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
What is the main purpose of a wound drain after surgery?
ATo keep the wound edges apart until it heals
BTo remove fluid or blood that could collect and delay healing
CTo give antibiotics directly into the wound until it has fully healed
DTo measure the temperature inside the wound
2.Nursing fundamentalsHard
A patient with a slow-healing leg ulcer is eating less than half of their meals. What is the most helpful nursing action?
ARefer to the dietitian and support protein and energy intake
BAsk the patient to drink less to avoid swelling
CGive extra salt to stimulate the appetite
DWait until the ulcer heals before addressing nutrition
3.Infection control & patient safetyMedium
Why are some patients screened with a nasal swab for MRSA on admission?
ATo check whether the patient is allergic to penicillin before surgery
BTo find carriers so precautions or decolonization can be used
CTo measure the patient’s immunity to MRSA
DTo diagnose a sinus infection
4.Infection control & patient safetyHard
A nurse teaches a patient with neutropenia about preventing infection at home. Which statement shows a need for further teaching?
A“I will avoid crowds and people who have colds.”
B“I will check my temperature and call if I have a fever.”
C“I can clean the cat’s litter box if I wear a face mask.”
D“I will wash my hands often and ask visitors to do the same.”
5.Prioritization & delegationMedium
Several patients on a gastroenterology unit need care. Which patient should the nurse see first?
AUlcerative colitis, asking about diet changes for home
BLong-standing back pain, asking for the usual analgesic
CTwo hours after a colonoscopy: rigid abdomen and severe new pain
DCrohn disease, waiting to be taken down for a scheduled CT scan
6.Prioritization & delegationHard
Which assignment by the charge nurse should be changed?
AAn LPN/LVN is assigned to admit a new patient from the emergency department
BAn RN is assigned to a patient receiving a blood transfusion
CAn LPN/LVN is assigned to give oral medications to stable patients
DA nursing assistant is assigned to help several stable patients with their meals
7.Clinical nursingMedium
How is Helicobacter pylori infection usually treated?
ASurgery to remove the stomach
BA single dose of paracetamol and a bland diet for a week
CAntacids alone, taken after every meal for a month
DA combination of antibiotics with a proton pump inhibitor
8.Clinical nursingHard
A patient with hyperkalaemia is given IV insulin with glucose. What is the purpose, and what must be monitored?
ATo treat hidden diabetes; HbA1c must be checked daily
BTo shift potassium into cells; blood glucose must be monitored for hypoglycaemia
CTo protect the heart muscle directly; the patient must be kept nil by mouth
DTo remove potassium from the body; urine output must be stopped for a time
9.Lab values & electrolytesMedium
A patient on levothyroxine has palpitations, weight loss and a TSH of 0.05 mIU/L. What is the most likely explanation?
AThe patient has stopped the drug
BThe thyroid is now completely normal
CThe levothyroxine dose is too low
DThe levothyroxine dose is too high
10.Lab values & electrolytesHard
An 82-year-old woman without a catheter has a urine culture growing bacteria, but no fever, urinary symptoms or change in mental state. What is the best interpretation?
APyelonephritis, which needs admission and IV fluids today
BContamination, so the culture must be repeated every week
CAsymptomatic bacteriuria, usually not treated with antibiotics
DA urinary tract infection that needs urgent IV antibiotics
11.PharmacologyMedium
How does heparin produce its anticoagulant effect?
AIt breaks down fibrin in existing clots
BIt enhances antithrombin, which inactivates thrombin and factor Xa
CIt blocks the vitamin K-dependent synthesis of clotting factors in the liver
DIt irreversibly inhibits platelet COX-1
12.PharmacologyHard
A patient with early aspirin (salicylate) overdose has tinnitus and is breathing fast. Which acid–base pattern is classic?
ARespiratory alkalosis followed by metabolic acidosis
BMetabolic alkalosis followed by respiratory acidosis
CRespiratory acidosis with normal bicarbonate
DPure metabolic alkalosis
13.Med-surg: cardiovascular & respiratoryMedium
Two days after a myocardial infarction, a patient develops sudden breathlessness, crackles and a new loud systolic murmur. Which complication should be suspected?
APapillary muscle rupture with acute mitral regurgitation
BA new episode of stable angina brought on by stress
CPost-infarction pericarditis causing a pericardial friction rub
DA pulmonary embolism caused by prolonged bed rest
14.Med-surg: cardiovascular & respiratoryHard
A patient with small-cell lung cancer becomes confused. Sodium is 122 mmol/L (122 mEq/L) with concentrated urine, and there are no signs of dehydration. What is the most likely cause?
ASyndrome of inappropriate ADH secretion
BExcess salt in the diet over several weeks
CSevere dehydration from poor oral intake
DCranial diabetes insipidus from brain metastases
15.Med-surg: neuro, endocrine & renalMedium
A patient has a nephrostomy tube. Which finding needs urgent action?
AA dry, intact dressing at the site
BLight pink urine on the first day after insertion
CSteady urine drainage into the bag
DDrainage that stops suddenly with new loin pain
16.Med-surg: neuro, endocrine & renalHard
Three days after a stroke, a patient with dysphagia on a modified diet has a temperature of 38.2 °C (100.8 °F), a respiratory rate of 24/min and crackles at the right lung base. What should the nurse do?
AGive paracetamol (acetaminophen) and continue the modified diet as before
BRecord the findings and recheck them at the next routine observation
CEncourage more fluids by mouth to treat the fever
DSuspect aspiration pneumonia, stop oral intake and escalate for review
17.Med-surg: GI, perioperative & oncologyMedium
Why might urea rise much more than creatinine in a patient with an upper GI bleed?
AUrea is produced by the bleeding stomach lining
BDigested blood is a protein load that raises urea
CThe bleed always damages the kidney tubules directly
DCreatinine is lost from the body in the vomit
18.Med-surg: GI, perioperative & oncologyHard
A patient has sharp, tearing pain on passing stool, "like passing glass", with a streak of fresh blood. Which condition is most likely?
AColorectal cancer
BAnal fissure
CUpper GI bleeding
DCrohn's disease of the ileum
19.Maternity & obstetric nursingMedium
The fundus is boggy, above the umbilicus and displaced to the right. What is the most likely cause?
AA full bladder
BA normal finding on day 1
CRetained placental tissue on the left
DA tear in the perineum
20.Maternity & obstetric nursingHard
A woman attempting a vaginal birth after a previous caesarean suddenly has severe abdominal pain, the fetal heart rate drops sharply and the presenting part can no longer be felt. What is most likely?
AEarly decelerations from head compression
BPlacenta praevia
CUterine rupture
DNormal progress into the second stage
21.Pediatric nursingMedium
A child has just spilled hot tea on his arm. What is the correct first aid?
ACool the burn under cool running water for about 20 minutes
BHold ice directly on the burn for about an hour to stop the pain
CBurst any blisters to let the heat out
DSpread butter or toothpaste on the burn
22.Pediatric nursingHard
A 3-year-old says the IV pump "is angry" when it beeps. Which feature of thinking does this show?
AObject permanence, typical of the sensorimotor stage
BAnimism, typical of preoperational thinking
CAbstract reasoning, typical of formal operations
DConservation, typical of concrete operations
23.Mental health nursingMedium
A patient taking sertraline wants to take ibuprofen regularly for arthritis. What should the nurse teach?
AThe combination is completely safe because they act on different systems
BIbuprofen should be taken instead of sertraline on the days when the arthritis pain is bad, to avoid any interaction
CIbuprofen will make the sertraline work faster
DThe combination increases the risk of bleeding, especially in the stomach, so discuss it with the prescriber
24.Mental health nursingHard
Which patient should the nurse check first?
AA patient given IM haloperidol and lorazepam 30 minutes ago who is hard to rouse, breathing 8/min
BA patient with OCD who is late for breakfast because of a long washing ritual in the bathroom
CA patient with schizophrenia who wants a cigarette break in the garden
DA patient with depression who is asking for help to phone his mother
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 103 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.
103 °F
T = °C
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 19:50 and finishes at 06:35 the next morning (24-hour clock). How many minutes t did it run?
19:5006:35
t = min
27.Dosage calculationsMedium
A child weighing 16 kg is prescribed 5 mg/kg of a drug. The stock solution contains 40 mg/mL. Draw up the dose: what volume V do you give?
16 kg5 mg/kg40 mg/mL
V = mL
28.Dosage calculationsHard
The prescription is 310 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?
310 units1000 units/mL
V = mL
29.IV infusion ratesMedium
A drip runs at 35 gtt/min through a set of 20 gtt/mL. How many millilitres V does the patient receive in 12 hours?
35 gtt/min20 gtt/mL12 h
V = mL
30.IV infusion ratesHard
A bag contains 4 g of a drug in 500 mL. The order is 4 mg per minute. At what rate R do you set the pump, in mL/h?
4 g/500 mL4 mg/min
R = mL/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 89 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
89 kg12 hurine: 150 mLurine: 375 mLwound drain: 80 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 80 mL/h. At 15:00, 100 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL100 mL infused80 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: no; secondary diagnosis: yes; ambulatory aid: none, bed rest or nurse assists; IV therapy or saline lock: yes; gait: weak; mental status: knows own limits. Find the Morse total MFS.
0–125
MFS =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 114 kg and is 171 cm tall. Calculate the BMI and click the WHO weight category.
114 kg171 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
3Solutions
1.Nursing fundamentals
Answer: B · To remove fluid or blood that could collect and delay healing
Why this is the answer
Drains let blood, serous fluid or pus escape, preventing collections such as seromas and haematomas. The nurse records the amount and type of drainage.
Answer
B · To remove fluid or blood that could collect and delay healing
2.Nursing fundamentals
Answer: A · Refer to the dietitian and support protein and energy intake
Why this is the answer
Poor intake delays healing. Screening, dietitian referral, food charts and support with meals, including protein and energy supplements if needed, help the wound heal.
Answer
A · Refer to the dietitian and support protein and energy intake
3.Infection control & patient safety
Answer: B · To find carriers so precautions or decolonization can be used
Why this is the answer
Screening identifies people who are colonized with MRSA, often in the nose. Precautions and, in some cases, decolonization reduce spread and the risk of the patient’s own infection after surgery.
Answer
B · To find carriers so precautions or decolonization can be used
4.Infection control & patient safety
Answer: C · “I can clean the cat’s litter box if I wear a face mask.”
Why this is the answer
Immunocompromised patients should avoid cleaning litter boxes and other animal waste, because of organisms such as Toxoplasma. Another person should do it. The other statements are correct.
Answer
C · “I can clean the cat’s litter box if I wear a face mask.”
5.Prioritization & delegation
Answer: C · Two hours after a colonoscopy: rigid abdomen and severe new pain
Why this is the answer
A rigid abdomen with severe pain after colonoscopy suggests bowel perforation and peritonitis, a surgical emergency. The other patients have stable, chronic or routine needs.
Answer
C · Two hours after a colonoscopy: rigid abdomen and severe new pain
6.Prioritization & delegation
Answer: A · An LPN/LVN is assigned to admit a new patient from the emergency department
Why this is the answer
Admitting a new patient includes the initial assessment and plan of care, which belong to the RN. The other assignments match each staff member’s role.
Answer
A · An LPN/LVN is assigned to admit a new patient from the emergency department
7.Clinical nursing
Answer: D · A combination of antibiotics with a proton pump inhibitor
Why this is the answer
Eradication therapy combines a PPI with two antibiotics for a set course. Completing the course is important for success.
Answer
D · A combination of antibiotics with a proton pump inhibitor
8.Clinical nursing
Answer: B · To shift potassium into cells; blood glucose must be monitored for hypoglycaemia
Why this is the answer
Insulin drives potassium into cells, temporarily lowering serum levels. Glucose is given to prevent hypoglycaemia, but glucose monitoring is still needed for several hours.
Answer
B · To shift potassium into cells; blood glucose must be monitored for hypoglycaemia
9.Lab values & electrolytes
Answer: D · The levothyroxine dose is too high
Why this is the answer
A very low TSH with symptoms of excess thyroid hormone suggests over-replacement. The dose is usually reduced, because long-term over-replacement raises the risk of atrial fibrillation and bone loss, especially in older adults.Checked against:TSH test · MedlinePlus (NIH) (2026)
Answer
D · The levothyroxine dose is too high
10.Lab values & electrolytes
Answer: C · Asymptomatic bacteriuria, usually not treated with antibiotics
Why this is the answer
Asymptomatic bacteriuria is common in older adults and usually should not be treated, because treatment brings adverse effects and resistance without benefit. Exceptions include pregnancy and some urological procedures.Checked against:Asymptomatic Bacteriuria · StatPearls (NCBI Bookshelf) (2023)
Answer
C · Asymptomatic bacteriuria, usually not treated with antibiotics
11.Pharmacology
Answer: B · It enhances antithrombin, which inactivates thrombin and factor Xa
Why this is the answer
Heparin binds antithrombin and greatly accelerates its inactivation of thrombin and factor Xa. Low-molecular-weight heparins act mainly on factor Xa.
Answer
B · It enhances antithrombin, which inactivates thrombin and factor Xa
12.Pharmacology
Answer: A · Respiratory alkalosis followed by metabolic acidosis
Why this is the answer
Salicylates stimulate breathing, causing respiratory alkalosis early. They then disturb cell metabolism, causing a metabolic acidosis with a raised anion gap. Adults often show a mixed picture.
Answer
A · Respiratory alkalosis followed by metabolic acidosis
13.Med-surg: cardiovascular & respiratory
Answer: A · Papillary muscle rupture with acute mitral regurgitation
Why this is the answer
Rupture of a papillary muscle (or of the ventricular septum) after MI produces a new murmur and sudden heart failure or shock. This is a surgical emergency. Pericarditis causes pleuritic chest pain and a friction rub rather than acute pulmonary oedema with a new murmur.
Answer
A · Papillary muscle rupture with acute mitral regurgitation
14.Med-surg: cardiovascular & respiratory
Answer: A · Syndrome of inappropriate ADH secretion
Why this is the answer
Small-cell lung cancer can secrete ADH, causing water retention and dilutional hyponatraemia (normal sodium about 135–145 mmol/L). Urine is inappropriately concentrated and the patient is not dry. Fluid restriction and treating the cancer are the main measures; sodium is corrected slowly to avoid osmotic demyelination.
Answer
A · Syndrome of inappropriate ADH secretion
15.Med-surg: neuro, endocrine & renal
Answer: D · Drainage that stops suddenly with new loin pain
Why this is the answer
A sudden stop in drainage with pain suggests the tube is blocked or dislodged, so the kidney is obstructed again. The nurse checks for kinks and escalates urgently. Fever or rigors may signal infection.
Answer
D · Drainage that stops suddenly with new loin pain
16.Med-surg: neuro, endocrine & renal
Answer: D · Suspect aspiration pneumonia, stop oral intake and escalate for review
Why this is the answer
These signs suggest aspiration pneumonia, which is a common and serious complication of dysphagia. The patient needs medical review, chest assessment, oxygen if needed, and reassessment of their swallow before eating again.
Answer
D · Suspect aspiration pneumonia, stop oral intake and escalate for review
17.Med-surg: GI, perioperative & oncology
Answer: B · Digested blood is a protein load that raises urea
Why this is the answer
Digested blood is a large protein load, so urea rises, often out of proportion to creatinine. Hypovolaemia can also raise urea. A high urea is part of risk scores such as the Glasgow-Blatchford score.
Answer
B · Digested blood is a protein load that raises urea
18.Med-surg: GI, perioperative & oncology
Answer: B · Anal fissure
Why this is the answer
An anal fissure causes severe pain during and after defecation with bright red blood. Treatment includes stool softeners, fibre and topical treatment to relax the sphincter.
Answer
B · Anal fissure
19.Maternity & obstetric nursing
Answer: A · A full bladder
Why this is the answer
A full bladder lifts and displaces the uterus, usually to the right, and stops it contracting well. Helping the woman to empty her bladder usually lets the fundus return to the midline and firm up.
Answer
A · A full bladder
20.Maternity & obstetric nursing
Answer: C · Uterine rupture
Why this is the answer
Sudden pain, fetal bradycardia and loss of station are classic signs of uterine rupture, a rare but life-threatening emergency that requires immediate surgery.
Answer
C · Uterine rupture
21.Pediatric nursing
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, within the first hours, limits burn depth and pain. Ice can cause further tissue damage and hypothermia, butter or toothpaste trap heat and add infection risk, and blisters should be left intact.
Answer
A · Cool the burn under cool running water for about 20 minutes
22.Pediatric nursing
Answer: B · Animism, typical of preoperational thinking
Why this is the answer
Animism, giving lifelike qualities to objects, is a feature of Piaget's preoperational stage. Nurses can use it by explaining equipment in simple, friendly terms and letting the child touch it.
Answer
B · Animism, typical of preoperational thinking
23.Mental health nursing
Answer: D · The combination increases the risk of bleeding, especially in the stomach, so discuss it with the prescriber
Why this is the answer
SSRIs reduce serotonin uptake into platelets, which impairs clotting. Combined with NSAIDs, aspirin or anticoagulants, the risk of gastrointestinal bleeding rises.
Answer
D · The combination increases the risk of bleeding, especially in the stomach, so discuss it with the prescriber
24.Mental health nursing
Answer: A · A patient given IM haloperidol and lorazepam 30 minutes ago who is hard to rouse, breathing 8/min
Why this is the answer
Over-sedation with respiratory depression after rapid tranquillisation is a medical emergency. Airway, breathing and vital signs are checked immediately, and help is called.
Answer
A · A patient given IM haloperidol and lorazepam 30 minutes ago who is hard to rouse, breathing 8/min
25.Nursing math & unit conversions
Answer: T = 39.4 °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
103 − 32 = 71
Multiply by 5/9
T = 71·5/9 = 39.44 ≈ 39.4 °C
Answer
T = 39.4 °C
26.Nursing math & unit conversions
Answer: t = 645 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
19:50 → 24:00 = 250 min
After midnight
00:00 → 06:35 = 395 min
Total
t = 250 + 395 = 645 min
Answer
t = 645 min
27.Dosage calculations
Answer: V = 2 mL
Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.
Dose from body weight
D = 5·16 = 80 mg
Volume
V = 80/40 = 2 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 2 mL
28.Dosage calculations
Answer: V = 0.31 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 = 310/1000 = 0.31 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.31 mL
29.IV infusion rates
Answer: V = 1260 mL
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
35·60/20 = 105 mL/h
Volume
V = 105·12 = 1260 mL
Answer
V = 1260 mL
30.IV infusion rates
Answer: R = 30 mL/h
Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).
Concentration
4000 mg/500 mL = 8 mg/mL
Dose per hour
4·60 = 240 mg/h
Pump rate
R = 240/8 = 30 mL/h
Answer
R = 30 mL/h
31.IV fluids & fluid balance
Answer: U = 0.49 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
150 + 375 = 525 mL
Per kilogram per hour
U = 525/(89·12) = 0.4916 ≈ 0.49 mL/kg/h
Answer
U = 0.49 mL/kg/h
32.IV fluids & fluid balance
Answer: t = 5 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.
Volume left
500 − 100 = 400 mL
Time
t = 400/80 = 5 h
Answer
t = 5 h
That is about 5 h 00 min, so the bag runs out at about 20:00.
33.Clinical assessment scores
Answer: MFS = 45
Morse fall scale: six items. History of falling: no 0, yes 25. Secondary diagnosis: no 0, yes 15. Ambulatory aid: none, bed rest or nurse assistance 0; crutches, cane or walker 15; holding on to furniture 30. IV therapy or saline lock: no 0, yes 20. Gait: normal, bed rest or wheelchair 0; weak 10; impaired 20. Mental status: knows own limits 0; overestimates or forgets limits 15. The total runs from 0 to 125. Risk cut-offs differ between hospitals; a common set is 0–24 low, 25–44 moderate and 45 or more high.
Score each item
history of falling in the last 3 months: no → 0
secondary diagnosis: yes → 15
ambulatory aid: none, bed rest or nurse assists → 0
IV therapy or saline lock: yes → 20
gait: weak → 10
mental status: knows own limits → 0
Add
Morse total = 0 + 15 + 0 + 20 + 10 + 0 = 45
Answer
MFS = 45
34.Clinical assessment scores
Answer: obesity class II
Body mass index: BMI = weight (kg)/height (m)², with the height converted to metres first. With pounds and inches, BMI = 703 × weight (lb)/height (in)². WHO adult categories: below 18.5 underweight, 18.5–24.9 healthy weight, 25.0–29.9 overweight, 30.0–34.9 obesity class I, 35.0–39.9 obesity class II and 40 or more obesity class III.
BMI
BMI = 114/1.71² = 38.99
Category
obesity class II
Answer
obesity class II
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