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?
AFit-testing checks whether the patient is still infectious
BIt only protects if it seals closely to the wearer's face
CIt must be tested to check it is the right colour
DFit-testing makes the mask reusable for a week
2.Nursing fundamentalsHard
A patient opens their eyes only to pain, makes incomprehensible sounds and withdraws from a painful stimulus. What is the Glasgow Coma Scale score?
A11
B6
C8
D9
3.Infection control & patient safetyMedium
A patient on a diuretic is at high risk of falls and often gets up at night. Which measure is most helpful?
AScheduled toileting, with the call light and walking aid in reach
BTelling the patient not to drink anything after lunch
CGiving the diuretic at bedtime so it works overnight
DKeeping the room completely dark at night to help the patient sleep
4.Infection control & patient safetyHard
A handwritten order is hard to read, and the nurse is not sure of the drug name. What should the nurse do?
AAsk a colleague to guess what it says
BContact the prescriber to clarify before giving anything
CChoose the drug that seems most likely from the diagnosis
DHold the drug until the next day without telling anyone
5.Prioritization & delegationMedium
During an IV vancomycin infusion, a patient develops flushing and itching of the face and neck. What should the nurse do first?
ASpeed up the infusion to finish it quickly
BIgnore it, because flushing is always harmless and passes
CStop or slow the infusion and inform the provider
DApply a warm compress to the face and neck
6.Prioritization & delegationHard
Two weeks after birth, a mother says she hears voices telling her the baby is evil. What is the priority?
AKeep the mother and baby safe and arrange urgent psychiatric care
BAdvise more sleep and book a routine follow-up visit for next month
CReassure her that this is normal “baby blues”
DLeave her alone with the baby to bond
7.Clinical nursingMedium
A nurse gives a patient analgesia for post-operative pain. What should be done next?
AReassess the pain and any side effects once the drug has had time to work
BAssume the pain has gone if the patient is quiet and has their eyes closed
CGive a second analgesic straight away just in case
DWait until the next shift before asking the patient about the pain
8.Clinical nursingHard
A nurse phones a doctor about a deteriorating patient using SBAR. Which statement belongs in the "R" section?
A"His blood pressure is 85/50 and he is confused."
B"Please review him within the next 15 minutes."
C"I am calling about Mr Smith, who is breathless."
D"He was admitted three days ago with pneumonia."
9.Lab values & electrolytesMedium
For most hospitalized adults with diabetes who are critically ill, which glucose target range is commonly recommended?
AAbout 250–300 mg/dL (13.9–16.7 mmol/L)
BAbout 300–350 mg/dL (16.7–19.4 mmol/L)
CAbout 60–80 mg/dL (3.3–4.4 mmol/L)
DAbout 140–180 mg/dL (7.8–10 mmol/L)
10.Lab values & electrolytesHard
A patient with C. difficile diarrhea has a white cell count of 24 × 10³/µL and a creatinine that has risen to 2.1 mg/dL (186 µmol/L). What does this indicate?
AUnrelated chronic kidney disease
BMild infection needing no treatment
CSevere C. difficile infection
DSuccessful response to treatment
11.PharmacologyMedium
After several years of levodopa treatment, which problem is common?
ADyskinesias and "on–off" fluctuations in response
BPermanent hearing loss
CComplete and permanent loss of all Parkinson's symptoms
DSevere hypoglycaemia after each dose
12.PharmacologyHard
Why are tetracyclines usually avoided in pregnancy and in young children (under 8 years in US guidance, under 12 years in the UK)?
AThey bind to growing teeth and bone and stain the teeth permanently
BThey cause grey baby syndrome in infants
CThey cause severe hearing loss in children
DThey block the action of growth hormone and stunt the child's growth
13.Med-surg: cardiovascular & respiratoryMedium
Why is a shock for cardioversion synchronised with the QRS complex?
ATo allow the use of a lower battery charge
BTo avoid delivering the shock during the T wave
CTo make the shock less painful for the patient
DTo keep the pads from burning the skin
14.Med-surg: cardiovascular & respiratoryHard
A patient with crushing chest pain has ST elevation in leads V1–V4. Which coronary artery is most likely blocked?
AThe circumflex artery
BThe left subclavian artery
CThe left anterior descending artery
DThe right coronary artery and its branches
15.Med-surg: neuro, endocrine & renalMedium
A nurse is teaching a patient going home after a mild concussion. Which statement shows a need for further teaching?
A"I will come back if I start vomiting again and again."
B"Someone will stay with me for the first night."
C"A few drinks tonight will help me relax and sleep."
D"I will return if my headache gets steadily worse."
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
CDeciding which morning medicines to hold
DWeighing the patient before they go to dialysis
17.Med-surg: GI, perioperative & oncologyMedium
Why is the time a surgical limb tourniquet is inflated carefully recorded?
AIt shows how long the anaesthetic gas was used
BThe surgeon is paid per minute of use
CLong inflation can cause nerve and muscle damage
DThe tourniquet slowly loses all its air after one minute
18.Med-surg: GI, perioperative & oncologyHard
During a nasogastric feed, a patient starts coughing and SpO₂ falls from 96% to 89%. What should the nurse do first?
ALay the patient flat to help them rest
BStop the feed and assess the airway and breathing
CGive a drink of water to clear the throat
DIncrease the feed rate to finish it sooner
19.Maternity & obstetric nursingMedium
A preterm baby at 30 weeks has repeated pauses in breathing of more than 20 seconds. Which drug is commonly used?
APhenobarbital
BNaloxone hydrochloride
CCaffeine citrate
DAtropine sulfate
20.Maternity & obstetric nursingHard
A newborn is pale, has a heart rate of 170/min and weak pulses after a difficult vacuum birth. The scalp is boggy and swelling across the sutures is increasing. What should the nurse suspect?
ANormal moulding
BSubgaleal haemorrhage
CSimple cephalhaematoma
DCaput succedaneum
21.Pediatric nursingMedium
How should anti-sickness medicine be given to a child receiving chemotherapy that often causes vomiting?
ABefore the chemotherapy starts and then regularly
BOnly at night, when the child is asleep
COnly after the child has already vomited at least twice
DOnly if the child asks for it
22.Pediatric nursingHard
Which statement by the parent of a child with peanut allergy shows a need for further teaching?
A"I'll read food labels for peanuts every time I shop."
B"I'll call an ambulance every time I use the auto-injector, even if she seems to recover quickly."
C"I'll check the use-by date on her auto-injectors regularly and replace them before they expire."
D"If she has a bad reaction, I'll give an antihistamine and wait an hour before using the auto-injector."
23.Mental health nursingMedium
A patient says, "I feel like I'm dying inside." Which nurse response best uses the technique of exploring?
A"Let's talk about something more cheerful."
B"Tell me more about what that feeling is like for you."
C"You shouldn't say things like that."
D"Everyone feels that way sometimes."
24.Mental health nursingHard
A patient with alcohol dependence is confused, unsteady on his feet and has abnormal eye movements. Why is it urgent to give thiamine?
AThiamine prevents all alcohol withdrawal seizures
BThiamine quickly lowers the blood alcohol level
CWernicke's encephalopathy can be reversed if treated early, but may otherwise lead to permanent Korsakoff syndrome
DThiamine will make him dislike the taste of alcohol in the future, which helps prevent a relapse
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 96.8 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.
96.8 °F
T = °C
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A prescription reads 1 tbsp of an oral suspension every 6 hours for 7 days. The suspension comes in 50 mL bottles. Using 1 tbsp = 15 mL, how many whole bottles N must be supplied so the course is complete?
1 tbspevery 6 hours7 days50 mL1 tbsp = 15 mL
N =
27.Dosage calculationsMedium
A patient weighs 45 kg. The prescribed dose is 30 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?
45 kg30 mg/kg/day4× per day
D = mg
28.Dosage calculationsHard
The prescription is 6600 units of a drug that comes as 10000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
6600 units10000 units/mL
V = mL
29.IV infusion ratesMedium
1000 mL was ordered over 10 hours. After 2 hours you find that 980 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?
1000 mL / 10 hafter 2 h: 980 mL
R = mL/h
30.IV infusion ratesHard
A drip runs at 32 gtt/min through a set of 60 gtt/mL. There are 400 mL left in the bag. How many hours t until it is empty?
32 gtt/min60 gtt/mL400 mL
t = h
31.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss).
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 120 mL/h. At 09:30, 600 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL600 mL infused120 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury opens the eyes only to pressure (a painful stimulus), talks in sentences but is confused and shows as the best motor response: abnormal flexion of the arms (decorticate posture). Work out the GCS and classify the head injury by it. Click your answer.
1mild
2moderate
3severe
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 60 mmHg. A patient’s systolic pressure is 80 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 60 mmHg?
MAP 60 mmHgSBP 80 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 · 8
Why this is the answer
Eyes to pain score 2, incomprehensible sounds score 2 and withdrawal from pain scores 4, giving 8. A GCS of 8 or less suggests the patient may not be able to protect their airway.
Answer
C · 8
3.Infection control & patient safety
Answer: A · Scheduled toileting, with the call light and walking aid in reach
Why this is the answer
Scheduled toileting and keeping the call light and aids within reach reduce unassisted trips. Giving the diuretic in the morning, not at bedtime, also helps. A night light is safer than darkness, and restricting fluids without a reason can cause dehydration.
Answer
A · Scheduled toileting, with the call light and walking aid in reach
4.Infection control & patient safety
Answer: B · Contact the prescriber to clarify before giving anything
Why this is the answer
Illegible or unclear orders are clarified directly with the prescriber. The nurse never guesses, and a held dose is reported so treatment is not missed.
Answer
B · Contact the prescriber to clarify before giving anything
5.Prioritization & delegation
Answer: C · Stop or slow the infusion and inform the provider
Why this is the answer
Flushing of the upper body during vancomycin is usually an infusion reaction related to the rate. The nurse stops or slows the infusion, assesses for anaphylaxis and informs the provider.
Answer
C · Stop or slow the infusion and inform the provider
6.Prioritization & delegation
Answer: A · Keep the mother and baby safe and arrange urgent psychiatric care
Why this is the answer
Hallucinations and delusions after birth suggest postpartum psychosis, a psychiatric emergency with risk to mother and baby. Safety and urgent specialist care are the priorities.
Answer
A · Keep the mother and baby safe and arrange urgent psychiatric care
7.Clinical nursing
Answer: A · Reassess the pain and any side effects once the drug has had time to work
Why this is the answer
The effect of analgesia should be reassessed when it is expected to work, with side effects such as sedation and breathing checked. The result is documented and the plan adjusted.
Answer
A · Reassess the pain and any side effects once the drug has had time to work
8.Clinical nursing
Answer: B · "Please review him within the next 15 minutes."
Why this is the answer
In SBAR, R is the recommendation or request, such as a review within a time frame. The other statements belong to Assessment, Background and Situation.
Answer
B · "Please review him within the next 15 minutes."
9.Lab values & electrolytes
Answer: D · About 140–180 mg/dL (7.8–10 mmol/L)
Why this is the answer
For most critically ill patients, insulin is used to keep glucose around 140–180 mg/dL (7.8–10 mmol/L). Lower targets increase the risk of hypoglycemia, and persistently higher levels increase infection and other complications.
Answer
D · About 140–180 mg/dL (7.8–10 mmol/L)
10.Lab values & electrolytes
Answer: C · Severe C. difficile infection
Why this is the answer
A white count of 15 × 10³/µL or more or a creatinine above 1.5 mg/dL marks severe C. difficile infection. These patients need prompt treatment, fluid replacement and close monitoring for complications such as toxic megacolon. Contact precautions with soap-and-water hand hygiene are used.
Answer
C · Severe C. difficile infection
11.Pharmacology
Answer: A · Dyskinesias and "on–off" fluctuations in response
Why this is the answer
Long-term levodopa use often leads to motor fluctuations, with periods of good control and periods of stiffness, and to dyskinesias at peak dose. Dose timing and add-on drugs are adjusted to manage this.
Answer
A · Dyskinesias and "on–off" fluctuations in response
12.Pharmacology
Answer: A · They bind to growing teeth and bone and stain the teeth permanently
Why this is the answer
Tetracyclines chelate calcium and are deposited in growing teeth and bones. This can cause permanent yellow-brown staining of the teeth and may affect bone growth. Short courses of doxycycline are sometimes still used in younger children for specific serious infections.
Answer
A · They bind to growing teeth and bone and stain the teeth permanently
13.Med-surg: cardiovascular & respiratory
Answer: B · To avoid delivering the shock during the T wave
Why this is the answer
A shock delivered on the T wave (the vulnerable period) can trigger ventricular fibrillation. Synchronisation times the shock to the R wave. In ventricular fibrillation there is no organised QRS, so defibrillation is unsynchronised.
Answer
B · To avoid delivering the shock during the T wave
14.Med-surg: cardiovascular & respiratory
Answer: C · The left anterior descending artery
Why this is the answer
ST elevation in V1–V4 indicates an anteroseptal STEMI, usually from LAD occlusion. Anterior MIs damage a large area of muscle and carry a high risk of heart failure and arrhythmias. Leads II, III and aVF suggest an inferior MI, usually from the right coronary artery.
Answer
C · The left anterior descending artery
15.Med-surg: neuro, endocrine & renal
Answer: C · "A few drinks tonight will help me relax and sleep."
Why this is the answer
After a head injury, alcohol and sedatives should be avoided because they can mask drowsiness and confusion. A responsible adult should stay with the patient, and worsening headache, repeated vomiting, confusion or drowsiness mean they must return.
Answer
C · "A few drinks tonight will help me relax and sleep."
16.Med-surg: neuro, endocrine & renal
Answer: D · 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
D · Weighing the patient before they go to dialysis
17.Med-surg: GI, perioperative & oncology
Answer: C · Long inflation can cause nerve and muscle damage
Why this is the answer
A tourniquet creates a bloodless field but causes limb ischaemia. Inflation time and pressure are recorded and the surgeon is told at set intervals, as long inflation can damage nerves and muscle.
Answer
C · Long inflation can cause nerve and muscle damage
18.Med-surg: GI, perioperative & oncology
Answer: B · Stop the feed and assess the airway and breathing
Why this is the answer
Coughing and desaturation suggest aspiration or a displaced tube. The feed is stopped, the patient is sat up, oxygen is given as needed, and medical review and checking of tube position follow.
Answer
B · Stop the feed and assess the airway and breathing
19.Maternity & obstetric nursing
Answer: C · Caffeine citrate
Why this is the answer
Apnoea of prematurity results from an immature respiratory centre. Caffeine citrate stimulates breathing and reduces apnoea episodes. Gentle stimulation is used during an episode.
Answer
C · Caffeine citrate
20.Maternity & obstetric nursing
Answer: B · Subgaleal haemorrhage
Why this is the answer
A subgaleal haemorrhage is bleeding under the scalp aponeurosis. It crosses suture lines, can grow rapidly and can cause hypovolaemic shock. It is an emergency, unlike caput or cephalhaematoma.
Answer
B · Subgaleal haemorrhage
21.Pediatric nursing
Answer: A · Before the chemotherapy starts and then regularly
Why this is the answer
Antiemetics work best when given before chemotherapy and on a regular schedule, not only after vomiting begins. Uncontrolled vomiting can also cause anticipatory nausea with later treatments.
Answer
A · Before the chemotherapy starts and then regularly
22.Pediatric nursing
Answer: D · "If she has a bad reaction, I'll give an antihistamine and wait an hour before using the auto-injector."
Why this is the answer
Adrenaline is the first treatment for anaphylaxis and must be given without delay; antihistamines do not treat airway swelling or shock. Checking expiry dates, reading labels and calling emergency services after use are correct.
Answer
D · "If she has a bad reaction, I'll give an antihistamine and wait an hour before using the auto-injector."
23.Mental health nursing
Answer: B · "Tell me more about what that feeling is like for you."
Why this is the answer
Exploring asks the patient to describe an experience in more detail. Generalising, disapproving and changing the subject block the patient from talking.
Answer
B · "Tell me more about what that feeling is like for you."
24.Mental health nursing
Answer: C · Wernicke's encephalopathy can be reversed if treated early, but may otherwise lead to permanent Korsakoff syndrome
Why this is the answer
Wernicke's encephalopathy is an emergency caused by thiamine deficiency. Prompt high-dose thiamine can reverse it, but delay can lead to Korsakoff syndrome with lasting memory loss, or death.
Answer
C · Wernicke's encephalopathy can be reversed if treated early, but may otherwise lead to permanent Korsakoff syndrome
25.Nursing math & unit conversions
Answer: T = 36 °C
Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.
Subtract 32
96.8 − 32 = 64.8
Multiply by 5/9
T = 64.8·5/9 = 36 °C
Answer
T = 36 °C
26.Nursing math & unit conversions
Answer: N = 9
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.
Total volume
15 mL × 4 × 7 = 420 mL
Bottles
420/50 = 8.4 → N = 9
Answer
N = 9
27.Dosage calculations
Answer: D = 337.5 mg
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Total per day
30·45 = 1350 mg
Per dose
D = 1350/4 = 337.5 mg
Answer
D = 337.5 mg
28.Dosage calculations
Answer: V = 0.66 mL
Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.
Volume
V = 6600/10000 = 0.66 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.66 mL
29.IV infusion rates
Answer: R = 122.5 mL/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.
Original rate
1000/10 = 100 mL/h
New rate
R = 980/8 = 122.5 mL/h
Answer
R = 122.5 mL/h
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
30.IV infusion rates
Answer: t = 12.5 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
32·60/60 = 32 mL/h
Time left
t = 400/32 = 12.5 h
Answer
t = 12.5 h
31.IV fluids & fluid balance
Answer: B = 1610 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: 200 + 200 = 400 mL
IV infusion: 125·12 = 1500 mL
IV antibiotic: 2·50 = 100 mL
total intake = 2000 mL
Total output
200 + 150 + 40 = 390 mL
Balance
B = 2000 − 390 = 1610 mL
Answer
B = 1610 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: t = 3.3 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 − 600 = 400 mL
Time
t = 400/120 = 3.333 ≈ 3.3 h
Answer
t = 3.3 h
That is about 3 h 20 min, so the bag runs out at about 12:50.
33.Clinical assessment scores
Answer: moderate
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.
Score each area
E: opens the eyes only to pressure (a painful stimulus) → 2
V: talks in sentences but is confused → 4
M: abnormal flexion of the arms (decorticate posture) → 3
Add
GCS = 2 + 4 + 3 = 9
Severity
GCS 9 → moderate
Answer
moderate
34.Clinical assessment scores
Answer: DBP = 50 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 = (3·60 − 80)/2 = 100/2 = 50 mmHg
Answer
DBP = 50 mmHg
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