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
When opening a sterile pack on a table, which flap is opened first?
AThe flap furthest away from you
BAny flap, as long as you wear sterile gloves
CThe flap nearest to you
DThe flap on your dominant side
2.Nursing fundamentalsHard
A patient asks for a same-sex nurse for intimate care because of their religious beliefs. What should the nurse do?
AAgree, but only if the patient has a written note from a religious leader
BTell the patient they must accept whoever is on duty
CRefuse, as all nurses are equally qualified
DArrange it where possible and record the preference in the care plan
3.Infection control & patient safetyMedium
How should a portable oxygen cylinder be kept in a patient’s room?
ASecured upright in a stand or holder
BPlaced next to a heater to keep it warm
CLying loose on the floor beside the bed
DLaid on the bed next to the patient
4.Infection control & patient safetyHard
A nurse teaches new parents how to cope with an infant’s crying. Which statement shows a need for further teaching?
A“I can call a friend or family member to help when I am tired.”
B“I will check whether he is hungry, wet or too warm.”
C“If he won’t stop crying, a quick shake will get his attention.”
D“If I get frustrated, I will put him safely in the crib and take a short break.”
5.Prioritization & delegationMedium
A patient with asthma has two inhalers: a corticosteroid and salbutamol (albuterol). Which statement shows a need for further teaching?
A“I will use my steroid inhaler when I have a sudden attack.”
B“I will use my steroid inhaler every day, even when I feel well.”
C“I will rinse my mouth after using the steroid inhaler.”
D“I will carry my salbutamol inhaler with me.”
6.Prioritization & delegationHard
An infant is choking and cannot cry or breathe. Which technique is correct?
AA blind finger sweep of the mouth
BAbdominal thrusts, as in adults
CHolding the infant upside down by the feet
DBack blows and chest thrusts
7.Clinical nursingMedium
A patient is admitted with cellulitis of the leg. Why might the nurse mark the edge of the redness on the skin?
ATo mark the site for an injection
BTo monitor whether the infection is spreading or improving
CTo show the surgeon exactly where to make the incision
DTo help the patient find the sore area
8.Clinical nursingHard
An older patient has fallen several times since starting a new medicine. Which drug group is most likely to contribute?
ALubricating eye drops
BBenzodiazepine sleeping tablets
CEmollient creams applied to the legs
DVitamin D supplements
9.Lab values & electrolytesMedium
A patient's potassium is 7.0 mEq/L. Which ECG change would the nurse expect?
AProminent U waves
BDelta waves before the QRS
CTall, peaked T waves
DFlattened T waves
10.Lab values & electrolytesHard
The nurse teaches a patient with thrombocytopenia (platelets 25 × 10³/µL) about home safety. Which statement shows a need for further teaching?
A"I'll use a soft-bristled toothbrush"
B"I'll take aspirin if I get a headache"
C"I'll blow my nose gently, not forcefully"
D"I'll use an electric razor to shave"
11.PharmacologyMedium
How long does it take, approximately, for a drug given at regular intervals to reach a steady state?
A1 half-life
B4 to 5 half-lives
CIt depends only on the dose size
D10 half-lives
12.PharmacologyHard
Methotrexate for rheumatoid arthritis is taken once a week. A patient mistakenly takes the same dose every day. What is the main danger?
ASevere hypertension from fluid retention
BHypoglycaemia because methotrexate strongly stimulates insulin release
CBone marrow suppression and mucositis from methotrexate toxicity
DThe arthritis gets worse because of drug tolerance
13.Med-surg: cardiovascular & respiratoryMedium
A patient is starting doxazosin, an alpha-blocker, for hypertension. Which advice is most important?
AAvoid all potassium-containing foods
BStop it suddenly if the heart rate rises after the first few doses
CTake the first dose at bedtime, as dizziness and fainting can occur
DTake it with a large glass of grapefruit juice to improve absorption
14.Med-surg: cardiovascular & respiratoryHard
A ventilated patient is coughing, and the high-pressure alarm sounds. Coarse sounds are heard over the trachea. What should the nurse do first?
ADeflate the endotracheal tube cuff fully
BAssess the patient and suction if secretions are present
CIncrease the tidal volume on the ventilator to overcome it
DTurn the alarm off and reassess the patient in an hour
15.Med-surg: neuro, endocrine & renalMedium
Which signs suggest rejection of a kidney transplant?
AA rash on the face after sun exposure
BA cough, wheeze and a runny nose with sneezing
CMore urine, a falling creatinine and weight loss
DLess urine, a rising creatinine and a tender graft
16.Med-surg: neuro, endocrine & renalHard
Three days after a stroke, a patient with dysphagia on a modified diet has a temperature of 38.2 °C (100.8 °F), a respiratory rate of 24/min and crackles at the right lung base. What should the nurse do?
AGive paracetamol (acetaminophen) and continue the modified diet as before
BRecord the findings and recheck them at the next routine observation
CSuspect aspiration pneumonia, stop oral intake and escalate for review
DEncourage more fluids by mouth to treat the fever
17.Med-surg: GI, perioperative & oncologyMedium
Which early symptoms suggest local anaesthetic systemic toxicity?
AMild itching of the feet the next day
BA red rash only at the injection site, with no other symptoms
CIncreased hunger and thirst over several hours, with a dry mouth
DTingling around the mouth, a metallic taste and tinnitus
18.Med-surg: GI, perioperative & oncologyHard
During a nerve block, a patient reports a metallic taste and ringing in the ears, then has a seizure. Besides calling for help and supporting the airway, which specific treatment is given?
AIV lipid emulsion
BIV naloxone
CIV glucose 50%
DIV dantrolene
19.Maternity & obstetric nursingMedium
When performing the first Leopold manoeuvre, what is the nurse trying to identify?
AWhether the head has entered the pelvis
BWhich fetal part lies in the fundus
CThe amount of amniotic fluid
DWhich side the fetal back lies on
20.Maternity & obstetric nursingHard
A term newborn has rapid breathing at 2 hours after a caesarean without labour. Saturation is normal, there is no fever and the chest X-ray shows fluid in the fissures. What is the most likely diagnosis?
AMeconium aspiration syndrome
BTransient tachypnoea of the newborn
CNeonatal pneumonia with sepsis
DRespiratory distress syndrome of prematurity
21.Pediatric nursingMedium
After a cardiac catheterisation through the femoral artery, which assessment is essential?
APulse, colour, warmth and sensation of the leg below the puncture site
BBowel sounds, abdominal girth and stool colour every 15 minutes for the first hours
CPupil size and reaction every 15 minutes
DUrine specific gravity at every void
22.Pediatric nursingHard
A child with sickle cell disease has new chest pain, cough, fever and an oxygen saturation of 90%. What should the nurse suspect?
AA mild cold
BAnxiety about being in hospital
CAcute chest syndrome, an emergency
DNormal pain from a limb crisis
23.Mental health nursingMedium
What should a patient on clozapine be taught to report immediately?
AFever, sore throat or other signs of infection
BIncreased saliva at night
CMild drowsiness after the evening dose
DA wish to eat more
24.Mental health nursingHard
A patient in a manic episode starts taking off her clothes in the busy day room. What is the most appropriate action?
ACalmly cover her and guide her to her room or a quiet area
BTell her loudly in front of everyone that she must stop
CAsk the other patients to ignore her and carry on
DCall security to remove her from the ward
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 97.6 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.
97.6 °F
T = °C
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). During a shift a patient takes ¾ cup of tea, 1 tsp of cough syrup, 1½ tbsp of liquid supplement. Using the equivalents given, find the total oral intake V in mL.
1 cup = 8 fl oz = 240 mL1 tsp = 5 mL1 tbsp = 15 mL
V = mL
27.Dosage calculationsMedium
A patient weighs 15 kg. The prescribed dose is 5 mg/kg per day, given in 2 equal doses. How many milligrams D are given per dose?
15 kg5 mg/kg/day2× per day
D = mg
28.Dosage calculationsHard
The prescription is 700 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
700 units5000 units/mL
V = mL
29.IV infusion ratesMedium
Infuse 500 mL over 8 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
500 mL8 h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 2 g of a drug in 500 mL. The order is 0.5 mg per minute. At what rate R do you set the pump, in mL/h?
2 g/500 mL0.5 mg/min
R = mL/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 total intake I in mL.
milk: 200 mLjelly: 100 mLIV infusion: 75 mL/h × 12 hIV antibiotic: 2 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 12:00 at 80 mL/h. After 3 hours the rate is changed to 50 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 mL80 mL/h · 3 h50 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), makes only incomprehensible sounds such as moaning and shows as the best motor response: withdraws the limb from pressure (normal flexion). 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). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 16/min, SpO₂ 99% on room air, blood pressure 142/86 mmHg, pulse 88/min, alert, temperature 34.8 °C. Which clinical risk group does the patient fall into? Click it.
RR 16SpO₂ 99%airSBP 142HR 88AT 34.8 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: A · The flap furthest away from you
Why this is the answer
Opening the far flap first means the nurse never reaches across the exposed sterile contents. The side flaps follow, and the nearest flap is opened last.
Answer
A · The flap furthest away from you
2.Nursing fundamentals
Answer: D · Arrange it where possible and record the preference in the care plan
Why this is the answer
Respecting such preferences supports dignity and trust. The nurse arranges it whenever possible, records it and explains if it cannot be met in an emergency.
Answer
D · Arrange it where possible and record the preference in the care plan
3.Infection control & patient safety
Answer: A · Secured upright in a stand or holder
Why this is the answer
Oxygen cylinders are under high pressure and can be damaged or cause injury if they fall. They are kept upright in a holder or cart, away from heat and flames.
Answer
A · Secured upright in a stand or holder
4.Infection control & patient safety
Answer: C · “If he won’t stop crying, a quick shake will get his attention.”
Why this is the answer
Shaking an infant can cause bleeding in the brain, permanent disability or death. Parents are taught to put the baby down safely and step away if they feel overwhelmed, and to ask for help.
Answer
C · “If he won’t stop crying, a quick shake will get his attention.”
5.Prioritization & delegation
Answer: A · “I will use my steroid inhaler when I have a sudden attack.”
Why this is the answer
Inhaled corticosteroids reduce inflammation over time and do not relieve an acute attack. Salbutamol (albuterol) is the quick-relief inhaler; rinsing after steroids helps prevent oral thrush.
Answer
A · “I will use my steroid inhaler when I have a sudden attack.”
6.Prioritization & delegation
Answer: D · Back blows and chest thrusts
Why this is the answer
For a choking infant, the nurse gives cycles of five back blows and five chest thrusts. Abdominal thrusts are not used in infants, and blind finger sweeps can push the object deeper.
Answer
D · Back blows and chest thrusts
7.Clinical nursing
Answer: B · To monitor whether the infection is spreading or improving
Why this is the answer
Marking the margin helps staff see whether the redness is spreading despite treatment, which may mean antibiotics need review. The limb is also elevated and observations monitored.
Answer
B · To monitor whether the infection is spreading or improving
8.Clinical nursing
Answer: B · Benzodiazepine sleeping tablets
Why this is the answer
Sedatives, hypnotics, antipsychotics and drugs that lower blood pressure increase falls risk. A medication review is part of every falls assessment.
Answer
B · Benzodiazepine sleeping tablets
9.Lab values & electrolytes
Answer: C · Tall, peaked T waves
Why this is the answer
Hyperkalemia first causes tall, peaked T waves, then a prolonged PR interval, loss of P waves and a wide QRS, which can lead to ventricular fibrillation or asystole. U waves and flat T waves are signs of hypokalemia.
Answer
C · Tall, peaked T waves
10.Lab values & electrolytes
Answer: B · "I'll take aspirin if I get a headache"
Why this is the answer
Aspirin irreversibly inhibits platelet function and raises the bleeding risk further in thrombocytopenia, so it and other NSAIDs are avoided unless prescribed. An electric razor, gentle nose blowing and a soft toothbrush reduce minor bleeding.
Answer
B · "I'll take aspirin if I get a headache"
11.Pharmacology
Answer: B · 4 to 5 half-lives
Why this is the answer
With repeated dosing, the level approaches steady state after about 4–5 half-lives, whatever the dose. A loading dose can be used to reach it faster.
Answer
B · 4 to 5 half-lives
12.Pharmacology
Answer: C · Bone marrow suppression and mucositis from methotrexate toxicity
Why this is the answer
Methotrexate inhibits dihydrofolate reductase. Daily dosing causes toxicity in dividing tissues such as bone marrow and gut lining, which can be fatal. Folinic acid is used as a rescue treatment.
Answer
C · Bone marrow suppression and mucositis from methotrexate toxicity
13.Med-surg: cardiovascular & respiratory
Answer: C · Take the first dose at bedtime, as dizziness and fainting can occur
Why this is the answer
Alpha-blockers can cause marked first-dose postural hypotension. Taking the first dose at bedtime and rising slowly reduces the risk of falls. They are also used for symptoms of an enlarged prostate.
Answer
C · Take the first dose at bedtime, as dizziness and fainting can occur
14.Med-surg: cardiovascular & respiratory
Answer: B · Assess the patient and suction if secretions are present
Why this is the answer
High-pressure alarms are caused by secretions, coughing, biting the tube, kinked tubing or bronchospasm. With secretions heard, suctioning is the logical first step after a quick assessment. Low-pressure alarms suggest a leak or disconnection. Alarms must never be silenced without finding the cause.
Answer
B · Assess the patient and suction if secretions are present
15.Med-surg: neuro, endocrine & renal
Answer: D · Less urine, a rising creatinine and a tender graft
Why this is the answer
Acute rejection may cause falling urine output, rising creatinine, weight gain, fever, and pain or tenderness over the graft. Many episodes are found on blood tests before symptoms appear, so regular monitoring is essential.
Answer
D · Less urine, a rising creatinine and a tender graft
16.Med-surg: neuro, endocrine & renal
Answer: C · Suspect aspiration pneumonia, stop oral intake and escalate for review
Why this is the answer
These signs suggest aspiration pneumonia, which is a common and serious complication of dysphagia. The patient needs medical review, chest assessment, oxygen if needed, and reassessment of their swallow before eating again.
Answer
C · Suspect aspiration pneumonia, stop oral intake and escalate for review
17.Med-surg: GI, perioperative & oncology
Answer: D · Tingling around the mouth, a metallic taste and tinnitus
Why this is the answer
High blood levels of local anaesthetic first cause CNS symptoms such as perioral tingling, metallic taste, tinnitus, light-headedness and confusion, then seizures and arrhythmias. The injection is stopped and help is called at once.
Answer
D · Tingling around the mouth, a metallic taste and tinnitus
18.Med-surg: GI, perioperative & oncology
Answer: A · IV lipid emulsion
Why this is the answer
These are signs of local anaesthetic systemic toxicity. The injection is stopped, help is called, the airway is secured and seizures are treated. IV lipid emulsion is the specific treatment, especially if the circulation is affected.
Answer
A · IV lipid emulsion
19.Maternity & obstetric nursing
Answer: B · Which fetal part lies in the fundus
Why this is the answer
The first Leopold manoeuvre palpates the fundus: a firm round head or a softer, irregular breech. The second finds the back and limbs, the third the presenting part and the fourth the degree of head flexion and descent.
Answer
B · Which fetal part lies in the fundus
20.Maternity & obstetric nursing
Answer: B · Transient tachypnoea of the newborn
Why this is the answer
Transient tachypnoea is common after caesarean birth without labour. Supportive care is usually enough, but infection must be considered if the baby becomes unwell or fails to improve.
Answer
B · Transient tachypnoea of the newborn
21.Pediatric nursing
Answer: A · Pulse, colour, warmth and sensation of the leg below the puncture site
Why this is the answer
After catheterisation, the nurse checks the puncture site for bleeding and the affected leg for pulses, colour, temperature and sensation to detect clotting or bleeding. The leg is kept straight for the time set by local policy.
Answer
A · Pulse, colour, warmth and sensation of the leg below the puncture site
22.Pediatric nursing
Answer: C · Acute chest syndrome, an emergency
Why this is the answer
Acute chest syndrome causes chest pain, fever, respiratory symptoms, hypoxia and new changes on the chest X-ray. It is a leading cause of death in sickle cell disease and needs urgent treatment.
Answer
C · Acute chest syndrome, an emergency
23.Mental health nursing
Answer: A · Fever, sore throat or other signs of infection
Why this is the answer
Fever, sore throat or flu-like symptoms may be the first signs of agranulocytosis and need an urgent blood count. Sedation and hypersalivation are common side effects.
Answer
A · Fever, sore throat or other signs of infection
24.Mental health nursing
Answer: A · Calmly cover her and guide her to her room or a quiet area
Why this is the answer
Disinhibition in mania can lead to embarrassment and exploitation. The nurse protects her privacy and dignity quietly and moves her to a less stimulating environment.
Answer
A · Calmly cover her and guide her to her room or a quiet area
25.Nursing math & unit conversions
Answer: T = 36.4 °C
Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.
Subtract 32
97.6 − 32 = 65.6
Multiply by 5/9
T = 65.6·5/9 = 36.44 ≈ 36.4 °C
Answer
T = 36.4 °C
26.Nursing math & unit conversions
Answer: V = 207.5 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
¾ cup = 0.75·240 = 180 mL
1 tsp = 1·5 = 5 mL
1½ tbsp = 1.5·15 = 22.5 mL
Add
V = 180 + 5 + 22.5 = 207.5 mL
Answer
V = 207.5 mL
27.Dosage calculations
Answer: D = 37.5 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
5·15 = 75 mg
Per dose
D = 75/2 = 37.5 mg
Answer
D = 37.5 mg
28.Dosage calculations
Answer: V = 0.14 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 = 700/5000 = 0.14 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.14 mL
29.IV infusion rates
Answer: R = 10 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
8·60 = 480 min
Drip rate
R = 500·10/480 = 10.42 ≈ 10 gtt/min
Answer
R = 10 gtt/min
At the bedside you round to the nearest whole drop: 10 gtt/min.
30.IV infusion rates
Answer: R = 7.5 mL/h
Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).
Concentration
2000 mg/500 mL = 4 mg/mL
Dose per hour
0.5·60 = 30 mg/h
Pump rate
R = 30/4 = 7.5 mL/h
Answer
R = 7.5 mL/h
31.IV fluids & fluid balance
Answer: I = 1300 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.
Add the intake
oral: 200 + 100 = 300 mL
IV infusion: 75·12 = 900 mL
IV antibiotic: 2·50 = 100 mL
I = 1300 mL
Answer
I = 1300 mL
32.IV fluids & fluid balance
Answer: t = 8.2 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
80·3 = 240 mL
500 − 240 = 260 mL left
Second part
260/50 = 5.2 h
Total time
t = 3 + 5.2 = 8.2 h
Answer
t = 8.2 h
That is about 8 h 12 min, so the bag runs out at about 20:12.
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: opens the eyes only to pressure (a painful stimulus) → 2
V: makes only incomprehensible sounds such as moaning → 2
M: withdraws the limb from pressure (normal flexion) → 4
Add
GCS = 2 + 2 + 4 = 8
Severity
GCS 8 → severe
Answer
severe
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 16/min → 0
SpO₂ 99% → 0
on air → 0
SBP 142 mmHg → 0
HR 88/min → 0
alert (A) → 0
T 34.8 °C → 3
Total and red scores
NEWS2 = 0 + 0 + 0 + 0 + 0 + 0 + 3 = 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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