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
A patient asks to see their own health records. What is correct in the UK?
APatients can see their records only with a court order
BOnly doctors are allowed to see health records
CPatients can only see their records once they have been discharged
DPatients have a legal right to request access to their records
2.Nursing fundamentalsHard
A pressure ulcer's base is completely covered with slough and dark eschar. How is it classified?
AUnstageable, because the depth cannot be seen
BHealed, because a scab has formed
CCategory 1, because the skin is not open
DCategory 2, because it is covered
3.Infection control & patient safetyMedium
A colleague has drawn up a medication and asks the nurse to give it to her patient. What should the nurse do?
AGive it, as long as the syringe has a label with the drug name on it
BGive it, because the colleague is experienced
CDecline, and give only medications that the nurse prepared or checked personally
DGive it, and document that the colleague prepared it
4.Infection control & patient safetyHard
During flu season, a nurse wakes up with fever, cough and muscle aches. What is the best action?
ATake an antipyretic so the fever does not show at work
BGo to work but wear a surgical mask for the whole shift
CGo to work but avoid caring for patients who have weak immune systems
DStay home and inform the employer according to the illness policy
5.Prioritization & delegationMedium
After a hip replacement using a posterior approach, which statement shows a need for further teaching?
A“I will use a raised toilet seat at home.”
B“I will keep a pillow between my knees when I lie on my side in bed.”
C“I will not bend my hip past 90 degrees.”
D“I will cross my legs when I sit, so I am more comfortable.”
6.Prioritization & delegationHard
An older adult with type 2 diabetes is confused and very dehydrated. The glucose is 900 mg/dL (50 mmol/L), and blood and urine show no significant ketones. What is the most likely problem?
AHypoglycemia with rebound
BHyperosmolar hyperglycemic state
CStress-induced mild hyperglycemia
DDiabetic ketoacidosis
7.Clinical nursingMedium
Which finding with a groin hernia needs urgent surgical review?
AThe lump has become painful and tender and cannot be pushed back
BThe lump disappears completely when the patient lies down flat
CThe lump gets bigger when the patient coughs
DThe lump has been present for several years without pain
8.Clinical nursingHard
A nurse is unsure whether a prescribed dose of a high-risk drug is correct. What is the safest action?
AGive half the dose as a compromise until the doctor is available
BAsk the patient whether the dose looks the same as usual and give it
CWithhold it and check with the prescriber or pharmacist first
DGive the dose because the doctor has signed the prescription
9.Lab values & electrolytesMedium
A patient has a platelet count of 18 × 10³/µL. Which nursing measure is appropriate?
ATake temperatures rectally every four hours for accuracy
BGive the prescribed aspirin when the patient has a headache
CEncourage flossing twice daily and shaving with a sharp razor blade
DSoft toothbrush, electric razor and no intramuscular injections
10.Lab values & electrolytesHard
Ten days after chemotherapy, a patient has a platelet count of 9 × 10³/µL and reports a sudden severe headache and blurred vision. What is the priority?
AGive acetaminophen (paracetamol) for the headache and reassess in 1 hour
BAssess neurological status and report it at once as possible brain bleeding
CEncourage the patient to drink more fluids and check the blood pressure later
DDim the lights and encourage rest, as headaches are common after chemotherapy
11.PharmacologyMedium
Which statement about allopurinol is correct?
AIt lowers uric acid over time and does not relieve the pain of an acute attack
BIt is taken only during an acute attack and stopped as soon as the pain settles
CIt increases uric acid production to flush out crystals
DIt works within an hour to relieve joint pain
12.PharmacologyHard
A patient on warfarin is taught about diet. Which statement shows a need for further teaching?
A"I will keep the amount of green leafy vegetables I eat about the same each week."
B"I will tell my dentist that I take warfarin."
C"I will use a soft toothbrush and an electric razor."
D"I will stop eating all green vegetables from now on."
13.Med-surg: cardiovascular & respiratoryMedium
The monitor shows ventricular fibrillation. The patient is unresponsive and not breathing normally. What is the key treatment?
AIV atropine and external pacing
BSynchronised cardioversion under deep sedation
CRapid IV adenosine followed by a flush
DCPR and defibrillation as soon as possible
14.Med-surg: cardiovascular & respiratoryHard
On day 6 of a heparin infusion, the platelet count has fallen by more than half and the patient has a new swollen arm. What should the nurse anticipate?
AContinuing the heparin and giving a platelet transfusion
BStopping all anticoagulation for two weeks
CSwitching to LMWH because it is a different drug
DStopping all heparin and starting a non-heparin anticoagulant
15.Med-surg: neuro, endocrine & renalMedium
What does a positive pronator drift test show?
ASubtle weakness in one arm
BA normal response in older adults
CLoss of hearing on one side
DWeakness of the eye muscles
16.Med-surg: neuro, endocrine & renalHard
A patient with a subarachnoid haemorrhage develops a low sodium. Why is fluid restriction usually avoided in this patient?
AFluid restriction raises the risk of seizures
BFluid restriction would cause the aneurysm to re-bleed
CLow sodium in this condition always corrects itself
DLow blood volume can worsen vasospasm and brain ischaemia
17.Med-surg: GI, perioperative & oncologyMedium
How can low-dose opioids help a patient with breathlessness from advanced cancer?
AThey cure the underlying lung disease
BThey reduce the feeling of breathlessness
CThey open the airways like an inhaler
DThey increase the oxygen level in the blood
18.Med-surg: GI, perioperative & oncologyHard
The skin around a patient's ileostomy is red, raw and weeping, and the pouch leaks often. What is the most likely cause?
AOutput on the skin, often from a poorly fitting appliance
BA normal reaction that needs no change in care
CAn allergy to the stool itself, which needs steroids
DIschaemia of the stoma, which needs urgent surgery
19.Maternity & obstetric nursingMedium
A newborn has a cleft lip and palate. Which feeding approach is most appropriate?
AFeeding only with a spoon from birth
BWithholding feeds until surgery
CFeeding lying flat on the back
DSpecial teats and an upright position
20.Maternity & obstetric nursingHard
A baby was stillborn at 38 weeks. Which nursing action is most appropriate?
AAvoid using the baby's name to prevent more grief
BOffer the parents time to see and hold their baby
CTell the parents they can try for another baby soon
DRemove the baby quickly so the parents are not upset
21.Pediatric nursingMedium
Which task can the registered nurse delegate to a healthcare assistant (nursing assistant) on a children's ward?
ATeaching a parent how to give insulin injections
BMeasuring and recording the vital signs of a stable child
CAssessing pain after surgery and choosing the analgesia
DCarrying out the admission assessment of a new patient
22.Pediatric nursingHard
A parent asks whether giving paracetamol (acetaminophen) at the first sign of fever will prevent another febrile seizure. What is the best answer?
ANo, because paracetamol can cause febrile seizures
BYes; giving it every 4 hours during a fever will always prevent seizures
CNo; it may ease discomfort but does not prevent febrile seizures
DYes, but only if a cold bath is given at the same time
23.Mental health nursingMedium
What should a patient starting zolpidem for insomnia be taught to report?
AFeeling slightly more rested and alert the next morning than before starting the medicine
BDoing things while not fully awake, such as sleepwalking or driving, with no memory of it
CFeeling sleepy about 30 minutes after taking it at bedtime
DSleeping through the night without waking up
24.Mental health nursingHard
A woman taking carbamazepine for bipolar disorder uses an oral contraceptive pill. What should the nurse teach?
AShe should take the pill and the carbamazepine at exactly the same time each day so that both of them stay fully effective
BCarbamazepine increases the effect of the pill, so she can take it every other day
CCarbamazepine can make the pill less effective, so she should discuss contraception with the prescriber
DThe two drugs do not interact in any way
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A drip-rate calculation gives 53.183 gtt/min. The rule in this exercise is that drip rates are rounded to the nearest whole drop. What value x do you record?
53.183 gtt/min
x = gtt/min
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 4 tbsp of liquid supplement, ½ tsp of cough syrup, 4 fl oz of juice, 3 cups of tea. Using the equivalents given, find the total oral intake V in mL.
1 tbsp = 15 mL1 tsp = 5 mL1 fl oz = 30 mL1 cup = 8 fl oz = 240 mL
V = mL
27.Dosage calculationsMedium
A vial contains 500 mg of powder. The label says: add 4.6 mL of water for injection to give a total volume of 5 mL. The prescription is 200 mg. What volume V of the reconstituted solution do you give?
500 mg+ 4.6 mL → 5 mL200 mg
V = mL
28.Dosage calculationsHard
The prescription is 890 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?
890 units1000 units/mL
V = mL
29.IV infusion ratesMedium
Infuse 500 mL over 2 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
500 mL2 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 28 gtt/min through a set of 15 gtt/mL. There are 750 mL left in the bag. How many hours t until it is empty? Round to one decimal place.
28 gtt/min15 gtt/mL750 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 IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss).
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 10:15 and runs by pump at 150 mL/h. How many mL V are left in the bag at 15:45?
1000 mL150 mL/h10:15 → 15:45
V = mL
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: completely limited; moisture: very moist; activity: bedfast; mobility: slightly limited; nutrition: adequate; friction and shear: potential problem. Find the Braden total B.
6–23
B =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: slightly limited; moisture: rarely moist; activity: chairfast; mobility: very limited; nutrition: excellent; friction and shear: no apparent problem. Use the bands 19–23 not at risk, 15–18 mild, 13–14 moderate, 10–12 high and 9 or below very high. Click the risk level.
1not at risk
2mild risk
3moderate risk
4high risk
5very high risk
3Solutions
1.Nursing fundamentals
Answer: D · Patients have a legal right to request access to their records
Why this is the answer
Under data protection law, patients can request access to their health records. The nurse explains the local process for making a request.
Answer
D · Patients have a legal right to request access to their records
2.Nursing fundamentals
Answer: A · Unstageable, because the depth cannot be seen
Why this is the answer
When slough or eschar hides the wound base, the true depth is unknown, so the ulcer is recorded as unstageable until the base can be seen.
Answer
A · Unstageable, because the depth cannot be seen
3.Infection control & patient safety
Answer: C · Decline, and give only medications that the nurse prepared or checked personally
Why this is the answer
Nurses give only medicines they prepared themselves or verified fully, because they are accountable for what they give. A drug prepared by someone else may be wrong in ways the nurse cannot see.
Answer
C · Decline, and give only medications that the nurse prepared or checked personally
4.Infection control & patient safety
Answer: D · Stay home and inform the employer according to the illness policy
Why this is the answer
Health care workers with signs of influenza should not work, because they can infect patients and colleagues. They follow the employer’s policy on when they may return.
Answer
D · Stay home and inform the employer according to the illness policy
5.Prioritization & delegation
Answer: D · “I will cross my legs when I sit, so I am more comfortable.”
Why this is the answer
After a posterior hip replacement, crossing the legs, bending the hip beyond 90 degrees and turning the leg inwards can cause dislocation. Raised seats and a pillow between the knees help prevent it.
Answer
D · “I will cross my legs when I sit, so I am more comfortable.”
6.Prioritization & delegation
Answer: B · Hyperosmolar hyperglycemic state
Why this is the answer
Hyperosmolar hyperglycemic state occurs mainly in type 2 diabetes, with extreme glucose, severe dehydration and little or no ketosis. Treatment starts with IV fluids, as in DKA.
Answer
B · Hyperosmolar hyperglycemic state
7.Clinical nursing
Answer: A · The lump has become painful and tender and cannot be pushed back
Why this is the answer
An irreducible, painful, tender hernia, especially with vomiting, suggests incarceration or strangulation. This is a surgical emergency because the trapped bowel can become ischaemic.
Answer
A · The lump has become painful and tender and cannot be pushed back
8.Clinical nursing
Answer: C · Withhold it and check with the prescriber or pharmacist first
Why this is the answer
Nurses must understand any drug they administer. If a dose seems wrong, they should check with the prescriber or pharmacist and document the action.
Answer
C · Withhold it and check with the prescriber or pharmacist first
9.Lab values & electrolytes
Answer: D · Soft toothbrush, electric razor and no intramuscular injections
Why this is the answer
Severe thrombocytopenia causes bleeding from minor trauma. Bleeding precautions include soft toothbrushes, electric razors, no IM injections or rectal procedures, and avoiding aspirin and NSAIDs.Checked against:Bleeding and Bruising (Thrombocytopenia) and Cancer Treatment · National Cancer Institute (NIH) (2022); Platelet Tests · MedlinePlus (NIH) (2024)
Answer
D · Soft toothbrush, electric razor and no intramuscular injections
10.Lab values & electrolytes
Answer: B · Assess neurological status and report it at once as possible brain bleeding
Why this is the answer
Platelet counts usually reach their lowest point (nadir) about 7–14 days after chemotherapy. With a count below 10 × 10³/µL, a sudden severe headache or visual change may signal intracranial bleeding, which is an emergency. The nurse assesses neurological status and reports it immediately.Checked against:Bleeding and Bruising (Thrombocytopenia) and Cancer Treatment · National Cancer Institute (NIH) (2022); Pancytopenia · StatPearls (NCBI Bookshelf) (2023)
Answer
B · Assess neurological status and report it at once as possible brain bleeding
11.Pharmacology
Answer: A · It lowers uric acid over time and does not relieve the pain of an acute attack
Why this is the answer
Allopurinol reduces urate production and is taken daily to prevent attacks. Acute attacks are treated with NSAIDs, colchicine or corticosteroids, and a new rash on allopurinol must be reported.
Answer
A · It lowers uric acid over time and does not relieve the pain of an acute attack
12.Pharmacology
Answer: D · "I will stop eating all green vegetables from now on."
Why this is the answer
Patients on warfarin should keep their vitamin K intake consistent rather than avoid it. Sudden changes in green vegetable intake can make the INR unstable.
Answer
D · "I will stop eating all green vegetables from now on."
13.Med-surg: cardiovascular & respiratory
Answer: D · CPR and defibrillation as soon as possible
Why this is the answer
Ventricular fibrillation is a cardiac arrest rhythm. High-quality CPR and early unsynchronised defibrillation are the interventions that improve survival. Synchronised cardioversion is for tachyarrhythmias with a pulse; atropine and pacing are for bradycardia.
Answer
D · CPR and defibrillation as soon as possible
14.Med-surg: cardiovascular & respiratory
Answer: D · Stopping all heparin and starting a non-heparin anticoagulant
Why this is the answer
Heparin-induced thrombocytopenia typically develops 5–10 days after starting heparin, with a large fall in platelets and new thrombosis. All heparin, including LMWH and heparin flushes, must stop, and a non-heparin anticoagulant (such as argatroban) is used. Platelet transfusion is generally avoided, and stopping anticoagulation would leave a very high clot risk.
Answer
D · Stopping all heparin and starting a non-heparin anticoagulant
15.Med-surg: neuro, endocrine & renal
Answer: A · Subtle weakness in one arm
Why this is the answer
When a weak arm drifts down and turns palm-down (pronates), it suggests a mild upper motor neuron weakness, for example from a stroke. It can detect weakness that is not obvious on routine testing.
Answer
A · Subtle weakness in one arm
16.Med-surg: neuro, endocrine & renal
Answer: D · Low blood volume can worsen vasospasm and brain ischaemia
Why this is the answer
Hyponatraemia after subarachnoid haemorrhage may come from SIADH or cerebral salt wasting. Restricting fluid can cause hypovolaemia, which makes delayed cerebral ischaemia more likely. Sodium is usually corrected with fluids or salt under specialist advice.
Answer
D · Low blood volume can worsen vasospasm and brain ischaemia
17.Med-surg: GI, perioperative & oncology
Answer: B · They reduce the feeling of breathlessness
Why this is the answer
In palliative care, low-dose opioids reduce the sensation of breathlessness and the anxiety it causes. Fans, positioning, relaxation and treating reversible causes are also used.
Answer
B · They reduce the feeling of breathlessness
18.Med-surg: GI, perioperative & oncology
Answer: A · Output on the skin, often from a poorly fitting appliance
Why this is the answer
Irritant dermatitis from leaking effluent is the commonest peristomal skin problem, particularly with ileostomies. The stoma is remeasured, the aperture and appliance (for example a convex base or seal) adjusted and skin protection used, ideally with stoma nurse input. Raw skin also makes the appliance stick less, worsening leaks.
Answer
A · Output on the skin, often from a poorly fitting appliance
19.Maternity & obstetric nursing
Answer: D · Special teats and an upright position
Why this is the answer
Babies with a cleft palate often need specialised bottles or teats, an upright feeding position, frequent burping and support from a cleft team. Some babies with a cleft lip only can breastfeed.
Answer
D · Special teats and an upright position
20.Maternity & obstetric nursing
Answer: B · Offer the parents time to see and hold their baby
Why this is the answer
Parents should be offered time with their baby, to name, hold and dress the baby if they wish, and keepsakes such as photographs, footprints or locks of hair. Their choices should be respected without pressure.
Answer
B · Offer the parents time to see and hold their baby
21.Pediatric nursing
Answer: B · Measuring and recording the vital signs of a stable child
Why this is the answer
Routine tasks with predictable outcomes for stable patients, such as recording vital signs, can be delegated. Assessment, care planning, teaching and evaluation remain the responsibility of the registered nurse, who also reviews the results.
Answer
B · Measuring and recording the vital signs of a stable child
22.Pediatric nursing
Answer: C · No; it may ease discomfort but does not prevent febrile seizures
Why this is the answer
Antipyretics relieve discomfort but have not been shown to prevent febrile seizure recurrence. Parents are taught seizure first aid, when to call for help and that most febrile seizures are harmless.
Answer
C · No; it may ease discomfort but does not prevent febrile seizures
23.Mental health nursing
Answer: B · 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
B · Doing things while not fully awake, such as sleepwalking or driving, with no memory of it
24.Mental health nursing
Answer: C · Carbamazepine can make the pill less effective, so she should discuss contraception with the prescriber
Why this is the answer
Carbamazepine induces liver enzymes and speeds up the breakdown of many drugs, including hormonal contraceptives. This can lead to unplanned pregnancy, and carbamazepine is also teratogenic.
Answer
C · Carbamazepine can make the pill less effective, so she should discuss contraception with the prescriber
25.Nursing math & unit conversions
Answer: x = 53 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
53.183 → 3
Only the next digit decides
53.183 → 1
1 is 4 or less, so 3 stays.
The digits after it (83) are ignored: round once, never step by step.
Round
x = 53 gtt/min
Answer
x = 53 gtt/min
26.Nursing math & unit conversions
Answer: V = 902.5 mL
Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.
Each item in mL
4 tbsp = 4·15 = 60 mL
½ tsp = 0.5·5 = 2.5 mL
4 fl oz = 4·30 = 120 mL
3 cups = 3·240 = 720 mL
Add
V = 60 + 2.5 + 120 + 720 = 902.5 mL
Answer
V = 902.5 mL
27.Dosage calculations
Answer: V = 2 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
500 mg/5 mL = 100 mg/mL
Volume
V = 200/100 = 2 mL
Answer
V = 2 mL
28.Dosage calculations
Answer: V = 0.89 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 = 890/1000 = 0.89 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.89 mL
29.IV infusion rates
Answer: R = 63 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
2·60 = 120 min
Drip rate
R = 500·15/120 = 62.5 ≈ 63 gtt/min
Answer
R = 63 gtt/min
At the bedside you round to the nearest whole drop: 63 gtt/min.
30.IV infusion rates
Answer: t = 6.7 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
28·60/15 = 112 mL/h
Time left
t = 750/112 = 6.696 ≈ 6.7 h
Answer
t = 6.7 h
31.IV fluids & fluid balance
Answer: B = 45 mL
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Total intake
oral: 200 + 150 = 350 mL
IV infusion: 75·12 = 900 mL
IV antibiotic: 2·50 = 100 mL
total intake = 1350 mL
Total output
375 + 500 + 300 + 130 = 1305 mL
Balance
B = 1350 − 1305 = 45 mL
Answer
B = 45 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: V = 175 mL
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.
Elapsed time
10:15 → 15:45 = 5.5 h
Volume infused
150·5.5 = 825 mL
Volume left
V = 1000 − 825 = 175 mL
Answer
V = 175 mL
33.Clinical assessment scores
Answer: B = 12
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: completely limited → 1
moisture: very moist → 2
activity: bedfast → 1
mobility: slightly limited → 3
nutrition: adequate → 3
friction and shear: potential problem → 2
Add
Braden total = 1 + 2 + 1 + 3 + 3 + 2 = 12
Answer
B = 12
34.Clinical assessment scores
Answer: mild risk
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: slightly limited → 3
moisture: rarely moist → 4
activity: chairfast → 2
mobility: very limited → 2
nutrition: excellent → 4
friction and shear: no apparent problem → 3
Add
Braden total = 3 + 4 + 2 + 2 + 4 + 3 = 18
Risk level
18 → mild risk
Answer
mild risk
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