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
Before discharge, what is most important to confirm about the patient's new medicines?
AThat they know which company makes each drug
BThat they know the chemical name of each drug
CThat they know how and when to take them and what to report
DThat they know the price of each medicine and where to buy it
2.Nursing fundamentalsHard
A pressure ulcer shows full-thickness tissue loss with exposed bone. How is it classified?
ACategory 3
BCategory 4
CCategory 2
DSuspected deep tissue injury
3.Infection control & patient safetyMedium
Why are oral liquid medicines given with oral or enteral syringes rather than standard IV syringes?
AOral syringes measure intravenous doses more accurately
BOral syringes do not fit IV lines, preventing wrong-route errors
CThere is no safety reason; it is only tradition
DIV syringes cannot measure small volumes of oral liquid accurately
4.Infection control & patient safetyHard
Victims of a chemical spill arrive at the emergency department with liquid on their skin and clothing. What is the priority before they enter the building?
ATake a full history in the waiting room
BGive them hospital gowns and seat them in triage
CDecontaminate them outside, with staff wearing appropriate PPE
DTake them straight into the resuscitation room so treatment is not delayed
5.Prioritization & delegationMedium
Which statement shows correct understanding of accountability in delegation?
A“If the task goes wrong, only the assistant is responsible.”
B“Once I delegate a task, it is no longer my concern.”
C“I stay accountable for deciding to delegate and for following up on the result.”
D“The nursing assistant is accountable for whether the task was right to delegate.”
6.Prioritization & delegationHard
A patient is bleeding internally after a fall. Which finding is usually an early sign of hypovolemic shock?
ARestlessness and a rising heart rate while the blood pressure is still normal
BA slow heart rate with warm, dry, flushed skin and a normal blood pressure throughout
CA very low blood pressure with fixed, dilated pupils
DLoss of consciousness with gasping breaths
7.Clinical nursingMedium
Which is the correct technique for using a metered-dose inhaler without a spacer?
ABreathe in quickly through the nose while pressing the canister
BBreathe out, then breathe in slowly and deeply while pressing the canister, then hold
CPress the canister and wait one minute before breathing in
DPress the canister twice quickly, then breathe in fast and breathe straight out again
8.Clinical nursingHard
A patient with lung cancer develops swelling of the face and arms, distended neck veins and breathlessness that is worse lying down. What should be suspected?
ASuperior vena cava obstruction
BAn allergic reaction to food
CHypothyroidism
DRight-sided heart failure from valve disease
9.Lab values & electrolytesMedium
In chronic kidney disease, a high serum phosphate is usually accompanied by which change in calcium?
AA high serum calcium
BA high serum potassium only, with no calcium change
CA low serum calcium
DNo change in calcium
10.Lab values & electrolytesHard
A man of Mediterranean descent develops dark urine, jaundice and a falling hemoglobin a few days after eating fava beans. Which condition is most likely?
AIron-deficiency anemia from poor diet
BG6PD deficiency with acute hemolysis
CVitamin B12 deficiency anemia
DSickle cell crisis with vaso-occlusion
11.PharmacologyMedium
Why is a spacer recommended with a metered-dose inhaler?
AIt removes the need to shake the inhaler
BMore drug reaches the lungs and less stays in the mouth
CIt turns the inhaler into a nebuliser
DIt doubles the dose of drug released by each puff of the inhaler
12.PharmacologyHard
A patient with severe chronic hyponatraemia receives hypertonic saline. Why is the rate of correction strictly limited?
AFast correction causes immediate kidney failure
BRaising sodium too fast can cause osmotic demyelination in the brain
CHypertonic saline is toxic to the liver at high rates
DRaising sodium too fast causes severe hypokalaemia and cardiac arrest
13.Med-surg: cardiovascular & respiratoryMedium
A patient with diabetes is starting a beta-blocker. What should the nurse teach about hypoglycaemia?
AThe beta-blocker will prevent all episodes of hypoglycaemia
BHypoglycaemia will always cause a very slow and weak pulse
CInsulin should be stopped while taking a beta-blocker
DSome warning signs, such as a fast heartbeat, may be masked
14.Med-surg: cardiovascular & respiratoryHard
The monitor shows a regular broad-complex tachycardia at 180/min. The patient is alert with BP 126/78 mmHg and no chest pain. What is the most appropriate plan?
AReassure the patient, as this is a normal rhythm
BRecord a 12-lead ECG, call senior help and anticipate an antiarrhythmic
CStart chest compressions straight away and give a dose of IV adrenaline
DDeliver an unsynchronised shock immediately, before any other assessment
15.Med-surg: neuro, endocrine & renalMedium
A patient has hypertension that is hard to control and a persistently low potassium, without taking diuretics. Which condition should be considered?
ACranial diabetes insipidus
BPrimary hypothyroidism
CPrimary adrenal insufficiency (Addison's)
DPrimary hyperaldosteronism (Conn's)
16.Med-surg: neuro, endocrine & renalHard
A patient on warfarin starts levothyroxine for hypothyroidism. What should the nurse expect to monitor more closely?
AThe potassium, because it may rise
BThe urine output, because it may stop
CThe INR, because it may rise
DThe blood glucose, because it may fall
17.Med-surg: GI, perioperative & oncologyMedium
Why is thiamine given to patients with alcohol dependence admitted to hospital?
ATo treat the cirrhosis directly
BTo reduce the craving for alcohol
CTo prevent Wernicke's encephalopathy
DTo prevent bleeding from varices
18.Med-surg: GI, perioperative & oncologyHard
On day 3 after a major burn, the patient starts passing large volumes of urine. Which electrolyte problem should the nurse anticipate?
AHyperkalaemia, as new tissue damage releases potassium
BHypernatraemia, as the kidneys begin to retain sodium
CHypokalaemia, as fluid returns to the circulation
DHypercalcaemia, caused by bed rest and immobilisation
19.Maternity & obstetric nursingMedium
A woman at 20 weeks says her gums bleed when she brushes her teeth. What is the best advice?
AStop brushing until the bleeding has settled after birth
BReport it at once because it is a sign of a clotting disorder
CAvoid all dental visits until after the baby is born
DUse a soft brush and keep up routine dental care
20.Maternity & obstetric nursingHard
Why does the ductus arteriosus normally close after birth?
APressure in the pulmonary artery rises
BThe cord is cut, which closes it directly
CRising oxygen levels and falling prostaglandins
DRising prostaglandins and falling oxygen levels
21.Pediatric nursingMedium
Which snack is safest for a 2-year-old?
AA handful of whole peanuts
BWhole grapes from the fruit bowl
CA small bowl of popcorn
DSmall pieces of soft cooked vegetables
22.Pediatric nursingHard
The parents of a 9-year-old who wets the bed most nights have been punishing him. What is the best advice?
AStop all drinks after lunch and keep him in nappies
BStop punishing him, praise dry nights and consider a bedwetting alarm
CWake him every hour through the night and make him change his own sheets
DWait, as no help is available until he is a teenager
23.Mental health nursingMedium
A patient is switching from an MAOI to an SSRI. What is essential?
ADouble the SSRI dose at the start
BA washout period of about 2 weeks before starting the SSRI
CTake both drugs together for a month
DStart the SSRI the same day
24.Mental health nursingHard
A voluntary patient who has no immediate risk of harm wants to leave the ward against medical advice. What is the correct general approach?
AExplain the risks, inform the team, document the discussion and respect their right to leave according to the law and policy
BLock the door to stop the patient leaving
CHide the patient's belongings
DTell the patient that staff will restrain them and bring them back to the ward if they try to leave without the doctor's permission
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A newborn weighs 5 lb 4 oz. Using 1 lb = 16 oz and 1 kg = 2.2 lb, find the weight m in kilograms. Round to two decimal places.
5 lb 4 oz1 lb = 16 oz1 kg = 2.2 lb
m = kg
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 22:20 and finishes at 07:45 the next morning (24-hour clock). How many minutes t did it run?
22:2007:45
t = min
27.Dosage calculationsMedium
A child weighing 20 kg is prescribed 2.5 mg/kg of a drug. The stock solution contains 10 mg/mL. Draw up the dose: what volume V do you give?
20 kg2.5 mg/kg10 mg/mL
V = mL
28.Dosage calculationsHard
You must prepare 200 mL of a 1% (w/v) solution from a 20% (w/v) stock solution. What volume of stock V₁ do you need?
C₁ = 20%C₂ = 1%V₂ = 200 mL
V₁ = mL
29.IV infusion ratesMedium
An infusion is ordered at 50 mL/h, but no pump is available. It runs by gravity through a giving set of 60 gtt/mL. Find the drip rate R in drops per minute.
50 mL/h60 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 200 mg of a drug in 50 mL and runs at 20 mL/h. How many milligrams per hour D does the patient receive?
200 mg/50 mL20 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 total intake I in mL.
water: 200 mLjuice: 100 mLsoup: 250 mLIV infusion: 50 mL/h × 8 hIV antibiotic: 2 × 100 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 21:30, 400 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL400 mL infused80 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 10, with E3 and V3. What motor score M was recorded, and which response does it describe? Give the number.
GCS 10E3V3
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 10/min, SpO₂ 88% on supplemental oxygen, blood pressure 112/68 mmHg, pulse 58/min, alert, temperature 36.9 °C. Which clinical risk group does the patient fall into? Click it.
RR 10SpO₂ 88%O₂SBP 112HR 58AT 36.9 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: C · That they know how and when to take them and what to report
Why this is the answer
Safe discharge needs the patient or carer to understand dose, timing, purpose and important side effects. Teach-back and written information help confirm this.
Answer
C · That they know how and when to take them and what to report
2.Nursing fundamentals
Answer: B · Category 4
Why this is the answer
Category 4 (Stage 4 in the US NPIAP system) involves full-thickness tissue loss with exposed bone, tendon or muscle. It carries a high risk of osteomyelitis and needs specialist input.
Answer
B · Category 4
3.Infection control & patient safety
Answer: B · Oral syringes do not fit IV lines, preventing wrong-route errors
Why this is the answer
Oral and enteral syringes have connectors that do not fit IV ports, so an oral liquid cannot be injected into a vein by mistake. Wrong-route errors with oral liquids have been fatal.
Answer
B · Oral syringes do not fit IV lines, preventing wrong-route errors
4.Infection control & patient safety
Answer: C · Decontaminate them outside, with staff wearing appropriate PPE
Why this is the answer
Contaminated patients are decontaminated outside the department so the chemical is not brought inside to harm staff and other patients. Staff doing this wear PPE suited to the hazard.
Answer
C · Decontaminate them outside, with staff wearing appropriate PPE
5.Prioritization & delegation
Answer: C · “I stay accountable for deciding to delegate and for following up on the result.”
Why this is the answer
The delegating nurse is accountable for the decision to delegate and for supervising and evaluating. The delegate is responsible for performing the task correctly within their competence.
Answer
C · “I stay accountable for deciding to delegate and for following up on the result.”
6.Prioritization & delegation
Answer: A · Restlessness and a rising heart rate while the blood pressure is still normal
Why this is the answer
In early shock, the body keeps the blood pressure up by raising the heart rate and narrowing vessels, so restlessness and tachycardia appear first. A falling blood pressure is a later sign.
Answer
A · Restlessness and a rising heart rate while the blood pressure is still normal
7.Clinical nursing
Answer: B · Breathe out, then breathe in slowly and deeply while pressing the canister, then hold
Why this is the answer
The patient breathes out, seals the lips around the mouthpiece, starts breathing in slowly, presses the canister and continues a deep breath, then holds it for about 10 seconds. Spacers make coordination easier.
Answer
B · Breathe out, then breathe in slowly and deeply while pressing the canister, then hold
8.Clinical nursing
Answer: A · Superior vena cava obstruction
Why this is the answer
Superior vena cava obstruction prevents venous drainage from the head and arms. It is an oncological emergency; patients are positioned upright and need urgent specialist treatment.
Answer
A · Superior vena cava obstruction
9.Lab values & electrolytes
Answer: C · A low serum calcium
Why this is the answer
When failing kidneys retain phosphate, phosphate binds calcium and vitamin D activation falls, so serum calcium tends to drop. This drives secondary hyperparathyroidism and bone disease.Checked against:Hypocalcemia (StatPearls) · StatPearls (NCBI Bookshelf) (2026); Phosphate in Blood · MedlinePlus (NIH) (2023)
Answer
C · A low serum calcium
10.Lab values & electrolytes
Answer: B · G6PD deficiency with acute hemolysis
Why this is the answer
G6PD deficiency makes red cells vulnerable to oxidative damage. Fava beans, some drugs (such as primaquine and some sulfonamides) and infections can trigger acute hemolysis, with dark urine, jaundice and anemia. Triggers are avoided.
Answer
B · G6PD deficiency with acute hemolysis
11.Pharmacology
Answer: B · More drug reaches the lungs and less stays in the mouth
Why this is the answer
A spacer holds the aerosol so it can be inhaled slowly, without precise coordination. This improves lung delivery and reduces mouth side effects such as thrush from inhaled steroids.
Answer
B · More drug reaches the lungs and less stays in the mouth
12.Pharmacology
Answer: B · Raising sodium too fast can cause osmotic demyelination in the brain
Why this is the answer
In chronic hyponatraemia the brain adapts to low osmolality. Correcting sodium too rapidly shrinks brain cells and can cause osmotic demyelination (central pontine myelinolysis), so sodium is checked often.
Answer
B · Raising sodium too fast can cause osmotic demyelination in the brain
13.Med-surg: cardiovascular & respiratory
Answer: D · Some warning signs, such as a fast heartbeat, may be masked
Why this is the answer
Beta-blockers can blunt adrenergic symptoms of hypoglycaemia such as palpitations and tremor. Sweating usually remains. Patients should check their glucose if they feel unwell and know their other warning signs.
Answer
D · Some warning signs, such as a fast heartbeat, may be masked
14.Med-surg: cardiovascular & respiratory
Answer: B · Record a 12-lead ECG, call senior help and anticipate an antiarrhythmic
Why this is the answer
A broad-complex tachycardia is treated as ventricular tachycardia until proven otherwise. With a pulse and no adverse features (shock, syncope, chest pain or heart failure), a 12-lead ECG, electrolyte correction and drug treatment such as amiodarone are used, with expert help. Unstable patients need synchronised cardioversion; pulseless VT is defibrillated.
Answer
B · Record a 12-lead ECG, call senior help and anticipate an antiarrhythmic
15.Med-surg: neuro, endocrine & renal
Answer: D · Primary hyperaldosteronism (Conn's)
Why this is the answer
Excess aldosterone causes sodium and water retention (hypertension) and potassium loss (hypokalaemia). Primary hyperaldosteronism is a common secondary cause of hypertension and is screened for with the aldosterone-to-renin ratio. Addison's disease causes the opposite pattern.
Answer
D · Primary hyperaldosteronism (Conn's)
16.Med-surg: neuro, endocrine & renal
Answer: C · The INR, because it may rise
Why this is the answer
As thyroid function returns to normal, clotting factors are broken down faster, which increases the effect of warfarin. The INR is checked more often and the warfarin dose may need to be reduced.
Answer
C · The INR, because it may rise
17.Med-surg: GI, perioperative & oncology
Answer: C · To prevent Wernicke's encephalopathy
Why this is the answer
Thiamine deficiency is common in alcohol dependence and can cause Wernicke's encephalopathy (confusion, ataxia, eye signs). Thiamine is given early, ideally before or with glucose, as glucose can worsen deficiency.
Answer
C · To prevent Wernicke's encephalopathy
18.Med-surg: GI, perioperative & oncology
Answer: C · Hypokalaemia, as fluid returns to the circulation
Why this is the answer
In the first hours, cell destruction and fluid shifts can raise potassium. After about 48–72 hours, capillary integrity improves, fluid returns to the circulation and diuresis begins, with potassium loss and hypokalaemia. Electrolytes are monitored throughout.
Answer
C · Hypokalaemia, as fluid returns to the circulation
19.Maternity & obstetric nursing
Answer: D · Use a soft brush and keep up routine dental care
Why this is the answer
Gum swelling and bleeding are common because of oestrogen-related vascular changes. Good oral hygiene and routine dental care are safe and recommended in pregnancy.
Answer
D · Use a soft brush and keep up routine dental care
20.Maternity & obstetric nursing
Answer: C · Rising oxygen levels and falling prostaglandins
Why this is the answer
Higher blood oxygen and lower prostaglandin levels after birth cause the ductus arteriosus to constrict. Prostaglandin infusions are used to keep it open in duct-dependent heart defects.
Answer
C · Rising oxygen levels and falling prostaglandins
21.Pediatric nursing
Answer: D · Small pieces of soft cooked vegetables
Why this is the answer
Round, firm foods such as whole grapes, nuts and popcorn can block a young child's airway. Soft foods cut into small pieces are safer, and children should always sit down and be supervised while eating.
Answer
D · Small pieces of soft cooked vegetables
22.Pediatric nursing
Answer: B · Stop punishing him, praise dry nights and consider a bedwetting alarm
Why this is the answer
Nocturnal enuresis is common and not deliberate; punishment worsens it. Support, reward systems for agreed behaviours, enuresis alarms and sometimes desmopressin are effective, along with normal daytime drinking and regular toileting.
Answer
B · Stop punishing him, praise dry nights and consider a bedwetting alarm
23.Mental health nursing
Answer: B · A washout period of about 2 weeks before starting the SSRI
Why this is the answer
Combining an MAOI with an SSRI can cause serotonin syndrome. A washout of about 2 weeks is usual after stopping an MAOI, and a longer gap (about 5 weeks) is needed when switching from fluoxetine to an MAOI because of its long half-life.
Answer
B · A washout period of about 2 weeks before starting the SSRI
24.Mental health nursing
Answer: A · Explain the risks, inform the team, document the discussion and respect their right to leave according to the law and policy
Why this is the answer
Voluntary patients can usually leave, although they may be asked to wait while their risk is assessed. Detaining someone needs legal authority. The nurse informs the team, assesses risk and documents.
Answer
A · Explain the risks, inform the team, document the discussion and respect their right to leave according to the law and policy
25.Nursing math & unit conversions
Answer: m = 2.39 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
4 oz/16 = 0.25 lb
5 + 0.25 = 5.25 lb
Pounds to kilograms
m = 5.25/2.2 = 2.386 ≈ 2.39 kg
Answer
m = 2.39 kg
26.Nursing math & unit conversions
Answer: t = 565 min
24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.
Before midnight
22:20 → 24:00 = 100 min
After midnight
00:00 → 07:45 = 465 min
Total
t = 100 + 465 = 565 min
Answer
t = 565 min
27.Dosage calculations
Answer: V = 5 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 = 2.5·20 = 50 mg
Volume
V = 50/10 = 5 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 5 mL
28.Dosage calculations
Answer: V₁ = 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.
Volume of stock
V₁ = 1·200/20 = 10 mL
Answer
V₁ = 10 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
50/60 = 0.8333 mL/min
Drip rate
R = 0.8333·60 = 50 gtt/min
Answer
R = 50 gtt/min
With a microdrip set (60 gtt/mL), gtt/min equals mL/h.
30.IV infusion rates
Answer: D = 80 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
200/50 = 4 mg/mL
Dose rate
D = 4·20 = 80 mg/h
Answer
D = 80 mg/h
31.IV fluids & fluid balance
Answer: I = 1150 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 + 100 + 250 = 550 mL
IV infusion: 50·8 = 400 mL
IV antibiotic: 2·100 = 200 mL
I = 1150 mL
Answer
I = 1150 mL
32.IV fluids & fluid balance
Answer: t = 7.5 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 − 400 = 600 mL
Time
t = 600/80 = 7.5 h
Answer
t = 7.5 h
That is about 7 h 30 min, so the bag runs out at about 05:00.
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 = 10 − 3 − 3 = 4
M4: withdraws the limb from pressure (normal flexion)
Answer
M = 4
34.Clinical assessment scores
Answer: 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 10/min → 1
SpO₂ 88% → 3
on oxygen → 2
SBP 112 mmHg → 0
HR 58/min → 0
alert (A) → 0
T 36.9 °C → 0
Total and red scores
NEWS2 = 1 + 3 + 2 + 0 + 0 + 0 + 0 = 6
At least one parameter scores 3.
Risk group
medium
Answer
medium
A total of 5 or more calls for an urgent clinical response.
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