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
Which of these is recorded as fluid intake on a fluid balance chart?
AVomit
BWound drainage
CIntravenous fluids
DUrine output from a catheter
2.Nursing fundamentalsHard
A patient describes burning, shooting pain with pins and needles in both feet. Which type of pain is most likely?
ANeuropathic pain
BAcute somatic pain
CVisceral pain
DReferred pain
3.Infection control & patient safetyMedium
A patient has received oral radioactive iodine therapy. Which precaution is usually taken?
ALet the patient share a bathroom with other patients
BLimit time close to the patient and handle body fluids per radiation policy
CPlace the patient on droplet precautions with a surgical mask
DEncourage pregnant visitors to sit close to the patient to give emotional support
4.Infection control & patient safetyHard
A patient weighs 180 kg and needs to be moved from bed to chair. The standard ceiling lift on the unit has a lower weight limit. What should the nurse do?
AHave two staff lift the patient by hand
BUse bariatric-rated equipment and enough trained staff
CUse the standard lift, because limits include a safety margin
DAsk the patient to stand and pivot without help
5.Prioritization & delegationMedium
During START triage at a mass-casualty scene, a victim can walk to the designated area when asked. Which category is the victim given?
ABlack (expectant)
BRed (immediate)
CYellow (delayed)
DGreen (minor)
6.Prioritization & delegationHard
A patient with heart failure is short of breath with crackles in both lungs. Which order of actions is correct?
ASit up, give oxygen as prescribed, then call the provider
BWeigh the patient first, then reassess the breathing in four hours
CLay the patient flat to rest, then start the IV maintenance fluids
DGive the scheduled oral medicines first, then sit the patient up
7.Clinical nursingMedium
Why are alternate sutures sometimes removed first when taking out stitches?
ATo make the procedure faster
BTo check the wound stays closed before removing the rest
CTo reduce the cost of dressings
DBecause the remaining sutures dissolve on their own within a day
8.Clinical nursingHard
A patient on an unfractionated heparin infusion is also started on warfarin. Which tests are used to monitor each drug?
APlatelet count for both drugs
BD-dimer for both drugs
CINR for heparin and APTT for warfarin
DAPTT for heparin and INR for warfarin
9.Lab values & electrolytesMedium
Two sets of blood cultures are ordered for a patient with suspected sepsis. How are they best collected?
AAfter the first antibiotic dose, so the infusion is not delayed
BFrom the existing IV line while the infusion continues to run
CBoth from the same site, one minute apart, to save time for the patient
DFrom two separate venipuncture sites, using strict aseptic technique
10.Lab values & electrolytesHard
A patient on high-dose dexamethasone has a white cell count of 15 × 10³/µL, mostly mature neutrophils with no bands. They have no fever and no signs of infection. What is the most likely explanation?
AA new leukemia that is confirmed by this result alone
BA laboratory error, because steroids always lower the white count
CA steroid effect that moves neutrophils into the circulating blood
DCertain sepsis that needs antibiotics started without delay
11.PharmacologyMedium
A patient is starting olanzapine. Which monitoring is most important over the following months?
AWeight, blood glucose and blood lipids
BPeak expiratory flow
CINR and platelet count
DHearing tests and vision tests every month
12.PharmacologyHard
A patient taking hydralazine for several months develops joint pain, fever and a rash. Anti-histone antibodies are positive. What is the most likely diagnosis?
ARheumatoid arthritis
BDrug-induced lupus
CGout
DAn acute viral infection
13.Med-surg: cardiovascular & respiratoryMedium
Which finding shows that long-standing hypertension has caused target organ damage?
AClear lung fields on the chest X-ray
BA normal fasting glucose
CLeft ventricular hypertrophy on the ECG
DA heart rate of 72/min
14.Med-surg: cardiovascular & respiratoryHard
A patient with stable severe COPD has a blood gas showing pH 7.37, a raised PaCO₂ and a raised bicarbonate. How should this be interpreted?
ARespiratory alkalosis from hyperventilation
BChronic respiratory acidosis with metabolic compensation
Which headache feature most suggests raised intracranial pressure from a brain tumour?
ABetter in the morning and worse with stress
BWorse on waking and on coughing, with vomiting
CA tight band across the forehead that eases with rest
DOnly present after reading for a long time
16.Med-surg: neuro, endocrine & renalHard
A patient with SIADH is taught about a fluid restriction. Which statement shows a need for further teaching?
A"If I feel thirsty, I can drink as much water as I like."
B"I will report any headaches or confusion."
C"I will weigh myself every morning."
D"I will count all drinks, including soup, in my daily total."
17.Med-surg: GI, perioperative & oncologyMedium
A patient with a new colostomy asks what to eat at home. Which advice is most appropriate?
AEat only liquids until the stoma is removed
BEat a normal, balanced diet and introduce foods gradually
CDrink as little fluid as possible to reduce output
DAvoid all fruit and vegetables for the rest of their life
18.Med-surg: GI, perioperative & oncologyHard
A patient with an ileostomy has had no output for 6 hours, with cramping pain, distension, nausea and a swollen stoma. What should the nurse suspect?
ADehydration from very high ileostomy output
BA stoma blockage, often from food, needing review
CA minor skin rash around the stoma
DNormal quiet period for a new ileostomy
19.Maternity & obstetric nursingMedium
Which behaviour shows positive early bonding between mother and newborn?
ACalling the baby "it" and not looking at it
BAsking staff to keep the baby in the nursery at all times
CAvoiding holding the baby during the first day
DFace-to-face eye contact and talking to the baby
20.Maternity & obstetric nursingHard
A woman in active labour has been at 6 cm for 4 hours despite regular contractions. Which factor among the "5 Ps" should the nurse consider first?
AThe past history of her mother's labour
BThe passenger: fetal size, position or presentation
CThe pulse rate during contractions
DThe placenta: whether it is anterior or posterior
21.Pediatric nursingMedium
How are feeds usually restarted after a pyloromyotomy for pyloric stenosis?
AWith large, full-volume feeds straight away to make up for the weight lost
BNot until 10 days after surgery, when the wound has healed
CWithin hours, increasing gradually as per protocol; some vomiting can be expected
DOnly by nasogastric tube for the first month at home
22.Pediatric nursingHard
Which order should the nurse question for a child with neutropenia after chemotherapy?
AMeasure the temperature rectally every 4 hours
BMonitor the temperature by the axillary or oral route
CReport a temperature of 38 °C or more immediately
DPerform careful hand hygiene before every contact
23.Mental health nursingMedium
A patient in a manic episode makes repeated sexual comments to a nurse. What is the most appropriate response?
ACalmly say that the comments are not acceptable and redirect him
BRespond with similar comments to build rapport
CAvoid the patient for the rest of the shift
DLaugh at the comments so he does not feel rejected
24.Mental health nursingHard
Two weeks after starting an SSRI, a patient says, "This isn't working. I'll stop taking it." What is the best response?
AAgree that he should stop it at once, because an antidepressant that has not helped after two weeks is unlikely ever to work
BExplain that it often takes several weeks to work fully, encourage him to continue and monitor his mood and safety
CTell him antidepressants never work
DTell him to double the dose
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 36.2 °C. Convert it to degrees Fahrenheit T with °F = °C × 9/5 + 32. Round to one decimal place.
36.2 °C
T = °F
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A maintenance infusion runs at 25 mL/h without a break. How many litres V does it deliver in 24 hours?
25 mL/h24 h
V = L
27.Dosage calculationsMedium
A child weighing 24 kg is prescribed 7.5 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?
24 kg7.5 mg/kg25 mg/mL
V = mL
28.Dosage calculationsHard
You must prepare 100 mL of a 0.5% (w/v) solution from a 50% (w/v) stock solution. What volume of stock V₁ do you need?
C₁ = 50%C₂ = 0.5%V₂ = 100 mL
V₁ = mL
29.IV infusion ratesMedium
Infuse 1000 mL over 12 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 mL12 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
An infusion of 100 mg in 250 mL runs at 18 mL/h. How many micrograms per minute D does the patient receive?
100 mg/250 mL18 mL/h
D = mcg/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 12-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.
milk: 200 mLsoup: 250 mLice chips: 240 mLIV infusion: 75 mL/h × 12 hIV antibiotic: 1 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 150 mL/h. At 13:00, 50 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL50 mL infused150 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 23/min, SpO₂ 91% on supplemental oxygen, blood pressure 136/82 mmHg, pulse 48/min, responds only to voice, temperature 37.9 °C. What is the NEWS2 total score?
RR 23SpO₂ 91%O₂SBP 136HR 48VT 37.9 °C
NEWS2 =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: yes; secondary diagnosis: yes; ambulatory aid: crutches, cane or walker; IV therapy or saline lock: yes; gait: impaired; mental status: overestimates or forgets limits. Using the cut-offs 0–24 low, 25–44 moderate and 45 or more high, click the fall-risk level.
1low risk
2moderate risk
3high risk
3Solutions
1.Nursing fundamentals
Answer: C · Intravenous fluids
Why this is the answer
Intake includes oral fluids, enteral feeds and IV fluids, including drug infusions. Urine, vomit, drainage and stool are output.
Answer
C · Intravenous fluids
2.Nursing fundamentals
Answer: A · Neuropathic pain
Why this is the answer
Neuropathic pain comes from damage to nerves, for example in diabetes, and is often burning, shooting or tingling. It may respond poorly to standard analgesics and need specific drugs.
Answer
A · Neuropathic pain
3.Infection control & patient safety
Answer: B · Limit time close to the patient and handle body fluids per radiation policy
Why this is the answer
Radioactive iodine is excreted in urine, sweat and saliva, so the patient is usually in a private room with their own bathroom. Staff limit time near them, use distance and follow policy for body fluids and waste.
Answer
B · Limit time close to the patient and handle body fluids per radiation policy
4.Infection control & patient safety
Answer: B · Use bariatric-rated equipment and enough trained staff
Why this is the answer
Using equipment above its rated capacity can cause collapse and injury. Bariatric lifts, chairs and beds are used, with enough trained staff and a plan agreed in advance.
Answer
B · Use bariatric-rated equipment and enough trained staff
5.Prioritization & delegation
Answer: D · Green (minor)
Why this is the answer
Victims who can walk are tagged green and directed away first. They are reassessed later, because some may have injuries that get worse.
Answer
D · Green (minor)
6.Prioritization & delegation
Answer: A · Sit up, give oxygen as prescribed, then call the provider
Why this is the answer
Sitting upright reduces the return of blood to the heart and eases breathing, and oxygen treats hypoxia. Then the provider is called and diuretics are prepared. Lying flat or giving IV fluids makes pulmonary congestion worse.
Answer
A · Sit up, give oxygen as prescribed, then call the provider
7.Clinical nursing
Answer: B · To check the wound stays closed before removing the rest
Why this is the answer
Removing alternate sutures allows the nurse to see whether the wound edges stay together. If they begin to separate, the remaining sutures can be left and the team informed.
Answer
B · To check the wound stays closed before removing the rest
8.Clinical nursing
Answer: D · APTT for heparin and INR for warfarin
Why this is the answer
The APTT reflects the intrinsic pathway and is used to adjust heparin infusions. Warfarin is monitored by the INR, a standardised prothrombin time. Platelets are also checked on heparin to detect HIT.
Answer
D · APTT for heparin and INR for warfarin
9.Lab values & electrolytes
Answer: D · From two separate venipuncture sites, using strict aseptic technique
Why this is the answer
Taking cultures from two separate sites helps distinguish true bacteremia (growth in both sets) from skin contamination (growth in only one). The skin is cleaned carefully, the bottle tops are disinfected, and cultures are taken before antibiotics.
Answer
D · From two separate venipuncture sites, using strict aseptic technique
10.Lab values & electrolytes
Answer: C · A steroid effect that moves neutrophils into the circulating blood
Why this is the answer
Corticosteroids raise the neutrophil count by releasing marginated neutrophils and slowing their exit from the blood, usually without a left shift. The nurse still assesses carefully, because steroids can also hide the usual signs of infection.
Answer
C · A steroid effect that moves neutrophils into the circulating blood
11.Pharmacology
Answer: A · Weight, blood glucose and blood lipids
Why this is the answer
Olanzapine and several other atypical antipsychotics cause weight gain, insulin resistance and dyslipidaemia. Weight, waist size, glucose and lipids are checked regularly.
Answer
A · Weight, blood glucose and blood lipids
12.Pharmacology
Answer: B · Drug-induced lupus
Why this is the answer
Hydralazine and procainamide are classic causes of drug-induced lupus, especially in slow acetylators. Symptoms usually resolve after the drug is stopped.
Answer
B · Drug-induced lupus
13.Med-surg: cardiovascular & respiratory
Answer: C · Left ventricular hypertrophy on the ECG
Why this is the answer
Target organ damage from hypertension includes left ventricular hypertrophy, retinopathy, chronic kidney disease with proteinuria, and stroke. Its presence changes treatment urgency and targets.
Answer
C · Left ventricular hypertrophy on the ECG
14.Med-surg: cardiovascular & respiratory
Answer: B · Chronic respiratory acidosis with metabolic compensation
Why this is the answer
In chronic CO₂ retention, the kidneys retain bicarbonate over days, bringing the pH back towards normal. A normal pH with high PaCO₂ and high bicarbonate is compensated chronic respiratory acidosis. These patients usually have target saturations of 88–92%.
Answer
B · Chronic respiratory acidosis with metabolic compensation
15.Med-surg: neuro, endocrine & renal
Answer: B · Worse on waking and on coughing, with vomiting
Why this is the answer
Headaches from raised ICP are often worse on waking, when coughing, sneezing or bending, and may come with vomiting or visual changes. A new headache with these features needs prompt assessment.
Answer
B · Worse on waking and on coughing, with vomiting
16.Med-surg: neuro, endocrine & renal
Answer: A · "If I feel thirsty, I can drink as much water as I like."
Why this is the answer
In SIADH, the body keeps too much water. Drinking freely when thirsty would lower the sodium further. All fluids count towards the restriction. Daily weights and reporting neurological symptoms are correct.
Answer
A · "If I feel thirsty, I can drink as much water as I like."
17.Med-surg: GI, perioperative & oncology
Answer: B · Eat a normal, balanced diet and introduce foods gradually
Why this is the answer
People with a colostomy can usually eat a normal diet. Foods are reintroduced gradually to see how each one affects gas, odour and output, and regular meals and fluids help.
Answer
B · Eat a normal, balanced diet and introduce foods gradually
18.Med-surg: GI, perioperative & oncology
Answer: B · A stoma blockage, often from food, needing review
Why this is the answer
Absent output with cramps, distension, nausea or vomiting and a swollen stoma suggests obstruction, often from fibrous food. The patient needs assessment; fluids may be given and specialist advice sought. Laxatives are not given without medical advice.
Answer
B · A stoma blockage, often from food, needing review
19.Maternity & obstetric nursing
Answer: D · Face-to-face eye contact and talking to the baby
Why this is the answer
En face positioning, touching, talking in a high-pitched voice and calling the baby by name are positive bonding behaviours. Persistent avoidance needs further assessment and support.
Answer
D · Face-to-face eye contact and talking to the baby
20.Maternity & obstetric nursing
Answer: B · The passenger: fetal size, position or presentation
Why this is the answer
When contractions are adequate but labour stalls, causes include a malpositioned or large fetus (passenger) or a narrow pelvis (passageway). Position changes, hydration and support of the psyche can also help progress.
Answer
B · The passenger: fetal size, position or presentation
21.Pediatric nursing
Answer: C · Within hours, increasing gradually as per protocol; some vomiting can be expected
Why this is the answer
After pyloromyotomy, feeding normally restarts within hours and is increased to full feeds as tolerated. Mild vomiting in the first day is common; the nurse monitors intake, weight and the wound.
Answer
C · Within hours, increasing gradually as per protocol; some vomiting can be expected
22.Pediatric nursing
Answer: A · Measure the temperature rectally every 4 hours
Why this is the answer
Rectal temperatures, enemas and suppositories are avoided in neutropenia because they can injure the mucosa and allow bacteria into the blood. Fever in neutropenia is an emergency.
Answer
A · Measure the temperature rectally every 4 hours
23.Mental health nursing
Answer: A · Calmly say that the comments are not acceptable and redirect him
Why this is the answer
Disinhibition is common in mania. Clear, calm limit setting and redirection protect both staff and patient and maintain boundaries without punishing him.
Answer
A · Calmly say that the comments are not acceptable and redirect him
24.Mental health nursing
Answer: B · Explain that it often takes several weeks to work fully, encourage him to continue and monitor his mood and safety
Why this is the answer
Antidepressants need several weeks for their full effect. Stopping suddenly can cause discontinuation symptoms. The nurse encourages adherence, monitors for suicidal thinking and passes on concerns to the prescriber.
Answer
B · Explain that it often takes several weeks to work fully, encourage him to continue and monitor his mood and safety
25.Nursing math & unit conversions
Answer: T = 97.2 °F
Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.
Multiply by 9/5
36.2·9/5 = 65.16
Add 32
T = 65.16 + 32 = 97.16 ≈ 97.2 °F
Answer
T = 97.2 °F
26.Nursing math & unit conversions
Answer: V = 0.6 L
Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.
Volume in a day
25 mL/h × 24 h = 600 mL
In litres
V = 600/1000 = 0.6 L
Answer
V = 0.6 L
27.Dosage calculations
Answer: V = 7.2 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 = 7.5·24 = 180 mg
Volume
V = 180/25 = 7.2 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 7.2 mL
28.Dosage calculations
Answer: V₁ = 1 mL
Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.
Volume of stock
V₁ = 0.5·100/50 = 1 mL
Answer
V₁ = 1 mL
29.IV infusion rates
Answer: R = 28 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
12·60 = 720 min
Drip rate
R = 1000·20/720 = 27.78 ≈ 28 gtt/min
Answer
R = 28 gtt/min
At the bedside you round to the nearest whole drop: 28 gtt/min.
30.IV infusion rates
Answer: D = 120 mcg/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
100000 mcg/250 mL = 400 mcg/mL
Dose per hour
18·400 = 7200 mcg/h
Dose per minute
D = 7200/60 = 120 mcg/min
Answer
D = 120 mcg/min
31.IV fluids & fluid balance
Answer: I = 1520 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: 200 + 250 = 450 mL
ice chips: 240/2 = 120 mL
IV infusion: 75·12 = 900 mL
IV antibiotic: 1·50 = 50 mL
I = 1520 mL
Answer
I = 1520 mL
32.IV fluids & fluid balance
Answer: t = 3 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 = 450/150 = 3 h
Answer
t = 3 h
That is about 3 h 00 min, so the bag runs out at about 16:00.
33.Clinical assessment scores
Answer: NEWS2 = 11
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 23/min → 2
SpO₂ 91% → 3
on oxygen → 2
SBP 136 mmHg → 0
HR 48/min → 1
responds only to voice (V) → 3
T 37.9 °C → 0
Add
NEWS2 = 2 + 3 + 2 + 0 + 1 + 3 + 0 = 11
Answer
NEWS2 = 11
34.Clinical assessment scores
Answer: high risk
Morse fall scale: six items. History of falling: no 0, yes 25. Secondary diagnosis: no 0, yes 15. Ambulatory aid: none, bed rest or nurse assistance 0; crutches, cane or walker 15; holding on to furniture 30. IV therapy or saline lock: no 0, yes 20. Gait: normal, bed rest or wheelchair 0; weak 10; impaired 20. Mental status: knows own limits 0; overestimates or forgets limits 15. The total runs from 0 to 125. Risk cut-offs differ between hospitals; a common set is 0–24 low, 25–44 moderate and 45 or more high.
Score each item
history of falling in the last 3 months: yes → 25
secondary diagnosis: yes → 15
ambulatory aid: crutches, cane or walker → 15
IV therapy or saline lock: yes → 20
gait: impaired → 20
mental status: overestimates or forgets limits → 15