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
Which stool sample is suitable for Clostridioides difficile testing?
AA stool sample mixed with urine
BA loose stool that takes the shape of the container
CA hard, formed stool collected first thing in the morning
DA dry smear of stool on a tissue
2.Nursing fundamentalsHard
Which postoperative finding should be reported most urgently?
ARespiratory rate 8/min and difficult to rouse
BUrine output of 50 mL in the last hour
CPain score of 4/10 at the wound site when moving
DTemperature 37.4 °C on the first day
3.Infection control & patient safetyMedium
A small spill of blood is found on the floor. How should it be cleaned?
ALeave it until housekeeping arrives the next morning
BCover it with a clean sheet and keep working
CWear gloves, absorb the blood, then clean the area with an approved disinfectant
DWipe it up quickly with a dry cloth using bare hands, then wash the hands well
4.Infection control & patient safetyHard
A patient with severe immunosuppression after a stem cell transplant is in a protective environment. Which item should not be brought into the room?
AA clean, disinfected tablet computer
BThe patient’s own clean clothes
CA family photo in a frame that has been wiped clean
DFresh flowers or potted plants
5.Prioritization & delegationMedium
A patient with mild dysphagia after a stroke is eating. Which technique helps make swallowing safer?
ATalking while eating to stay alert
BLying flat with the head tilted back
CDrinking thin fluids quickly through a straw between bites
DSitting upright with the chin tucked down while swallowing
6.Prioritization & delegationHard
An older adult with type 2 diabetes is confused and very dehydrated. The glucose is 900 mg/dL (50 mmol/L), and blood and urine show no significant ketones. What is the most likely problem?
AHypoglycemia with rebound
BDiabetic ketoacidosis
CHyperosmolar hyperglycemic state
DStress-induced mild hyperglycemia
7.Clinical nursingMedium
Why must levodopa for Parkinson's disease be given at the exact times prescribed in hospital?
AEarly doses cause severe low blood glucose and sweating attacks
BDelays can quickly worsen rigidity, immobility and swallowing
CLate doses cause dangerous high potassium
DThe drug only works if taken at midnight
8.Clinical nursingHard
Two days after a bowel resection, a patient has rising pain, fever, tachycardia and fluid that looks like faeces in the wound drain. What is most likely?
AUrinary retention
BNormal postoperative recovery
CConstipation
DAnastomotic leak
9.Lab values & electrolytesMedium
A patient taking phenazopyridine for bladder pain has bright orange urine. What should the nurse know about urine tests?
AThe drug improves the accuracy of all dipsticks
BThe dye can interfere with dipstick color readings
CThe color shows severe liver failure is present
DThe color proves blood is present in the urine
10.Lab values & electrolytesHard
A patient receiving parenteral nutrition with lipid emulsion has a triglyceride level of 620 mg/dL (7.0 mmol/L). Why is this result important?
AIt is a normal fasting value for adults
BIt means the patient needs more lipid
CIt raises the risk of acute pancreatitis
DIt shows the nutrition is fully effective
11.PharmacologyMedium
Which adverse effect is typical of metoclopramide, especially in young people?
ADry cough
BSevere constipation
CLow blood glucose
DExtrapyramidal movement disorders such as acute dystonia
12.PharmacologyHard
A patient taking azathioprine is prescribed allopurinol for gout. What is the main danger?
AGout becomes worse because allopurinol is inactivated by azathioprine
BSevere hypertension from the combination
CSevere bone marrow suppression, because azathioprine breakdown is reduced
DLiver enzyme induction, making azathioprine ineffective
13.Med-surg: cardiovascular & respiratoryMedium
Why is a higher level of HDL cholesterol considered protective?
AHDL lowers the blood pressure directly
BHDL thins the blood in the same way as an anticoagulant
CHDL is converted into vitamin D in the walls of the arteries
DHDL carries cholesterol from the tissues back to the liver
14.Med-surg: cardiovascular & respiratoryHard
Four hours after PCI via the femoral artery, the groin dressing is soaked with blood and a firm swelling is growing. What is the immediate action?
AHelp the patient sit up and walk to the toilet to void
BApply firm pressure just above the puncture site and call for help
CIncrease the heparin infusion rate so that no clot forms at the site
DRemove the dressing and leave the site open to the air
15.Med-surg: neuro, endocrine & renalMedium
A patient with type 1 diabetes plans a long cycle ride. Which advice is most appropriate?
ATake an extra dose of rapid-acting insulin before setting off
BAvoid checking glucose until the ride is over
CSkip breakfast so the exercise burns body fat
DCheck glucose before and after, and carry fast-acting carbohydrate
16.Med-surg: neuro, endocrine & renalHard
Weeks after starting insulin, a patient with newly diagnosed type 1 diabetes needs much less insulin and has frequent mild hypos. What is the most likely explanation?
AA honeymoon phase, but insulin is still needed
BThe insulin has gone off and should be replaced
CThe diabetes has been cured, so insulin can stop
DThe patient actually has type 2 diabetes
17.Med-surg: GI, perioperative & oncologyMedium
Which bedside assessments are used to follow ascites?
APupil size and reaction twice daily
BCapillary glucose before each meal
CDaily weight and abdominal girth
DPeak flow and oxygen saturation
18.Med-surg: GI, perioperative & oncologyHard
A patient with a sacral pressure ulcer keeps sliding down the bed when the head is raised high. Which advice best reduces shear?
AKeep the head of the bed at or below 30° if possible; use slide sheets
BUse a dry sheet and drag the patient up the bed
CRaise the head of the bed to 90° and pull the patient up the bed by the arms
DSit the patient upright without any support for the feet
19.Maternity & obstetric nursingMedium
A woman with hyperemesis gravidarum has been vomiting for weeks. Which vitamin is given before glucose-containing fluids to prevent Wernicke encephalopathy?
AAscorbic acid (vitamin C)
BVitamin D
CThiamine (vitamin B1)
DPhytomenadione (vitamin K)
20.Maternity & obstetric nursingHard
A newborn's left foot is turned inward and downward and cannot be moved to a normal position. What should the nurse tell the parents?
AIt is caused by a lack of vitamin D
BSurgery is needed within the first day
CIt is normal positioning in the uterus and needs no follow-up
DIt suggests clubfoot, treated early with casting
21.Pediatric nursingMedium
A 3-year-old who used to speak in short sentences has stopped talking and no longer responds to her name. What is the most important point?
AIt is normal regression at this age
BIt means the child is tired and should be seen in a year
CLanguage develops in sudden spurts, so this is expected
DLoss of previously gained skills at any age needs prompt assessment
22.Pediatric nursingHard
A toddler with tetralogy of Fallot is crying hard and becomes deeply cyanotic and limp. What should the nurse do first?
APlace the child in a knee–chest position, keep them calm and call for help
BTake the child for a walk to calm down
CMeasure the head circumference
DLie the child flat with the legs raised to increase the return of blood to the heart
23.Mental health nursingMedium
A patient taking an antipsychotic is going on a summer day trip. What should the nurse teach?
AStop the medicine for the day so that it does not interact with the sunlight and cause a dangerous reaction
BAvoid all fluids so that there is less need to find a toilet
CExercise as hard as possible in the heat to burn off the extra weight
DDrink enough fluids and avoid overheating, because the medicine can affect temperature control
24.Mental health nursingHard
A voluntary patient who has no immediate risk of harm wants to leave the ward against medical advice. What is the correct general approach?
ATell the patient that staff will restrain them and bring them back to the ward if they try to leave without the doctor's permission
BExplain the risks, inform the team, document the discussion and respect their right to leave according to the law and policy
CLock the door to stop the patient leaving
DHide the patient's belongings
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient is 4 ft 1 in tall. Using 1 ft = 12 in and 1 in = 2.54 cm, find the height h in centimetres, to the nearest whole centimetre.
4 ft 1 in1 ft = 12 in1 in = 2.54 cm
h = cm
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A maintenance infusion runs at 60 mL/h without a break. How many litres V does it deliver in 24 hours?
60 mL/h24 h
V = L
27.Dosage calculationsMedium
A patient weighs 90 kg. The prescribed dose is 20 mg/kg per day, given in 2 equal doses. How many milligrams D are given per dose?
90 kg20 mg/kg/day2× per day
D = mg
28.Dosage calculationsHard
You must prepare 250 mL of a 2% (w/v) solution from a 20% (w/v) stock solution. What volume of stock V₁ do you need?
C₁ = 20%C₂ = 2%V₂ = 250 mL
V₁ = mL
29.IV infusion ratesMedium
A drip runs at 75 gtt/min through a set of 60 gtt/mL. How many millilitres V does the patient receive in 3 hours?
75 gtt/min60 gtt/mL3 h
V = mL
30.IV infusion ratesHard
500 mg of a drug is diluted in 250 mL and given by gravity through a set of 60 gtt/mL. The order is 60 mg per hour. Find the drip rate R in drops per minute.
500 mg/250 mL60 mg/h60 gtt/mL
R = gtt/min
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 patient weighs 110 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 60 mL/h. At 18:00, 300 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL300 mL infused60 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: holds on to furniture; IV therapy or saline lock: no; gait: weak; mental status: overestimates or forgets limits. Find the Morse total MFS.
0–125
MFS =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 106 kg and is 151 cm tall. Calculate the BMI and click the WHO weight category.
106 kg151 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
3Solutions
1.Nursing fundamentals
Answer: B · A loose stool that takes the shape of the container
Why this is the answer
Only diarrhoeal stool (types 5–7 on the Bristol Stool Chart) is tested for C. difficile. The sample is collected in a clean pot without urine contamination.
Answer
B · A loose stool that takes the shape of the container
2.Nursing fundamentals
Answer: A · Respiratory rate 8/min and difficult to rouse
Why this is the answer
A low respiratory rate with reduced consciousness may mean opioid toxicity or deterioration and threatens the airway. The other findings are common after surgery and can be managed routinely.
Answer
A · Respiratory rate 8/min and difficult to rouse
3.Infection control & patient safety
Answer: C · Wear gloves, absorb the blood, then clean the area with an approved disinfectant
Why this is the answer
Blood spills are cleaned promptly by staff wearing gloves. The blood is absorbed with disposable material, then the area is cleaned and disinfected with a hospital disinfectant, and waste goes into clinical waste.
Answer
C · Wear gloves, absorb the blood, then clean the area with an approved disinfectant
4.Infection control & patient safety
Answer: D · Fresh flowers or potted plants
Why this is the answer
Fresh flowers and plants can carry molds such as Aspergillus and water-borne bacteria, which can cause serious infections in severely immunocompromised patients. Clean, wipeable personal items are usually allowed.
Answer
D · Fresh flowers or potted plants
5.Prioritization & delegation
Answer: D · Sitting upright with the chin tucked down while swallowing
Why this is the answer
Sitting upright and tucking the chin narrows the airway entrance and helps food pass into the esophagus. The nurse follows the speech therapist’s plan, which may include thickened fluids.
Answer
D · Sitting upright with the chin tucked down while swallowing
6.Prioritization & delegation
Answer: C · Hyperosmolar hyperglycemic state
Why this is the answer
Hyperosmolar hyperglycemic state occurs mainly in type 2 diabetes, with extreme glucose, severe dehydration and little or no ketosis. Treatment starts with IV fluids, as in DKA.
Answer
C · Hyperosmolar hyperglycemic state
7.Clinical nursing
Answer: B · Delays can quickly worsen rigidity, immobility and swallowing
Why this is the answer
Levodopa has a short effect, so missed or late doses can lead to severe stiffness, falls, swallowing problems and, rarely, a dangerous hyperpyrexia-like state. Parkinson's medicines are treated as time-critical.
Answer
B · Delays can quickly worsen rigidity, immobility and swallowing
8.Clinical nursing
Answer: D · Anastomotic leak
Why this is the answer
An anastomotic leak lets bowel contents into the abdomen, causing peritonitis and sepsis. It is a surgical emergency that needs urgent review.
Answer
D · Anastomotic leak
9.Lab values & electrolytes
Answer: B · The dye can interfere with dipstick color readings
Why this is the answer
Phenazopyridine is a urinary analgesic dye that turns urine orange-red. It can interfere with color-based dipstick tests, so the laboratory should be told. The color is harmless, but it can stain contact lenses and clothing.
Answer
B · The dye can interfere with dipstick color readings
10.Lab values & electrolytes
Answer: C · It raises the risk of acute pancreatitis
Why this is the answer
Triglycerides are monitored in patients receiving lipid emulsions, because high levels can cause pancreatitis and show that lipid is not being cleared. The result is reported, and the lipid dose may be reduced or held.
Answer
C · It raises the risk of acute pancreatitis
11.Pharmacology
Answer: D · Extrapyramidal movement disorders such as acute dystonia
Why this is the answer
Metoclopramide is a dopamine D2 antagonist. Blocking dopamine in the basal ganglia can cause dystonia and other extrapyramidal effects, more often in young adults.
Answer
D · Extrapyramidal movement disorders such as acute dystonia
12.Pharmacology
Answer: C · Severe bone marrow suppression, because azathioprine breakdown is reduced
Why this is the answer
Azathioprine is converted to mercaptopurine, which is partly inactivated by xanthine oxidase. Allopurinol blocks this enzyme, so levels rise and dangerous myelosuppression can occur unless the dose is greatly reduced or the combination avoided.
Answer
C · Severe bone marrow suppression, because azathioprine breakdown is reduced
13.Med-surg: cardiovascular & respiratory
Answer: D · HDL carries cholesterol from the tissues back to the liver
Why this is the answer
HDL transports cholesterol from the tissues and artery walls to the liver for removal (reverse cholesterol transport), so higher levels are linked with lower cardiovascular risk. LDL carries cholesterol to tissues and drives atherosclerosis.
Answer
D · HDL carries cholesterol from the tissues back to the liver
14.Med-surg: cardiovascular & respiratory
Answer: B · Apply firm pressure just above the puncture site and call for help
Why this is the answer
Bleeding or haematoma at the arterial access site is a common complication, made worse by antiplatelet and anticoagulant drugs. Firm manual pressure just above the skin puncture (over the arterial puncture), with the patient lying flat, is the first action, together with vital signs, distal pulses and escalation. Retroperitoneal bleeding can be hidden, so watch for back pain and hypotension.
Answer
B · Apply firm pressure just above the puncture site and call for help
15.Med-surg: neuro, endocrine & renal
Answer: D · Check glucose before and after, and carry fast-acting carbohydrate
Why this is the answer
Exercise increases glucose uptake and insulin sensitivity, so hypos can occur during and for hours after activity. Checking glucose, carrying carbohydrate and, if advised, adjusting insulin or food reduce the risk.
Answer
D · Check glucose before and after, and carry fast-acting carbohydrate
16.Med-surg: neuro, endocrine & renal
Answer: A · A honeymoon phase, but insulin is still needed
Why this is the answer
After diagnosis and correction of high glucose, remaining beta cells may work better for a while, so insulin needs fall. This honeymoon phase is temporary. The doses are reduced, but insulin is not stopped.
Answer
A · A honeymoon phase, but insulin is still needed
17.Med-surg: GI, perioperative & oncology
Answer: C · Daily weight and abdominal girth
Why this is the answer
Daily weights and abdominal girth measured at the same marked level show whether ascites is increasing or decreasing. Fluid balance, renal function and electrolytes are also monitored, especially on diuretics.
Answer
C · Daily weight and abdominal girth
18.Med-surg: GI, perioperative & oncology
Answer: A · Keep the head of the bed at or below 30° if possible; use slide sheets
Why this is the answer
A high head position makes patients slide, causing shear on the sacrum. A lower head position when clinically possible, knee break or foot support, and slide sheets for moving reduce shear and friction.
Answer
A · Keep the head of the bed at or below 30° if possible; use slide sheets
19.Maternity & obstetric nursing
Answer: C · Thiamine (vitamin B1)
Why this is the answer
Prolonged vomiting depletes thiamine. Giving glucose without thiamine can trigger Wernicke encephalopathy, with confusion, ataxia and eye movement problems.
Answer
C · Thiamine (vitamin B1)
20.Maternity & obstetric nursing
Answer: D · It suggests clubfoot, treated early with casting
Why this is the answer
A fixed foot that cannot be brought to neutral suggests congenital talipes equinovarus. Gentle casting and bracing (the Ponseti method) usually start in the first weeks. A positional foot that corrects easily is common and benign.
Answer
D · It suggests clubfoot, treated early with casting
21.Pediatric nursing
Answer: D · Loss of previously gained skills at any age needs prompt assessment
Why this is the answer
Regression, the loss of language, social or motor skills, is always a red flag and needs prompt developmental and medical assessment.
Answer
D · Loss of previously gained skills at any age needs prompt assessment
22.Pediatric nursing
Answer: A · Place the child in a knee–chest position, keep them calm and call for help
Why this is the answer
In a hypercyanotic ("tet") spell, the knee–chest position increases systemic resistance and lung blood flow. Calm the child, give oxygen and call for urgent help; drugs such as morphine may be ordered.
Answer
A · Place the child in a knee–chest position, keep them calm and call for help
23.Mental health nursing
Answer: D · Drink enough fluids and avoid overheating, because the medicine can affect temperature control
Why this is the answer
Antipsychotics, especially those with anticholinergic effects, can impair sweating and thermoregulation, increasing the risk of heat stroke. Hydration, shade and avoiding strenuous activity in the heat are advised.
Answer
D · Drink enough fluids and avoid overheating, because the medicine can affect temperature control
24.Mental health nursing
Answer: B · Explain the risks, inform the team, document the discussion and respect their right to leave according to the law and policy
Why this is the answer
Voluntary patients can usually leave, although they may be asked to wait while their risk is assessed. Detaining someone needs legal authority. The nurse informs the team, assesses risk and documents.
Answer
B · Explain the risks, inform the team, document the discussion and respect their right to leave according to the law and policy
25.Nursing math & unit conversions
Answer: h = 124 cm
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.
Height in inches
4·12 + 1 = 49 in
Inches to centimetres
h = 49·2.54 = 124.5 ≈ 124 cm
Answer
h = 124 cm
26.Nursing math & unit conversions
Answer: V = 1.44 L
Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.
Volume in a day
60 mL/h × 24 h = 1440 mL
In litres
V = 1440/1000 = 1.44 L
Answer
V = 1.44 L
27.Dosage calculations
Answer: D = 900 mg
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Total per day
20·90 = 1800 mg
Per dose
D = 1800/2 = 900 mg
Answer
D = 900 mg
28.Dosage calculations
Answer: V₁ = 25 mL
Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.
Volume of stock
V₁ = 2·250/20 = 25 mL
Answer
V₁ = 25 mL
29.IV infusion rates
Answer: V = 225 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
75·60/60 = 75 mL/h
Volume
V = 75·3 = 225 mL
Answer
V = 225 mL
30.IV infusion rates
Answer: R = 30 gtt/min
Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).
Concentration
500/250 = 2 mg/mL
Volume per hour
60/2 = 30 mL/h
Drip rate
R = 30·60/60 = 30 gtt/min
Answer
R = 30 gtt/min
31.IV fluids & fluid balance
Answer: U = 0.72 mL/kg/h
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 urine
250 + 450 + 250 = 950 mL
Per kilogram per hour
U = 950/(110·12) = 0.7197 ≈ 0.72 mL/kg/h
Answer
U = 0.72 mL/kg/h
32.IV fluids & fluid balance
Answer: t = 3.3 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Volume left
500 − 300 = 200 mL
Time
t = 200/60 = 3.333 ≈ 3.3 h
Answer
t = 3.3 h
That is about 3 h 20 min, so the bag runs out at about 21:20.
33.Clinical assessment scores
Answer: MFS = 70
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: holds on to furniture → 30
IV therapy or saline lock: no → 0
gait: weak → 10
mental status: overestimates or forgets limits → 15
Add
Morse total = 0 + 15 + 30 + 0 + 10 + 15 = 70
Answer
MFS = 70
34.Clinical assessment scores
Answer: obesity class III
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 = 106/1.51² = 46.49
Category
obesity class III
Answer
obesity class III
This is independent practice material. ExamProblems is not affiliated with or endorsed by the organisation that runs this exam, and the exam name is used only to describe the content. NCLEX®, NCLEX-RN® and NCLEX-PN® are trademarks of the National Council of State Boards of Nursing, Inc. (NCSBN), which is not affiliated with ExamProblems and does not endorse it or vouch for its accuracy.