital food is causing the symptoms
DThe child is pretending to be ill to avoid school
23.Mental health nursingMedium
How does repetitive transcranial magnetic stimulation (rTMS) differ from ECT?
AIt involves surgically implanting electrodes deep in the brain under anaesthetic
BIt needs a general anaesthetic and causes a seizure, like ECT
CIt uses magnetic pulses on the scalp while the patient is awake, without causing a seizure
DIt is given as a daily tablet that contains tiny magnetic particles
24.Mental health nursingHard
A patient on olanzapine has gained 8 kg in 3 months and reports thirst and passing urine frequently. What should the nurse do?
AStop the olanzapine straight away without telling the prescriber
BArrange a blood glucose test and inform the prescriber
CAdvise him to drink less water
DReassure him that this is unrelated to the drug
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 37.6 °C. Convert it to degrees Fahrenheit T with °F = °C × 9/5 + 32. Round to one decimal place.
37.6 °C
T = °F
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A haemoglobin result is 141 g/L. Express it in g/dL Hb.
141 g/L1 L = 10 dL
Hb = g/dL
27.Dosage calculationsMedium
A patient weighing 44 kg has a body surface area of 1.21 m². The prescription is 250 mg/m². Find the dose D in mg.
44 kgBSA = 1.21 m²250 mg/m²
D = mg
28.Dosage calculationsHard
The prescription is 0.71 mg. The ampoule contains 1000 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
0.71 mg1000 mcg/mL
V = mL
29.IV infusion ratesMedium
Infuse 500 mL over 8 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
500 mL8 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 400 mg of a drug in 50 mL and runs at 5 mL/h. How many milligrams per hour D does the patient receive?
400 mg/50 mL5 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 500 mL bag runs by pump at 100 mL/h. At 21:00, 250 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL250 mL infused100 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 136/min and a blood pressure of 141/78 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.
HR 136/minBP 141/78 mmHg
SI =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 20/min, SpO₂ 98% on room air, blood pressure 150/90 mmHg, pulse 82/min, alert, temperature 34.8 °C. Which clinical risk group does the patient fall into? Click it.
RR 20SpO₂ 98%airSBP 150HR 82AT 34.8 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: A · No more than 10 seconds
Why this is the answer
Rescuers look, listen and feel for normal breathing for no more than 10 seconds. If breathing is absent or not normal, they call for help and start CPR.
Answer
A · No more than 10 seconds
2.Nursing fundamentals
Answer: B · Help the patient sit or lie down safely
Why this is the answer
These signs suggest postural hypotension and a risk of fainting. The nurse lowers the patient safely first, then checks blood pressure and pulse and reports the finding.
Answer
B · Help the patient sit or lie down safely
3.Infection control & patient safety
Answer: B · Using a standard format such as SBAR or I-PASS, with time for questions
Why this is the answer
Many errors happen at transitions of care. A structured handoff with an opportunity to ask questions, ideally at the bedside, reduces missed information.
Answer
B · Using a standard format such as SBAR or I-PASS, with time for questions
4.Infection control & patient safety
Answer: D · Leave the area, keep others out and alert the trained response team
Why this is the answer
An unknown chemical spill may be toxic or flammable. The nurse moves people away, prevents entry and calls the designated hazardous materials team, who check the Safety Data Sheet and use the right equipment.
Answer
D · Leave the area, keep others out and alert the trained response team
5.Prioritization & delegation
Answer: B · Call emergency services now and note the time it started
Why this is the answer
Stroke is time-critical. Emergency services can begin assessment on the way and take the patient to a stroke center; the time of onset guides treatment.
Answer
B · Call emergency services now and note the time it started
6.Prioritization & delegation
Answer: C · Encourage the patient to keep coughing and stay with them
Why this is the answer
A partial obstruction with a forceful cough is best cleared by the patient’s own coughing. The nurse stays and is ready to act if the cough becomes weak or the patient cannot speak or breathe.
Answer
C · Encourage the patient to keep coughing and stay with them
7.Clinical nursing
Answer: D · Signs of an allergic reaction such as rash, wheeze or swelling
Why this is the answer
First doses carry a risk of anaphylaxis. Watch for rash, urticaria, swelling, wheeze, breathlessness and falling blood pressure.
Answer
D · Signs of an allergic reaction such as rash, wheeze or swelling
8.Clinical nursing
Answer: B · Malignant hyperthermia
Why this is the answer
Malignant hyperthermia is a hypermetabolic reaction triggered by volatile anaesthetics or suxamethonium (succinylcholine) in susceptible people. It is treated urgently with dantrolene, cooling and stopping the trigger.
Answer
B · Malignant hyperthermia
9.Lab values & electrolytes
Answer: C · It binds potassium in the gut so it leaves in the stool
Why this is the answer
Potassium binders exchange potassium in the gut for another ion, so potassium is removed from the body in the stool. They act over hours, so they are not used alone for emergencies; calcium protects the heart, and insulin with glucose shifts potassium into cells quickly.Checked against:High potassium level · MedlinePlus (NIH) (2025)
Answer
C · It binds potassium in the gut so it leaves in the stool
10.Lab values & electrolytes
Answer: B · Chest pain with troponin rising from the first to the second sample
Why this is the answer
A rising troponin with chest pain indicates acute myocardial injury, possibly infarction, which needs urgent assessment and treatment. High cholesterol is a long-term risk, a falling BNP shows improvement, and a potassium of 3.6 mEq/L is normal.Checked against:Troponin Test · MedlinePlus (NIH) (2023)
Answer
B · Chest pain with troponin rising from the first to the second sample
11.Pharmacology
Answer: C · To reduce drainage into the nose and absorption into blood
Why this is the answer
Nasolacrimal occlusion keeps the drop in the eye longer and reduces systemic absorption through the nasal mucosa. This matters for drugs such as timolol, which can cause bradycardia or bronchospasm.
Answer
C · To reduce drainage into the nose and absorption into blood
12.Pharmacology
Answer: A · Stevens–Johnson syndrome; stop the drug and get urgent medical care
Why this is the answer
Stevens–Johnson syndrome is a severe drug reaction with skin blistering and mucosal involvement. Sulfonamides are a common cause, and the drug must be stopped immediately.
Answer
A · Stevens–Johnson syndrome; stop the drug and get urgent medical care
13.Med-surg: cardiovascular & respiratory
Answer: A · To make both ventricles contract together and more efficiently
Why this is the answer
In heart failure with a wide QRS (often left bundle branch block), the ventricles contract out of step. Pacing both ventricles restores coordinated contraction, improving symptoms and survival. Many devices also include a defibrillator.
Answer
A · To make both ventricles contract together and more efficiently
14.Med-surg: cardiovascular & respiratory
Answer: C · The tube has entered the right main bronchus
Why this is the answer
The right main bronchus is more in line with the trachea, so a tube pushed too far usually enters it and only the right lung is ventilated. The tube is withdrawn slightly by the team and position is rechecked. Oesophageal intubation gives no breath sounds and gastric gurgling.
Answer
C · The tube has entered the right main bronchus
15.Med-surg: neuro, endocrine & renal
Answer: B · It protects the kidneys and reduces albumin loss
Why this is the answer
ACE inhibitors and ARBs reduce glomerular pressure, lower albuminuria and slow the progression of diabetic kidney disease, as well as treating blood pressure. Potassium and creatinine are checked after starting them.
Answer
B · It protects the kidneys and reduces albumin loss
16.Med-surg: neuro, endocrine & renal
Answer: B · A patient who had major abdominal surgery five days ago
Why this is the answer
Recent major surgery (within roughly 14 days in many guidelines) greatly increases the bleeding risk and is a contraindication to thrombolysis. Onset within 4.5 hours, a blood pressure below 185/110 mmHg and a CT without haemorrhage are conditions that permit it.
Answer
B · A patient who had major abdominal surgery five days ago
17.Med-surg: GI, perioperative & oncology
Answer: A · If sterility is in doubt, the item is treated as contaminated
Why this is the answer
Sterile technique treats any doubtful item as contaminated. A gown is sterile only from chest to waist in front, and wet packaging can let microorganisms through.
Answer
A · If sterility is in doubt, the item is treated as contaminated
18.Med-surg: GI, perioperative & oncology
Answer: B · An anastomotic leak
Why this is the answer
Leakage at the join in the bowel causes peritonitis and sepsis, usually a few days after surgery. Faeculent drain fluid makes it very likely. It needs urgent surgical review, sepsis care and often return to theatre.
Answer
B · An anastomotic leak
19.Maternity & obstetric nursing
Answer: D · Progressive dilation and effacement of the cervix
Why this is the answer
True labour causes progressive cervical change. Its contractions become regular, stronger and closer and do not stop with rest or walking. False labour contractions are irregular and ease with rest or position change.
Answer
D · Progressive dilation and effacement of the cervix
20.Maternity & obstetric nursing
Answer: D · "If I feel very angry, it is fine to shake him a little to stop the crying."
Why this is the answer
Shaking a baby can cause brain injury, retinal haemorrhages and death. Parents are taught that crying is normal, to put the baby down safely and step away when frustrated, and to ask for help.
Answer
D · "If I feel very angry, it is fine to shake him a little to stop the crying."
21.Pediatric nursing
Answer: B · About 9 to 10 months
Why this is the answer
A pincer grasp typically appears at about 9–10 months and becomes a neat, refined pincer by about 12 months. It is also why small objects become a choking risk at this age.
Answer
B · About 9 to 10 months
22.Pediatric nursing
Answer: B · Fabricated or induced illness; follow safeguarding procedures
Why this is the answer
Fabricated or induced illness (formerly Munchausen syndrome by proxy) is a form of abuse in which a carer invents or causes illness. Careful objective documentation and early involvement of the safeguarding team are essential; the carer should not be confronted alone.
Answer
B · Fabricated or induced illness; follow safeguarding procedures
23.Mental health nursing
Answer: C · It uses magnetic pulses on the scalp while the patient is awake, without causing a seizure
Why this is the answer
rTMS stimulates specific brain areas with a magnetic coil held on the head. It does not need anaesthesia or cause a seizure and is used for depression that has not responded to medicines.
Answer
C · It uses magnetic pulses on the scalp while the patient is awake, without causing a seizure
24.Mental health nursing
Answer: B · Arrange a blood glucose test and inform the prescriber
Why this is the answer
Olanzapine can cause weight gain, insulin resistance and new diabetes. Thirst and polyuria suggest hyperglycaemia, so glucose is checked and the prescriber reviews the treatment.
Answer
B · Arrange a blood glucose test and inform the prescriber
25.Nursing math & unit conversions
Answer: T = 99.7 °F
Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.
Multiply by 9/5
37.6·9/5 = 67.68
Add 32
T = 67.68 + 32 = 99.68 ≈ 99.7 °F
Answer
T = 99.7 °F
26.Nursing math & unit conversions
Answer: Hb = 14.1 g/dL
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.
Convert
Hb = 141 g/L × (1 L/10 dL) = 14.1 g/dL
Answer
Hb = 14.1 g/dL
27.Dosage calculations
Answer: D = 302.5 mg
Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).
Dose
D = 250·1.21 = 302.5 mg
Answer
D = 302.5 mg
28.Dosage calculations
Answer: V = 0.71 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.
Same units
0.71 mg = 710 mcg
Volume
V = 710/1000 = 0.71 mL
Answer
V = 0.71 mL
29.IV infusion rates
Answer: R = 16 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
8·60 = 480 min
Drip rate
R = 500·15/480 = 15.63 ≈ 16 gtt/min
Answer
R = 16 gtt/min
At the bedside you round to the nearest whole drop: 16 gtt/min.
30.IV infusion rates
Answer: D = 40 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
400/50 = 8 mg/mL
Dose rate
D = 8·5 = 40 mg/h
Answer
D = 40 mg/h
31.IV fluids & fluid balance
Answer: B = 615 mL
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Total intake
oral: 100 + 200 + 250 = 550 mL
IV infusion: 80·8 = 640 mL
IV antibiotic: 2·100 = 200 mL
total intake = 1390 mL
Total output
500 + 275 = 775 mL
Balance
B = 1390 − 775 = 615 mL
Answer
B = 615 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: t = 2.5 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Volume left
500 − 250 = 250 mL
Time
t = 250/100 = 2.5 h
Answer
t = 2.5 h
That is about 2 h 30 min, so the bag runs out at about 23:30.
33.Clinical assessment scores
Answer: SI = 0.96
Blood pressure values: pulse pressure PP = SBP − DBP. Mean arterial pressure MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3, an estimate based on the heart spending about two thirds of each beat in diastole at a normal heart rate (less accurate when the heart rate is fast); a MAP of at least about 65 mmHg is a common target for organ perfusion. The shock index SI = heart rate/SBP is normally about 0.5–0.7; a value above about 1 is a warning sign of shock.
Shock index
SI = 136/141 = 0.9645 ≈ 0.96
Answer
SI = 0.96
Above the usual 0.5–0.7.
34.Clinical assessment scores
Answer: low–medium
NEWS2 (National Early Warning Score 2, Royal College of Physicians 2017): score each of the seven parameters with the chart (respiration rate, SpO₂ on scale 1, air or supplemental oxygen, systolic blood pressure, pulse, consciousness on the ACVPU scale and temperature) and add the scores. Clinical risk: 0–4 low; a score of 3 in any single parameter low–medium; 5–6 medium; 7 or more high. A total of 5 or more needs an urgent response.
Score each parameter
RR 20/min → 0
SpO₂ 98% → 0
on air → 0
SBP 150 mmHg → 0
HR 82/min → 0
alert (A) → 0
T 34.8 °C → 3
Total and red scores
NEWS2 = 0 + 0 + 0 + 0 + 0 + 0 + 3 = 3
At least one parameter scores 3.
Risk group
low–medium
Answer
low–medium
A single score of 3 needs an urgent review even when the total is low.
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