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
How can a patient reduce pain when coughing after abdominal surgery?
AAvoid coughing completely until the stitches have been removed
BHold a pillow firmly against the wound while coughing
CCough while bending forward with no support
DLie flat on their back with arms by their sides
2.Nursing fundamentalsHard
A healthcare assistant (nursing assistant) has recorded a blood pressure of 82/50 mmHg during routine observations but did not report it. What should the registered nurse do first?
ARepeat the observations at the next routine time
BComplete an incident report
CTalk to the healthcare assistant about reporting
DAssess the patient straight away
3.Infection control & patient safetyMedium
During a norovirus outbreak on a ward, which hand hygiene method should staff use after patient care?
AWashing with soap and water
BNo hand hygiene if gloves were worn
CAlcohol hand rub only
DWiping hands on a paper towel only
4.Infection control & patient safetyHard
A nurse discovers that an insulin infusion was programmed using the wrong drug concentration in the pump library. What should the nurse do first?
AReprogram the pump and finish the shift before reporting
BStop the infusion and check the patient’s blood glucose
CLeave it running and check the glucose at the next routine time
DDouble the rate to correct for the error
5.Prioritization & delegationMedium
A nursing assistant refuses a delegated task, saying they have not been trained to do it. What is the best response from the nurse?
AThank the assistant, make sure the task is done safely and arrange training
BLeave the task for the next shift, when someone trained is on
CTell the assistant it is in the job description and must be done
DReport the assistant to the manager for refusing a task
6.Prioritization & delegationHard
During START triage, a non-walking adult breathes 24 times a minute, has a radial pulse, but cannot follow simple commands. Which category is the victim given?
ABlack (expectant)
BYellow (delayed)
CRed (immediate)
DGreen (minor)
7.Clinical nursingMedium
Which instruction is correct for taking weekly alendronic acid (alendronate)?
AChew the tablet with breakfast and a cup of milky tea
BTake it with plain water on an empty stomach and stay upright for 30 minutes
CTake it with a glass of milk at bedtime and then lie down straight away
DTake it with an antacid to protect the stomach
8.Clinical nursingHard
A patient with an epidural catheter develops new back pain and increasing leg weakness when the block should be wearing off. What should be suspected?
AAn epidural haematoma or abscess compressing the spinal cord
BMild hypokalaemia
CThe normal expected effect of the local anaesthetic
DMuscle strain from lying in the same position in bed for many hours
9.Lab values & electrolytesMedium
In chronic kidney disease, a high serum phosphate is usually accompanied by which change in calcium?
AA high serum potassium only, with no calcium change
BA high serum calcium
CNo change in calcium
DA low serum calcium
10.Lab values & electrolytesHard
A patient using an insulin pump has a glucose of 300 mg/dL (16.7 mmol/L) that has not fallen 2 hours after a correction bolus through the pump. Blood ketones are 1.8 mmol/L. What is the most likely problem and action?
ANormal pump function; wait for the next mealtime bolus to lower the glucose
BInsulin overdose from the pump; suspend the pump and stop all insulin for a day
CRebound after a hypo; give fast-acting carbohydrate and recheck in 15 minutes
DInsulin delivery failure; inject a correction dose by pen and change the set
11.PharmacologyMedium
A patient is starting olanzapine. Which monitoring is most important over the following months?
AHearing tests and vision tests every month
BWeight, blood glucose and blood lipids
CINR and platelet count
DPeak expiratory flow
12.PharmacologyHard
An 80-year-old man with an enlarged prostate starts oxybutynin for an overactive bladder. He becomes confused and cannot pass urine. What is the most likely explanation?
AOpioid toxicity
BAnticholinergic adverse effects
CSerotonin syndrome
DAn allergic reaction to the drug
13.Med-surg: cardiovascular & respiratoryMedium
How is a patient usually positioned for a thoracentesis?
AProne with the arms by the sides
BSitting upright and leaning forward over a table
CLying on the affected side with the head down
DFlat on the back with the legs raised
14.Med-surg: cardiovascular & respiratoryHard
A patient with heart failure is breathless at rest, with cool peripheries, a systolic BP of 80 mmHg and falling urine output. What does this suggest?
AMild dehydration that oral fluids will correct
BAnxiety causing a vasovagal response
CCardiogenic shock with poor tissue perfusion
DStable, well-compensated chronic heart failure
15.Med-surg: neuro, endocrine & renalMedium
Why is an ACE inhibitor often given to a patient with diabetes and albumin in the urine?
AIt raises potassium to protect the heart
BIt stops the kidneys from passing so much urine at night
CIt protects the kidneys and reduces albumin loss
DIt lowers the blood glucose to normal
16.Med-surg: neuro, endocrine & renalHard
A patient with diabetes insipidus after head trauma needs hourly urine output measurement. Which task can be delegated to a trained healthcare assistant (nursing assistant)?
ADeciding whether to give the next desmopressin dose
BInterpreting the serum sodium results
CMeasuring hourly urine and reporting results above a set amount
DAssessing the patient's level of consciousness
17.Med-surg: GI, perioperative & oncologyMedium
A patient with an ileal conduit (urostomy) is worried about mucus in the urine. What is the correct explanation?
AIt shows a bowel obstruction is developing
BIt means the stoma is failing and needs surgery
CIt is normal, as the conduit is made from small bowel
DIt is a sign of a kidney stone and must be reported today
18.Med-surg: GI, perioperative & oncologyHard
A patient's platelet count is 18 × 109/L (18,000/µL). Which order should the nurse question?
AA soft diet with mouthwashes
BDaily full blood count
CAn intramuscular injection
DOral paracetamol for headache
19.Maternity & obstetric nursingMedium
Parents ask where their newborn should sleep at night. Which advice reduces the risk of sudden infant death?
AIn the parents' bed, between the two adults
BIn a separate cot or crib in the parents' room
CIn a separate bedroom from the first night
DOn a sofa with a parent when the baby is unsettled
20.Maternity & obstetric nursingHard
Routine screening at the booking visit shows asymptomatic bacteriuria. Why is treatment important even though the woman has no symptoms?
ATreatment is not needed because it will settle after birth
BIt can progress to pyelonephritis and trigger preterm labour
CIt is treated only to prevent bladder stones
DIt will cause gestational diabetes later in the pregnancy if left untreated
21.Pediatric nursingMedium
Which nursing measure is most helpful for an infant with bronchiolitis?
ARoutine antibiotics
BGentle nasal suctioning before feeds and monitoring of hydration and oxygen saturation
CLying the infant flat on the stomach to sleep so that secretions can drain from the airway
DHolding all feeds until the infant improves
22.Pediatric nursingHard
A 7-year-old with an asthma attack was wheezing loudly but is now quiet, drowsy and has very reduced air entry. What does this indicate?
AA life-threatening deterioration with exhaustion and very poor air movement
BA good response to the reliever inhaler, with the airways now opening up again
CThe child is falling asleep normally
DThe attack is resolving
23.Mental health nursingMedium
In families of people with schizophrenia, which pattern of "high expressed emotion" is linked to a higher rate of relapse?
ARegular contact with the care team and other families
BFrequent criticism, hostility and emotional over-involvement
CEncouraging the patient to take part in activities
DCalm, supportive and warm communication
24.Mental health nursingHard
A man whose wife died a month ago is rude and angry with the nurses about small things. What is the best understanding of his behaviour?
AHis anger may be part of grief, displaced onto staff, so she should not take it personally
BHe should be told that his behaviour is unacceptable and that visits will be stopped
CHe does not care about his wife's death and is using it as an excuse to be rude
DHe has antisocial personality disorder that was not noticed before
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 95 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.
95 °F
T = °C
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). During a shift a patient takes ¾ cup of tea, 1½ tsp of cough syrup, 3 tbsp of liquid supplement. Using the equivalents given, find the total oral intake V in mL.
1 cup = 8 fl oz = 240 mL1 tsp = 5 mL1 tbsp = 15 mL
V = mL
27.Dosage calculationsMedium
A child weighing 11 kg is prescribed 20 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?
11 kg20 mg/kg50 mg/mL
V = mL
28.Dosage calculationsHard
An infusion contains 40000 units of a drug in 250 mL. The prescription is 1500 units per hour. At what rate R do you set the pump, in mL/h?
40000 units/250 mL1500 units/h
R = mL/h
29.IV infusion ratesMedium
500 mL was ordered over 10 hours. After 2 hours you find that 470 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?
500 mL / 10 hafter 2 h: 470 mL
R = mL/h
30.IV infusion ratesHard
A bag contains 200 mg of a drug in 500 mL and runs at 8 mL/h. How many milligrams per hour D does the patient receive?
200 mg/500 mL8 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 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 500 mL bag runs by pump at 100 mL/h. At 14:30, 300 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL300 mL infused100 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 24/min, SpO₂ 98% on room air, blood pressure 88/52 mmHg, pulse 126/min, alert, temperature 36.7 °C. What is the NEWS2 total score?
RR 24SpO₂ 98%airSBP 88HR 126AT 36.7 °C
NEWS2 =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 97 kg and is 190 cm tall. Calculate the BMI and click the WHO weight category.
97 kg190 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
3Solutions
1.Nursing fundamentals
Answer: B · Hold a pillow firmly against the wound while coughing
Why this is the answer
Splinting the incision with a pillow or folded towel supports the wound and reduces pain, so the patient can cough effectively and clear secretions.
Answer
B · Hold a pillow firmly against the wound while coughing
2.Nursing fundamentals
Answer: D · Assess the patient straight away
Why this is the answer
A low blood pressure may mean deterioration, so the nurse assesses the patient at once and escalates if needed. Feedback to the assistant and reporting follow afterwards.
Answer
D · Assess the patient straight away
3.Infection control & patient safety
Answer: A · Washing with soap and water
Why this is the answer
Norovirus is not reliably killed by alcohol hand rub, so hands are washed with soap and water, which removes it mechanically. Contact precautions and thorough environmental cleaning are also used.
Answer
A · Washing with soap and water
4.Infection control & patient safety
Answer: B · Stop the infusion and check the patient’s blood glucose
Why this is the answer
A concentration error means the dose delivered was wrong. The nurse stops the infusion, assesses the patient including blood glucose, treats as needed, notifies the prescriber and reports the event.
Answer
B · Stop the infusion and check the patient’s blood glucose
5.Prioritization & delegation
Answer: A · Thank the assistant, make sure the task is done safely and arrange training
Why this is the answer
A delegate should refuse a task they are not competent to do. The nurse makes sure the task is done safely now and arranges training for the future. Forcing the task or leaving it undone puts the patient at risk.
Answer
A · Thank the assistant, make sure the task is done safely and arrange training
6.Prioritization & delegation
Answer: C · Red (immediate)
Why this is the answer
A victim who fails the mental status check (cannot follow simple commands) is immediate, even when breathing and perfusion are acceptable. This may signal a head injury or shock.
Answer
C · Red (immediate)
7.Clinical nursing
Answer: B · Take it with plain water on an empty stomach and stay upright for 30 minutes
Why this is the answer
Alendronic acid must be taken with plain water before food, and the patient must stay upright to reduce oesophageal irritation. Food, milk and antacids reduce absorption.
Answer
B · Take it with plain water on an empty stomach and stay upright for 30 minutes
8.Clinical nursing
Answer: A · An epidural haematoma or abscess compressing the spinal cord
Why this is the answer
Increasing motor block, back pain or new weakness after an epidural can mean a haematoma or abscess compressing the cord. This is a surgical emergency: stop the infusion and get urgent medical review.
Answer
A · An epidural haematoma or abscess compressing the spinal cord
9.Lab values & electrolytes
Answer: D · 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
D · A low serum calcium
10.Lab values & electrolytes
Answer: D · Insulin delivery failure; inject a correction dose by pen and change the set
Why this is the answer
A high glucose that does not respond to a pump bolus, with rising ketones, suggests a kinked, blocked or dislodged cannula. Because pumps use only rapid-acting insulin, DKA can develop within hours. The usual advice is to give a correction dose by pen or syringe, change the infusion set, check glucose and ketones often, and seek help if ketones keep rising or vomiting starts.
Answer
D · Insulin delivery failure; inject a correction dose by pen and change the set
11.Pharmacology
Answer: B · Weight, blood glucose and blood lipids
Why this is the answer
Olanzapine and several other atypical antipsychotics cause weight gain, insulin resistance and dyslipidaemia. Weight, waist size, glucose and lipids are checked regularly.
Answer
B · Weight, blood glucose and blood lipids
12.Pharmacology
Answer: B · Anticholinergic adverse effects
Why this is the answer
Antimuscarinic drugs reduce bladder contraction, which can cause urinary retention in men with prostate enlargement. In older people they can also cause confusion, so their total anticholinergic burden should be kept low.
Answer
B · Anticholinergic adverse effects
13.Med-surg: cardiovascular & respiratory
Answer: B · Sitting upright and leaning forward over a table
Why this is the answer
Sitting upright and leaning forward on a bedside table widens the intercostal spaces at the back and lets the fluid settle at the base. If the patient cannot sit, lying on the unaffected side may be used.
Answer
B · Sitting upright and leaning forward over a table
14.Med-surg: cardiovascular & respiratory
Answer: C · Cardiogenic shock with poor tissue perfusion
Why this is the answer
Cardiogenic shock is pump failure with hypotension and hypoperfusion (cool skin, oliguria, confusion, raised lactate), often with pulmonary congestion. It needs urgent critical care review. Large fluid boluses can worsen congestion unless guided by careful assessment.
Answer
C · Cardiogenic shock with poor tissue perfusion
15.Med-surg: neuro, endocrine & renal
Answer: C · It protects the kidneys and reduces albumin loss
Why this is the answer
ACE inhibitors and ARBs reduce glomerular pressure, lower albuminuria and slow the progression of diabetic kidney disease, as well as treating blood pressure. Potassium and creatinine are checked after starting them.
Answer
C · It protects the kidneys and reduces albumin loss
16.Med-surg: neuro, endocrine & renal
Answer: C · Measuring hourly urine and reporting results above a set amount
Why this is the answer
Measuring and recording urine output with clear instructions on when to report is suitable for a trained assistant. Medication decisions, neurological assessment and interpreting results stay with the registered nurse.
Answer
C · Measuring hourly urine and reporting results above a set amount
17.Med-surg: GI, perioperative & oncology
Answer: C · It is normal, as the conduit is made from small bowel
Why this is the answer
An ileal conduit uses a segment of ileum, which continues to produce mucus. Patients are encouraged to drink well to keep the urine flowing. Cloudy, offensive urine with fever, however, suggests infection.
Answer
C · It is normal, as the conduit is made from small bowel
18.Med-surg: GI, perioperative & oncology
Answer: C · An intramuscular injection
Why this is the answer
IM injections can cause haematomas in severe thrombocytopenia. Rectal procedures, NSAIDs and aspirin are also avoided. The nurse checks with the prescriber and the oral or IV route is used where possible.
Answer
C · An intramuscular injection
19.Maternity & obstetric nursing
Answer: B · In a separate cot or crib in the parents' room
Why this is the answer
Both US (AAP) and UK (NHS) guidance advise room-sharing without bed-sharing: the baby sleeps on the back in a cot or crib in the parents' room for at least the first 6 months. Sleeping with a baby on a sofa or armchair is especially dangerous.
Answer
B · In a separate cot or crib in the parents' room
20.Maternity & obstetric nursing
Answer: B · It can progress to pyelonephritis and trigger preterm labour
Why this is the answer
Urinary stasis in pregnancy lets bacteria ascend, so untreated bacteriuria often progresses to pyelonephritis, which is linked with preterm labour. A pregnancy-safe antibiotic and a repeat culture are standard.
Answer
B · It can progress to pyelonephritis and trigger preterm labour
21.Pediatric nursing
Answer: B · Gentle nasal suctioning before feeds and monitoring of hydration and oxygen saturation
Why this is the answer
Care in bronchiolitis is supportive: clear the nose, support feeding and hydration, and give oxygen if saturation is low. Antibiotics do not help viral bronchiolitis.
Answer
B · Gentle nasal suctioning before feeds and monitoring of hydration and oxygen saturation
22.Pediatric nursing
Answer: A · A life-threatening deterioration with exhaustion and very poor air movement
Why this is the answer
A "silent chest" and drowsiness mean that too little air is moving and the child is tiring. This is an emergency: call for help, give oxygen and emergency treatment as ordered.
Answer
A · A life-threatening deterioration with exhaustion and very poor air movement
23.Mental health nursing
Answer: B · Frequent criticism, hostility and emotional over-involvement
Why this is the answer
High expressed emotion, including criticism, hostility and over-involvement, is associated with relapse. Family psychoeducation and support can reduce it.
Answer
B · Frequent criticism, hostility and emotional over-involvement
24.Mental health nursing
Answer: A · His anger may be part of grief, displaced onto staff, so she should not take it personally
Why this is the answer
Anger is a common part of grief and may be directed at staff who are safer targets. The nurse responds calmly, sets limits if needed and invites him to talk about his loss.
Answer
A · His anger may be part of grief, displaced onto staff, so she should not take it personally
25.Nursing math & unit conversions
Answer: T = 35 °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
95 − 32 = 63
Multiply by 5/9
T = 63·5/9 = 35 °C
Answer
T = 35 °C
26.Nursing math & unit conversions
Answer: V = 232.5 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
¾ cup = 0.75·240 = 180 mL
1½ tsp = 1.5·5 = 7.5 mL
3 tbsp = 3·15 = 45 mL
Add
V = 180 + 7.5 + 45 = 232.5 mL
Answer
V = 232.5 mL
27.Dosage calculations
Answer: V = 4.4 mL
Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.
Dose from body weight
D = 20·11 = 220 mg
Volume
V = 220/50 = 4.4 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 4.4 mL
28.Dosage calculations
Answer: R = 9.375 mL/h
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.
Concentration
40000/250 = 160 units/mL
Pump rate
R = 1500/160 = 9.375 mL/h
Answer
R = 9.375 mL/h
29.IV infusion rates
Answer: R = 58.75 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
500/10 = 50 mL/h
New rate
R = 470/8 = 58.75 mL/h
Answer
R = 58.75 mL/h
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
30.IV infusion rates
Answer: D = 3.2 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
200/500 = 0.4 mg/mL
Dose rate
D = 0.4·8 = 3.2 mg/h
Answer
D = 3.2 mg/h
31.IV fluids & fluid balance
Answer: B = 995 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 + 200 = 600 mL
IV infusion: 100·12 = 1200 mL
IV antibiotic: 2·50 = 100 mL
total intake = 1900 mL
Total output
200 + 375 + 200 + 130 = 905 mL
Balance
B = 1900 − 905 = 995 mL
Answer
B = 995 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: t = 2 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
500 − 300 = 200 mL
Time
t = 200/100 = 2 h
Answer
t = 2 h
That is about 2 h 00 min, so the bag runs out at about 16:30.
33.Clinical assessment scores
Answer: NEWS2 = 7
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 24/min → 2
SpO₂ 98% → 0
on air → 0
SBP 88 mmHg → 3
HR 126/min → 2
alert (A) → 0
T 36.7 °C → 0
Add
NEWS2 = 2 + 0 + 0 + 3 + 2 + 0 + 0 = 7
Answer
NEWS2 = 7
34.Clinical assessment scores
Answer: overweight
Body mass index: BMI = weight (kg)/height (m)², with the height converted to metres first. With pounds and inches, BMI = 703 × weight (lb)/height (in)². WHO adult categories: below 18.5 underweight, 18.5–24.9 healthy weight, 25.0–29.9 overweight, 30.0–34.9 obesity class I, 35.0–39.9 obesity class II and 40 or more obesity class III.
BMI
BMI = 97/1.9² = 26.87
Category
overweight
Answer
overweight
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