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
Which behaviour shows active listening?
APlanning your reply while the patient is talking
BChanging the subject when emotions come up
CParaphrasing what the patient said to check understanding
DLooking at the computer screen to take notes during the conversation
2.Nursing fundamentalsHard
A patient with heart failure weighs 2 kg more than yesterday on the same scales. What does this most likely show?
AThe scales must have been faulty
BThe patient is becoming dehydrated
CThe patient has gained 2 kg of body fat
DAbout 2 litres of fluid has been retained
3.Infection control & patient safetyMedium
A patient cannot bear weight and cannot help with transfers. Which method is safest to move the patient from bed to chair?
AAsking the patient to stand and try their best
BOne nurse doing a standing pivot transfer
CTwo nurses lifting the patient under the arms
DA mechanical lift used by enough trained staff
4.Infection control & patient safetyHard
A unit keeps vials of concentrated potassium chloride in the ward stock cupboard. Why do many safety guidelines advise against this?
APotassium chloride vials expire within a day of opening
BPotassium chloride is too expensive to keep as general ward stock
CPotassium chloride must always be given by mouth
DUndiluted concentrate given by mistake can stop the heart
5.Prioritization & delegationMedium
A stable adult with normal vital signs has a cut on the hand that needs sutures and nothing else. Which ESI level fits?
ALevel 5
BLevel 3
CLevel 4
DLevel 2
6.Prioritization & delegationHard
A patient has a potassium of 7.0 mEq/L with peaked T waves. Several drugs are prescribed. Which one is usually given first to protect the heart?
AOral sodium bicarbonate
BIV furosemide
CIV calcium gluconate
DOral potassium binder
7.Clinical nursingMedium
A patient with heart failure has pink, frothy sputum and crackles throughout both lungs. What is happening?
APneumothorax
BAcute pulmonary oedema
CUpper gastrointestinal bleeding
DAsthma attack
8.Clinical nursingHard
A nurse realises she has given a patient a medicine prescribed for another patient. What should she do first?
AWait to see whether any side effects develop
BAsk a colleague not to mention it
CCheck the patient's condition and inform the doctor
DGive the patient's own medicine as well to balance it
9.Lab values & electrolytesMedium
A patient taking warfarin for atrial fibrillation has an INR of 5.2 and no bleeding. What is the nurse’s best action?
AGive the usual dose and recheck in a month
BHold the warfarin dose and inform the prescriber
CGive a double dose
DAdvise the patient to stop eating green vegetables from today
10.Lab values & electrolytesHard
A patient with a round face, central weight gain and purple stretch marks has a glucose of 210 mg/dL (11.7 mmol/L) and a potassium of 3.1 mEq/L. Which condition fits best?
AHypothyroidism
BAdrenal insufficiency
CCushing syndrome
DDiabetes insipidus
11.PharmacologyMedium
Why is propranolol usually avoided in patients with asthma?
AIt increases mucus production by blocking histamine
BIt causes tolerance to inhaled corticosteroids
CIt stimulates alpha-1 receptors in the airways and raises blood pressure
DIt blocks beta-2 receptors in the airways and can cause bronchospasm
12.PharmacologyHard
A drug has a half-life of 6 hours. Its plasma level is 80 mg/L. Assuming first-order elimination and no further doses, what is the level after 18 hours?
A40 mg/L
B10 mg/L
C20 mg/L
D26.7 mg/L
13.Med-surg: cardiovascular & respiratoryMedium
Why are patients with mitral stenosis at high risk of atrial fibrillation?
AThe left atrium enlarges as it pushes blood through the narrow valve
BThe narrow valve presses on the sinus node and slows it down directly
CThe right ventricle shrinks and stops contracting properly over time
DThe coronary arteries become blocked by the valve
14.Med-surg: cardiovascular & respiratoryHard
A patient has been on continuous NIV via a full-face mask for two days. Which nursing measure helps prevent the most common complication?
ACheck mask fit and protect the bridge of the nose
BUse the same mask size for every patient
CRemove the mask for an hour each time the alarm sounds
DTighten the straps as far as they will go to stop any leak
15.Med-surg: neuro, endocrine & renalMedium
Which CSF result is most typical of bacterial meningitis?
ABlood-stained fluid that clears in later tubes
BCloudy fluid, many neutrophils, low glucose and high protein
CClear fluid, many lymphocytes, normal glucose and slightly raised protein
DClear fluid with normal cells, glucose and protein
16.Med-surg: neuro, endocrine & renalHard
Which nursing care is important for a patient receiving mannitol for raised intracranial pressure?
AClose monitoring of urine output, sodium and osmolality
BClamping the catheter to keep fluid in the body
CStopping the fluid balance chart during treatment
DGiving the drug orally with meals to reduce nausea
17.Med-surg: GI, perioperative & oncologyMedium
Aspirate from a nasogastric tube has a pH of 7. What should the nurse do?
AFlush with 50 mL of air and start the feed
BGive the medicines but not the feed
CDo not use it; re-test later or arrange an X-ray as per policy
DStart the feed slowly and watch the patient closely for coughing
18.Med-surg: GI, perioperative & oncologyHard
A patient's platelet count is 18 × 109/L (18,000/µL). Which order should the nurse question?
AAn intramuscular injection
BOral paracetamol for headache
CDaily full blood count
DA soft diet with mouthwashes
19.Maternity & obstetric nursingMedium
On day 2, a newborn has red blotches with small yellow-white centres on the trunk. The baby is well. What is most likely?
AErythema toxicum
BNeonatal sepsis
CHerpes simplex infection
DPort-wine stain
20.Maternity & obstetric nursingHard
Just after the membranes rupture, there is painless vaginal bleeding and the fetal heart rate drops sharply. The mother's vital signs are normal. Which condition is most likely?
APlacental abruption
BRuptured vasa praevia
CUterine rupture
DBloody show
21.Pediatric nursingMedium
Why is aspirin used in Kawasaki disease even though it is usually avoided in children?
AIt is used only as a painkiller for the rash and joint pain, and is stopped once the fever settles
BIt prevents Reye syndrome
CIt reduces inflammation and the risk of coronary artery clots, under specialist supervision
DIt cures the infection that causes the disease
22.Pediatric nursingHard
A 2-month-old is brought in with bruises on both cheeks. The parent says the baby "bumps into things". What should the nurse do?
AAccept the explanation because babies often bump into things
BDocument the findings objectively and follow the safeguarding procedure to report the concern
CTell the parent that a report will be made, then let them take the baby home before it is reviewed
DAccuse the parent of abuse in front of other families
23.Mental health nursingMedium
What does the Mini-Cog screening test for cognitive impairment involve?
AMeasuring the level of alcohol in the blood
BA 30-minute brain scan
CRecall of three words and a clock-drawing task
DA questionnaire about mood over the past 2 weeks
24.Mental health nursingHard
A patient who took a high-dose benzodiazepine daily for a year tells you she stopped it suddenly 2 days ago. What is the main risk?
AHypoglycaemia
BHair loss
CWeight gain
DWithdrawal seizures
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose calculation for a small injection gives 0.75145 mL. The rule in this exercise is that volumes below 1 mL are rounded to the nearest hundredth of a mL. What value x do you record?
0.75145 mL
x = mL
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 20:30 and finishes at 04:20 the next morning (24-hour clock). How many minutes t did it run?
20:3004:20
t = min
27.Dosage calculationsMedium
A patient weighs 22 kg. The prescribed dose is 25 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?
22 kg25 mg/kg/day3× per day
D = mg
28.Dosage calculationsHard
The prescription is 710 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?
710 units1000 units/mL
V = mL
29.IV infusion ratesMedium
Infuse 500 mL over 6 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 mL6 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 200 mL left in the bag. How many hours t until it is empty? Round to one decimal place.
42 gtt/min15 gtt/mL200 mL
t = h
31.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 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 runs by pump at 125 mL/h. At 10:30, 750 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL750 mL infused125 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: no impairment; moisture: occasionally moist; activity: chairfast; mobility: completely immobile; nutrition: excellent; friction and shear: no apparent problem. Find the Braden total B.
6–23
B =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 122 kg and is 150 cm tall. Calculate the BMI and click the WHO weight category.
122 kg150 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
3Solutions
1.Nursing fundamentals
Answer: C · Paraphrasing what the patient said to check understanding
Why this is the answer
Active listening includes attention, appropriate eye contact, nodding, reflecting and paraphrasing. It helps patients feel heard and gives the nurse accurate information.
Answer
C · Paraphrasing what the patient said to check understanding
2.Nursing fundamentals
Answer: D · About 2 litres of fluid has been retained
Why this is the answer
A rapid weight change over a day reflects fluid, not fat; 1 kg is roughly 1 litre. Daily weights taken at the same time on the same scales are a sensitive measure of fluid retention.
Answer
D · About 2 litres of fluid has been retained
3.Infection control & patient safety
Answer: D · A mechanical lift used by enough trained staff
Why this is the answer
For a patient who cannot bear weight or help, a mechanical lift prevents injury to both patient and staff. Lifting under the arms can injure the shoulders, and pivot transfers need weight bearing.
Answer
D · A mechanical lift used by enough trained staff
4.Infection control & patient safety
Answer: D · Undiluted concentrate given by mistake can stop the heart
Why this is the answer
Concentrated potassium chloride given undiluted or too quickly can stop the heart. Removing the concentrate from general ward stock and using premixed, ready-to-use bags is a widely recommended safety measure.
Answer
D · Undiluted concentrate given by mistake can stop the heart
5.Prioritization & delegation
Answer: C · Level 4
Why this is the answer
For a stable patient, ESI levels 3 to 5 depend on the expected resources: two or more is level 3, one is level 4 and none is level 5. Simple suturing counts as one resource, so this is level 4.
Answer
C · Level 4
6.Prioritization & delegation
Answer: C · IV calcium gluconate
Why this is the answer
IV calcium stabilizes the cardiac cell membranes within minutes and is given first when hyperkalemia changes the ECG. Insulin with glucose, binders and diuretics then lower the potassium.
Answer
C · IV calcium gluconate
7.Clinical nursing
Answer: B · Acute pulmonary oedema
Why this is the answer
Acute pulmonary oedema causes severe breathlessness, crackles and frothy sputum. Sit the patient up, give oxygen and call urgently for medical help; diuretics are commonly given.
Answer
B · Acute pulmonary oedema
8.Clinical nursing
Answer: C · Check the patient's condition and inform the doctor
Why this is the answer
The first priority is the patient: assess them and inform the prescriber so that any treatment can be given. The error must then be documented, reported and discussed openly with the patient (open disclosure; in the UK, the statutory duty of candour).
Answer
C · Check the patient's condition and inform the doctor
9.Lab values & electrolytes
Answer: B · Hold the warfarin dose and inform the prescriber
Why this is the answer
An INR of 5.2 is far above the target and increases the bleeding risk. The nurse holds the dose, checks for signs of bleeding and informs the prescriber, who may prescribe a lower dose or vitamin K.Checked against:Prothrombin Time Test and INR (PT/INR) · MedlinePlus (NIH) (2024); Warfarin · MedlinePlus (NIH) (2026)
Answer
B · Hold the warfarin dose and inform the prescriber
10.Lab values & electrolytes
Answer: C · Cushing syndrome
Why this is the answer
Excess cortisol raises glucose, causes central obesity, a round face and purple striae, and has some mineralocorticoid effect that lowers potassium. Adrenal insufficiency causes low glucose and high potassium.Checked against:Hypercortisolism (Cushing Syndrome) · StatPearls (NCBI Bookshelf) (2025); Hypokalemia · StatPearls (NCBI Bookshelf) (2025)
Answer
C · Cushing syndrome
11.Pharmacology
Answer: D · It blocks beta-2 receptors in the airways and can cause bronchospasm
Why this is the answer
Non-selective beta blockers block both beta-1 and beta-2 receptors. Blocking beta-2 receptors in the bronchi removes their relaxing effect and can trigger severe bronchospasm.
Answer
D · It blocks beta-2 receptors in the airways and can cause bronchospasm
12.Pharmacology
Answer: B · 10 mg/L
Why this is the answer
18 hours is three half-lives. The level halves three times: 80 → 40 → 20 → 10 mg/L.
Answer
B · 10 mg/L
13.Med-surg: cardiovascular & respiratory
Answer: A · The left atrium enlarges as it pushes blood through the narrow valve
Why this is the answer
A narrowed mitral valve raises pressure in the left atrium, which dilates. A stretched atrium is prone to atrial fibrillation, and blood stasis there carries a high risk of clots and stroke. Anticoagulation is therefore essential in mitral stenosis with AF.
Answer
A · The left atrium enlarges as it pushes blood through the narrow valve
14.Med-surg: cardiovascular & respiratory
Answer: A · Check mask fit and protect the bridge of the nose
Why this is the answer
Pressure injury over the bridge of the nose is common with NIV masks. Correctly sized masks, avoiding overtightening (allowing a small gap under the straps), protective dressings and regular skin checks reduce it. Other problems include eye irritation, dryness and gastric distension.
Answer
A · Check mask fit and protect the bridge of the nose
15.Med-surg: neuro, endocrine & renal
Answer: B · Cloudy fluid, many neutrophils, low glucose and high protein
Why this is the answer
Bacterial meningitis usually gives turbid CSF with raised neutrophils and protein and low glucose. Viral meningitis typically shows clear fluid with lymphocytes and normal glucose.
Answer
B · Cloudy fluid, many neutrophils, low glucose and high protein
16.Med-surg: neuro, endocrine & renal
Answer: A · Close monitoring of urine output, sodium and osmolality
Why this is the answer
Mannitol draws water out of the brain into the blood and is excreted by the kidneys, causing a large diuresis. Monitoring for dehydration, hypotension, electrolyte disturbance and high osmolality is required, and a urinary catheter is usually needed.
Answer
A · Close monitoring of urine output, sodium and osmolality
17.Med-surg: GI, perioperative & oncology
Answer: C · Do not use it; re-test later or arrange an X-ray as per policy
Why this is the answer
A pH above 5.5 may mean the tube is in the lung or oesophagus, or the stomach acid is reduced by drugs or feed. Nothing is given until position is confirmed according to local policy.
Answer
C · Do not use it; re-test later or arrange an X-ray as per policy
18.Med-surg: GI, perioperative & oncology
Answer: A · An intramuscular injection
Why this is the answer
IM injections can cause haematomas in severe thrombocytopenia. Rectal procedures, NSAIDs and aspirin are also avoided. The nurse checks with the prescriber and the oral or IV route is used where possible.
Answer
A · An intramuscular injection
19.Maternity & obstetric nursing
Answer: A · Erythema toxicum
Why this is the answer
Erythema toxicum is a common, benign rash that appears in the first days and resolves without treatment. A well baby with a typical rash needs only reassurance, but blistering or an unwell baby needs review.
Answer
A · Erythema toxicum
20.Maternity & obstetric nursing
Answer: B · Ruptured vasa praevia
Why this is the answer
Rupture of the membranes can tear unprotected fetal vessels in vasa praevia. Fetal blood loss causes rapid bradycardia while the mother stays stable. An emergency caesarean is needed.
Answer
B · Ruptured vasa praevia
21.Pediatric nursing
Answer: C · It reduces inflammation and the risk of coronary artery clots, under specialist supervision
Why this is the answer
Kawasaki disease is a vasculitis that can cause coronary artery aneurysms. It is treated with IV immunoglobulin and aspirin under specialist supervision, with echocardiography to check the coronary arteries.
Answer
C · It reduces inflammation and the risk of coronary artery clots, under specialist supervision
22.Pediatric nursing
Answer: B · Document the findings objectively and follow the safeguarding procedure to report the concern
Why this is the answer
Bruising in a non-mobile infant is a strong warning sign of abuse, and the history does not match the baby's development. The nurse documents facts, keeps the child safe and follows the safeguarding procedure.
Answer
B · Document the findings objectively and follow the safeguarding procedure to report the concern
23.Mental health nursing
Answer: C · Recall of three words and a clock-drawing task
Why this is the answer
The Mini-Cog combines a three-word recall with drawing a clock face. It is a quick screen; an abnormal result needs a fuller assessment.
Answer
C · Recall of three words and a clock-drawing task
24.Mental health nursing
Answer: D · Withdrawal seizures
Why this is the answer
Abrupt withdrawal after long-term high-dose use can cause severe anxiety, tremor, perceptual disturbances and seizures. The prescriber should be informed and a supervised taper considered.
Answer
D · Withdrawal seizures
25.Nursing math & unit conversions
Answer: x = 0.75 mL
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 hundredths place
0.75145 → 5
Only the next digit decides
0.75145 → 1
1 is 4 or less, so 5 stays.
The digits after it (45) are ignored: round once, never step by step.
Round
x = 0.75 mL
Answer
x = 0.75 mL
26.Nursing math & unit conversions
Answer: t = 470 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
20:30 → 24:00 = 210 min
After midnight
00:00 → 04:20 = 260 min
Total
t = 210 + 260 = 470 min
Answer
t = 470 min
27.Dosage calculations
Answer: D = 183.3 mg
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.
Total per day
25·22 = 550 mg
Per dose
D = 550/3 = 183.3 mg
Answer
D = 183.3 mg
28.Dosage calculations
Answer: V = 0.71 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 = 710/1000 = 0.71 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.71 mL
29.IV infusion rates
Answer: R = 21 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
6·60 = 360 min
Drip rate
R = 500·15/360 = 20.83 ≈ 21 gtt/min
Answer
R = 21 gtt/min
At the bedside you round to the nearest whole drop: 21 gtt/min.
30.IV infusion rates
Answer: t = 1.2 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 = 200/168 = 1.19 ≈ 1.2 h
Answer
t = 1.2 h
31.IV fluids & fluid balance
Answer: B = 650 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: 180 + 240 + 120 = 540 mL
IV infusion: 50·12 = 600 mL
IV antibiotic: 2·100 = 200 mL
total intake = 1340 mL
Total output
150 + 200 + 250 + 90 = 690 mL
Balance
B = 1340 − 690 = 650 mL
Answer
B = 650 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: t = 2 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
1000 − 750 = 250 mL
Time
t = 250/125 = 2 h
Answer
t = 2 h
That is about 2 h 00 min, so the bag runs out at about 12:30.
33.Clinical assessment scores
Answer: B = 17
Braden scale: six subscales for pressure-injury risk. Sensory perception, moisture, activity, mobility and nutrition score 1 to 4, from the worst level (1) to no problem (4); friction and shear scores 1 to 3. The total runs from 6 to 23, and a lower total means a higher risk. Common bands: 19–23 not at risk, 15–18 mild risk, 13–14 moderate risk, 10–12 high risk and 9 or below very high risk.
Score each subscale
sensory perception: no impairment → 4
moisture: occasionally moist → 3
activity: chairfast → 2
mobility: completely immobile → 1
nutrition: excellent → 4
friction and shear: no apparent problem → 3
Add
Braden total = 4 + 3 + 2 + 1 + 4 + 3 = 17
Answer
B = 17
34.Clinical assessment scores
Answer: obesity class III
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 = 122/1.5² = 54.22
Category
obesity class III
Answer
obesity class III
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