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
Before fitting anti-embolism stockings, what should the nurse do?
AMeasure the legs to get the right size and check for arterial disease
BChoose a size by looking at the patient's shoe size and weight
CFit them over existing bandages or wounds
DFit the tightest size available so the stockings give the best effect
2.Nursing fundamentalsHard
A patient's oxygen saturation target is 88–92%. Which condition most likely explains this lower target?
APneumonia in a previously healthy patient with no chronic lung disease
BCarbon monoxide poisoning
CAsthma attack in a young adult
DChronic obstructive pulmonary disease with risk of hypercapnia
3.Infection control & patient safetyMedium
A nurse receives a verbal order by telephone. What is the safest practice?
AAsk a colleague to listen in and remember it as well
BWrite it down and read it back to the prescriber
CRemember it and write it down at the end of the shift
DCarry it out without recording it
4.Infection control & patient safetyHard
A nurse calculates a child’s prescribed dose and finds it is ten times higher than the usual dose for the child’s weight. What should the nurse do?
AGive it, because the prescriber must have a reason
BGive half the dose and watch the child closely
CGive one-tenth of the dose without telling anyone about it
DHold the dose and verify it with the prescriber and pharmacist
5.Prioritization & delegationMedium
A patient is raising his voice, pacing and clenching his fists. What should the nurse do first?
AApply physical restraints at once
BTurn away and ignore the behavior
CStand very close to him and tell him firmly and loudly to sit down and be quiet
DSpeak calmly, keep a safe distance and invite him to talk about what is wrong
6.Prioritization & delegationHard
An infant with pyloric stenosis has repeated projectile vomiting. Which acid-base imbalance is most likely?
AMetabolic acidosis
BRespiratory alkalosis
CRespiratory acidosis
DMetabolic alkalosis
7.Clinical nursingMedium
A patient is having a 12-lead ECG. Where are the chest electrodes placed?
AIn standard numbered positions across the front and left of the chest
BIn a straight line down the centre of the sternum from top to bottom
COn both shoulders and both hips only
DAnywhere on the chest where the skin is clear
8.Clinical nursingHard
A patient faints during cannulation, with a slow pulse and pallor, and recovers quickly when laid flat. There is no rash, wheeze or swelling. What is most likely?
AA hypoglycaemic coma
BA stroke
CVasovagal syncope
DAnaphylaxis
9.Lab values & electrolytesMedium
A patient on digoxin has a level of 2.8 ng/mL and a heart rate of 52/min. What is the nurse’s best action?
AGive a double dose to correct the rhythm
BGive the dose and recheck the level in a month
CGive the dose, as the heart rate is above 50/min
DHold the dose and inform the prescriber
10.Lab values & electrolytesHard
A patient's bedside glucose meter shows "HI" (above its measuring range). The patient is drowsy. What should the nurse do?
AGive oral glucose in case the reading is wrong and the patient is low
BRecord "HI" and repeat the meter test at the next scheduled time
CAssume the meter is broken and give the usual insulin dose
DSend a venous sample to the lab and inform the provider at once
11.PharmacologyMedium
A patient with heart failure starts furosemide. Which self-monitoring instruction is most useful?
AWeigh daily at the same time on the same scales
BMeasure the temperature twice a day and record it in a diary
CCheck the blood glucose before every meal
DCount the respiratory rate each evening
12.PharmacologyHard
Before starting rituximab, patients are tested for hepatitis B. Why?
AHepatitis B infection makes rituximab completely ineffective
BRituximab is made from the hepatitis B virus
CRituximab can reactivate hepatitis B and cause liver failure
DRituximab is a vaccine against hepatitis B
13.Med-surg: cardiovascular & respiratoryMedium
A patient's capillary refill time at the fingertip is 4 seconds. What does this suggest?
AAn unusually strong cardiac output
BNormal peripheral perfusion
CReduced peripheral perfusion
DA high haemoglobin level
14.Med-surg: cardiovascular & respiratoryHard
A patient with severe chronic kidney disease needs therapeutic anticoagulation for a DVT. Why might unfractionated heparin be chosen instead of a low-molecular-weight heparin?
AUnfractionated heparin has no bleeding risk at all
BUnfractionated heparin is taken by mouth
CLMWH cannot be given to anyone over 60
DLMWH is cleared by the kidneys and can accumulate
15.Med-surg: neuro, endocrine & renalMedium
Why is IV calcium gluconate given in severe hyperkalaemia?
AIt moves potassium into the cells
BIt removes potassium through the kidneys
CIt protects the heart from arrhythmias
DIt binds potassium in the gut
16.Med-surg: neuro, endocrine & renalHard
A patient with a severe head injury does not open the eyes, and in response to pain the arms extend and rotate inwards with the legs extended. What does this indicate?
AA normal withdrawal response to a painful stimulus
BExtensor (decerebrate) posturing: severe brainstem injury
CA focal seizure that will stop without any treatment
DFlexor (decorticate) posturing, a sign of mild cortical injury
17.Med-surg: GI, perioperative & oncologyMedium
Which practice is correct when giving parenteral nutrition through a central line?
AUse a dedicated lumen and strict aseptic technique
BLet the bag hang at room temperature for several days
CGive other IV drugs through the same lumen to save time
DDisconnect and reconnect the line without cleaning the hub
18.Med-surg: GI, perioperative & oncologyHard
A patient is splashed in the eye with an alkaline cleaning product. What is the first action?
ACover the eye with a pad and wait for a doctor to examine it first
BIrrigate the eye at once with large volumes of water or saline
CAsk the patient to rub the eye to clear it
DAdd a few drops of vinegar to neutralise it
19.Maternity & obstetric nursingMedium
Which antihypertensive is commonly used in pregnancy but should be avoided in a woman with asthma?
ALabetalol
BMethyldopa
CHydralazine
DNifedipine
20.Maternity & obstetric nursingHard
A woman at 9 weeks has hCG levels that are much higher than expected, a uterus large for dates, severe vomiting and dark brown spotting. Which condition should be suspected?
AA missed miscarriage
BA threatened miscarriage
CAn ectopic pregnancy
DA hydatidiform (molar) pregnancy
21.Pediatric nursingMedium
What is a normal capillary refill time in a child?
A2 seconds or less
B5 seconds or less
C8 to 10 seconds
D15 to 20 seconds
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?
AChildren of this age are already likely to have the virus, so it treats the infection
BIt is only effective if given in the first year of secondary school, before exams start
CIt works best before any exposure to the virus, and young adolescents respond strongly
DIt is given at this age because it prevents chickenpox in adolescence
23.Mental health nursingMedium
What should a patient starting zolpidem for insomnia be taught to report?
AFeeling sleepy about 30 minutes after taking it at bedtime
BFeeling slightly more rested and alert the next morning than before starting the medicine
CSleeping through the night without waking up
DDoing things while not fully awake, such as sleepwalking or driving, with no memory of it
24.Mental health nursingHard
A resident with Alzheimer's disease becomes very agitated and hits out when staff try to help him bathe. What is the best approach?
AGet more staff to hold him so the bath can be finished quickly
BSkip bathing for the rest of his stay
CAsk the doctor for a sedative to be given before every bath so that he stays calm and cooperative
DStop, try again later or in a different way, and explain each step calmly
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 37.1 °C. Convert it to degrees Fahrenheit T with °F = °C × 9/5 + 32. Round to one decimal place.
37.1 °C
T = °F
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 18:40 and finishes at 01:40 the next morning (24-hour clock). How many minutes t did it run?
18:4001:40
t = min
27.Dosage calculationsMedium
A child weighing 20 kg is prescribed 3 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?
20 kg3 mg/kg25 mg/mL
V = mL
28.Dosage calculationsHard
A child weighing 20 kg is prescribed 12.5 mg/kg per dose of an oral suspension that contains 100 mg in 5 mL. What volume V do you give?
20 kg12.5 mg/kg100 mg/5 mL
V = mL
29.IV infusion ratesMedium
Infuse 500 mL over 8 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
500 mL8 h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
1500 mL was ordered over 6 hours. After 4 hours you find that 640 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 / 6 hafter 4 h: 640 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). Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 12:00 at 125 mL/h. After 4 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 · 4 h75 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: no impairment; moisture: rarely moist; activity: chairfast; mobility: completely immobile; nutrition: very poor; friction and shear: problem. Find the Braden total B.
6–23
B =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). At 5 minutes after birth, a practice newborn has a pink body with blue hands and feet, a heart rate of 130/min, a grimace when stimulated, some flexion of the arms and legs and no breathing. Score the APGAR and click how the score is interpreted.
1reassuring
2moderately abnormal
3low
3Solutions
1.Nursing fundamentals
Answer: A · Measure the legs to get the right size and check for arterial disease
Why this is the answer
Wrong-sized stockings can cause skin damage or a tourniquet effect. They are not used in significant peripheral arterial disease, and the skin is checked daily.
Answer
A · Measure the legs to get the right size and check for arterial disease
2.Nursing fundamentals
Answer: D · Chronic obstructive pulmonary disease with risk of hypercapnia
Why this is the answer
In COPD patients at risk of hypercapnic respiratory failure, too much oxygen can raise CO₂ levels, so a target of 88–92% is used.
Answer
D · Chronic obstructive pulmonary disease with risk of hypercapnia
3.Infection control & patient safety
Answer: B · Write it down and read it back to the prescriber
Why this is the answer
Writing the order down and reading it back confirms that it was heard correctly. Verbal orders are limited to urgent situations according to policy and are signed by the prescriber later.
Answer
B · Write it down and read it back to the prescriber
4.Infection control & patient safety
Answer: D · Hold the dose and verify it with the prescriber and pharmacist
Why this is the answer
Tenfold errors are common in pediatrics, usually from decimal or unit mistakes. The nurse holds the dose and clarifies it, and never changes the dose on their own.
Answer
D · Hold the dose and verify it with the prescriber and pharmacist
5.Prioritization & delegation
Answer: D · Speak calmly, keep a safe distance and invite him to talk about what is wrong
Why this is the answer
Early verbal de-escalation, with a calm voice and a safe distance, is the first approach for rising agitation. Restraint is a last resort, and crowding the patient can make things worse.
Answer
D · Speak calmly, keep a safe distance and invite him to talk about what is wrong
6.Prioritization & delegation
Answer: D · Metabolic alkalosis
Why this is the answer
Repeated vomiting of stomach contents loses hydrochloric acid, causing metabolic alkalosis, often with low chloride and potassium. Fluids and electrolytes are corrected before surgery.
Answer
D · Metabolic alkalosis
7.Clinical nursing
Answer: A · In standard numbered positions across the front and left of the chest
Why this is the answer
The six chest leads (V1–V6) have standard anatomical positions, from the 4th intercostal space beside the sternum to the mid-axillary line. Wrong placement can change the ECG and lead to misinterpretation.
Answer
A · In standard numbered positions across the front and left of the chest
8.Clinical nursing
Answer: C · Vasovagal syncope
Why this is the answer
Vasovagal syncope is a reflex drop in heart rate and blood pressure triggered by pain, fear or needles. Anaphylaxis would usually include skin, airway or breathing features and a fast pulse.
Answer
C · Vasovagal syncope
9.Lab values & electrolytes
Answer: D · Hold the dose and inform the prescriber
Why this is the answer
A level of 2.8 ng/mL is above the usual range, and the slow heart rate fits toxicity. The nurse holds the dose, checks potassium and the ECG and informs the prescriber.
Answer
D · Hold the dose and inform the prescriber
10.Lab values & electrolytes
Answer: D · Send a venous sample to the lab and inform the provider at once
Why this is the answer
"HI" means the glucose exceeds the meter's range, so the true value is unknown and may be very high, as in DKA or HHS. A laboratory sample is sent, the provider is informed promptly, and the patient is assessed for dehydration and ketones.Checked against:Blood Glucose Test · MedlinePlus (NIH) (2024); Diabetic ketoacidosis - Medical Encyclopedia · MedlinePlus (NIH) (2025)
Answer
D · Send a venous sample to the lab and inform the provider at once
11.Pharmacology
Answer: A · Weigh daily at the same time on the same scales
Why this is the answer
Daily weight is the best home measure of fluid balance. A rapid gain suggests fluid retention, and a rapid loss suggests overdiuresis and dehydration, both of which should be reported.
Answer
A · Weigh daily at the same time on the same scales
12.Pharmacology
Answer: C · Rituximab can reactivate hepatitis B and cause liver failure
Why this is the answer
Rituximab destroys CD20-positive B cells, weakening control of latent hepatitis B. Reactivation can cause fulminant hepatitis, so carriers receive monitoring or antiviral prophylaxis.
Answer
C · Rituximab can reactivate hepatitis B and cause liver failure
13.Med-surg: cardiovascular & respiratory
Answer: C · Reduced peripheral perfusion
Why this is the answer
Capillary refill time above about 2 seconds suggests poor peripheral perfusion, for example from dehydration, shock or cold. It should be interpreted with other signs such as heart rate, blood pressure, skin temperature and urine output.
Answer
C · Reduced peripheral perfusion
14.Med-surg: cardiovascular & respiratory
Answer: D · LMWH is cleared by the kidneys and can accumulate
Why this is the answer
Low-molecular-weight heparins are mainly renally excreted, so they accumulate in severe renal impairment and increase bleeding risk. Unfractionated heparin is cleared mainly by other routes, has a short half-life and can be monitored with aPTT and reversed with protamine.
Answer
D · LMWH is cleared by the kidneys and can accumulate
15.Med-surg: neuro, endocrine & renal
Answer: C · It protects the heart from arrhythmias
Why this is the answer
Calcium stabilises the cardiac cell membrane and reduces the risk of arrhythmias within minutes. It does not change the potassium level, so other treatments are needed to shift and remove potassium.
Answer
C · It protects the heart from arrhythmias
16.Med-surg: neuro, endocrine & renal
Answer: B · Extensor (decerebrate) posturing: severe brainstem injury
Why this is the answer
Abnormal extension to pain (GCS motor score 2) indicates severe injury at or near the brainstem and carries a worse prognosis than abnormal flexion (decorticate posturing, motor score 3). Any new abnormal posturing needs immediate escalation.
Answer
B · Extensor (decerebrate) posturing: severe brainstem injury
17.Med-surg: GI, perioperative & oncology
Answer: A · Use a dedicated lumen and strict aseptic technique
Why this is the answer
PN is rich in nutrients that bacteria can use. A dedicated lumen, aseptic non-touch technique and hanging limits reduce catheter-related bloodstream infection.
Answer
A · Use a dedicated lumen and strict aseptic technique
18.Med-surg: GI, perioperative & oncology
Answer: B · Irrigate the eye at once with large volumes of water or saline
Why this is the answer
Alkali burns can cause severe, deep eye damage. Immediate, prolonged irrigation, checking the pH, and urgent ophthalmology review are needed. Neutralising agents are not used.
Answer
B · Irrigate the eye at once with large volumes of water or saline
19.Maternity & obstetric nursing
Answer: A · Labetalol
Why this is the answer
Labetalol is a beta and alpha blocker and can cause bronchospasm, so it is avoided in asthma. Nifedipine, a calcium channel blocker, is often used instead.
Answer
A · Labetalol
20.Maternity & obstetric nursing
Answer: D · A hydatidiform (molar) pregnancy
Why this is the answer
A molar pregnancy causes very high hCG, a uterus larger than dates, hyperemesis and bleeding. Ectopic and failing pregnancies usually have lower than expected hCG.
Answer
D · A hydatidiform (molar) pregnancy
21.Pediatric nursing
Answer: A · 2 seconds or less
Why this is the answer
A capillary refill time of 2 seconds or less is normal. A longer time suggests poor perfusion, as in dehydration or shock, though a cold environment can also prolong it.
Answer
A · 2 seconds or less
22.Pediatric nursing
Answer: C · 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
C · It works best before any exposure to the virus, and young adolescents respond strongly
23.Mental health nursing
Answer: D · Doing things while not fully awake, such as sleepwalking or driving, with no memory of it
Why this is the answer
Zolpidem and similar "Z-drugs" can cause complex sleep behaviours, such as sleep-walking, sleep-driving or cooking while not fully awake, which can cause serious injury. These must be reported and the drug stopped.
Answer
D · Doing things while not fully awake, such as sleepwalking or driving, with no memory of it
24.Mental health nursing
Answer: D · Stop, try again later or in a different way, and explain each step calmly
Why this is the answer
Bathing can feel frightening or undignified. Changing the timing, approach or method, for example a bed bath or shower, giving simple explanations and keeping him covered and warm often reduces distress without force.
Answer
D · Stop, try again later or in a different way, and explain each step calmly
25.Nursing math & unit conversions
Answer: T = 98.8 °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
37.1·9/5 = 66.78
Add 32
T = 66.78 + 32 = 98.78 ≈ 98.8 °F
Answer
T = 98.8 °F
26.Nursing math & unit conversions
Answer: t = 420 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
18:40 → 24:00 = 320 min
After midnight
00:00 → 01:40 = 100 min
Total
t = 320 + 100 = 420 min
Answer
t = 420 min
27.Dosage calculations
Answer: V = 2.4 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 = 3·20 = 60 mg
Volume
V = 60/25 = 2.4 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 2.4 mL
28.Dosage calculations
Answer: V = 12.5 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
12.5·20 = 250 mg
Volume
V = (250/100)·5 = 12.5 mL
Answer
V = 12.5 mL
29.IV infusion rates
Answer: R = 10 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 = 500·10/480 = 10.42 ≈ 10 gtt/min
Answer
R = 10 gtt/min
At the bedside you round to the nearest whole drop: 10 gtt/min.
30.IV infusion rates
Answer: Δ = 28 %
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 = 640/2 = 320 mL/h
Percentage change
Δ = (320 − 250)/250·100% = 28%
Answer
Δ = 28%
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.
31.IV fluids & fluid balance
Answer: B = −335 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: 350 + 120 + 120 = 590 mL
ice chips: 200/2 = 100 mL
IV infusion: 80·8 = 640 mL
IV antibiotic: 2·50 = 100 mL
total intake = 1430 mL
Total output
200 + 375 + 450 + 500 + 140 + 100 = 1765 mL
Balance
B = 1430 − 1765 = −335 mL
Answer
B = −335 mL
Negative: the patient lost more fluid than went in.
32.IV fluids & fluid balance
Answer: t = 10.7 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
125·4 = 500 mL
1000 − 500 = 500 mL left
Second part
500/75 = 6.667 h
Total time
t = 4 + 6.667 = 10.67 ≈ 10.7 h
Answer
t = 10.7 h
That is about 10 h 40 min, so the bag runs out at about 22:40.
33.Clinical assessment scores
Answer: B = 13
Braden scale: six subscales for pressure-injury risk. Sensory perception, moisture, activity, mobility and nutrition score 1 to 4, from the worst level (1) to no problem (4); friction and shear scores 1 to 3. The total runs from 6 to 23, and a lower total means a higher risk. Common bands: 19–23 not at risk, 15–18 mild risk, 13–14 moderate risk, 10–12 high risk and 9 or below very high risk.
Score each subscale
sensory perception: no impairment → 4
moisture: rarely moist → 4
activity: chairfast → 2
mobility: completely immobile → 1
nutrition: very poor → 1
friction and shear: problem → 1
Add
Braden total = 4 + 4 + 2 + 1 + 1 + 1 = 13
Answer
B = 13
34.Clinical assessment scores
Answer: moderately abnormal
APGAR score: five signs, each scored 0, 1 or 2, checked at 1 and 5 minutes after birth. Appearance (colour): blue or pale 0, pink body with blue extremities 1, pink all over 2. Pulse: absent 0, below 100/min 1, 100/min or more 2. Grimace (reflex irritability): none 0, grimace 1, cry, cough or sneeze 2. Activity (tone): limp 0, some flexion 1, active movement 2. Respiration: absent 0, slow or irregular with a weak cry 1, good with a strong cry 2. A total of 7–10 is reassuring, 4–6 moderately abnormal and 0–3 low.
Score each sign
Appearance: a pink body with blue hands and feet → 1
Pulse: 130/min → 2
Grimace: a grimace when stimulated → 1
Activity: some flexion of the arms and legs → 1
Respiration: no breathing → 0
Add
APGAR = 1 + 2 + 1 + 1 + 0 = 5
Interpretation
5 → moderately abnormal
Answer
moderately abnormal
Below 7 at 5 minutes, the score is usually repeated every 5 minutes up to 20 minutes.
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