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 are non-sterile gloves needed?
AOnly when the patient is known to have an infection
BFor every patient contact, including taking a pulse or blood pressure
CWhen contact with blood, body fluids or broken skin is expected
DOnly when handling medicines
2.Nursing fundamentalsHard
A patient has acute diarrhoea and is suspected of having Clostridioides difficile. Which combination of measures is correct?
AWait for the lab result before taking any precautions
BWear a respirator mask only and no gloves
CIsolate the patient, use gloves and apron, and wash hands with soap and water
DUse alcohol hand rub only, and keep the patient in a shared bay with the curtains drawn
3.Infection control & patient safetyMedium
A person in scrubs without a hospital ID badge asks to take a newborn to the nursery. What should the nurse do?
ALet the parents decide whether to hand the baby over
BHand over the baby if the person seems confident
CRefuse, keep the baby with the mother and alert security
DAsk the person their name and then give them the baby
4.Infection control & patient safetyHard
A patient after heart surgery has temporary epicardial pacing wires. Why do staff take special care with electrical safety?
ASmall currents can travel along the wires straight to the heart and cause arrhythmias
BPacing wires can only carry current coming from the pacemaker box itself
CThe wires make the patient immune to electric shock
DElectrical safety only matters for patients who have permanent implanted pacemakers
5.Prioritization & delegationMedium
A patient is receiving continuous tube feeds. Which action best reduces the risk of aspiration?
AIncrease the feed rate so the stomach empties sooner
BKeep the head of the bed raised to at least 30 degrees
CLay the patient flat for an hour after each bag is hung
DTurn the feed off only while the patient is asleep at night
6.Prioritization & delegationHard
A nurse teaches a patient to inject enoxaparin at home. Which statement shows a need for further teaching?
A“I will inject into the fat of my abdomen, away from the navel.”
B“I will change the injection site each time.”
C“I will tell my doctor if I notice unusual bruising or bleeding.”
D“I will rub the area after the injection to help it absorb.”
7.Clinical nursingMedium
Long-term amiodarone treatment can affect which of the following?
ABlood glucose and cholesterol only
BThe sense of smell and taste only, with no other effects
CThyroid function, the lungs and the skin's sensitivity to sunlight
DHair colour and nail growth only, with no effect on organs
8.Clinical nursingHard
A nurse teaches a patient with heart failure about self-care. Which statement shows a need for further teaching?
A"I will take my water tablet in the morning."
B"I will weigh myself each morning after passing urine."
C"I only need to weigh myself once a month."
D"I will report it if I need more pillows to sleep."
9.Lab values & electrolytesMedium
A patient has a hot, swollen big toe. The serum uric acid is normal. Which statement is correct?
AGout is still possible, as urate can be normal in an attack
BGout is ruled out, as uric acid is always high in an attack
CGout is certain, as a normal urate proves the diagnosis
DGout can only be diagnosed with a CT scan of the foot
10.Lab values & electrolytesHard
A middle-aged man has fatigue, joint pain, a raised ALT and new diabetes. His ferritin is very high and his transferrin saturation is above 60%. Which condition is most likely?
AAnemia of chronic disease
BHereditary hemochromatosis
CAcute viral hepatitis A
DIron-deficiency anemia
11.PharmacologyMedium
How should a topical corticosteroid cream usually be applied?
AAs a thin layer to the affected area only, as directed
BOn broken, infected skin to speed healing
CAs a thick layer over the whole body
DUnder a tight plastic dressing every night without advice
12.PharmacologyHard
Why are oral liquid medicines drawn up in dedicated oral or enteral syringes that do not fit IV connectors?
ATo prevent oral liquids being given intravenously by mistake
BBecause IV syringes cannot hold liquids
CTo make the oral dose more accurate than a dose given through an IV syringe
DTo keep the medicine sterile for injection
13.Med-surg: cardiovascular & respiratoryMedium
During an episode of chest pain, a patient's ECG shows new horizontal ST depression. What does this most likely indicate?
AMyocardial ischaemia
BPericarditis
CA normal finding during pain
DHyperkalaemia
14.Med-surg: cardiovascular & respiratoryHard
A patient recovering from an MI is anxious about returning to normal life. Which intervention best supports recovery?
AAdvice to stop tablets once they feel well
BAdvice to avoid all exercise permanently
CAdvice to rest in bed for three months
DReferral to cardiac rehabilitation
15.Med-surg: neuro, endocrine & renalMedium
A patient with Addison's disease takes fludrocortisone as well as hydrocortisone. Why?
ATo replace the missing aldosterone
BTo lower the blood pressure
CTo replace the missing adrenaline
DTo treat a low thyroid hormone level
16.Med-surg: neuro, endocrine & renalHard
A patient with Guillain–Barré syndrome has a blood pressure that swings between 80/50 and 190/100 mmHg and a heart rate that changes suddenly. What does this suggest?
AA drug reaction that means all medicines must stop
BA faulty blood pressure cuff that should be replaced and the readings ignored
CAutonomic dysfunction, which needs continuous cardiac monitoring
DAnxiety that will settle with reassurance alone
17.Med-surg: GI, perioperative & oncologyMedium
Which finding suggests a deep tissue pressure injury?
AIntact skin that is purple or maroon over a bony area
BPale pink skin that blanches quickly when pressed
CA small scratch on the skin with a little fresh red blood
DDry, flaky skin on both shins
18.Med-surg: GI, perioperative & oncologyHard
Which new prescription for a patient with cirrhosis should the nurse question?
ALactulose to keep the bowels open
BThiamine supplements
CRegular ibuprofen for back pain
DSpironolactone for ascites
19.Maternity & obstetric nursingMedium
Which finding in a term newborn's first hours is normal?
ACentral cyanosis of the lips and tongue
BPauses in breathing of 30 seconds with bradycardia
CA respiratory rate of 80 at rest with retractions
DShort breathing pauses with no colour change
20.Maternity & obstetric nursingHard
Shortly after an epidural is started, a labouring woman's blood pressure falls to 86/50 mmHg and the fetal heart rate drops. What should the nurse do first?
ATurn her onto her side to move the uterus off the large vessels
BRaise the head of the bed to a high sitting position to improve her breathing
CAsk her to walk around the room
DIncrease the epidural infusion rate
21.Pediatric nursingMedium
A newborn has a cephalohaematoma. What should the nurse monitor closely over the next days?
AUrine colour, because the swelling causes kidney damage
BHead circumference twice daily, because it signals hydrocephalus
CJaundice, because the breakdown of the trapped blood adds to bilirubin
DBlood pressure, because the swelling causes hypertension
22.Pediatric nursingHard
A parent asks why the HPV vaccine is offered in early adolescence (at about 11 to 13 years, depending on the country). Which answer is best?
AIt is given at this age because it prevents chickenpox in adolescence
BIt is only effective if given in the first year of secondary school, before exams start
CChildren of this age are already likely to have the virus, so it treats the infection
DIt works best before any exposure to the virus, and young adolescents respond strongly
23.Mental health nursingMedium
Which risk applies when antipsychotics are used in older people with dementia?
AA lower risk of falls than with no medicine at all
BImproved memory within a few days
CA guaranteed cure of the dementia
DAn increased risk of stroke and death
24.Mental health nursingHard
A new nurse asks why the therapeutic relationship is different from a social relationship. Which statement is correct?
AThe patient is responsible for setting the boundaries of the relationship
BIt is goal-directed and focused on the patient's needs, with the nurse responsible for keeping boundaries
CBoth people share their needs equally, as in any friendship
DIt has no fixed end, and it can continue as a friendship after discharge if both the nurse and the patient want it to
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A drip-rate calculation gives 107.713 gtt/min. The rule in this exercise is that drip rates are rounded to the nearest whole drop. What value x do you record?
107.713 gtt/min
x = gtt/min
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). During a shift a patient takes ½ tbsp of liquid supplement, 1 fl oz of juice, 1½ tsp of cough syrup. Using the equivalents given, find the total oral intake V in mL.
1 tbsp = 15 mL1 fl oz = 30 mL1 tsp = 5 mL
V = mL
27.Dosage calculationsMedium
A patient weighs 30 kg and is prescribed 2 mg/kg as a single dose. Find the dose D in mg.
30 kg2 mg/kg
D = mg
28.Dosage calculationsHard
The prescription is 0.17 mg. The ampoule contains 1000 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
0.17 mg1000 mcg/mL
V = mL
29.IV infusion ratesMedium
Infuse 250 mL over 2 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
250 mL2 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 400 mg of a drug in 500 mL and runs at 15 mL/h. How many milligrams per hour D does the patient receive?
400 mg/500 mL15 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 IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL.
milk: 240 mLjelly: 100 mLwater: 350 mLIV infusion: 50 mL/h × 8 hIV antibiotic: 2 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 20:00 at 75 mL/h. After 2 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.
1000 mL75 mL/h · 2 h50 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 129/min and a blood pressure of 106/58 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.
HR 129/minBP 106/58 mmHg
SI =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 14/min, SpO₂ 99% on supplemental oxygen, blood pressure 124/74 mmHg, pulse 126/min, alert, temperature 38.1 °C. Which clinical risk group does the patient fall into? Click it.
RR 14SpO₂ 99%O₂SBP 124HR 126AT 38.1 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: C · When contact with blood, body fluids or broken skin is expected
Why this is the answer
Under standard precautions, gloves are worn when exposure to blood or body fluids is likely. Wearing them for all contact gives false security and can spread germs if not changed.
Answer
C · When contact with blood, body fluids or broken skin is expected
2.Nursing fundamentals
Answer: C · Isolate the patient, use gloves and apron, and wash hands with soap and water
Why this is the answer
Suspected C. difficile needs prompt isolation with contact precautions. Spores are not killed by alcohol, so hands are washed with soap and water, and the environment is cleaned with a sporicidal agent such as chlorine.
Answer
C · Isolate the patient, use gloves and apron, and wash hands with soap and water
3.Infection control & patient safety
Answer: C · Refuse, keep the baby with the mother and alert security
Why this is the answer
Infants are only handed to staff with proper identification, as set out in the infant security policy. Suspicious behavior is reported to security at once, and parents are taught to do the same.
Answer
C · Refuse, keep the baby with the mother and alert security
4.Infection control & patient safety
Answer: A · Small currents can travel along the wires straight to the heart and cause arrhythmias
Why this is the answer
Wires that lead directly to the heart allow tiny currents (microshock) to reach the myocardium and cause ventricular fibrillation. Staff wear gloves when handling them, cover exposed ends and use properly grounded equipment.
Answer
A · Small currents can travel along the wires straight to the heart and cause arrhythmias
5.Prioritization & delegation
Answer: B · Keep the head of the bed raised to at least 30 degrees
Why this is the answer
Raising the head of the bed to at least 30 degrees during and after feeding lowers the risk of reflux and aspiration. Lying flat greatly increases the risk.
Answer
B · Keep the head of the bed raised to at least 30 degrees
6.Prioritization & delegation
Answer: D · “I will rub the area after the injection to help it absorb.”
Why this is the answer
Rubbing the site after a low-molecular-weight heparin injection increases bruising. The abdomen away from the navel, rotating sites and reporting bleeding are correct.
Answer
D · “I will rub the area after the injection to help it absorb.”
7.Clinical nursing
Answer: C · Thyroid function, the lungs and the skin's sensitivity to sunlight
Why this is the answer
Amiodarone can cause hypo- or hyperthyroidism, pulmonary fibrosis, liver problems and photosensitivity. Regular monitoring of thyroid and liver function is needed.
Answer
C · Thyroid function, the lungs and the skin's sensitivity to sunlight
8.Clinical nursing
Answer: C · "I only need to weigh myself once a month."
Why this is the answer
Daily weights at the same time with the same scales detect fluid retention early. A rapid gain, worsening breathlessness or needing more pillows should be reported.
Answer
C · "I only need to weigh myself once a month."
9.Lab values & electrolytes
Answer: A · Gout is still possible, as urate can be normal in an attack
Why this is the answer
Serum urate can be normal or even low during an acute gout attack. The definitive test is joint aspiration showing needle-shaped urate crystals, which also helps rule out septic arthritis.Checked against:Gout · MedlinePlus (NIH) (2025); Synovial Fluid Analysis · MedlinePlus (NIH) (2024)
Answer
A · Gout is still possible, as urate can be normal in an attack
10.Lab values & electrolytes
Answer: B · Hereditary hemochromatosis
Why this is the answer
Hemochromatosis is an inherited disorder of increased iron absorption. Iron is deposited in the liver, pancreas, joints, heart and skin. A high transferrin saturation with a high ferritin suggests the diagnosis, and treatment is regular venesection (phlebotomy).Checked against:Hemochromatosis · MedlinePlus (NIH) (2026); Ferritin Blood Test · MedlinePlus (NIH) (2025)
Answer
B · Hereditary hemochromatosis
11.Pharmacology
Answer: A · As a thin layer to the affected area only, as directed
Why this is the answer
Thin application to affected skin limits systemic absorption and skin atrophy. Occlusive dressings increase absorption and are used only when prescribed.
Answer
A · As a thin layer to the affected area only, as directed
12.Pharmacology
Answer: A · To prevent oral liquids being given intravenously by mistake
Why this is the answer
Wrong-route errors, such as giving an oral liquid IV, can be fatal. Syringes with connectors that cannot fit IV lines make this error physically difficult.
Answer
A · To prevent oral liquids being given intravenously by mistake
13.Med-surg: cardiovascular & respiratory
Answer: A · Myocardial ischaemia
Why this is the answer
New horizontal or downsloping ST depression during pain suggests myocardial ischaemia, as in unstable angina or NSTEMI. It should be reported immediately with serial ECGs and troponins. ST depression can also reflect reciprocal change opposite a STEMI.
Answer
A · Myocardial ischaemia
14.Med-surg: cardiovascular & respiratory
Answer: D · Referral to cardiac rehabilitation
Why this is the answer
Cardiac rehabilitation combines supervised exercise, risk factor education, medication advice and psychological support. It improves quality of life and reduces cardiovascular mortality and readmissions. Patients are encouraged to return gradually to activity, including work, driving and sex, according to advice.
Answer
D · Referral to cardiac rehabilitation
15.Med-surg: neuro, endocrine & renal
Answer: A · To replace the missing aldosterone
Why this is the answer
In primary adrenal insufficiency, both cortisol and aldosterone are lacking. Hydrocortisone replaces cortisol, and fludrocortisone replaces aldosterone to keep sodium, potassium and blood pressure normal.
Answer
A · To replace the missing aldosterone
16.Med-surg: neuro, endocrine & renal
Answer: C · Autonomic dysfunction, which needs continuous cardiac monitoring
Why this is the answer
Guillain–Barré syndrome can involve autonomic nerves, causing labile blood pressure and dangerous arrhythmias. Patients need continuous ECG monitoring and close observation, often in a high-dependency setting.
Answer
C · Autonomic dysfunction, which needs continuous cardiac monitoring
17.Med-surg: GI, perioperative & oncology
Answer: A · Intact skin that is purple or maroon over a bony area
Why this is the answer
A deep tissue injury appears as persistent purple, maroon or dark discolouration, or a blood-filled blister, from pressure and shear on underlying tissue. It may quickly turn into a deep wound.
Answer
A · Intact skin that is purple or maroon over a bony area
18.Med-surg: GI, perioperative & oncology
Answer: C · Regular ibuprofen for back pain
Why this is the answer
NSAIDs can cause kidney injury, fluid retention and GI bleeding in cirrhosis and should be avoided. Paracetamol at a reduced, carefully reviewed dose is usually preferred for pain.
Answer
C · Regular ibuprofen for back pain
19.Maternity & obstetric nursing
Answer: D · Short breathing pauses with no colour change
Why this is the answer
Newborns breathe irregularly, with short pauses of a few seconds and no change in colour or heart rate. Apnoea of 20 seconds or more, or any pause with cyanosis or bradycardia, is abnormal.
Answer
D · Short breathing pauses with no colour change
20.Maternity & obstetric nursing
Answer: A · Turn her onto her side to move the uterus off the large vessels
Why this is the answer
A lateral position relieves aortocaval compression and improves venous return and placental flow. Then increase IV fluids as ordered, notify the anaesthetist or provider and give a vasopressor if prescribed.
Answer
A · Turn her onto her side to move the uterus off the large vessels
21.Pediatric nursing
Answer: C · Jaundice, because the breakdown of the trapped blood adds to bilirubin
Why this is the answer
A cephalohaematoma is a collection of blood under the periosteum. As the red cells break down, bilirubin rises, so these babies have a higher risk of jaundice. The swelling itself usually resolves over weeks without treatment.
Answer
C · Jaundice, because the breakdown of the trapped blood adds to bilirubin
22.Pediatric nursing
Answer: D · It works best before any exposure to the virus, and young adolescents respond strongly
Why this is the answer
HPV is passed on through sexual contact, so vaccination is most effective before any exposure. Younger adolescents also produce a strong antibody response. The vaccine protects against HPV types that cause cervical and other cancers and genital warts.
Answer
D · It works best before any exposure to the virus, and young adolescents respond strongly
23.Mental health nursing
Answer: D · An increased risk of stroke and death
Why this is the answer
Antipsychotics in older people with dementia are linked to increased rates of stroke and death. They are used only when non-drug approaches have failed and distress or risk is severe, at the lowest dose for the shortest time.
Answer
D · An increased risk of stroke and death
24.Mental health nursing
Answer: B · It is goal-directed and focused on the patient's needs, with the nurse responsible for keeping boundaries
Why this is the answer
A therapeutic relationship has a clear purpose, focuses on the patient's needs and has a planned end. The nurse, not the patient, is responsible for keeping professional boundaries.
Answer
B · It is goal-directed and focused on the patient's needs, with the nurse responsible for keeping boundaries
25.Nursing math & unit conversions
Answer: x = 108 gtt/min
Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.
Digit in the ones place
107.713 → 7
Only the next digit decides
107.713 → 7
7 is 5 or more, so round 7 up.
The digits after it (13) are ignored: round once, never step by step.
Round
x = 108 gtt/min
Answer
x = 108 gtt/min
26.Nursing math & unit conversions
Answer: V = 45 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
½ tbsp = 0.5·15 = 7.5 mL
1 fl oz = 1·30 = 30 mL
1½ tsp = 1.5·5 = 7.5 mL
Add
V = 7.5 + 30 + 7.5 = 45 mL
Answer
V = 45 mL
27.Dosage calculations
Answer: D = 60 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.
Dose
2·30 = 60 mg
Answer
D = 60 mg
28.Dosage calculations
Answer: V = 0.17 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.
Same units
0.17 mg = 170 mcg
Volume
V = 170/1000 = 0.17 mL
Answer
V = 0.17 mL
29.IV infusion rates
Answer: R = 31 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
2·60 = 120 min
Drip rate
R = 250·15/120 = 31.25 ≈ 31 gtt/min
Answer
R = 31 gtt/min
At the bedside you round to the nearest whole drop: 31 gtt/min.
30.IV infusion rates
Answer: D = 12 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
400/500 = 0.8 mg/mL
Dose rate
D = 0.8·15 = 12 mg/h
Answer
D = 12 mg/h
31.IV fluids & fluid balance
Answer: I = 1190 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: 240 + 100 + 350 = 690 mL
IV infusion: 50·8 = 400 mL
IV antibiotic: 2·50 = 100 mL
I = 1190 mL
Answer
I = 1190 mL
32.IV fluids & fluid balance
Answer: t = 19 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
75·2 = 150 mL
1000 − 150 = 850 mL left
Second part
850/50 = 17 h
Total time
t = 2 + 17 = 19 h
Answer
t = 19 h
That is about 19 h 00 min, so the bag runs out at about 15:00.
33.Clinical assessment scores
Answer: SI = 1.22
Blood pressure values: pulse pressure PP = SBP − DBP. Mean arterial pressure MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3, an estimate based on the heart spending about two thirds of each beat in diastole at a normal heart rate (less accurate when the heart rate is fast); a MAP of at least about 65 mmHg is a common target for organ perfusion. The shock index SI = heart rate/SBP is normally about 0.5–0.7; a value above about 1 is a warning sign of shock.
Shock index
SI = 129/106 = 1.217 ≈ 1.22
Answer
SI = 1.22
1 or more: a warning sign of shock in this practice case.
34.Clinical assessment scores
Answer: 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 14/min → 0
SpO₂ 99% → 0
on oxygen → 2
SBP 124 mmHg → 0
HR 126/min → 2
alert (A) → 0
T 38.1 °C → 1
Total and red scores
NEWS2 = 0 + 0 + 2 + 0 + 2 + 0 + 1 = 5
No parameter scores 3.
Risk group
medium
Answer
medium
A total of 5 or more calls for an urgent clinical response.
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