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
When measuring blood pressure, what happens if the cuff is too small for the arm?
AThe reading is unaffected
BOnly the diastolic value changes, downwards
CThe reading is falsely low
DThe reading is falsely high
2.Nursing fundamentalsHard
An older patient with diarrhoea for three days is dizzy on standing and passing small amounts of dark urine. What is the most likely problem?
AFluid overload from drinking too much
BDehydration from fluid loss
CUrinary retention caused by a full bladder
DNormal ageing that needs no action
3.Infection control & patient safetyMedium
A patient has a weak left leg. Which instruction about using a cane is correct?
AMove the cane and the right leg forward together
BHold the cane in the right hand, on the stronger side
CKeep the cane well out to the side, away from the body
DHold the cane in the left hand, on the weaker side
4.Infection control & patient safetyHard
A patient given naloxone for an opioid overdose wakes up. An hour later, the patient is drowsy again with slow breathing. What is the likely reason?
AThe patient is now allergic to naloxone
BThe patient is simply tired after the event
CNaloxone wears off sooner than many opioids, so the opioid effect returns
DNaloxone itself causes slow breathing and drowsiness once it has been given
5.Prioritization & delegationMedium
A patient receiving IV magnesium sulfate for pre-eclampsia has absent knee reflexes and a respiratory rate of 10/min. What does the nurse do first?
AIncrease the infusion to prevent a seizure
BStop the magnesium infusion and call for help
CTurn the patient onto her back and recheck later
DGive oral fluids to help clear the drug faster
6.Prioritization & delegationHard
A patient with anorexia nervosa is admitted. Which finding is the priority?
AHeart rate 38/min and potassium 2.8 mEq/L
BHas fine, downy hair on her arms
CRefuses to eat in front of other people
DSays she feels fat although she is very thin
7.Clinical nursingMedium
What is the main benefit of pulmonary rehabilitation for patients with COPD?
AReversal of the lung damage caused by smoking
BNo further need for inhalers
CA cure for the disease within months
DBetter exercise capacity and quality of life
8.Clinical nursingHard
A patient with severe sepsis starts bleeding from cannula sites and the gums, with a low platelet count and prolonged clotting times. What is most likely?
AAn allergic reaction to the cannula
BHaemophilia A
CDisseminated intravascular coagulation
DVitamin C deficiency
9.Lab values & electrolytesMedium
Which instruction is correct for a patient taking an oral potassium chloride supplement?
ACrush the extended-release tablets and mix them with a little water if needed
BUse a salt substitute as well, so less of the tablet is needed each day
CTake it on an empty stomach with only a small sip of water to speed absorption
DTake it with food and a full glass of water, and do not crush extended-release tablets
10.Lab values & electrolytesHard
A patient on IV gentamicin has a trough level above the target, and the creatinine has risen since yesterday. The next dose is due. What is the best action?
AHold the dose and report the results to the prescriber
BGive half of the dose and document the reason for it
CGive the dose now and recheck the levels next week
DGive the dose with extra oral fluids to protect the kidneys
11.PharmacologyMedium
A patient starting sulfasalazine should be told about which harmless effect?
AGreen colouring of the sweat
BWhite spots on the nails
CBlue colouring of the tongue and gums
DOrange-yellow colouring of the urine
12.PharmacologyHard
A patient receiving cisplatin is given large volumes of IV fluid before and after each dose. What is the main purpose?
ATo reduce kidney damage
BTo increase drug absorption from the gut
CTo prevent hair loss
DTo prevent bleeding
13.Med-surg: cardiovascular & respiratoryMedium
A patient in cardiac rehabilitation asks how hard to exercise. Which simple guide is commonly taught?
AExercise only until the heart rate rises even slightly
BExercise until they are too breathless to speak at all
CExercise until chest pain starts, then stop
DExercise so they are a little breathless but can still talk
14.Med-surg: cardiovascular & respiratoryHard
A patient with known hypertension has a BP of 186/112 mmHg with no symptoms and no signs of organ damage. Which response is most appropriate?
AGive an IV antihypertensive bolus to reach 120/80 mmHg within 15 minutes
BCall the cardiac arrest team and prepare for intubation
CRecheck it, report it and expect oral treatment over hours to days
DTake no action, because the patient feels well and has no symptoms
15.Med-surg: neuro, endocrine & renalMedium
A stroke patient understands what is said but struggles to find words and speaks in short, effortful phrases. What type of aphasia is this?
AReceptive (Wernicke's) aphasia
BGlobal aphasia with no understanding
CExpressive (Broca's) aphasia
DDysarthria from weak facial muscles
16.Med-surg: neuro, endocrine & renalHard
On the first day after a kidney transplant, urine output suddenly falls from 200 mL/h to 10 mL/h. What should the nurse check first?
AThe patient's temperature and pulse
BWhether the patient has eaten
CThat the catheter is not blocked or kinked
DThe patient's blood glucose level
17.Med-surg: GI, perioperative & oncologyMedium
How should pancreatic enzyme replacement capsules usually be taken?
AOnly on days with abdominal pain
BOne hour after meals, on an empty stomach
CWith every meal and snack
DOnce a day at bedtime
18.Med-surg: GI, perioperative & oncologyHard
A nurse teaches a carer about overnight tube feeding at home. Which statement shows a need for further teaching?
A"I'll stop the feed and call if he coughs or struggles to breathe."
B"I'll check the external length mark on the tube every day."
C"I'll flush the tube with water before and after his medicines."
D"I'll let him lie flat so he sleeps better while the feed runs."
19.Maternity & obstetric nursingMedium
Which position of the fetal head presents the smallest diameter to the pelvis?
APartial extension, with the brow presenting
BA neutral position with no flexion
CFull extension, with the face presenting
DFull flexion, with the chin on the chest
20.Maternity & obstetric nursingHard
Just after delivery of the placenta, a woman suddenly has severe pain, heavy bleeding and shock. No fundus can be felt abdominally and a mass is seen at the vulva. What is most likely?
ACervical laceration
BAmniotic fluid embolism
CUterine inversion
DUterine atony
21.Pediatric nursingMedium
A child with suspected appendicitis is waiting for surgery. Which action must the nurse avoid?
AKeeping the child nil by mouth
BGiving IV fluids as prescribed
CRegular pain assessment
DPutting a heat pad on the abdomen
22.Pediatric nursingHard
A child on chemotherapy for leukaemia was in close contact with a classmate who has chickenpox. What should the nurse do?
AWait to see whether a rash develops before acting
BGive the live varicella vaccine to the child that same day to boost immunity
CTell the oncology team at once, as preventive treatment may be needed
DReassure the family, as chickenpox is mild in all children
23.Mental health nursingMedium
Which goal for a patient with depression is written in a SMART way?
A"The patient will walk with staff for 15 minutes once a day by Friday."
B"The patient will feel better soon."
C"The patient will be happier."
D"The patient will improve her mood and sleep and start exercising more at some point."
24.Mental health nursingHard
A nurse feels strong irritation every time she cares for a patient who reminds her of her abusive father. What is the most appropriate action?
AAvoid the patient and let other staff do all of his care
BIgnore the feeling, because feelings do not affect nursing care
CRecognise this as countertransference and discuss it in clinical supervision
DTell the patient that he reminds her of her father
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 41 °C. Convert it to degrees Fahrenheit T with °F = °C × 9/5 + 32. Round to one decimal place.
41 °C
T = °F
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A prescription reads 1½ tsp of an oral suspension four times a day for 10 days. Using 1 tsp = 5 mL, how many mL V are needed for the whole course?
1½ tspfour times a day10 days1 tsp = 5 mL
V = mL
27.Dosage calculationsMedium
A patient weighs 18 kg. The prescribed dose is 10 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?
18 kg10 mg/kg/day4× per day
D = mg
28.Dosage calculationsHard
You must prepare 500 mL of a 2.5% (w/v) solution from a 20% (w/v) stock solution. What volume of stock V₁ do you need?
C₁ = 20%C₂ = 2.5%V₂ = 500 mL
V₁ = mL
29.IV infusion ratesMedium
Infuse 500 mL over 4 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
500 mL4 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 500 mg of a drug in 500 mL and runs at 15 mL/h. How many milligrams per hour D does the patient receive?
500 mg/500 mL15 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 total intake I in mL.
juice: 150 mLwater: 120 mLIV infusion: 125 mL/h × 12 hIV antibiotic: 2 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 07:00 and runs by pump at 120 mL/h. How many mL V are left in the bag at 14:30?
1000 mL120 mL/h07:00 → 14:30
V = mL
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: no; secondary diagnosis: no; ambulatory aid: none, bed rest or nurse assists; IV therapy or saline lock: yes; gait: weak; mental status: knows own limits. Find the Morse total MFS.
0–125
MFS =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 20/min, SpO₂ 89% on supplemental oxygen, blood pressure 222/134 mmHg, pulse 82/min, alert, temperature 36.2 °C. Which clinical risk group does the patient fall into? Click it.
RR 20SpO₂ 89%O₂SBP 222HR 82AT 36.2 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: D · The reading is falsely high
Why this is the answer
A cuff that is too small overestimates blood pressure; one that is too large underestimates it. The bladder should cover about 80% of the arm circumference.
Answer
D · The reading is falsely high
2.Nursing fundamentals
Answer: B · Dehydration from fluid loss
Why this is the answer
Diarrhoea causes loss of water and electrolytes. Postural dizziness and concentrated low-volume urine show dehydration, which needs fluid replacement, electrolyte checks and close monitoring.
Answer
B · Dehydration from fluid loss
3.Infection control & patient safety
Answer: B · Hold the cane in the right hand, on the stronger side
Why this is the answer
The cane is held on the strong side and moved forward with the weak leg, so it shares the weight that the weak leg cannot take. It is kept close to the body for stability.
Answer
B · Hold the cane in the right hand, on the stronger side
4.Infection control & patient safety
Answer: C · Naloxone wears off sooner than many opioids, so the opioid effect returns
Why this is the answer
Naloxone acts for a shorter time than many opioids, so sedation and respiratory depression can return. Patients are monitored closely, and repeat doses or an infusion may be needed.
Answer
C · Naloxone wears off sooner than many opioids, so the opioid effect returns
5.Prioritization & delegation
Answer: B · Stop the magnesium infusion and call for help
Why this is the answer
Loss of deep tendon reflexes and slow breathing suggest magnesium toxicity. The nurse stops the infusion, supports breathing and escalates; calcium gluconate is the antidote kept ready.
Answer
B · Stop the magnesium infusion and call for help
6.Prioritization & delegation
Answer: A · Heart rate 38/min and potassium 2.8 mEq/L
Why this is the answer
Severe bradycardia and low potassium can cause fatal arrhythmias. The body-image beliefs and eating behaviors matter, but physiological safety comes first.
Answer
A · Heart rate 38/min and potassium 2.8 mEq/L
7.Clinical nursing
Answer: D · Better exercise capacity and quality of life
Why this is the answer
Pulmonary rehabilitation improves breathlessness, exercise tolerance and well-being, and reduces hospital admissions. It does not reverse the underlying lung damage.
Answer
D · Better exercise capacity and quality of life
8.Clinical nursing
Answer: C · Disseminated intravascular coagulation
Why this is the answer
In DIC, widespread activation of clotting consumes platelets and clotting factors, causing both small clots and bleeding. Treating the underlying cause and replacing blood products as needed are key.
Answer
C · Disseminated intravascular coagulation
9.Lab values & electrolytes
Answer: D · Take it with food and a full glass of water, and do not crush extended-release tablets
Why this is the answer
Oral potassium can irritate the esophagus and stomach, so it is taken with food and plenty of fluid, and extended-release forms are swallowed whole. Most salt substitutes contain potassium chloride and can add to the risk of hyperkalemia.
Answer
D · Take it with food and a full glass of water, and do not crush extended-release tablets
10.Lab values & electrolytes
Answer: A · Hold the dose and report the results to the prescriber
Why this is the answer
A high aminoglycoside trough with rising creatinine means the drug is accumulating, which increases the risk of kidney damage and hearing loss. The nurse holds the dose, reports to the prescriber and asks about hearing changes and tinnitus. Only the prescriber or pharmacist changes the regimen.
Answer
A · Hold the dose and report the results to the prescriber
11.Pharmacology
Answer: D · Orange-yellow colouring of the urine
Why this is the answer
Sulfasalazine can colour urine and sometimes skin and contact lenses orange-yellow. More serious adverse effects include blood disorders and rash, so blood counts are monitored.
Answer
D · Orange-yellow colouring of the urine
12.Pharmacology
Answer: A · To reduce kidney damage
Why this is the answer
Cisplatin is nephrotoxic, and hydration helps protect the kidneys. It also causes ototoxicity, peripheral neuropathy, severe nausea and low magnesium.
Answer
A · To reduce kidney damage
13.Med-surg: cardiovascular & respiratory
Answer: D · Exercise so they are a little breathless but can still talk
Why this is the answer
Moderate-intensity exercise makes the patient slightly breathless but able to hold a conversation. Programmes start gently and progress. Patients stop and seek help if they get chest pain, severe breathlessness or dizziness.
Answer
D · Exercise so they are a little breathless but can still talk
14.Med-surg: cardiovascular & respiratory
Answer: C · Recheck it, report it and expect oral treatment over hours to days
Why this is the answer
Severe hypertension without acute organ damage (sometimes called hypertensive urgency) is managed by confirming the reading, looking for causes such as pain or missed doses and adjusting oral therapy to lower the pressure over hours to days. Rapid lowering risks ischaemia of the brain, heart and kidneys, but ignoring it is also unsafe.
Answer
C · Recheck it, report it and expect oral treatment over hours to days
15.Med-surg: neuro, endocrine & renal
Answer: C · Expressive (Broca's) aphasia
Why this is the answer
Expressive aphasia, from damage to Broca's area in the frontal lobe, causes non-fluent, effortful speech with relatively preserved understanding. Receptive aphasia causes fluent but meaningless speech and poor comprehension. Dysarthria is a motor speech problem with intact language.
Answer
C · Expressive (Broca's) aphasia
16.Med-surg: neuro, endocrine & renal
Answer: C · That the catheter is not blocked or kinked
Why this is the answer
A sudden drop in output after transplant may be caused by a blocked catheter, often from clots. The nurse checks the tubing and may flush the catheter per protocol, and then escalates urgently, because vascular thrombosis or rejection are also possible.
Answer
C · That the catheter is not blocked or kinked
17.Med-surg: GI, perioperative & oncology
Answer: C · With every meal and snack
Why this is the answer
Pancreatic enzymes digest fat, protein and carbohydrate, so they are taken with meals and snacks. The dose is adjusted to reduce steatorrhoea and support weight gain.
Answer
C · With every meal and snack
18.Med-surg: GI, perioperative & oncology
Answer: D · "I'll let him lie flat so he sleeps better while the feed runs."
Why this is the answer
The head should stay raised by at least 30–45° during feeding and for a while afterwards. Flushing, checking the tube length and stopping for breathing problems are all correct.
Answer
D · "I'll let him lie flat so he sleeps better while the feed runs."
19.Maternity & obstetric nursing
Answer: D · Full flexion, with the chin on the chest
Why this is the answer
When the head is fully flexed, the suboccipitobregmatic diameter of about 9.5 cm presents. Extension, as in brow and face presentations, presents larger diameters and can obstruct labour.
Answer
D · Full flexion, with the chin on the chest
20.Maternity & obstetric nursing
Answer: C · Uterine inversion
Why this is the answer
An absent fundus on palpation with a mass in the vagina and shock suggest uterine inversion. Help is called immediately, oxytocin is stopped and the uterus is replaced as soon as possible by the medical team.
Answer
C · Uterine inversion
21.Pediatric nursing
Answer: D · Putting a heat pad on the abdomen
Why this is the answer
Heat on the abdomen and laxatives or enemas are avoided in suspected appendicitis because they can increase the risk of perforation. Nil by mouth, IV fluids, analgesia and close monitoring are appropriate.
Answer
D · Putting a heat pad on the abdomen
22.Pediatric nursing
Answer: C · Tell the oncology team at once, as preventive treatment may be needed
Why this is the answer
In immunosuppressed children, chickenpox can cause severe pneumonia, hepatitis and encephalitis. After exposure, the team may give varicella-zoster immunoglobulin or antivirals. Live varicella vaccine is not given during chemotherapy.
Answer
C · Tell the oncology team at once, as preventive treatment may be needed
23.Mental health nursing
Answer: A · "The patient will walk with staff for 15 minutes once a day by Friday."
Why this is the answer
A SMART goal states exactly what the patient will do, how much and by when, so that progress can be evaluated. Vague goals cannot be measured.
Answer
A · "The patient will walk with staff for 15 minutes once a day by Friday."
24.Mental health nursing
Answer: C · Recognise this as countertransference and discuss it in clinical supervision
Why this is the answer
Countertransference is common and is not a failure, but it can affect care if not recognised. Supervision helps the nurse understand the reaction and keep the relationship therapeutic.
Answer
C · Recognise this as countertransference and discuss it in clinical supervision
25.Nursing math & unit conversions
Answer: T = 105.8 °F
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.
Multiply by 9/5
41·9/5 = 73.8
Add 32
T = 73.8 + 32 = 105.8 °F
Answer
T = 105.8 °F
26.Nursing math & unit conversions
Answer: V = 300 mL
Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.
Volume per dose
1½ tsp = 1.5·5 = 7.5 mL
Whole course
V = 7.5 mL × 4/day × 10 = 300 mL
Answer
V = 300 mL
27.Dosage calculations
Answer: D = 45 mg
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Total per day
10·18 = 180 mg
Per dose
D = 180/4 = 45 mg
Answer
D = 45 mg
28.Dosage calculations
Answer: V₁ = 62.5 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 = 2.5·500/20 = 62.5 mL
Answer
V₁ = 62.5 mL
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
4·60 = 240 min
Drip rate
R = 500·20/240 = 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 = 15 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
500/500 = 1 mg/mL
Dose rate
D = 1·15 = 15 mg/h
Answer
D = 15 mg/h
31.IV fluids & fluid balance
Answer: I = 1870 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 + 120 = 270 mL
IV infusion: 125·12 = 1500 mL
IV antibiotic: 2·50 = 100 mL
I = 1870 mL
Answer
I = 1870 mL
32.IV fluids & fluid balance
Answer: V = 100 mL
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.
Elapsed time
07:00 → 14:30 = 7.5 h
Volume infused
120·7.5 = 900 mL
Volume left
V = 1000 − 900 = 100 mL
Answer
V = 100 mL
33.Clinical assessment scores
Answer: MFS = 30
Morse fall scale: six items. History of falling: no 0, yes 25. Secondary diagnosis: no 0, yes 15. Ambulatory aid: none, bed rest or nurse assistance 0; crutches, cane or walker 15; holding on to furniture 30. IV therapy or saline lock: no 0, yes 20. Gait: normal, bed rest or wheelchair 0; weak 10; impaired 20. Mental status: knows own limits 0; overestimates or forgets limits 15. The total runs from 0 to 125. Risk cut-offs differ between hospitals; a common set is 0–24 low, 25–44 moderate and 45 or more high.
Score each item
history of falling in the last 3 months: no → 0
secondary diagnosis: no → 0
ambulatory aid: none, bed rest or nurse assists → 0
IV therapy or saline lock: yes → 20
gait: weak → 10
mental status: knows own limits → 0
Add
Morse total = 0 + 0 + 0 + 20 + 10 + 0 = 30
Answer
MFS = 30
34.Clinical assessment scores
Answer: high
NEWS2 (National Early Warning Score 2, Royal College of Physicians 2017): score each of the seven parameters with the chart (respiration rate, SpO₂ on scale 1, air or supplemental oxygen, systolic blood pressure, pulse, consciousness on the ACVPU scale and temperature) and add the scores. Clinical risk: 0–4 low; a score of 3 in any single parameter low–medium; 5–6 medium; 7 or more high. A total of 5 or more needs an urgent response.
Score each parameter
RR 20/min → 0
SpO₂ 89% → 3
on oxygen → 2
SBP 222 mmHg → 3
HR 82/min → 0
alert (A) → 0
T 36.2 °C → 0
Total and red scores
NEWS2 = 0 + 3 + 2 + 3 + 0 + 0 + 0 = 8
At least one parameter scores 3.
Risk group
high
Answer
high
A total of 5 or more calls for an urgent clinical response.