Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
Prioritization & delegation
Method
Ask what will harm the patient soonest if nothing is done.
Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
Assess before you act unless it is an emergency; then choose the step the others depend on.
For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.
Lab values & electrolytes
Method
Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
Link the value to its typical signs and to the drugs and conditions that cause it.
Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.
Med-surg: cardiovascular & respiratory
Method
Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
Choose the safe first action, then escalate and reassess.
Med-surg: neuro, endocrine & renal
Method
Check the glucose in every patient with new confusion, weakness or a seizure.
Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.
Med-surg: GI, perioperative & oncology
Method
Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.
Maternity & obstetric nursing
Method
Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.
Pediatric nursing
Method
Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
Match the action to the development stage and involve the family.
Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.
Mental health nursing
Method
Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
Respect rights: the least restrictive option, consent and confidentiality with its limits.
Nursing math & unit conversions
Metric steps
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
Weight and length
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
Household measures
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
falls 25, diagnosis 15, aid 15/30, IV 20, gait 10/20, mental status 15
NEWS2 risk
0–4 low; single 3 low–medium; 5–6 medium; ≥ 7 high
Mean arterial pressure
MAP = (SBP + 2·DBP)/3 = DBP + PP/3
Pulse pressure and shock index
PP = SBP − DBP, SI = HR/SBP
Body mass index
BMI = kg/m² = 703·lb/in²
Method
Find the score sheet that the question uses and its range (GCS 3–15, APGAR 0–10, Braden 6–23, Morse 0–125).
Score every item separately, matching the description to its level.
Add the item scores and check that the total lies inside the range.
Apply the cut-offs: for NEWS2 also look for any single parameter scoring 3.
For derived values use MAP = (SBP + 2·DBP)/3, PP = SBP − DBP, SI = HR/SBP and BMI = kg/m².
2Practice problems
1.Nursing fundamentalsMedium
How is a 24-hour urine collection started?
AOnly urine passed at night is collected
BA sample is taken every four hours and the rest discarded
CThe first urine of the morning is discarded and the time noted, then all urine is kept
DThe first urine of the morning is kept and the rest of the day's urine is discarded
2.Nursing fundamentalsHard
A patient with a slow-healing leg ulcer is eating less than half of their meals. What is the most helpful nursing action?
AWait until the ulcer heals before addressing nutrition
BRefer to the dietitian and support protein and energy intake
CGive extra salt to stimulate the appetite
DAsk the patient to drink less to avoid swelling
3.Infection control & patient safetyMedium
Two patients infected with the same organism are admitted, and no single room is available. What is an accepted option?
AStopping contact precautions
BPlacing each with a patient who has a weakened immune system
CCohorting them in the same room, according to infection control advice
DPlacing them in the corridor
4.Infection control & patient safetyHard
A patient has signed a surgical consent form but tells the nurse, “I don’t really understand what they are going to do.” What should the nurse do?
AGive the preoperative sedative so the patient relaxes
BInform the surgeon so the procedure can be explained again before any sedation
CExplain the risks and benefits in place of the surgeon
DReassure the patient that the surgeon knows best and continue with the preparation
5.Prioritization & delegationMedium
A patient arrives in the recovery room after general anesthesia. What does the nurse assess first?
AThe pain score
BAirway patency and breathing
CUrine output
DThe surgical dressing and the drains
6.Prioritization & delegationHard
Two call lights go on at the same time. One patient has pain of 7/10 after surgery. The other is a confused patient at high risk of falls who is climbing out of bed alone. Who does the nurse go to first?
AThe confused patient climbing out of bed
BThe patient in pain after surgery
CWhichever patient’s room is closer to the station
DThe patient whose call light went on first
7.Clinical nursingMedium
A patient with neutropenia after chemotherapy has a temperature of 38.3 °C. What is the priority?
AEncourage the patient to go for a walk
BWait 24 hours to see whether the fever settles
CGive paracetamol only and recheck the temperature again tomorrow
DTreat as neutropenic sepsis and give IV antibiotics urgently
8.Clinical nursingHard
A nurse teaches a patient with reflux disease. Which statement shows a need for further teaching?
A"A big meal just before bed is fine if I take my tablet."
B"I will cut down on alcohol."
C"I will raise the head of my bed with blocks."
D"I will try to lose some weight over the next months."
9.Lab values & electrolytesMedium
On the first day after major surgery, a patient's white cell count is 12.5 × 10³/µL, with no fever or wound signs. What is the best interpretation?
ADefinite wound infection that needs antibiotics now
BA common stress response to surgery that is monitored
CA sign of leukemia that needs bone marrow testing
DA laboratory error, since surgery lowers white cells
10.Lab values & electrolytesHard
A patient's low calcium does not improve despite several days of calcium replacement. Which other electrolyte should be checked and corrected?
ABicarbonate
BChloride
CSodium
DMagnesium
11.PharmacologyMedium
A patient starting niacin (nicotinic acid) complains of flushing and warmth after doses. Which advice may reduce this?
ATake the niacin with a hot drink so that it dissolves and acts faster
BTake it on an empty stomach in a hot bath
CTake aspirin 30 minutes before the niacin, if the prescriber agrees
DDouble the dose to build tolerance faster
12.PharmacologyHard
Why are antipsychotics used with great caution in older people with dementia?
AThey cause severe hypoglycaemia in older people
BThey always cure the dementia and stop all behaviour problems
CThey are linked to a higher risk of stroke and death
DThey are not absorbed in people over 65
13.Med-surg: cardiovascular & respiratoryMedium
A patient uses a glyceryl trinitrate (nitroglycerin) patch for angina. Why is it usually removed for several hours each day?
AIt lowers the risk of a high potassium level
BThe patch works only during the night
CA nitrate-free interval prevents tolerance
DThe skin needs a break to absorb a larger dose
14.Med-surg: cardiovascular & respiratoryHard
A patient on an unfractionated heparin infusion has a nosebleed that will not stop, and the aPTT is far above the target range. What is the most appropriate action?
AGive vitamin K and continue the infusion at a slightly lower rate
BIncrease the infusion, as the aPTT will settle
CContinue the infusion at the same rate and pack the nose firmly
DStop the infusion, inform the prescriber and anticipate protamine
15.Med-surg: neuro, endocrine & renalMedium
After a change in the levothyroxine dose, when is the TSH usually rechecked?
AAfter about 2 years of treatment
BAfter 24 hours
CAfter about 6–8 weeks
DAfter 3 days
16.Med-surg: neuro, endocrine & renalHard
A patient with hypopituitarism needs both hydrocortisone and levothyroxine. Which is usually started first?
ANeither, until symptoms appear
BHydrocortisone
CBoth on the same day, in any order
DLevothyroxine
17.Med-surg: GI, perioperative & oncologyMedium
A patient is starting regular oral morphine. Which bowel advice is most appropriate?
ATake a bulk-forming laxative only with very little water
BWait until there has been no stool for a week
CStop eating fibre completely
DStart a regular laxative at the same time
18.Med-surg: GI, perioperative & oncologyHard
A patient with a high-voltage electrical injury has small entry and exit wounds. Why is close monitoring needed?
AElectrical injuries never cause damage beneath the skin surface
BSmall skin wounds show that the internal injury must also be minor
CThe only real risk is a minor infection of the skin wounds
A woman with hypothyroidism becomes pregnant. What usually happens to her levothyroxine needs?
AThey stay the same, so no monitoring is needed
BThey usually rise, so levels are checked early
CShe switches to iodine tablets instead
DThey decrease to zero, so she stops the drug
20.Maternity & obstetric nursingHard
A woman 5 hours after birth had a large blood loss and now has a heart rate of 128/min, blood pressure of 88/50 mmHg and cold hands. Which action is most important?
AAsk her to walk to improve circulation
BCall for urgent help and start fluid resuscitation
CGive her a hot drink and recheck in an hour
DEncourage her to breastfeed to contract the uterus
21.Pediatric nursingMedium
If the MMR and varicella vaccines are not given on the same day, what is the general rule?
AGive the second within 24 hours of the first
BSeparate them by at least 1 week
CSeparate them by at least 4 weeks
DNever give both vaccines in the same year
22.Pediatric nursingHard
A 3-month-old is gaining weight poorly. The mother says she adds extra water to the formula to make each tin last longer. Besides poor growth, what serious complication is the nurse concerned about?
AVitamin K deficiency bleeding from the extra water
BLow sodium from water intoxication, which can cause seizures
CHigh blood glucose from the sugar in the diluted formula, causing diabetes
DHigh sodium from too much powder, which causes dehydration
23.Mental health nursingMedium
According to Maslow's hierarchy of needs, which patient need should a nurse on a mental health ward address first?
AA patient who wants to find a new hobby
BA patient who feels lonely and wants more visitors
CA patient who has not eaten or drunk anything for two days
DA patient who wants to improve her self-esteem
24.Mental health nursingHard
A patient with borderline personality disorder and frequent self-harm says, "I'm going to kill myself tonight," after an argument on the phone. A colleague says, "She always says that." What should the nurse do?
ACarry out a full suicide risk assessment, as with any patient who expresses suicidal intent
BAgree with the colleague and take no action at all
CWait until the next morning to see if she still feels the same once the argument has settled down
DTell the patient she is only seeking attention
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 96.5 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.
96.5 °F
T = °C
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 19:20 and finishes at 07:15 the next morning (24-hour clock). How many hours t did it run? Give the answer in hours as a decimal, rounded to two decimal places.
19:2007:15
t = h
27.Dosage calculationsMedium
A child weighing 8 kg is prescribed 7.5 mg/kg of a drug. The stock solution contains 10 mg/mL. Draw up the dose: what volume V do you give?
8 kg7.5 mg/kg10 mg/mL
V = mL
28.Dosage calculationsHard
The prescription is 0.38 mg. The ampoule contains 2000 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
0.38 mg2000 mcg/mL
V = mL
29.IV infusion ratesMedium
500 mL was ordered over 8 hours. After 5 hours you find that 230 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 / 8 hafter 5 h: 230 mL
R = mL/h
30.IV infusion ratesHard
500 mL was ordered over 6 hours. After 3 hours you find that 300 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?
500 mL / 6 hafter 3 h: 300 mL
Δ = %
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 1000 mL bag was started at 10:30 and runs by pump at 50 mL/h. How many mL V are left in the bag at 17:00?
1000 mL50 mL/h10:30 → 17:00
V = mL
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 12, with E4 and V4. What motor score M was recorded, and which response does it describe? Give the number.
GCS 12E4V4
M =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 65 mmHg. A patient’s systolic pressure is 105 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 65 mmHg?
MAP 65 mmHgSBP 105 mmHg
DBP = mmHg
3Solutions
1.Nursing fundamentals
Answer: C · The first urine of the morning is discarded and the time noted, then all urine is kept
Why this is the answer
The patient empties the bladder at the start and that urine is discarded. All urine for the next 24 hours is kept, including a final void at the end time.
Answer
C · The first urine of the morning is discarded and the time noted, then all urine is kept
2.Nursing fundamentals
Answer: B · Refer to the dietitian and support protein and energy intake
Why this is the answer
Poor intake delays healing. Screening, dietitian referral, food charts and support with meals, including protein and energy supplements if needed, help the wound heal.
Answer
B · Refer to the dietitian and support protein and energy intake
3.Infection control & patient safety
Answer: C · Cohorting them in the same room, according to infection control advice
Why this is the answer
When single rooms are short, patients with the same organism (and no other infections) can share a room (cohorting), with precautions continued. Infection control staff advise on this.
Answer
C · Cohorting them in the same room, according to infection control advice
4.Infection control & patient safety
Answer: B · Inform the surgeon so the procedure can be explained again before any sedation
Why this is the answer
Informed consent is the responsibility of the person doing the procedure. If the patient does not understand, the nurse pauses the process and tells the surgeon, before any sedative drug is given.
Answer
B · Inform the surgeon so the procedure can be explained again before any sedation
5.Prioritization & delegation
Answer: B · Airway patency and breathing
Why this is the answer
After anesthesia, the airway can be blocked by the tongue or secretions, and breathing may be depressed. The airway and breathing are checked first, followed by circulation and the wound.
Answer
B · Airway patency and breathing
6.Prioritization & delegation
Answer: A · The confused patient climbing out of bed
Why this is the answer
A confused patient climbing out of bed could fall and be badly injured within moments. Pain needs prompt treatment, but the immediate safety risk comes first.
Answer
A · The confused patient climbing out of bed
7.Clinical nursing
Answer: D · Treat as neutropenic sepsis and give IV antibiotics urgently
Why this is the answer
Neutropenic sepsis is an oncological emergency. Broad-spectrum IV antibiotics should be given within an hour, without waiting for test results.
Answer
D · Treat as neutropenic sepsis and give IV antibiotics urgently
8.Clinical nursing
Answer: A · "A big meal just before bed is fine if I take my tablet."
Why this is the answer
Large late meals increase reflux even when a PPI is taken. Raising the head of the bed, losing weight and reducing alcohol are correct measures.
Answer
A · "A big meal just before bed is fine if I take my tablet."
9.Lab values & electrolytes
Answer: B · A common stress response to surgery that is monitored
Why this is the answer
A mild leukocytosis is common after surgery because of tissue injury and the stress response. It is monitored along with temperature and wound assessment. A rising count after several days, or fever, suggests infection.Checked against:WBC count · MedlinePlus (NIH) (2025)
Answer
B · A common stress response to surgery that is monitored
10.Lab values & electrolytes
Answer: D · Magnesium
Why this is the answer
Low magnesium reduces parathyroid hormone secretion and the body's response to it, so hypocalcemia does not correct until magnesium is replaced. The same applies to refractory hypokalemia.Checked against:Magnesium Blood Test · MedlinePlus (NIH) (2023)
Answer
D · Magnesium
11.Pharmacology
Answer: C · Take aspirin 30 minutes before the niacin, if the prescriber agrees
Why this is the answer
Niacin causes prostaglandin-mediated vasodilation and flushing. Aspirin beforehand, taking it with food and avoiding hot drinks and alcohol reduce this effect.
Answer
C · Take aspirin 30 minutes before the niacin, if the prescriber agrees
12.Pharmacology
Answer: C · They are linked to a higher risk of stroke and death
Why this is the answer
In older people with dementia, antipsychotics increase the risk of stroke and death. Non-drug approaches are tried first, and antipsychotics are used at low doses for short periods if needed.
Answer
C · They are linked to a higher risk of stroke and death
13.Med-surg: cardiovascular & respiratory
Answer: C · A nitrate-free interval prevents tolerance
Why this is the answer
Continuous nitrate use leads to tolerance within days. A daily nitrate-free period (often overnight, when angina is least likely) keeps the drug effective. Patients are taught to rotate patch sites.
Answer
C · A nitrate-free interval prevents tolerance
14.Med-surg: cardiovascular & respiratory
Answer: D · Stop the infusion, inform the prescriber and anticipate protamine
Why this is the answer
With bleeding and a high aPTT, the heparin infusion is stopped at once and the prescriber informed. Because heparin's effect wears off within hours, stopping is often enough, but protamine sulfate can reverse it. Vitamin K reverses warfarin, not heparin.
Answer
D · Stop the infusion, inform the prescriber and anticipate protamine
15.Med-surg: neuro, endocrine & renal
Answer: C · After about 6–8 weeks
Why this is the answer
Levothyroxine has a half-life of about a week, so it takes several weeks to reach a new steady state. TSH is usually rechecked about 6–8 weeks after a dose change.
Answer
C · After about 6–8 weeks
16.Med-surg: neuro, endocrine & renal
Answer: B · Hydrocortisone
Why this is the answer
Starting thyroid replacement first increases metabolism and cortisol clearance and can trigger an adrenal crisis in a patient with low cortisol. Glucocorticoid replacement is started before levothyroxine.
Answer
B · Hydrocortisone
17.Med-surg: GI, perioperative & oncology
Answer: D · Start a regular laxative at the same time
Why this is the answer
Opioids slow gut movement, and tolerance to constipation does not develop. A regular laxative, often a stimulant with a softener, is started with the opioid, alongside fluids and mobility where possible.
Answer
D · Start a regular laxative at the same time
18.Med-surg: GI, perioperative & oncology
Answer: D · Hidden muscle damage: arrhythmias, rhabdomyolysis, kidney injury
Why this is the answer
Electrical current travels along nerves, vessels and muscles, causing deep injury beneath small skin wounds. Patients need cardiac monitoring, assessment for compartment syndrome and urine checks for myoglobin (dark urine), with a higher urine output target if myoglobinuria is present.
Answer
D · Hidden muscle damage: arrhythmias, rhabdomyolysis, kidney injury
19.Maternity & obstetric nursing
Answer: B · They usually rise, so levels are checked early
Why this is the answer
Levothyroxine needs usually rise in pregnancy. Thyroid function is checked as soon as pregnancy is confirmed and regularly afterwards, because untreated hypothyroidism can affect fetal brain development.
Answer
B · They usually rise, so levels are checked early
20.Maternity & obstetric nursing
Answer: B · Call for urgent help and start fluid resuscitation
Why this is the answer
Tachycardia, hypotension and cool peripheries indicate hypovolaemic shock. Help is called, IV access secured, fluids and blood given as prescribed, and the cause of bleeding treated.
Answer
B · Call for urgent help and start fluid resuscitation
21.Pediatric nursing
Answer: C · Separate them by at least 4 weeks
Why this is the answer
Two live injected vaccines are given either on the same day or at least 4 weeks apart. A shorter gap can reduce the immune response to the second vaccine.
Answer
C · Separate them by at least 4 weeks
22.Pediatric nursing
Answer: B · Low sodium from water intoxication, which can cause seizures
Why this is the answer
Over-diluted formula gives too few calories and too much free water, which can cause hyponatraemia and seizures. The nurse should also address the underlying problem, for example by linking the family with financial or social support.
Answer
B · Low sodium from water intoxication, which can cause seizures
23.Mental health nursing
Answer: C · A patient who has not eaten or drunk anything for two days
Why this is the answer
Maslow places physiological needs, such as food and fluids, before safety, love and belonging, esteem and self-actualisation. A patient who is not eating or drinking has the most basic unmet need.
Answer
C · A patient who has not eaten or drunk anything for two days
24.Mental health nursing
Answer: A · Carry out a full suicide risk assessment, as with any patient who expresses suicidal intent
Why this is the answer
People with borderline personality disorder have a significantly raised risk of suicide. Every statement of suicidal intent must be assessed; labelling it as attention-seeking can lead to missed risk.
Answer
A · Carry out a full suicide risk assessment, as with any patient who expresses suicidal intent
25.Nursing math & unit conversions
Answer: T = 35.8 °C
Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.
Subtract 32
96.5 − 32 = 64.5
Multiply by 5/9
T = 64.5·5/9 = 35.83 ≈ 35.8 °C
Answer
T = 35.8 °C
26.Nursing math & unit conversions
Answer: t = 11.92 h
24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.
Before midnight
19:20 → 24:00 = 280 min
After midnight
00:00 → 07:15 = 435 min
Total
280 + 435 = 715 min
t = 715/60 = 11.92 h
Answer
t = 11.92 h
27.Dosage calculations
Answer: V = 6 mL
Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.
Dose from body weight
D = 7.5·8 = 60 mg
Volume
V = 60/10 = 6 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 6 mL
28.Dosage calculations
Answer: V = 0.19 mL
Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.
Same units
0.38 mg = 380 mcg
Volume
V = 380/2000 = 0.19 mL
Answer
V = 0.19 mL
29.IV infusion rates
Answer: R = 76.67 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
500/8 = 62.5 mL/h
New rate
R = 230/3 = 76.67 mL/h
Answer
R = 76.67 mL/h
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
30.IV infusion rates
Answer: Δ = 20 %
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
500/6 = 83.33 mL/h
New rate
R = 300/3 = 100 mL/h
Percentage change
Δ = (100 − 83.33)/83.33·100% = 20%
Answer
Δ = 20%
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
31.IV fluids & fluid balance
Answer: B = −305 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: 100 + 240 = 340 mL
IV infusion: 50·12 = 600 mL
IV antibiotic: 2·50 = 100 mL
total intake = 1040 mL
Total output
300 + 250 + 450 + 225 + 120 = 1345 mL
Balance
B = 1040 − 1345 = −305 mL
Answer
B = −305 mL
Negative: the patient lost more fluid than went in.
32.IV fluids & fluid balance
Answer: V = 675 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
10:30 → 17:00 = 6.5 h
Volume infused
50·6.5 = 325 mL
Volume left
V = 1000 − 325 = 675 mL
Answer
V = 675 mL
33.Clinical assessment scores
Answer: M = 4
Glasgow Coma Scale: add the best response in three areas. Eye opening E: 4 spontaneous, 3 to sound or speech, 2 to pressure, 1 none. Verbal V: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Motor M: 6 obeys commands, 5 localises, 4 normal flexion (withdraws), 3 abnormal flexion, 2 extension, 1 none. The total runs from 3 to 15. After a head injury, 13–15 is usually called mild, 9–12 moderate and 3–8 severe.
Motor score
M = 12 − 4 − 4 = 4
M4: withdraws the limb from pressure (normal flexion)
Answer
M = 4
34.Clinical assessment scores
Answer: DBP = 45 mmHg
Blood pressure values: pulse pressure PP = SBP − DBP. Mean arterial pressure MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3, an estimate based on the heart spending about two thirds of each beat in diastole at a normal heart rate (less accurate when the heart rate is fast); a MAP of at least about 65 mmHg is a common target for organ perfusion. The shock index SI = heart rate/SBP is normally about 0.5–0.7; a value above about 1 is a warning sign of shock.
Rearrange
DBP = (3·MAP − SBP)/2
Substitute
DBP = (3·65 − 105)/2 = 90/2 = 45 mmHg
Answer
DBP = 45 mmHg
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