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
A registered nurse delegates a task to a healthcare assistant. Who is accountable for the decision to delegate?
AOnly the healthcare assistant
BThe registered nurse
CThe patient
DNobody, once the task is handed over
2.Nursing fundamentalsHard
When is a "clean" (non-sterile) technique acceptable instead of an aseptic technique?
AFor inserting a central venous catheter
BFor procedures that do not enter sterile body areas, such as giving an oral medicine
CFor dressing a fresh surgical wound in theatre, provided that non-sterile gloves are worn throughout
DFor inserting a urinary catheter
3.Infection control & patient safetyMedium
A patient has leftover opioid tablets after surgery. Which advice about disposal is best?
AReturn them to a pharmacy or an approved take-back site
BKeep them in an unlocked drawer at home in case of future pain
CGive them to a friend or relative who has back pain
DLeave them in the bathroom cabinet indefinitely
4.Infection control & patient safetyHard
A nurse teaches a patient who has had a splenectomy. Which statement shows a need for further teaching?
A“Now that my spleen is out, a fever is nothing to worry about.”
B“I will keep my vaccinations up to date.”
C“I will get medical help quickly if I get a high temperature.”
D“I will tell all of my health care providers that I have no spleen.”
5.Prioritization & delegationMedium
A nurse delegates the measurement of blood glucose to a trained assistant but never asks for the result. Which right of delegation is missing?
ARight task for the setting
BRight person for the task
CRight circumstance
DRight supervision and evaluation
6.Prioritization & delegationHard
Which patient finding is unexpected and needs action after a transurethral resection of the prostate with continuous bladder irrigation?
ALight pink urine that becomes clearer over the day
BMild bladder spasms that ease with the prescribed antispasmodic medication
CA feeling of needing to pass urine despite the catheter
DBright red urine with clots and reduced flow out of the catheter
7.Clinical nursingMedium
Why is it important to prevent hypothermia during and after surgery?
AIt makes the patient wake up too quickly and become agitated in recovery
BIt increases the risk of wound infection, bleeding and cardiac complications
CIt causes high blood glucose only
DIt makes the patient's pain disappear
8.Clinical nursingHard
A patient is admitted with suspected meningococcal disease. Which infection control measure is usually needed?
ADroplet precautions until 24 hours of effective antibiotics have been given
BAirborne precautions with a negative-pressure room for the whole hospital stay
CIsolation only after the patient has gone home
DNo precautions, because it is not contagious
9.Lab values & electrolytesMedium
How should a blood sample for serum ammonia be handled?
APlaced on ice and sent to the laboratory at once
BLeft at room temperature for several hours first
CShaken firmly to mix it before it is sent away
DKept warm and sent with the next routine batch
10.Lab values & electrolytesHard
A patient with suspected Cushing syndrome takes dexamethasone at night. The next morning, the cortisol is still high. What does this suggest?
ACortisol is being produced without normal feedback control
BThe result is normal, as dexamethasone raises cortisol
CThe patient has primary hypothyroidism instead
DThe adrenal glands are not able to produce enough cortisol
11.PharmacologyMedium
During adult cardiac arrest, how often is IV adrenaline (epinephrine) usually repeated?
AOnce only, at the start
BEvery 3–5 minutes
CEvery 30 seconds
DEvery 15–20 minutes
12.PharmacologyHard
A patient with severe liver cirrhosis takes oral propranolol, a drug with a high first-pass metabolism. What effect is expected?
AMore drug reaches the circulation, so a lower dose may be needed
BLess drug is absorbed from the gut, so a higher dose is needed
CThe first-pass effect increases, so the drug becomes inactive
DThe drug is excreted faster by the kidney, so it works for a shorter time
13.Med-surg: cardiovascular & respiratoryMedium
A 34-year-old has hypertension that is hard to control and a low serum potassium without taking diuretics. Which cause should be considered?
AEssential hypertension of ageing
BIron-deficiency anaemia
CPrimary hyperaldosteronism
DHypothyroidism
14.Med-surg: cardiovascular & respiratoryHard
Which task for a stable patient with heart failure can the registered nurse most appropriately delegate to a healthcare assistant (unlicensed assistive personnel)?
ATeaching the patient about a low-salt diet
BDeciding whether to give the furosemide dose
CAssessing lung sounds for new crackles
DMeasuring and recording the morning weight
15.Med-surg: neuro, endocrine & renalMedium
A patient has a nephrostomy tube. Which finding needs urgent action?
AA dry, intact dressing at the site
BLight pink urine on the first day after insertion
CSteady urine drainage into the bag
DDrainage that stops suddenly with new loin pain
16.Med-surg: neuro, endocrine & renalHard
Why may nitrofurantoin be avoided in an older patient with significantly reduced kidney function?
AIt turns the urine red in kidney disease
BIt works less well and is more likely to be toxic
CIt cannot be taken with food in kidney disease
DIt cures kidney disease too quickly
17.Med-surg: GI, perioperative & oncologyMedium
A patient received IV morphine 20 minutes ago and the surgical consent form has not been signed. What should the nurse do?
ATell the surgeon, as the patient may not be able to consent now
BAsk a relative to sign instead of the patient
CSign the form on the patient's behalf as a witness
DAsk the patient to sign quickly before they get sleepier
18.Med-surg: GI, perioperative & oncologyHard
Two days after surgery, a patient on regular ibuprofen has a low urine output and a rising creatinine, and intake has been poor. What should the nurse do?
AGive the next dose with extra food
BIncrease the dose to treat the pain better and encourage fluids
CWithhold the next dose and report to the prescriber
DChange to a higher-strength NSAID tablet
19.Maternity & obstetric nursingMedium
Which event in an Rh-negative, non-sensitised woman requires an extra dose of anti-D immunoglobulin?
AAmniocentesis
BA routine urine test
CA glucose tolerance test
DA blood pressure check
20.Maternity & obstetric nursingHard
A newborn in the first hours sneezes, has a high-pitched cry, tremors and loose stools. The mother took opioids throughout pregnancy. Which intervention is most appropriate first?
ABright lights and frequent handling to keep the baby awake
BA quiet, dim room, swaddling and small, frequent feeds
CGiving naloxone to reverse the opioids
DWithholding feeds until the symptoms settle
21.Pediatric nursingMedium
A child with respiratory distress becomes bradycardic. What does this mean?
AA sign of severe hypoxia and possible imminent cardiac arrest
BThe child is recovering and calming down
CA side effect of the oxygen therapy
DA normal response to sleep
22.Pediatric nursingHard
A formula-fed infant is diagnosed with cow's milk protein allergy. Which formula is usually advised?
AA goat's milk formula
BA lactose-free cow's milk formula
CA rice milk drink fortified with calcium
DAn extensively hydrolysed formula
23.Mental health nursingMedium
When is the best time to teach a patient with an anxiety disorder a relaxation technique?
AWhen the patient's anxiety is severe, so that the effect can be seen clearly
BDuring a panic attack, when the patient needs it most
CWhen the patient's anxiety is at a mild level
DOnly after the patient has been discharged from hospital
24.Mental health nursingHard
A patient starting clozapine is being taught about blood tests. Which statement shows a need for further teaching?
A"I'll need regular blood tests for as long as I take clozapine."
B"After a few months I can stop having blood tests."
C"If I get a sore throat or fever, I'll tell someone straight away."
D"The tests are done because clozapine can lower my white cells."
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 22:15 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.
22:15
110:15 AM
29:15 PM
312:15 PM
410:15 PM
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A blood glucose result is 11.3 mmol/L. Using 1 mmol/L = 18 mg/dL for glucose, find c in mg/dL to the nearest whole number.
11.3 mmol/L1 mmol/L = 18 mg/dL
c = mg/dL
27.Dosage calculationsMedium
A patient weighs 18 kg and is prescribed 30 mg/kg as a single dose. Find the dose D in mg.
18 kg30 mg/kg
D = mg
28.Dosage calculationsHard
A patient is 112 cm tall and weighs 28 kg. The prescription is 50 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.
112 cm28 kg50 mg/m²
D = mg
29.IV infusion ratesMedium
500 mL was ordered over 10 hours. After 2 hours you find that 460 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: 460 mL
R = mL/h
30.IV infusion ratesHard
A drip runs at 20 gtt/min through a set of 15 gtt/mL. There are 600 mL left in the bag. How many hours t until it is empty?
20 gtt/min15 gtt/mL600 mL
t = 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.
water: 200 mLtea: 240 mLjuice: 200 mLIV infusion: 100 mL/h × 12 hIV antibiotic: 1 × 100 mL
I = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 13:30 at 150 mL/h. After 3 hours the rate is changed to 100 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
1000 mL150 mL/h · 3 h100 mL/h
t = h
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: yes; ambulatory aid: none, bed rest or nurse assists; IV therapy or saline lock: yes; gait: normal, bed rest or wheelchair; 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). An adult weighs 107 kg and is 192 cm tall. Calculate the BMI and click the WHO weight category.
107 kg192 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
3Solutions
1.Nursing fundamentals
Answer: B · The registered nurse
Why this is the answer
The nurse is accountable for delegating appropriately, to someone competent, with supervision as needed. The person who accepts the task is accountable for carrying it out properly.
Answer
B · The registered nurse
2.Nursing fundamentals
Answer: B · For procedures that do not enter sterile body areas, such as giving an oral medicine
Why this is the answer
Aseptic technique is required when entering normally sterile sites or handling key parts of invasive devices. Routine non-invasive tasks only need standard precautions.
Answer
B · For procedures that do not enter sterile body areas, such as giving an oral medicine
3.Infection control & patient safety
Answer: A · Return them to a pharmacy or an approved take-back site
Why this is the answer
Returning unused opioids to a pharmacy or an approved take-back site is the preferred way to dispose of them. Leftover opioids at home can be misused or taken by children or pets.
Answer
A · Return them to a pharmacy or an approved take-back site
4.Infection control & patient safety
Answer: A · “Now that my spleen is out, a fever is nothing to worry about.”
Why this is the answer
People without a spleen are at risk of overwhelming infection, especially from encapsulated bacteria. Fever needs prompt medical assessment, and vaccines are kept up to date.
Answer
A · “Now that my spleen is out, a fever is nothing to worry about.”
5.Prioritization & delegation
Answer: D · Right supervision and evaluation
Why this is the answer
The nurse must follow up, check the result and act on it. Delegating without checking the outcome breaks the right of supervision and evaluation.
Answer
D · Right supervision and evaluation
6.Prioritization & delegation
Answer: D · Bright red urine with clots and reduced flow out of the catheter
Why this is the answer
Bright red urine with clots suggests arterial bleeding and can block the catheter, causing bladder distension. Light pink urine, urgency and mild spasms are common after this operation.
Answer
D · Bright red urine with clots and reduced flow out of the catheter
7.Clinical nursing
Answer: B · It increases the risk of wound infection, bleeding and cardiac complications
Why this is the answer
Inadvertent perioperative hypothermia impairs clotting and immune function and increases cardiac events and wound infection. Patients are warmed actively and their temperature monitored.
Answer
B · It increases the risk of wound infection, bleeding and cardiac complications
8.Clinical nursing
Answer: A · Droplet precautions until 24 hours of effective antibiotics have been given
Why this is the answer
Neisseria meningitidis spreads through droplets and close contact. Droplet precautions are used until 24 hours of effective antibiotics, and public health arranges prophylaxis for close contacts.
Answer
A · Droplet precautions until 24 hours of effective antibiotics have been given
9.Lab values & electrolytes
Answer: A · Placed on ice and sent to the laboratory at once
Why this is the answer
Ammonia can rise in a standing sample as red cells and proteins break down. The sample is usually placed on ice and analyzed promptly to avoid a falsely high result.
Answer
A · Placed on ice and sent to the laboratory at once
10.Lab values & electrolytes
Answer: A · Cortisol is being produced without normal feedback control
Why this is the answer
Dexamethasone normally suppresses ACTH and lowers morning cortisol. Failure to suppress suggests autonomous cortisol excess (Cushing syndrome). Further tests then find the source, such as a pituitary or adrenal tumor.
Answer
A · Cortisol is being produced without normal feedback control
11.Pharmacology
Answer: B · Every 3–5 minutes
Why this is the answer
In adult advanced life support, adrenaline 1 mg IV or IO is repeated every 3–5 minutes during the arrest. High-quality CPR and defibrillation for shockable rhythms remain the priorities.
Answer
B · Every 3–5 minutes
12.Pharmacology
Answer: A · More drug reaches the circulation, so a lower dose may be needed
Why this is the answer
In cirrhosis, less of the oral dose is removed by the liver on its first pass, partly because blood bypasses the liver through shunts. Bioavailability and plasma levels rise, so doses of such drugs often need to be reduced.
Answer
A · More drug reaches the circulation, so a lower dose may be needed
13.Med-surg: cardiovascular & respiratory
Answer: C · Primary hyperaldosteronism
Why this is the answer
Excess aldosterone (for example from an adrenal adenoma, Conn's syndrome) causes sodium retention, hypertension and potassium loss. Young age, resistant hypertension and unexplained hypokalaemia suggest a secondary cause and need investigation.
Answer
C · Primary hyperaldosteronism
14.Med-surg: cardiovascular & respiratory
Answer: D · Measuring and recording the morning weight
Why this is the answer
Weighing a stable patient is a routine, measurable task that can be delegated, with the result reported to the nurse. Assessment, patient teaching and clinical decisions about medicines require the registered nurse's judgement and cannot be delegated.
Answer
D · Measuring and recording the morning weight
15.Med-surg: neuro, endocrine & renal
Answer: D · Drainage that stops suddenly with new loin pain
Why this is the answer
A sudden stop in drainage with pain suggests the tube is blocked or dislodged, so the kidney is obstructed again. The nurse checks for kinks and escalates urgently. Fever or rigors may signal infection.
Answer
D · Drainage that stops suddenly with new loin pain
16.Med-surg: neuro, endocrine & renal
Answer: B · It works less well and is more likely to be toxic
Why this is the answer
Nitrofurantoin is concentrated in the urine. With poor kidney function, urine levels fall, so it works less well, and blood levels rise, increasing side effects such as neuropathy. Another antibiotic is usually chosen.
Answer
B · It works less well and is more likely to be toxic
17.Med-surg: GI, perioperative & oncology
Answer: A · Tell the surgeon, as the patient may not be able to consent now
Why this is the answer
Opioids and sedatives can impair understanding, so consent may not be valid. The surgeon is informed; consent is obtained when the patient has capacity, or other legal processes are followed in an emergency.
Answer
A · Tell the surgeon, as the patient may not be able to consent now
18.Med-surg: GI, perioperative & oncology
Answer: C · Withhold the next dose and report to the prescriber
Why this is the answer
NSAIDs can cause acute kidney injury, particularly with hypovolaemia, older age or other nephrotoxic drugs. The nurse withholds and reports, and fluid status and other analgesia are reviewed.
Answer
C · Withhold the next dose and report to the prescriber
19.Maternity & obstetric nursing
Answer: A · Amniocentesis
Why this is the answer
Any potentially sensitising event, such as amniocentesis, abdominal trauma, bleeding, miscarriage or ectopic pregnancy, can mix fetal and maternal blood. Anti-D is given after it to prevent antibody formation.
Answer
A · Amniocentesis
20.Maternity & obstetric nursing
Answer: B · A quiet, dim room, swaddling and small, frequent feeds
Why this is the answer
Neonatal abstinence (withdrawal) is managed first with non-drug care: low stimulation, swaddling, skin-to-skin, responsive feeding and rooming-in. Medication is added if scores stay high. Naloxone can precipitate seizures.
Answer
B · A quiet, dim room, swaddling and small, frequent feeds
21.Pediatric nursing
Answer: A · A sign of severe hypoxia and possible imminent cardiac arrest
Why this is the answer
In children, bradycardia caused by hypoxia is an ominous, pre-arrest sign. It needs immediate airway and breathing support and an emergency call.
Answer
A · A sign of severe hypoxia and possible imminent cardiac arrest
22.Pediatric nursing
Answer: D · An extensively hydrolysed formula
Why this is the answer
Extensively hydrolysed formulas contain milk proteins broken into small pieces that rarely trigger allergy; amino acid formulas are used for severe cases. Lactose-free formula still contains cow's milk protein, goat's milk proteins cross-react, and rice milk is unsuitable for infants.
Answer
D · An extensively hydrolysed formula
23.Mental health nursing
Answer: C · When the patient's anxiety is at a mild level
Why this is the answer
Patients with severe anxiety or panic cannot take in new information. New coping skills are taught when anxiety is low, so they can be used later when anxiety rises.
Answer
C · When the patient's anxiety is at a mild level
24.Mental health nursing
Answer: B · "After a few months I can stop having blood tests."
Why this is the answer
Blood count monitoring is most frequent in the first months of clozapine treatment but continues throughout treatment, because agranulocytosis can occur at any time.
Answer
B · "After a few months I can stop having blood tests."
25.Nursing math & unit conversions
Answer: 10:15 PM
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.
Convert the hour
22 − 12 = 10 → PM
Answer
10:15 PM
Answer
10:15 PM
26.Nursing math & unit conversions
Answer: c = 203 mg/dL
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.
Convert
c = 11.3·18 = 203.4 ≈ 203 mg/dL
Answer
c = 203 mg/dL
27.Dosage calculations
Answer: D = 540 mg
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Dose
30·18 = 540 mg
Answer
D = 540 mg
28.Dosage calculations
Answer: D = 46.67 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 = √(112·28/3600) = √0.8711 = 0.9333 m²
Dose
D = 50·0.9333 = 46.67 mg
Answer
D = 46.67 mg
29.IV infusion rates
Answer: R = 57.5 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 = 460/8 = 57.5 mL/h
Answer
R = 57.5 mL/h
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
30.IV infusion rates
Answer: t = 7.5 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.
Rate in mL/h
20·60/15 = 80 mL/h
Time left
t = 600/80 = 7.5 h
Answer
t = 7.5 h
31.IV fluids & fluid balance
Answer: I = 1940 mL
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Add the intake
oral: 200 + 240 + 200 = 640 mL
IV infusion: 100·12 = 1200 mL
IV antibiotic: 1·100 = 100 mL
I = 1940 mL
Answer
I = 1940 mL
32.IV fluids & fluid balance
Answer: t = 8.5 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
First part
150·3 = 450 mL
1000 − 450 = 550 mL left
Second part
550/100 = 5.5 h
Total time
t = 3 + 5.5 = 8.5 h
Answer
t = 8.5 h
That is about 8 h 30 min, so the bag runs out at about 22:00.
33.Clinical assessment scores
Answer: MFS = 35
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: yes → 15
ambulatory aid: none, bed rest or nurse assists → 0
IV therapy or saline lock: yes → 20
gait: normal, bed rest or wheelchair → 0
mental status: knows own limits → 0
Add
Morse total = 0 + 15 + 0 + 20 + 0 + 0 = 35
Answer
MFS = 35
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 = 107/1.92² = 29.03
Category
overweight
Answer
overweight
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