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
CPatients who feel well after six hours never need any treatment at all
DParacetamol damage only shows up in the kidneys, many weeks later
9.Lab values & electrolytesMedium
A urine culture is ordered for a patient with an indwelling urinary catheter. How should the nurse collect the sample?
ADisconnect the catheter from the tubing and let it drain
BPour urine from the drainage bag into a sterile cup
CAspirate from the sampling port with a sterile syringe
DRemove the catheter and culture the catheter tip
10.Lab values & electrolytesHard
Three days after starting haloperidol, a patient has a temperature of 40 °C, severe muscle rigidity and confusion. Which laboratory result would the nurse expect?
AA very high serum lithium
BA very low serum sodium
CA very high creatine kinase (CK)
DA very low white cell count
11.PharmacologyMedium
How does glyceryl trinitrate (GTN) relieve angina?
AIt releases nitric oxide, mainly dilating veins and reducing cardiac workload
BIt increases the force of contraction so the heart pumps blood more efficiently
CIt blocks beta-1 receptors and slows the heart
DIt dissolves the clot in the coronary artery
12.PharmacologyHard
A patient took a large paracetamol (acetaminophen) overdose 6 hours ago and feels well. Why is treatment still urgent?
AThe patient is at risk of immediate respiratory arrest
BThe drug will cause kidney stones within a few hours
CParacetamol overdose only causes harm if symptoms start in the first hour
DLiver damage appears 1–3 days later, and early treatment works best
13.Med-surg: cardiovascular & respiratoryMedium
The telemetry monitor suddenly shows a chaotic waveform resembling ventricular fibrillation, but the patient is talking and brushing their teeth. What should the nurse do first?
ACheck the patient and the electrodes, as this is likely artefact
BDeliver an immediate defibrillation shock before checking anything
CStart chest compressions straight away and call the arrest team
DGive IV amiodarone as a bolus
14.Med-surg: cardiovascular & respiratoryHard
A patient being treated for infective endocarditis of the mitral valve suddenly develops slurred speech and weakness of the right arm. What is the most likely cause?
ALow blood glucose from a reduced appetite
BA side effect of the IV antibiotic on the nerves
CA migraine aura triggered by the fever
DAn embolus from a valve vegetation causing a stroke
15.Med-surg: neuro, endocrine & renalMedium
A patient taking carbimazole for hyperthyroidism reports a sore throat and fever. What should the nurse do?
AAdvise salt-water gargles and continue the drug for a week
BDouble the dose to bring the thyroid under control faster
CArrange an urgent full blood count to look for agranulocytosis
DReassure the patient, as the drug has no serious blood side effects
16.Med-surg: neuro, endocrine & renalHard
After surgery, a patient with Graves' disease has a temperature of 39.8 °C, a heart rate of 160/min, agitation and vomiting. Which treatment set is most appropriate?
ACooling, a beta-blocker, an antithyroid drug, then iodine and steroids
BAspirin for the fever and a review by the GP within a week
CLevothyroxine and warm blankets to settle the shivering
DFluid restriction and a loop diuretic to treat the tachycardia
17.Med-surg: GI, perioperative & oncologyMedium
Why is a pregnancy test often done before surgery in women who could be pregnant?
APregnant women cannot sign consent forms
BPregnancy always makes surgery impossible
CIt is needed to calculate the anaesthetic drug dose
DAnaesthesia, drugs and some tests may harm a fetus
18.Med-surg: GI, perioperative & oncologyHard
A nurse finds a dislodged sealed radiation source in the bed of a patient receiving brachytherapy. What should the nurse do?
AUse long-handled forceps to put it in the lead container; report it
BLeave it in the bed until the end of the shift
CPick it up with gloved hands and put it in the nearest sharps bin quickly
DThrow it in the clinical waste bag
19.Maternity & obstetric nursingMedium
Which lochia finding is expected on day 6 after birth?
APink to brownish discharge (lochia serosa)
BGreen, foul-smelling discharge
CNo discharge at all
DBright red discharge with large clots
20.Maternity & obstetric nursingHard
An ultrasound at 30 weeks shows polyhydramnios and no visible fetal stomach bubble. Which fetal condition should be considered?
ARenal agenesis
BOesophageal atresia
CPost-term pregnancy
DFetal growth from maternal diabetes only
21.Pediatric nursingMedium
Why are codeine and tramadol not recommended for children under 12 years?
AThey always cause allergies
BSome children metabolise them very quickly, causing dangerous breathing depression
CThey can only be given intravenously
DThey are too weak to relieve moderate pain, so stronger opioids are always preferred
22.Pediatric nursingHard
A large baby born to a mother with diabetes becomes jittery at 1 hour of age. What should the nurse check first?
AThe baby's serum bilirubin
BThe baby's blood glucose
CThe baby's blood group
DThe baby's haemoglobin
23.Mental health nursingMedium
Which group of findings suggests serotonin syndrome?
AWeight gain and dry mouth
BAgitation, sweating, tremor, hyperreflexia and clonus starting within hours of a drug change
CLow temperature and slow heart rate
DSlowly developing rigidity with low reflexes and high fever over several days after an antipsychotic
24.Mental health nursingHard
A patient with bulimia nervosa has a serum potassium of 2.8 mmol/L. What is the main concern?
AA risk of weight gain
BIncreased appetite
CImproved muscle strength
DA risk of life-threatening cardiac arrhythmias
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose calculation for an injection gives 6.4861 mL. The rule in this exercise is that volumes of 1 mL or more are rounded to the nearest tenth of a mL. What value x do you record?
6.4861 mL
x = mL
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 21:50 and finishes at 03:45 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.
21:5003:45
t = h
27.Dosage calculationsMedium
A child weighing 35 kg is prescribed 10 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?
35 kg10 mg/kg50 mg/mL
V = mL
28.Dosage calculationsHard
A patient is 108 cm tall and weighs 22 kg. The prescription is 100 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.
108 cm22 kg100 mg/m²
D = mg
29.IV infusion ratesMedium
Infuse 1000 mL over 4 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
1000 mL4 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 250 mg of a drug in 250 mL and runs at 20 mL/h. How many milligrams per hour D does the patient receive?
250 mg/250 mL20 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 total intake I in mL. Count ice chips as half their volume.
milk: 100 mLjuice: 150 mLice chips: 200 mLIV infusion: 80 mL/h × 12 hIV antibiotic: 1 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 12:00 at 125 mL/h. After 4 hours the rate is changed to 75 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
1000 mL125 mL/h · 4 h75 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 20/min, SpO₂ 98% on supplemental oxygen, blood pressure 110/66 mmHg, pulse 76/min, responds only to pain, temperature 39.0 °C. What is the NEWS2 total score?
RR 20SpO₂ 98%O₂SBP 110HR 76PT 39.0 °C
NEWS2 =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 96 kg and is 177 cm tall. Calculate the BMI and click the WHO weight category.
96 kg177 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
3Solutions
1.Nursing fundamentals
Answer: A · When contact with blood, body fluids or broken skin is expected
Why this is the answer
Under standard precautions, gloves are worn when exposure to blood or body fluids is likely. Wearing them for all contact gives false security and can spread germs if not changed.
Answer
A · When contact with blood, body fluids or broken skin is expected
2.Nursing fundamentals
Answer: D · Category 2
Why this is the answer
Category 2 (Stage 2 in the US NPIAP system) is partial-thickness skin loss, seen as a shallow open ulcer with a pink-red bed or as a blister. Category 1 is intact skin; categories 3 and 4 are full thickness.
Answer
D · Category 2
3.Infection control & patient safety
Answer: D · Call “all clear” and check that nobody is touching the patient or bed
Why this is the answer
Anyone touching the patient or bed could receive the shock. The operator announces “clear” and looks to confirm that nobody is in contact, and oxygen is moved away from the chest.
Answer
D · Call “all clear” and check that nobody is touching the patient or bed
4.Infection control & patient safety
Answer: D · Chest thrusts
Why this is the answer
For people in late pregnancy or who are very obese, chest thrusts replace abdominal thrusts because the rescuer cannot get around the abdomen effectively. Blind finger sweeps can push the object deeper.
Answer
D · Chest thrusts
5.Prioritization & delegation
Answer: C · Help the patient empty her bladder
Why this is the answer
A uterus that is high and displaced to one side usually means a full bladder. A full bladder stops the uterus contracting well, so the nurse helps the patient void and reassesses.
Answer
C · Help the patient empty her bladder
6.Prioritization & delegation
Answer: C · Large-volume IV fluids with close monitoring of urine output
Why this is the answer
Once the airway is secure, the early priority in major burns is fluid resuscitation to prevent burn shock. Urine output is a key guide to whether enough fluid is being given.
Answer
C · Large-volume IV fluids with close monitoring of urine output
7.Clinical nursing
Answer: B · Sit down before using it, as it can cause dizziness and low blood pressure
Why this is the answer
GTN causes vasodilation, which can lead to headache, flushing, dizziness and hypotension. Patients should sit, and seek emergency help if the pain does not settle after the advised doses.
Answer
B · Sit down before using it, as it can cause dizziness and low blood pressure
8.Clinical nursing
Answer: A · Liver damage develops later, and the antidote works best when given early
Why this is the answer
Paracetamol overdose may cause few early symptoms, but liver failure can develop over days. Acetylcysteine is most effective when started early, guided by timed paracetamol levels.
Answer
A · Liver damage develops later, and the antidote works best when given early
9.Lab values & electrolytes
Answer: C · Aspirate from the sampling port with a sterile syringe
Why this is the answer
The catheter sampling port is cleaned and urine is aspirated with a sterile syringe, keeping the system closed. Urine in the drainage bag has been standing and can contain bacteria that multiplied there; opening the system raises the risk of infection.
Answer
C · Aspirate from the sampling port with a sterile syringe
10.Lab values & electrolytes
Answer: C · A very high creatine kinase (CK)
Why this is the answer
These signs suggest neuroleptic malignant syndrome, a medical emergency. Muscle rigidity releases CK, often to very high levels, and the white count is often raised. Myoglobin can damage the kidneys. The antipsychotic is stopped and supportive care is started.
Answer
C · A very high creatine kinase (CK)
11.Pharmacology
Answer: A · It releases nitric oxide, mainly dilating veins and reducing cardiac workload
Why this is the answer
GTN is converted to nitric oxide, which relaxes vascular smooth muscle through cGMP. Venodilation lowers preload, so the heart works less and needs less oxygen.
Answer
A · It releases nitric oxide, mainly dilating veins and reducing cardiac workload
12.Pharmacology
Answer: D · Liver damage appears 1–3 days later, and early treatment works best
Why this is the answer
Paracetamol overdose often causes few symptoms at first, while the toxic metabolite damages the liver. Liver injury peaks after about 3 days, so the decision to treat is based on the timed blood level, not on symptoms.
Answer
D · Liver damage appears 1–3 days later, and early treatment works best
13.Med-surg: cardiovascular & respiratory
Answer: A · Check the patient and the electrodes, as this is likely artefact
Why this is the answer
Movement, loose electrodes and muscle activity can create artefact that looks like VF. A conscious, talking patient cannot be in VF. The nurse assesses the patient and checks the leads and electrodes, then reattaches them if needed.
Answer
A · Check the patient and the electrodes, as this is likely artefact
14.Med-surg: cardiovascular & respiratory
Answer: D · An embolus from a valve vegetation causing a stroke
Why this is the answer
Vegetations on the mitral or aortic valve can break off and embolise to the brain, kidneys, spleen or limbs. Sudden focal neurological signs suggest an embolic stroke: the nurse calls for urgent help, checks the blood glucose to exclude hypoglycaemia and expects urgent brain imaging. Thrombolysis is generally avoided in endocarditis because of the bleeding risk.
Answer
D · An embolus from a valve vegetation causing a stroke
15.Med-surg: neuro, endocrine & renal
Answer: C · Arrange an urgent full blood count to look for agranulocytosis
Why this is the answer
Thionamides (carbimazole, methimazole, propylthiouracil) can cause agranulocytosis, a rare but life-threatening fall in neutrophils. Patients are taught to report sore throat, fever or mouth ulcers immediately and have an urgent blood count; the drug is stopped if neutrophils are low.
Answer
C · Arrange an urgent full blood count to look for agranulocytosis
16.Med-surg: neuro, endocrine & renal
Answer: A · Cooling, a beta-blocker, an antithyroid drug, then iodine and steroids
Why this is the answer
Thyroid storm is life-threatening. Treatment includes supportive care and cooling, beta-blockade for adrenergic symptoms, a thionamide (often propylthiouracil) to block synthesis, iodine given after the thionamide to block hormone release, and corticosteroids. Aspirin is avoided because it can increase free thyroid hormone.
Answer
A · Cooling, a beta-blocker, an antithyroid drug, then iodine and steroids
17.Med-surg: GI, perioperative & oncology
Answer: D · Anaesthesia, drugs and some tests may harm a fetus
Why this is the answer
Unknown pregnancy can change the decision to operate, the timing, and the choice of drugs and X-rays. Testing is offered with consent, according to local policy.
Answer
D · Anaesthesia, drugs and some tests may harm a fetus
18.Med-surg: GI, perioperative & oncology
Answer: A · Use long-handled forceps to put it in the lead container; report it
Why this is the answer
A dislodged source is picked up with long-handled forceps and placed in the shielded container kept in the room. The radiation safety officer and team are informed, following local policy.
Answer
A · Use long-handled forceps to put it in the lead container; report it
19.Maternity & obstetric nursing
Answer: A · Pink to brownish discharge (lochia serosa)
Why this is the answer
Lochia serosa is expected from about day 4 to day 10. Large clots or a return to heavy bright red bleeding suggest retained tissue or subinvolution; a foul smell suggests infection.
Answer
A · Pink to brownish discharge (lochia serosa)
20.Maternity & obstetric nursing
Answer: B · Oesophageal atresia
Why this is the answer
If the fetus cannot swallow, as in oesophageal atresia, amniotic fluid builds up and the stomach is not seen. Renal agenesis causes the opposite, severe oligohydramnios.
Answer
B · Oesophageal atresia
21.Pediatric nursing
Answer: B · Some children metabolise them very quickly, causing dangerous breathing depression
Why this is the answer
In ultra-rapid metabolisers, codeine is quickly converted to morphine, which can cause life-threatening respiratory depression. Regulators advise against codeine and tramadol in children under 12, and after tonsil or adenoid surgery in those under 18.
Answer
B · Some children metabolise them very quickly, causing dangerous breathing depression
22.Pediatric nursing
Answer: B · The baby's blood glucose
Why this is the answer
Babies of mothers with diabetes produce extra insulin before birth, so after the cord is cut they are at high risk of hypoglycaemia. Jitteriness is a common sign, so blood glucose is checked straight away and the baby is fed or treated as per protocol.
Answer
B · The baby's blood glucose
23.Mental health nursing
Answer: B · Agitation, sweating, tremor, hyperreflexia and clonus starting within hours of a drug change
Why this is the answer
Serotonin syndrome develops quickly after a new serotonergic drug, a higher dose or an interaction. Neuromuscular excitation (hyperreflexia, clonus), autonomic signs and agitation are typical.
Answer
B · Agitation, sweating, tremor, hyperreflexia and clonus starting within hours of a drug change
24.Mental health nursing
Answer: D · A risk of life-threatening cardiac arrhythmias
Why this is the answer
Repeated vomiting causes hypokalaemia and metabolic alkalosis. A potassium of 2.8 mmol/L is dangerously low and can cause arrhythmias. The patient needs cardiac monitoring and potassium replacement as prescribed.
Answer
D · A risk of life-threatening cardiac arrhythmias
25.Nursing math & unit conversions
Answer: x = 6.5 mL
Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.
Digit in the tenths place
6.4861 → 4
Only the next digit decides
6.4861 → 8
8 is 5 or more, so round 4 up.
The digits after it (61) are ignored: round once, never step by step.
Round
x = 6.5 mL
Answer
x = 6.5 mL
26.Nursing math & unit conversions
Answer: t = 5.92 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
21:50 → 24:00 = 130 min
After midnight
00:00 → 03:45 = 225 min
Total
130 + 225 = 355 min
t = 355/60 = 5.917 ≈ 5.92 h
Answer
t = 5.92 h
27.Dosage calculations
Answer: V = 7 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 = 10·35 = 350 mg
Volume
V = 350/50 = 7 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 7 mL
28.Dosage calculations
Answer: D = 81.24 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).
Body surface area
BSA = √(108·22/3600) = √0.66 = 0.8124 m²
Dose
D = 100·0.8124 = 81.24 mg
Answer
D = 81.24 mg
29.IV infusion rates
Answer: R = 83 gtt/min
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Time in minutes
4·60 = 240 min
Drip rate
R = 1000·20/240 = 83.33 ≈ 83 gtt/min
Answer
R = 83 gtt/min
At the bedside you round to the nearest whole drop: 83 gtt/min.
30.IV infusion rates
Answer: D = 20 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
250/250 = 1 mg/mL
Dose rate
D = 1·20 = 20 mg/h
Answer
D = 20 mg/h
31.IV fluids & fluid balance
Answer: I = 1360 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: 100 + 150 = 250 mL
ice chips: 200/2 = 100 mL
IV infusion: 80·12 = 960 mL
IV antibiotic: 1·50 = 50 mL
I = 1360 mL
Answer
I = 1360 mL
32.IV fluids & fluid balance
Answer: t = 10.7 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.
First part
125·4 = 500 mL
1000 − 500 = 500 mL left
Second part
500/75 = 6.667 h
Total time
t = 4 + 6.667 = 10.67 ≈ 10.7 h
Answer
t = 10.7 h
That is about 10 h 40 min, so the bag runs out at about 22:40.
33.Clinical assessment scores
Answer: NEWS2 = 7
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 20/min → 0
SpO₂ 98% → 0
on oxygen → 2
SBP 110 mmHg → 1
HR 76/min → 0
responds only to pain (P) → 3
T 39.0 °C → 1
Add
NEWS2 = 0 + 0 + 2 + 1 + 0 + 3 + 1 = 7
Answer
NEWS2 = 7
34.Clinical assessment scores
Answer: obesity class I
Body mass index: BMI = weight (kg)/height (m)², with the height converted to metres first. With pounds and inches, BMI = 703 × weight (lb)/height (in)². WHO adult categories: below 18.5 underweight, 18.5–24.9 healthy weight, 25.0–29.9 overweight, 30.0–34.9 obesity class I, 35.0–39.9 obesity class II and 40 or more obesity class III.
BMI
BMI = 96/1.77² = 30.64
Category
obesity class I
Answer
obesity class I
This is independent practice material. ExamProblems is not affiliated with or endorsed by the organisation that runs this exam, and the exam name is used only to describe the content. NCLEX®, NCLEX-RN® and NCLEX-PN® are trademarks of the National Council of State Boards of Nursing, Inc. (NCSBN), which is not affiliated with ExamProblems and does not endorse it or vouch for its accuracy.