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
BParacetamol damage only shows up in the kidneys, many weeks later
CLiver damage develops later, and the antidote works best when given early
DPatients who feel well after six hours never need any treatment at all
9.Lab values & electrolytesMedium
A patient on phenytoin has a level of 28 mcg/mL (usual range about 10–20 mcg/mL). Which findings would the nurse expect?
AHunger and weight gain
BNystagmus, unsteady gait and slurred speech
CTall, peaked T waves
DHyperactive behavior and insomnia only
10.Lab values & electrolytesHard
The nurse teaches a patient starting lithium. Which statement shows a need for further teaching?
A"I will drink plenty of fluids, especially in hot weather"
B"I will cut out salt from my diet completely to stay healthy"
C"I will tell my doctor if I have vomiting or diarrhea"
D"I will check with the pharmacist before taking ibuprofen"
11.PharmacologyMedium
During a rapid infusion of vancomycin, a patient develops flushing and a red rash on the face, neck and upper body. What is the most likely cause and action?
AA normal effect; increase the infusion rate to finish sooner
BAcute kidney failure; stop all IV fluids and antibiotics at once
CAn infusion reaction; stop or slow the infusion and inform the prescriber
DA sign that the infection is spreading; give a second dose
12.PharmacologyHard
Why is clavulanic acid combined with amoxicillin (co-amoxiclav)?
AIt inhibits beta-lactamase enzymes that would destroy amoxicillin
BIt slows the kidney excretion of amoxicillin
CIt reduces the risk of penicillin allergy
DIt makes amoxicillin cross the blood–brain barrier more easily
13.Med-surg: cardiovascular & respiratoryMedium
Two days after a myocardial infarction, a patient develops sudden breathlessness, crackles and a new loud systolic murmur. Which complication should be suspected?
APost-infarction pericarditis causing a pericardial friction rub
BA new episode of stable angina brought on by stress
CPapillary muscle rupture with acute mitral regurgitation
DA pulmonary embolism caused by prolonged bed rest
14.Med-surg: cardiovascular & respiratoryHard
A patient with a COPD exacerbation has been on NIV for two hours. They are now more drowsy, and the pH has fallen further despite a good mask fit. What should the nurse do?
AGive a sedative to help the patient tolerate the mask
BEscalate urgently for review of intubation or a ceiling of care
CRemove the mask and give nebulised bronchodilators only from now on
DContinue NIV unchanged and repeat the blood gas tomorrow morning
15.Med-surg: neuro, endocrine & renalMedium
Before a haemodialysis catheter is used, why is the lock solution withdrawn from each lumen?
AIt contains a strong antibiotic that must be kept
BIt contains concentrated anticoagulant
CIt contains the patient's urine
DIt contains air that keeps the line open
16.Med-surg: neuro, endocrine & renalHard
Which medication timing issue is important for patients on haemodialysis?
AAll medicines must be given just before the session
BNo medicines can be taken on dialysis days
CDialysable drugs may need to be given after the session
DDialysis does not remove any medicines
17.Med-surg: GI, perioperative & oncologyMedium
Which signs suggest severe acute pancreatitis with bleeding into the tissues?
ABruising around the umbilicus or flanks
BA purple rash on the palms and soles
CSwelling of the lips, tongue and face
DYellow discolouration of the fingernails
18.Med-surg: GI, perioperative & oncologyHard
A nurse has a needlestick injury after taking blood from a patient with hepatitis B. What should the nurse do first?
AWash the site with soap and running water, without scrubbing
BScrub the area hard with a nail brush and alcohol
CSuck the wound to remove as much of the blood as possible
DFinish the shift and report it the next day
19.Maternity & obstetric nursingMedium
Which finding is a contraindication to a fetal scalp electrode?
AMembranes that have ruptured
BCervical dilation of 4 cm
CMaternal HIV infection
DA cephalic presentation
20.Maternity & obstetric nursingHard
A deceleration lasts 3 minutes before the baseline recovers. How is this classified?
AAn early deceleration
BA change of baseline
CA variable acceleration
DA prolonged deceleration
21.Pediatric nursingMedium
A 2-year-old suddenly began coughing while eating peanuts. He now has a wheeze on one side of the chest only. What is most likely?
AAn inhaled foreign body
BA first attack of asthma
CBronchiolitis
DViral croup
22.Pediatric nursingHard
A 12-year-old with asthma has been prescribed a preventer inhaler (inhaled corticosteroid) to take every day. Which statement shows a need for further teaching?
A"I use my spacer with my inhaler, even at school."
B"I rinse my mouth after using my preventer inhaler."
C"I carry my reliever inhaler with me everywhere I go."
D"I stop taking my preventer inhaler whenever I've had a few good days."
23.Mental health nursingMedium
An 86-year-old nursing home resident becomes acutely confused over two days. Which cause should be considered first?
AA first episode of schizophrenia caused by moving into the home
BAn infection such as a urinary tract infection, or a medicine side effect
CThe normal ageing process
DA sudden onset of Alzheimer's disease
24.Mental health nursingHard
Five days after starting haloperidol, a patient has a temperature of 40 °C, rigid limbs, confusion, fluctuating blood pressure and sweating. What should the nurse do first?
AGive paracetamol for the fever and recheck the observations in 4 hours
BWithhold the antipsychotic and get urgent medical help
CEncourage him to exercise to reduce stiffness
DGive another dose of haloperidol to calm him
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A drip-rate calculation gives 153.743 gtt/min. The rule in this exercise is that drip rates are rounded to the nearest whole drop. What value x do you record?
153.743 gtt/min
x = gtt/min
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). During a shift a patient takes ½ cup of tea, 2 tsp of cough syrup, 1 fl oz of juice. Using the equivalents given, find the total oral intake V in mL.
1 cup = 8 fl oz = 240 mL1 tsp = 5 mL1 fl oz = 30 mL
V = mL
27.Dosage calculationsMedium
A patient weighs 30 kg and is prescribed 25 mg/kg as a single dose. Find the dose D in mg.
30 kg25 mg/kg
D = mg
28.Dosage calculationsHard
The prescription is 900 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
900 units5000 units/mL
V = mL
29.IV infusion ratesMedium
Infuse 500 mL over 3 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
500 mL3 h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
1500 mL was ordered over 10 hours. After 6 hours you find that 770 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?
1500 mL / 10 hafter 6 h: 770 mL
Δ = %
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 patient weighs 79 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
79 kg8 hurine: 225 mLurine: 425 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 16:30 at 150 mL/h. After 4 hours the rate is changed to 60 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
1000 mL150 mL/h · 4 h60 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 11, with E3 and V4. What motor score M was recorded, and which response does it describe? Give the number.
GCS 11E3V4
M =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 20/min, SpO₂ 86% on room air, blood pressure 112/68 mmHg, pulse 76/min, alert, temperature 38.1 °C. Which clinical risk group does the patient fall into? Click it.
RR 20SpO₂ 86%airSBP 112HR 76AT 38.1 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: B · The adult has capacity unless it is shown that they lack it
Why this is the answer
The Act begins with a presumption of capacity. A person is not treated as lacking capacity just because of age, appearance or an unwise decision.
Answer
B · The adult has capacity unless it is shown that they lack it
2.Nursing fundamentals
Answer: A · They may have neutropenic sepsis, which can quickly become fatal
Why this is the answer
Patients with a low neutrophil count may have few signs of infection apart from fever and can deteriorate fast. Urgent assessment and IV antibiotics, usually within an hour, are needed.
Answer
A · They may have neutropenic sepsis, which can quickly become fatal
3.Infection control & patient safety
Answer: A · It is written factually and does not replace documenting the fall in the patient’s record
Why this is the answer
The nurse documents the facts of the fall, the assessment and the care given in the patient’s record. The incident report is a separate quality-improvement document and is not filed in the chart. Policies differ on whether the record notes that a report was made: many US facilities advise against it, while many UK services record the report reference. Falls are reported whether or not there is an injury.
Answer
A · It is written factually and does not replace documenting the fall in the patient’s record
4.Infection control & patient safety
Answer: A · Avoid direct patient care and handling of equipment until it heals, and see occupational health
Why this is the answer
Weeping skin lesions increase the risk of passing organisms to patients and of the nurse picking up bloodborne pathogens. The nurse should avoid direct patient contact and handling of patient equipment until the condition is assessed and resolved.
Answer
A · Avoid direct patient care and handling of equipment until it heals, and see occupational health
5.Prioritization & delegation
Answer: B · Fecal impaction with liquid stool passing around it
Why this is the answer
In fecal impaction, liquid stool from higher in the bowel leaks around the hard mass. Giving an antidiarrheal would make things worse; the nurse assesses and reports.
Answer
B · Fecal impaction with liquid stool passing around it
6.Prioritization & delegation
Answer: D · Report it at once, as it may mean the brain is being compressed
Why this is the answer
A newly fixed, dilated pupil suggests pressure on the third cranial nerve from rising intracranial pressure or a bleed. It is a neurological emergency that needs immediate escalation.
Answer
D · Report it at once, as it may mean the brain is being compressed
7.Clinical nursing
Answer: A · It increases the risk of wound infection, bleeding and cardiac complications
Why this is the answer
Inadvertent perioperative hypothermia impairs clotting and immune function and increases cardiac events and wound infection. Patients are warmed actively and their temperature monitored.
Answer
A · It increases the risk of wound infection, bleeding and cardiac complications
8.Clinical nursing
Answer: C · Liver damage develops later, and the antidote works best when given early
Why this is the answer
Paracetamol overdose may cause few early symptoms, but liver failure can develop over days. Acetylcysteine is most effective when started early, guided by timed paracetamol levels.
Answer
C · Liver damage develops later, and the antidote works best when given early
9.Lab values & electrolytes
Answer: B · Nystagmus, unsteady gait and slurred speech
Why this is the answer
Phenytoin toxicity causes nystagmus, ataxia, slurred speech and drowsiness. The nurse holds the dose and informs the prescriber. Low albumin increases the free (active) drug, so toxicity can occur even with a normal total level.
Answer
B · Nystagmus, unsteady gait and slurred speech
10.Lab values & electrolytes
Answer: B · "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
B · "I will cut out salt from my diet completely to stay healthy"
11.Pharmacology
Answer: C · An infusion reaction; stop or slow the infusion and inform the prescriber
Why this is the answer
Rapid vancomycin infusion releases histamine, causing flushing and itching of the upper body (formerly called "red man syndrome"). It is managed by stopping or slowing the infusion, and sometimes with an antihistamine.
Answer
C · An infusion reaction; stop or slow the infusion and inform the prescriber
12.Pharmacology
Answer: A · It inhibits beta-lactamase enzymes that would destroy amoxicillin
Why this is the answer
Many bacteria produce beta-lactamases that inactivate penicillins. Clavulanic acid inhibits these enzymes, so amoxicillin can work against these organisms.
Answer
A · It inhibits beta-lactamase enzymes that would destroy amoxicillin
13.Med-surg: cardiovascular & respiratory
Answer: C · Papillary muscle rupture with acute mitral regurgitation
Why this is the answer
Rupture of a papillary muscle (or of the ventricular septum) after MI produces a new murmur and sudden heart failure or shock. This is a surgical emergency. Pericarditis causes pleuritic chest pain and a friction rub rather than acute pulmonary oedema with a new murmur.
Answer
C · Papillary muscle rupture with acute mitral regurgitation
14.Med-surg: cardiovascular & respiratory
Answer: B · Escalate urgently for review of intubation or a ceiling of care
Why this is the answer
Worsening acidosis and consciousness on NIV mean treatment is failing. Senior review is needed to decide on intubation and ventilation or, if agreed in advance, a ceiling of care. Ideally the plan for NIV failure is documented when NIV is started. Sedation would depress breathing further.
Answer
B · Escalate urgently for review of intubation or a ceiling of care
15.Med-surg: neuro, endocrine & renal
Answer: B · It contains concentrated anticoagulant
Why this is the answer
Dialysis catheter lumens are filled with a concentrated heparin or citrate lock. If it is flushed into the patient, it can cause bleeding or other effects. Catheters are usually accessed only by trained staff.
Answer
B · It contains concentrated anticoagulant
16.Med-surg: neuro, endocrine & renal
Answer: C · Dialysable drugs may need to be given after the session
Why this is the answer
Drugs that are dialysable (for example some antibiotics) may be given after the session so they are not removed. Antihypertensives are often withheld before dialysis to avoid hypotension. The prescriber and pharmacist set the timing.
Answer
C · Dialysable drugs may need to be given after the session
17.Med-surg: GI, perioperative & oncology
Answer: A · Bruising around the umbilicus or flanks
Why this is the answer
Cullen's sign (periumbilical bruising) and Grey Turner's sign (flank bruising) are uncommon, late signs of retroperitoneal haemorrhage in severe pancreatitis. They indicate a poor prognosis.
Answer
A · Bruising around the umbilicus or flanks
18.Med-surg: GI, perioperative & oncology
Answer: A · Wash the site with soap and running water, without scrubbing
Why this is the answer
The site is washed with soap and running water; it may be allowed to bleed gently, but it is not scrubbed or sucked. The injury is reported immediately so that post-exposure assessment, including hepatitis B immunity and treatment if needed, can start quickly.
Answer
A · Wash the site with soap and running water, without scrubbing
19.Maternity & obstetric nursing
Answer: C · Maternal HIV infection
Why this is the answer
A scalp electrode punctures fetal skin and could transmit blood-borne infections such as HIV, hepatitis B or C and herpes. It needs ruptured membranes, some dilation and an identifiable presenting part.
Answer
C · Maternal HIV infection
20.Maternity & obstetric nursing
Answer: D · A prolonged deceleration
Why this is the answer
A prolonged deceleration lasts at least 2 minutes but less than 10. A decrease of 10 minutes or more is a baseline change. The cause, such as hypotension or tachysystole, should be found and corrected.
Answer
D · A prolonged deceleration
21.Pediatric nursing
Answer: A · An inhaled foreign body
Why this is the answer
A sudden cough or choking episode while eating, followed by a one-sided wheeze or reduced breath sounds, strongly suggests foreign body aspiration. It needs urgent assessment and usually removal by bronchoscopy.
Answer
A · An inhaled foreign body
22.Pediatric nursing
Answer: D · "I stop taking my preventer inhaler whenever I've had a few good days."
Why this is the answer
Preventer (inhaled corticosteroid) inhalers reduce airway inflammation and must be taken daily as prescribed, even when the child feels well. Carrying a reliever, rinsing the mouth and using a spacer are correct.
Answer
D · "I stop taking my preventer inhaler whenever I've had a few good days."
23.Mental health nursing
Answer: B · An infection such as a urinary tract infection, or a medicine side effect
Why this is the answer
Acute confusion in an older adult suggests delirium, which has an underlying cause. Common causes include infections, medicines (especially anticholinergics and sedatives), dehydration, hypoxia, pain and urinary retention.
Answer
B · An infection such as a urinary tract infection, or a medicine side effect
24.Mental health nursing
Answer: B · Withhold the antipsychotic and get urgent medical help
Why this is the answer
These findings suggest neuroleptic malignant syndrome. Stop the antipsychotic, call for urgent medical review, start cooling and supportive care, and monitor vital signs, kidney function and CK.
Answer
B · Withhold the antipsychotic and get urgent medical help
25.Nursing math & unit conversions
Answer: x = 154 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
153.743 → 3
Only the next digit decides
153.743 → 7
7 is 5 or more, so round 3 up.
The digits after it (43) are ignored: round once, never step by step.
Round
x = 154 gtt/min
Answer
x = 154 gtt/min
26.Nursing math & unit conversions
Answer: V = 160 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
½ cup = 0.5·240 = 120 mL
2 tsp = 2·5 = 10 mL
1 fl oz = 1·30 = 30 mL
Add
V = 120 + 10 + 30 = 160 mL
Answer
V = 160 mL
27.Dosage calculations
Answer: D = 750 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.
Dose
25·30 = 750 mg
Answer
D = 750 mg
28.Dosage calculations
Answer: V = 0.18 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 = 900/5000 = 0.18 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.18 mL
29.IV infusion rates
Answer: R = 28 gtt/min
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Time in minutes
3·60 = 180 min
Drip rate
R = 500·10/180 = 27.78 ≈ 28 gtt/min
Answer
R = 28 gtt/min
At the bedside you round to the nearest whole drop: 28 gtt/min.
30.IV infusion rates
Answer: Δ = 28.33 %
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
1500/10 = 150 mL/h
New rate
R = 770/4 = 192.5 mL/h
Percentage change
Δ = (192.5 − 150)/150·100% = 28.33%
Answer
Δ = 28.33%
This is more than a 25% increase: most hospitals require you to contact the prescriber instead of catching up, and to assess the patient for fluid overload.
31.IV fluids & fluid balance
Answer: U = 1.03 mL/kg/h
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 urine
225 + 425 = 650 mL
Per kilogram per hour
U = 650/(79·8) = 1.028 ≈ 1.03 mL/kg/h
Answer
U = 1.03 mL/kg/h
32.IV fluids & fluid balance
Answer: t = 10.7 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.
First part
150·4 = 600 mL
1000 − 600 = 400 mL left
Second part
400/60 = 6.667 h
Total time
t = 4 + 6.667 = 10.67 ≈ 10.7 h
Answer
t = 10.7 h
That is about 10 h 40 min, so the bag runs out at about 03:10.
33.Clinical assessment scores
Answer: M = 4
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 = 11 − 3 − 4 = 4
M4: withdraws the limb from pressure (normal flexion)
Answer
M = 4
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 20/min → 0
SpO₂ 86% → 3
on air → 0
SBP 112 mmHg → 0
HR 76/min → 0
alert (A) → 0
T 38.1 °C → 1
Total and red scores
NEWS2 = 0 + 3 + 0 + 0 + 0 + 0 + 1 = 4
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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