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
At what angle is an intramuscular injection given?
A90 degrees
B15 degrees
C30 degrees
D45 degrees
2.Nursing fundamentalsHard
Why must a needlestick injury be reported straight away rather than at the end of the shift?
APost-exposure prophylaxis works best when it is started as soon as possible
BThe source patient will be discharged soon
CReporting late means the nurse has to pay for the tests
DThe injury must be documented within ten minutes for the report to be valid
3.Infection control & patient safetyMedium
Which equipment practice is correct for a patient on contact precautions?
AUsing a dedicated stethoscope and blood pressure cuff for that patient
BUsing the same stethoscope for all patients without cleaning
CTaking the patient’s equipment to the next room
DUsing equipment from the clean utility room and putting it back unchanged
4.Infection control & patient safetyHard
A chemical cloud has been released near the hospital, and authorities order “shelter in place”. What should staff do?
AKeep everyone inside, close windows and doors and shut off outside air intake
BEvacuate all patients into the car park at once
COpen the windows to let fresh air into the wards and dilute the chemical
DSend all visitors home through the main entrance
5.Prioritization & delegationMedium
Which patient on an addiction unit should the nurse see first?
ALast drink one week ago; asking about support groups
BIn recovery for a year; came to the clinic today for a routine check and a repeat prescription
CLast drink two days ago; now shaking, sweating, heart rate 124/min and seeing insects
DLast drink this morning; asking when lunch will arrive
6.Prioritization & delegationHard
Four patients arrive at the emergency department at the same time. Who should be seen first?
AA child with a temperature of 39 °C who is alert and drinking
BAn older adult with weakness on one side that began 40 minutes ago
CAn adult with kidney stone pain of 9/10 and stable vital signs
DA young adult with a swollen, painful ankle after a fall on the stairs
7.Clinical nursingMedium
Which of these is a non-drug measure that can help relieve pain?
ARepositioning and distraction
BRestricting visitors completely
CKeeping the patient awake all night
DTelling the patient that the pain is not real
8.Clinical nursingHard
Which type of drug is commonly used to treat neuropathic pain?
ASome anticonvulsants or antidepressants, such as gabapentin
BAntihistamines such as cetirizine
CAntibiotics such as amoxicillin, given as a long course
DProton pump inhibitors such as omeprazole
9.Lab values & electrolytesMedium
Why must a blue-top (citrate) coagulation tube be filled to the correct level?
AUnderfilled tubes always give a falsely low hemoglobin and hematocrit
BThe laboratory charges extra when a tube is not filled correctly
CAn overfull tube is needed to measure the potassium level
DThe blood-to-anticoagulant ratio must be right for accurate clotting times
10.Lab values & electrolytesHard
A patient has fatigue, weight gain and constipation. Results: TSH 24 mIU/L, free T4 low, total cholesterol 285 mg/dL (7.4 mmol/L), sodium 131 mEq/L. What is the best interpretation?
AFamilial hypercholesterolemia, unrelated to the thyroid results
BSecondary hypothyroidism from failure of the pituitary gland
CHyperthyroidism, with suppressed thyroid hormone production
DPrimary hypothyroidism, which can raise lipids and lower sodium
11.PharmacologyMedium
Which fraction of a drug in plasma can reach the receptor and produce an effect?
AThe fraction bound to albumin
BThe fraction stored in red blood cells
CThe fraction bound to globulins
DThe unbound (free) fraction
12.PharmacologyHard
A woman with epilepsy who takes an antiepileptic drug plans to become pregnant. Which advice is standard?
ATake folic acid before conception and seek specialist review of her medication
BNo change is needed, as antiepileptics carry no risk in pregnancy
CAvoid folic acid because it lowers drug levels
DStop all antiepileptic drugs straight away as soon as she stops contraception
13.Med-surg: cardiovascular & respiratoryMedium
A patient on theophylline develops nausea, vomiting, a fast heart rate and restlessness. What should the nurse suspect?
AHypoglycaemia caused by the drug
BTheophylline toxicity
CA theophylline allergy causing a rash
DAn expected sign that the drug is working
14.Med-surg: cardiovascular & respiratoryHard
A patient with both COPD and heart disease is more breathless, with bilateral basal crackles, raised JVP, ankle swelling and a markedly raised NT-proBNP. Which problem is most likely driving this episode?
AHyperventilation from anxiety
BA primary spontaneous pneumothorax
CDecompensated heart failure
DAn asthma attack
15.Med-surg: neuro, endocrine & renalMedium
Which long-term risk should a kidney transplant recipient be taught to reduce with sun protection?
AKidney stones
BGout
CHair loss
DSkin cancer
16.Med-surg: neuro, endocrine & renalHard
After surgery, a patient's urine output is 15 mL/h for 3 hours, with a pulse of 110/min, BP 96/58 mmHg and dry mucous membranes. What is the most likely cause of the low urine output?
ASIADH caused by the surgery
BFluid overload from IV fluids
CPre-renal AKI from hypovolaemia
DDiabetes insipidus after anaesthesia
17.Med-surg: GI, perioperative & oncologyMedium
Which neutrophil count indicates severe neutropenia?
AAbove 2.0 × 109/L
BBelow 0.5 × 109/L
CAbove 10 × 109/L
DBelow 7.5 × 109/L
18.Med-surg: GI, perioperative & oncologyHard
After surgery, a patient says they have "no pain" but grimaces, breathes shallowly and refuses to move or cough. What should the nurse do?
ATell the patient firmly that they must stop hiding their pain from staff
BInsist they walk without any analgesia
CExplore their beliefs and explain how analgesia aids recovery
DAccept the statement and record a pain score of 0
19.Maternity & obstetric nursingMedium
Why is the hearing of newborns screened before discharge or soon after birth?
AEarly support improves language development
BIt is required before vitamin K can be given
CIt detects congenital heart disease
DHearing loss can be cured with a single injection
20.Maternity & obstetric nursingHard
A newborn is pale, has a heart rate of 170/min and weak pulses after a difficult vacuum birth. The scalp is boggy and swelling across the sutures is increasing. What should the nurse suspect?
ANormal moulding
BCaput succedaneum
CSubgaleal haemorrhage
DSimple cephalhaematoma
21.Pediatric nursingMedium
Which finding at an 18-month check requires referral for developmental assessment?
AThe child plays alongside other children rather than with them
BThe child is afraid of strangers
CThe child says only a few words
DThe child is not yet walking independently
22.Pediatric nursingHard
A 6-year-old with sickle cell disease has a temperature of 39.0 °C. Why is this treated as urgent?
AFever means a sickling crisis has started, so the child needs a blood transfusion straight away to replace the damaged cells
BChildren with sickle cell disease have reduced spleen function and are at high risk of serious bacterial infection
CIt is not urgent; fever is common in all children
DFever is the normal start of every pain crisis
23.Mental health nursingMedium
When is the risk of suicide particularly high for patients after psychiatric inpatient care?
AOnly while the patient is asleep in hospital
BIn the first weeks after discharge
COnly after one year at home
DThere is no change in risk after discharge
24.Mental health nursingHard
On the second day after his last drink, a patient has a marked tremor, sees insects on the walls, a heart rate of 124/min, a blood pressure of 170/100 mmHg and heavy sweating. What is the priority?
AExplain that the insects are not real and leave him to rest
BRestrict his fluid intake
CTreat it as possible delirium tremens: get urgent medical help, give benzodiazepines as prescribed and keep him safe
DGive him a small amount of alcohol to settle the symptoms, then let him sleep it off in a quiet side room with the door closed
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient is 6 ft 11 in tall. Using 1 ft = 12 in and 1 in = 2.54 cm, find the height h in centimetres, to the nearest whole centimetre.
6 ft 11 in1 ft = 12 in1 in = 2.54 cm
h = cm
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A prescription reads ½ tbsp of an oral suspension every 12 hours for 10 days. The suspension comes in 100 mL bottles. Using 1 tbsp = 15 mL, how many whole bottles N must be supplied so the course is complete?
½ tbspevery 12 hours10 days100 mL1 tbsp = 15 mL
N =
27.Dosage calculationsMedium
A child weighing 11 kg is prescribed 15 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?
11 kg15 mg/kg25 mg/mL
V = mL
28.Dosage calculationsHard
The prescription is 260 micrograms. The ampoule contains 0.5 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
260 mcg0.5 mg/mL
V = mL
29.IV infusion ratesMedium
A drip runs at 40 gtt/min through a set of 60 gtt/mL. How many millilitres V does the patient receive in 12 hours?
40 gtt/min60 gtt/mL12 h
V = mL
30.IV infusion ratesHard
A drip runs at 32 gtt/min through a set of 20 gtt/mL. There are 200 mL left in the bag. How many hours t until it is empty? Round to one decimal place.
32 gtt/min20 gtt/mL200 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 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). Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 100 mL/h. At 18:30, 100 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL100 mL infused100 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 66/min and a blood pressure of 136/82 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.
HR 66/minBP 136/82 mmHg
SI =
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 120/min, a cry, cough or sneeze when stimulated, active movement and good breathing with a strong cry. Score the APGAR and click how the score is interpreted.
1reassuring
2moderately abnormal
3low
3Solutions
1.Nursing fundamentals
Answer: A · 90 degrees
Why this is the answer
Intramuscular injections are given at 90 degrees so the needle passes through the skin and fat into the muscle. Intradermal injections use about 10–15 degrees.
Answer
A · 90 degrees
2.Nursing fundamentals
Answer: A · Post-exposure prophylaxis works best when it is started as soon as possible
Why this is the answer
After a high-risk exposure, for example to HIV or hepatitis B, preventive treatment is most effective when started early. Prompt reporting also allows the source patient to be assessed.
Answer
A · Post-exposure prophylaxis works best when it is started as soon as possible
3.Infection control & patient safety
Answer: A · Using a dedicated stethoscope and blood pressure cuff for that patient
Why this is the answer
Non-critical equipment such as stethoscopes and cuffs is dedicated to the patient, or cleaned and disinfected before it is used for another patient.
Answer
A · Using a dedicated stethoscope and blood pressure cuff for that patient
4.Infection control & patient safety
Answer: A · Keep everyone inside, close windows and doors and shut off outside air intake
Why this is the answer
Sheltering in place keeps people inside, away from the hazard. Windows and doors are closed and ventilation systems that bring in outside air are shut off until the all-clear.
Answer
A · Keep everyone inside, close windows and doors and shut off outside air intake
5.Prioritization & delegation
Answer: C · Last drink two days ago; now shaking, sweating, heart rate 124/min and seeing insects
Why this is the answer
Hallucinations, tremor, sweating and tachycardia two to three days after the last drink suggest severe withdrawal and possible delirium tremens, which can be fatal. This patient needs prompt assessment and treatment.
Answer
C · Last drink two days ago; now shaking, sweating, heart rate 124/min and seeing insects
6.Prioritization & delegation
Answer: B · An older adult with weakness on one side that began 40 minutes ago
Why this is the answer
Sudden one-sided weakness suggests a stroke, and treatment depends on how quickly it starts. Severe kidney stone pain needs prompt pain relief, but the patient is stable.
Answer
B · An older adult with weakness on one side that began 40 minutes ago
7.Clinical nursing
Answer: A · Repositioning and distraction
Why this is the answer
Positioning, heat or cold where safe, relaxation, distraction and explanation can all reduce pain alongside analgesics.
Answer
A · Repositioning and distraction
8.Clinical nursing
Answer: A · Some anticonvulsants or antidepressants, such as gabapentin
Why this is the answer
Neuropathic pain responds poorly to standard analgesics. Drugs that modify nerve signalling, such as gabapentinoids and some antidepressants, are used, with doses increased gradually.
Answer
A · Some anticonvulsants or antidepressants, such as gabapentin
9.Lab values & electrolytes
Answer: D · 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
D · The blood-to-anticoagulant ratio must be right for accurate clotting times
10.Lab values & electrolytes
Answer: D · Primary hypothyroidism, which can raise lipids and lower sodium
D · Primary hypothyroidism, which can raise lipids and lower sodium
11.Pharmacology
Answer: D · The unbound (free) fraction
Why this is the answer
Only the free drug can diffuse into tissues, act on receptors and be metabolised or excreted. Protein-bound drug acts as a reservoir.
Answer
D · The unbound (free) fraction
12.Pharmacology
Answer: A · 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
A · Take folic acid before conception and seek specialist review of her medication
13.Med-surg: cardiovascular & respiratory
Answer: B · Theophylline toxicity
Why this is the answer
Theophylline has a narrow therapeutic window. Toxicity causes nausea, vomiting, tachycardia, arrhythmias, agitation and seizures. Levels are monitored, and many drugs and smoking status change its clearance. The nurse should hold the dose and report.
Answer
B · Theophylline toxicity
14.Med-surg: cardiovascular & respiratory
Answer: C · Decompensated heart failure
Why this is the answer
Basal crackles, raised JVP, oedema and a high natriuretic peptide point to heart failure rather than a COPD exacerbation alone. Distinguishing them matters, because treatment (diuretics and HF drugs versus bronchodilators and steroids) is different. Both may occur together.
Answer
C · Decompensated heart failure
15.Med-surg: neuro, endocrine & renal
Answer: D · Skin cancer
Why this is the answer
Transplant recipients have a much higher risk of skin cancers, especially squamous cell carcinoma, because of immunosuppression. Sun protection and regular skin checks are important.
Answer
D · Skin cancer
16.Med-surg: neuro, endocrine & renal
Answer: C · Pre-renal AKI from hypovolaemia
Why this is the answer
Tachycardia, low blood pressure and dry mucous membranes suggest hypovolaemia reducing kidney perfusion. The nurse checks that the catheter is patent and escalates; the team will usually prescribe a fluid challenge and look for the cause, such as bleeding or high losses.
Answer
C · Pre-renal AKI from hypovolaemia
17.Med-surg: GI, perioperative & oncology
Answer: B · Below 0.5 × 109/L
Why this is the answer
A neutrophil count below 0.5 × 109/L (500/mm³) is severe neutropenia, with a high risk of life-threatening infection. Fever in this setting is treated as neutropenic sepsis.
Answer
B · Below 0.5 × 109/L
18.Med-surg: GI, perioperative & oncology
Answer: C · Explore their beliefs and explain how analgesia aids recovery
Why this is the answer
Patients may under-report pain because of beliefs, fear of addiction or not wanting to bother staff. Exploring these concerns and explaining that good analgesia helps breathing and mobility supports a shared plan.
Answer
C · Explore their beliefs and explain how analgesia aids recovery
19.Maternity & obstetric nursing
Answer: A · Early support improves language development
Why this is the answer
Early detection of hearing loss allows hearing aids, cochlear implants or other support in the first months, which greatly improves language outcomes.
Answer
A · Early support improves language development
20.Maternity & obstetric nursing
Answer: C · Subgaleal haemorrhage
Why this is the answer
A subgaleal haemorrhage is bleeding under the scalp aponeurosis. It crosses suture lines, can grow rapidly and can cause hypovolaemic shock. It is an emergency, unlike caput or cephalhaematoma.
Answer
C · Subgaleal haemorrhage
21.Pediatric nursing
Answer: D · The child is not yet walking independently
Why this is the answer
Not walking by about 18 months is a red flag. A few words, parallel play and stranger wariness are typical at this age.
Answer
D · The child is not yet walking independently
22.Pediatric nursing
Answer: B · Children with sickle cell disease have reduced spleen function and are at high risk of serious bacterial infection
Why this is the answer
Repeated infarction damages the spleen early in childhood (functional asplenia), so encapsulated bacteria can cause overwhelming sepsis. Fever needs urgent assessment and usually antibiotics.
Answer
B · Children with sickle cell disease have reduced spleen function and are at high risk of serious bacterial infection
23.Mental health nursing
Answer: B · In the first weeks after discharge
Why this is the answer
The period shortly after discharge carries a high risk of suicide. Early follow-up, a safety plan and clear crisis contacts help bridge the transition.
Answer
B · In the first weeks after discharge
24.Mental health nursing
Answer: C · Treat it as possible delirium tremens: get urgent medical help, give benzodiazepines as prescribed and keep him safe
Why this is the answer
Hallucinations, autonomic instability and tremor 48–96 hours after the last drink suggest delirium tremens, a medical emergency. Treatment includes benzodiazepines, fluids, thiamine, close monitoring and a safe, calm environment.
Answer
C · Treat it as possible delirium tremens: get urgent medical help, give benzodiazepines as prescribed and keep him safe
25.Nursing math & unit conversions
Answer: h = 211 cm
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.
Height in inches
6·12 + 11 = 83 in
Inches to centimetres
h = 83·2.54 = 210.8 ≈ 211 cm
Answer
h = 211 cm
26.Nursing math & unit conversions
Answer: N = 2
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 × 2 × 10 = 150 mL
Bottles
150/100 = 1.5 → N = 2
Answer
N = 2
27.Dosage calculations
Answer: V = 6.6 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 = 15·11 = 165 mg
Volume
V = 165/25 = 6.6 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 6.6 mL
28.Dosage calculations
Answer: V = 0.52 mL
Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.
Same units
0.5 mg/mL = 500 mcg/mL
Volume
V = 260/500 = 0.52 mL
Answer
V = 0.52 mL
29.IV infusion rates
Answer: V = 480 mL
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
40·60/60 = 40 mL/h
Volume
V = 40·12 = 480 mL
Answer
V = 480 mL
30.IV infusion rates
Answer: t = 2.1 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
32·60/20 = 96 mL/h
Time left
t = 200/96 = 2.083 ≈ 2.1 h
Answer
t = 2.1 h
31.IV fluids & fluid balance
Answer: B = −175 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: 150 + 120 + 150 = 420 mL
ice chips: 240/2 = 120 mL
IV infusion: 80·8 = 640 mL
IV antibiotic: 2·100 = 200 mL
total intake = 1380 mL
Total output
250 + 475 + 250 + 500 + 80 = 1555 mL
Balance
B = 1380 − 1555 = −175 mL
Answer
B = −175 mL
Negative: the patient lost more fluid than went in.
32.IV fluids & fluid balance
Answer: t = 4 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 − 100 = 400 mL
Time
t = 400/100 = 4 h
Answer
t = 4 h
That is about 4 h 00 min, so the bag runs out at about 22:30.
33.Clinical assessment scores
Answer: SI = 0.49
Blood pressure values: pulse pressure PP = SBP − DBP. Mean arterial pressure MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3, an estimate based on the heart spending about two thirds of each beat in diastole at a normal heart rate (less accurate when the heart rate is fast); a MAP of at least about 65 mmHg is a common target for organ perfusion. The shock index SI = heart rate/SBP is normally about 0.5–0.7; a value above about 1 is a warning sign of shock.
Shock index
SI = 66/136 = 0.4853 ≈ 0.49
Answer
SI = 0.49
Within or below the usual 0.5–0.7.
34.Clinical assessment scores
Answer: reassuring
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: 120/min → 2
Grimace: a cry, cough or sneeze when stimulated → 2
Activity: active movement → 2
Respiration: good breathing with a strong cry → 2
Add
APGAR = 1 + 2 + 2 + 2 + 2 = 9
Interpretation
9 → reassuring
Answer
reassuring
This is independent practice material. ExamProblems is not affiliated with or endorsed by the organisation that runs this exam, and the exam name is used only to describe the content. NCLEX®, NCLEX-RN® and NCLEX-PN® are trademarks of the National Council of State Boards of Nursing, Inc. (NCSBN), which is not affiliated with ExamProblems and does not endorse it or vouch for its accuracy.