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
While being helped to eat, a patient with dysphagia coughs and their voice sounds wet and gurgly. What should the nurse do?
AGive a drink of water to wash the food down
BFeed more quickly so the meal is finished before they tire
CStop feeding and report for a swallowing assessment
DLie the patient flat to rest
2.Nursing fundamentalsHard
Where must the final identity check before a blood transfusion take place?
AIn the blood fridge, using the bag label
BAt the nurses' station, with the ward list
CIn the ward office, using the patient's notes and the prescription
DAt the bedside, with the patient and their wristband
3.Infection control & patient safetyMedium
When should blood specimen tubes be labeled?
ABy the laboratory staff after the tubes arrive
BAt the nurses’ station before going to the patient, to save time
CAt the bedside, in front of the patient, right after collection
DBack at the station after all the samples are collected
4.Infection control & patient safetyHard
Over a few hours, the emergency department sees many previously healthy people with the same unusual severe symptoms. What should the nurse do?
ASend the patients home quickly to avoid crowding the emergency department
BTell only the patients’ families about the pattern
CReport it to infection prevention and public health authorities promptly
DTreat each patient and wait to see if more arrive next week
5.Prioritization & delegationMedium
A patient had a colostomy formed yesterday. Which stoma appearance should be reported straight away?
ASlightly swollen
BDark purple or black
CMoist and pink-red
DA little bleeding when cleaned
6.Prioritization & delegationHard
In a disaster with very limited resources, a victim with severe burns over almost the whole body is tagged black. Which principle explains this decision?
ATreating the most severely injured person first
BDoing the greatest good for the greatest number
CTreating victims in the order in which they arrive
DTreating the youngest victims first
7.Clinical nursingMedium
A patient is newly confused, has a respiratory rate of 24/min and a systolic blood pressure of 95 mmHg. What should you suspect first?
ASepsis
BAnxiety
CAlcohol intoxication
DNormal postoperative recovery
8.Clinical nursingHard
A patient after abdominal surgery has not passed urine for eight hours, has lower abdominal discomfort and a palpable bladder. What is the most likely problem?
AAcute urinary retention
BDehydration only
CAcute kidney injury with no urine production
DUrinary tract infection without retention
9.Lab values & electrolytesMedium
A patient with hyperkalemia is prescribed an oral potassium binder such as patiromer or sodium zirconium cyclosilicate. How does this drug lower potassium?
AIt stops the kidneys from absorbing water in the tubules
BIt protects the heart muscle against high potassium levels
CIt moves potassium into cells in the next few minutes
DIt binds potassium in the gut so it leaves in the stool
10.Lab values & electrolytesHard
The nurse teaches a patient starting lithium. Which statement shows a need for further teaching?
A"I will cut out salt from my diet completely to stay healthy"
B"I will check with the pharmacist before taking ibuprofen"
C"I will tell my doctor if I have vomiting or diarrhea"
D"I will drink plenty of fluids, especially in hot weather"
11.PharmacologyMedium
A patient is starting lamotrigine. Which adverse effect should the patient report at once?
AA brief change in taste
BMild headache on the first day
CSlight tiredness in the afternoon
DAny new skin rash
12.PharmacologyHard
A patient with heart failure on furosemide is also given metolazone, a thiazide-like diuretic. Which risk increases most?
ASevere hypokalaemia, hyponatraemia and dehydration
BHypoglycaemia and weight gain
CHyperkalaemia and fluid overload
DSevere hypertension, tachycardia and fluid retention
13.Med-surg: cardiovascular & respiratoryMedium
A patient on home oxygen has dry, sore lips. Which product is safest to use?
AAn alcohol-based gel
BPetroleum jelly
CA water-based lubricant
DAn oil-based balm
14.Med-surg: cardiovascular & respiratoryHard
The monitor of a patient with a permanent pacemaker shows pacing spikes, but none of them is followed by a QRS complex. What does this mean?
AFailure to sense
BNormal pacemaker function
CAtrial fibrillation
DFailure to capture
15.Med-surg: neuro, endocrine & renalMedium
Before IV thrombolysis for stroke, which blood pressure limit is commonly used?
AAbove about 200/120 mmHg
BBelow about 90/60 mmHg
CBelow about 185/110 mmHg
DThere is no blood pressure limit
16.Med-surg: neuro, endocrine & renalHard
A patient had a witnessed tonic-clonic seizure. Afterwards their left arm is weak, and the weakness improves over the next few hours. What is the best interpretation?
ACertainly a stroke, so the seizure can be ignored
BPossible postictal (Todd's) paresis, but a stroke must still be excluded
CA sign that the patient is pretending to be weak
DNormal postictal tiredness that needs no further assessment or imaging at all
17.Med-surg: GI, perioperative & oncologyMedium
Why is a gastrostomy tube with an internal bumper usually advanced and rotated regularly once the tract has healed?
ATo stop the inner bumper becoming buried in the stomach wall
BTo make the tube longer as the patient grows or gains weight
CTo remove any feed left in the stomach
DTo check that the patient is still hungry
18.Med-surg: GI, perioperative & oncologyHard
On day 2 of severe acute pancreatitis, a patient becomes breathless, with SpO₂ 88% and bilateral infiltrates on chest X-ray. Which complication is most likely?
AAcute respiratory distress syndrome (ARDS)
BAspiration of a foreign body
CSpontaneous tension pneumothorax
DAcute severe asthma attack
19.Maternity & obstetric nursingMedium
Parents ask where their newborn should sleep at night. Which advice reduces the risk of sudden infant death?
AIn a separate cot or crib in the parents' room
BIn the parents' bed, between the two adults
CIn a separate bedroom from the first night
DOn a sofa with a parent when the baby is unsettled
20.Maternity & obstetric nursingHard
An ultrasound at 30 weeks shows polyhydramnios and no visible fetal stomach bubble. Which fetal condition should be considered?
AFetal growth from maternal diabetes only
BRenal agenesis
CPost-term pregnancy
DOesophageal atresia
21.Pediatric nursingMedium
A child with a known egg allergy is due for an influenza vaccine. Which statement reflects most current guidance?
AThe child needs a skin test with the vaccine first
BEgg allergy alone is generally no longer a reason to withhold influenza vaccination
CThe vaccine must never be given to anyone with egg allergy
DThe child should receive half the dose on two separate days, with observation after each
22.Pediatric nursingHard
A 9-year-old with Down syndrome has new neck pain, clumsy walking and changes in bladder control. What should the nurse suspect?
AAtlantoaxial instability with spinal cord compression
BThe normal low muscle tone of Down syndrome getting worse with age
CGrowing pains in the legs
DA simple urinary infection causing tiredness
23.Mental health nursingMedium
A 24-year-old woman with bipolar disorder is starting valproate. What is the most important teaching point?
AIt must be taken with grapefruit juice to be absorbed
BIt is safe in pregnancy and needs no special precautions
CIt will cause her to lose weight quickly, so she should eat extra meals and snacks every day
DIt can seriously harm an unborn baby, so effective contraception and specialist advice are essential
24.Mental health nursingHard
An 83-year-old becomes confused and constipated and cannot pass urine. She takes amitriptyline, oxybutynin and an over-the-counter sleep aid with diphenhydramine. What is the most likely cause?
AThe normal effects of ageing
BSudden-onset Alzheimer's disease
CA sign that she needs a higher dose of amitriptyline
DThe combined anticholinergic effects of her medicines
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A drip-rate calculation gives 41.727 gtt/min. The rule in this exercise is that drip rates are rounded to the nearest whole drop. What value x do you record?
41.727 gtt/min
x = gtt/min
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A prescription reads 1½ tsp of an oral suspension every 8 hours for 10 days. Using 1 tsp = 5 mL, how many mL V are needed for the whole course?
1½ tspevery 8 hours10 days1 tsp = 5 mL
V = mL
27.Dosage calculationsMedium
A prefilled syringe of epinephrine (adrenaline) is labelled 1:10 000 (0.1 mg/mL). The prescription is 1 mg IV in cardiac arrest. What volume V do you give?
1:10 0001 mg
V = mL
28.Dosage calculationsHard
A child weighing 28 kg is prescribed 12.5 mg/kg per dose of an oral suspension that contains 120 mg in 5 mL. What volume V do you give? Round to one decimal place.
28 kg12.5 mg/kg120 mg/5 mL
V = mL
29.IV infusion ratesMedium
Infuse 1500 mL over 12 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
1500 mL12 h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 42 gtt/min through a set of 60 gtt/mL. There are 300 mL left in the bag. How many hours t until it is empty? Round to one decimal place.
42 gtt/min60 gtt/mL300 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 total intake I in mL.
tea: 200 mLwater: 300 mLsoup: 250 mLIV infusion: 50 mL/h × 12 hIV antibiotic: 2 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 80 mL/h. At 16:30, 50 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL50 mL infused80 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 144/min and a blood pressure of 104/68 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.
HR 144/minBP 104/68 mmHg
SI =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 25/min, SpO₂ 99% on room air, blood pressure 150/90 mmHg, pulse 64/min, alert, temperature 37.4 °C. Which clinical risk group does the patient fall into? Click it.
RR 25SpO₂ 99%airSBP 150HR 64AT 37.4 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: C · Stop feeding and report for a swallowing assessment
Why this is the answer
Coughing, choking and a wet voice during meals suggest food or drink is entering the airway. Feeding stops, the patient sits upright and a speech and language therapist assesses them.
Answer
C · Stop feeding and report for a swallowing assessment
2.Nursing fundamentals
Answer: D · At the bedside, with the patient and their wristband
Why this is the answer
The final check matches the patient's identity, by asking and from the wristband, with the blood bag and prescription at the bedside. Most wrong-blood events come from checks done away from the patient.
Answer
D · At the bedside, with the patient and their wristband
3.Infection control & patient safety
Answer: C · At the bedside, in front of the patient, right after collection
Why this is the answer
Labeling tubes at the bedside, using two patient identifiers and in the patient’s presence, prevents wrong-patient specimens. Pre-labeled or later-labeled tubes are easily mixed up.
Answer
C · At the bedside, in front of the patient, right after collection
4.Infection control & patient safety
Answer: C · Report it to infection prevention and public health authorities promptly
Why this is the answer
Clusters of similar unusual illness can signal an outbreak or bioterrorism. Early reporting allows public health to investigate, guide precautions and treatment, and protect the community.
Answer
C · Report it to infection prevention and public health authorities promptly
5.Prioritization & delegation
Answer: B · Dark purple or black
Why this is the answer
A healthy stoma is moist and pink to red, and early swelling or slight bleeding is common. A dark purple or black stoma suggests poor blood supply (ischemia) and needs urgent review.
Answer
B · Dark purple or black
6.Prioritization & delegation
Answer: B · Doing the greatest good for the greatest number
Why this is the answer
In a mass-casualty event, resources are used where they save the most lives. A victim who is unlikely to survive even with full treatment is given comfort care, while staff treat salvageable victims. In everyday triage, the sickest patient is usually seen first.
Answer
B · Doing the greatest good for the greatest number
7.Clinical nursing
Answer: A · Sepsis
Why this is the answer
These three signs form the qSOFA criteria and suggest a high risk of poor outcome from sepsis. Escalate urgently and start the sepsis pathway.
Answer
A · Sepsis
8.Clinical nursing
Answer: A · Acute urinary retention
Why this is the answer
Anaesthesia, opioids and pain can cause retention. A bladder scan confirms residual volume; catheterisation is often needed.
Answer
A · Acute urinary retention
9.Lab values & electrolytes
Answer: D · It binds potassium in the gut so it leaves in the stool
Why this is the answer
Potassium binders exchange potassium in the gut for another ion, so potassium is removed from the body in the stool. They act over hours, so they are not used alone for emergencies; calcium protects the heart, and insulin with glucose shifts potassium into cells quickly.Checked against:High potassium level · MedlinePlus (NIH) (2025)
Answer
D · It binds potassium in the gut so it leaves in the stool
10.Lab values & electrolytes
Answer: A · "I will cut out salt from my diet completely to stay healthy"
Why this is the answer
A sudden fall in sodium intake makes the kidneys keep more sodium and lithium, raising the lithium level towards toxicity. Patients keep a normal, steady salt intake, drink enough fluids, report fluid loss and avoid NSAIDs unless approved.
Answer
A · "I will cut out salt from my diet completely to stay healthy"
11.Pharmacology
Answer: D · Any new skin rash
Why this is the answer
Lamotrigine can cause serious skin reactions such as Stevens–Johnson syndrome. The dose is increased slowly, especially with valproate, and any rash must be assessed promptly.
Answer
D · Any new skin rash
12.Pharmacology
Answer: A · Severe hypokalaemia, hyponatraemia and dehydration
Why this is the answer
Combining a loop and a thiazide diuretic gives a strong synergistic diuresis. This can cause marked electrolyte loss and volume depletion, so weight, electrolytes and kidney function are monitored closely.
Answer
A · Severe hypokalaemia, hyponatraemia and dehydration
13.Med-surg: cardiovascular & respiratory
Answer: C · A water-based lubricant
Why this is the answer
Oil-based products such as petroleum jelly can ignite or burn intensely in high oxygen concentrations and have caused facial burns. Water-based products are recommended. Oxygen cylinders are kept upright and secured, away from heat and flames.
Answer
C · A water-based lubricant
14.Med-surg: cardiovascular & respiratory
Answer: D · Failure to capture
Why this is the answer
Failure to capture means the pacing stimulus does not depolarise the myocardium, so no QRS follows the spike. Causes include lead displacement, a raised threshold or battery problems. It can cause bradycardia or asystole, so the patient is assessed and the team informed urgently.
Answer
D · Failure to capture
15.Med-surg: neuro, endocrine & renal
Answer: C · Below about 185/110 mmHg
Why this is the answer
Many guidelines require blood pressure below 185/110 mmHg before thrombolysis and below 180/105 mmHg for 24 hours afterwards, because very high pressure increases the risk of haemorrhagic transformation. Higher readings are lowered carefully first.
Answer
C · Below about 185/110 mmHg
16.Med-surg: neuro, endocrine & renal
Answer: B · Possible postictal (Todd's) paresis, but a stroke must still be excluded
Why this is the answer
Todd's paresis is a temporary weakness after a seizure that usually resolves within hours to a couple of days. Because a stroke can cause seizures and look the same, the patient still needs a full assessment and usually imaging.
Answer
B · Possible postictal (Todd's) paresis, but a stroke must still be excluded
17.Med-surg: GI, perioperative & oncology
Answer: A · To stop the inner bumper becoming buried in the stomach wall
Why this is the answer
Buried bumper syndrome occurs when the internal fixator embeds in the gastric wall. Following local guidance, the tube is gently advanced, rotated and returned once healed, and the external fixator is kept slightly loose.
Answer
A · To stop the inner bumper becoming buried in the stomach wall
18.Med-surg: GI, perioperative & oncology
Answer: A · Acute respiratory distress syndrome (ARDS)
Why this is the answer
Severe pancreatitis triggers a systemic inflammatory response that can cause ARDS, AKI and shock. Hypoxaemia with bilateral infiltrates is typical. Escalation to critical care for respiratory support is needed.
Answer
A · Acute respiratory distress syndrome (ARDS)
19.Maternity & obstetric nursing
Answer: A · In a separate cot or crib in the parents' room
Why this is the answer
Both US (AAP) and UK (NHS) guidance advise room-sharing without bed-sharing: the baby sleeps on the back in a cot or crib in the parents' room for at least the first 6 months. Sleeping with a baby on a sofa or armchair is especially dangerous.
Answer
A · In a separate cot or crib in the parents' room
20.Maternity & obstetric nursing
Answer: D · Oesophageal atresia
Why this is the answer
If the fetus cannot swallow, as in oesophageal atresia, amniotic fluid builds up and the stomach is not seen. Renal agenesis causes the opposite, severe oligohydramnios.
Answer
D · Oesophageal atresia
21.Pediatric nursing
Answer: B · Egg allergy alone is generally no longer a reason to withhold influenza vaccination
Why this is the answer
Guidance in many countries now states that children with egg allergy can receive influenza vaccines in routine settings, because the ovalbumin content is very low. Follow the current national guidance for specific cases.
Answer
B · Egg allergy alone is generally no longer a reason to withhold influenza vaccination
22.Pediatric nursing
Answer: A · Atlantoaxial instability with spinal cord compression
Why this is the answer
Children with Down syndrome can have instability between the first two cervical vertebrae. Neck pain, changes in gait, weakness and bladder or bowel changes suggest cord compression and need urgent assessment.
Answer
A · Atlantoaxial instability with spinal cord compression
23.Mental health nursing
Answer: D · It can seriously harm an unborn baby, so effective contraception and specialist advice are essential
Why this is the answer
Valproate is highly teratogenic, causing neural tube defects and developmental problems. Women who could become pregnant need clear information, effective contraception and specialist review.
Answer
D · It can seriously harm an unborn baby, so effective contraception and specialist advice are essential
24.Mental health nursing
Answer: D · The combined anticholinergic effects of her medicines
Why this is the answer
Several drugs with anticholinergic effects add up, increasing the risk of delirium, constipation and urinary retention in older adults. A medicine review aims to reduce the total anticholinergic burden.
Answer
D · The combined anticholinergic effects of her medicines
25.Nursing math & unit conversions
Answer: x = 42 gtt/min
Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.
Digit in the ones place
41.727 → 1
Only the next digit decides
41.727 → 7
7 is 5 or more, so round 1 up.
The digits after it (27) are ignored: round once, never step by step.
Round
x = 42 gtt/min
Answer
x = 42 gtt/min
26.Nursing math & unit conversions
Answer: V = 225 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
1½ tsp = 1.5·5 = 7.5 mL
Whole course
V = 7.5 mL × 3/day × 10 = 225 mL
Answer
V = 225 mL
27.Dosage calculations
Answer: V = 10 mL
Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.
Concentration
1:10 000 = 1 g/10000 mL = 0.1 mg/mL
Volume
V = 1/0.1 = 10 mL
Answer
V = 10 mL
US labels now state mg/mL (1 mg/mL = 1:1000; 0.1 mg/mL = 1:10 000). Never give 1 mg/mL epinephrine IV push.
28.Dosage calculations
Answer: V = 14.6 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
12.5·28 = 350 mg
Volume
V = (350/120)·5 = 14.58 ≈ 14.6 mL
Answer
V = 14.6 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
12·60 = 720 min
Drip rate
R = 1500·10/720 = 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 = 7.1 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
42·60/60 = 42 mL/h
Time left
t = 300/42 = 7.143 ≈ 7.1 h
Answer
t = 7.1 h
31.IV fluids & fluid balance
Answer: I = 1450 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.
Add the intake
oral: 200 + 300 + 250 = 750 mL
IV infusion: 50·12 = 600 mL
IV antibiotic: 2·50 = 100 mL
I = 1450 mL
Answer
I = 1450 mL
32.IV fluids & fluid balance
Answer: t = 11.9 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 − 50 = 950 mL
Time
t = 950/80 = 11.88 ≈ 11.9 h
Answer
t = 11.9 h
That is about 11 h 53 min, so the bag runs out at about 04:23.
33.Clinical assessment scores
Answer: SI = 1.38
Blood pressure values: pulse pressure PP = SBP − DBP. Mean arterial pressure MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3, an estimate based on the heart spending about two thirds of each beat in diastole at a normal heart rate (less accurate when the heart rate is fast); a MAP of at least about 65 mmHg is a common target for organ perfusion. The shock index SI = heart rate/SBP is normally about 0.5–0.7; a value above about 1 is a warning sign of shock.
Shock index
SI = 144/104 = 1.385 ≈ 1.38
Answer
SI = 1.38
1 or more: a warning sign of shock in this practice case.
34.Clinical assessment scores
Answer: low–medium
NEWS2 (National Early Warning Score 2, Royal College of Physicians 2017): score each of the seven parameters with the chart (respiration rate, SpO₂ on scale 1, air or supplemental oxygen, systolic blood pressure, pulse, consciousness on the ACVPU scale and temperature) and add the scores. Clinical risk: 0–4 low; a score of 3 in any single parameter low–medium; 5–6 medium; 7 or more high. A total of 5 or more needs an urgent response.
Score each parameter
RR 25/min → 3
SpO₂ 99% → 0
on air → 0
SBP 150 mmHg → 0
HR 64/min → 0
alert (A) → 0
T 37.4 °C → 0
Total and red scores
NEWS2 = 3 + 0 + 0 + 0 + 0 + 0 + 0 = 3
At least one parameter scores 3.
Risk group
low–medium
Answer
low–medium
A single score of 3 needs an urgent review even when the total is low.
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