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
Under the Mental Capacity Act 2005 (England and Wales), what is the starting assumption about an adult's capacity?
ACapacity is assumed only if a relative agrees
BOlder adults are assumed to lack capacity
CThe adult lacks capacity until a doctor has formally confirmed otherwise
DThe adult has capacity unless it is shown that they lack it
2.Nursing fundamentalsHard
A patient has been taught to walk with underarm crutches. Which statement shows a need for further teaching?
A"I'll rest my weight on the tops of the crutches under my arms."
B"I'll take my weight through my hands on the hand grips."
C"I'll check the rubber tips regularly for wear."
D"I'll keep the crutch tips about a step out to the side and front."
3.Infection control & patient safetyMedium
A child has swallowed a button battery. Why is this urgent?
AIt is only harmful if several batteries are swallowed
BIt always passes through the gut without harm
CThe only risk is poisoning from heavy metals years later
DIt can burn through the lining of the esophagus within hours
4.Infection control & patient safetyHard
A patient sitting in a chair starts to have a generalized seizure. What should the nurse do?
AEase the patient to the floor, protect the head and turn them on their side
BPut a padded tongue blade between the teeth to protect the tongue and airway
CHold the patient firmly in the chair until the seizure stops
DLeave to get the provider, then return
5.Prioritization & delegationMedium
A patient is booked for a CT scan with iodinated contrast. Which of the patient’s medications may need to be held according to protocol?
AMetformin
BAcetaminophen (paracetamol)
COmeprazole
DLevothyroxine
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 patient whose call light went on first
BWhichever patient’s room is closer to the station
CThe confused patient climbing out of bed
DThe patient in pain after surgery
7.Clinical nursingMedium
What should a patient be told before using sublingual glyceryl trinitrate (GTN, nitroglycerin) spray for angina?
ATake it with a large glass of milk to protect the stomach lining
BSit down before using it, as it can cause dizziness and low blood pressure
CSwallow the spray rather than leaving it under the tongue
DUse it only after the pain has lasted over an hour, with the patient lying flat
8.Clinical nursingHard
A nurse teaches a patient with asthma about a new inhaled steroid "preventer". Which statement shows a need for further teaching?
A"I will rinse my mouth after using it."
B"I'll keep my reliever inhaler with me."
C"I will only use it when I'm wheezy."
D"I will use it every day even when I feel well."
9.Lab values & electrolytesMedium
When should a blood specimen tube be labeled?
AIn the laboratory, by the staff who receive the unlabeled sample
BBefore entering the room, so tubes are ready for the next patients
CAt the bedside, in the patient's presence, using two identifiers
DAt the nurses' station, after all samples for the shift are drawn
10.Lab values & electrolytesHard
Two sets of blood cultures were taken from separate sites. Only one bottle in one set grows coagulase-negative staphylococci, and the patient has no line or implant. What is the most likely interpretation?
AInfection with a resistant organism such as MRSA
BCertain bloodstream infection needing treatment
CProof that the patient has infective endocarditis
DProbable skin contamination of the sample
11.PharmacologyMedium
How does metformin mainly lower blood glucose?
AIt reduces glucose production by the liver
BIt replaces missing insulin
CIt blocks glucose absorption in the kidney
DIt stimulates insulin release from the pancreas
12.PharmacologyHard
A woman with chronic hypertension who takes lisinopril is now pregnant. What is the key concern?
ALisinopril works better in pregnancy, so the dose should be increased
BAll antihypertensives must be stopped in pregnancy
CLisinopril has no known fetal effects and should be continued
DACE inhibitors harm fetal kidneys, so a safer drug is used
13.Med-surg: cardiovascular & respiratoryMedium
Which emergency equipment should be kept at the bedside of a patient with a tracheostomy?
AA nasogastric tube and a feeding pump
BSpare tubes (same size and one smaller), suction and oxygen
CA urinary catheter set, a blood glucose meter and a thermometer
DOnly a spare oxygen mask, since the tube rarely causes problems
14.Med-surg: cardiovascular & respiratoryHard
During CPR on an adult, a nurse notices a colleague compressing at about 140/min and leaning on the chest between compressions. Which correction is most appropriate?
AStop compressions until a pulse is felt
BPress more gently, to a depth of about 2 cm
CSlow to 100–120/min and allow full chest recoil
DSpeed up to about 160/min to improve the blood flow
15.Med-surg: neuro, endocrine & renalMedium
A nurse is teaching a patient going home after a mild concussion. Which statement shows a need for further teaching?
A"A few drinks tonight will help me relax and sleep."
B"Someone will stay with me for the first night."
C"I will return if my headache gets steadily worse."
D"I will come back if I start vomiting again and again."
16.Med-surg: neuro, endocrine & renalHard
A patient with known back pain says they now cannot feel the skin between their legs and have not passed urine for 12 hours. What should happen?
AA routine physiotherapy appointment next week
BUrgent MRI and referral to the spinal surgeons
CA laxative and review in the clinic in a month
DAdvice to rest at home and take stronger painkillers
17.Med-surg: GI, perioperative & oncologyMedium
Why is the time a surgical limb tourniquet is inflated carefully recorded?
AIt shows how long the anaesthetic gas was used
BThe surgeon is paid per minute of use
CThe tourniquet slowly loses all its air after one minute
DLong inflation can cause nerve and muscle damage
18.Med-surg: GI, perioperative & oncologyHard
On day 6 after abdominal surgery, a patient says something "gave way" when coughing, and bowel is visible through the wound. What should the nurse do immediately?
ALeave the wound uncovered and sit the patient fully upright in bed
BCover with saline-soaked sterile dressings, bend the knees, call the surgeon
CGive the patient a light meal to calm them while waiting for the team
DPush the bowel back gently and tape the wound edges together firmly
19.Maternity & obstetric nursingMedium
A woman with pre-eclampsia is on magnesium sulfate. Why does the nurse monitor her urine output closely?
ALow urine output shows that the magnesium is working
BMagnesium causes a large diuresis that leads to dehydration
CUrine output tells the nurse exactly when to stop the infusion after the birth
DMagnesium is cleared by the kidneys, so oliguria raises the risk of toxicity
20.Maternity & obstetric nursingHard
A healthy newborn is jittery. Which finding helps tell jitteriness from a seizure?
ASeizures stop when the limb is held
BJitteriness stops when the limb is gently held
CJitteriness comes with eye deviation and apnoea
DSeizures are always triggered by loud sounds
21.Pediatric nursingMedium
Why should a child with diabetes rotate insulin injection sites?
ABecause the same site causes an allergy to insulin
BTo stop the insulin from becoming less effective over the years
CTo prevent lumpy fatty areas that absorb insulin unpredictably
DTo make sure each part of the body gets the same amount of insulin
22.Pediatric nursingHard
A toddler swallowed a button battery 30 minutes ago and seems well. What is the correct action?
AGive a glass of milk and observe at home
BArrange immediate transfer to emergency care for imaging and removal
CWait for the battery to pass naturally and check the nappies for several days
DMake the toddler vomit
23.Mental health nursingMedium
A patient insists that the staff are poisoning his food. What is the best initial approach?
AArgue logically until he admits he is wrong
BAgree with him so he trusts you
CTell him firmly that he will not be given any food until he stops making the accusation
DAcknowledge his fear without arguing about the belief and focus on reality-based topics
24.Mental health nursingHard
A patient with anxiety asks for her PRN lorazepam every time it is due. What is the best nursing approach?
AAssess her anxiety each time, offer other coping strategies and give it if indicated
BRefuse to give it, because she might become dependent
CAlways give it as soon as she asks, without assessment
DGive her a placebo tablet instead, without telling her, to see whether she really needs it
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 10:00 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.
10:00
110:00 AM
210:00 PM
312:00 AM
49:00 AM
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 3 tbsp of liquid supplement, 4 fl oz of juice, 3 cups of tea. Using the equivalents given, find the total oral intake V in mL.
1 tbsp = 15 mL1 fl oz = 30 mL1 cup = 8 fl oz = 240 mL
V = mL
27.Dosage calculationsMedium
A patient weighs 12 kg. The prescribed dose is 30 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?
12 kg30 mg/kg/day4× per day
D = mg
28.Dosage calculationsHard
The prescription is 5200 units of a drug that comes as 10000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
5200 units10000 units/mL
V = mL
29.IV infusion ratesMedium
Infuse 250 mL over 4 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
250 mL4 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 50 gtt/min through a set of 15 gtt/mL. There are 400 mL left in the bag. How many hours t until it is empty?
50 gtt/min15 gtt/mL400 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). Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 60 mL/h. At 18:30, 150 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL150 mL infused60 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 56/min and a blood pressure of 73/44 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.
HR 56/minBP 73/44 mmHg
SI =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 8/min, SpO₂ 98% on room air, blood pressure 112/68 mmHg, pulse 82/min, alert, temperature 36.7 °C. Which clinical risk group does the patient fall into? Click it.
RR 8SpO₂ 98%airSBP 112HR 82AT 36.7 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: D · The adult has capacity unless it is shown that they lack it
Why this is the answer
The Act begins with a presumption of capacity. A person is not treated as lacking capacity just because of age, appearance or an unwise decision.
Answer
D · The adult has capacity unless it is shown that they lack it
2.Nursing fundamentals
Answer: A · "I'll rest my weight on the tops of the crutches under my arms."
Why this is the answer
Leaning on the armpits can damage the brachial plexus and cause crutch palsy. Weight is taken through the hands, with a gap of a few finger-widths between the crutch top and the armpit.
Answer
A · "I'll rest my weight on the tops of the crutches under my arms."
3.Infection control & patient safety
Answer: D · It can burn through the lining of the esophagus within hours
Why this is the answer
A button battery lodged in the esophagus can cause severe chemical burns within a few hours, so the child needs emergency assessment and often removal. It should never be treated as harmless.
Answer
D · It can burn through the lining of the esophagus within hours
4.Infection control & patient safety
Answer: A · Ease the patient to the floor, protect the head and turn them on their side
Why this is the answer
The nurse guides the patient gently to the floor, cushions the head, moves objects away and turns the patient on their side to protect the airway. The nurse stays, times the seizure and calls for help.
Answer
A · Ease the patient to the floor, protect the head and turn them on their side
5.Prioritization & delegation
Answer: A · Metformin
Why this is the answer
If contrast causes kidney injury, metformin can build up and cause lactic acidosis. Protocols often hold metformin around the procedure, especially when kidney function is reduced.
Answer
A · Metformin
6.Prioritization & delegation
Answer: C · 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
C · The confused patient climbing out of bed
7.Clinical nursing
Answer: B · Sit down before using it, as it can cause dizziness and low blood pressure
Why this is the answer
GTN causes vasodilation, which can lead to headache, flushing, dizziness and hypotension. Patients should sit, and seek emergency help if the pain does not settle after the advised doses.
Answer
B · Sit down before using it, as it can cause dizziness and low blood pressure
8.Clinical nursing
Answer: C · "I will only use it when I'm wheezy."
Why this is the answer
Inhaled corticosteroids must be used regularly to reduce airway inflammation and prevent attacks. The short-acting reliever is used for symptoms.
Answer
C · "I will only use it when I'm wheezy."
9.Lab values & electrolytes
Answer: C · 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
C · At the bedside, in the patient's presence, using two identifiers
10.Lab values & electrolytes
Answer: D · Probable skin contamination of the sample
Why this is the answer
Coagulase-negative staphylococci are common skin flora. Growth in only one of several bottles, without a catheter or implant, most often reflects contamination during collection. Good skin antisepsis reduces contamination, which can lead to unnecessary antibiotics.Checked against:Blood culture · MedlinePlus (NIH) (2025)
Answer
D · Probable skin contamination of the sample
11.Pharmacology
Answer: A · It reduces glucose production by the liver
Why this is the answer
Metformin mainly reduces hepatic gluconeogenesis and improves insulin sensitivity. Because it does not stimulate insulin release, hypoglycaemia is rare when used alone.
Answer
A · It reduces glucose production by the liver
12.Pharmacology
Answer: D · ACE inhibitors harm fetal kidneys, so a safer drug is used
Why this is the answer
ACE inhibitors and ARBs cause fetal kidney damage, oligohydramnios and other problems, especially later in pregnancy. Drugs such as labetalol, nifedipine or methyldopa are used instead.
Answer
D · ACE inhibitors harm fetal kidneys, so a safer drug is used
13.Med-surg: cardiovascular & respiratory
Answer: B · Spare tubes (same size and one smaller), suction and oxygen
Why this is the answer
Bedside equipment usually includes spare tracheostomy tubes (same size and one size smaller), an obturator if used, suction with catheters, oxygen, a bag-valve-mask and tracheal dilators where policy requires. It is checked at every shift.
Answer
B · Spare tubes (same size and one smaller), suction and oxygen
14.Med-surg: cardiovascular & respiratory
Answer: C · Slow to 100–120/min and allow full chest recoil
Why this is the answer
High-quality adult CPR uses a rate of 100–120/min, a depth of 5–6 cm, full recoil after each compression and minimal interruptions. Leaning prevents the chest from re-expanding, so the heart fills less. Compressors should swap about every 2 minutes to avoid fatigue.
Answer
C · Slow to 100–120/min and allow full chest recoil
15.Med-surg: neuro, endocrine & renal
Answer: A · "A few drinks tonight will help me relax and sleep."
Why this is the answer
After a head injury, alcohol and sedatives should be avoided because they can mask drowsiness and confusion. A responsible adult should stay with the patient, and worsening headache, repeated vomiting, confusion or drowsiness mean they must return.
Answer
A · "A few drinks tonight will help me relax and sleep."
16.Med-surg: neuro, endocrine & renal
Answer: B · Urgent MRI and referral to the spinal surgeons
Why this is the answer
Saddle anaesthesia with urinary retention suggests cauda equina syndrome. Delay can lead to permanent bladder, bowel and sexual dysfunction. The patient needs an emergency MRI and surgical decompression if confirmed.
Answer
B · Urgent MRI and referral to the spinal surgeons
17.Med-surg: GI, perioperative & oncology
Answer: D · Long inflation can cause nerve and muscle damage
Why this is the answer
A tourniquet creates a bloodless field but causes limb ischaemia. Inflation time and pressure are recorded and the surgeon is told at set intervals, as long inflation can damage nerves and muscle.
Answer
D · Long inflation can cause nerve and muscle damage
18.Med-surg: GI, perioperative & oncology
Answer: B · Cover with saline-soaked sterile dressings, bend the knees, call the surgeon
Why this is the answer
Evisceration is a surgical emergency. Cover the organs with sterile, saline-moistened dressings, place the patient in a low Fowler's position with knees flexed to reduce tension, keep them nil by mouth, monitor for shock and call the surgeon. Never try to replace the organs.
Answer
B · Cover with saline-soaked sterile dressings, bend the knees, call the surgeon
19.Maternity & obstetric nursing
Answer: D · Magnesium is cleared by the kidneys, so oliguria raises the risk of toxicity
Why this is the answer
Magnesium is cleared by the kidneys, so oliguria, which is common in pre-eclampsia, allows levels to rise. The nurse also monitors reflexes, respiratory rate and level of consciousness.
Answer
D · Magnesium is cleared by the kidneys, so oliguria raises the risk of toxicity
20.Maternity & obstetric nursing
Answer: B · Jitteriness stops when the limb is gently held
Why this is the answer
Jitteriness is a rhythmic tremor that is stimulus-sensitive and stops when the limb is held or flexed. Seizures continue when restrained and may include eye deviation, apnoea or lip smacking. Glucose and calcium are checked in both.
Answer
B · Jitteriness stops when the limb is gently held
21.Pediatric nursing
Answer: C · To prevent lumpy fatty areas that absorb insulin unpredictably
Why this is the answer
Injecting repeatedly into the same spot causes lipohypertrophy, thickened fatty lumps where insulin absorption is erratic. Rotating within and between sites keeps absorption more predictable.
Answer
C · To prevent lumpy fatty areas that absorb insulin unpredictably
22.Pediatric nursing
Answer: B · Arrange immediate transfer to emergency care for imaging and removal
Why this is the answer
Button batteries in the oesophagus can cause severe burns within 2 hours. Even a well-looking child needs urgent X-ray and, if the battery is in the oesophagus, endoscopic removal.
Answer
B · Arrange immediate transfer to emergency care for imaging and removal
23.Mental health nursing
Answer: D · Acknowledge his fear without arguing about the belief and focus on reality-based topics
Why this is the answer
Arguing strengthens delusions and damages trust, and agreeing reinforces them. Respond to the feeling (fear), keep to reality, and offer practical options such as sealed or packaged food.
Answer
D · Acknowledge his fear without arguing about the belief and focus on reality-based topics
24.Mental health nursing
Answer: A · Assess her anxiety each time, offer other coping strategies and give it if indicated
Why this is the answer
Each PRN dose requires an assessment of need and an evaluation afterwards. Offering other strategies supports coping skills, and patterns of use are discussed with the team.
Answer
A · Assess her anxiety each time, offer other coping strategies and give it if indicated
25.Nursing math & unit conversions
Answer: 10:00 AM
24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.
Convert the hour
10 → 10 AM
Answer
10:00 AM
Answer
10:00 AM
26.Nursing math & unit conversions
Answer: V = 885 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
3 tbsp = 3·15 = 45 mL
4 fl oz = 4·30 = 120 mL
3 cups = 3·240 = 720 mL
Add
V = 45 + 120 + 720 = 885 mL
Answer
V = 885 mL
27.Dosage calculations
Answer: D = 90 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
30·12 = 360 mg
Per dose
D = 360/4 = 90 mg
Answer
D = 90 mg
28.Dosage calculations
Answer: V = 0.52 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.
Volume
V = 5200/10000 = 0.52 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.52 mL
29.IV infusion rates
Answer: R = 21 gtt/min
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Time in minutes
4·60 = 240 min
Drip rate
R = 250·20/240 = 20.83 ≈ 21 gtt/min
Answer
R = 21 gtt/min
At the bedside you round to the nearest whole drop: 21 gtt/min.
30.IV infusion rates
Answer: t = 2 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
50·60/15 = 200 mL/h
Time left
t = 400/200 = 2 h
Answer
t = 2 h
31.IV fluids & fluid balance
Answer: B = 780 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 + 100 + 240 = 440 mL
ice chips: 200/2 = 100 mL
IV infusion: 125·12 = 1500 mL
IV antibiotic: 1·100 = 100 mL
total intake = 2140 mL
Total output
275 + 150 + 325 + 500 + 110 = 1360 mL
Balance
B = 2140 − 1360 = 780 mL
Answer
B = 780 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: t = 5.8 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 − 150 = 350 mL
Time
t = 350/60 = 5.833 ≈ 5.8 h
Answer
t = 5.8 h
That is about 5 h 50 min, so the bag runs out at about 00:20.
33.Clinical assessment scores
Answer: SI = 0.77
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.
Shock index
SI = 56/73 = 0.7671 ≈ 0.77
Answer
SI = 0.77
Above the usual 0.5–0.7.
34.Clinical assessment scores
Answer: low–medium
NEWS2 (National Early Warning Score 2, Royal College of Physicians 2017): score each of the seven parameters with the chart (respiration rate, SpO₂ on scale 1, air or supplemental oxygen, systolic blood pressure, pulse, consciousness on the ACVPU scale and temperature) and add the scores. Clinical risk: 0–4 low; a score of 3 in any single parameter low–medium; 5–6 medium; 7 or more high. A total of 5 or more needs an urgent response.
Score each parameter
RR 8/min → 3
SpO₂ 98% → 0
on air → 0
SBP 112 mmHg → 0
HR 82/min → 0
alert (A) → 0
T 36.7 °C → 0
Total and red scores
NEWS2 = 3 + 0 + 0 + 0 + 0 + 0 + 0 = 3
At least one parameter scores 3.
Risk group
low–medium
Answer
low–medium
A single score of 3 needs an urgent review even when the total is low.
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