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 can wash their face and arms but cannot reach their back and feet. What is the best approach?
AAsk the patient to wait until a relative visits
BLet the patient do what they can and help with the rest
CWash the patient completely yourself to save time and effort
DLeave the back and feet unwashed
2.Nursing fundamentalsHard
A patient standing for the first time after surgery becomes pale, sweaty and dizzy. What should the nurse do first?
AHelp the patient sit or lie down safely
BLeave the patient standing and fetch the blood pressure machine
CEncourage the patient to keep walking to build strength
DGive the patient a sugary drink while standing
3.Infection control & patient safetyMedium
A nurse who wears prescription glasses must irrigate a wound where splashing is likely. Which eye protection is suitable?
AThe glasses with a surgical mask
BGoggles or a face shield worn over the glasses
CNo eye protection, if the nurse stands to one side
DThe prescription glasses alone
4.Infection control & patient safetyHard
A handwritten order is hard to read, and the nurse is not sure of the drug name. What should the nurse do?
AContact the prescriber to clarify before giving anything
BHold the drug until the next day without telling anyone
CAsk a colleague to guess what it says
DChoose the drug that seems most likely from the diagnosis
5.Prioritization & delegationMedium
Which patient should the nurse see first?
AA patient with type 2 diabetes asking about the diet
BA patient with new slurred speech and a facial droop that started 30 minutes ago
CA patient with chronic kidney disease due for dialysis tomorrow
DA patient with long-standing rheumatoid arthritis and the usual morning joint stiffness
6.Prioritization & delegationHard
A patient is receiving parenteral nutrition through a central line. Which finding needs immediate action?
AA glucose of 150 mg/dL (8.3 mmol/L) while the infusion is running
BSweating, shakiness and a glucose of 62 mg/dL (3.4 mmol/L) after the infusion stopped unexpectedly
CA dry, intact dressing over the line
DA weight gain of 0.2 kg since yesterday
7.Clinical nursingMedium
Why are patients asked to fast before a general anaesthetic?
ATo make the surgery shorter
BTo lower the blood glucose before surgery
CTo reduce the risk of aspirating stomach contents
DTo prevent postoperative constipation and abdominal bloating
8.Clinical nursingHard
An older patient with delirium is trying to leave the ward at night, saying he must go home. What is the best initial approach?
APhysically restrain him in bed until the morning so that he cannot fall
BGive a sedative straight away without a prescription
CCalmly reassure and redirect him while the team assesses his capacity and safety
DLet him leave, because adults can always do as they wish whatever their state
9.Lab values & electrolytesMedium
A conscious patient with a blood glucose of 54 mg/dL (3.0 mmol/L) has taken 15 g of fast-acting carbohydrate. When should the glucose be rechecked?
AAfter about 2 hours
BAfter about 15 minutes
CAt the next meal
DThe next morning
10.Lab values & electrolytesHard
On the evening after surgery, a patient’s hemoglobin has fallen from 12.5 g/dL to 8.1 g/dL (125 to 81 g/L), and the heart rate is 118/min. What is the most likely problem?
ADehydration
BAn improving condition
CBleeding
DNormal dilution after surgery that needs no action
11.PharmacologyMedium
Aciclovir is mainly used to treat infections caused by:
AHerpes viruses such as herpes simplex and varicella-zoster
BHIV
CBacteria that produce beta-lactamase
DInfluenza A virus
12.PharmacologyHard
Which regimen is standard for eradicating Helicobacter pylori?
AAn antacid alone, taken after meals and at bedtime for six months
BA single dose of an antibiotic given intravenously
CAcid suppression plus at least two antibiotics, often with bismuth, for 14 days
DAn H2 blocker taken only when pain occurs
13.Med-surg: cardiovascular & respiratoryMedium
Unless fluids are restricted, why are patients with pneumonia encouraged to drink plenty?
ATo lower the temperature by diluting the blood plasma
BTo prevent dehydration and keep secretions thinner
CTo make the cough completely stop
DTo flush the bacteria out through the urine
14.Med-surg: cardiovascular & respiratoryHard
A patient with COPD on a 28% Venturi mask (SpO₂ 90%) wants to eat a meal. What is the most appropriate plan?
AChange to a non-rebreather mask at 15 L/min during the meal
BRemove all oxygen during the meal and replace it afterwards
CKeep the Venturi mask on and give only liquids through a straw
DSwitch to nasal cannula at low flow, keeping SpO₂ at 88–92%
15.Med-surg: neuro, endocrine & renalMedium
An older patient with a long-term catheter has bacteria in the urine but no symptoms. What is usually appropriate?
AAntibiotics for life to keep the urine sterile
BA full course of antibiotics straight away
CNo antibiotics, as long as there are no symptoms
DRemove the catheter permanently at once
16.Med-surg: neuro, endocrine & renalHard
A patient's potassium is 7.1 mmol/L, and the ECG shows peaked T waves and broad QRS complexes. What is the first treatment?
AIV furosemide
BIV calcium gluconate
COral potassium binder
DOral sodium bicarbonate
17.Med-surg: GI, perioperative & oncologyMedium
A dying patient can no longer drink. Which mouth care is most appropriate?
ANo mouth care, to avoid disturbing the patient
BFrequent, gentle moistening of the mouth and lips
CBrushing hard with a stiff toothbrush twice a day
DLemon and glycerine swabs every hour to stimulate saliva
18.Med-surg: GI, perioperative & oncologyHard
Why is an SGLT2 inhibitor such as dapagliflozin usually withheld before surgery?
AIt makes the patient's potassium dangerously high
BIt raises the risk of ketoacidosis, even with near-normal glucose
CIt interacts with all general anaesthetic gases and stops them working
DIt causes the surgical wound to bleed more
19.Maternity & obstetric nursingMedium
How does breast milk jaundice usually differ from early breastfeeding jaundice?
AIt appears later, after the first week, in a thriving baby
BIt appears in the first 24 hours in a sick baby
CIt always needs the baby to stop breastfeeding permanently
DIt is caused by too little milk intake
20.Maternity & obstetric nursingHard
A woman in labour is receiving oxytocin. The tracing now shows recurrent late decelerations. Which action should the nurse take first?
AIncrease the oxytocin rate to speed up the birth
BDocument the pattern and reassess in 30 minutes
CHelp her lie flat on her back
DStop the oxytocin infusion
21.Pediatric nursingMedium
A parent asks how to care for a child with mild croup at home. Which advice is correct?
AKeep the child calm and upright, and get urgent help if there is noisy breathing at rest
BHold the child over a bowl of hot, steaming water to loosen the cough
CLay the child flat in a cool room so the airway can relax
DGive an over-the-counter cough syrup every hour until the barking cough stops
22.Pediatric nursingHard
A 7-year-old has had morning headaches and vomiting for several weeks, now with clumsiness. What should the nurse suspect?
AMigraine caused by stress at school
BA brain tumour with raised intracranial pressure
CA need for new glasses because of eye strain
DViral gastroenteritis
23.Mental health nursingMedium
Which effect is expected and temporary after electroconvulsive therapy (ECT)?
AShort-term confusion and memory loss around the time of treatment
BLoss of speech for months
CPermanent loss of all long-term memories from before the treatment
DParalysis of the legs
24.Mental health nursingHard
A patient in a mental health unit asks to read his own health records. What is the correct general principle?
APsychiatric patients are never allowed to see their records
BPatients generally have a right of access, with limited exceptions to prevent serious harm
CThe nurse should give him the records immediately without following any procedure
DOnly his family can request access to his records on his behalf
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A newborn weighs 6 lb 7 oz. Using 1 lb = 16 oz and 1 kg = 2.2 lb, find the weight m in kilograms. Round to two decimal places.
6 lb 7 oz1 lb = 16 oz1 kg = 2.2 lb
m = kg
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 22:30 and finishes at 01:35 the next morning (24-hour clock). How many hours t did it run? Give the answer in hours as a decimal, rounded to two decimal places.
22:3001:35
t = h
27.Dosage calculationsMedium
A patient weighing 12 kg has a body surface area of 0.72 m². The prescription is 135 mg/m². Find the dose D in mg.
12 kgBSA = 0.72 m²135 mg/m²
D = mg
28.Dosage calculationsHard
A child weighing 8 kg is prescribed 12.5 mg/kg per dose of an oral suspension that contains 125 mg in 5 mL. What volume V do you give?
8 kg12.5 mg/kg125 mg/5 mL
V = mL
29.IV infusion ratesMedium
Infuse 500 mL over 8 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
500 mL8 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 250 mg of a drug in 500 mL and runs at 25 mL/h. How many milligrams per hour D does the patient receive?
250 mg/500 mL25 mL/h
D = mg/h
31.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-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 1000 mL bag runs by pump at 125 mL/h. At 19:00, 450 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL450 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 9/min, SpO₂ 99% on room air, blood pressure 118/70 mmHg, pulse 70/min, responds only to voice, temperature 38.0 °C. What is the NEWS2 total score?
RR 9SpO₂ 99%airSBP 118HR 70VT 38.0 °C
NEWS2 =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 65 mmHg. A patient’s systolic pressure is 101 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 65 mmHg?
MAP 65 mmHgSBP 101 mmHg
DBP = mmHg
3Solutions
1.Nursing fundamentals
Answer: B · Let the patient do what they can and help with the rest
Why this is the answer
Encouraging patients to do what they can maintains independence, dignity and function. The nurse helps with the parts they cannot manage.
Answer
B · Let the patient do what they can and help with the rest
2.Nursing fundamentals
Answer: A · Help the patient sit or lie down safely
Why this is the answer
These signs suggest postural hypotension and a risk of fainting. The nurse lowers the patient safely first, then checks blood pressure and pulse and reports the finding.
Answer
A · Help the patient sit or lie down safely
3.Infection control & patient safety
Answer: B · Goggles or a face shield worn over the glasses
Why this is the answer
Prescription glasses do not protect against splashes from the sides, top or bottom. Goggles or a face shield that fit over them are worn when splashes are likely.
Answer
B · Goggles or a face shield worn over the glasses
4.Infection control & patient safety
Answer: A · Contact the prescriber to clarify before giving anything
Why this is the answer
Illegible or unclear orders are clarified directly with the prescriber. The nurse never guesses, and a held dose is reported so treatment is not missed.
Answer
A · Contact the prescriber to clarify before giving anything
5.Prioritization & delegation
Answer: B · A patient with new slurred speech and a facial droop that started 30 minutes ago
Why this is the answer
Sudden slurred speech and facial droop suggest a stroke, and treatment depends on time. The others have chronic, stable problems that can wait.
Answer
B · A patient with new slurred speech and a facial droop that started 30 minutes ago
6.Prioritization & delegation
Answer: B · Sweating, shakiness and a glucose of 62 mg/dL (3.4 mmol/L) after the infusion stopped unexpectedly
Why this is the answer
Parenteral nutrition contains a lot of glucose, and the body responds with high insulin levels. If the infusion stops suddenly, rebound hypoglycemia can follow. The nurse treats the low glucose per protocol, informs the provider and follows the policy for an interrupted infusion. A modestly raised glucose, an intact dressing and a small weight change are expected or minor.
Answer
B · Sweating, shakiness and a glucose of 62 mg/dL (3.4 mmol/L) after the infusion stopped unexpectedly
7.Clinical nursing
Answer: C · To reduce the risk of aspirating stomach contents
Why this is the answer
Under general anaesthesia the airway reflexes are lost, so food or fluid in the stomach could be regurgitated and inhaled. Fasting reduces the risk of aspiration pneumonitis.
Answer
C · To reduce the risk of aspirating stomach contents
8.Clinical nursing
Answer: C · Calmly reassure and redirect him while the team assesses his capacity and safety
Why this is the answer
De-escalation, reorientation and supervision come first. If he lacks capacity, the team must act in his best interests using the least restrictive measures, following local law and policy.
Answer
C · Calmly reassure and redirect him while the team assesses his capacity and safety
9.Lab values & electrolytes
Answer: B · After about 15 minutes
Why this is the answer
The rule of 15 is 15 g of fast-acting carbohydrate, a recheck after 15 minutes, and a repeat if the glucose is still below 70 mg/dL (3.9 mmol/L). A snack or meal then helps prevent a recurrence.Checked against:Low blood sugar - self-care · MedlinePlus (NIH) (2026)
Answer
B · After about 15 minutes
10.Lab values & electrolytes
Answer: C · Bleeding
Why this is the answer
A fall of more than 4 g/dL with a fast heart rate suggests ongoing blood loss. The nurse assesses the wound and drains, monitors the vital signs and escalates urgently. Some dilution from IV fluids is common, but not this much, and not with tachycardia.Checked against:Hemoglobin Test · MedlinePlus (NIH) (2024)
Answer
C · Bleeding
11.Pharmacology
Answer: A · Herpes viruses such as herpes simplex and varicella-zoster
Why this is the answer
Aciclovir is phosphorylated by viral thymidine kinase in infected cells and then blocks viral DNA polymerase. It is used for cold sores, genital herpes, chickenpox and shingles.
Answer
A · Herpes viruses such as herpes simplex and varicella-zoster
12.Pharmacology
Answer: C · Acid suppression plus at least two antibiotics, often with bismuth, for 14 days
Why this is the answer
Eradication combines acid suppression (usually a PPI) with at least two antibiotics; bismuth quadruple therapy for 14 days is now often first-line because clarithromycin resistance makes older triple therapy fail. Taking every dose matters, and cure is confirmed with a breath or stool test.
Answer
C · Acid suppression plus at least two antibiotics, often with bismuth, for 14 days
13.Med-surg: cardiovascular & respiratory
Answer: B · To prevent dehydration and keep secretions thinner
Why this is the answer
Fever, sweating and tachypnoea increase insensible fluid loss. Good hydration prevents dehydration and helps keep secretions less sticky. Patients with heart failure or other restrictions need individual plans.
Answer
B · To prevent dehydration and keep secretions thinner
14.Med-surg: cardiovascular & respiratory
Answer: D · Switch to nasal cannula at low flow, keeping SpO₂ at 88–92%
Why this is the answer
Oxygen is prescribed to a target range and should not be stopped for meals in a patient who needs it. Nasal cannulae allow eating and talking; the flow (for example 1–2 L/min) is titrated to keep the saturation in the target range. High-concentration oxygen risks hypercapnia.
Answer
D · Switch to nasal cannula at low flow, keeping SpO₂ at 88–92%
15.Med-surg: neuro, endocrine & renal
Answer: C · No antibiotics, as long as there are no symptoms
Why this is the answer
Nearly all long-term catheters become colonised. Treating asymptomatic bacteriuria does not improve outcomes and promotes resistance. Antibiotics are reserved for symptomatic infection.
Answer
C · No antibiotics, as long as there are no symptoms
16.Med-surg: neuro, endocrine & renal
Answer: B · IV calcium gluconate
Why this is the answer
ECG changes mean the heart is at risk. IV calcium is given first to stabilise the myocardium, followed by insulin with glucose (and often nebulised salbutamol) to shift potassium into cells. Binders or dialysis then remove it.
Answer
B · IV calcium gluconate
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: B · It raises the risk of ketoacidosis, even with near-normal glucose
Why this is the answer
SGLT2 inhibitors can cause euglycaemic diabetic ketoacidosis around fasting and surgery. They are usually paused before surgery as advised, and ketones are checked if the patient becomes unwell.
Answer
B · It raises the risk of ketoacidosis, even with near-normal glucose
19.Maternity & obstetric nursing
Answer: A · It appears later, after the first week, in a thriving baby
Why this is the answer
Breast milk jaundice begins after the first week and can last several weeks in an otherwise healthy, well-fed baby. It is thought to be caused by substances in milk and rarely needs breastfeeding to stop.
Answer
A · It appears later, after the first week, in a thriving baby
20.Maternity & obstetric nursing
Answer: D · Stop the oxytocin infusion
Why this is the answer
Stopping the oxytocin reduces contraction-related loss of placental flow. Other steps follow at once: a lateral position, an IV fluid bolus as ordered, checking maternal blood pressure and notifying the provider. Waiting or lying supine makes the hypoxia worse.
Answer
D · Stop the oxytocin infusion
21.Pediatric nursing
Answer: A · Keep the child calm and upright, and get urgent help if there is noisy breathing at rest
Why this is the answer
Calm and comfort reduce distress and airway narrowing. Steam inhalation is not effective and risks scalds. Parents should seek urgent help for stridor at rest, retractions, drooling, blue colour or drowsiness.
Answer
A · Keep the child calm and upright, and get urgent help if there is noisy breathing at rest
22.Pediatric nursing
Answer: B · A brain tumour with raised intracranial pressure
Why this is the answer
Early-morning headache and vomiting suggest raised intracranial pressure, and clumsiness suggests a lesion in the cerebellum, a common site in children. Urgent neuroimaging is needed.
Answer
B · A brain tumour with raised intracranial pressure
23.Mental health nursing
Answer: A · Short-term confusion and memory loss around the time of treatment
Why this is the answer
Brief confusion, headache and memory gaps around the treatment period are common. Nurses reorient the patient, monitor vital signs and airway during recovery and ensure safety.
Answer
A · Short-term confusion and memory loss around the time of treatment
24.Mental health nursing
Answer: B · Patients generally have a right of access, with limited exceptions to prevent serious harm
Why this is the answer
Data protection and health records laws in many countries give patients a right to access their records. Requests follow a formal procedure, and information may be withheld only in limited cases, for example if it could cause serious harm.
Answer
B · Patients generally have a right of access, with limited exceptions to prevent serious harm
25.Nursing math & unit conversions
Answer: m = 2.93 kg
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.
Ounces to pounds
7 oz/16 = 0.4375 lb
6 + 0.4375 = 6.438 lb
Pounds to kilograms
m = 6.438/2.2 = 2.926 ≈ 2.93 kg
Answer
m = 2.93 kg
26.Nursing math & unit conversions
Answer: t = 3.08 h
24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.
Before midnight
22:30 → 24:00 = 90 min
After midnight
00:00 → 01:35 = 95 min
Total
90 + 95 = 185 min
t = 185/60 = 3.083 ≈ 3.08 h
Answer
t = 3.08 h
27.Dosage calculations
Answer: D = 97.2 mg
Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).
Dose
D = 135·0.72 = 97.2 mg
Answer
D = 97.2 mg
28.Dosage calculations
Answer: V = 4 mL
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Dose from weight
12.5·8 = 100 mg
Volume
V = (100/125)·5 = 4 mL
Answer
V = 4 mL
29.IV infusion rates
Answer: R = 16 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
8·60 = 480 min
Drip rate
R = 500·15/480 = 15.63 ≈ 16 gtt/min
Answer
R = 16 gtt/min
At the bedside you round to the nearest whole drop: 16 gtt/min.
30.IV infusion rates
Answer: D = 12.5 mg/h
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Concentration
250/500 = 0.5 mg/mL
Dose rate
D = 0.5·25 = 12.5 mg/h
Answer
D = 12.5 mg/h
31.IV fluids & fluid balance
Answer: B = 1390 mL
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Total intake
oral: 200 + 240 + 240 = 680 mL
ice chips: 200/2 = 100 mL
IV infusion: 125·12 = 1500 mL
IV antibiotic: 1·100 = 100 mL
total intake = 2380 mL
Total output
325 + 275 + 250 + 140 = 990 mL
Balance
B = 2380 − 990 = 1390 mL
Answer
B = 1390 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: t = 4.4 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
1000 − 450 = 550 mL
Time
t = 550/125 = 4.4 h
Answer
t = 4.4 h
That is about 4 h 24 min, so the bag runs out at about 23:24.
33.Clinical assessment scores
Answer: NEWS2 = 4
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 9/min → 1
SpO₂ 99% → 0
on air → 0
SBP 118 mmHg → 0
HR 70/min → 0
responds only to voice (V) → 3
T 38.0 °C → 0
Add
NEWS2 = 1 + 0 + 0 + 0 + 0 + 3 + 0 = 4
Answer
NEWS2 = 4
34.Clinical assessment scores
Answer: DBP = 47 mmHg
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.
Rearrange
DBP = (3·MAP − SBP)/2
Substitute
DBP = (3·65 − 101)/2 = 94/2 = 47 mmHg
Answer
DBP = 47 mmHg
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