Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
Prioritization & delegation
Method
Ask what will harm the patient soonest if nothing is done.
Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
Assess before you act unless it is an emergency; then choose the step the others depend on.
For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.
Lab values & electrolytes
Method
Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
Link the value to its typical signs and to the drugs and conditions that cause it.
Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.
Med-surg: cardiovascular & respiratory
Method
Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
Choose the safe first action, then escalate and reassess.
Med-surg: neuro, endocrine & renal
Method
Check the glucose in every patient with new confusion, weakness or a seizure.
Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.
Med-surg: GI, perioperative & oncology
Method
Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.
Maternity & obstetric nursing
Method
Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.
Pediatric nursing
Method
Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
Match the action to the development stage and involve the family.
Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.
Mental health nursing
Method
Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
Respect rights: the least restrictive option, consent and confidentiality with its limits.
Nursing math & unit conversions
Metric steps
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
Weight and length
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
Household measures
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
falls 25, diagnosis 15, aid 15/30, IV 20, gait 10/20, mental status 15
NEWS2 risk
0–4 low; single 3 low–medium; 5–6 medium; ≥ 7 high
Mean arterial pressure
MAP = (SBP + 2·DBP)/3 = DBP + PP/3
Pulse pressure and shock index
PP = SBP − DBP, SI = HR/SBP
Body mass index
BMI = kg/m² = 703·lb/in²
Method
Find the score sheet that the question uses and its range (GCS 3–15, APGAR 0–10, Braden 6–23, Morse 0–125).
Score every item separately, matching the description to its level.
Add the item scores and check that the total lies inside the range.
Apply the cut-offs: for NEWS2 also look for any single parameter scoring 3.
For derived values use MAP = (SBP + 2·DBP)/3, PP = SBP − DBP, SI = HR/SBP and BMI = kg/m².
2Practice problems
1.Nursing fundamentalsMedium
A caller says they are a patient's daughter and asks for details of the patient's condition. What should the nurse do?
AHang up without saying anything
BCheck the patient's wishes and the caller's identity first
CGive full details, as close family members have a right to know
DRead out the latest notes over the phone
2.Nursing fundamentalsHard
A patient has a platelet count of 40 × 10⁹/L (40,000/mm³). Which nursing measure is appropriate?
AGive aspirin for any headaches
BEncourage contact sports to raise the count
CUse a firm toothbrush and floss hard to keep the gums healthy
DUse a soft toothbrush and avoid IM injections where possible
3.Infection control & patient safetyMedium
What is the purpose of “Tall Man” lettering, as in hydrOXYzine and hydrALAZINE?
ATo show which of the two drugs is a high-alert medication
BTo indicate the brand name
CTo make look-alike drug names easier to tell apart
DTo show the strength of the drug
4.Infection control & patient safetyHard
A conscious patient who is at risk of choking is being given oral medicines. Which practice is safest?
ACrush all the tablets without checking whether this is allowed
BLay the patient flat on the back to make swallowing easier
CGive all the tablets together to save time
DSit the patient upright and give one tablet at a time
5.Prioritization & delegationMedium
Which finding is an early sign of compartment syndrome in a patient with a lower leg fracture?
AMild bruising around the fracture site on the second day
BItching under the cast during the first week after it was applied
CA strong pedal pulse with warm, pink toes and pain that settles with analgesia
DPain out of proportion to the injury that worsens when the toes are stretched
6.Prioritization & delegationHard
During JumpSTART triage, a child who cannot walk is breathing 50 times a minute. Which category is the child given?
ARed (immediate)
BBlack (expectant)
CYellow (delayed)
DGreen (minor)
7.Clinical nursingMedium
A patient is prescribed two different eye drops at the same time. What is correct?
AWait about five minutes between the two drops
BMix the two drops in one bottle
CGive one drop now and the other the next day
DGive both drops at once into the same eye
8.Clinical nursingHard
Which feature best distinguishes delirium from dementia?
ADelirium starts suddenly and fluctuates, while dementia develops gradually
BDementia always causes visual hallucinations
CDelirium only affects people under 50, while dementia affects older people
DDelirium is permanent, while dementia is reversible
9.Lab values & electrolytesMedium
Which ECG change is linked to hypocalcemia?
AA shortened QT interval
BA prominent delta wave
CA prolonged QT interval
DTall, peaked T waves
10.Lab values & electrolytesHard
A patient taking isoniazid for latent TB reports nausea, loss of appetite and dark urine. The ALT is five times the upper limit of normal. What is the best action?
AContinue the isoniazid and give it with food to settle the stomach
BDouble the dose to finish the treatment course more quickly
CHold the isoniazid and report the findings to the prescriber at once
DReassure the patient that dark urine is a harmless drug effect
11.PharmacologyMedium
How does clopidogrel reduce platelet aggregation?
AIt inhibits platelet COX-1
BIt activates antithrombin
CIt blocks the platelet P2Y12 receptor for ADP
DIt blocks the glycoprotein IIb/IIIa receptor directly
12.PharmacologyHard
A patient who uses insulin is taught sick-day rules. Which statement shows a need for further teaching?
A"I will check my blood glucose and ketones more often while I am ill."
B"I will seek help if I keep vomiting or have ketones."
C"I will keep drinking fluids, even if I cannot eat much."
D"If I am ill and not eating, I will stop my insulin completely."
13.Med-surg: cardiovascular & respiratoryMedium
A patient is going home with a 24-hour Holter monitor. Which instruction is most important?
ARemove the monitor whenever symptoms occur and restart it
BShower as normal with the monitor on
CStay in bed for the full 24 hours so the trace is clear
DKeep a diary of symptoms and activities with the times
14.Med-surg: cardiovascular & respiratoryHard
A patient with COPD is going home on long-term oxygen. Which teaching point is most important for safety?
AStore spare cylinders next to the cooker
BTurn the flow up as high as needed when breathless
CNever smoke or allow open flames near the oxygen
DUse petroleum jelly to soothe dry nostrils
15.Med-surg: neuro, endocrine & renalMedium
Why are insulin and glucose given together to treat hyperkalaemia?
AGlucose binds the potassium in the blood and removes it
BInsulin makes the kidneys pass more potassium in the urine
CInsulin moves potassium into cells; glucose prevents a hypo
DInsulin protects the heart muscle cells from the potassium
16.Med-surg: neuro, endocrine & renalHard
A patient with Addison's disease has been vomiting for a day. They are confused, with BP 78/40 mmHg, sodium 126 mmol/L and potassium 6.0 mmol/L. What is the priority?
AIV hydrocortisone straight away, plus IV fluids
BA fluid restriction for the low sodium
CIV potassium to correct the electrolytes
DOral hydrocortisone and an antiemetic by mouth
17.Med-surg: GI, perioperative & oncologyMedium
Which is a recognised side effect of ondansetron?
AHair loss
BHearing loss
CSevere hypoglycaemia
DConstipation
18.Med-surg: GI, perioperative & oncologyHard
A patient arrives in the anaesthetic room without an identity band. What should the nurse do?
AUse the spare identity band from the front of the patient's notes folder
BStop and confirm identity, then apply a band
CProceed because the patient can say their name
DProceed and add a band once in recovery
19.Maternity & obstetric nursingMedium
Misoprostol is given for postpartum haemorrhage. Which side effect is common?
AShivering and fever
BSevere hypertension
CBronchospasm in all patients
DBradycardia and hypoglycaemia
20.Maternity & obstetric nursingHard
One hour after birth, the large baby of a mother with diabetes is jittery and feeding poorly. What should the nurse do first?
AReassure the parents that jitteriness is normal
BCheck the baby's blood glucose
CWrap the baby tightly and recheck in 4 hours
DGive a bath to wake the baby up
21.Pediatric nursingMedium
Which signs suggest a child is ready to start toilet training?
AStaying dry for about 2 hours, showing interest and being able to follow simple instructions
BBeing able to walk
CSaying the first word
DReaching the first birthday and being able to walk, whether or not the child shows any interest
22.Pediatric nursingHard
A large baby born to a mother with diabetes becomes jittery at 1 hour of age. What should the nurse check first?
AThe baby's haemoglobin
BThe baby's blood group
CThe baby's blood glucose
DThe baby's serum bilirubin
23.Mental health nursingMedium
How should the nurse position herself when talking to an agitated patient?
AAt a safe distance, slightly to the side, with a clear exit available
BDirectly face to face, as close as possible, to show confidence
CBetween the patient and the wall, so the patient can leave easily
DBehind the patient and close to him, so that the patient does not feel threatened by eye contact
24.Mental health nursingHard
Five days after starting haloperidol, a patient has a temperature of 40 °C, rigid limbs, confusion, fluctuating blood pressure and sweating. What should the nurse do first?
AEncourage him to exercise to reduce stiffness
BGive paracetamol for the fever and recheck the observations in 4 hours
CWithhold the antipsychotic and get urgent medical help
DGive another dose of haloperidol to calm him
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient is 4 ft 7 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 7 in1 ft = 12 in1 in = 2.54 cm
h = cm
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 21:15 and finishes at 05:45 the next morning (24-hour clock). How many minutes t did it run?
21:1505:45
t = min
27.Dosage calculationsMedium
A patient weighs 18 kg. The prescribed dose is 25 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?
18 kg25 mg/kg/day3× per day
D = mg
28.Dosage calculationsHard
A patient weighs 145.2 lb. The prescription is 1 mg/kg as a single dose, and the stock contains 200 mg in 5 mL. Using 1 kg = 2.2 lb, what volume V do you give? Round to one decimal place.
145.2 lb1 mg/kg200 mg/5 mL1 kg = 2.2 lb
V = mL
29.IV infusion ratesMedium
A drip runs at 25 gtt/min through a set of 20 gtt/mL. How many millilitres V does the patient receive in 3 hours?
25 gtt/min20 gtt/mL3 h
V = mL
30.IV infusion ratesHard
A bag contains 500 mg of a drug in 100 mL and runs at 25 mL/h. How many milligrams per hour D does the patient receive?
500 mg/100 mL25 mL/h
D = mg/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 8-hour shift. The patient weighs 105 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 1000 mL bag runs by pump at 120 mL/h. At 12:30, 550 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL550 mL infused120 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury opens the eyes only to pressure (a painful stimulus), talks in sentences but is confused and shows as the best motor response: moves a hand to the site of pressure (localises). Work out the GCS and classify the head injury by it. Click your answer.
1mild
2moderate
3severe
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 84 kg and is 164 cm tall. Calculate the BMI and click the WHO weight category.
84 kg164 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
3Solutions
1.Nursing fundamentals
Answer: B · Check the patient's wishes and the caller's identity first
Why this is the answer
Information is shared only with people the patient has agreed to, and the caller's identity is checked as per policy. Often only limited information is given by phone.
Answer
B · Check the patient's wishes and the caller's identity first
2.Nursing fundamentals
Answer: D · Use a soft toothbrush and avoid IM injections where possible
Why this is the answer
A low platelet count raises the risk of bleeding. Bleeding precautions include soft toothbrushes, electric razors, avoiding IM injections and avoiding aspirin and NSAIDs.
Answer
D · Use a soft toothbrush and avoid IM injections where possible
3.Infection control & patient safety
Answer: C · To make look-alike drug names easier to tell apart
Why this is the answer
Tall Man lettering puts the different letters of similar names in capitals so that staff notice the difference when reading labels, screens and orders.
Answer
C · To make look-alike drug names easier to tell apart
4.Infection control & patient safety
Answer: D · Sit the patient upright and give one tablet at a time
Why this is the answer
Upright positioning and giving medicines one at a time reduce choking risk. Crushing is only done when the pharmacy confirms it is safe, because some modified-release and enteric-coated products are dangerous when crushed.
Answer
D · Sit the patient upright and give one tablet at a time
5.Prioritization & delegation
Answer: D · Pain out of proportion to the injury that worsens when the toes are stretched
Why this is the answer
The earliest sign is severe pain that is not relieved by usual analgesia and worsens on passive stretch. Loss of pulse is a late sign, so the nurse reports pain early.
Answer
D · Pain out of proportion to the injury that worsens when the toes are stretched
6.Prioritization & delegation
Answer: A · Red (immediate)
Why this is the answer
In JumpSTART, a respiratory rate below 15 or above 45 per minute makes the child immediate (red). Children breathe faster than adults, so the adult cut-off of 30 is not used.
Answer
A · Red (immediate)
7.Clinical nursing
Answer: A · Wait about five minutes between the two drops
Why this is the answer
Leaving a few minutes between different drops lets each one be absorbed. Gentle pressure on the inner corner of the eye can also reduce systemic absorption.
Answer
A · Wait about five minutes between the two drops
8.Clinical nursing
Answer: A · Delirium starts suddenly and fluctuates, while dementia develops gradually
Why this is the answer
Delirium develops over hours to days, with fluctuating attention and consciousness, and is often reversible when the cause is treated. Dementia is a gradual, progressive decline. Patients with dementia are at higher risk of delirium.
Answer
A · Delirium starts suddenly and fluctuates, while dementia develops gradually
9.Lab values & electrolytes
Answer: C · A prolonged QT interval
Why this is the answer
Low calcium prolongs the QT interval, which can lead to dangerous arrhythmias. High calcium shortens the QT interval, and peaked T waves are typical of hyperkalemia.
Answer
C · A prolonged QT interval
10.Lab values & electrolytes
Answer: C · Hold the isoniazid and report the findings to the prescriber at once
Why this is the answer
Isoniazid can cause hepatitis, which may be severe. Symptoms such as nausea, loss of appetite and dark urine with a markedly raised ALT mean the drug should be held and the prescriber informed. Patients are taught to avoid alcohol and report these symptoms early.
Answer
C · Hold the isoniazid and report the findings to the prescriber at once
11.Pharmacology
Answer: C · It blocks the platelet P2Y12 receptor for ADP
Why this is the answer
Clopidogrel is activated in the liver and irreversibly blocks the P2Y12 ADP receptor on platelets. It is often combined with aspirin after a heart attack or stent.
Answer
C · It blocks the platelet P2Y12 receptor for ADP
12.Pharmacology
Answer: D · "If I am ill and not eating, I will stop my insulin completely."
Why this is the answer
Stress hormones during illness often raise glucose, so basal insulin is usually continued and doses may need adjusting. Stopping insulin in type 1 diabetes can lead to ketoacidosis.
Answer
D · "If I am ill and not eating, I will stop my insulin completely."
13.Med-surg: cardiovascular & respiratory
Answer: D · Keep a diary of symptoms and activities with the times
Why this is the answer
A Holter monitor records the ECG continuously during normal daily life. A diary of symptoms and activities lets the reviewer match symptoms such as palpitations or dizziness to the rhythm. The device is kept dry unless it is designed to be waterproof.
Answer
D · Keep a diary of symptoms and activities with the times
14.Med-surg: cardiovascular & respiratory
Answer: C · Never smoke or allow open flames near the oxygen
Why this is the answer
Smoking while using oxygen is a major cause of burns and fatal fires. Patients must keep oxygen away from flames and heat sources, use water-based (not oil-based) lubricants and follow the prescribed flow, because unsupervised increases can worsen CO₂ retention.
Answer
C · Never smoke or allow open flames near the oxygen
15.Med-surg: neuro, endocrine & renal
Answer: C · Insulin moves potassium into cells; glucose prevents a hypo
Why this is the answer
Insulin activates the sodium–potassium pump, moving potassium into cells and lowering the serum level within about 15–30 minutes. Glucose is given to prevent hypoglycaemia. The effect is temporary, so potassium must also be removed.
Answer
C · Insulin moves potassium into cells; glucose prevents a hypo
16.Med-surg: neuro, endocrine & renal
Answer: A · IV hydrocortisone straight away, plus IV fluids
Why this is the answer
An adrenal crisis is life-threatening. IV or IM hydrocortisone is given immediately, without waiting for tests, together with IV saline and checks of glucose and electrolytes. Vomiting prevents tablets from being absorbed.
Answer
A · IV hydrocortisone straight away, plus IV fluids
17.Med-surg: GI, perioperative & oncology
Answer: D · Constipation
Why this is the answer
Common side effects of ondansetron include constipation and headache. It can also prolong the QT interval, so caution is needed with other QT-prolonging drugs and electrolyte imbalance.
Answer
D · Constipation
18.Med-surg: GI, perioperative & oncology
Answer: B · Stop and confirm identity, then apply a band
Why this is the answer
Correct identification before anaesthesia prevents wrong-patient surgery. The process stops until identity is confirmed with the patient and records and a band is applied, following the checklist.
Answer
B · Stop and confirm identity, then apply a band
19.Maternity & obstetric nursing
Answer: A · Shivering and fever
Why this is the answer
Misoprostol, a prostaglandin E1 analogue, commonly causes shivering and a raised temperature, as well as nausea and diarrhoea. It is useful where other uterotonics are not available.
Answer
A · Shivering and fever
20.Maternity & obstetric nursing
Answer: B · Check the baby's blood glucose
Why this is the answer
Jitteriness and poor feeding in a high-risk newborn suggest hypoglycaemia. A point-of-care glucose check guides treatment, such as feeding or glucose gel per protocol, with escalation if the level stays low.
Answer
B · Check the baby's blood glucose
21.Pediatric nursing
Answer: A · Staying dry for about 2 hours, showing interest and being able to follow simple instructions
Why this is the answer
Readiness signs include bladder control for a few hours, awareness of a wet nappy, interest in the toilet and the ability to sit, walk and follow simple instructions, usually between about 18 months and 3 years.
Answer
A · Staying dry for about 2 hours, showing interest and being able to follow simple instructions
22.Pediatric nursing
Answer: C · The baby's blood glucose
Why this is the answer
Babies of mothers with diabetes produce extra insulin before birth, so after the cord is cut they are at high risk of hypoglycaemia. Jitteriness is a common sign, so blood glucose is checked straight away and the baby is fed or treated as per protocol.
Answer
C · The baby's blood glucose
23.Mental health nursing
Answer: A · At a safe distance, slightly to the side, with a clear exit available
Why this is the answer
Standing at an angle and outside arm's reach is less confrontational and safer. The nurse makes sure neither she nor the patient is trapped, so both have an exit.
Answer
A · At a safe distance, slightly to the side, with a clear exit available
24.Mental health nursing
Answer: C · Withhold the antipsychotic and get urgent medical help
Why this is the answer
These findings suggest neuroleptic malignant syndrome. Stop the antipsychotic, call for urgent medical review, start cooling and supportive care, and monitor vital signs, kidney function and CK.
Answer
C · Withhold the antipsychotic and get urgent medical help
25.Nursing math & unit conversions
Answer: h = 140 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 + 7 = 55 in
Inches to centimetres
h = 55·2.54 = 139.7 ≈ 140 cm
Answer
h = 140 cm
26.Nursing math & unit conversions
Answer: t = 510 min
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
21:15 → 24:00 = 165 min
After midnight
00:00 → 05:45 = 345 min
Total
t = 165 + 345 = 510 min
Answer
t = 510 min
27.Dosage calculations
Answer: D = 150 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
25·18 = 450 mg
Per dose
D = 450/3 = 150 mg
Answer
D = 150 mg
28.Dosage calculations
Answer: V = 1.7 mL
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Weight in kg
145.2/2.2 = 66 kg
Dose
1·66 = 66 mg
Volume
V = (66/200)·5 = 1.65 ≈ 1.7 mL
Answer
V = 1.7 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
25·60/20 = 75 mL/h
Volume
V = 75·3 = 225 mL
Answer
V = 225 mL
30.IV infusion rates
Answer: D = 125 mg/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.
Concentration
500/100 = 5 mg/mL
Dose rate
D = 5·25 = 125 mg/h
Answer
D = 125 mg/h
31.IV fluids & fluid balance
Answer: U = 1.04 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
350 + 300 + 225 = 875 mL
Per kilogram per hour
U = 875/(105·8) = 1.042 ≈ 1.04 mL/kg/h
Answer
U = 1.04 mL/kg/h
32.IV fluids & fluid balance
Answer: t = 3.8 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
1000 − 550 = 450 mL
Time
t = 450/120 = 3.75 ≈ 3.8 h
Answer
t = 3.8 h
That is about 3 h 45 min, so the bag runs out at about 16:15.
33.Clinical assessment scores
Answer: moderate
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.
Score each area
E: opens the eyes only to pressure (a painful stimulus) → 2
V: talks in sentences but is confused → 4
M: moves a hand to the site of pressure (localises) → 5
Add
GCS = 2 + 4 + 5 = 11
Severity
GCS 11 → moderate
Answer
moderate
34.Clinical assessment scores
Answer: obesity class I
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 = 84/1.64² = 31.23
Category
obesity class I
Answer
obesity class I
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.