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
BOnly when handling medicines
CFor every patient contact, including taking a pulse or blood pressure
DWhen contact with blood, body fluids or broken skin is expected
2.Nursing fundamentalsHard
Two days after surgery a patient has a temperature of 37.9 °C and reduced breath sounds at the lung bases. What is the most helpful nursing action, alongside reporting it?
AKeep the patient lying flat in bed so they can rest and save energy
BEncourage deep breathing, coughing and getting out of bed
CStop all pain relief so the patient stays alert
DRestrict all fluids to dry the secretions
3.Infection control & patient safetyMedium
When should an N95 respirator be removed after caring for a patient on airborne precautions?
AStraight after entering the room
BAfter leaving the room and closing the door
CNever; it is worn for the rest of the shift
DBefore taking off the gloves, inside the room
4.Infection control & patient safetyHard
A nurse who has a cold sore (herpes labialis) is assigned to the newborn nursery. What is most appropriate?
AWork as usual, since cold sores are very common
BTell no one, and cover the lesion with makeup during shifts
CWear gloves and carry on as usual
DInform the manager, who may reassign the nurse for now
5.Prioritization & delegationMedium
A patient on a medical unit tells the nurse he has a plan to end his life and has saved tablets at home. What is the priority action?
AAsk him to promise he will not harm himself
BEnsure constant observation and remove anything he could use to harm himself
CArrange a psychiatry appointment for next week
DReassure him that things usually look better in the morning after some sleep
6.Prioritization & delegationHard
A visitor on the ward becomes threatening and shows a knife. What is the nurse’s priority?
AIgnore the visitor and carry on with patient care
BArgue with the visitor to persuade them to leave
CTry to take the knife away from the visitor straight away before anyone is hurt
DMove away to safety, keep others away and call security or the police
7.Clinical nursingMedium
Which instruction is correct for taking weekly alendronic acid (alendronate)?
ATake it with plain water on an empty stomach and stay upright for 30 minutes
BTake it with a glass of milk at bedtime and then lie down straight away
CChew the tablet with breakfast and a cup of milky tea
DTake it with an antacid to protect the stomach
8.Clinical nursingHard
A patient with long-term steroid use is acutely unwell after vomiting and missing doses, with hypotension and confusion. Which emergency should be considered?
AHypercalcaemia
BAdrenal crisis
CThyroid storm
DDiabetes insipidus
9.Lab values & electrolytesMedium
A patient with type 2 diabetes has a target HbA1c below 7% (53 mmol/mol). Today's result is 7.8% (62 mmol/mol). What is the best interpretation?
AThe result shows today's fasting glucose is above the target
BAverage glucose over the past months has been above the target
CThe patient has had frequent episodes of severe hypoglycemia
DGlucose control has been excellent for the past several months
10.Lab values & electrolytesHard
A patient with severe hypertriglyceridemia has a measured sodium of 128 mEq/L, but a measured serum osmolality is normal, and the patient has no symptoms. What is the most likely explanation?
APseudohyponatremia, an artifact caused by very high lipids
BHyponatremia caused by severe hyperglycemia in diabetes
CHyponatremia caused by drinking far too much water
DTrue hyponatremia from SIADH that needs fluid restriction
11.PharmacologyMedium
A patient takes regular paracetamol (acetaminophen) at home. Which teaching point best prevents accidental overdose?
ACheck cold and flu remedies, as many also contain paracetamol
BUse paracetamol only on an empty stomach
CTake an extra dose if the first one does not work within 10 minutes
DTake paracetamol with alcohol to improve absorption
12.PharmacologyHard
Why should a dose never be written as "5.0 mg" on a medication order?
AIt is too precise for most drugs
BIt means the dose must be given five times
CThe pharmacy cannot supply doses that contain a decimal point
DThe decimal point may be missed, and the dose read as 50 mg
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?
AA normal finding during pain
BHyperkalaemia
CMyocardial ischaemia
DPericarditis
14.Med-surg: cardiovascular & respiratoryHard
After cardiac catheterisation via the radial artery, which assessment is most important?
ABowel sounds and abdominal girth every hour after the test
BCirculation, sensation and movement of the hand, and the site
CPupil size and reaction to light every 15 minutes
DUrine specific gravity every four hours
15.Med-surg: neuro, endocrine & renalMedium
Which measure best detects a decline in breathing in a patient with Guillain–Barré syndrome?
AOxygen saturation alone
BPeak flow before and after a bronchodilator
CDaily chest X-rays
DRegular forced vital capacity measurements
16.Med-surg: neuro, endocrine & renalHard
A patient arrives five hours after the onset of a stroke. A CT angiogram shows a blockage of a large artery in the brain. What is the most appropriate next step?
AGive aspirin and plan a review on the ward tomorrow
BStart IV alteplase immediately without further imaging
CUrgent referral for assessment for mechanical thrombectomy
DNo treatment, because the time for any reperfusion has passed
17.Med-surg: GI, perioperative & oncologyMedium
What are anticipatory ("just in case") medicines at the end of life usually prescribed for?
AInfection prevention and vaccination
BWeight gain and appetite stimulation
CPain, nausea, agitation and respiratory secretions
DHigh blood pressure, high cholesterol and diabetes
18.Med-surg: GI, perioperative & oncologyHard
During general anaesthesia, a patient develops jaw rigidity, rising end-tidal CO₂ and tachycardia, then a rapidly rising temperature. Which drug is the specific treatment?
ANaloxone
BParacetamol
CDantrolene
DSuxamethonium
19.Maternity & obstetric nursingMedium
Where universal screening for group B streptococcus is used, when is the vaginal–rectal swab usually taken?
AAfter the membranes rupture in labour
BAt the first antenatal visit
CAt about 36 to 37 weeks
DAt about 20 weeks
20.Maternity & obstetric nursingHard
A student nurse is caring for a newborn receiving phototherapy for jaundice. Which action requires correction?
ACovering the baby's eyes with eye shields during phototherapy
BRemoving the eye shields during feeds when the lights are off
CApplying baby oil to the skin before the lights are switched on
DChecking the baby's temperature and hydration regularly
21.Pediatric nursingMedium
Which non-drug technique suits a 5-year-old during a cannula insertion?
ADoing slow breathing exercises with a numeric scale
BBlowing bubbles or looking at a pop-up book
CReading a detailed leaflet about the procedure
DBeing left alone so the child can concentrate
22.Pediatric nursingHard
A 9-month-old with suspected intussusception has been crying in episodes. While waiting for a procedure, the baby passes a normal brown stool and the pain stops. What should the nurse do?
AGive an enema to clear the bowel
BFeed the baby a large meal straight away
CIgnore it, because a normal stool has no clinical meaning in intussusception
DReport it at once, because it may mean the intussusception has reduced
23.Mental health nursingMedium
A woman with advanced dementia keeps asking for her mother, who died many years ago. Which response is most appropriate?
A"Please stop asking about her now and finish your lunch before it gets cold."
B"You're thinking about your mother. Tell me about her."
C"Your mother will visit you later this afternoon."
D"Your mother died 30 years ago. You know that."
24.Mental health nursingHard
A patient says, "My boss didn't say hello this morning, so she must think I'm useless." Which cognitive distortion is shown, and what is a helpful nursing response?
AAll-or-nothing thinking; agree that the boss is being unfair
BMind reading; ask what other reasons there might be for the boss's behaviour
CPersonalisation; advise the patient to ask for a new manager
DCatastrophising; tell the patient that she will definitely not be fired
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose calculation for a small injection gives 0.83752 mL. The rule in this exercise is that volumes below 1 mL are rounded to the nearest hundredth of a mL. What value x do you record?
0.83752 mL
x = mL
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A maintenance infusion runs at 120 mL/h without a break. How many litres V does it deliver in 24 hours?
120 mL/h24 h
V = L
27.Dosage calculationsMedium
A patient weighs 45 kg. The prescribed dose is 25 mg/kg per day, given in 2 equal doses. How many milligrams D are given per dose?
45 kg25 mg/kg/day2× per day
D = mg
28.Dosage calculationsHard
A patient is 167 cm tall and weighs 63 kg. The prescription is 75 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.
167 cm63 kg75 mg/m²
D = mg
29.IV infusion ratesMedium
Infuse 1500 mL over 6 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
1500 mL6 h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 1 g of a drug in 500 mL. The order is 4 mg per minute. At what rate R do you set the pump, in mL/h?
1 g/500 mL4 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 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL.
jelly: 100 mLjuice: 200 mLIV infusion: 100 mL/h × 8 hIV antibiotic: 1 × 100 mL
I = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 14:00 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.
500 mL75 mL/h · 2 h50 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: yes; secondary diagnosis: yes; ambulatory aid: holds on to furniture; IV therapy or saline lock: no; gait: impaired; mental status: overestimates or forgets limits. Find the Morse total MFS.
0–125
MFS =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 65 mmHg. A patient’s systolic pressure is 125 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 65 mmHg?
MAP 65 mmHgSBP 125 mmHg
DBP = mmHg
3Solutions
1.Nursing fundamentals
Answer: D · 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
D · When contact with blood, body fluids or broken skin is expected
2.Nursing fundamentals
Answer: B · Encourage deep breathing, coughing and getting out of bed
Why this is the answer
These signs suggest atelectasis or early chest infection. Deep breathing, coughing, adequate pain relief and mobilisation help re-expand the lungs.
Answer
B · Encourage deep breathing, coughing and getting out of bed
3.Infection control & patient safety
Answer: B · After leaving the room and closing the door
Why this is the answer
Because infectious particles remain in the air of the room, the respirator is taken off outside the room after the door is closed, followed by hand hygiene. Gloves, eyewear and gown are removed first.
Answer
B · After leaving the room and closing the door
4.Infection control & patient safety
Answer: D · Inform the manager, who may reassign the nurse for now
Why this is the answer
Herpes simplex can cause severe infection in newborns. Staff with active lesions inform their manager and follow occupational health advice, which often means avoiding contact with newborns and other high-risk patients until the lesion has healed.
Answer
D · Inform the manager, who may reassign the nurse for now
5.Prioritization & delegation
Answer: B · Ensure constant observation and remove anything he could use to harm himself
Why this is the answer
A patient with a plan and means is at high risk. Safety comes first: constant observation, removal of means and urgent referral. A “no-harm promise” does not protect the patient.
Answer
B · Ensure constant observation and remove anything he could use to harm himself
6.Prioritization & delegation
Answer: D · Move away to safety, keep others away and call security or the police
Why this is the answer
In a threat involving a weapon, staff keep a safe distance, protect patients where possible and call security or the police. Trying to disarm the person puts staff at serious risk.
Answer
D · Move away to safety, keep others away and call security or the police
7.Clinical nursing
Answer: A · Take it with plain water on an empty stomach and stay upright for 30 minutes
Why this is the answer
Alendronic acid must be taken with plain water before food, and the patient must stay upright to reduce oesophageal irritation. Food, milk and antacids reduce absorption.
Answer
A · Take it with plain water on an empty stomach and stay upright for 30 minutes
8.Clinical nursing
Answer: B · Adrenal crisis
Why this is the answer
Missing steroid doses during illness can cause adrenal crisis, with shock, vomiting and confusion. It is treated urgently with parenteral hydrocortisone and fluids.
Answer
B · Adrenal crisis
9.Lab values & electrolytes
Answer: B · Average glucose over the past months has been above the target
Why this is the answer
An HbA1c of 7.8% shows that average glucose has been above the individual target over about 2–3 months. The nurse explores diet, activity, medication use and barriers, and the treatment plan may be adjusted.Checked against:Hemoglobin A1C (HbA1c) Test · MedlinePlus (NIH) (2025)
Answer
B · Average glucose over the past months has been above the target
10.Lab values & electrolytes
Answer: A · Pseudohyponatremia, an artifact caused by very high lipids
Why this is the answer
Very high lipids or proteins take up part of the plasma volume, so some laboratory methods report a falsely low sodium. The osmolality and the sodium measured by direct methods are normal. Treating this "hyponatremia" would be harmful.
Answer
A · Pseudohyponatremia, an artifact caused by very high lipids
11.Pharmacology
Answer: A · Check cold and flu remedies, as many also contain paracetamol
Why this is the answer
Many combination products contain paracetamol, so a patient can take too much without realising. Regular alcohol use and liver disease also increase the risk of liver damage.
Answer
A · Check cold and flu remedies, as many also contain paracetamol
12.Pharmacology
Answer: D · The decimal point may be missed, and the dose read as 50 mg
Why this is the answer
Trailing zeros (5.0) and missing leading zeros (.5) are well-known causes of tenfold errors. Safe practice is to write 5 mg and 0.5 mg.
Answer
D · The decimal point may be missed, and the dose read as 50 mg
13.Med-surg: cardiovascular & respiratory
Answer: C · 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
C · Myocardial ischaemia
14.Med-surg: cardiovascular & respiratory
Answer: B · Circulation, sensation and movement of the hand, and the site
Why this is the answer
After radial access, the compression device and puncture site are checked for bleeding or haematoma, and the hand for colour, warmth, capillary refill, sensation and movement. Radial artery occlusion and forearm compartment syndrome are possible complications.
Answer
B · Circulation, sensation and movement of the hand, and the site
15.Med-surg: neuro, endocrine & renal
Answer: D · Regular forced vital capacity measurements
Why this is the answer
In Guillain–Barré syndrome, the breathing muscles weaken progressively. A falling vital capacity shows this early, long before oxygen saturation drops. A weak cough and difficulty counting in one breath are other warning signs.
Answer
D · Regular forced vital capacity measurements
16.Med-surg: neuro, endocrine & renal
Answer: C · Urgent referral for assessment for mechanical thrombectomy
Why this is the answer
IV thrombolysis is usually given within 4.5 hours of onset. Mechanical thrombectomy for a large vessel occlusion can be done later, typically up to 6 hours and in selected patients up to 24 hours, based on imaging. Time still matters, so referral is urgent.
Answer
C · Urgent referral for assessment for mechanical thrombectomy
17.Med-surg: GI, perioperative & oncology
Answer: C · Pain, nausea, agitation and respiratory secretions
Why this is the answer
Anticipatory medicines are prescribed in advance, usually for subcutaneous use, so that common end-of-life symptoms can be treated quickly without delay, especially at home.
Answer
C · Pain, nausea, agitation and respiratory secretions
18.Med-surg: GI, perioperative & oncology
Answer: C · Dantrolene
Why this is the answer
Malignant hyperthermia is treated by stopping triggering agents, hyperventilating with 100% oxygen, giving IV dantrolene (which reduces calcium release from the sarcoplasmic reticulum), active cooling and treating hyperkalaemia and arrhythmias. Suxamethonium is a trigger.
Answer
C · Dantrolene
19.Maternity & obstetric nursing
Answer: C · At about 36 to 37 weeks
Why this is the answer
Colonisation can come and go, so the swab is taken late in pregnancy, close to birth. A positive result leads to intrapartum antibiotics to protect the newborn. Some countries use a risk-based approach instead.
Answer
C · At about 36 to 37 weeks
20.Maternity & obstetric nursing
Answer: C · Applying baby oil to the skin before the lights are switched on
Why this is the answer
Oils and lotions can cause burns under phototherapy lights and should not be applied. Eye shields protect the retina, temperature and hydration are monitored because of increased fluid loss, and feeds are an opportunity for eye contact without the shields.
Answer
C · Applying baby oil to the skin before the lights are switched on
21.Pediatric nursing
Answer: B · Blowing bubbles or looking at a pop-up book
Why this is the answer
Distraction that suits the child's age, such as bubbles, books, toys or videos, reduces pain and distress. Blowing bubbles also encourages slow, deep breathing. Parents are encouraged to stay and help.
Answer
B · Blowing bubbles or looking at a pop-up book
22.Pediatric nursing
Answer: D · Report it at once, because it may mean the intussusception has reduced
Why this is the answer
A normal stool may mean the intussusception has reduced by itself. The provider must be informed, because the planned procedure may change; the baby is still monitored for recurrence.
Answer
D · Report it at once, because it may mean the intussusception has reduced
23.Mental health nursing
Answer: B · "You're thinking about your mother. Tell me about her."
Why this is the answer
In advanced dementia, repeatedly correcting the facts can cause fresh grief each time. Validation responds to the feelings and need behind the words, such as comfort or security, without lying.
Answer
B · "You're thinking about your mother. Tell me about her."
24.Mental health nursing
Answer: B · Mind reading; ask what other reasons there might be for the boss's behaviour
Why this is the answer
Mind reading is assuming others' thoughts without evidence. Exploring alternative explanations, such as the boss being busy, helps the patient test the thought and reduce distress.
Answer
B · Mind reading; ask what other reasons there might be for the boss's behaviour
25.Nursing math & unit conversions
Answer: x = 0.84 mL
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 hundredths place
0.83752 → 3
Only the next digit decides
0.83752 → 7
7 is 5 or more, so round 3 up.
The digits after it (52) are ignored: round once, never step by step.
Round
x = 0.84 mL
Answer
x = 0.84 mL
26.Nursing math & unit conversions
Answer: V = 2.88 L
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.
Volume in a day
120 mL/h × 24 h = 2880 mL
In litres
V = 2880/1000 = 2.88 L
Answer
V = 2.88 L
27.Dosage calculations
Answer: D = 562.5 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
25·45 = 1125 mg
Per dose
D = 1125/2 = 562.5 mg
Answer
D = 562.5 mg
28.Dosage calculations
Answer: D = 128.2 mg
Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).
Body surface area
BSA = √(167·63/3600) = √2.922 = 1.71 m²
Dose
D = 75·1.71 = 128.2 mg
Answer
D = 128.2 mg
29.IV infusion rates
Answer: R = 42 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
6·60 = 360 min
Drip rate
R = 1500·10/360 = 41.67 ≈ 42 gtt/min
Answer
R = 42 gtt/min
At the bedside you round to the nearest whole drop: 42 gtt/min.
30.IV infusion rates
Answer: R = 120 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
1000 mg/500 mL = 2 mg/mL
Dose per hour
4·60 = 240 mg/h
Pump rate
R = 240/2 = 120 mL/h
Answer
R = 120 mL/h
31.IV fluids & fluid balance
Answer: I = 1200 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: 100 + 200 = 300 mL
IV infusion: 100·8 = 800 mL
IV antibiotic: 1·100 = 100 mL
I = 1200 mL
Answer
I = 1200 mL
32.IV fluids & fluid balance
Answer: t = 9 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
500 − 150 = 350 mL left
Second part
350/50 = 7 h
Total time
t = 2 + 7 = 9 h
Answer
t = 9 h
That is about 9 h 00 min, so the bag runs out at about 23:00.
33.Clinical assessment scores
Answer: MFS = 105
Morse fall scale: six items. History of falling: no 0, yes 25. Secondary diagnosis: no 0, yes 15. Ambulatory aid: none, bed rest or nurse assistance 0; crutches, cane or walker 15; holding on to furniture 30. IV therapy or saline lock: no 0, yes 20. Gait: normal, bed rest or wheelchair 0; weak 10; impaired 20. Mental status: knows own limits 0; overestimates or forgets limits 15. The total runs from 0 to 125. Risk cut-offs differ between hospitals; a common set is 0–24 low, 25–44 moderate and 45 or more high.
Score each item
history of falling in the last 3 months: yes → 25
secondary diagnosis: yes → 15
ambulatory aid: holds on to furniture → 30
IV therapy or saline lock: no → 0
gait: impaired → 20
mental status: overestimates or forgets limits → 15
Add
Morse total = 25 + 15 + 30 + 0 + 20 + 15 = 105
Answer
MFS = 105
34.Clinical assessment scores
Answer: DBP = 35 mmHg
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.
Rearrange
DBP = (3·MAP − SBP)/2
Substitute
DBP = (3·65 − 125)/2 = 70/2 = 35 mmHg
Answer
DBP = 35 mmHg
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