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
Why must a respirator such as an FFP3 or N95 mask be fit-tested?
AIt must be tested to check it is the right colour
BIt only protects if it seals closely to the wearer's face
CFit-testing makes the mask reusable for a week
DFit-testing checks whether the patient is still infectious
2.Nursing fundamentalsHard
An AED is about to deliver a shock. What must the rescuer do?
AKeep doing chest compressions during the shock
BRemove the pads and place them again
CMake sure no one is touching the patient
DHold the patient's hand to reassure them
3.Infection control & patient safetyMedium
When should a nurse call the rapid response team?
AOnly when the patient’s family makes a complaint
BOnly after a patient has had a cardiac or respiratory arrest on the ward
CWhen a patient shows an acute decline, such as new confusion or a sharp change in vital signs
DOnly when the provider has written an order for a rapid response call in the chart
4.Infection control & patient safetyHard
A patient’s allergy band says “penicillin”, and an order has been written for amoxicillin. What should the nurse do?
AGive the drug and watch the patient closely
BHold the drug and contact the prescriber
CAsk the patient whether they would like to take it anyway
DGive an antihistamine first and then the drug
5.Prioritization & delegationMedium
A drowsy patient who has just returned from surgery starts to vomit. What should the nurse do first?
AGive a drink of water
BTurn the patient onto their side
CRaise the legs above the heart
DGive an oral anti-sickness tablet
6.Prioritization & delegationHard
A competent adult patient refuses a blood transfusion for religious reasons. What should the nurse do?
ARespect the refusal, check the patient understands the risks and inform the provider
BAsk the family to persuade the patient until they agree
CGive the transfusion while the patient is asleep, because saving their life comes first
DTell the patient that refusing treatment is not allowed in hospital
7.Clinical nursingMedium
How does CPAP help a patient with obstructive sleep apnoea?
AIt keeps the upper airway open during sleep with continuous air pressure
BIt delivers bronchodilator drugs deep into the lungs overnight
CIt removes excess carbon dioxide from the lungs by gentle suction
DIt strengthens the breathing muscles during the day
8.Clinical nursingHard
A patient has a blood pressure of 220/130 mmHg with headache, confusion and visual disturbance. Why is the blood pressure lowered in a controlled way rather than as fast as possible?
ARapid lowering always causes the hypertension to come back much worse
BRapid lowering causes hyperglycaemia
CA sudden drop can reduce blood flow to the brain, heart and kidneys
DBlood pressure cannot be lowered with drugs
9.Lab values & electrolytesMedium
A patient on hemodialysis has an arteriovenous (AV) fistula in the left arm. Where should the nurse draw routine blood samples?
AFrom the left wrist
BFrom the left hand
CFrom the right arm
DFrom the fistula
10.Lab values & electrolytesHard
Four drug levels are reported. Which patient should the nurse assess first?
ADigoxin 1.0 ng/mL with a pulse of 72/min
BPhenytoin 15 mcg/mL with no symptoms
CLithium 1.8 mEq/L with a new coarse tremor
DValproate 75 mcg/mL with no symptoms
11.PharmacologyMedium
An IV site is cool, swollen and pale, and the infusion is running slowly. What should the nurse do?
AApply a tight bandage over the site
BIncrease the infusion rate to push through and clear the blockage
CFlush the cannula forcefully with saline
DStop the infusion, remove the cannula and elevate the limb
12.PharmacologyHard
A patient has a serum potassium of 7.0 mmol/L (mEq/L) and peaked T waves on the ECG. Which drug is given first to protect the heart?
AIntravenous furosemide
BOral potassium chloride
COral sodium polystyrene sulfonate
DIntravenous calcium gluconate
13.Med-surg: cardiovascular & respiratoryMedium
Which set of side effects is typical of thiazide or thiazide-like diuretics such as indapamide?
AHigh sodium and magnesium, with low blood glucose
BLow potassium and sodium, raised uric acid and raised glucose
CDry cough, taste disturbance and swelling of the lips
DHigh potassium and sodium, low uric acid and low blood glucose
14.Med-surg: cardiovascular & respiratoryHard
A patient on warfarin for atrial fibrillation is prescribed clarithromycin. Which action is most appropriate?
AStop the warfarin for the whole antibiotic course
BChange nothing, as antibiotics do not affect warfarin
CAsk whether the INR should be checked sooner, as it may rise
DDouble the warfarin dose during the course
15.Med-surg: neuro, endocrine & renalMedium
Before surgery for a phaeochromocytoma, why is an alpha-blocker started before any beta-blocker?
AAlpha-blockers lower the blood glucose before surgery
BThe order of the two drugs makes no difference
CA beta-blocker alone can cause a dangerous rise in BP
DBeta-blockers given first would make the tumour grow faster
16.Med-surg: neuro, endocrine & renalHard
A patient on haemodialysis is on a medical ward. Which task can the registered nurse delegate to a healthcare assistant (nursing assistant)?
ATeaching the patient about fluid restriction
BAssessing the thrill and bruit of the fistula
CWeighing the patient before they go to dialysis
DDeciding which morning medicines to hold
17.Med-surg: GI, perioperative & oncologyMedium
Which statement about giving medicines through a feeding tube is correct?
ATubes do not need flushing between medicines
BMedicines can be added to the bag of feed
CAll tablets can be crushed together and given at once
DModified-release tablets should not be crushed
18.Med-surg: GI, perioperative & oncologyHard
During burn resuscitation, a 70 kg adult's urine output has been 120 mL/h for 3 hours, and the face and limbs are very oedematous. What should the nurse do?
AGive a diuretic without discussing it
BDiscuss reducing the fluid rate with the team
CStop all IV fluids completely and remove the catheter
DIncrease the fluid rate to keep the output high
19.Maternity & obstetric nursingMedium
Which drug is a known teratogen that must be stopped before a planned pregnancy?
AParacetamol (acetaminophen)
BIsotretinoin
CLevothyroxine
DFolic acid
20.Maternity & obstetric nursingHard
A biophysical profile scores 4 out of 10 at 38 weeks. How should the nurse interpret this?
AIt is normal and reassuring
BIt only means the woman needs to drink more water
CIt is equivocal and should be repeated next week
DIt is abnormal and needs prompt review
21.Pediatric nursingMedium
A child's asthma action plan shows he is in the yellow zone. What should he do?
AStop all medicines and wait to see if the symptoms pass
BUse the reliever as the plan says and contact the doctor if it does not help
CDouble the preventer dose and do nothing else
DGo straight to the emergency department without using any medicine first
22.Pediatric nursingHard
A 9-year-old is being treated for an acute asthma attack. Which finding shows that treatment is working?
AThe wheeze has disappeared and the child is now very drowsy
BThe heart rate has risen further after each dose of salbutamol
CThe child is now sitting bolt upright, leaning on the arms
DSlower breathing, easier speech and less use of the neck and chest muscles
23.Mental health nursingMedium
A patient intoxicated with phencyclidine (PCP) is agitated and has nystagmus and high blood pressure. Which nursing approach is best?
AProvide a quiet, low-stimulation environment and keep staff and patient safe
BPut him in a busy area so that staff can watch him more easily
CTry to talk the patient down by discussing his feelings in detail
DEncourage him to walk around the ward and join in activities to help burn off the drug
24.Mental health nursingHard
A nurse notices that a colleague smells of alcohol, has slurred speech and is about to give medicines. What should the nurse do?
ASay nothing, because it is not her responsibility
BGive the colleague some strong coffee and let her continue with the medicine round if she says she feels fine
CWait until the end of the shift, then talk privately with the colleague
DReport the concern immediately to the nurse in charge, following policy, to protect patients
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A newborn weighs 7 lb 7 oz. Using 1 lb = 16 oz and 1 kg = 2.2 lb, find the weight m in kilograms. Round to two decimal places.
7 lb 7 oz1 lb = 16 oz1 kg = 2.2 lb
m = kg
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 2 tsp of cough syrup, 3 cups of tea, 8 fl oz of juice. Using the equivalents given, find the total oral intake V in mL.
1 tsp = 5 mL1 cup = 8 fl oz = 240 mL1 fl oz = 30 mL
V = mL
27.Dosage calculationsMedium
A child weighing 16 kg is prescribed 4 mg/kg of a drug. The stock solution contains 10 mg/mL. Draw up the dose: what volume V do you give?
16 kg4 mg/kg10 mg/mL
V = mL
28.Dosage calculationsHard
A child weighing 24 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?
24 kg12.5 mg/kg120 mg/5 mL
V = mL
29.IV infusion ratesMedium
An infusion is ordered at 150 mL/h, but no pump is available. It runs by gravity through a giving set of 20 gtt/mL. Find the drip rate R in drops per minute.
150 mL/h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 500 mg of a drug in 50 mL and runs at 5 mL/h. How many milligrams per hour D does the patient receive?
500 mg/50 mL5 mL/h
D = mg/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 8-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 150 mL/h. At 22:00, 150 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL150 mL infused150 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 6, with E2 and V2. What motor score M was recorded, and which response does it describe? Give the number.
GCS 6E2V2
M =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 65 mmHg. A patient’s systolic pressure is 91 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 65 mmHg?
MAP 65 mmHgSBP 91 mmHg
DBP = mmHg
3Solutions
1.Nursing fundamentals
Answer: B · It only protects if it seals closely to the wearer's face
Why this is the answer
A respirator filters tiny airborne particles only if air passes through the filter, not around a gap. Fit-testing and a fit-check every time it is worn make sure it seals.
Answer
B · It only protects if it seals closely to the wearer's face
2.Nursing fundamentals
Answer: C · Make sure no one is touching the patient
Why this is the answer
Before the shock the rescuer shouts a warning and checks that everyone is clear. Compressions restart straight after the shock as the AED instructs.
Answer
C · Make sure no one is touching the patient
3.Infection control & patient safety
Answer: C · When a patient shows an acute decline, such as new confusion or a sharp change in vital signs
Why this is the answer
Rapid response teams bring critical care skills to a patient who is getting worse, with the aim of preventing cardiac arrest or ICU transfer. Any nurse who is worried about an acute change can call them.
Answer
C · When a patient shows an acute decline, such as new confusion or a sharp change in vital signs
4.Infection control & patient safety
Answer: B · Hold the drug and contact the prescriber
Why this is the answer
Amoxicillin is a penicillin, so it could cause a serious allergic reaction. The nurse holds the drug, clarifies the allergy and contacts the prescriber for a safe alternative.
Answer
B · Hold the drug and contact the prescriber
5.Prioritization & delegation
Answer: B · Turn the patient onto their side
Why this is the answer
A drowsy patient who vomits can aspirate. Turning them to the side lets vomit drain from the mouth; suction and a prescribed antiemetic follow.
Answer
B · Turn the patient onto their side
6.Prioritization & delegation
Answer: A · Respect the refusal, check the patient understands the risks and inform the provider
Why this is the answer
Competent adults have the right to refuse treatment, even if it could save their life. The nurse makes sure the refusal is informed, informs the provider and documents it.
Answer
A · Respect the refusal, check the patient understands the risks and inform the provider
7.Clinical nursing
Answer: A · It keeps the upper airway open during sleep with continuous air pressure
Why this is the answer
Continuous positive airway pressure acts as a splint for the upper airway, preventing collapse and apnoeas. Patients should bring their CPAP machine into hospital.
Answer
A · It keeps the upper airway open during sleep with continuous air pressure
8.Clinical nursing
Answer: C · A sudden drop can reduce blood flow to the brain, heart and kidneys
Why this is the answer
In a hypertensive emergency, autoregulation in vital organs is reset to higher pressures. Lowering BP too fast can cause ischaemia, so it is reduced gradually under close monitoring.
Answer
C · A sudden drop can reduce blood flow to the brain, heart and kidneys
9.Lab values & electrolytes
Answer: C · From the right arm
Why this is the answer
Venipuncture, blood pressure readings and IV lines are avoided in the arm with an AV fistula or graft, to prevent damage, clotting and infection of the access. Only the dialysis team uses the access, for dialysis.
Answer
C · From the right arm
10.Lab values & electrolytes
Answer: C · Lithium 1.8 mEq/L with a new coarse tremor
Why this is the answer
A lithium level of 1.8 mEq/L with a coarse tremor suggests toxicity, which can progress to confusion and seizures. The digoxin, phenytoin and valproate levels are within commonly cited ranges and the patients are stable.
Answer
C · Lithium 1.8 mEq/L with a new coarse tremor
11.Pharmacology
Answer: D · Stop the infusion, remove the cannula and elevate the limb
Why this is the answer
These signs suggest infiltration. The infusion is stopped and the cannula removed, the limb is elevated, and a new cannula is placed elsewhere; vesicant drugs need the extravasation protocol.
Answer
D · Stop the infusion, remove the cannula and elevate the limb
12.Pharmacology
Answer: D · Intravenous calcium gluconate
Why this is the answer
IV calcium stabilises the myocardial cell membrane within minutes and reduces the risk of arrhythmia. Other treatments then shift potassium into cells (insulin with glucose) or remove it from the body.
Answer
D · Intravenous calcium gluconate
13.Med-surg: cardiovascular & respiratory
Answer: B · Low potassium and sodium, raised uric acid and raised glucose
Why this is the answer
Thiazides cause hypokalaemia, hyponatraemia, hypomagnesaemia, hyperuricaemia (gout), hyperglycaemia and hypercalcaemia (they reduce calcium excretion). Dry cough and angioedema are ACE inhibitor effects.
Answer
B · Low potassium and sodium, raised uric acid and raised glucose
14.Med-surg: cardiovascular & respiratory
Answer: C · Ask whether the INR should be checked sooner, as it may rise
Why this is the answer
Several antibiotics, including macrolides such as clarithromycin, some fluoroquinolones and co-trimoxazole, can raise the INR and the bleeding risk. Closer INR monitoring and possible dose adjustment are needed. Stopping or doubling warfarin without advice is unsafe.
Answer
C · Ask whether the INR should be checked sooner, as it may rise
15.Med-surg: neuro, endocrine & renal
Answer: C · A beta-blocker alone can cause a dangerous rise in BP
Why this is the answer
Blocking beta receptors alone leaves catecholamines acting on alpha receptors, causing severe vasoconstriction and a hypertensive crisis. Alpha blockade, such as with phenoxybenzamine, comes first, and a beta-blocker may be added later for tachycardia.
Answer
C · A beta-blocker alone can cause a dangerous rise in BP
16.Med-surg: neuro, endocrine & renal
Answer: C · Weighing the patient before they go to dialysis
Why this is the answer
Weighing a patient is a routine task suitable for a trained assistant. Assessing the access, making medication decisions and teaching require the registered nurse's knowledge and judgement.
Answer
C · Weighing the patient before they go to dialysis
17.Med-surg: GI, perioperative & oncology
Answer: D · Modified-release tablets should not be crushed
Why this is the answer
Crushing modified-release or enteric-coated tablets can cause toxicity or loss of effect. Liquid forms are preferred; each medicine is given separately with flushes, and a pharmacist advises.
Answer
D · Modified-release tablets should not be crushed
18.Med-surg: GI, perioperative & oncology
Answer: B · Discuss reducing the fluid rate with the team
Why this is the answer
An output of about 1.7 mL/kg/h suggests over-resuscitation. Excess fluid ("fluid creep") worsens oedema and can cause pulmonary oedema and compartment syndromes, so the rate is reviewed and reduced under the burn protocol.
Answer
B · Discuss reducing the fluid rate with the team
19.Maternity & obstetric nursing
Answer: B · Isotretinoin
Why this is the answer
Isotretinoin causes severe birth defects, so pregnancy must be prevented during treatment and for a period afterwards. Paracetamol is the usual analgesic in pregnancy, and levothyroxine should be continued.
Answer
B · Isotretinoin
20.Maternity & obstetric nursing
Answer: D · It is abnormal and needs prompt review
Why this is the answer
A score of 8 to 10 is normal, 6 is equivocal, and 4 or less is abnormal and suggests fetal hypoxia. At term, a low score usually leads to prompt review and consideration of birth.
Answer
D · It is abnormal and needs prompt review
21.Pediatric nursing
Answer: B · Use the reliever as the plan says and contact the doctor if it does not help
Why this is the answer
In the yellow zone (often 50–80% of personal best), the child follows the plan, usually extra reliever doses, and seeks medical advice if symptoms do not improve. Red-zone symptoms need emergency help.
Answer
B · Use the reliever as the plan says and contact the doctor if it does not help
22.Pediatric nursing
Answer: D · Slower breathing, easier speech and less use of the neck and chest muscles
Why this is the answer
Improvement shows as a lower respiratory rate, easier speech, less accessory muscle use and better oxygen saturation. A quiet chest with drowsiness signals exhaustion and danger, and tripod positioning shows ongoing distress.
Answer
D · Slower breathing, easier speech and less use of the neck and chest muscles
23.Mental health nursing
Answer: A · Provide a quiet, low-stimulation environment and keep staff and patient safe
Why this is the answer
PCP can cause agitation, violence, psychosis, nystagmus and hypertension. Reducing stimulation and keeping enough staff present for safety are key; "talking down" is less effective than with other hallucinogens.
Answer
A · Provide a quiet, low-stimulation environment and keep staff and patient safe
24.Mental health nursing
Answer: D · Report the concern immediately to the nurse in charge, following policy, to protect patients
Why this is the answer
An impaired nurse is a risk to patients. The concern is reported at once through the proper channel so the colleague can be removed from patient care and offered support through the organisation's procedures.
Answer
D · Report the concern immediately to the nurse in charge, following policy, to protect patients
25.Nursing math & unit conversions
Answer: m = 3.38 kg
Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.
Ounces to pounds
7 oz/16 = 0.4375 lb
7 + 0.4375 = 7.438 lb
Pounds to kilograms
m = 7.438/2.2 = 3.381 ≈ 3.38 kg
Answer
m = 3.38 kg
26.Nursing math & unit conversions
Answer: V = 970 mL
Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.
Each item in mL
2 tsp = 2·5 = 10 mL
3 cups = 3·240 = 720 mL
8 fl oz = 8·30 = 240 mL
Add
V = 10 + 720 + 240 = 970 mL
Answer
V = 970 mL
27.Dosage calculations
Answer: V = 6.4 mL
Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.
Dose from body weight
D = 4·16 = 64 mg
Volume
V = 64/10 = 6.4 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 6.4 mL
28.Dosage calculations
Answer: V = 12.5 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
12.5·24 = 300 mg
Volume
V = (300/120)·5 = 12.5 mL
Answer
V = 12.5 mL
29.IV infusion rates
Answer: R = 50 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.
Millilitres per minute
150/60 = 2.5 mL/min
Drip rate
R = 2.5·20 = 50 gtt/min
Answer
R = 50 gtt/min
30.IV infusion rates
Answer: D = 50 mg/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.
Concentration
500/50 = 10 mg/mL
Dose rate
D = 10·5 = 50 mg/h
Answer
D = 50 mg/h
31.IV fluids & fluid balance
Answer: B = 25 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: 350 + 150 + 100 = 600 mL
IV infusion: 100·8 = 800 mL
IV antibiotic: 1·100 = 100 mL
total intake = 1500 mL
Total output
200 + 275 + 325 + 425 + 250 = 1475 mL
Balance
B = 1500 − 1475 = 25 mL
Answer
B = 25 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: t = 5.7 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 − 150 = 850 mL
Time
t = 850/150 = 5.667 ≈ 5.7 h
Answer
t = 5.7 h
That is about 5 h 40 min, so the bag runs out at about 03:40.
33.Clinical assessment scores
Answer: M = 2
Glasgow Coma Scale: add the best response in three areas. Eye opening E: 4 spontaneous, 3 to sound or speech, 2 to pressure, 1 none. Verbal V: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Motor M: 6 obeys commands, 5 localises, 4 normal flexion (withdraws), 3 abnormal flexion, 2 extension, 1 none. The total runs from 3 to 15. After a head injury, 13–15 is usually called mild, 9–12 moderate and 3–8 severe.
Motor score
M = 6 − 2 − 2 = 2
M2: extension of the arms and legs (abnormal extension)
Answer
M = 2
34.Clinical assessment scores
Answer: DBP = 52 mmHg
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.
Rearrange
DBP = (3·MAP − SBP)/2
Substitute
DBP = (3·65 − 91)/2 = 104/2 = 52 mmHg
Answer
DBP = 52 mmHg
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