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 you are walking with starts to fall. What should you do?
ATry to hold them upright with your arms around their chest
BGrab them under the armpits and lift them
CLet go quickly and call for help
DEase them gently to the floor while protecting their head
2.Nursing fundamentalsHard
A patient's NEWS2 score suddenly rises from 1 to 7. What is the appropriate response?
ADocument it, repeat the observations and inform the doctor at the next ward round
BRecheck the observations tomorrow morning
CUrgent or emergency response with immediate senior clinical review
DContinue four-hourly observations
3.Infection control & patient safetyMedium
A family member will visit a patient on contact precautions. What should the nurse do?
ATell them precautions only apply to staff
BTell them visits are not allowed at all
CShow them how to use the gown and gloves and how to clean their hands
DAsk them to wear an N95 respirator only, with no gown or gloves
4.Infection control & patient safetyHard
A night nurse suggests restraining a calm but wandering patient “so we can manage with fewer staff tonight”. Which response is correct?
ARestraints are acceptable if the family agrees to them in writing first
BRestraints are acceptable at night when staffing is low
CRestraints are acceptable if removed in the morning
DRestraint is never for staff convenience; use rounding or a sitter
5.Prioritization & delegationMedium
A patient uses patient-controlled analgesia (PCA) after surgery. Which statement by a family member shows a need for further teaching?
A“Only she should press the button when she needs pain relief.”
B“I will press the button for her while she is asleep so she stays comfortable.”
C“I will tell the nurse if she becomes very sleepy or hard to wake.”
D“The pump has limits set by the nurse so she cannot get too much at once.”
6.Prioritization & delegationHard
A patient with Guillain-Barré syndrome has weakness that is spreading up from the legs. Which assessment has the highest priority?
ASkin condition over the heels
BThe patient’s mood and coping
CMuscle strength in the feet and ankles at the start of each morning
DBreathing strength, such as vital capacity and the ability to cough
7.Clinical nursingMedium
What should a nurse do during a generalised tonic-clonic seizure?
AGive the patient a drink of water
BPut a tongue depressor between the teeth so that the tongue is not bitten
CHold the limbs firmly to stop the jerking and prevent injury
DProtect the head, time the seizure and do not put anything in the mouth
8.Clinical nursingHard
A patient with a burn of 30% body surface area is admitted. Which early complication is of greatest concern in the first 24 hours?
AConstipation
BPressure ulcers from prolonged immobility
CScarring and contractures
DHypovolaemic shock from fluid loss
9.Lab values & electrolytesMedium
In chronic kidney disease, a high serum phosphate is usually accompanied by which change in calcium?
AA high serum potassium only, with no calcium change
BNo change in calcium
CA low serum calcium
DA high serum calcium
10.Lab values & electrolytesHard
A child with sickle cell disease and a recent viral illness is pale and tired. The hemoglobin has fallen sharply, and the reticulocyte count is very low. What is the most likely problem?
AA vaso-occlusive pain crisis in the bones
BIron deficiency from a poor diet over months
CAn aplastic crisis, often caused by parvovirus B19
DA normal finding in sickle cell disease
11.PharmacologyMedium
Which side effect is typical of the calcium channel blocker amlodipine?
AAnkle swelling
BHyperkalaemia
CDry cough
DBronchospasm
12.PharmacologyHard
Before starting long-term bisphosphonate treatment, a patient is advised to have a dental check-up. Why?
ABisphosphonates dissolve tooth enamel within weeks
BBisphosphonates stain the teeth black if taken for many years
CThey are linked to osteonecrosis of the jaw after dental surgery
DBisphosphonates cause severe gum overgrowth
13.Med-surg: cardiovascular & respiratoryMedium
A patient with bronchiectasis of the right lower lobe is taught postural drainage. How should they be positioned?
AFlat on the back with the arms raised
BWith the affected lobe uppermost so gravity drains it
CWith the affected lobe lowest so it fills with mucus
DSitting fully upright at all times
14.Med-surg: cardiovascular & respiratoryHard
Hours after surgery to restore blood flow to an ischaemic leg, the patient has severe calf pain that is worse when the toes are moved passively, and the calf feels tense. What should the nurse suspect?
ACramp from lying still in bed
BExpected postoperative pain from the leg wound
CCompartment syndrome from reperfusion swelling
DA superficial thrombophlebitis of the long saphenous vein
15.Med-surg: neuro, endocrine & renalMedium
Which symptoms are typical of hypokalaemia?
ATingling lips and facial twitching
BExcess thirst and very high glucose
CMuscle weakness, cramps and palpitations
DHeat intolerance and weight loss
16.Med-surg: neuro, endocrine & renalHard
A seizure has lasted 12 minutes. Two doses of benzodiazepine have been given, and the seizure continues. Airway and oxygen are managed. What is the next step in common protocols?
AWaiting another 30 minutes to see whether the seizure stops
BGiving oral antiseizure tablets once the patient can swallow
CA second-line IV drug such as levetiracetam or phenytoin
DA third and fourth dose of benzodiazepine every two minutes
17.Med-surg: GI, perioperative & oncologyMedium
Which wound drain observation should be reported immediately?
ASmall amounts of pink serous fluid
BA sudden large volume of fresh red blood
CDrainage slowly falling each day
DA little dried blood around the drain site
18.Med-surg: GI, perioperative & oncologyHard
A patient is booked for a urea breath test for H. pylori. Which medicine should usually be stopped 2 weeks before the test?
AOmeprazole
BLevothyroxine
CAmlodipine
DParacetamol (acetaminophen)
19.Maternity & obstetric nursingMedium
How does breast milk jaundice usually differ from early breastfeeding jaundice?
AIt always needs the baby to stop breastfeeding permanently
BIt appears in the first 24 hours in a sick baby
CIt appears later, after the first week, in a thriving baby
DIt is caused by too little milk intake
20.Maternity & obstetric nursingHard
A woman with gestational diabetes was on insulin during pregnancy. What change in her insulin needs is expected right after birth?
AThey double because of the stress of birth, so the insulin dose is increased
BThey fall quickly, so glucose is monitored and insulin is often stopped
CShe will need lifelong insulin
DThey stay the same for 6 weeks
21.Pediatric nursingMedium
Which sign shows that a baby is ready to start solid foods?
AHas cut a first tooth
BSits with support, holds the head steady and shows interest in food
CHas reached 6 weeks of age
DStarts waking more often during the night and seems hungry after milk feeds
22.Pediatric nursingHard
A 3-month-old is gaining weight poorly. The mother says she adds extra water to the formula to make each tin last longer. Besides poor growth, what serious complication is the nurse concerned about?
AHigh sodium from too much powder, which causes dehydration
BHigh blood glucose from the sugar in the diluted formula, causing diabetes
CVitamin K deficiency bleeding from the extra water
DLow sodium from water intoxication, which can cause seizures
23.Mental health nursingMedium
Which pattern suggests premenstrual dysphoric disorder?
AMood symptoms that begin only after the menopause and last for several years
BMild bloating the day before a period, without any mood changes
CMarked mood symptoms in the week before menstruation that improve within a few days after it starts
DLow mood throughout the whole month that is not linked to the menstrual cycle
24.Mental health nursingHard
During a session, a patient asks the nurse, "Are you married? Do you have children?" Which response is most appropriate?
AShare details about the nurse's family to build a friendship
BIgnore the question completely and stay silent until the patient changes the subject
CEnd the session because personal questions are not allowed
DAnswer briefly or decline politely, then return the focus to the patient
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A newborn weighs 9 lb 9 oz. Using 1 lb = 16 oz and 1 kg = 2.2 lb, find the weight m in kilograms. Round to two decimal places.
9 lb 9 oz1 lb = 16 oz1 kg = 2.2 lb
m = kg
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A prescription reads 2 tsp of an oral suspension twice a day for 10 days. The suspension comes in 150 mL bottles. Using 1 tsp = 5 mL, how many whole bottles N must be supplied so the course is complete?
2 tsptwice a day10 days150 mL1 tsp = 5 mL
N =
27.Dosage calculationsMedium
A child weighing 6 kg is prescribed 3 mg/kg of a drug. The stock solution contains 10 mg/mL. Draw up the dose: what volume V do you give?
6 kg3 mg/kg10 mg/mL
V = mL
28.Dosage calculationsHard
An infusion contains 50000 units of a drug in 500 mL. The prescription is 800 units per hour. At what rate R do you set the pump, in mL/h?
50000 units/500 mL800 units/h
R = mL/h
29.IV infusion ratesMedium
1500 mL was ordered over 12 hours. After 4 hours you find that 1280 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?
1500 mL / 12 hafter 4 h: 1280 mL
R = mL/h
30.IV infusion ratesHard
500 mL was ordered over 8 hours. After 3 hours you find that 410 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?
500 mL / 8 hafter 3 h: 410 mL
Δ = %
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).
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 100 mL/h. At 14:30, 400 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL400 mL infused100 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 135/min and a blood pressure of 149/89 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.
HR 135/minBP 149/89 mmHg
SI =
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 111 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 111 mmHg
DBP = mmHg
3Solutions
1.Nursing fundamentals
Answer: D · Ease them gently to the floor while protecting their head
Why this is the answer
Trying to stop a fall can injure both the nurse and the patient. The nurse widens their stance, supports the patient and guides them down, protecting the head.
Answer
D · Ease them gently to the floor while protecting their head
2.Nursing fundamentals
Answer: C · Urgent or emergency response with immediate senior clinical review
Why this is the answer
A NEWS2 of 7 or more calls for an emergency response: continuous monitoring and immediate assessment by a clinician with critical care skills.
Answer
C · Urgent or emergency response with immediate senior clinical review
3.Infection control & patient safety
Answer: C · Show them how to use the gown and gloves and how to clean their hands
Why this is the answer
Visitors are taught how to put on and remove PPE as required by the policy and how to perform hand hygiene, so they protect themselves and other patients.
Answer
C · Show them how to use the gown and gloves and how to clean their hands
4.Infection control & patient safety
Answer: D · Restraint is never for staff convenience; use rounding or a sitter
Why this is the answer
Restraint is allowed only to protect the patient or others from immediate harm when less restrictive measures have failed, never for convenience or discipline. Rounding, a bed alarm, a sitter and a calm environment are alternatives.
Answer
D · Restraint is never for staff convenience; use rounding or a sitter
5.Prioritization & delegation
Answer: B · “I will press the button for her while she is asleep so she stays comfortable.”
Why this is the answer
PCA is safe because a sleepy patient cannot press the button. If someone else presses it, the patient can receive too much opioid and develop respiratory depression.
Answer
B · “I will press the button for her while she is asleep so she stays comfortable.”
6.Prioritization & delegation
Answer: D · Breathing strength, such as vital capacity and the ability to cough
Why this is the answer
Guillain-Barré syndrome causes ascending weakness that can involve the respiratory muscles. Falling vital capacity or a weak cough can mean the patient needs ventilation, so breathing is monitored closely.
Answer
D · Breathing strength, such as vital capacity and the ability to cough
7.Clinical nursing
Answer: D · Protect the head, time the seizure and do not put anything in the mouth
Why this is the answer
Remove nearby hazards, cushion the head, note the time and do not restrain or put objects in the mouth. Once jerking stops, place the patient in the recovery position and check the airway.
Answer
D · Protect the head, time the seizure and do not put anything in the mouth
8.Clinical nursing
Answer: D · Hypovolaemic shock from fluid loss
Why this is the answer
Major burns cause fluid to shift out of the circulation, so formula-guided IV fluid resuscitation and urine output monitoring are key. Airway burns are another early danger.
Answer
D · Hypovolaemic shock from fluid loss
9.Lab values & electrolytes
Answer: C · A low serum calcium
Why this is the answer
When failing kidneys retain phosphate, phosphate binds calcium and vitamin D activation falls, so serum calcium tends to drop. This drives secondary hyperparathyroidism and bone disease.Checked against:Hypocalcemia (StatPearls) · StatPearls (NCBI Bookshelf) (2026); Phosphate in Blood · MedlinePlus (NIH) (2023)
Answer
C · A low serum calcium
10.Lab values & electrolytes
Answer: C · An aplastic crisis, often caused by parvovirus B19
Why this is the answer
Patients with sickle cell disease depend on a high reticulocyte count because their red cells live only a short time. Parvovirus B19 can stop red cell production for days, causing a rapid fall in hemoglobin with very low reticulocytes. Transfusion may be needed.Checked against:Reticulocyte Count · MedlinePlus (NIH) (2024)
Answer
C · An aplastic crisis, often caused by parvovirus B19
11.Pharmacology
Answer: A · Ankle swelling
Why this is the answer
Dihydropyridine calcium channel blockers dilate arterioles, raising capillary pressure in the legs and causing ankle oedema. Dry cough is typical of ACE inhibitors.
Answer
A · Ankle swelling
12.Pharmacology
Answer: C · They are linked to osteonecrosis of the jaw after dental surgery
Why this is the answer
Osteonecrosis of the jaw is a rare but serious adverse effect, mostly after invasive dental work. Dental problems are treated before starting, and good oral hygiene is maintained.
Answer
C · They are linked to osteonecrosis of the jaw after dental surgery
13.Med-surg: cardiovascular & respiratory
Answer: B · With the affected lobe uppermost so gravity drains it
Why this is the answer
Postural drainage places the patient so the affected segment is above the main bronchus, letting gravity move secretions towards the larger airways to be coughed up. It is combined with breathing techniques. Head-down positions are avoided in patients with reflux, recent surgery or breathlessness.
Answer
B · With the affected lobe uppermost so gravity drains it
14.Med-surg: cardiovascular & respiratory
Answer: C · Compartment syndrome from reperfusion swelling
Why this is the answer
When blood flow returns to ischaemic muscle, swelling can raise pressure in a fascial compartment. Pain out of proportion and pain on passive stretch are early signs; pulses may remain until late. It is reported urgently, as fasciotomy may be needed. The limb is kept at heart level, not raised high.
Answer
C · Compartment syndrome from reperfusion swelling
15.Med-surg: neuro, endocrine & renal
Answer: C · Muscle weakness, cramps and palpitations
Why this is the answer
Low potassium causes muscle weakness, cramps, constipation and arrhythmias. ECG changes include flattened T waves and U waves. Tingling and twitching suggest low calcium.
Answer
C · Muscle weakness, cramps and palpitations
16.Med-surg: neuro, endocrine & renal
Answer: C · A second-line IV drug such as levetiracetam or phenytoin
Why this is the answer
Status epilepticus that continues after two doses of benzodiazepine (established status) is treated with a second-line IV drug. If it still continues (refractory status), anaesthesia and intubation in critical care are needed. Glucose, airway and monitoring continue throughout. Repeated benzodiazepines increase respiratory depression without much extra benefit.
Answer
C · A second-line IV drug such as levetiracetam or phenytoin
17.Med-surg: GI, perioperative & oncology
Answer: B · A sudden large volume of fresh red blood
Why this is the answer
A sudden increase in bright red drainage suggests active haemorrhage. The nurse checks vital signs and informs the surgical team urgently. Gradually decreasing serosanguinous drainage is expected.
Answer
B · A sudden large volume of fresh red blood
18.Med-surg: GI, perioperative & oncology
Answer: A · Omeprazole
Why this is the answer
PPIs suppress H. pylori and can give false-negative breath or stool tests, so they are usually stopped 2 weeks before. Antibiotics are usually stopped 4 weeks before testing.
Answer
A · Omeprazole
19.Maternity & obstetric nursing
Answer: C · 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
C · It appears later, after the first week, in a thriving baby
20.Maternity & obstetric nursing
Answer: B · They fall quickly, so glucose is monitored and insulin is often stopped
Why this is the answer
The placenta produced the hormones that caused insulin resistance. After birth, glucose usually returns to normal, so insulin is often stopped and glucose is checked. She needs a glucose test some weeks after birth and long-term screening for type 2 diabetes.
Answer
B · They fall quickly, so glucose is monitored and insulin is often stopped
21.Pediatric nursing
Answer: B · Sits with support, holds the head steady and shows interest in food
Why this is the answer
Readiness for solids, usually around 6 months, includes good head control, sitting with support, interest in food and loss of the tongue-thrust reflex. Night waking and teething are not signs of readiness.
Answer
B · Sits with support, holds the head steady and shows interest in food
22.Pediatric nursing
Answer: D · Low sodium from water intoxication, which can cause seizures
Why this is the answer
Over-diluted formula gives too few calories and too much free water, which can cause hyponatraemia and seizures. The nurse should also address the underlying problem, for example by linking the family with financial or social support.
Answer
D · Low sodium from water intoxication, which can cause seizures
23.Mental health nursing
Answer: C · Marked mood symptoms in the week before menstruation that improve within a few days after it starts
Why this is the answer
In PMDD, symptoms such as irritability, low mood, anxiety and mood swings occur in the final week before menses, improve after onset and are minimal in the week after. Symptoms should be confirmed with daily ratings over at least two cycles.
Answer
C · Marked mood symptoms in the week before menstruation that improve within a few days after it starts
24.Mental health nursing
Answer: D · Answer briefly or decline politely, then return the focus to the patient
Why this is the answer
Patients often ask personal questions out of curiosity or to make the relationship more equal. A brief answer or a polite refusal, followed by redirecting to the patient's concerns, maintains boundaries without rejecting the patient.
Answer
D · Answer briefly or decline politely, then return the focus to the patient
25.Nursing math & unit conversions
Answer: m = 4.35 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
9 oz/16 = 0.5625 lb
9 + 0.5625 = 9.563 lb
Pounds to kilograms
m = 9.563/2.2 = 4.347 ≈ 4.35 kg
Answer
m = 4.35 kg
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
10 mL × 2 × 10 = 200 mL
Bottles
200/150 = 1.333 → N = 2
Answer
N = 2
27.Dosage calculations
Answer: V = 1.8 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 = 3·6 = 18 mg
Volume
V = 18/10 = 1.8 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 1.8 mL
28.Dosage calculations
Answer: R = 8 mL/h
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Concentration
50000/500 = 100 units/mL
Pump rate
R = 800/100 = 8 mL/h
Answer
R = 8 mL/h
29.IV infusion rates
Answer: R = 160 mL/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.
Original rate
1500/12 = 125 mL/h
New rate
R = 1280/8 = 160 mL/h
Answer
R = 160 mL/h
This is more than a 25% increase: most hospitals require you to contact the prescriber instead of catching up, and to assess the patient for fluid overload.
30.IV infusion rates
Answer: Δ = 31.2 %
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.
Original rate
500/8 = 62.5 mL/h
New rate
R = 410/5 = 82 mL/h
Percentage change
Δ = (82 − 62.5)/62.5·100% = 31.2%
Answer
Δ = 31.2%
This is more than a 25% increase: most hospitals require you to contact the prescriber instead of catching up, and to assess the patient for fluid overload.
31.IV fluids & fluid balance
Answer: B = 315 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: 100 + 150 + 120 = 370 mL
IV infusion: 80·8 = 640 mL
IV antibiotic: 2·50 = 100 mL
total intake = 1110 mL
Total output
275 + 275 + 175 + 70 = 795 mL
Balance
B = 1110 − 795 = 315 mL
Answer
B = 315 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: t = 6 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Volume left
1000 − 400 = 600 mL
Time
t = 600/100 = 6 h
Answer
t = 6 h
That is about 6 h 00 min, so the bag runs out at about 20:30.
33.Clinical assessment scores
Answer: SI = 0.91
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 = 135/149 = 0.906 ≈ 0.91
Answer
SI = 0.91
Above the usual 0.5–0.7.
34.Clinical assessment scores
Answer: DBP = 42 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 − 111)/2 = 84/2 = 42 mmHg
Answer
DBP = 42 mmHg
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