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
Where in the eye should eye drops be placed?
AInto the inner corner of the eye only
BDirectly onto the centre of the cornea
COnto the upper eyelid while the eye is shut
DInto the pocket of the lower eyelid
2.Nursing fundamentalsHard
A patient has had a stroke. Why must swallowing be screened before giving food, drink or oral medicine?
ADysphagia is common after stroke and can cause aspiration pneumonia
BOral medicines are never used after a stroke
CSwallowing checks are only needed if the patient asks
DPatients after a stroke are always kept nil by mouth for at least a week
3.Infection control & patient safetyMedium
During a surgical hand scrub, how are the hands held?
ABelow the elbows, so water runs off the fingertips into the sink
BAbove the elbows, so water runs from the fingertips toward the elbows
CAt the level of the waist, close to the body
DPointing downward into the sink at all times
4.Infection control & patient safetyHard
During a sterile central line dressing change, a colleague reaches across the open sterile field to pass the nurse a roll of tape. What should the nurse do?
ARemove only the items nearest to where the arm passed over
BCover the field with a sterile towel and continue on top of it
CContinue, because the colleague did not touch any sterile item
DTreat the field as contaminated and set up a new one
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
BDay 1 after bowel surgery with a new temperature of 38.5 °C
CPneumonia, with an oxygen need that rose overnight from 2 to 4 L/min
DAdmitted two hours ago with chest pain; troponin result still pending
6.Prioritization & delegationHard
A patient suddenly has severe pain in one leg. The leg is pale and cold with no pedal pulse. What does this suggest?
AAcute arterial occlusion, which is an emergency
BA deep vein thrombosis that can be treated next week
CChronic venous insufficiency that needs elevation
DA muscle cramp that will pass with stretching
7.Clinical nursingMedium
Why must levodopa for Parkinson's disease be given at the exact times prescribed in hospital?
AThe drug only works if taken at midnight
BLate doses cause dangerous high potassium
CEarly doses cause severe low blood glucose and sweating attacks
DDelays can quickly worsen rigidity, immobility and swallowing
8.Clinical nursingHard
A patient on an anticoagulant falls and hits their head but appears well. What is the correct action?
AEncourage the patient to sleep without observations
BNo action, because the patient appears well
CGive an extra dose of anticoagulant
DArrange medical review and likely CT scan, with neurological observations
9.Lab values & electrolytesMedium
A patient's eGFR has fallen to 24 mL/min/1.73 m². Which prescribed drug should the nurse question before giving it?
ALevothyroxine
BAcetaminophen (paracetamol)
CInsulin glargine
DMetformin
10.Lab values & electrolytesHard
A patient with a platelet count of 35 × 10³/µL is prescribed an intramuscular injection. What should the nurse do?
AGive the injection and apply a heat pack
BGive the injection with a longer needle
CAsk the prescriber whether another route can be used
DGive the injection as prescribed and massage the site firmly
11.PharmacologyMedium
Why is testing for HLA-B*15:02 recommended before carbamazepine in people of some Asian ancestries?
AThis gene variant makes carbamazepine ineffective
BThis gene variant causes carbamazepine to raise blood glucose
CThis gene variant speeds up the kidney excretion of carbamazepine
DIt greatly raises the risk of Stevens–Johnson syndrome
12.PharmacologyHard
Which strategy is most effective at preventing errors with IV insulin infusions?
AWriting "U" for units on the order
BAn independent double check and a smart pump with a drug library
CUsing insulin syringes to measure large IV volumes
DPreparing insulin infusions in advance and leaving them unlabelled
13.Med-surg: cardiovascular & respiratoryMedium
Why are IV fluids given cautiously to a patient with heart failure?
AIV fluids stop diuretics from being absorbed
BIV fluids directly damage the heart valves
CExtra volume can quickly cause pulmonary oedema
DIV fluids lower the blood pressure dangerously
14.Med-surg: cardiovascular & respiratoryHard
An 84-year-old with heart failure becomes breathless with new crackles and a rising blood pressure during a blood transfusion. What should the nurse suspect?
AAn acute haemolytic reaction from wrong blood
BTransfusion-associated circulatory overload
CA mild febrile reaction
DNormal effects of the transfusion
15.Med-surg: neuro, endocrine & renalMedium
Which picture fits Brown-Séquard syndrome?
AWeakness of both arms with normal strength in the legs
BWeakness on the same side and loss of pain on the opposite side
CLoss of all feeling but normal movement on both sides
DParalysis of both legs, with normal sensation everywhere in the body
16.Med-surg: neuro, endocrine & renalHard
Which task can the registered nurse delegate to a trained healthcare assistant (nursing assistant)?
ADeciding the dose of correction insulin from the glucose result
BAssessing a confused patient whose glucose is 2.6 mmol/L (47 mg/dL)
CTeaching a new patient how to inject insulin
DChecking pre-meal glucose and reporting results out of range
17.Med-surg: GI, perioperative & oncologyMedium
How should pancreatic enzyme replacement capsules usually be taken?
AOnly on days with abdominal pain
BOne hour after meals, on an empty stomach
CWith every meal and snack
DOnce a day at bedtime
18.Med-surg: GI, perioperative & oncologyHard
A patient taking IV antibiotics has three unexplained loose stools in 24 hours. What should the nurse do first?
AWait two days to see if the diarrhoea settles
BMove the patient to a bay with other patients to watch them closely
CGive loperamide after each loose stool and continue as usual
DIsolate the patient and send a stool sample for testing
19.Maternity & obstetric nursingMedium
A preterm baby on feeds develops a swollen abdomen, bloody stools and feeding intolerance. Which condition is suspected?
ACow's milk protein allergy
BInfantile pyloric stenosis
CNecrotising enterocolitis
DHirschsprung disease
20.Maternity & obstetric nursingHard
A mother on day 1 is quiet, lets the nurse change the baby and talks repeatedly about the birth. How should the nurse interpret this?
ARejection of the baby
BSigns of postpartum psychosis
CNormal letting-go behaviour
DNormal taking-in behaviour
21.Pediatric nursingMedium
Which medicine may be used to close a patent ductus arteriosus in a preterm baby?
AProstaglandin E1
BIbuprofen or indomethacin
CIntravenous furosemide infusion
DSalbutamol
22.Pediatric nursingHard
A parent asks why the HPV vaccine is offered in early adolescence (at about 11 to 13 years, depending on the country). Which answer is best?
AIt works best before any exposure to the virus, and young adolescents respond strongly
BIt is given at this age because it prevents chickenpox in adolescence
CIt is only effective if given in the first year of secondary school, before exams start
DChildren of this age are already likely to have the virus, so it treats the infection
23.Mental health nursingMedium
A patient intoxicated with phencyclidine (PCP) is agitated and has nystagmus and high blood pressure. Which nursing approach is best?
AProvide a quiet, low-stimulation environment and keep staff and patient safe
BEncourage him to walk around the ward and join in activities to help burn off the drug
CPut him in a busy area so that staff can watch him more easily
DTry to talk the patient down by discussing his feelings in detail
24.Mental health nursingHard
A community nurse visits an older woman with hoarding disorder whose home is so cluttered that the exits are blocked. What is the most appropriate approach?
ATell her that she will be evicted unless everything is thrown away today
BArrange for the whole house to be cleared while she is out
CIgnore the clutter, because it is her own home
DWork with her to clear the exits first, then agree a gradual plan together
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A drip-rate calculation gives 28.458 gtt/min. The rule in this exercise is that drip rates are rounded to the nearest whole drop. What value x do you record?
28.458 gtt/min
x = gtt/min
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 17:10 and finishes at 00:50 the next morning (24-hour clock). How many minutes t did it run?
17:1000:50
t = min
27.Dosage calculationsMedium
A child weighing 24 kg is prescribed 5 mg/kg of a drug. The stock solution contains 40 mg/mL. Draw up the dose: what volume V do you give?
24 kg5 mg/kg40 mg/mL
V = mL
28.Dosage calculationsHard
A child weighing 10 kg is prescribed 20 mg/kg per dose of an oral suspension that contains 40 mg in 1 mL. What volume V do you give?
10 kg20 mg/kg40 mg/1 mL
V = mL
29.IV infusion ratesMedium
Infuse 1000 mL over 3 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 mL3 h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 50 gtt/min through a set of 60 gtt/mL. There are 200 mL left in the bag. How many hours t until it is empty?
50 gtt/min60 gtt/mL200 mL
t = 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 total intake I in mL.
tea: 150 mLjuice: 150 mLIV infusion: 60 mL/h × 8 hIV antibiotic: 2 × 100 mL
I = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 12:00 at 125 mL/h. After 2 hours the rate is changed to 75 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
1000 mL125 mL/h · 2 h75 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 14, with E4 and V5. What motor score M was recorded, and which response does it describe? Give the number.
GCS 14E4V5
M =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 60 mmHg. A patient’s systolic pressure is 84 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 60 mmHg?
MAP 60 mmHgSBP 84 mmHg
DBP = mmHg
3Solutions
1.Nursing fundamentals
Answer: D · Into the pocket of the lower eyelid
Why this is the answer
Drops go into the lower conjunctival sac, which is less sensitive than the cornea. Pressing gently on the inner corner afterwards reduces drainage into the nose.
Answer
D · Into the pocket of the lower eyelid
2.Nursing fundamentals
Answer: A · Dysphagia is common after stroke and can cause aspiration pneumonia
Why this is the answer
Stroke often affects swallowing, and silent aspiration is possible. A swallow screen, with referral to a speech and language therapist if needed, guides safe food textures and routes for medicines.
Answer
A · Dysphagia is common after stroke and can cause aspiration pneumonia
3.Infection control & patient safety
Answer: B · Above the elbows, so water runs from the fingertips toward the elbows
Why this is the answer
After a surgical scrub, the hands are the cleanest area, so they are held above the elbows to let water drain away from them toward the less clean elbows.
Answer
B · Above the elbows, so water runs from the fingertips toward the elbows
4.Infection control & patient safety
Answer: D · Treat the field as contaminated and set up a new one
Why this is the answer
Reaching across a sterile field with non-sterile arms or items contaminates it, even without touching. The field is replaced, and non-sterile items are passed around the field, not over it. When sterility is in doubt, the field is treated as contaminated.
Answer
D · Treat the field as contaminated and set up a new one
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: A · Acute arterial occlusion, which is an emergency
Why this is the answer
Sudden pain, pallor, coldness and loss of pulse suggest an embolus blocking an artery. The limb can be lost within hours, so the nurse escalates immediately.
Answer
A · Acute arterial occlusion, which is an emergency
7.Clinical nursing
Answer: D · Delays can quickly worsen rigidity, immobility and swallowing
Why this is the answer
Levodopa has a short effect, so missed or late doses can lead to severe stiffness, falls, swallowing problems and, rarely, a dangerous hyperpyrexia-like state. Parkinson's medicines are treated as time-critical.
Answer
D · Delays can quickly worsen rigidity, immobility and swallowing
8.Clinical nursing
Answer: D · Arrange medical review and likely CT scan, with neurological observations
Why this is the answer
Anticoagulated patients have a high risk of intracranial bleeding after head injury, even with mild symptoms, so guidelines recommend early imaging and neurological monitoring.
Answer
D · Arrange medical review and likely CT scan, with neurological observations
9.Lab values & electrolytes
Answer: D · Metformin
Why this is the answer
Metformin is cleared by the kidneys, and it is contraindicated when the eGFR is below 30 mL/min/1.73 m² because of the risk of lactic acidosis. Insulin doses may also need adjustment, but insulin is not contraindicated.
Answer
D · Metformin
10.Lab values & electrolytes
Answer: C · Ask the prescriber whether another route can be used
Why this is the answer
IM injections can cause bleeding into the muscle when platelets are low. The nurse asks for another route, such as oral or IV. If an injection is unavoidable, firm pressure without massage is applied afterwards.
Answer
C · Ask the prescriber whether another route can be used
11.Pharmacology
Answer: D · It greatly raises the risk of Stevens–Johnson syndrome
Why this is the answer
The HLA-B*15:02 allele, common in parts of South-East Asia, is strongly linked to carbamazepine-induced Stevens–Johnson syndrome and toxic epidermal necrolysis. Carriers are given a different drug.
Answer
D · It greatly raises the risk of Stevens–Johnson syndrome
12.Pharmacology
Answer: B · An independent double check and a smart pump with a drug library
Why this is the answer
Independent double checks, standard concentrations and smart pumps with dose limits reduce insulin errors. "U" for units is avoided because it can be misread as a zero.
Answer
B · An independent double check and a smart pump with a drug library
13.Med-surg: cardiovascular & respiratory
Answer: C · Extra volume can quickly cause pulmonary oedema
Why this is the answer
In heart failure, the ventricle cannot cope with large increases in preload, so IV fluids can raise filling pressures and cause pulmonary oedema. When fluids are needed, smaller volumes are given with close reassessment of breathing, crackles, JVP, weight and fluid balance.
Answer
C · Extra volume can quickly cause pulmonary oedema
14.Med-surg: cardiovascular & respiratory
Answer: B · Transfusion-associated circulatory overload
Why this is the answer
Transfusion-associated circulatory overload causes breathlessness, crackles, raised BP and JVP during or soon after transfusion, especially in older people and those with heart or kidney disease. The transfusion is stopped or slowed, the patient sat up and given oxygen, and diuretics may be prescribed. Slow rates and single units with reassessment reduce the risk.
Answer
B · Transfusion-associated circulatory overload
15.Med-surg: neuro, endocrine & renal
Answer: B · Weakness on the same side and loss of pain on the opposite side
Why this is the answer
Damage to one side of the spinal cord, often from a stab wound, causes motor loss and loss of proprioception on the same side, and loss of pain and temperature on the opposite side. The pain fibres cross soon after entering the cord.
Answer
B · Weakness on the same side and loss of pain on the opposite side
16.Med-surg: neuro, endocrine & renal
Answer: D · Checking pre-meal glucose and reporting results out of range
Why this is the answer
Trained assistants can measure and record glucose and report abnormal results. Dose decisions, teaching and the assessment of an unstable patient need the registered nurse.
Answer
D · Checking pre-meal glucose and reporting results out of range
17.Med-surg: GI, perioperative & oncology
Answer: C · With every meal and snack
Why this is the answer
Pancreatic enzymes digest fat, protein and carbohydrate, so they are taken with meals and snacks. The dose is adjusted to reduce steatorrhoea and support weight gain.
Answer
C · With every meal and snack
18.Med-surg: GI, perioperative & oncology
Answer: D · Isolate the patient and send a stool sample for testing
Why this is the answer
Unexplained diarrhoea in a patient on antibiotics should be treated as possible C. difficile. The patient is isolated promptly, a stool sample is sent and the antibiotics are reviewed with the medical team.
Answer
D · Isolate the patient and send a stool sample for testing
19.Maternity & obstetric nursing
Answer: C · Necrotising enterocolitis
Why this is the answer
Necrotising enterocolitis mainly affects preterm babies. Signs include abdominal distension, bilious aspirates, bloody stools and instability. Feeds are stopped and the baby is urgently reviewed. Breast milk lowers the risk.
Answer
C · Necrotising enterocolitis
20.Maternity & obstetric nursing
Answer: D · Normal taking-in behaviour
Why this is the answer
In the first day or two, dependence, passivity and retelling the birth story are typical of the taking-in phase. The nurse supports rest and comfort and reassesses bonding later.
Answer
D · Normal taking-in behaviour
21.Pediatric nursing
Answer: B · Ibuprofen or indomethacin
Why this is the answer
Indomethacin and ibuprofen inhibit prostaglandin production and can close a patent duct in preterm infants; paracetamol is also used in some units. Prostaglandin E1 does the opposite and keeps the duct open.
Answer
B · Ibuprofen or indomethacin
22.Pediatric nursing
Answer: A · It works best before any exposure to the virus, and young adolescents respond strongly
Why this is the answer
HPV is passed on through sexual contact, so vaccination is most effective before any exposure. Younger adolescents also produce a strong antibody response. The vaccine protects against HPV types that cause cervical and other cancers and genital warts.
Answer
A · It works best before any exposure to the virus, and young adolescents respond strongly
23.Mental health nursing
Answer: A · Provide a quiet, low-stimulation environment and keep staff and patient safe
Why this is the answer
PCP can cause agitation, violence, psychosis, nystagmus and hypertension. Reducing stimulation and keeping enough staff present for safety are key; "talking down" is less effective than with other hallucinogens.
Answer
A · Provide a quiet, low-stimulation environment and keep staff and patient safe
24.Mental health nursing
Answer: D · Work with her to clear the exits first, then agree a gradual plan together
Why this is the answer
Forced clear-outs cause great distress and the clutter usually returns. Collaborative, gradual work focusing first on safety, such as fire exits and fall risks, with involvement of relevant services, is more effective.
Answer
D · Work with her to clear the exits first, then agree a gradual plan together
25.Nursing math & unit conversions
Answer: x = 28 gtt/min
Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.
Digit in the ones place
28.458 → 8
Only the next digit decides
28.458 → 4
4 is 4 or less, so 8 stays.
The digits after it (58) are ignored: round once, never step by step.
Round
x = 28 gtt/min
Answer
x = 28 gtt/min
26.Nursing math & unit conversions
Answer: t = 460 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
17:10 → 24:00 = 410 min
After midnight
00:00 → 00:50 = 50 min
Total
t = 410 + 50 = 460 min
Answer
t = 460 min
27.Dosage calculations
Answer: V = 3 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 = 5·24 = 120 mg
Volume
V = 120/40 = 3 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 3 mL
28.Dosage calculations
Answer: V = 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
20·10 = 200 mg
Volume
V = (200/40)·1 = 5 mL
Answer
V = 5 mL
29.IV infusion rates
Answer: R = 56 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
3·60 = 180 min
Drip rate
R = 1000·10/180 = 55.56 ≈ 56 gtt/min
Answer
R = 56 gtt/min
At the bedside you round to the nearest whole drop: 56 gtt/min.
30.IV infusion rates
Answer: t = 4 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.
Rate in mL/h
50·60/60 = 50 mL/h
Time left
t = 200/50 = 4 h
Answer
t = 4 h
31.IV fluids & fluid balance
Answer: I = 980 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: 150 + 150 = 300 mL
IV infusion: 60·8 = 480 mL
IV antibiotic: 2·100 = 200 mL
I = 980 mL
Answer
I = 980 mL
32.IV fluids & fluid balance
Answer: t = 12 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
125·2 = 250 mL
1000 − 250 = 750 mL left
Second part
750/75 = 10 h
Total time
t = 2 + 10 = 12 h
Answer
t = 12 h
That is about 12 h 00 min, so the bag runs out at about 00:00.
33.Clinical assessment scores
Answer: M = 5
Glasgow Coma Scale: add the best response in three areas. Eye opening E: 4 spontaneous, 3 to sound or speech, 2 to pressure, 1 none. Verbal V: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Motor M: 6 obeys commands, 5 localises, 4 normal flexion (withdraws), 3 abnormal flexion, 2 extension, 1 none. The total runs from 3 to 15. After a head injury, 13–15 is usually called mild, 9–12 moderate and 3–8 severe.
Motor score
M = 14 − 4 − 5 = 5
M5: moves a hand to the site of pressure (localises)
Answer
M = 5
34.Clinical assessment scores
Answer: DBP = 48 mmHg
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.
Rearrange
DBP = (3·MAP − SBP)/2
Substitute
DBP = (3·60 − 84)/2 = 96/2 = 48 mmHg
Answer
DBP = 48 mmHg
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