Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
Prioritization & delegation
Method
Ask what will harm the patient soonest if nothing is done.
Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
Assess before you act unless it is an emergency; then choose the step the others depend on.
For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.
Lab values & electrolytes
Method
Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
Link the value to its typical signs and to the drugs and conditions that cause it.
Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.
Med-surg: cardiovascular & respiratory
Method
Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
Choose the safe first action, then escalate and reassess.
Med-surg: neuro, endocrine & renal
Method
Check the glucose in every patient with new confusion, weakness or a seizure.
Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.
Med-surg: GI, perioperative & oncology
Method
Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.
Maternity & obstetric nursing
Method
Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.
Pediatric nursing
Method
Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
Match the action to the development stage and involve the family.
Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.
Mental health nursing
Method
Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
Respect rights: the least restrictive option, consent and confidentiality with its limits.
Nursing math & unit conversions
Metric steps
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
Weight and length
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
Household measures
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
falls 25, diagnosis 15, aid 15/30, IV 20, gait 10/20, mental status 15
NEWS2 risk
0–4 low; single 3 low–medium; 5–6 medium; ≥ 7 high
Mean arterial pressure
MAP = (SBP + 2·DBP)/3 = DBP + PP/3
Pulse pressure and shock index
PP = SBP − DBP, SI = HR/SBP
Body mass index
BMI = kg/m² = 703·lb/in²
Method
Find the score sheet that the question uses and its range (GCS 3–15, APGAR 0–10, Braden 6–23, Morse 0–125).
Score every item separately, matching the description to its level.
Add the item scores and check that the total lies inside the range.
Apply the cut-offs: for NEWS2 also look for any single parameter scoring 3.
For derived values use MAP = (SBP + 2·DBP)/3, PP = SBP − DBP, SI = HR/SBP and BMI = kg/m².
2Practice problems
1.Nursing fundamentalsMedium
A patient with a weak left leg walks with a stick in the right hand. What is the correct sequence?
AMove the right leg first, then the stick, then the left leg
BMove both legs forward together first, then bring the stick level with them
CMove the stick and the right leg together, then the left leg
DMove the stick and the left leg forward together, then the right leg
2.Nursing fundamentalsHard
Which task is most appropriate for a registered nurse to delegate to a healthcare assistant (nursing assistant)?
AHelping a stable patient walk to the bathroom
BTeaching a patient how to use crutches
CEvaluating a patient who has just fallen
DAssessing a newly admitted patient's falls risk
3.Infection control & patient safetyMedium
A nurse finds a used needle in a patient’s bed linen. What should the nurse do?
ALeave it where it is for the housekeeping staff to remove later in the day
BFold it into the linen and send it to the laundry
CPick it up by the hub or with forceps, put it in a sharps container and report it
DRecap it with two hands before throwing it away
4.Infection control & patient safetyHard
A hospital will introduce new infusion pumps and wants to find out how the process could fail before any harm occurs. Which method fits best?
AA morbidity and mortality meeting
BRoot cause analysis (RCA) of the new pumps
CAn incident report for each new pump
DFailure mode and effects analysis (FMEA)
5.Prioritization & delegationMedium
A patient taking lisinopril develops swelling of the lips and tongue. What should the nurse do first?
ATell the patient this is a common, harmless effect
BAssess the airway and call for urgent help
CGive the next dose of lisinopril with water
DApply a cold pack and recheck in an hour
6.Prioritization & delegationHard
Two patients on the unit have the same surname. What should the nurse do before giving a medication?
AUse the room number as the main identifier
BAsk the patient, “Are you Mr Smith?” and give the drug once he says yes
CCheck two identifiers against the wristband and the medication record
DAsk a nursing assistant which patient is which
7.Clinical nursingMedium
Which observation is most important after giving a patient a first dose of a new antibiotic intravenously?
AWhether their hair loss increases
BTheir appetite at the next meal
CHow much they walk that day
DSigns of an allergic reaction such as rash, wheeze or swelling
8.Clinical nursingHard
A patient on enteral tube feeding after a long period of starvation develops low phosphate, low potassium and arrhythmias. What is most likely?
ADumping syndrome
BRefeeding syndrome
CDiabetic ketoacidosis
DHyperthyroidism
9.Lab values & electrolytesMedium
Why is a baseline platelet count taken before starting heparin therapy?
ASo that the INR can be calculated from the platelet count later
BBecause heparin is given at a dose based on the platelet count
CSo a later fall from heparin-induced thrombocytopenia is detected
DBecause heparin increases the platelet count to dangerous levels
10.Lab values & electrolytesHard
A patient has a continuous heparin infusion for a pulmonary embolism. A new nurse plans to adjust the infusion using today's INR of 1.1. What should the experienced nurse explain?
AHeparin needs no laboratory monitoring once the infusion is started
BThe INR is the correct test, and 1.1 means heparin is therapeutic
CThe INR of 1.1 means the heparin rate must be doubled at once
DHeparin is adjusted using the aPTT or anti-Xa level, not the INR
11.PharmacologyMedium
A patient with insulin-treated diabetes is found unconscious with very low blood glucose. There is no IV access. Which drug can a trained helper give?
AOral glucose gel poured into the mouth
BGlucagon by injection or nasal spray
CRapid-acting insulin under the skin
DIntramuscular adrenaline
12.PharmacologyHard
A woman with epilepsy who takes an antiepileptic drug plans to become pregnant. Which advice is standard?
AStop all antiepileptic drugs straight away as soon as she stops contraception
BNo change is needed, as antiepileptics carry no risk in pregnancy
CTake folic acid before conception and seek specialist review of her medication
DAvoid folic acid because it lowers drug levels
13.Med-surg: cardiovascular & respiratoryMedium
A patient is on a short course of oral prednisolone for an asthma exacerbation. Which effect should the nurse monitor for?
ASlow heart rate
BLow blood sodium
CLow blood pressure
DRaised blood glucose
14.Med-surg: cardiovascular & respiratoryHard
During drainage of a large pleural effusion, a patient starts coughing and feels tight in the chest. What should the nurse do?
ALie the patient flat until the drainage is complete
BAsk the patient to cough harder to help the flow
CStop or clamp the drainage and inform the doctor
DSpeed up the drainage to finish quickly
15.Med-surg: neuro, endocrine & renalMedium
A patient on insulin asks about drinking alcohol. Which advice is correct?
AAlcohol should replace a meal on the days it is drunk
BAlcohol raises glucose, so extra insulin should be taken first
CAlcohol has no effect on blood glucose in people with diabetes
DAlcohol can cause hypos, even the next day, so eat carbs with it
16.Med-surg: neuro, endocrine & renalHard
Six weeks after a kidney transplant, a patient has a fever, tenderness over the graft, less urine and a rising creatinine. What is most likely?
AAcute rejection, needing urgent transplant team review
BA normal finding as the kidney settles in
CA side effect of sun exposure
DDehydration that needs only more oral fluids and rest
17.Med-surg: GI, perioperative & oncologyMedium
A dying patient can no longer drink. Which mouth care is most appropriate?
ABrushing hard with a stiff toothbrush twice a day
BFrequent, gentle moistening of the mouth and lips
CLemon and glycerine swabs every hour to stimulate saliva
DNo mouth care, to avoid disturbing the patient
18.Med-surg: GI, perioperative & oncologyHard
A patient with cirrhosis and ascites has a new fever, abdominal tenderness and worsening confusion. Which complication should be suspected?
AAcute pancreatitis
BSimple constipation
CSpontaneous bacterial peritonitis
DNormal progression of ascites
19.Maternity & obstetric nursingMedium
Which drug is a known teratogen that must be stopped before a planned pregnancy?
AParacetamol (acetaminophen)
BIsotretinoin
CLevothyroxine
DFolic acid
20.Maternity & obstetric nursingHard
On abdominal palpation, the nurse feels a hard, round, movable mass in the fundus, and the fetal heart is heard above the umbilicus. What does this suggest?
AA breech presentation
BA transverse lie with the head in the pelvis
CAn occiput posterior position
DA cephalic presentation
21.Pediatric nursingMedium
Which measure should be avoided in a sickle cell pain crisis?
ARegular pain assessment and analgesia
BWarm packs and gentle positioning
CCold packs on the painful area
DGenerous fluids by mouth or IV
22.Pediatric nursingHard
The nurse has taught the parents of a child with epilepsy. Which statement shows a need for further teaching?
A"I'll time the seizure and give the rescue medicine if it lasts too long."
B"I'll move hard objects away and put something soft under his head."
C"When the jerking stops, I'll turn him onto his side."
D"I'll put a spoon in his mouth so he doesn't bite or swallow his tongue."
23.Mental health nursingMedium
Which setting is best for an initial assessment interview with a new patient?
AA quiet, private room with chairs at the same level and easy access to the door
BThe corridor, so that the interview can be done quickly
CThe busy day room, so that the patient feels part of the ward
DA small office with the nurse sitting behind a high desk between herself and the door
24.Mental health nursingHard
A woman taking carbamazepine for bipolar disorder uses an oral contraceptive pill. What should the nurse teach?
ACarbamazepine increases the effect of the pill, so she can take it every other day
BShe should take the pill and the carbamazepine at exactly the same time each day so that both of them stay fully effective
CThe two drugs do not interact in any way
DCarbamazepine can make the pill less effective, so she should discuss contraception with the prescriber
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 6:35 PM. Which entry is the same time on the 24-hour clock? Click it.
6:35 PM
117:35
206:35
318:35
419:35
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An order reads 4 mcg/kg/min for a patient who weighs 52 kg. Express the dose rate D in mg/h. Round to two decimal places.
4 mcg/kg/min52 kg
D = mg/h
27.Dosage calculationsMedium
A patient weighs 90 kg. The prescribed dose is 25 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?
90 kg25 mg/kg/day3× per day
D = mg
28.Dosage calculationsHard
A child weighing 8 kg is prescribed 15 mg/kg per dose of an oral suspension that contains 40 mg in 1 mL. What volume V do you give?
8 kg15 mg/kg40 mg/1 mL
V = mL
29.IV infusion ratesMedium
An infusion is ordered at 30 mL/h, but no pump is available. It runs by gravity through a giving set of 20 gtt/mL. Find the drip rate R in drops per minute.
30 mL/h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 100 mg of a drug in 500 mL and runs at 15 mL/h. How many milligrams per hour D does the patient receive?
100 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 fluid balance B = intake − output in mL (a negative answer means a net loss).
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 75 mL/h. At 09:30, 300 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL300 mL infused75 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 13, with E3 and V4. What motor score M was recorded, and which response does it describe? Give the number.
GCS 13E3V4
M =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). At 5 minutes after birth, a practice newborn has a pink body with blue hands and feet, a heart rate of 105/min, no response to stimulation, active movement and slow, irregular breathing with a weak cry. Score the APGAR and click how the score is interpreted.
1reassuring
2moderately abnormal
3low
3Solutions
1.Nursing fundamentals
Answer: D · Move the stick and the left leg forward together, then the right leg
Why this is the answer
The stick and the weak leg move together so the stick takes part of the load, then the strong leg steps through.
Answer
D · Move the stick and the left leg forward together, then the right leg
2.Nursing fundamentals
Answer: A · Helping a stable patient walk to the bathroom
Why this is the answer
Routine help with care for a stable patient can be delegated. Assessment, teaching and evaluation need registered nurse judgement.
Answer
A · Helping a stable patient walk to the bathroom
3.Infection control & patient safety
Answer: C · Pick it up by the hub or with forceps, put it in a sharps container and report it
Why this is the answer
A loose needle is a hazard to everyone who handles the linen. The nurse disposes of it safely without recapping, using an instrument if needed, and reports the incident so the cause can be addressed.
Answer
C · Pick it up by the hub or with forceps, put it in a sharps container and report it
4.Infection control & patient safety
Answer: D · Failure mode and effects analysis (FMEA)
Why this is the answer
FMEA is a proactive method that looks at each step of a process, asks how it could fail and what the effect would be, and changes the process in advance. Root cause analysis is used after an event has happened.
Answer
D · Failure mode and effects analysis (FMEA)
5.Prioritization & delegation
Answer: B · Assess the airway and call for urgent help
Why this is the answer
Angioedema is a rare but dangerous effect of ACE inhibitors. The airway comes first: the nurse assesses breathing, calls for urgent help and holds the drug.
Answer
B · Assess the airway and call for urgent help
6.Prioritization & delegation
Answer: C · Check two identifiers against the wristband and the medication record
Why this is the answer
The nurse uses at least two identifiers, such as full name and date of birth, checked against the wristband and record. Open questions (“Please tell me your name”) are safer than yes/no questions.
Answer
C · Check two identifiers against the wristband and the medication record
7.Clinical nursing
Answer: D · Signs of an allergic reaction such as rash, wheeze or swelling
Why this is the answer
First doses carry a risk of anaphylaxis. Watch for rash, urticaria, swelling, wheeze, breathlessness and falling blood pressure.
Answer
D · Signs of an allergic reaction such as rash, wheeze or swelling
8.Clinical nursing
Answer: B · Refeeding syndrome
Why this is the answer
Refeeding syndrome results from rapid shifts of phosphate, potassium and magnesium into cells when feeding resumes. High-risk patients start slowly with electrolyte monitoring and thiamine.
Answer
B · Refeeding syndrome
9.Lab values & electrolytes
Answer: C · So a later fall from heparin-induced thrombocytopenia is detected
Why this is the answer
Heparin-induced thrombocytopenia is diagnosed partly by a fall of about 50% or more from the baseline count, usually 5–14 days after starting. A baseline count and regular checks make this possible.Checked against:Heparin-Induced Thrombocytopenia · StatPearls (NCBI Bookshelf) (2023)
Answer
C · So a later fall from heparin-induced thrombocytopenia is detected
10.Lab values & electrolytes
Answer: D · Heparin is adjusted using the aPTT or anti-Xa level, not the INR
Why this is the answer
Unfractionated heparin infusions are adjusted using the aPTT or anti-factor Xa level according to protocol. The INR monitors warfarin and is little affected by heparin at usual doses. Using the wrong test can cause under- or over-anticoagulation.Checked against:Partial Thromboplastin Time (PTT) Test · MedlinePlus (NIH) (2026); Prothrombin Time Test and INR (PT/INR) · MedlinePlus (NIH) (2024)
Answer
D · Heparin is adjusted using the aPTT or anti-Xa level, not the INR
11.Pharmacology
Answer: B · Glucagon by injection or nasal spray
Why this is the answer
Glucagon breaks down liver glycogen and raises blood glucose. Nothing is given by mouth to an unconscious patient because of the risk of choking and aspiration.
Answer
B · Glucagon by injection or nasal spray
12.Pharmacology
Answer: C · Take folic acid before conception and seek specialist review of her medication
Why this is the answer
Folic acid before and in early pregnancy reduces the risk of neural tube defects. Medication should be reviewed before conception, but drugs should not be stopped suddenly because uncontrolled seizures are also dangerous.
Answer
C · Take folic acid before conception and seek specialist review of her medication
13.Med-surg: cardiovascular & respiratory
Answer: D · Raised blood glucose
Why this is the answer
Corticosteroids raise blood glucose, which matters especially in diabetes. Short courses can also cause mood changes, insomnia, indigestion and fluid retention. Long-term use adds osteoporosis, adrenal suppression and infection risk.
Answer
D · Raised blood glucose
14.Med-surg: cardiovascular & respiratory
Answer: C · Stop or clamp the drainage and inform the doctor
Why this is the answer
Rapid removal of a large effusion can cause re-expansion pulmonary oedema. Coughing, chest tightness or pain are warning signs. Drainage is stopped and the doctor is informed, and the volume is usually drained in a controlled way.
Answer
C · Stop or clamp the drainage and inform the doctor
15.Med-surg: neuro, endocrine & renal
Answer: D · Alcohol can cause hypos, even the next day, so eat carbs with it
Why this is the answer
Alcohol reduces the liver's release of glucose, so it increases the risk of hypoglycaemia, which may be delayed for many hours. Patients should eat carbohydrate, check glucose before bed and tell friends that a hypo can look like drunkenness.
Answer
D · Alcohol can cause hypos, even the next day, so eat carbs with it
16.Med-surg: neuro, endocrine & renal
Answer: A · Acute rejection, needing urgent transplant team review
Why this is the answer
Fever, graft tenderness, falling urine output and rising creatinine suggest acute rejection, although infection must also be ruled out. Early treatment, often with high-dose steroids, can save the graft, so the transplant team is contacted urgently.
Answer
A · Acute rejection, needing urgent transplant team review
17.Med-surg: GI, perioperative & oncology
Answer: B · Frequent, gentle moistening of the mouth and lips
Why this is the answer
Regular gentle mouth care with water or saliva substitutes and lip balm relieves dryness and discomfort. Lemon and glycerine swabs can dry the mouth further. Families can be involved if they wish.
Answer
B · Frequent, gentle moistening of the mouth and lips
18.Med-surg: GI, perioperative & oncology
Answer: C · Spontaneous bacterial peritonitis
Why this is the answer
Spontaneous bacterial peritonitis is infection of ascitic fluid without an obvious source. It can present with fever, abdominal pain, encephalopathy or kidney injury. A diagnostic ascitic tap (neutrophil count) and prompt antibiotics are needed.
Answer
C · Spontaneous bacterial peritonitis
19.Maternity & obstetric nursing
Answer: B · Isotretinoin
Why this is the answer
Isotretinoin causes severe birth defects, so pregnancy must be prevented during treatment and for a period afterwards. Paracetamol is the usual analgesic in pregnancy, and levothyroxine should be continued.
Answer
B · Isotretinoin
20.Maternity & obstetric nursing
Answer: A · A breech presentation
Why this is the answer
A hard, round, ballotable head in the fundus means the buttocks are presenting. The fetal heart in breech presentations is usually heard above the umbilicus.
Answer
A · A breech presentation
21.Pediatric nursing
Answer: C · Cold packs on the painful area
Why this is the answer
Cold causes vasoconstriction and can increase sickling, so cold packs are avoided. Warmth, hydration, effective analgesia (often including opioids) and oxygen if hypoxic are used.
Answer
C · Cold packs on the painful area
22.Pediatric nursing
Answer: D · "I'll put a spoon in his mouth so he doesn't bite or swallow his tongue."
Why this is the answer
Putting objects in the mouth can break teeth, injure the mouth or block the airway; the tongue cannot be swallowed. Timing the seizure, protecting from injury and placing the child on the side afterwards are correct.
Answer
D · "I'll put a spoon in his mouth so he doesn't bite or swallow his tongue."
23.Mental health nursing
Answer: A · A quiet, private room with chairs at the same level and easy access to the door
Why this is the answer
A private, quiet space protects confidentiality and helps the patient talk. Seating at the same level is less intimidating, and keeping access to the door supports safety for both people.
Answer
A · A quiet, private room with chairs at the same level and easy access to the door
24.Mental health nursing
Answer: D · Carbamazepine can make the pill less effective, so she should discuss contraception with the prescriber
Why this is the answer
Carbamazepine induces liver enzymes and speeds up the breakdown of many drugs, including hormonal contraceptives. This can lead to unplanned pregnancy, and carbamazepine is also teratogenic.
Answer
D · Carbamazepine can make the pill less effective, so she should discuss contraception with the prescriber
25.Nursing math & unit conversions
Answer: 18:35
24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.
Convert the hour
6 PM → 6 + 12 = 18
Answer
18:35
Answer
18:35
26.Nursing math & unit conversions
Answer: D = 12.48 mg/h
Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.
Set up the chain
D = 4 mcg/kg/min × 52 kg × (60 min/1 h) × (1 mg/1000 mcg)
Calculate
D = 4·52·60/1000 = 12.48 mg/h
Answer
D = 12.48 mg/h
27.Dosage calculations
Answer: D = 750 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
25·90 = 2250 mg
Per dose
D = 2250/3 = 750 mg
Answer
D = 750 mg
28.Dosage calculations
Answer: V = 3 mL
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Dose from weight
15·8 = 120 mg
Volume
V = (120/40)·1 = 3 mL
Answer
V = 3 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.
Millilitres per minute
30/60 = 0.5 mL/min
Drip rate
R = 0.5·20 = 10 gtt/min
Answer
R = 10 gtt/min
30.IV infusion rates
Answer: D = 3 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
100/500 = 0.2 mg/mL
Dose rate
D = 0.2·15 = 3 mg/h
Answer
D = 3 mg/h
31.IV fluids & fluid balance
Answer: B = 75 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.
Total intake
oral: 200 + 100 + 200 = 500 mL
IV infusion: 125·8 = 1000 mL
IV antibiotic: 1·100 = 100 mL
total intake = 1600 mL
Total output
375 + 400 + 500 + 50 + 200 = 1525 mL
Balance
B = 1600 − 1525 = 75 mL
Answer
B = 75 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: t = 2.7 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Volume left
500 − 300 = 200 mL
Time
t = 200/75 = 2.667 ≈ 2.7 h
Answer
t = 2.7 h
That is about 2 h 40 min, so the bag runs out at about 12:10.
33.Clinical assessment scores
Answer: M = 6
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.
Motor score
M = 13 − 3 − 4 = 6
M6: obeys commands
Answer
M = 6
34.Clinical assessment scores
Answer: moderately abnormal
APGAR score: five signs, each scored 0, 1 or 2, checked at 1 and 5 minutes after birth. Appearance (colour): blue or pale 0, pink body with blue extremities 1, pink all over 2. Pulse: absent 0, below 100/min 1, 100/min or more 2. Grimace (reflex irritability): none 0, grimace 1, cry, cough or sneeze 2. Activity (tone): limp 0, some flexion 1, active movement 2. Respiration: absent 0, slow or irregular with a weak cry 1, good with a strong cry 2. A total of 7–10 is reassuring, 4–6 moderately abnormal and 0–3 low.
Score each sign
Appearance: a pink body with blue hands and feet → 1
Pulse: 105/min → 2
Grimace: no response to stimulation → 0
Activity: active movement → 2
Respiration: slow, irregular breathing with a weak cry → 1
Add
APGAR = 1 + 2 + 0 + 2 + 1 = 6
Interpretation
6 → moderately abnormal
Answer
moderately abnormal
Below 7 at 5 minutes, the score is usually repeated every 5 minutes up to 20 minutes.
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