Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
Prioritization & delegation
Method
Ask what will harm the patient soonest if nothing is done.
Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
Assess before you act unless it is an emergency; then choose the step the others depend on.
For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.
Lab values & electrolytes
Method
Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
Link the value to its typical signs and to the drugs and conditions that cause it.
Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.
Med-surg: cardiovascular & respiratory
Method
Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
Choose the safe first action, then escalate and reassess.
Med-surg: neuro, endocrine & renal
Method
Check the glucose in every patient with new confusion, weakness or a seizure.
Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.
Med-surg: GI, perioperative & oncology
Method
Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.
Maternity & obstetric nursing
Method
Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.
Pediatric nursing
Method
Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
Match the action to the development stage and involve the family.
Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.
Mental health nursing
Method
Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
Respect rights: the least restrictive option, consent and confidentiality with its limits.
Nursing math & unit conversions
Metric steps
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
Weight and length
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
Household measures
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
falls 25, diagnosis 15, aid 15/30, IV 20, gait 10/20, mental status 15
NEWS2 risk
0–4 low; single 3 low–medium; 5–6 medium; ≥ 7 high
Mean arterial pressure
MAP = (SBP + 2·DBP)/3 = DBP + PP/3
Pulse pressure and shock index
PP = SBP − DBP, SI = HR/SBP
Body mass index
BMI = kg/m² = 703·lb/in²
Method
Find the score sheet that the question uses and its range (GCS 3–15, APGAR 0–10, Braden 6–23, Morse 0–125).
Score every item separately, matching the description to its level.
Add the item scores and check that the total lies inside the range.
Apply the cut-offs: for NEWS2 also look for any single parameter scoring 3.
For derived values use MAP = (SBP + 2·DBP)/3, PP = SBP − DBP, SI = HR/SBP and BMI = kg/m².
2Practice problems
1.Nursing fundamentalsMedium
Why are patients with a new ileostomy at risk of dehydration?
AThe colon removes too much water from the stool
BThe stoma absorbs water from the body
CThe output is liquid and contains a lot of water and salt
DThey are not allowed to drink for several weeks after surgery
2.Nursing fundamentalsHard
Which statement about the use of physical restraint is correct?
AIt is a last resort, uses the least restrictive option and needs regular checks
BIt never needs to be documented if it is used only overnight
CIt is the best way to stop older patients from falling
DIt can be used whenever a patient is confused, without further assessment
3.Infection control & patient safetyMedium
A patient with diabetes will use lancets and insulin needles at home. Which teaching about disposal is correct?
APut them in a puncture-resistant container with a lid and follow local disposal rules
BFlush the used lancets and needles down the toilet
CRecap each needle with two hands before putting it in the kitchen trash
DPut them loose in the household trash bag, as long as the bag is tied shut
4.Infection control & patient safetyHard
During an oral drug round, a patient asks to take a tablet later. The nurse leaves it on the bedside table. What is the main safety problem?
AThe tablet may lose its color and become hard to identify later
BTablets dissolve quickly when left in the open air
CThere is no safety problem if the patient is alert
DThe nurse cannot confirm it was taken, and another person could take it
5.Prioritization & delegationMedium
A nurse delegates the measurement of blood glucose to a trained assistant but never asks for the result. Which right of delegation is missing?
ARight circumstance
BRight person for the task
CRight supervision and evaluation
DRight task for the setting
6.Prioritization & delegationHard
A patient has a new spinal cord injury at C4. Which assessment is the priority?
ASkin over the sacrum and heels
BBowel sounds in all four abdominal quadrants
CAbility to feed themselves
DBreathing effort and ability to cough
7.Clinical nursingMedium
Which adverse effects should be monitored for in a patient receiving IV gentamicin?
AKidney damage and hearing loss
BConstipation and urinary retention
CHair loss and weight gain
DHyperglycaemia and tremor
8.Clinical nursingHard
A nurse phones a doctor about a deteriorating patient using SBAR. Which statement belongs in the "R" section?
A"His blood pressure is 85/50 and he is confused."
B"Please review him within the next 15 minutes."
C"He was admitted three days ago with pneumonia."
D"I am calling about Mr Smith, who is breathless."
9.Lab values & electrolytesMedium
A patient due for digoxin has a potassium of 3.1 mEq/L. Why is this result important?
ALow potassium makes digoxin ineffective, so the dose should be doubled
BPotassium and digoxin do not interact
CLow potassium increases the risk of digoxin toxicity
DLow potassium protects the heart from digoxin side effects
10.Lab values & electrolytesHard
A patient has painless jaundice, itching, dark urine and pale stools. ALP is markedly raised, conjugated (direct) bilirubin is high and ALT is only mildly raised. What is the most likely cause?
AIncreased breakdown of red blood cells (hemolytic anemia)
BBlockage of bile flow, for example by a tumor in the bile duct
CAcute viral hepatitis with widespread liver cell damage
DGilbert syndrome, a harmless inherited bilirubin disorder
11.PharmacologyMedium
A patient with difficulty swallowing is prescribed several tablets. Which one should not be crushed?
AA plain paracetamol tablet
BA modified-release (extended-release) tablet
CA tablet that the pharmacist says may be crushed
DA plain aspirin dispersible tablet
12.PharmacologyHard
Which regimen is standard for eradicating Helicobacter pylori?
AAcid suppression plus at least two antibiotics, often with bismuth, for 14 days
BAn antacid alone, taken after meals and at bedtime for six months
CAn H2 blocker taken only when pain occurs
DA single dose of an antibiotic given intravenously
13.Med-surg: cardiovascular & respiratoryMedium
Which statement about a spacer for a metered-dose inhaler is correct?
AIt is designed to be used with dry-powder inhalers
BIt means the steroid preventer inhaler can be stopped altogether
CLess coordination is needed, and more drug reaches the lungs
DIt makes each puff of the drug stronger than usual
14.Med-surg: cardiovascular & respiratoryHard
A 28-year-old woman taking the combined pill comes in breathless and anxious. RR is 30/min, heart rate 118/min and SpO₂ 90% on air. A colleague says it is a panic attack. What should the nurse conclude?
ALow oxygen saturation is not explained by anxiety; PE must be excluded
BBreathing into a paper bag is the best first treatment for her
CShe should be sent home after a sedative
DThe saturation is normal for an anxious person who is breathing fast
15.Med-surg: neuro, endocrine & renalMedium
Why is once-daily prednisolone usually taken in the morning with food?
ATo match the natural cortisol rhythm and protect the stomach
BBecause food doubles the strength of the dose
CBecause it cannot be absorbed at night
DBecause it causes drowsiness and is safer to take during the day
16.Med-surg: neuro, endocrine & renalHard
A man who takes tamsulosin for BPH is listed for cataract surgery. Which statement is correct?
AIt should be swapped for oxybutynin the night before to protect the eye
BThe dose should be doubled before surgery to prevent urinary retention
CThe eye surgeon must be told, as it can cause floppy iris during surgery
DTamsulosin has no effects outside the urinary tract, so nothing changes
17.Med-surg: GI, perioperative & oncologyMedium
Which bedside assessments are used to follow ascites?
APeak flow and oxygen saturation
BDaily weight and abdominal girth
CPupil size and reaction twice daily
DCapillary glucose before each meal
18.Med-surg: GI, perioperative & oncologyHard
An immobile patient on opioids drinks very little. Which laxative choice is least appropriate?
AAn osmotic laxative such as a macrogol
BA bulk-forming laxative used on its own
CA stimulant laxative taken regularly
DA stool softener with a stimulant laxative
19.Maternity & obstetric nursingMedium
A newborn's anterior fontanelle is sunken. What should the nurse suspect?
ANormal crying
BDehydration
CRaised intracranial pressure
DHydrocephalus
20.Maternity & obstetric nursingHard
Why does the ductus arteriosus normally close after birth?
ARising prostaglandins and falling oxygen levels
BPressure in the pulmonary artery rises
CThe cord is cut, which closes it directly
DRising oxygen levels and falling prostaglandins
21.Pediatric nursingMedium
How should a nurse approach a health interview with a 15-year-old?
AInterview the adolescent with friends present for support
BSpend part of the visit alone with the adolescent and explain the limits of confidentiality
CSpeak only to the parent
DTell the adolescent that everything said will be shared with the parents to keep them informed
22.Pediatric nursingHard
A child develops the "slapped cheek" rash of fifth disease. The parent asks whether the child is still infectious. What is the best answer?
AYes, for 6 weeks after the rash appears
BYes, until every trace of the rash has faded from the cheeks and limbs
CUsually not; the child was most infectious before the rash appeared
DThe illness is not infectious at any stage
23.Mental health nursingMedium
A patient lies awake in bed for hours worrying about not sleeping. Which stimulus control advice is correct?
ADo vigorous exercise in the bedroom until tired enough to fall asleep straight away
BLook at the clock often to check how much sleep is being lost
CStay in bed and watch television or use a phone until sleep finally comes
DIf still awake after about 20 minutes, get up, do something calm and return when sleepy
24.Mental health nursingHard
A patient with depression and a family history of bipolar disorder started an antidepressant 2 weeks ago. He now sleeps 3 hours a night, talks rapidly and is spending large amounts of money. What should the nurse suspect?
ASerotonin syndrome caused by a high dose
BThe expected improvement in mood from the antidepressant
CNormal relief and extra energy now that his depression has finally lifted after the treatment
DA switch into mania or hypomania triggered by the antidepressant
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient is 4 ft 0 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 0 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 delivers 10 mg/h. Express this dose rate D in mcg/min. Round to one decimal place.
10 mg/h1 mg = 1000 mcg1 h = 60 min
D = mcg/min
27.Dosage calculationsMedium
A vial contains 2 g of powder. The label says: add 9.2 mL of water for injection to give a total volume of 10 mL. The prescription is 480 mg. What volume V of the reconstituted solution do you give?
2 g+ 9.2 mL → 10 mL480 mg
V = mL
28.Dosage calculationsHard
The prescription is 520 units of a drug that comes as 1000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
520 units1000 units/mL
V = mL
29.IV infusion ratesMedium
Infuse 1000 mL over 10 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
1000 mL10 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
1500 mL was ordered over 8 hours. After 5 hours you find that 650 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?
1500 mL / 8 hafter 5 h: 650 mL
Δ = %
31.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The patient weighs 109 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
109 kg12 hurine: 175 mLurine: 300 mLvomit: 200 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 12:00 at 125 mL/h. After 3 hours the rate is changed to 75 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
500 mL125 mL/h · 3 h75 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury does not open the eyes at all, makes only incomprehensible sounds such as moaning and shows as the best motor response: extension of the arms and legs (abnormal extension). 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 116 kg and is 181 cm tall. Calculate the BMI and click the WHO weight category.
116 kg181 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
3Solutions
1.Nursing fundamentals
Answer: C · The output is liquid and contains a lot of water and salt
Why this is the answer
The colon normally reabsorbs water and salt. An ileostomy bypasses it, so high output can quickly cause dehydration and low sodium; output is monitored and fluids encouraged.
Answer
C · The output is liquid and contains a lot of water and salt
2.Nursing fundamentals
Answer: A · It is a last resort, uses the least restrictive option and needs regular checks
Why this is the answer
Restraint carries risks such as injury, distress and pressure damage. It is used only when alternatives have failed, in the least restrictive form, for the shortest time, with monitoring and documentation.
Answer
A · It is a last resort, uses the least restrictive option and needs regular checks
3.Infection control & patient safety
Answer: A · Put them in a puncture-resistant container with a lid and follow local disposal rules
Why this is the answer
Home sharps go into a puncture-resistant container, such as an approved sharps container or a rigid plastic bottle if local rules allow, which is closed and disposed of according to local guidance.
Answer
A · Put them in a puncture-resistant container with a lid and follow local disposal rules
4.Infection control & patient safety
Answer: D · The nurse cannot confirm it was taken, and another person could take it
Why this is the answer
Medicines are not left at the bedside unless there is an agreed self-administration plan. The nurse must see the medication taken to document it correctly, and unattended tablets can be taken by another patient or lost.
Answer
D · The nurse cannot confirm it was taken, and another person could take it
5.Prioritization & delegation
Answer: C · Right supervision and evaluation
Why this is the answer
The nurse must follow up, check the result and act on it. Delegating without checking the outcome breaks the right of supervision and evaluation.
Answer
C · Right supervision and evaluation
6.Prioritization & delegation
Answer: D · Breathing effort and ability to cough
Why this is the answer
Injuries at C3–C5 can affect the phrenic nerve and diaphragm, so breathing may fail. Respiratory function is monitored closely, and the patient may need ventilatory support.
Answer
D · Breathing effort and ability to cough
7.Clinical nursing
Answer: A · Kidney damage and hearing loss
Why this is the answer
Gentamicin is nephrotoxic and ototoxic. Blood levels and renal function are monitored, and any tinnitus, dizziness or hearing change is reported.
Answer
A · Kidney damage and hearing loss
8.Clinical nursing
Answer: B · "Please review him within the next 15 minutes."
Why this is the answer
In SBAR, R is the recommendation or request, such as a review within a time frame. The other statements belong to Assessment, Background and Situation.
Answer
B · "Please review him within the next 15 minutes."
9.Lab values & electrolytes
Answer: C · Low potassium increases the risk of digoxin toxicity
Why this is the answer
Digoxin binds where potassium normally binds on the sodium–potassium pump, so a low potassium increases digoxin’s effect and the risk of arrhythmias. The nurse reports the value before giving the dose.
Answer
C · Low potassium increases the risk of digoxin toxicity
10.Lab values & electrolytes
Answer: B · Blockage of bile flow, for example by a tumor in the bile duct
Why this is the answer
In obstruction, conjugated bilirubin backs up into the blood and is passed in the urine, making it dark, while stools are pale and ALP rises. Hemolysis and Gilbert syndrome raise unconjugated bilirubin; hepatitis raises ALT much more.Checked against:Bilirubin in Urine · MedlinePlus (NIH) (2024)
Answer
B · Blockage of bile flow, for example by a tumor in the bile duct
11.Pharmacology
Answer: B · A modified-release (extended-release) tablet
Why this is the answer
Crushing modified-release products destroys the release mechanism and can cause toxic peaks. Enteric-coated tablets should also not be crushed; the pharmacist can advise on liquid or other forms.
Answer
B · A modified-release (extended-release) tablet
12.Pharmacology
Answer: A · Acid suppression plus at least two antibiotics, often with bismuth, for 14 days
Why this is the answer
Eradication combines acid suppression (usually a PPI) with at least two antibiotics; bismuth quadruple therapy for 14 days is now often first-line because clarithromycin resistance makes older triple therapy fail. Taking every dose matters, and cure is confirmed with a breath or stool test.
Answer
A · Acid suppression plus at least two antibiotics, often with bismuth, for 14 days
13.Med-surg: cardiovascular & respiratory
Answer: C · Less coordination is needed, and more drug reaches the lungs
Why this is the answer
A spacer slows the aerosol and holds it so the patient can inhale it with slow breaths. More drug reaches the lungs and less is deposited in the mouth. It is used with pressurised metered-dose inhalers, not dry-powder devices.
Answer
C · Less coordination is needed, and more drug reaches the lungs
14.Med-surg: cardiovascular & respiratory
Answer: A · Low oxygen saturation is not explained by anxiety; PE must be excluded
Why this is the answer
Panic-related hyperventilation causes respiratory alkalosis but normal oxygen saturation. Hypoxaemia with tachycardia in a woman taking oestrogen suggests PE. She needs oxygen, urgent medical assessment and investigation. Paper-bag rebreathing is unsafe and can worsen hypoxaemia.
Answer
A · Low oxygen saturation is not explained by anxiety; PE must be excluded
15.Med-surg: neuro, endocrine & renal
Answer: A · To match the natural cortisol rhythm and protect the stomach
Why this is the answer
Morning dosing mimics the normal early-morning cortisol peak, causes less adrenal suppression and less sleep disturbance. Taking it with food reduces gastric irritation.
Answer
A · To match the natural cortisol rhythm and protect the stomach
16.Med-surg: neuro, endocrine & renal
Answer: C · The eye surgeon must be told, as it can cause floppy iris during surgery
Why this is the answer
Tamsulosin blocks alpha-1A receptors in the iris dilator muscle as well as in the prostate, which can cause intraoperative floppy iris syndrome during cataract surgery. The effect can persist after the drug is stopped, so the surgeon must know in advance to plan the operation. Whether to pause it is a decision for the team.
Answer
C · The eye surgeon must be told, as it can cause floppy iris during surgery
17.Med-surg: GI, perioperative & oncology
Answer: B · 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
B · Daily weight and abdominal girth
18.Med-surg: GI, perioperative & oncology
Answer: B · A bulk-forming laxative used on its own
Why this is the answer
Bulk-forming laxatives need good fluid intake and mobility and can worsen constipation or cause obstruction without them. They do not counter the effect of opioids on gut movement, so stimulant or osmotic laxatives are preferred.
Answer
B · A bulk-forming laxative used on its own
19.Maternity & obstetric nursing
Answer: B · Dehydration
Why this is the answer
A sunken fontanelle suggests dehydration. A tense or bulging fontanelle when the baby is calm and upright can indicate raised intracranial pressure, such as from meningitis or hydrocephalus.
Answer
B · Dehydration
20.Maternity & obstetric nursing
Answer: D · Rising oxygen levels and falling prostaglandins
Why this is the answer
Higher blood oxygen and lower prostaglandin levels after birth cause the ductus arteriosus to constrict. Prostaglandin infusions are used to keep it open in duct-dependent heart defects.
Answer
D · Rising oxygen levels and falling prostaglandins
21.Pediatric nursing
Answer: B · Spend part of the visit alone with the adolescent and explain the limits of confidentiality
Why this is the answer
Adolescents are more open when interviewed alone. Explain that what they say is confidential unless there is a risk of serious harm. Frameworks such as HEADSSS cover home, education, activities, drugs, sexuality, suicide and safety.
Answer
B · Spend part of the visit alone with the adolescent and explain the limits of confidentiality
22.Pediatric nursing
Answer: C · Usually not; the child was most infectious before the rash appeared
Why this is the answer
In fifth disease the child is most infectious during the mild illness before the rash. By the time the rash appears, the child is usually no longer infectious and does not need to be kept off school.
Answer
C · Usually not; the child was most infectious before the rash appeared
23.Mental health nursing
Answer: D · If still awake after about 20 minutes, get up, do something calm and return when sleepy
Why this is the answer
Stimulus control strengthens the bed as a cue for sleep. Getting up when unable to sleep, using the bed only for sleep and intimacy, and keeping a regular wake time are key parts.
Answer
D · If still awake after about 20 minutes, get up, do something calm and return when sleepy
24.Mental health nursing
Answer: D · A switch into mania or hypomania triggered by the antidepressant
Why this is the answer
Antidepressants can trigger mania or hypomania in people with bipolar disorder, particularly without a mood stabiliser. The nurse reports this so the prescriber can reassess the diagnosis and treatment.
Answer
D · A switch into mania or hypomania triggered by the antidepressant
25.Nursing math & unit conversions
Answer: h = 122 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 + 0 = 48 in
Inches to centimetres
h = 48·2.54 = 121.9 ≈ 122 cm
Answer
h = 122 cm
26.Nursing math & unit conversions
Answer: D = 166.7 mcg/min
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.
Set up the chain
D = 10 mg/h × (1000 mcg/1 mg) × (1 h/60 min)
Calculate
D = 10000/60 = 166.7 mcg/min
Answer
D = 166.7 mcg/min
27.Dosage calculations
Answer: V = 2.4 mL
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Concentration after mixing
2000 mg/10 mL = 200 mg/mL
Volume
V = 480/200 = 2.4 mL
Answer
V = 2.4 mL
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 = 520/1000 = 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 = 33 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
10·60 = 600 min
Drip rate
R = 1000·20/600 = 33.33 ≈ 33 gtt/min
Answer
R = 33 gtt/min
At the bedside you round to the nearest whole drop: 33 gtt/min.
30.IV infusion rates
Answer: Δ = 15.56 %
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Original rate
1500/8 = 187.5 mL/h
New rate
R = 650/3 = 216.7 mL/h
Percentage change
Δ = (216.7 − 187.5)/187.5·100% = 15.56%
Answer
Δ = 15.56%
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
31.IV fluids & fluid balance
Answer: U = 0.36 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
175 + 300 = 475 mL
Per kilogram per hour
U = 475/(109·12) = 0.3631 ≈ 0.36 mL/kg/h
Answer
U = 0.36 mL/kg/h
32.IV fluids & fluid balance
Answer: t = 4.7 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.
First part
125·3 = 375 mL
500 − 375 = 125 mL left
Second part
125/75 = 1.667 h
Total time
t = 3 + 1.667 = 4.667 ≈ 4.7 h
Answer
t = 4.7 h
That is about 4 h 40 min, so the bag runs out at about 16:40.
33.Clinical assessment scores
Answer: severe
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: does not open the eyes at all → 1
V: makes only incomprehensible sounds such as moaning → 2
M: extension of the arms and legs (abnormal extension) → 2
Add
GCS = 1 + 2 + 2 = 5
Severity
GCS 5 → severe
Answer
severe
34.Clinical assessment scores
Answer: obesity class II
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 = 116/1.81² = 35.41
Category
obesity class II
Answer
obesity class II
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