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 medicine commonly causes constipation?
ACodeine
BDocusate
CLactulose
DSenna
2.Nursing fundamentalsHard
A patient has a temperature of 38.7 °C and a white cell count of 18 × 10⁹/L (18,000/mm³). What do these findings most suggest?
ADehydration only
BA normal post-meal result
CAn infection or significant inflammation
DA low risk of infection because the count is high
3.Infection control & patient safetyMedium
A parent calls because a toddler has swallowed some household cleaner. The child is awake and breathing normally. What should the nurse advise first?
AMake the child vomit, using a finger at the back of the throat
BGive syrup of ipecac from the medicine cabinet
CWait to see whether any symptoms develop over the next day
DContact the local poison advice service now for specific advice
4.Infection control & patient safetyHard
A nurse often skips barcode scanning to save time, as many colleagues do. In a just culture, how is this behavior classed?
ASimple human error, managed only by consoling the nurse and moving on
BAcceptable behavior, because it is common on the unit
CReckless behavior, managed by immediate dismissal and reporting to the licensing board
DAt-risk behavior, managed by coaching and fixing the system pressures behind it
5.Prioritization & delegationMedium
A pregnant nurse is on the unit. Which patient should the charge nurse avoid assigning to her?
AA patient with type 2 diabetes who needs insulin teaching before discharge
BA patient with a fractured wrist
CA patient after a hip replacement
DA patient with a sealed radioactive implant for cervical cancer
6.Prioritization & delegationHard
On a surgical unit, which postoperative patient should the nurse see first?
A2 days after colostomy formation: stoma moist and pink, small amount of output
B2 days after hip replacement: pain 5/10 on moving, analgesic given 1 hour ago
CAfter prostate surgery with bladder irrigation: light pink urine, no clots
D6 hours after carotid endarterectomy: neck swelling increasing, says it is hard to swallow
7.Clinical nursingMedium
What is the main benefit of pulmonary rehabilitation for patients with COPD?
AA cure for the disease within months
BReversal of the lung damage caused by smoking
CNo further need for inhalers
DBetter exercise capacity and quality of life
8.Clinical nursingHard
A patient with a central venous catheter needs the line removed. Which position reduces the risk of air embolism during removal of a neck or chest line?
ASitting fully upright and taking a deep breath in as the line comes out
BLying flat or slightly head-down, holding the breath or breathing out
CStanding up and walking
DLying on the right side with the legs raised
9.Lab values & electrolytesMedium
Which instruction is correct for a patient taking an oral potassium chloride supplement?
ATake it with food and a full glass of water, and do not crush extended-release tablets
BUse a salt substitute as well, so less of the tablet is needed each day
CTake it on an empty stomach with only a small sip of water to speed absorption
DCrush the extended-release tablets and mix them with a little water if needed
10.Lab values & electrolytesHard
A patient receiving parenteral nutrition with lipid emulsion has a triglyceride level of 620 mg/dL (7.0 mmol/L). Why is this result important?
AIt shows the nutrition is fully effective
BIt raises the risk of acute pancreatitis
CIt is a normal fasting value for adults
DIt means the patient needs more lipid
11.PharmacologyMedium
Apixaban and rivaroxaban are anticoagulants that directly inhibit:
AVitamin K epoxide reductase
BThrombin
CFactor Xa
DThe platelet P2Y12 receptor
12.PharmacologyHard
Which regimen is standard for eradicating Helicobacter pylori?
AA single dose of an antibiotic given intravenously
BAn antacid alone, taken after meals and at bedtime for six months
CAn H2 blocker taken only when pain occurs
DAcid suppression plus at least two antibiotics, often with bismuth, for 14 days
13.Med-surg: cardiovascular & respiratoryMedium
A patient in cardiac rehabilitation asks how hard to exercise. Which simple guide is commonly taught?
AExercise until they are too breathless to speak at all
BExercise only until the heart rate rises even slightly
CExercise so they are a little breathless but can still talk
DExercise until chest pain starts, then stop
14.Med-surg: cardiovascular & respiratoryHard
A patient taking dabigatran has a serious gastrointestinal bleed. Which specific reversal agent may be used?
AProtamine sulfate
BIdarucizumab
CTranexamic acid alone
DPhytomenadione (vitamin K)
15.Med-surg: neuro, endocrine & renalMedium
A patient wakes up with stroke symptoms. They went to bed well at 23:00 and woke at 06:30. Which time is used as the time of onset?
A06:30, when the symptoms were first noticed
BThe time the CT scan was performed
CThe time of arrival at the hospital
D23:00, when they were last known to be well
16.Med-surg: neuro, endocrine & renalHard
A patient has episodes of severe headache, sweating, palpitations and very high blood pressure. Which condition should be considered?
AHypothyroidism
BDiabetes insipidus
CPhaeochromocytoma
DAddison's disease
17.Med-surg: GI, perioperative & oncologyMedium
For which stoma can colostomy irrigation be considered?
AAny stoma that has liquid or very loose output
BAn established descending or sigmoid colostomy
CA new ileostomy in the first week
DAn ileal conduit draining urine
18.Med-surg: GI, perioperative & oncologyHard
After a coughing fit, the external mark on a patient's nasogastric tube has moved 10 cm. Feed is due. What should the nurse do?
APush the tube back to the original mark and start the feed
BGive the medicines only and save the feed for later
CDo not use the tube until its position is confirmed by policy
DStart the feed at a slow rate and watch for coughing
19.Maternity & obstetric nursingMedium
Which feature best distinguishes true labour from false labour?
AProgressive dilation and effacement of the cervix
BContractions that are felt only in the lower abdomen
CContractions that stop when the woman walks around
DDiscomfort that eases with a warm bath and rest
20.Maternity & obstetric nursingHard
A newborn boy's scrotum is empty on one side and the testis cannot be felt in the groin. What is appropriate?
AMassage the groin daily to push it down
BArrange emergency surgery on the testis today
CTell the parents it will never descend
DRecord it and arrange follow-up; many descend later
21.Pediatric nursingMedium
Which signs in a 2-day-old baby suggest sepsis?
ASmall white spots on the nose and a pink face
BRegular feeding with six wet nappies a day
CHiccups after feeds with a strong, lusty cry between feeds
DUnstable temperature, poor feeding, lethargy and breathing difficulty
22.Pediatric nursingHard
A 4-year-old has had pallor, tiredness, bruising, bone pain and fevers for 3 weeks. What is the most important next step?
AReassurance that these are growing pains that will pass with time
BAn urgent full blood count to look for leukaemia
CIron supplements for 3 months, then review
DA course of antibiotics for a viral infection
23.Mental health nursingMedium
A patient says, "The doctor says I'm getting better, but I don't think anyone here really knows me." Which nurse response is most therapeutic?
A"You feel that people here don't really know you?"
B"Everyone here knows you well, so don't worry."
C"Why do you think the doctor is wrong about you?"
D"The doctor is very experienced, so you should trust her."
24.Mental health nursingHard
On the fourth day after giving birth, a mother is tearful and moody but is caring for her baby, eating and sleeping when she can. What is the most appropriate nursing response?
ATell her that antidepressants must be started at once
BExplain that these "baby blues" are common, offer support and advise her to seek help if they last more than about 2 weeks
CAdvise her to stop breastfeeding and let others feed the baby at night so that she can rest and recover
DArrange an emergency psychiatric admission today
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose calculation for an injection gives 5.6812 mL. The rule in this exercise is that volumes of 1 mL or more are rounded to the nearest tenth of a mL. What value x do you record?
5.6812 mL
x = mL
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A prescription reads 1 tbsp of an oral suspension four times a day for 14 days. Using 1 tbsp = 15 mL, how many mL V are needed for the whole course?
1 tbspfour times a day14 days1 tbsp = 15 mL
V = mL
27.Dosage calculationsMedium
A patient weighing 39 kg has a body surface area of 1.13 m². The prescription is 135 mg/m². Find the dose D in mg.
39 kgBSA = 1.13 m²135 mg/m²
D = mg
28.Dosage calculationsHard
A child weighing 10 kg is prescribed 20 mg/kg per dose of an oral suspension that contains 125 mg in 5 mL. What volume V do you give?
10 kg20 mg/kg125 mg/5 mL
V = mL
29.IV infusion ratesMedium
Infuse 250 mL over 3 hours with a giving set of 60 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
250 mL3 h60 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 20 gtt/min through a set of 15 gtt/mL. There are 450 mL left in the bag. How many hours t until it is empty? Round to one decimal place.
20 gtt/min15 gtt/mL450 mL
t = h
31.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 07:30 at 120 mL/h. After 3 hours the rate is changed to 80 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
500 mL120 mL/h · 3 h80 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: very limited; moisture: very moist; activity: walks frequently; mobility: no limitation; nutrition: adequate; friction and shear: 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: occasionally moist; activity: walks occasionally; mobility: no limitation; nutrition: excellent; friction and shear: potential 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: A · Codeine
Why this is the answer
Opioids such as codeine and morphine slow gut movement and commonly cause constipation. Senna, lactulose and docusate are laxatives.
Answer
A · Codeine
2.Nursing fundamentals
Answer: C · An infection or significant inflammation
Why this is the answer
A raised white cell count with fever usually means the body is fighting an infection or major inflammation. The nurse reports it and looks for the source, including sepsis.
Answer
C · An infection or significant inflammation
3.Infection control & patient safety
Answer: D · Contact the local poison advice service now for specific advice
Why this is the answer
A poison advice service (poison control in the US, or NHS 111 in the UK) can give advice for the exact product. Inducing vomiting is not recommended, because corrosive products can burn the esophagus again and vomit can be aspirated. Emergency services are called if the child has trouble breathing or is drowsy.
Answer
D · Contact the local poison advice service now for specific advice
4.Infection control & patient safety
Answer: D · At-risk behavior, managed by coaching and fixing the system pressures behind it
Why this is the answer
At-risk behavior is a choice whose risk is not recognized or is believed to be justified, often because shortcuts have become normal. It is managed by coaching and removing the pressures behind it, while reckless behavior may need disciplinary action.
Answer
D · At-risk behavior, managed by coaching and fixing the system pressures behind it
5.Prioritization & delegation
Answer: D · A patient with a sealed radioactive implant for cervical cancer
Why this is the answer
A sealed radioactive implant (brachytherapy) emits radiation, and pregnant staff should not care for these patients. The other patients pose no special risk to a pregnancy.
Answer
D · A patient with a sealed radioactive implant for cervical cancer
6.Prioritization & delegation
Answer: D · 6 hours after carotid endarterectomy: neck swelling increasing, says it is hard to swallow
Why this is the answer
Growing neck swelling after carotid surgery suggests a hematoma that can compress the airway. A pink, moist stoma and light pink urine with irrigation are expected, and moderate pain with movement is common.
Answer
D · 6 hours after carotid endarterectomy: neck swelling increasing, says it is hard to swallow
7.Clinical nursing
Answer: D · Better exercise capacity and quality of life
Why this is the answer
Pulmonary rehabilitation improves breathlessness, exercise tolerance and well-being, and reduces hospital admissions. It does not reverse the underlying lung damage.
Answer
D · Better exercise capacity and quality of life
8.Clinical nursing
Answer: B · Lying flat or slightly head-down, holding the breath or breathing out
Why this is the answer
A flat or head-down position and a Valsalva manoeuvre or breath-hold raise central venous pressure, reducing the risk of air being drawn in. An occlusive dressing is then applied.
Answer
B · Lying flat or slightly head-down, holding the breath or breathing out
9.Lab values & electrolytes
Answer: A · Take it with food and a full glass of water, and do not crush extended-release tablets
Why this is the answer
Oral potassium can irritate the esophagus and stomach, so it is taken with food and plenty of fluid, and extended-release forms are swallowed whole. Most salt substitutes contain potassium chloride and can add to the risk of hyperkalemia.Checked against:Potassium (drug information) · MedlinePlus (NIH) (2024)
Answer
A · Take it with food and a full glass of water, and do not crush extended-release tablets
10.Lab values & electrolytes
Answer: B · It raises the risk of acute pancreatitis
Why this is the answer
Triglycerides are monitored in patients receiving lipid emulsions, because high levels can cause pancreatitis and show that lipid is not being cleared. The result is reported, and the lipid dose may be reduced or held.Checked against:Triglycerides Test · MedlinePlus (NIH) (2024)
Answer
B · It raises the risk of acute pancreatitis
11.Pharmacology
Answer: C · Factor Xa
Why this is the answer
Apixaban and rivaroxaban are direct factor Xa inhibitors. Dabigatran directly inhibits thrombin, warfarin blocks vitamin K recycling and clopidogrel blocks P2Y12.
Answer
C · Factor Xa
12.Pharmacology
Answer: D · Acid suppression plus at least two antibiotics, often with bismuth, for 14 days
Why this is the answer
Eradication combines acid suppression (usually a PPI) with at least two antibiotics; bismuth quadruple therapy for 14 days is now often first-line because clarithromycin resistance makes older triple therapy fail. Taking every dose matters, and cure is confirmed with a breath or stool test.
Answer
D · Acid suppression plus at least two antibiotics, often with bismuth, for 14 days
13.Med-surg: cardiovascular & respiratory
Answer: C · Exercise so they are a little breathless but can still talk
Why this is the answer
Moderate-intensity exercise makes the patient slightly breathless but able to hold a conversation. Programmes start gently and progress. Patients stop and seek help if they get chest pain, severe breathlessness or dizziness.
Answer
C · Exercise so they are a little breathless but can still talk
14.Med-surg: cardiovascular & respiratory
Answer: B · Idarucizumab
Why this is the answer
Idarucizumab binds dabigatran and reverses its effect within minutes. Andexanet alfa (or prothrombin complex concentrate where it is not available) is used for factor Xa inhibitors. Protamine reverses heparin and vitamin K reverses warfarin. Tranexamic acid may support haemostasis but is not a reversal agent.
Answer
B · Idarucizumab
15.Med-surg: neuro, endocrine & renal
Answer: D · 23:00, when they were last known to be well
Why this is the answer
For "wake-up strokes", onset is taken as the time the patient was last known well, because the stroke could have happened at any point since then. This often places the patient outside the standard thrombolysis window, although advanced imaging can sometimes identify patients who may still benefit.
Answer
D · 23:00, when they were last known to be well
16.Med-surg: neuro, endocrine & renal
Answer: C · Phaeochromocytoma
Why this is the answer
Phaeochromocytoma is a catecholamine-secreting tumour, usually of the adrenal medulla. It causes episodic hypertension, headache, sweating and tachycardia. Before surgery, alpha-blockade is started before any beta-blocker, because beta-blockade alone can cause a hypertensive crisis.
Answer
C · Phaeochromocytoma
17.Med-surg: GI, perioperative & oncology
Answer: B · An established descending or sigmoid colostomy
Why this is the answer
Irrigation instils water into a sigmoid or descending colostomy to empty the bowel at set times. It is not used for ileostomies or urostomies and needs specialist teaching.
Answer
B · An established descending or sigmoid colostomy
18.Med-surg: GI, perioperative & oncology
Answer: C · Do not use the tube until its position is confirmed by policy
Why this is the answer
A change in external length means the tube may have moved. Pushing it back blindly is unsafe. It is not used until placement is confirmed by pH or X-ray, or it is replaced.
Answer
C · Do not use the tube until its position is confirmed by policy
19.Maternity & obstetric nursing
Answer: A · Progressive dilation and effacement of the cervix
Why this is the answer
True labour causes progressive cervical change. Its contractions become regular, stronger and closer and do not stop with rest or walking. False labour contractions are irregular and ease with rest or position change.
Answer
A · Progressive dilation and effacement of the cervix
20.Maternity & obstetric nursing
Answer: D · Record it and arrange follow-up; many descend later
Why this is the answer
An undescended testis is common, especially in preterm boys, and often descends in the first months. If it has not descended by about 6 months, referral for surgery (orchidopexy) is recommended.
Answer
D · Record it and arrange follow-up; many descend later
21.Pediatric nursing
Answer: D · Unstable temperature, poor feeding, lethargy and breathing difficulty
Why this is the answer
Neonatal sepsis may present with temperature instability, poor feeding, lethargy, irritability, apnoea, breathing difficulty or jaundice. Early-onset sepsis, often due to group B streptococcus, needs prompt cultures and IV antibiotics.
Answer
D · Unstable temperature, poor feeding, lethargy and breathing difficulty
22.Pediatric nursing
Answer: B · An urgent full blood count to look for leukaemia
Why this is the answer
Pallor (low red cells), bruising (low platelets), infections or fever (abnormal white cells) and bone pain from marrow expansion together suggest leukaemia. An urgent full blood count and blood film are needed.
Answer
B · An urgent full blood count to look for leukaemia
23.Mental health nursing
Answer: A · "You feel that people here don't really know you?"
Why this is the answer
Reflecting the patient's concern invites them to explore it. Defending the doctor, reassuring falsely or asking "why" all close the conversation down.
Answer
A · "You feel that people here don't really know you?"
24.Mental health nursing
Answer: B · Explain that these "baby blues" are common, offer support and advise her to seek help if they last more than about 2 weeks
Why this is the answer
Baby blues are common in the first days after birth and usually resolve within 2 weeks. Symptoms that last longer or are severe may indicate postpartum depression and need assessment.
Answer
B · Explain that these "baby blues" are common, offer support and advise her to seek help if they last more than about 2 weeks
25.Nursing math & unit conversions
Answer: x = 5.7 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 tenths place
5.6812 → 6
Only the next digit decides
5.6812 → 8
8 is 5 or more, so round 6 up.
The digits after it (12) are ignored: round once, never step by step.
Round
x = 5.7 mL
Answer
x = 5.7 mL
26.Nursing math & unit conversions
Answer: V = 840 mL
Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.
Volume per dose
1 tbsp = 1·15 = 15 mL
Whole course
V = 15 mL × 4/day × 14 = 840 mL
Answer
V = 840 mL
27.Dosage calculations
Answer: D = 152.5 mg
Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).
Dose
D = 135·1.13 = 152.5 mg
Answer
D = 152.5 mg
28.Dosage calculations
Answer: V = 8 mL
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Dose from weight
20·10 = 200 mg
Volume
V = (200/125)·5 = 8 mL
Answer
V = 8 mL
29.IV infusion rates
Answer: R = 83 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
3·60 = 180 min
Drip rate
R = 250·60/180 = 83.33 ≈ 83 gtt/min
Answer
R = 83 gtt/min
At the bedside you round to the nearest whole drop: 83 gtt/min.
30.IV infusion rates
Answer: t = 5.6 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
20·60/15 = 80 mL/h
Time left
t = 450/80 = 5.625 ≈ 5.6 h
Answer
t = 5.6 h
31.IV fluids & fluid balance
Answer: B = 155 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: 250 + 250 = 500 mL
ice chips: 100/2 = 50 mL
IV infusion: 100·12 = 1200 mL
IV antibiotic: 2·100 = 200 mL
total intake = 1950 mL
Total output
225 + 500 + 250 + 500 + 120 + 200 = 1795 mL
Balance
B = 1950 − 1795 = 155 mL
Answer
B = 155 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: t = 4.8 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
First part
120·3 = 360 mL
500 − 360 = 140 mL left
Second part
140/80 = 1.75 h
Total time
t = 3 + 1.75 = 4.75 ≈ 4.8 h
Answer
t = 4.8 h
That is about 4 h 45 min, so the bag runs out at about 12:15.
33.Clinical assessment scores
Answer: B = 16
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: very limited → 2
moisture: very moist → 2
activity: walks frequently → 4
mobility: no limitation → 4
nutrition: adequate → 3
friction and shear: problem → 1
Add
Braden total = 2 + 2 + 4 + 4 + 3 + 1 = 16
Answer
B = 16
34.Clinical assessment scores
Answer: not at 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: occasionally moist → 3
activity: walks occasionally → 3
mobility: no limitation → 4
nutrition: excellent → 4
friction and shear: potential problem → 2
Add
Braden total = 3 + 3 + 3 + 4 + 4 + 2 = 19
Risk level
19 → not at risk
Answer
not at risk
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