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 has just died. What should the nurse find out before starting last offices?
AWhether the patient's bills had all been paid
BThe patient's blood group
CThe family's religious and cultural wishes
DThe patient's favourite food
2.Nursing fundamentalsHard
Four patients need you at the same time. Who should you see first?
AA patient with pain of 6/10 who was given oral analgesia 20 minutes ago
BA patient due for a routine oral medicine
CA patient who has developed noisy, high-pitched breathing (stridor)
DA patient asking about their discharge time
3.Infection control & patient safetyMedium
A parent will give a liquid antibiotic to a child at home. Which teaching is best?
AEstimate the dose by pouring into a cup
BUse a tablespoon for doses over 5 mL
CUse the oral syringe or dosing cup that comes with the medicine
DUse any teaspoon or tablespoon from the kitchen drawer at home
4.Infection control & patient safetyHard
In a US hospital (CMS rules), a patient keeps pulling at an endotracheal tube, and alternatives have failed. The nurse applies wrist restraints in an emergency. What must happen next?
AObtain a time-limited order for the restraint promptly, following policy
BAsk the provider for a PRN restraint order to use as needed
CKeep the restraints on without an order until the patient is calm
DAsk the family to sign a consent form instead of an order
5.Prioritization & delegationMedium
A patient is booked for a CT scan with iodinated contrast. Which of the patient’s medications may need to be held according to protocol?
AAcetaminophen (paracetamol)
BMetformin
COmeprazole
DLevothyroxine
6.Prioritization & delegationHard
A patient admitted with suspected appendicitis says the pain suddenly got better, but now the abdomen is rigid and the heart rate is rising. What does this suggest?
AThe patient’s analgesic has finally started to work
BThe pain has moved to a different, harmless place
CThe appendix may have ruptured, causing peritonitis
DThe appendicitis is getting better without surgery
7.Clinical nursingMedium
Which electrolyte disturbance is most dangerous for the heart rhythm?
AHigh chloride
BLow sodium
CLow phosphate
DHigh or low potassium
8.Clinical nursingHard
A patient has had nausea and vomiting for three days and is taking furosemide. Which electrolyte problem is most likely?
AHypokalaemia
BHyperkalaemia
CHypercalcaemia
DHypernatraemia only
9.Lab values & electrolytesMedium
Why must a blue-top (citrate) coagulation tube be filled to the correct level?
AThe laboratory charges extra when a tube is not filled correctly
BThe blood-to-anticoagulant ratio must be right for accurate clotting times
CUnderfilled tubes always give a falsely low hemoglobin and hematocrit
DAn overfull tube is needed to measure the potassium level
10.Lab values & electrolytesHard
A patient on digoxin has a level of 1.2 ng/mL, a potassium of 2.8 mEq/L and new frequent ventricular ectopic beats. What is the best interpretation?
AToxicity is possible, because low potassium increases digoxin’s effect
BDigoxin cannot be the cause, because the level is within the usual range
CThe patient needs a higher digoxin dose to control the rhythm
DPotassium has no effect on the heart rhythm
11.PharmacologyMedium
Which patient should usually not use the combined oral contraceptive pill?
AA 25-year-old woman with heavy periods
BA 38-year-old woman who smokes 20 cigarettes a day
CA 22-year-old non-smoker with acne
DA 30-year-old non-smoker with no medical problems
12.PharmacologyHard
A patient recently started on haloperidol develops high fever, "lead-pipe" muscle rigidity, confusion and a very high creatine kinase. What is the most likely diagnosis?
ASerotonin syndrome
BNeuroleptic malignant syndrome
CMalignant hyperthermia from anaesthesia
DAcute dystonia
13.Med-surg: cardiovascular & respiratoryMedium
A patient with heart failure takes furosemide once a day. When is the best time to take it?
AJust before the evening meal, with a large drink
BAt bedtime, so the effect lasts through the night
CWhenever the ankles look swollen, on those days only
DIn the morning, to avoid needing the toilet at night
14.Med-surg: cardiovascular & respiratoryHard
A heavy smoker is having surgery tomorrow and asks whether stopping smoking now is pointless. Which reply is most accurate?
AStopping now will make the operation more dangerous
BSmoking before surgery protects the lungs from the anaesthetic gases
CIt is pointless unless they stopped smoking at least a year ago
DStopping even today lowers carbon monoxide levels before surgery
15.Med-surg: neuro, endocrine & renalMedium
Which picture fits Brown-Séquard syndrome?
AParalysis of both legs, with normal sensation everywhere in the body
BWeakness on the same side and loss of pain on the opposite side
CLoss of all feeling but normal movement on both sides
DWeakness of both arms with normal strength in the legs
16.Med-surg: neuro, endocrine & renalHard
An adult stares blankly for about a minute, smacks their lips and fumbles with their clothes. Afterwards they are confused for ten minutes and remember nothing. Which seizure type fits best?
AMyoclonic seizure
BAbsence seizure
CAtonic (drop) seizure with a fall
DFocal impaired awareness seizure
17.Med-surg: GI, perioperative & oncologyMedium
A dying patient can no longer drink. Which mouth care is most appropriate?
ALemon and glycerine swabs every hour to stimulate saliva
BFrequent, gentle moistening of the mouth and lips
CBrushing hard with a stiff toothbrush twice a day
DNo mouth care, to avoid disturbing the patient
18.Med-surg: GI, perioperative & oncologyHard
A patient with an epidural after abdominal surgery has BP 82/48 mmHg, a pulse of 70/min and warm feet. Bleeding has been excluded. What is the most likely cause?
ACardiogenic shock after surgery
BHypovolaemic shock from blood loss
CAnaphylaxis to the local anaesthetic
DSympathetic block from the epidural
19.Maternity & obstetric nursingMedium
Which complication should the nurse monitor for after an epidural is started in labour?
AMaternal hypotension
BMaternal hyperglycaemia
CMaternal hypertension
DIncreased bladder sensation
20.Maternity & obstetric nursingHard
A nurse teaches a first-time mother about exclusive breastfeeding. Which statement shows a need for further teaching?
A"Wet nappies help me check that she is getting enough."
B"I should feed my baby whenever she shows hunger cues."
C"My milk supply increases the more often she feeds."
D"On hot days I should give my baby extra water between feeds."
21.Pediatric nursingMedium
Why do young children with sickle cell disease usually take daily penicillin?
ASickle cells make the child allergic to most other antibiotics
BPenicillin stops red cells from changing shape
CPenicillin prevents pain crises in cold weather
DPoor spleen function puts them at high risk of pneumococcal infection
22.Pediatric nursingHard
A 3-year-old who was toilet trained starts wetting the bed during a hospital stay. The parents are worried. What should the nurse say?
AThe child is being naughty and should be told off
BRegression is a common response to the stress of hospital and usually passes; do not punish the child
CThis proves the child has a serious kidney disease
DThe child should be put back into nappies permanently, and toilet training should not be tried again for years
23.Mental health nursingMedium
How should a nurse screen a patient for intimate partner violence?
AAsk the partner instead of the patient
BAsk in private, without the partner or family present
COnly ask patients who have visible injuries
DAsk in front of the partner to see how he reacts
24.Mental health nursingHard
A 6-month-old has a spiral fracture of the arm. The parents say he "rolled off the sofa". The nurse also notices bruises of different colours on his back. What is the most appropriate action?
ADischarge the child quickly so that the parents do not become angry and stop bringing him for medical care
BTell the parents that the nurse knows they are abusing the child
CAccept the parents' explanation, because babies often fall
DReport the concerns through child protection procedures and ensure the child's safety
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A weight conversion gives 100.5650 kg. The rule in this exercise is that weights are rounded to the nearest tenth of a kilogram. What value x do you record?
100.5650 kg
x = kg
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A prescription reads 1½ tsp of an oral suspension four times a day for 7 days. The suspension comes in 100 mL bottles. Using 1 tsp = 5 mL, how many whole bottles N must be supplied so the course is complete?
1½ tspfour times a day7 days100 mL1 tsp = 5 mL
N =
27.Dosage calculationsMedium
A child weighing 6 kg is prescribed 20 mg/kg of a drug. The stock solution contains 40 mg/mL. Draw up the dose: what volume V do you give?
6 kg20 mg/kg40 mg/mL
V = mL
28.Dosage calculationsHard
A patient weighs 169.4 lb. The prescription is 5 mg/kg as a single dose, and the stock contains 50 mg in 1 mL. Using 1 kg = 2.2 lb, what volume V do you give?
169.4 lb5 mg/kg50 mg/1 mL1 kg = 2.2 lb
V = mL
29.IV infusion ratesMedium
Infuse 1000 mL over 4 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
1000 mL4 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 50 gtt/min through a set of 15 gtt/mL. There are 750 mL left in the bag. How many hours t until it is empty? Round to one decimal place.
50 gtt/min15 gtt/mL750 mL
t = h
31.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The patient weighs 68 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
68 kg12 hurine: 150 mLurine: 450 mLvomit: 200 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 125 mL/h. At 19:00, 50 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL50 mL infused125 mL/h
t = h
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 90% on room air, blood pressure 150/90 mmHg, pulse 38/min, alert, temperature 38.1 °C. What is the NEWS2 total score?
RR 26SpO₂ 90%airSBP 150HR 38AT 38.1 °C
NEWS2 =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: slightly limited; moisture: occasionally moist; activity: chairfast; mobility: no limitation; nutrition: excellent; friction and shear: no apparent problem. Use the bands 19–23 not at risk, 15–18 mild, 13–14 moderate, 10–12 high and 9 or below very high. Click the risk level.
1not at risk
2mild risk
3moderate risk
4high risk
5very high risk
3Solutions
1.Nursing fundamentals
Answer: C · The family's religious and cultural wishes
Why this is the answer
Some faiths have specific rules, for example about who may touch or wash the body and how soon burial should happen. Asking first respects the person and the family.
Answer
C · The family's religious and cultural wishes
2.Nursing fundamentals
Answer: C · A patient who has developed noisy, high-pitched breathing (stridor)
Why this is the answer
Stridor signals a partly blocked upper airway, which can quickly become life-threatening. Airway problems come before breathing, circulation and other needs.
Answer
C · A patient who has developed noisy, high-pitched breathing (stridor)
3.Infection control & patient safety
Answer: C · Use the oral syringe or dosing cup that comes with the medicine
Why this is the answer
Household spoons vary widely in size and cause dosing errors. A marked oral syringe or dosing device in mL gives an accurate dose.
Answer
C · Use the oral syringe or dosing cup that comes with the medicine
4.Infection control & patient safety
Answer: A · Obtain a time-limited order for the restraint promptly, following policy
Why this is the answer
Under US CMS rules, a nurse may apply a restraint first in an emergency, but an order from a licensed provider must be obtained promptly according to policy. PRN restraint orders are not allowed, and family consent does not replace an order. Other countries use different legal frameworks, but restraint is always a last resort that must be authorized, reviewed and documented.
Answer
A · Obtain a time-limited order for the restraint promptly, following policy
5.Prioritization & delegation
Answer: B · Metformin
Why this is the answer
If contrast causes kidney injury, metformin can build up and cause lactic acidosis. Protocols often hold metformin around the procedure, especially when kidney function is reduced.
Answer
B · Metformin
6.Prioritization & delegation
Answer: C · The appendix may have ruptured, causing peritonitis
Why this is the answer
A sudden ease in pain followed by a rigid abdomen and a rising pulse can mean rupture and peritonitis. This is a surgical emergency, so the nurse reports at once.
Answer
C · The appendix may have ruptured, causing peritonitis
7.Clinical nursing
Answer: D · High or low potassium
Why this is the answer
Both hyperkalaemia and hypokalaemia can cause life-threatening arrhythmias. Potassium must never be given as an undiluted rapid IV bolus.
Answer
D · High or low potassium
8.Clinical nursing
Answer: A · Hypokalaemia
Why this is the answer
Vomiting and loop diuretics both cause potassium loss. Hypokalaemia causes weakness, cramps and arrhythmias and needs monitoring and replacement.
Answer
A · Hypokalaemia
9.Lab values & electrolytes
Answer: B · The blood-to-anticoagulant ratio must be right for accurate clotting times
Why this is the answer
Citrate tubes contain a set volume of anticoagulant. If the tube is underfilled, the extra citrate falsely prolongs the PT and aPTT, so the laboratory may reject the sample.
Answer
B · The blood-to-anticoagulant ratio must be right for accurate clotting times
10.Lab values & electrolytes
Answer: A · Toxicity is possible, because low potassium increases digoxin’s effect
Why this is the answer
Hypokalemia increases digoxin binding to heart cells, so toxicity can occur at a normal level. The nurse holds the dose, reports the result and expects potassium replacement.
Answer
A · Toxicity is possible, because low potassium increases digoxin’s effect
11.Pharmacology
Answer: B · A 38-year-old woman who smokes 20 cigarettes a day
Why this is the answer
Smoking over the age of 35 greatly increases the risk of myocardial infarction and stroke with combined hormonal contraception. Progestogen-only or non-hormonal methods are preferred.
Answer
B · A 38-year-old woman who smokes 20 cigarettes a day
12.Pharmacology
Answer: B · Neuroleptic malignant syndrome
Why this is the answer
Neuroleptic malignant syndrome follows dopamine antagonists and develops over days, with lead-pipe rigidity, fever and raised CK. Serotonin syndrome develops faster and features clonus and hyperreflexia.
Answer
B · Neuroleptic malignant syndrome
13.Med-surg: cardiovascular & respiratory
Answer: D · In the morning, to avoid needing the toilet at night
Why this is the answer
Loop diuretics produce a brisk diuresis that lasts several hours. Taking them in the morning (and a second dose by early afternoon if prescribed) avoids nocturia, broken sleep and night-time falls.
Answer
D · In the morning, to avoid needing the toilet at night
14.Med-surg: cardiovascular & respiratory
Answer: D · Stopping even today lowers carbon monoxide levels before surgery
Why this is the answer
Carboxyhaemoglobin falls substantially within about 12–24 hours of stopping, improving oxygen delivery. Longer abstinence improves airway function, wound healing and reduces complications further. Any stop is beneficial, and support should be offered.
Answer
D · Stopping even today lowers carbon monoxide levels before surgery
15.Med-surg: neuro, endocrine & renal
Answer: B · Weakness on the same side and loss of pain on the opposite side
Why this is the answer
Damage to one side of the spinal cord, often from a stab wound, causes motor loss and loss of proprioception on the same side, and loss of pain and temperature on the opposite side. The pain fibres cross soon after entering the cord.
Answer
B · Weakness on the same side and loss of pain on the opposite side
16.Med-surg: neuro, endocrine & renal
Answer: D · Focal impaired awareness seizure
Why this is the answer
Focal impaired awareness seizures often come from the temporal lobe. They last about a minute or two, with automatisms such as lip smacking and fumbling, and are followed by confusion. Absence seizures are shorter and have no postictal phase.
Answer
D · Focal impaired awareness seizure
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: D · Sympathetic block from the epidural
Why this is the answer
Epidural local anaesthetic can block sympathetic outflow, causing vasodilation and hypotension. Management follows the epidural protocol: assess, lie the patient flat, give fluid or vasopressors as prescribed and inform the anaesthetist. Bleeding must always be considered too.
Answer
D · Sympathetic block from the epidural
19.Maternity & obstetric nursing
Answer: A · Maternal hypotension
Why this is the answer
An epidural causes vasodilation, so blood pressure can fall, which reduces blood flow to the placenta. Blood pressure and the fetal heart rate are checked frequently, and bladder distension is common because sensation is reduced.
Answer
A · Maternal hypotension
20.Maternity & obstetric nursing
Answer: D · "On hot days I should give my baby extra water between feeds."
Why this is the answer
Exclusively breastfed babies under 6 months do not need extra water, even in hot weather; more frequent feeds meet their needs. Water can fill the stomach and reduce milk intake.
Answer
D · "On hot days I should give my baby extra water between feeds."
21.Pediatric nursing
Answer: D · Poor spleen function puts them at high risk of pneumococcal infection
Why this is the answer
Repeated sickling damages the spleen early in life, making children vulnerable to encapsulated bacteria such as pneumococcus. Daily penicillin prophylaxis and full vaccination greatly reduce the risk of life-threatening infection.
Answer
D · Poor spleen function puts them at high risk of pneumococcal infection
22.Pediatric nursing
Answer: B · Regression is a common response to the stress of hospital and usually passes; do not punish the child
Why this is the answer
Temporary regression is common in hospitalised young children. Accept it without punishment, keep familiar routines and praise the child; skills usually return after discharge.
Answer
B · Regression is a common response to the stress of hospital and usually passes; do not punish the child
23.Mental health nursing
Answer: B · Ask in private, without the partner or family present
Why this is the answer
Screening should be done privately, using direct, non-judgemental questions. Abuse occurs in all groups, so routine screening is better than asking only those with obvious injuries.
Answer
B · Ask in private, without the partner or family present
24.Mental health nursing
Answer: D · Report the concerns through child protection procedures and ensure the child's safety
Why this is the answer
Injuries that do not fit the child's developmental stage or the history, and bruises of different ages, are warning signs of abuse. The nurse documents objectively and reports through safeguarding procedures.
Answer
D · Report the concerns through child protection procedures and ensure the child's safety
25.Nursing math & unit conversions
Answer: x = 100.6 kg
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 tenths place
100.5650 → 5
Only the next digit decides
100.5650 → 6
6 is 5 or more, so round 5 up.
The digits after it (5) are ignored: round once, never step by step.
Round
x = 100.6 kg
Answer
x = 100.6 kg
26.Nursing math & unit conversions
Answer: N = 3
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.
Total volume
7.5 mL × 4 × 7 = 210 mL
Bottles
210/100 = 2.1 → N = 3
Answer
N = 3
27.Dosage calculations
Answer: V = 3 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 = 20·6 = 120 mg
Volume
V = 120/40 = 3 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 3 mL
28.Dosage calculations
Answer: V = 7.7 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.
Weight in kg
169.4/2.2 = 77 kg
Dose
5·77 = 385 mg
Volume
V = (385/50)·1 = 7.7 mL
Answer
V = 7.7 mL
29.IV infusion rates
Answer: R = 83 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
4·60 = 240 min
Drip rate
R = 1000·20/240 = 83.33 ≈ 83 gtt/min
Answer
R = 83 gtt/min
At the bedside you round to the nearest whole drop: 83 gtt/min.
30.IV infusion rates
Answer: t = 3.8 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.
Rate in mL/h
50·60/15 = 200 mL/h
Time left
t = 750/200 = 3.75 ≈ 3.8 h
Answer
t = 3.8 h
31.IV fluids & fluid balance
Answer: U = 0.74 mL/kg/h
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 urine
150 + 450 = 600 mL
Per kilogram per hour
U = 600/(68·12) = 0.7353 ≈ 0.74 mL/kg/h
Answer
U = 0.74 mL/kg/h
32.IV fluids & fluid balance
Answer: t = 3.6 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 − 50 = 450 mL
Time
t = 450/125 = 3.6 h
Answer
t = 3.6 h
That is about 3 h 36 min, so the bag runs out at about 22:36.
33.Clinical assessment scores
Answer: NEWS2 = 10
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 90% → 3
on air → 0
SBP 150 mmHg → 0
HR 38/min → 3
alert (A) → 0
T 38.1 °C → 1
Add
NEWS2 = 3 + 3 + 0 + 0 + 3 + 0 + 1 = 10
Answer
NEWS2 = 10
34.Clinical assessment scores
Answer: not at risk
Braden scale: six subscales for pressure-injury risk. Sensory perception, moisture, activity, mobility and nutrition score 1 to 4, from the worst level (1) to no problem (4); friction and shear scores 1 to 3. The total runs from 6 to 23, and a lower total means a higher risk. Common bands: 19–23 not at risk, 15–18 mild risk, 13–14 moderate risk, 10–12 high risk and 9 or below very high risk.