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
How should the ear be positioned when taking a tympanic temperature in an adult?
AGently pull the outer ear up and back
BLeave the ear alone and insert the probe deeply
CPush the outer ear forward against the cheek
DGently pull the outer ear down and back
2.Nursing fundamentalsHard
A patient spills hot tea on their forearm. What is the best immediate first aid?
ACool the burn under cool running water for about 20 minutes
BPut ice or an ice pack directly on the burn for about 10 minutes
CCover it with butter or a greasy cream
DPop any blisters to let the heat escape
3.Infection control & patient safetyMedium
An infant has had a cleft lip repair. Why are elbow restraints often used?
ATo keep the infant from rolling over in the crib
BTo prevent the infant from sucking a pacifier
CTo hold the IV line in place during feeds and stop it being pulled out
DTo stop the infant’s hands reaching the mouth while still allowing arm movement
4.Infection control & patient safetyHard
An 84-year-old resident with an indwelling catheter suddenly becomes confused but has no fever. What should the nurse consider?
AAn infection may present as confusion in older adults, so assess further and report
BInfection can be ruled out because there is no fever
CThe confusion is part of normal aging at this age and needs no further action
DA sedative is needed to keep the resident calm
5.Prioritization & delegationMedium
A patient coughs hard after abdominal surgery, and loops of bowel appear through the opened wound. What does the nurse do first?
ACover the wound with sterile dressings moistened with saline
BLeave the wound uncovered so the surgeon can see it on arrival
CHelp the patient walk to the toilet to relieve abdominal pressure
DPush the bowel gently back into the abdomen with a gloved hand
6.Prioritization & delegationHard
During birth, the baby’s head delivers but the shoulders do not follow. What should the nurse do first?
APush firmly on the top of the uterus (fundal pressure)
BHelp with the McRoberts position and give suprapubic pressure as directed
CPull hard on the baby’s head and neck to free the trapped shoulders quickly
DAsk the mother to stop pushing and wait an hour
7.Clinical nursingMedium
Which assessment best detects compartment syndrome after a fractured leg is put in a cast?
AMild itching under the cast
BA strong pulse in the foot
CA warm, pink foot
DPain out of proportion to the injury, especially on passive stretch
8.Clinical nursingHard
Why is morphine more likely to cause toxicity in a patient with severe kidney impairment?
AKidney failure makes the stomach absorb more morphine
BThe kidneys normally activate morphine, so more of it becomes active
CKidney disease makes the opioid receptors disappear
DIts active metabolites build up because the kidneys excrete them
9.Lab values & electrolytesMedium
A patient has a hot, swollen big toe. The serum uric acid is normal. Which statement is correct?
AGout is still possible, as urate can be normal in an attack
BGout is certain, as a normal urate proves the diagnosis
CGout can only be diagnosed with a CT scan of the foot
DGout is ruled out, as uric acid is always high in an attack
10.Lab values & electrolytesHard
A patient with acute kidney injury has a potassium of 6.8 mEq/L despite medical treatment, a pH of 7.12 and pulmonary edema not responding to diuretics. Which treatment is most likely needed?
AMore oral fluid
BAn IV magnesium dose
CA potassium supplement
DUrgent dialysis
11.PharmacologyMedium
Which drug is the antidote for an opioid overdose?
ANaloxone
BAcetylcysteine
CAtropine
DFlumazenil
12.PharmacologyHard
A patient on valproate becomes lethargic, starts vomiting and develops jaundice. Which adverse effect should be suspected first?
AHypothyroidism
BNormal start-up side effects
CLiver toxicity
DKidney stones
13.Med-surg: cardiovascular & respiratoryMedium
A patient with COPD uses an inhaled corticosteroid combination inhaler. Which risk should the nurse be aware of?
AAn increased risk of high blood pressure crises
BAn increased risk of pneumonia
CHearing loss after every dose
DA sharp drop in potassium after each dose
14.Med-surg: cardiovascular & respiratoryHard
Three hours after femoral cardiac catheterisation, a patient has new lower back and flank pain, a heart rate of 112/min and BP 92/60 mmHg. The groin looks normal. What should the nurse suspect?
ANormal back ache from lying flat
BA urinary tract infection
CRetroperitoneal bleeding
DAn allergic reaction to the contrast
15.Med-surg: neuro, endocrine & renalMedium
What is the dexamethasone suppression test used for?
ATo measure kidney function
BTo check thyroid function
CTo diagnose diabetes insipidus
DTo help diagnose Cushing's syndrome
16.Med-surg: neuro, endocrine & renalHard
A seizure has lasted 12 minutes. Two doses of benzodiazepine have been given, and the seizure continues. Airway and oxygen are managed. What is the next step in common protocols?
AGiving oral antiseizure tablets once the patient can swallow
BA second-line IV drug such as levetiracetam or phenytoin
CWaiting another 30 minutes to see whether the seizure stops
DA third and fourth dose of benzodiazepine every two minutes
17.Med-surg: GI, perioperative & oncologyMedium
Which statement about corticosteroids in inflammatory bowel disease is correct?
AThey are given only as a one-off injection
BThey cure the disease after one course
CThey are used to induce remission, not for maintenance
DThey are the best long-term maintenance treatment
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?
AIsolate the patient and send a stool sample for testing
BMove the patient to a bay with other patients to watch them closely
CGive loperamide after each loose stool and continue as usual
DWait two days to see if the diarrhoea settles
19.Maternity & obstetric nursingMedium
Which baby is at greatest risk of early-onset group B streptococcal infection?
AA baby born at 40 weeks to a mother with no risk factors
BA baby of a GBS-positive mother with no antibiotics
CA baby whose mother was GBS-negative at 36 weeks
DA baby born by planned caesarean with intact membranes
20.Maternity & obstetric nursingHard
After birth of the head, the nurse feels the umbilical cord loosely around the baby's neck. What is the appropriate action?
AAsk the woman to stop pushing for 30 minutes
BClamp and cut the cord before the shoulders deliver in every case
CSlip the loop over the head or let the body deliver through it
DPush the baby's head back into the vagina
21.Pediatric nursingMedium
A child is scored with the FLACC scale. What is the range of the total score?
A1 to 20
B0 to 100
C0 to 10
D0 to 5
22.Pediatric nursingHard
A 5-week-old with pyloric stenosis is scheduled for surgery. Blood tests show low chloride and a metabolic alkalosis. What is the priority before surgery?
ATake the baby to theatre immediately
BGive an antacid
CCorrect the dehydration and electrolyte imbalance with IV fluids as prescribed
DGive large milk feeds before theatre to build up the baby's strength and weight
23.Mental health nursingMedium
A patient on lamotrigine for bipolar disorder develops a new rash. What should the nurse do?
AIgnore it, because rashes are always harmless
BReport it promptly, because it may be the start of a serious skin reaction
CDouble the dose
DApply a moisturiser, and continue the drug as normal because rashes are common
24.Mental health nursingHard
A nurse is teaching a patient who has started haloperidol for schizophrenia. Which statement shows a need for further teaching?
A"I should get up slowly if I feel dizzy."
B"I'll avoid alcohol while I'm taking this medicine."
C"I can stop taking it as soon as the voices go away."
D"I should tell the nurse if my neck or jaw muscles feel stiff."
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 100.7 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.
100.7 °F
T = °C
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An order reads 2.5 mcg/kg/min for a patient who weighs 60 kg. Express the dose rate D in mg/h. Round to two decimal places.
2.5 mcg/kg/min60 kg
D = mg/h
27.Dosage calculationsMedium
A vial contains 1 g of powder. The label says: add 4.2 mL of water for injection to give a total volume of 5 mL. The prescription is 480 mg. What volume V of the reconstituted solution do you give?
1 g+ 4.2 mL → 5 mL480 mg
V = mL
28.Dosage calculationsHard
The prescription is 830 units of a drug that comes as 1000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
830 units1000 units/mL
V = mL
29.IV infusion ratesMedium
Infuse 1500 mL over 8 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
1500 mL8 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 42 gtt/min through a set of 15 gtt/mL. There are 450 mL left in the bag. How many hours t until it is empty? Round to one decimal place.
42 gtt/min15 gtt/mL450 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 12-hour shift. The patient weighs 64 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
64 kg12 hurine: 375 mLurine: 250 mLwound drain: 30 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 16:30 at 75 mL/h. After 2 hours the rate is changed to 200 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 mL75 mL/h · 2 h200 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury opens the eyes only to pressure (a painful stimulus), makes no sounds and shows as the best motor response: no movement at all. Work out the GCS and classify the head injury by it. Click your answer.
1mild
2moderate
3severe
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 92% on supplemental oxygen, blood pressure 150/90 mmHg, pulse 88/min, responds only to pain, temperature 34.8 °C. Which clinical risk group does the patient fall into? Click it.
RR 20SpO₂ 92%O₂SBP 150HR 88PT 34.8 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: A · Gently pull the outer ear up and back
Why this is the answer
Pulling the pinna up and back straightens the adult ear canal so the probe points at the eardrum. In young children the pinna is pulled down and back instead.
Answer
A · Gently pull the outer ear up and back
2.Nursing fundamentals
Answer: A · Cool the burn under cool running water for about 20 minutes
Why this is the answer
Cool running water for about 20 minutes reduces pain and depth of injury. Ice can damage tissue further, grease holds heat in, and blisters are left intact to protect the skin.
Answer
A · Cool the burn under cool running water for about 20 minutes
3.Infection control & patient safety
Answer: D · To stop the infant’s hands reaching the mouth while still allowing arm movement
Why this is the answer
Elbow restraints keep the elbows straight so the infant cannot touch the suture line. They are removed regularly, one at a time, for skin checks and movement under supervision.
Answer
D · To stop the infant’s hands reaching the mouth while still allowing arm movement
4.Infection control & patient safety
Answer: A · An infection may present as confusion in older adults, so assess further and report
Why this is the answer
In older adults, infections such as urinary tract infection may present with new confusion, falls or reduced appetite rather than fever. Sudden confusion is assessed and reported, not dismissed as aging.
Answer
A · An infection may present as confusion in older adults, so assess further and report
5.Prioritization & delegation
Answer: A · Cover the wound with sterile dressings moistened with saline
Why this is the answer
Evisceration is a surgical emergency. The nurse covers the organs with sterile saline-moistened dressings, stays with the patient, positions them to reduce strain and calls the surgeon at once.
Answer
A · Cover the wound with sterile dressings moistened with saline
6.Prioritization & delegation
Answer: B · Help with the McRoberts position and give suprapubic pressure as directed
Why this is the answer
In shoulder dystocia, the McRoberts maneuver (flexing the mother’s thighs onto her abdomen) and suprapubic pressure help free the shoulder. Fundal pressure and pulling on the head can worsen the injury.
Answer
B · Help with the McRoberts position and give suprapubic pressure as directed
7.Clinical nursing
Answer: D · Pain out of proportion to the injury, especially on passive stretch
Why this is the answer
Increasing pain that is not relieved by analgesia and worsens with passive stretching is the earliest sign. Pallor, numbness and absent pulses are late signs.
Answer
D · Pain out of proportion to the injury, especially on passive stretch
8.Clinical nursing
Answer: D · Its active metabolites build up because the kidneys excrete them
Why this is the answer
Morphine metabolites, including morphine-6-glucuronide, are cleared by the kidneys and accumulate in renal impairment, causing sedation and respiratory depression. Alternative opioids or lower doses are often chosen.
Answer
D · Its active metabolites build up because the kidneys excrete them
9.Lab values & electrolytes
Answer: A · Gout is still possible, as urate can be normal in an attack
Why this is the answer
Serum urate can be normal or even low during an acute gout attack. The definitive test is joint aspiration showing needle-shaped urate crystals, which also helps rule out septic arthritis.Checked against:Gout · MedlinePlus (NIH) (2025); Synovial Fluid Analysis · MedlinePlus (NIH) (2024)
Answer
A · Gout is still possible, as urate can be normal in an attack
10.Lab values & electrolytes
Answer: D · Urgent dialysis
Why this is the answer
Indications for urgent dialysis in AKI include refractory hyperkalemia, severe metabolic acidosis, fluid overload not responding to diuretics, uremic complications and some poisonings. This patient has three of them.Checked against:Acute tubular necrosis · MedlinePlus (NIH) (2025)
Answer
D · Urgent dialysis
11.Pharmacology
Answer: A · Naloxone
Why this is the answer
Naloxone reverses opioid-induced respiratory depression. Flumazenil reverses benzodiazepines, acetylcysteine treats paracetamol overdose and atropine treats bradycardia or organophosphate poisoning.
Answer
A · Naloxone
12.Pharmacology
Answer: C · Liver toxicity
Why this is the answer
Valproate can cause serious hepatotoxicity, especially in young children and early in treatment. Liver function tests are checked, and the drug may need to be stopped; pancreatitis is another serious risk.
Answer
C · Liver toxicity
13.Med-surg: cardiovascular & respiratory
Answer: B · An increased risk of pneumonia
Why this is the answer
In COPD, inhaled corticosteroids increase the risk of pneumonia. They are used where there are frequent exacerbations or features of asthma, and their benefit is weighed against this risk. Signs of pneumonia should be reported promptly.
Answer
B · An increased risk of pneumonia
14.Med-surg: cardiovascular & respiratory
Answer: C · Retroperitoneal bleeding
Why this is the answer
A high femoral puncture can bleed into the retroperitoneal space without visible groin swelling. Back or flank pain with tachycardia and hypotension is a warning sign. The nurse calls for urgent help, assesses for shock and expects bloods and imaging.
Answer
C · Retroperitoneal bleeding
15.Med-surg: neuro, endocrine & renal
Answer: D · To help diagnose Cushing's syndrome
Why this is the answer
A dose of dexamethasone normally suppresses ACTH and cortisol. In Cushing's syndrome, cortisol stays high. The test is part of the work-up for cortisol excess.
Answer
D · To help diagnose Cushing's syndrome
16.Med-surg: neuro, endocrine & renal
Answer: B · A second-line IV drug such as levetiracetam or phenytoin
Why this is the answer
Status epilepticus that continues after two doses of benzodiazepine (established status) is treated with a second-line IV drug. If it still continues (refractory status), anaesthesia and intubation in critical care are needed. Glucose, airway and monitoring continue throughout. Repeated benzodiazepines increase respiratory depression without much extra benefit.
Answer
B · A second-line IV drug such as levetiracetam or phenytoin
17.Med-surg: GI, perioperative & oncology
Answer: C · They are used to induce remission, not for maintenance
Why this is the answer
Steroids settle flares but are not effective or safe for maintenance because of side effects such as osteoporosis, diabetes and infection. Drugs such as aminosalicylates, immunomodulators or biologics maintain remission.
Answer
C · They are used to induce remission, not for maintenance
18.Med-surg: GI, perioperative & oncology
Answer: A · 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
A · Isolate the patient and send a stool sample for testing
19.Maternity & obstetric nursing
Answer: B · A baby of a GBS-positive mother with no antibiotics
Why this is the answer
GBS colonisation, no intrapartum antibiotics, prolonged rupture of membranes, maternal fever and prematurity increase the risk. Intrapartum IV antibiotics greatly lower early-onset GBS disease.
Answer
B · A baby of a GBS-positive mother with no antibiotics
20.Maternity & obstetric nursing
Answer: C · Slip the loop over the head or let the body deliver through it
Why this is the answer
A loose nuchal cord can usually be slipped over the head or the baby can be born through it (somersault manoeuvre). Clamping and cutting before birth is reserved for a tight cord that prevents delivery.
Answer
C · Slip the loop over the head or let the body deliver through it
21.Pediatric nursing
Answer: C · 0 to 10
Why this is the answer
FLACC has five categories each scored 0, 1 or 2, so the total is 0–10, similar to a numeric self-report scale.
Answer
C · 0 to 10
22.Pediatric nursing
Answer: C · Correct the dehydration and electrolyte imbalance with IV fluids as prescribed
Why this is the answer
Repeated vomiting causes dehydration and a hypochloraemic, hypokalaemic metabolic alkalosis. These are corrected first, because anaesthesia is unsafe until fluid and electrolytes are normal. Pyloromyotomy is not an emergency operation.
Answer
C · Correct the dehydration and electrolyte imbalance with IV fluids as prescribed
23.Mental health nursing
Answer: B · Report it promptly, because it may be the start of a serious skin reaction
Why this is the answer
Lamotrigine can cause Stevens–Johnson syndrome, especially early in treatment or if the dose is increased too quickly. Any rash needs prompt medical review.
Answer
B · Report it promptly, because it may be the start of a serious skin reaction
24.Mental health nursing
Answer: C · "I can stop taking it as soon as the voices go away."
Why this is the answer
Antipsychotics are continued after symptoms improve, because stopping them early is a major cause of relapse. Any change should be discussed with the prescriber.
Answer
C · "I can stop taking it as soon as the voices go away."
25.Nursing math & unit conversions
Answer: T = 38.2 °C
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.
Subtract 32
100.7 − 32 = 68.7
Multiply by 5/9
T = 68.7·5/9 = 38.17 ≈ 38.2 °C
Answer
T = 38.2 °C
26.Nursing math & unit conversions
Answer: D = 9 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 = 2.5 mcg/kg/min × 60 kg × (60 min/1 h) × (1 mg/1000 mcg)
Calculate
D = 2.5·60·60/1000 = 9 mg/h
Answer
D = 9 mg/h
27.Dosage calculations
Answer: V = 2.4 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.
Concentration after mixing
1000 mg/5 mL = 200 mg/mL
Volume
V = 480/200 = 2.4 mL
Answer
V = 2.4 mL
28.Dosage calculations
Answer: V = 0.83 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 = 830/1000 = 0.83 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.83 mL
29.IV infusion rates
Answer: R = 47 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 = 1500·15/480 = 46.88 ≈ 47 gtt/min
Answer
R = 47 gtt/min
At the bedside you round to the nearest whole drop: 47 gtt/min.
30.IV infusion rates
Answer: t = 2.7 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
42·60/15 = 168 mL/h
Time left
t = 450/168 = 2.679 ≈ 2.7 h
Answer
t = 2.7 h
31.IV fluids & fluid balance
Answer: U = 0.81 mL/kg/h
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 urine
375 + 250 = 625 mL
Per kilogram per hour
U = 625/(64·12) = 0.8138 ≈ 0.81 mL/kg/h
Answer
U = 0.81 mL/kg/h
32.IV fluids & fluid balance
Answer: t = 6.3 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
75·2 = 150 mL
1000 − 150 = 850 mL left
Second part
850/200 = 4.25 h
Total time
t = 2 + 4.25 = 6.25 ≈ 6.3 h
Answer
t = 6.3 h
That is about 6 h 15 min, so the bag runs out at about 22:45.
33.Clinical assessment scores
Answer: severe
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.
Score each area
E: opens the eyes only to pressure (a painful stimulus) → 2
V: makes no sounds → 1
M: no movement at all → 1
Add
GCS = 2 + 1 + 1 = 4
Severity
GCS 4 → severe
Answer
severe
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 92% → 2
on oxygen → 2
SBP 150 mmHg → 0
HR 88/min → 0
responds only to pain (P) → 3
T 34.8 °C → 3
Total and red scores
NEWS2 = 0 + 2 + 2 + 0 + 0 + 3 + 3 = 10
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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