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
Why should a patient wash and dry their hands before a fingerprick glucose test?
AClean hands make the finger bleed more slowly
BIt is only needed if the hands look dirty
CSugar on the skin can give a falsely high reading
DWet hands give a falsely high reading
2.Nursing fundamentalsHard
When is a "clean" (non-sterile) technique acceptable instead of an aseptic technique?
AFor procedures that do not enter sterile body areas, such as giving an oral medicine
BFor dressing a fresh surgical wound in theatre, provided that non-sterile gloves are worn throughout
CFor inserting a central venous catheter
DFor inserting a urinary catheter
3.Infection control & patient safetyMedium
A patient walking with a gait belt suddenly starts to fall. What should the nurse do?
AHold the belt, widen the stance and ease the patient gently to the floor
BLet go of the belt and run to call for help
CGrab the patient under both arms and try hard to keep them standing up
DPull the patient backwards quickly toward the bed
4.Infection control & patient safetyHard
A nurse who is not immune to chickenpox was exposed to a patient with varicella before precautions began. What usually happens?
AThe nurse only needs to wear gloves for the next month
BThe nurse must take a two-week course of antibiotics to prevent the infection
CThe nurse continues working with all patients as usual, including newborns
DThe nurse is assessed and kept from patient contact during the incubation period per policy
5.Prioritization & delegationMedium
A cardiac monitor shows a flat line (asystole) for a patient, but the patient is sitting up and talking. What does the nurse do first?
ACheck the patient and the electrode leads
BStart chest compressions at once
CPrepare the defibrillator to deliver a shock
DCall the cardiac arrest team
6.Prioritization & delegationHard
During surgery under general anesthesia, a patient develops rising end-tidal carbon dioxide, muscle rigidity and a rapidly increasing temperature. Which drug should the nurse anticipate?
AFlumazenil
BAtropine
CDantrolene
DNaloxone
7.Clinical nursingMedium
What is the best way to protect the heels of a bed-bound patient from pressure damage?
AMassage the heels firmly several times a day to help circulation
BRest the heels on a rolled-up towel
COffload the heels so they do not touch the mattress
DApply a tight bandage to the heels
8.Clinical nursingHard
Why are early surgery and early mobilisation recommended for older patients with a hip fracture?
AThey allow the bone to heal fully without any need for pain relief
BThey reduce complications such as pneumonia, pressure ulcers and delirium
CThey make physiotherapy and rehabilitation unnecessary after discharge
DThey mainly reduce the cost of the operation
9.Lab values & electrolytesMedium
When should a blood specimen tube be labeled?
AAt the bedside, in the patient's presence, using two identifiers
BIn the laboratory, by the staff who receive the unlabeled sample
CAt the nurses' station, after all samples for the shift are drawn
DBefore entering the room, so tubes are ready for the next patients
10.Lab values & electrolytesHard
A patient started methimazole for hyperthyroidism 6 weeks ago and now has a fever and a severe sore throat. Which action is most important?
AGive the next dose and suggest warm salt-water gargles for comfort
BAdvise the patient to continue the drug and drink more fluid
CCheck the TSH and double the dose if it is still low
DHold the drug and arrange an urgent white cell and neutrophil count
11.PharmacologyMedium
Digoxin 0.25 mg is ordered. The tablets available are 0.125 mg. How many tablets should be given?
A0.5 tablet
B2 tablets
C1 tablet
D4 tablets
12.PharmacologyHard
Beta-lactam antibiotics show time-dependent killing. What does this mean for administration?
ADoses should be given on time at evenly spaced intervals
BA single very large daily dose works best
CDoses should be given only when the patient has a fever
DDoses can be given at any time as long as the daily total is right
13.Med-surg: cardiovascular & respiratoryMedium
Which energy-conservation advice is most useful for a patient with severe COPD?
ADo all the household tasks quickly in the morning to get them done
BHold the breath while lifting heavy objects
CSit down for tasks such as washing and dressing, and pace activities
DAvoid any activity at all, staying in a chair to save their energy
14.Med-surg: cardiovascular & respiratoryHard
A patient with lung cancer develops swelling of the face and arms, distended neck and chest veins and breathlessness that is worse when bending forward. What is the most likely cause?
ARight-sided heart failure
BSuperior vena cava obstruction
CAn allergic reaction to chemotherapy
DA deep vein thrombosis in the leg
15.Med-surg: neuro, endocrine & renalMedium
After a kidney biopsy, which observation is most important?
AThe colour of the patient's skin on the face
BSigns of bleeding, such as haematuria and a rising pulse
CThe temperature every four hours only
DThe patient's appetite at the next meal
16.Med-surg: neuro, endocrine & renalHard
A patient with motor neurone disease reports morning headaches, poor sleep and sleepiness during the day. What do these symptoms suggest?
ANormal tiredness that needs no specific action
BWeak breathing at night, so a review for ventilation support
CLow mood, which should be treated with an antidepressant first
DA side effect of riluzole, which should be stopped straight away by the nurse
17.Med-surg: GI, perioperative & oncologyMedium
Which risk is particularly linked with tramadol?
ASevere stomach ulcers in all patients
BSerotonin syndrome with some antidepressants, and seizures
CRapid liver failure at normal doses
DHigh blood pressure that needs emergency treatment in most patients
18.Med-surg: GI, perioperative & oncologyHard
Which preoperative blood result should the nurse report to the team before elective surgery?
AHaemoglobin 138 g/L (13.8 g/dL) in a man
BSodium 139 mmol/L
CPotassium 2.9 mmol/L
DFasting glucose 5.4 mmol/L (97 mg/dL)
19.Maternity & obstetric nursingMedium
A woman received an opioid shortly before giving birth, and the baby is born with poor breathing effort. Which statement about the baby's care is correct?
AEffective ventilation comes first; naloxone is not routine
BNo support is needed because the effect lasts only seconds
CNaloxone is given before any ventilation is started
DFlumazenil is given to reverse the opioid
20.Maternity & obstetric nursingHard
A woman at 30 weeks has regular painful contractions every 5 minutes with cervical change. Which treatment is expected to protect the baby's lungs if birth occurs?
AAnti-D immunoglobulin
BAntenatal corticosteroids
COxytocin
DMethylergonovine
21.Pediatric nursingMedium
A newborn is still wet a few minutes after birth. Which heat-loss mechanism is the main concern, and how is it prevented?
AConduction; place the baby on a cold firm surface
BConvection; leave the baby uncovered in a draught
CRadiation; move the cot close to an outside window
DEvaporation; dry the baby straight away, including the head
22.Pediatric nursingHard
A 4-month-old is brought in drowsy and vomiting, with no visible injuries. Retinal haemorrhages are found. What should the nurse suspect?
AAbusive head trauma
BNormal newborn retinal changes
CMigraine
DViral gastroenteritis
23.Mental health nursingMedium
A patient says, "I feel like I'm dying inside." Which nurse response best uses the technique of exploring?
A"Tell me more about what that feeling is like for you."
B"Let's talk about something more cheerful."
C"You shouldn't say things like that."
D"Everyone feels that way sometimes."
24.Mental health nursingHard
For which patient is electroconvulsive therapy (ECT) most likely to be considered?
AA patient with a personality disorder who self-harms when stressed
BA patient with a first episode of mild depression who has not yet tried any other treatment
CA patient with severe psychotic depression who has stopped eating and drinking
DA patient with mild anxiety before exams
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient is 176 cm tall. Using 1 in = 2.54 cm, find the height h in inches. Round to one decimal place.
176 cm1 in = 2.54 cm
h = in
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 1½ tsp of cough syrup, 3 cups of tea, 1 tbsp of liquid supplement, 1½ fl oz of juice. Using the equivalents given, find the total oral intake V in mL.
1 tsp = 5 mL1 cup = 8 fl oz = 240 mL1 tbsp = 15 mL1 fl oz = 30 mL
V = mL
27.Dosage calculationsMedium
A vial contains 500 mg of powder. The label says: add 9.6 mL of water for injection to give a total volume of 10 mL. The prescription is 120 mg. What volume V of the reconstituted solution do you give?
500 mg+ 9.6 mL → 10 mL120 mg
V = mL
28.Dosage calculationsHard
A patient weighs 30.8 lb. The prescription is 15 mg/kg as a single dose, and the stock contains 250 mg in 5 mL. Using 1 kg = 2.2 lb, what volume V do you give?
30.8 lb15 mg/kg250 mg/5 mL1 kg = 2.2 lb
V = mL
29.IV infusion ratesMedium
A drip runs at 25 gtt/min through a set of 20 gtt/mL. How many millilitres V does the patient receive in 6 hours?
25 gtt/min20 gtt/mL6 h
V = mL
30.IV infusion ratesHard
A drip runs at 20 gtt/min through a set of 60 gtt/mL. There are 450 mL left in the bag. How many hours t until it is empty?
20 gtt/min60 gtt/mL450 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 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 was started at 08:15 and runs by pump at 50 mL/h. How many mL V are left in the bag at 12:15?
500 mL50 mL/h08:15 → 12:15
V = mL
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: slightly limited; moisture: constantly moist; activity: walks frequently; mobility: very limited; nutrition: probably inadequate; friction and shear: no apparent problem. Find the Braden total B.
6–23
B =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 65 kg and is 182 cm tall. Calculate the BMI and click the WHO weight category.
65 kg182 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
3Solutions
1.Nursing fundamentals
Answer: C · Sugar on the skin can give a falsely high reading
Why this is the answer
Traces of food or drink on the finger can raise the reading. Washing with water and drying fully gives an accurate result; alcohol wipes can also affect some meters.
Answer
C · Sugar on the skin can give a falsely high reading
2.Nursing fundamentals
Answer: A · 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
A · For procedures that do not enter sterile body areas, such as giving an oral medicine
3.Infection control & patient safety
Answer: A · Hold the belt, widen the stance and ease the patient gently to the floor
Why this is the answer
The nurse keeps hold of the gait belt, takes a wide base of support and slides the patient down along their own leg to the floor, protecting the head. This controls the fall and protects the nurse’s back.
Answer
A · Hold the belt, widen the stance and ease the patient gently to the floor
4.Infection control & patient safety
Answer: D · The nurse is assessed and kept from patient contact during the incubation period per policy
Why this is the answer
A non-immune worker exposed to varicella may become infectious before the rash appears, so they are usually excluded from patient contact for the incubation period, and post-exposure vaccination or other measures may be offered.
Answer
D · The nurse is assessed and kept from patient contact during the incubation period per policy
5.Prioritization & delegation
Answer: A · Check the patient and the electrode leads
Why this is the answer
A talking patient has a pulse, so the flat line is almost certainly a lead or electrode problem. The nurse assesses the patient and fixes the leads. CPR and defibrillation are for patients who are actually in arrest.
Answer
A · Check the patient and the electrode leads
6.Prioritization & delegation
Answer: C · Dantrolene
Why this is the answer
Malignant hyperthermia is a reaction to some anesthetic agents that causes hypermetabolism. The triggering drug is stopped and dantrolene is given, with active cooling and support.
Answer
C · Dantrolene
7.Clinical nursing
Answer: C · Offload the heels so they do not touch the mattress
Why this is the answer
Heels are a common pressure ulcer site. Offloading devices or pillows under the calves keep the heels free of the mattress; massage over bony prominences can damage tissue.
Answer
C · Offload the heels so they do not touch the mattress
8.Clinical nursing
Answer: B · They reduce complications such as pneumonia, pressure ulcers and delirium
Why this is the answer
Delayed surgery and immobility increase the risk of chest infection, VTE, pressure ulcers, delirium and loss of independence. Guidelines recommend surgery within about 24–48 hours of admission (UK guidance: the day of or day after) and mobilisation soon after.
Answer
B · They reduce complications such as pneumonia, pressure ulcers and delirium
9.Lab values & electrolytes
Answer: A · At the bedside, in the patient's presence, using two identifiers
Why this is the answer
Specimens are labeled immediately after collection, at the bedside, after checking two patient identifiers such as name and date of birth. Pre-labeling or labeling away from the patient can put the wrong patient's name on the sample, which can lead to harmful decisions.
Answer
A · At the bedside, in the patient's presence, using two identifiers
10.Lab values & electrolytes
Answer: D · Hold the drug and arrange an urgent white cell and neutrophil count
Why this is the answer
Methimazole and propylthiouracil can cause agranulocytosis, often in the first months of therapy. Fever or sore throat must be reported at once; the drug is held and a CBC with differential is checked. Infection is treated urgently if neutrophils are low.
Answer
D · Hold the drug and arrange an urgent white cell and neutrophil count
11.Pharmacology
Answer: B · 2 tablets
Why this is the answer
0.25 mg ÷ 0.125 mg = 2 tablets. Doses that need more than a few tablets or unusual fractions should be double-checked.
Answer
B · 2 tablets
12.Pharmacology
Answer: A · Doses should be given on time at evenly spaced intervals
Why this is the answer
For beta-lactams, efficacy depends on the time the drug level stays above the minimum inhibitory concentration. Evenly spaced, on-time doses, or extended infusions, support this.
Answer
A · Doses should be given on time at evenly spaced intervals
13.Med-surg: cardiovascular & respiratory
Answer: C · Sit down for tasks such as washing and dressing, and pace activities
Why this is the answer
Planning and pacing, sitting for tasks, keeping frequently used items within reach and breathing out during effort reduce breathlessness. Complete inactivity worsens deconditioning, so activity is encouraged within limits.
Answer
C · Sit down for tasks such as washing and dressing, and pace activities
14.Med-surg: cardiovascular & respiratory
Answer: B · Superior vena cava obstruction
Why this is the answer
A tumour in the mediastinum can compress the superior vena cava, causing swelling of the face, neck and arms, dilated veins on the chest and breathlessness. It is an oncological emergency. The patient is sat upright and given oxygen if hypoxic, and treatment may include a stent, steroids or radiotherapy.
Answer
B · Superior vena cava obstruction
15.Med-surg: neuro, endocrine & renal
Answer: B · Signs of bleeding, such as haematuria and a rising pulse
Why this is the answer
Bleeding is the main complication of kidney biopsy. The patient usually has bed rest for some hours, with frequent BP and pulse checks and inspection of urine for haematuria. Back pain or a falling BP is reported at once.
Answer
B · Signs of bleeding, such as haematuria and a rising pulse
16.Med-surg: neuro, endocrine & renal
Answer: B · Weak breathing at night, so a review for ventilation support
Why this is the answer
Weak respiratory muscles cause nocturnal hypoventilation and a rise in CO2, leading to morning headaches, disturbed sleep and daytime drowsiness. Non-invasive ventilation can improve symptoms and survival, in line with the patient's wishes.
Answer
B · Weak breathing at night, so a review for ventilation support
17.Med-surg: GI, perioperative & oncology
Answer: B · Serotonin syndrome with some antidepressants, and seizures
Why this is the answer
Tramadol is a weak opioid that also inhibits serotonin and noradrenaline reuptake. It can lower the seizure threshold and cause serotonin syndrome with SSRIs and other serotonergic drugs.
Answer
B · Serotonin syndrome with some antidepressants, and seizures
18.Med-surg: GI, perioperative & oncology
Answer: C · Potassium 2.9 mmol/L
Why this is the answer
Normal potassium is about 3.5–5.0 mmol/L. Hypokalaemia increases the risk of arrhythmias during anaesthesia and needs correction before elective surgery. The other results are within normal ranges.
Answer
C · Potassium 2.9 mmol/L
19.Maternity & obstetric nursing
Answer: A · Effective ventilation comes first; naloxone is not routine
Why this is the answer
Opioids cross the placenta and can depress newborn breathing. Resuscitation guidelines put effective ventilation first; naloxone is not part of routine newborn resuscitation and should be avoided if the mother uses opioids long term, as it can cause acute withdrawal and seizures. Flumazenil reverses benzodiazepines, not opioids.
Answer
A · Effective ventilation comes first; naloxone is not routine
20.Maternity & obstetric nursing
Answer: B · Antenatal corticosteroids
Why this is the answer
Antenatal corticosteroids reduce respiratory distress in preterm babies. Tocolysis may be used to gain time, and magnesium sulfate may be given for fetal neuroprotection when birth before about 32 weeks is likely.
Answer
B · Antenatal corticosteroids
21.Pediatric nursing
Answer: D · Evaporation; dry the baby straight away, including the head
Why this is the answer
A wet newborn loses heat rapidly through evaporation. Drying the baby at once, removing wet towels, covering the head and skin-to-skin contact all reduce heat loss.
Answer
D · Evaporation; dry the baby straight away, including the head
22.Pediatric nursing
Answer: A · Abusive head trauma
Why this is the answer
Abusive head trauma (shaken baby syndrome) often shows subdural haemorrhage and retinal haemorrhages with few external injuries. The infant needs urgent medical care, and the nurse follows the safeguarding procedure.
Answer
A · Abusive head trauma
23.Mental health nursing
Answer: A · "Tell me more about what that feeling is like for you."
Why this is the answer
Exploring asks the patient to describe an experience in more detail. Generalising, disapproving and changing the subject block the patient from talking.
Answer
A · "Tell me more about what that feeling is like for you."
24.Mental health nursing
Answer: C · A patient with severe psychotic depression who has stopped eating and drinking
Why this is the answer
ECT is effective for severe depression, especially with psychotic features, high suicide risk or refusal of food and fluids, when a rapid response is needed. It is not a first choice for mild conditions.
Answer
C · A patient with severe psychotic depression who has stopped eating and drinking
25.Nursing math & unit conversions
Answer: h = 69.3 in
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.
Centimetres to inches
h = 176/2.54 = 69.29 ≈ 69.3 in
Answer
h = 69.3 in
26.Nursing math & unit conversions
Answer: V = 787.5 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
1½ tsp = 1.5·5 = 7.5 mL
3 cups = 3·240 = 720 mL
1 tbsp = 1·15 = 15 mL
1½ fl oz = 1.5·30 = 45 mL
Add
V = 7.5 + 720 + 15 + 45 = 787.5 mL
Answer
V = 787.5 mL
27.Dosage calculations
Answer: V = 2.4 mL
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 after mixing
500 mg/10 mL = 50 mg/mL
Volume
V = 120/50 = 2.4 mL
Answer
V = 2.4 mL
28.Dosage calculations
Answer: V = 4.2 mL
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.
Weight in kg
30.8/2.2 = 14 kg
Dose
15·14 = 210 mg
Volume
V = (210/250)·5 = 4.2 mL
Answer
V = 4.2 mL
29.IV infusion rates
Answer: V = 450 mL
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
25·60/20 = 75 mL/h
Volume
V = 75·6 = 450 mL
Answer
V = 450 mL
30.IV infusion rates
Answer: t = 22.5 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
20·60/60 = 20 mL/h
Time left
t = 450/20 = 22.5 h
Answer
t = 22.5 h
31.IV fluids & fluid balance
Answer: B = 1535 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: 250 + 120 + 240 = 610 mL
IV infusion: 125·12 = 1500 mL
IV antibiotic: 1·50 = 50 mL
total intake = 2160 mL
Total output
475 + 150 = 625 mL
Balance
B = 2160 − 625 = 1535 mL
Answer
B = 1535 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: V = 300 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
08:15 → 12:15 = 4 h
Volume infused
50·4 = 200 mL
Volume left
V = 500 − 200 = 300 mL
Answer
V = 300 mL
33.Clinical assessment scores
Answer: B = 15
Braden scale: six subscales for pressure-injury risk. Sensory perception, moisture, activity, mobility and nutrition score 1 to 4, from the worst level (1) to no problem (4); friction and shear scores 1 to 3. The total runs from 6 to 23, and a lower total means a higher risk. Common bands: 19–23 not at risk, 15–18 mild risk, 13–14 moderate risk, 10–12 high risk and 9 or below very high risk.
Score each subscale
sensory perception: slightly limited → 3
moisture: constantly moist → 1
activity: walks frequently → 4
mobility: very limited → 2
nutrition: probably inadequate → 2
friction and shear: no apparent problem → 3
Add
Braden total = 3 + 1 + 4 + 2 + 2 + 3 = 15
Answer
B = 15
34.Clinical assessment scores
Answer: healthy weight
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 = 65/1.82² = 19.62
Category
healthy weight
Answer
healthy weight
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