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
Which patient is at greatest risk of injury from a heat pack?
AA patient with reduced sensation from diabetic neuropathy
BA patient with period pain
CA patient with a sore lower back after gardening
DA young adult with a stiff neck after sleeping in an awkward position
2.Nursing fundamentalsHard
The intact skin over a patient's heel is deep purple and feels boggy. What should be suspected?
AA category 1 pressure ulcer that will heal by itself
BA normal bruise from a minor knock
CA fungal skin infection
DA suspected deep tissue injury
3.Infection control & patient safetyMedium
When should an N95 respirator be removed after caring for a patient on airborne precautions?
ANever; it is worn for the rest of the shift
BAfter leaving the room and closing the door
CBefore taking off the gloves, inside the room
DStraight after entering the room
4.Infection control & patient safetyHard
During an oral drug round, a patient asks to take a tablet later. The nurse leaves it on the bedside table. What is the main safety problem?
AThere is no safety problem if the patient is alert
BThe nurse cannot confirm it was taken, and another person could take it
CThe tablet may lose its color and become hard to identify later
DTablets dissolve quickly when left in the open air
5.Prioritization & delegationMedium
A patient with heart failure gained 2 kg (about 4 lb) since yesterday and is more breathless when lying down. What should the nurse do first?
ARecord the weight on the chart and recheck it at the next weekly weigh-in
BEncourage extra fluids to correct the weight change
CLay the patient flat to help them breathe more easily
DAssess the lungs, oxygen saturation and swelling, then inform the provider
6.Prioritization & delegationHard
Two hours after a femoral cardiac catheterization, the nurse sees blood spreading from the puncture site. What is the first action?
AAsk the patient to bend the leg at the hip to stop the bleeding
BRemove the dressing and leave the site open to the air
CRaise the head of the bed so the patient can sit up
DApply firm, direct pressure just above the puncture site
7.Clinical nursingMedium
A patient with anaphylaxis is hypotensive but has no breathing difficulty. How should they be positioned?
ALying face down
BLying flat, with the legs raised
CStanding up and walking around
DSitting upright with the legs dangling
8.Clinical nursingHard
How should pain be assessed in a patient with advanced dementia who cannot describe it?
AWith an observational pain tool that scores facial expression, behaviour and body language
BBy assuming the patient has no pain unless they are crying out or calling for help
CBy asking the patient to rate their pain on a numerical scale from 0 to 10
DBy checking the blood pressure only
9.Lab values & electrolytesMedium
A patient has taken a proton pump inhibitor (such as omeprazole) for many years and now has muscle cramps and tremor. Which electrolyte is most likely to be low?
APhosphate
BSodium
CMagnesium
DChloride
10.Lab values & electrolytesHard
Which patient’s result should the nurse report first?
AGlucose 42 mg/dL (2.3 mmol/L) in a patient who is sweating and confused
BCreatinine 1.6 mg/dL (141 µmol/L) in a patient with known stable CKD
CTotal cholesterol slightly above target
DHbA1c 7.4% (57 mmol/mol) in a patient with type 2 diabetes
11.PharmacologyMedium
Which approach is usually recommended to prevent constipation in a patient on regular opioids?
AA stimulant laxative such as senna, often with a stool softener
BBulk-forming fibre alone, with fluid intake restricted
CAn antidiarrhoeal drug at night to slow the gut
DNo laxative until the patient has not opened the bowels for a week
12.PharmacologyHard
A patient has received a sodium nitroprusside infusion for several days. He becomes confused and develops a metabolic acidosis. What should be suspected?
AAn allergic reaction to the plastic of the infusion bag
BCyanide toxicity from nitroprusside breakdown
CHyperkalaemia from the infusion
DHypoglycaemia from nitroprusside
13.Med-surg: cardiovascular & respiratoryMedium
A patient taking isosorbide mononitrate asks about sildenafil for erectile dysfunction. What is the main danger?
ABleeding from the gums
BSevere hypertension
CSevere hypotension
DA very high potassium level
14.Med-surg: cardiovascular & respiratoryHard
A patient taking apixaban for atrial fibrillation is booked for elective surgery. Which statement reflects correct practice?
AStop it two weeks before surgery and replace it with warfarin
BIt is stopped and then reversed with oral vitamin K
CIt is always continued up to the morning of the operation
DPause it for a set time, based on bleeding risk and kidney function
15.Med-surg: neuro, endocrine & renalMedium
Why can a patient with an insulin pump develop DKA within hours if the pump stops working?
AThe battery in the pump releases chemicals into the blood
BThe pump gives long-acting insulin, which builds up and stops working all at once
CThe pump gives only rapid-acting insulin, so there is no long-acting reserve
DThe body becomes allergic to insulin when the pump stops
16.Med-surg: neuro, endocrine & renalHard
A haemodialysis patient with a tunnelled central venous catheter develops fever and rigors soon after dialysis starts. What should the nurse suspect and do?
ANormal reaction to dialysis; continue and give paracetamol only
BCatheter-related bloodstream infection; stop, take cultures and escalate
CAir embolism; tilt the patient head-up and continue
DDialysis disequilibrium; speed up dialysis to finish sooner
17.Med-surg: GI, perioperative & oncologyMedium
In the SBAR communication tool, what belongs under "A"?
AThe address and phone number of the patient's next of kin
BThe nurse's assessment of what the problem is
CThe patient's admission date only
DA list of the patient's allergies only
18.Med-surg: GI, perioperative & oncologyHard
A sacral wound has heavy exudate, and the surrounding skin is white, soft and wrinkled. What should the nurse do?
AApply a tight plastic film directly over the wound
BProtect the skin edges and use a more absorbent dressing
CUse a dressing that adds even more moisture
DLeave the same dressing in place for a week so the wound is not disturbed
19.Maternity & obstetric nursingMedium
Why do newborns become cold so easily?
AThey cannot produce heat at all
BTheir blood is thicker than adult blood
CThey have a large surface area and little fat
DThey sweat more than adults
20.Maternity & obstetric nursingHard
A woman with a previous caesarean is having a trial of labour. Which induction agent should the nurse question?
AOxytocin used per protocol
BAmniotomy
CA balloon catheter
DMisoprostol
21.Pediatric nursingMedium
How is a child usually positioned for a lumbar puncture?
AStanding and leaning against the wall
BFlat on the back with the legs straight and a small pillow under the head
COn the side, curled up with knees drawn up and head bent forward
DProne with a pillow under the chest
22.Pediatric nursingHard
The mother of a 6-week-old says the baby cries for hours and she fears she might lose control. What is the best advice?
AHold the baby face down on her lap until he falls asleep, however long it takes
BPut the baby safely in the cot, take a few minutes' break and ask for support
CShake the baby gently for a few seconds to stop the crying and calm him
DGive the baby a little honey on a dummy to settle him at night
23.Mental health nursingMedium
When should blood be taken to measure a patient's lithium level?
AAt any time of day, since it makes no difference
B1 hour after the last dose
CImmediately after the morning dose
DAbout 12 hours after the last dose
24.Mental health nursingHard
The nurse receives handover for four patients. Which patient should she see first?
AA woman with bipolar disorder who wants to talk about her discharge plans for next week
BA woman with anorexia nervosa who is due to be weighed and have her blood taken in two hours
CA man with schizophrenia who is asking for his PRN laxative
DA newly admitted man with depression who says he has given away his dog and written letters to his children
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose calculation for a small injection gives 0.73866 mL. The rule in this exercise is that volumes below 1 mL are rounded to the nearest hundredth of a mL. What value x do you record?
0.73866 mL
x = mL
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 22:35 and finishes at 08:25 the next morning (24-hour clock). How many hours t did it run? Give the answer in hours as a decimal, rounded to two decimal places.
22:3508:25
t = h
27.Dosage calculationsMedium
A child weighing 6 kg is prescribed 5 mg/kg of a drug. The stock solution contains 10 mg/mL. Draw up the dose: what volume V do you give?
6 kg5 mg/kg10 mg/mL
V = mL
28.Dosage calculationsHard
A patient is 188 cm tall and weighs 57 kg. The prescription is 135 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.
188 cm57 kg135 mg/m²
D = mg
29.IV infusion ratesMedium
Infuse 1500 mL over 12 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
1500 mL12 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
An infusion of 25 mg in 250 mL runs at 18 mL/h. How many micrograms per minute D does the patient receive?
25 mg/250 mL18 mL/h
D = mcg/min
31.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL. Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 06:30 at 125 mL/h. After 2 hours the rate is changed to 150 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
500 mL125 mL/h · 2 h150 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 22/min, SpO₂ 95% on room air, blood pressure 130/78 mmHg, pulse 82/min, unresponsive, temperature 37.0 °C. Which clinical risk group does the patient fall into? Click it.
RR 22SpO₂ 95%airSBP 130HR 82UT 37.0 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: A · A patient with reduced sensation from diabetic neuropathy
Why this is the answer
Patients who cannot feel heat properly, such as those with neuropathy, spinal injury or reduced consciousness, can be burned without noticing. Their skin needs extra checks or heat should be avoided.
Answer
A · A patient with reduced sensation from diabetic neuropathy
2.Nursing fundamentals
Answer: D · A suspected deep tissue injury
Why this is the answer
A purple or maroon area of intact skin, often firm or boggy, suggests deep tissue injury from pressure and shear. It can quickly become a deep open ulcer, so pressure must be removed at once.
Answer
D · A suspected deep tissue injury
3.Infection control & patient safety
Answer: B · After leaving the room and closing the door
Why this is the answer
Because infectious particles remain in the air of the room, the respirator is taken off outside the room after the door is closed, followed by hand hygiene. Gloves, eyewear and gown are removed first.
Answer
B · After leaving the room and closing the door
4.Infection control & patient safety
Answer: B · The nurse cannot confirm it was taken, and another person could take it
Why this is the answer
Medicines are not left at the bedside unless there is an agreed self-administration plan. The nurse must see the medication taken to document it correctly, and unattended tablets can be taken by another patient or lost.
Answer
B · The nurse cannot confirm it was taken, and another person could take it
5.Prioritization & delegation
Answer: D · Assess the lungs, oxygen saturation and swelling, then inform the provider
Why this is the answer
A rapid weight gain with orthopnea suggests fluid overload and worsening heart failure. The nurse assesses breathing and fluid status and informs the provider, who may adjust the diuretic.
Answer
D · Assess the lungs, oxygen saturation and swelling, then inform the provider
6.Prioritization & delegation
Answer: D · Apply firm, direct pressure just above the puncture site
Why this is the answer
Direct manual pressure just above the puncture site compresses the femoral artery and stops bleeding. The patient keeps the leg straight, and the nurse checks vital signs and distal pulses and informs the provider.
Answer
D · Apply firm, direct pressure just above the puncture site
7.Clinical nursing
Answer: B · Lying flat, with the legs raised
Why this is the answer
Lying flat with the legs raised supports circulation in anaphylactic shock. Patients with breathing difficulty may prefer to sit up, but should not stand or walk, as this can cause collapse.
Answer
B · Lying flat, with the legs raised
8.Clinical nursing
Answer: A · With an observational pain tool that scores facial expression, behaviour and body language
Why this is the answer
Observational tools such as PAINAD or the Abbey Pain Scale help assess pain in people who cannot self-report. Family and carers can describe changes in usual behaviour.
Answer
A · With an observational pain tool that scores facial expression, behaviour and body language
Answer: A · Glucose 42 mg/dL (2.3 mmol/L) in a patient who is sweating and confused
Why this is the answer
Symptomatic hypoglycemia can quickly lead to seizures and brain injury, so it is treated straight away according to protocol. The other results are chronic or stable and can be discussed later.Checked against:Low blood sugar · MedlinePlus (NIH) (2026)
Answer
A · Glucose 42 mg/dL (2.3 mmol/L) in a patient who is sweating and confused
11.Pharmacology
Answer: A · A stimulant laxative such as senna, often with a stool softener
Why this is the answer
Opioid-induced constipation does not usually resolve with time, so a laxative is started with the opioid. Stimulant laxatives counter reduced motility; bulk-forming laxatives alone can worsen symptoms if fluid intake is low.
Answer
A · A stimulant laxative such as senna, often with a stool softener
12.Pharmacology
Answer: B · Cyanide toxicity from nitroprusside breakdown
Why this is the answer
Nitroprusside releases cyanide, which is normally converted to thiocyanate. With high doses, long infusions or poor organ function, cyanide and thiocyanate can accumulate; the infusion is also protected from light.
Answer
B · Cyanide toxicity from nitroprusside breakdown
13.Med-surg: cardiovascular & respiratory
Answer: C · Severe hypotension
Why this is the answer
Phosphodiesterase-5 inhibitors such as sildenafil enhance the vasodilator effect of nitrates and can cause profound, life-threatening hypotension. The combination is contraindicated, and patients should tell emergency staff if they have taken one.
Answer
C · Severe hypotension
14.Med-surg: cardiovascular & respiratory
Answer: D · Pause it for a set time, based on bleeding risk and kidney function
Why this is the answer
Because DOACs wear off within days, they are usually paused for a defined period before surgery (often 1–3 days) depending on the procedure's bleeding risk and renal function; bridging with heparin is generally not needed. Vitamin K does not reverse DOACs.
Answer
D · Pause it for a set time, based on bleeding risk and kidney function
15.Med-surg: neuro, endocrine & renal
Answer: C · The pump gives only rapid-acting insulin, so there is no long-acting reserve
Why this is the answer
Insulin pumps deliver a continuous flow of rapid-acting insulin. If delivery stops, there is no depot of long-acting insulin, so ketones can rise within a few hours. Patients carry pens or syringes as a backup.
Answer
C · The pump gives only rapid-acting insulin, so there is no long-acting reserve
16.Med-surg: neuro, endocrine & renal
Answer: B · Catheter-related bloodstream infection; stop, take cultures and escalate
Why this is the answer
Fever and rigors when dialysis starts through a central catheter strongly suggest a catheter-related bloodstream infection. Dialysis is stopped or adjusted per protocol, blood cultures are taken (from the catheter and peripherally), the team is informed and IV antibiotics are started as prescribed. The exit site is inspected.
Answer
B · Catheter-related bloodstream infection; stop, take cultures and escalate
17.Med-surg: GI, perioperative & oncology
Answer: B · The nurse's assessment of what the problem is
Why this is the answer
SBAR is Situation, Background, Assessment and Recommendation. Under Assessment, the nurse gives the findings and their interpretation, for example "I think the patient may be bleeding".
Answer
B · The nurse's assessment of what the problem is
18.Med-surg: GI, perioperative & oncology
Answer: B · Protect the skin edges and use a more absorbent dressing
Why this is the answer
Maceration shows that exudate is not being managed. A barrier film or cream protects the surrounding skin, and a more absorbent dressing or more frequent changes are used. The cause of high exudate is reviewed.
Answer
B · Protect the skin edges and use a more absorbent dressing
19.Maternity & obstetric nursing
Answer: C · They have a large surface area and little fat
Why this is the answer
Newborns have a large surface area relative to body mass, little subcutaneous fat and thin skin with blood vessels near the surface. They rely on brown fat and cannot shiver effectively.
Answer
C · They have a large surface area and little fat
20.Maternity & obstetric nursing
Answer: D · Misoprostol
Why this is the answer
Misoprostol is avoided in women with a uterine scar because of a high risk of uterine rupture. Mechanical methods, amniotomy and carefully monitored oxytocin may be used.
Answer
D · Misoprostol
21.Pediatric nursing
Answer: C · On the side, curled up with knees drawn up and head bent forward
Why this is the answer
Curling the child on the side (or sitting and bending forward) flexes the spine and widens the spaces between lumbar vertebrae for the needle. A nurse holds the child gently and monitors breathing, as tight flexion can compromise the airway in infants.
Answer
C · On the side, curled up with knees drawn up and head bent forward
22.Pediatric nursing
Answer: B · Put the baby safely in the cot, take a few minutes' break and ask for support
Why this is the answer
Crying peaks at about 6–8 weeks and can be very stressful. Parents are taught that it is safe to put the baby down and take a break, never to shake a baby, and how to get help from partners, family or health services.
Answer
B · Put the baby safely in the cot, take a few minutes' break and ask for support
23.Mental health nursing
Answer: D · About 12 hours after the last dose
Why this is the answer
Lithium levels are drawn about 12 hours after the last dose, usually in the morning before the next dose, so results can be compared with the target range.
Answer
D · About 12 hours after the last dose
24.Mental health nursing
Answer: D · A newly admitted man with depression who says he has given away his dog and written letters to his children
Why this is the answer
Giving away pets or possessions and writing goodbye letters are warning signs of a suicide plan. This patient needs immediate assessment; the others have needs that can safely wait a little.
Answer
D · A newly admitted man with depression who says he has given away his dog and written letters to his children
25.Nursing math & unit conversions
Answer: x = 0.74 mL
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 hundredths place
0.73866 → 3
Only the next digit decides
0.73866 → 8
8 is 5 or more, so round 3 up.
The digits after it (66) are ignored: round once, never step by step.
Round
x = 0.74 mL
Answer
x = 0.74 mL
26.Nursing math & unit conversions
Answer: t = 9.83 h
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
22:35 → 24:00 = 85 min
After midnight
00:00 → 08:25 = 505 min
Total
85 + 505 = 590 min
t = 590/60 = 9.833 ≈ 9.83 h
Answer
t = 9.83 h
27.Dosage calculations
Answer: V = 3 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 = 5·6 = 30 mg
Volume
V = 30/10 = 3 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 3 mL
28.Dosage calculations
Answer: D = 232.9 mg
Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).
Body surface area
BSA = √(188·57/3600) = √2.977 = 1.725 m²
Dose
D = 135·1.725 = 232.9 mg
Answer
D = 232.9 mg
29.IV infusion rates
Answer: R = 42 gtt/min
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Time in minutes
12·60 = 720 min
Drip rate
R = 1500·20/720 = 41.67 ≈ 42 gtt/min
Answer
R = 42 gtt/min
At the bedside you round to the nearest whole drop: 42 gtt/min.
30.IV infusion rates
Answer: D = 30 mcg/min
Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).
Concentration
25000 mcg/250 mL = 100 mcg/mL
Dose per hour
18·100 = 1800 mcg/h
Dose per minute
D = 1800/60 = 30 mcg/min
Answer
D = 30 mcg/min
31.IV fluids & fluid balance
Answer: I = 2260 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: 150 + 240 + 150 = 540 mL
ice chips: 240/2 = 120 mL
IV infusion: 125·12 = 1500 mL
IV antibiotic: 2·50 = 100 mL
I = 2260 mL
Answer
I = 2260 mL
32.IV fluids & fluid balance
Answer: t = 3.7 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
125·2 = 250 mL
500 − 250 = 250 mL left
Second part
250/150 = 1.667 h
Total time
t = 2 + 1.667 = 3.667 ≈ 3.7 h
Answer
t = 3.7 h
That is about 3 h 40 min, so the bag runs out at about 10:10.
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: 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 22/min → 2
SpO₂ 95% → 1
on air → 0
SBP 130 mmHg → 0
HR 82/min → 0
unresponsive (U) → 3
T 37.0 °C → 0
Total and red scores
NEWS2 = 2 + 1 + 0 + 0 + 0 + 3 + 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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