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 large pressure ulcer is left open and fills in with new tissue from its base. This is called healing by:
ATertiary intention
BSecondary intention
CDelayed intention
DPrimary intention
2.Nursing fundamentalsHard
Which pair of details is best for confirming a patient's identity before giving a medicine?
AThe name on the door and the patient's face
BBed number and the patient's first name, checked against the ward list
CFull name and date of birth, checked against the wristband
DRoom number and diagnosis
3.Infection control & patient safetyMedium
How does a nurse add a sterile gauze pack to a sterile field that is already set up?
AReach across the field with clean gloves to place the item
BOpen the wrapper away from the field and drop the item on it without reaching over
CPlace the whole wrapped pack on the field and open it there with sterile gloves
DTip the item onto the field and push it into place with the wrapper
4.Infection control & patient safetyHard
A nurse is unsure whether a sterile glove touched the edge of the sterile field. What is the correct action?
AAsk the patient whether they saw it
BWipe the glove with alcohol
CContinue, because the nurse is not sure
DTreat the glove as contaminated and change it
5.Prioritization & delegationMedium
An arterial blood gas shows pH 7.28, PaCO₂ 40 mmHg (5.3 kPa) and HCO₃⁻ 16 mEq/L (mmol/L). How should the nurse interpret it?
ARespiratory acidosis
BRespiratory alkalosis
CMetabolic alkalosis
DMetabolic acidosis
6.Prioritization & delegationHard
An infant with pyloric stenosis has repeated projectile vomiting. Which acid-base imbalance is most likely?
AMetabolic alkalosis
BMetabolic acidosis
CRespiratory alkalosis
DRespiratory acidosis
7.Clinical nursingMedium
Long-term amiodarone treatment can affect which of the following?
AThyroid function, the lungs and the skin's sensitivity to sunlight
BBlood glucose and cholesterol only
CHair colour and nail growth only, with no effect on organs
DThe sense of smell and taste only, with no other effects
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
BDiabetic ketoacidosis
CRefeeding syndrome
DHyperthyroidism
9.Lab values & electrolytesMedium
A patient who has been vomiting for two days has a BUN of 32 mg/dL (urea 11.4 mmol/L) and a normal creatinine. What is the most likely cause?
AOverhydration
BLow-protein diet
CDehydration
DLiver failure
10.Lab values & electrolytesHard
A young woman with frequent self-induced vomiting has swollen salivary glands. Which laboratory pattern is most likely?
AHigh calcium, high phosphate and high glucose
BLow sodium, low bicarbonate and high lipase
CLow potassium, high bicarbonate and high amylase
DHigh potassium, low bicarbonate and low amylase
11.PharmacologyMedium
100 mL of an antibiotic is to be given over 30 minutes using a giving set of 20 drops/mL. What is the drip rate?
AAbout 100 drops per minute
BAbout 33 drops per minute
CAbout 67 drops per minute
DAbout 20 drops per minute
12.PharmacologyHard
A farmer exposed to an organophosphate pesticide has small pupils, heavy salivation, sweating, bronchial secretions and bradycardia. What is the mechanism?
ABlockade of GABA-A receptors
BBlockade of muscarinic receptors
CInhibition of acetylcholinesterase
DExcess release of noradrenaline
13.Med-surg: cardiovascular & respiratoryMedium
A patient uses a glyceryl trinitrate (nitroglycerin) patch for angina. Why is it usually removed for several hours each day?
AA nitrate-free interval prevents tolerance
BThe skin needs a break to absorb a larger dose
CIt lowers the risk of a high potassium level
DThe patch works only during the night
14.Med-surg: cardiovascular & respiratoryHard
A 28-year-old woman taking the combined pill comes in breathless and anxious. RR is 30/min, heart rate 118/min and SpO₂ 90% on air. A colleague says it is a panic attack. What should the nurse conclude?
ABreathing into a paper bag is the best first treatment for her
BShe should be sent home after a sedative
CThe saturation is normal for an anxious person who is breathing fast
DLow oxygen saturation is not explained by anxiety; PE must be excluded
15.Med-surg: neuro, endocrine & renalMedium
After a change in the levothyroxine dose, when is the TSH usually rechecked?
AAfter 24 hours
BAfter about 6–8 weeks
CAfter about 2 years of treatment
DAfter 3 days
16.Med-surg: neuro, endocrine & renalHard
On the first day after a kidney transplant, urine output suddenly falls from 200 mL/h to 10 mL/h. What should the nurse check first?
AThe patient's blood glucose level
BWhether the patient has eaten
CThe patient's temperature and pulse
DThat the catheter is not blocked or kinked
17.Med-surg: GI, perioperative & oncologyMedium
A patient received IV morphine 20 minutes ago and the surgical consent form has not been signed. What should the nurse do?
ASign the form on the patient's behalf as a witness
BAsk the patient to sign quickly before they get sleepier
CAsk a relative to sign instead of the patient
DTell the surgeon, as the patient may not be able to consent now
18.Med-surg: GI, perioperative & oncologyHard
An 80-year-old has a fluid balance 3 L positive two days after surgery. They are now breathless, with crackles at both lung bases and swollen ankles. What should the nurse do?
AEncourage the patient to drink more fluids
BLie the patient flat with the legs raised
CIncrease the IV fluid rate to improve kidney flow
DStop the IV fluids, sit the patient up and escalate
19.Maternity & obstetric nursingMedium
A woman with pre-eclampsia reports a severe headache and seeing flashing lights. What does this suggest?
AA tension headache, which is common and harmless in late pregnancy
BNormal effects of magnesium sulfate
CPre-eclampsia with severe features, with a risk of eclampsia
DLow blood glucose
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
BAn occiput posterior position
CA cephalic presentation
DA transverse lie with the head in the pelvis
21.Pediatric nursingMedium
A 16-year-old starts an SSRI antidepressant. What is especially important to monitor in the first weeks?
AWeight gain of more than 10 kg in the first month
BA sudden rise in blood glucose
CWorsening mood or new suicidal thoughts
DA drop in the platelet count
22.Pediatric nursingHard
A baby born to a mother who used opioids in pregnancy has a high-pitched cry, tremors, sneezing and poor feeding. Which plan is best?
AGive naloxone to reverse the effects of the opioid
BKeep the baby in a bright, busy area of the unit and stimulate them often to keep them awake
CLow-stimulation care, swaddling, small frequent feeds and a withdrawal scoring tool
DDelay all feeds until the tremors and sneezing have settled
23.Mental health nursingMedium
When should blood be taken to measure a patient's lithium level?
AAbout 12 hours after the last dose
BImmediately after the morning dose
C1 hour after the last dose
DAt any time of day, since it makes no difference
24.Mental health nursingHard
During a session, a patient asks the nurse, "Are you married? Do you have children?" Which response is most appropriate?
AShare details about the nurse's family to build a friendship
BEnd the session because personal questions are not allowed
CIgnore the question completely and stay silent until the patient changes the subject
DAnswer briefly or decline politely, then return the focus to the patient
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A drip-rate calculation gives 200.032 gtt/min. The rule in this exercise is that drip rates are rounded to the nearest whole drop. What value x do you record?
200.032 gtt/min
x = gtt/min
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 4 fl oz of juice, 2 cups of tea, 1 tbsp of liquid supplement. Using the equivalents given, find the total oral intake V in mL.
1 fl oz = 30 mL1 cup = 8 fl oz = 240 mL1 tbsp = 15 mL
V = mL
27.Dosage calculationsMedium
A child weighing 24 kg is prescribed 15 mg/kg of a drug. The stock solution contains 40 mg/mL. Draw up the dose: what volume V do you give?
24 kg15 mg/kg40 mg/mL
V = mL
28.Dosage calculationsHard
An infusion contains 20000 units of a drug in 1000 mL. The prescription is 800 units per hour. At what rate R do you set the pump, in mL/h?
20000 units/1000 mL800 units/h
R = mL/h
29.IV infusion ratesMedium
Infuse 250 mL over 3 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 mL3 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
500 mg of a drug is diluted in 500 mL and given by gravity through a set of 60 gtt/mL. The order is 40 mg per hour. Find the drip rate R in drops per minute.
500 mg/500 mL40 mg/h60 gtt/mL
R = gtt/min
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. Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 10:15 and runs by pump at 150 mL/h. How many mL V are left in the bag at 11:15?
1000 mL150 mL/h10:15 → 11:15
V = mL
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 26/min, SpO₂ 88% on room air, blood pressure 150/90 mmHg, pulse 130/min, alert, temperature 35.8 °C. What is the NEWS2 total score?
RR 26SpO₂ 88%airSBP 150HR 130AT 35.8 °C
NEWS2 =
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 95/min, a grimace when stimulated, some flexion of the arms and legs and no breathing. Score the APGAR and click how the score is interpreted.
1reassuring
2moderately abnormal
3low
3Solutions
1.Nursing fundamentals
Answer: B · Secondary intention
Why this is the answer
Wounds with tissue loss that cannot be closed heal by secondary intention, with granulation filling the wound and more scarring. Tertiary (delayed primary) closure is when a wound is left open first and closed later.
Answer
B · Secondary intention
2.Nursing fundamentals
Answer: C · Full name and date of birth, checked against the wristband
Why this is the answer
At least two personal identifiers, such as name, date of birth and hospital number, are checked with the patient and the wristband. Bed and room numbers change and are not identifiers.
Answer
C · Full name and date of birth, checked against the wristband
3.Infection control & patient safety
Answer: B · Open the wrapper away from the field and drop the item on it without reaching over
Why this is the answer
The nurse opens the package so the sterile item can be dropped onto the field from a short height, without the wrapper or arms crossing over the sterile area. The item must land well inside the non-sterile border.
Answer
B · Open the wrapper away from the field and drop the item on it without reaching over
4.Infection control & patient safety
Answer: D · Treat the glove as contaminated and change it
Why this is the answer
The principle is “if in doubt, it is not sterile”. The edge of the field is non-sterile, so the glove is changed. Continuing on an uncertain basis puts the patient at risk of infection.
Answer
D · Treat the glove as contaminated and change it
5.Prioritization & delegation
Answer: D · Metabolic acidosis
Why this is the answer
The pH is low (acidosis), the PaCO₂ is normal and the bicarbonate is low, so the cause is metabolic. Causes include diabetic ketoacidosis, sepsis and kidney failure.
Answer
D · Metabolic acidosis
6.Prioritization & delegation
Answer: A · Metabolic alkalosis
Why this is the answer
Repeated vomiting of stomach contents loses hydrochloric acid, causing metabolic alkalosis, often with low chloride and potassium. Fluids and electrolytes are corrected before surgery.
Answer
A · Metabolic alkalosis
7.Clinical nursing
Answer: A · 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
A · Thyroid function, the lungs and the skin's sensitivity to sunlight
8.Clinical nursing
Answer: C · 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
C · Refeeding syndrome
9.Lab values & electrolytes
Answer: C · Dehydration
Why this is the answer
When the body is short of fluid, the kidneys reabsorb more urea, so the BUN rises out of proportion to creatinine (a BUN-to-creatinine ratio above 20:1). Liver failure and a low-protein diet lower the BUN.Checked against:BUN (Blood Urea Nitrogen) · MedlinePlus (NIH) (2024)
Answer
C · Dehydration
10.Lab values & electrolytes
Answer: C · Low potassium, high bicarbonate and high amylase
Why this is the answer
Repeated vomiting causes hypokalemia and metabolic alkalosis (high bicarbonate) from the loss of stomach acid. Enlarged salivary glands can raise salivary amylase. Hypokalemia can cause dangerous arrhythmias, so it is monitored and corrected.Checked against:Bulimia · MedlinePlus (NIH) (2026)
Answer
C · Low potassium, high bicarbonate and high amylase
11.Pharmacology
Answer: C · About 67 drops per minute
Why this is the answer
100 mL × 20 drops/mL ÷ 30 min = 66.7, so about 67 drops per minute. Gravity infusions are counted for a full minute and checked regularly.
Answer
C · About 67 drops per minute
12.Pharmacology
Answer: C · Inhibition of acetylcholinesterase
Why this is the answer
Organophosphates inhibit acetylcholinesterase, so acetylcholine builds up at muscarinic and nicotinic receptors. Atropine blocks the muscarinic effects and pralidoxime can reactivate the enzyme if given early.
Answer
C · Inhibition of acetylcholinesterase
13.Med-surg: cardiovascular & respiratory
Answer: A · A nitrate-free interval prevents tolerance
Why this is the answer
Continuous nitrate use leads to tolerance within days. A daily nitrate-free period (often overnight, when angina is least likely) keeps the drug effective. Patients are taught to rotate patch sites.
Answer
A · A nitrate-free interval prevents tolerance
14.Med-surg: cardiovascular & respiratory
Answer: D · Low oxygen saturation is not explained by anxiety; PE must be excluded
Why this is the answer
Panic-related hyperventilation causes respiratory alkalosis but normal oxygen saturation. Hypoxaemia with tachycardia in a woman taking oestrogen suggests PE. She needs oxygen, urgent medical assessment and investigation. Paper-bag rebreathing is unsafe and can worsen hypoxaemia.
Answer
D · Low oxygen saturation is not explained by anxiety; PE must be excluded
15.Med-surg: neuro, endocrine & renal
Answer: B · After about 6–8 weeks
Why this is the answer
Levothyroxine has a half-life of about a week, so it takes several weeks to reach a new steady state. TSH is usually rechecked about 6–8 weeks after a dose change.
Answer
B · After about 6–8 weeks
16.Med-surg: neuro, endocrine & renal
Answer: D · That the catheter is not blocked or kinked
Why this is the answer
A sudden drop in output after transplant may be caused by a blocked catheter, often from clots. The nurse checks the tubing and may flush the catheter per protocol, and then escalates urgently, because vascular thrombosis or rejection are also possible.
Answer
D · That the catheter is not blocked or kinked
17.Med-surg: GI, perioperative & oncology
Answer: D · Tell the surgeon, as the patient may not be able to consent now
Why this is the answer
Opioids and sedatives can impair understanding, so consent may not be valid. The surgeon is informed; consent is obtained when the patient has capacity, or other legal processes are followed in an emergency.
Answer
D · Tell the surgeon, as the patient may not be able to consent now
18.Med-surg: GI, perioperative & oncology
Answer: D · Stop the IV fluids, sit the patient up and escalate
Why this is the answer
Older patients and those with heart or kidney disease can develop fluid overload. The nurse stops fluids, sits the patient up, gives oxygen if needed and asks for medical review, often for diuretics.
Answer
D · Stop the IV fluids, sit the patient up and escalate
19.Maternity & obstetric nursing
Answer: C · Pre-eclampsia with severe features, with a risk of eclampsia
Why this is the answer
New severe headache and visual disturbance are cerebral signs of severe pre-eclampsia and may come before a seizure. They need urgent escalation.
Answer
C · Pre-eclampsia with severe features, with a risk of eclampsia
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 · Worsening mood or new suicidal thoughts
Why this is the answer
Antidepressants may be linked to increased suicidal thinking in some young people, especially early in treatment or after dose changes. Close follow-up, safety planning and involving the family are advised.
Answer
C · Worsening mood or new suicidal thoughts
22.Pediatric nursing
Answer: C · Low-stimulation care, swaddling, small frequent feeds and a withdrawal scoring tool
Why this is the answer
Neonatal abstinence (withdrawal) is managed first with calm, low-stimulation care, swaddling, frequent feeds and support for parents, with regular scoring to guide any drug treatment. Naloxone is avoided because it can trigger acute withdrawal and seizures.
Answer
C · Low-stimulation care, swaddling, small frequent feeds and a withdrawal scoring tool
23.Mental health nursing
Answer: A · About 12 hours after the last dose
Why this is the answer
Lithium levels are drawn about 12 hours after the last dose, usually in the morning before the next dose, so results can be compared with the target range.
Answer
A · About 12 hours after the last dose
24.Mental health nursing
Answer: D · Answer briefly or decline politely, then return the focus to the patient
Why this is the answer
Patients often ask personal questions out of curiosity or to make the relationship more equal. A brief answer or a polite refusal, followed by redirecting to the patient's concerns, maintains boundaries without rejecting the patient.
Answer
D · Answer briefly or decline politely, then return the focus to the patient
25.Nursing math & unit conversions
Answer: x = 200 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
200.032 → 0
Only the next digit decides
200.032 → 0
0 is 4 or less, so 0 stays.
The digits after it (32) are ignored: round once, never step by step.
Round
x = 200 gtt/min
Answer
x = 200 gtt/min
26.Nursing math & unit conversions
Answer: V = 615 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
4 fl oz = 4·30 = 120 mL
2 cups = 2·240 = 480 mL
1 tbsp = 1·15 = 15 mL
Add
V = 120 + 480 + 15 = 615 mL
Answer
V = 615 mL
27.Dosage calculations
Answer: V = 9 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.
Dose from body weight
D = 15·24 = 360 mg
Volume
V = 360/40 = 9 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 9 mL
28.Dosage calculations
Answer: R = 40 mL/h
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Concentration
20000/1000 = 20 units/mL
Pump rate
R = 800/20 = 40 mL/h
Answer
R = 40 mL/h
29.IV infusion rates
Answer: R = 21 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
3·60 = 180 min
Drip rate
R = 250·15/180 = 20.83 ≈ 21 gtt/min
Answer
R = 21 gtt/min
At the bedside you round to the nearest whole drop: 21 gtt/min.
30.IV infusion rates
Answer: R = 40 gtt/min
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
500/500 = 1 mg/mL
Volume per hour
40/1 = 40 mL/h
Drip rate
R = 40·60/60 = 40 gtt/min
Answer
R = 40 gtt/min
31.IV fluids & fluid balance
Answer: I = 1290 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: 150 + 120 + 120 = 390 mL
ice chips: 200/2 = 100 mL
IV infusion: 75·8 = 600 mL
IV antibiotic: 2·100 = 200 mL
I = 1290 mL
Answer
I = 1290 mL
32.IV fluids & fluid balance
Answer: V = 850 mL
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.
Elapsed time
10:15 → 11:15 = 1 h
Volume infused
150·1 = 150 mL
Volume left
V = 1000 − 150 = 850 mL
Answer
V = 850 mL
33.Clinical assessment scores
Answer: NEWS2 = 9
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 26/min → 3
SpO₂ 88% → 3
on air → 0
SBP 150 mmHg → 0
HR 130/min → 2
alert (A) → 0
T 35.8 °C → 1
Add
NEWS2 = 3 + 3 + 0 + 0 + 2 + 0 + 1 = 9
Answer
NEWS2 = 9
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: 95/min → 1
Grimace: a grimace when stimulated → 1
Activity: some flexion of the arms and legs → 1
Respiration: no breathing → 0
Add
APGAR = 1 + 1 + 1 + 1 + 0 = 4
Interpretation
4 → 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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