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
Under the Mental Capacity Act 2005 (England and Wales), what is the starting assumption about an adult's capacity?
AOlder adults are assumed to lack capacity
BCapacity is assumed only if a relative agrees
CThe adult has capacity unless it is shown that they lack it
DThe adult lacks capacity until a doctor has formally confirmed otherwise
2.Nursing fundamentalsHard
A patient with severe anaemia has an SpO₂ of 98%. Why can this reading be misleading?
AAnaemia damages the light sensor of the oximeter
BAnaemia makes the oximeter read about 10% higher than the true saturation
CPatients with anaemia always have a low true saturation
DThe red cells present are saturated, but the blood carries little oxygen
3.Infection control & patient safetyMedium
A patient is on a ventilator. Which bed position helps to prevent ventilator-associated pneumonia?
AHead of the bed raised about 10 degrees
BTrendelenburg position
CHead of the bed raised 30 to 45 degrees
DLying completely flat
4.Infection control & patient safetyHard
A conscious patient who is at risk of choking is being given oral medicines. Which practice is safest?
ASit the patient upright and give one tablet at a time
BLay the patient flat on the back to make swallowing easier
CGive all the tablets together to save time
DCrush all the tablets without checking whether this is allowed
5.Prioritization & delegationMedium
A charge nurse needs to free a bed. Which patient is most appropriate for discharge or transfer to a lower level of care?
ADay 3 after uncomplicated appendectomy, eating, on oral analgesia
BPneumonia, with an oxygen need that rose overnight from 2 to 4 L/min
CDay 1 after bowel surgery with a new temperature of 38.5 °C
DAdmitted two hours ago with chest pain; troponin result still pending
6.Prioritization & delegationHard
A trauma patient has an open leg fracture, absent breath sounds on one side, a trachea shifted to the other side and a falling blood pressure. Which problem is the priority?
AThe open fracture of the leg
BThe pain from the fracture
CThe risk of wound infection
DThe suspected tension pneumothorax
7.Clinical nursingMedium
Which drug is used to reverse unfractionated heparin?
ANaloxone
BProtamine sulfate
CFlumazenil
DVitamin K (phytomenadione)
8.Clinical nursingHard
A dying patient has noisy, rattling breathing caused by secretions in the throat and is unconscious. Which approach is appropriate?
ABegin rapid intravenous fluids to thin and clear the secretions
BReposition, consider prescribed antisecretory drugs and support the family
CTell the family that the patient is suffocating and needs ventilation
DStart deep oropharyngeal suctioning every 10 minutes through the night
9.Lab values & electrolytesMedium
Why can a patient with liver failure have a raised INR without taking warfarin?
AThe liver makes most clotting factors, so production falls
BBilirubin directly destroys the clotting factors
CThe kidneys stop clearing the clotting factors from the blood
DAlbumin is a clotting factor, and its level falls
10.Lab values & electrolytesHard
A patient with alcohol use disorder has a potassium of 3.0 mEq/L despite two days of replacement. The magnesium is 0.9 mEq/L. What is the most appropriate next step?
AReplace the magnesium; low magnesium keeps the kidneys losing potassium
BStop all electrolyte replacement for 24 hours and recheck
CGive a diuretic to remove the excess magnesium
DDouble the potassium dose and leave the magnesium for later
11.PharmacologyMedium
How does heparin produce its anticoagulant effect?
AIt irreversibly inhibits platelet COX-1
BIt blocks the vitamin K-dependent synthesis of clotting factors in the liver
CIt enhances antithrombin, which inactivates thrombin and factor Xa
DIt breaks down fibrin in existing clots
12.PharmacologyHard
A patient took a large paracetamol (acetaminophen) overdose 6 hours ago and feels well. Why is treatment still urgent?
AParacetamol overdose only causes harm if symptoms start in the first hour
BThe drug will cause kidney stones within a few hours
CLiver damage appears 1–3 days later, and early treatment works best
DThe patient is at risk of immediate respiratory arrest
13.Med-surg: cardiovascular & respiratoryMedium
Why is aspirin chewed rather than swallowed whole in a suspected acute coronary syndrome?
AChewing stops the aspirin from irritating the lining of the stomach
BWhole aspirin tablets cannot be absorbed at all from the gut
CChewing speeds absorption, giving a faster antiplatelet effect
DChewing changes aspirin into an anticoagulant
14.Med-surg: cardiovascular & respiratoryHard
A patient's blood gas shows pH 7.26, PaCO₂ 9.0 kPa (68 mmHg) and bicarbonate 25 mmol/L. What does this show?
AMetabolic acidosis with compensation
BAcute respiratory acidosis
CRespiratory alkalosis
DMetabolic alkalosis
15.Med-surg: neuro, endocrine & renalMedium
A week after thyroid surgery, a patient's voice is still hoarse and weak. Which complication is most likely?
AAn allergic reaction to the adhesive dressing tape
BLow calcium from parathyroid injury
CA thyroid storm caused by surgery
DDamage to a recurrent laryngeal nerve
16.Med-surg: neuro, endocrine & renalHard
After a total thyroidectomy, a patient becomes anxious with stridor and a tense swelling in the neck. What should the nurse do first?
AGive analgesia and reassess the swelling again in an hour
BAsk the patient to talk as much as possible to test the voice
CApply an ice pack to the neck and lie the patient flat
DCall for emergency help: a haematoma may compress the airway
17.Med-surg: GI, perioperative & oncologyMedium
A patient with a new ileostomy has a very high output. What is the main risk?
AConstipation and faecal impaction in the bowel above the stoma
BFluid overload and swelling of the ankles
CHigh calcium and kidney stones within days
DDehydration and loss of sodium, potassium and magnesium
18.Med-surg: GI, perioperative & oncologyHard
A patient with cirrhosis and ascites has a new fever, abdominal tenderness and worsening confusion. Which complication should be suspected?
ANormal progression of ascites
BSpontaneous bacterial peritonitis
CSimple constipation
DAcute pancreatitis
19.Maternity & obstetric nursingMedium
A woman is prescribed low molecular weight heparin after a caesarean. Which teaching is correct?
AIt is given into the muscle of the thigh
BIt is injected under the skin; report unusual bleeding
CIt is a tablet taken with meals
DIt must be stopped if she chooses to breastfeed her baby
20.Maternity & obstetric nursingHard
A labouring woman has a temperature of 38.5 °C (101.3 °F), and the fetal baseline has risen from 140 to 170 bpm over the last hour. What is the most likely explanation?
AReassuring fetal response to contractions
BFetal tachycardia due to maternal fever or infection
CFetal tachycardia due to a maternal opioid
DFetal head compression
21.Pediatric nursingMedium
How should the nurse position the ear when giving ear drops to a 2-year-old?
APull the pinna gently down and back
BLeave the pinna alone and tilt the head
CPull the pinna gently up and back
DPull the earlobe gently forward and up
22.Pediatric nursingHard
Which finding in a child with a ventriculoperitoneal shunt requires immediate follow-up?
AA small, soft bump over the valve that is unchanged
BA healed scar along the shunt tract
CNormal appetite and play
DHeadache, repeated vomiting and increasing drowsiness
23.Mental health nursingMedium
Which monitoring is especially important for patients on second-generation antipsychotics such as olanzapine?
AHearing and eyesight only, as these are most affected by the drug
BWeight, waist circumference, blood glucose and lipids
CBone density only
DPlatelet count only
24.Mental health nursingHard
A patient with capacity has signed consent for a course of ECT. After two sessions, she says she wants to stop. What is correct?
AShe can withdraw her consent at any time, and her decision must be respected and reported to the team
BHer signed consent becomes binding after the first session, so the agreed course must now be completed
CShe must complete the course once she has signed
DShe can only stop if her family agrees
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 12:20 AM. Which entry is the same time on the 24-hour clock? Click it.
12:20 AM
100:20
201:20
312:20
424:20
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion delivers 25 mcg/min. Express this dose rate D in mg/h.
25 mcg/min1 h = 60 min1 mg = 1000 mcg
D = mg/h
27.Dosage calculationsMedium
A child weighing 40 kg is prescribed 4 mg/kg of a drug. The stock solution contains 20 mg/mL. Draw up the dose: what volume V do you give?
40 kg4 mg/kg20 mg/mL
V = mL
28.Dosage calculationsHard
The prescription is 2100 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?
2100 units5000 units/mL
V = mL
29.IV infusion ratesMedium
1500 mL was ordered over 6 hours. After 3 hours you find that 960 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?
1500 mL / 6 hafter 3 h: 960 mL
R = mL/h
30.IV infusion ratesHard
1500 mL was ordered over 12 hours. After 5 hours you find that 1080 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 / 12 hafter 5 h: 1080 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 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 infusion starts at 15:30 at 75 mL/h. After 4 hours the rate is changed to 60 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
500 mL75 mL/h · 4 h60 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 54/min and a blood pressure of 117/76 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.
HR 54/minBP 117/76 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 86% on room air, blood pressure 88/52 mmHg, pulse 38/min, responds only to pain, temperature 37.6 °C. Which clinical risk group does the patient fall into? Click it.
RR 20SpO₂ 86%airSBP 88HR 38PT 37.6 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: C · The adult has capacity unless it is shown that they lack it
Why this is the answer
The Act begins with a presumption of capacity. A person is not treated as lacking capacity just because of age, appearance or an unwise decision.
Answer
C · The adult has capacity unless it is shown that they lack it
2.Nursing fundamentals
Answer: D · The red cells present are saturated, but the blood carries little oxygen
Why this is the answer
SpO₂ shows the percentage of haemoglobin that carries oxygen, not how much haemoglobin there is. With very little haemoglobin the oxygen content of the blood can be low despite a normal saturation.
Answer
D · The red cells present are saturated, but the blood carries little oxygen
3.Infection control & patient safety
Answer: C · Head of the bed raised 30 to 45 degrees
Why this is the answer
Raising the head of the bed to 30–45 degrees reduces aspiration of oral and gastric secretions into the lungs. It is part of the usual ventilator care bundle, unless contraindicated.
Answer
C · Head of the bed raised 30 to 45 degrees
4.Infection control & patient safety
Answer: A · Sit the patient upright and give one tablet at a time
Why this is the answer
Upright positioning and giving medicines one at a time reduce choking risk. Crushing is only done when the pharmacy confirms it is safe, because some modified-release and enteric-coated products are dangerous when crushed.
Answer
A · Sit the patient upright and give one tablet at a time
5.Prioritization & delegation
Answer: A · Day 3 after uncomplicated appendectomy, eating, on oral analgesia
Why this is the answer
The appendectomy patient is stable, eating and managing with oral pain relief. A pending troponin, rising oxygen needs and a new fever all mean the patient’s course is not yet clear.
Answer
A · Day 3 after uncomplicated appendectomy, eating, on oral analgesia
6.Prioritization & delegation
Answer: D · The suspected tension pneumothorax
Why this is the answer
A shifted trachea, absent breath sounds and hypotension suggest tension pneumothorax, which threatens breathing and circulation within minutes. The fracture is important, but it comes after the immediate life threat.
Answer
D · The suspected tension pneumothorax
7.Clinical nursing
Answer: B · Protamine sulfate
Why this is the answer
Protamine binds heparin and neutralises it. Vitamin K is used for warfarin.
Answer
B · Protamine sulfate
8.Clinical nursing
Answer: B · Reposition, consider prescribed antisecretory drugs and support the family
Why this is the answer
The "death rattle" is managed by repositioning, mouth care and sometimes drugs that reduce secretions. Explaining it to relatives eases their distress.
Answer
B · Reposition, consider prescribed antisecretory drugs and support the family
9.Lab values & electrolytes
Answer: A · The liver makes most clotting factors, so production falls
Why this is the answer
The liver makes most clotting factors, including the vitamin K–dependent ones. In severe liver disease their production falls, so the INR rises. A raised INR is one of the markers of how severe liver failure is.Checked against:Prothrombin Time Test and INR (PT/INR) · MedlinePlus (NIH) (2024)
Answer
A · The liver makes most clotting factors, so production falls
10.Lab values & electrolytes
Answer: A · Replace the magnesium; low magnesium keeps the kidneys losing potassium
Why this is the answer
Low magnesium makes the kidneys lose potassium, so hypokalemia does not correct until the magnesium is replaced. Both are common in alcohol use disorder.Checked against:Low blood potassium · MedlinePlus (NIH) (2025); Magnesium Blood Test · MedlinePlus (NIH) (2023)
Answer
A · Replace the magnesium; low magnesium keeps the kidneys losing potassium
11.Pharmacology
Answer: C · It enhances antithrombin, which inactivates thrombin and factor Xa
Why this is the answer
Heparin binds antithrombin and greatly accelerates its inactivation of thrombin and factor Xa. Low-molecular-weight heparins act mainly on factor Xa.
Answer
C · It enhances antithrombin, which inactivates thrombin and factor Xa
12.Pharmacology
Answer: C · Liver damage appears 1–3 days later, and early treatment works best
Why this is the answer
Paracetamol overdose often causes few symptoms at first, while the toxic metabolite damages the liver. Liver injury peaks after about 3 days, so the decision to treat is based on the timed blood level, not on symptoms.
Answer
C · Liver damage appears 1–3 days later, and early treatment works best
13.Med-surg: cardiovascular & respiratory
Answer: C · Chewing speeds absorption, giving a faster antiplatelet effect
Why this is the answer
Aspirin irreversibly inhibits platelet cyclo-oxygenase, reducing thromboxane A2 and platelet aggregation. Chewing a non-enteric-coated tablet speeds absorption. It reduces mortality in acute coronary syndromes and is given unless there is a true allergy.
Answer
C · Chewing speeds absorption, giving a faster antiplatelet effect
14.Med-surg: cardiovascular & respiratory
Answer: B · Acute respiratory acidosis
Why this is the answer
A low pH with raised PaCO₂ is respiratory acidosis. A normal bicarbonate (about 22–26 mmol/L) shows the kidneys have not yet compensated, so the problem is acute, as in opioid toxicity, exhaustion or an acute COPD exacerbation. Treatment targets ventilation.
Answer
B · Acute respiratory acidosis
15.Med-surg: neuro, endocrine & renal
Answer: D · Damage to a recurrent laryngeal nerve
Why this is the answer
The recurrent laryngeal nerves run close to the thyroid and supply most of the laryngeal muscles. Injury causes hoarseness; bilateral injury can cause stridor and airway obstruction. Mild hoarseness from intubation usually settles within days. Parathyroid injury causes hypocalcaemia with tingling and cramps.
Answer
D · Damage to a recurrent laryngeal nerve
16.Med-surg: neuro, endocrine & renal
Answer: D · Call for emergency help: a haematoma may compress the airway
Why this is the answer
A rapidly enlarging neck haematoma with stridor is an airway emergency. Urgent help is called; in many units the clips or sutures are removed at the bedside to release the haematoma (following local emergency procedures) before definitive airway management and surgery.
Answer
D · Call for emergency help: a haematoma may compress the airway
17.Med-surg: GI, perioperative & oncology
Answer: D · Dehydration and loss of sodium, potassium and magnesium
Why this is the answer
High-output ileostomies (often defined as over about 1.5–2 L a day) can cause dehydration, acute kidney injury and electrolyte loss. Fluid balance, weight, urine output and electrolytes are monitored. Patients may need oral rehydration solution and drugs to slow output.
Answer
D · Dehydration and loss of sodium, potassium and magnesium
18.Med-surg: GI, perioperative & oncology
Answer: B · Spontaneous bacterial peritonitis
Why this is the answer
Spontaneous bacterial peritonitis is infection of ascitic fluid without an obvious source. It can present with fever, abdominal pain, encephalopathy or kidney injury. A diagnostic ascitic tap (neutrophil count) and prompt antibiotics are needed.
Answer
B · Spontaneous bacterial peritonitis
19.Maternity & obstetric nursing
Answer: B · It is injected under the skin; report unusual bleeding
Why this is the answer
Low molecular weight heparin is given subcutaneously and is compatible with breastfeeding. She should rotate sites, not rub them, and report bleeding or unusual bruising.
Answer
B · It is injected under the skin; report unusual bleeding
20.Maternity & obstetric nursing
Answer: B · Fetal tachycardia due to maternal fever or infection
Why this is the answer
Maternal fever, often from intra-amniotic infection, is a common cause of fetal tachycardia. The provider is informed, and treatment of fever and infection is expected. Opioids reduce variability rather than raise the rate.
Answer
B · Fetal tachycardia due to maternal fever or infection
21.Pediatric nursing
Answer: A · Pull the pinna gently down and back
Why this is the answer
In children under about 3 years the ear canal is short and angled upward, so the pinna is pulled down and back. In older children and adults it is pulled up and back.
Answer
A · Pull the pinna gently down and back
22.Pediatric nursing
Answer: D · Headache, repeated vomiting and increasing drowsiness
Why this is the answer
Headache, vomiting, irritability and drowsiness suggest raised intracranial pressure from shunt blockage or infection. In infants, a bulging fontanelle and a rising head circumference are also signs.
Answer
D · Headache, repeated vomiting and increasing drowsiness
23.Mental health nursing
Answer: B · Weight, waist circumference, blood glucose and lipids
Why this is the answer
Many second-generation antipsychotics cause weight gain, insulin resistance and dyslipidaemia. Metabolic monitoring is done at baseline and regularly during treatment.
Answer
B · Weight, waist circumference, blood glucose and lipids
24.Mental health nursing
Answer: A · She can withdraw her consent at any time, and her decision must be respected and reported to the team
Why this is the answer
A person with capacity can withdraw consent at any time. The nurse informs the team, who discuss the decision with her. Treatment without consent is only possible under specific legal conditions.
Answer
A · She can withdraw her consent at any time, and her decision must be respected and reported to the team
25.Nursing math & unit conversions
Answer: 00:20
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
12 AM → 00
Answer
00:20
Answer
00:20
26.Nursing math & unit conversions
Answer: D = 1.5 mg/h
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 = 25 mcg/min × (60 min/1 h) × (1 mg/1000 mcg)
Calculate
D = 25·60/1000 = 1.5 mg/h
Answer
D = 1.5 mg/h
27.Dosage calculations
Answer: V = 8 mL
Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.
Dose from body weight
D = 4·40 = 160 mg
Volume
V = 160/20 = 8 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 8 mL
28.Dosage calculations
Answer: V = 0.42 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 = 2100/5000 = 0.42 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.42 mL
29.IV infusion rates
Answer: R = 320 mL/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.
Original rate
1500/6 = 250 mL/h
New rate
R = 960/3 = 320 mL/h
Answer
R = 320 mL/h
This is more than a 25% increase: most hospitals require you to contact the prescriber instead of catching up, and to assess the patient for fluid overload.
30.IV infusion rates
Answer: Δ = 23.43 %
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
1500/12 = 125 mL/h
New rate
R = 1080/7 = 154.3 mL/h
Percentage change
Δ = (154.3 − 125)/125·100% = 23.43%
Answer
Δ = 23.43%
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
31.IV fluids & fluid balance
Answer: B = 405 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: 200 + 250 = 450 mL
IV infusion: 125·8 = 1000 mL
IV antibiotic: 2·100 = 200 mL
total intake = 1650 mL
Total output
375 + 500 + 300 + 70 = 1245 mL
Balance
B = 1650 − 1245 = 405 mL
Answer
B = 405 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: t = 7.3 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
First part
75·4 = 300 mL
500 − 300 = 200 mL left
Second part
200/60 = 3.333 h
Total time
t = 4 + 3.333 = 7.333 ≈ 7.3 h
Answer
t = 7.3 h
That is about 7 h 20 min, so the bag runs out at about 22:50.
33.Clinical assessment scores
Answer: SI = 0.46
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 = 54/117 = 0.4615 ≈ 0.46
Answer
SI = 0.46
Within or below the usual 0.5–0.7.
34.Clinical assessment scores
Answer: high
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 86% → 3
on air → 0
SBP 88 mmHg → 3
HR 38/min → 3
responds only to pain (P) → 3
T 37.6 °C → 0
Total and red scores
NEWS2 = 0 + 3 + 0 + 3 + 3 + 3 + 0 = 12
At least one parameter scores 3.
Risk group
high
Answer
high
A total of 5 or more calls for an urgent clinical response.
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