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
When should discharge planning begin?
AAfter the patient has gone home
BOn the morning of discharge
COn admission, or as early as possible
DOnly after the doctor agrees to discharge
2.Nursing fundamentalsHard
A dehydrated patient is receiving IV fluids. Which finding best shows the treatment is working?
AThe patient feels more thirsty than before the fluids started
BUrine output rises and the heart rate falls towards normal
CThe urine becomes darker and more concentrated
DThe heart rate rises and the skin becomes cooler
3.Infection control & patient safetyMedium
A patient with delirium is at risk of falls and of pulling out lines. Which option is less restrictive than restraints?
AA sedative given every few hours as needed
BA trained sitter or video monitoring with staff nearby
CA vest restraint applied for the whole night
DFour side rails raised and the door closed so the patient stays in bed
4.Infection control & patient safetyHard
Victims of a chemical spill arrive at the emergency department with liquid on their skin and clothing. What is the priority before they enter the building?
ATake a full history in the waiting room
BGive them hospital gowns and seat them in triage
CDecontaminate them outside, with staff wearing appropriate PPE
DTake them straight into the resuscitation room so treatment is not delayed
5.Prioritization & delegationMedium
A patient is receiving continuous tube feeds. Which action best reduces the risk of aspiration?
ATurn the feed off only while the patient is asleep at night
BLay the patient flat for an hour after each bag is hung
CIncrease the feed rate so the stomach empties sooner
DKeep the head of the bed raised to at least 30 degrees
6.Prioritization & delegationHard
A child is admitted with a suspected Wilms tumor (nephroblastoma). Which instruction is most important for all staff?
AEncourage the child to play contact sports
BDo not palpate the abdomen
CGive a warm bath with abdominal massage
DMeasure abdominal girth by pressing firmly
7.Clinical nursingMedium
A patient is admitted with cellulitis of the leg. Why might the nurse mark the edge of the redness on the skin?
ATo show the surgeon exactly where to make the incision
BTo help the patient find the sore area
CTo mark the site for an injection
DTo monitor whether the infection is spreading or improving
8.Clinical nursingHard
Why should chronic hypernatraemia be corrected gradually?
ASlow correction is only needed in children
BFast correction causes severe hyperkalaemia
CLowering the sodium too fast can cause cerebral oedema
DFast correction causes osmotic demyelination from swelling of the kidneys
9.Lab values & electrolytesMedium
On the first day after major surgery, a patient's white cell count is 12.5 × 10³/µL, with no fever or wound signs. What is the best interpretation?
AA sign of leukemia that needs bone marrow testing
BA laboratory error, since surgery lowers white cells
CA common stress response to surgery that is monitored
DDefinite wound infection that needs antibiotics now
10.Lab values & electrolytesHard
A health care worker's hepatitis B tests show: HBsAg negative, anti-HBs positive, anti-HBc positive. What does this mean?
ACurrent chronic hepatitis B infection
BImmunity from vaccination only, never infected
CPast infection that has resolved, with immunity
DNot immune and never exposed to the virus
11.PharmacologyMedium
Warfarin works by:
ADirectly inhibiting thrombin
BActivating antithrombin
CBlocking platelet aggregation through irreversible inhibition of COX-1
DBlocking the vitamin K-dependent synthesis of clotting factors
12.PharmacologyHard
A heparin infusion contains 25,000 units in 500 mL. The order is 1,000 units per hour. What rate should be set on the pump?
A10 mL/h
B20 mL/h
C25 mL/h
D50 mL/h
13.Med-surg: cardiovascular & respiratoryMedium
Where is the V1 electrode placed for a 12-lead ECG?
AOver the left nipple
BThe fourth intercostal space just right of the sternum
CJust below the left collarbone
DThe fifth intercostal space in the mid-axillary line
14.Med-surg: cardiovascular & respiratoryHard
Seconds after an intramuscular injection, a patient becomes pale, sweaty and faint, with a heart rate of 48/min. There is no rash, wheeze or swelling, and they recover quickly when laid flat. What is the most likely cause?
AA tension pneumothorax
BA vasovagal reaction
CA myocardial infarction
DAnaphylaxis
15.Med-surg: neuro, endocrine & renalMedium
A patient is due a rapid-acting insulin dose before lunch, but the meal trays are delayed. What should the nurse do?
AOmit the dose entirely for the rest of the day
BGive the insulin now and the meal when it comes
CGive the insulin with a glass of water instead
DWait to give the insulin until the meal arrives
16.Med-surg: neuro, endocrine & renalHard
A woman with epilepsy who takes valproate says she is planning a pregnancy. Which response is most appropriate?
AReassure her that valproate is safe throughout pregnancy
BTell her to stop taking the valproate completely from today
CSuggest doubling the dose to protect the baby from seizures
DAdvise not stopping it suddenly and urgent specialist review
17.Med-surg: GI, perioperative & oncologyMedium
Why is it important to prevent perioperative hypothermia?
AIt increases bleeding, wound infection and heart complications
BIt reduces the amount of anaesthetic needed, which is unsafe
CIt makes patients wake up from the anaesthetic too quickly
DIt lowers the risk of pain after surgery
18.Med-surg: GI, perioperative & oncologyHard
A nurse spills a small amount of a cytotoxic drug on the floor. What is the correct approach?
AMop it up with the ward mop and rinse the mop in the sluice
BLeave it to evaporate and keep people away for a few minutes
CUse the spill kit with PPE, clean up, bag as cytotoxic waste and report
DWipe it with a paper towel and put it in the general waste bin
19.Maternity & obstetric nursingMedium
A preterm baby on feeds develops a swollen abdomen, bloody stools and feeding intolerance. Which condition is suspected?
AInfantile pyloric stenosis
BHirschsprung disease
CNecrotising enterocolitis
DCow's milk protein allergy
20.Maternity & obstetric nursingHard
A woman at 10 weeks has been vomiting for days, has ketones in her urine, has lost 6% of her body weight and feels dizzy on standing. What is the priority?
ACorrect the dehydration with IV fluids and electrolytes as prescribed
BStart a weight-loss diet
CTell her it will pass by itself after the first trimester and no follow-up is needed
DAdvise her to eat three large meals a day
21.Pediatric nursingMedium
A child's tonic–clonic seizure has lasted more than 5 minutes. What should the nurse do?
AGive the prescribed rescue medicine and call for emergency help
BPut a tongue depressor between the child's teeth
CHold the child's arms and legs firmly to stop the movements
DWait another 15 minutes, because most seizures stop on their own
22.Pediatric nursingHard
A 5-year-old with leukaemia tells the nurse she is ill because she was naughty. What is the best response?
AExplain the cell biology of leukaemia to her in detail
BIgnore the remark, as she is too young to understand
CAgree that being good may help her get better faster
DReassure her clearly that nothing she did or thought made her ill
23.Mental health nursingMedium
A patient intoxicated with phencyclidine (PCP) is agitated and has nystagmus and high blood pressure. Which nursing approach is best?
APut him in a busy area so that staff can watch him more easily
BTry to talk the patient down by discussing his feelings in detail
CProvide a quiet, low-stimulation environment and keep staff and patient safe
DEncourage him to walk around the ward and join in activities to help burn off the drug
24.Mental health nursingHard
A patient with a known panic disorder says she has chest pain and difficulty breathing. What should the nurse do first?
AAsk her to breathe slowly into a paper bag and leave her alone until the panic has passed, as it always does in panic disorder
BTell her it is just another panic attack
CGive her a lecture on cognitive restructuring
DAssess her physically, including vital signs, and get an ECG according to policy, before assuming it is panic
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 3:15 AM. Which entry is the same time on the 24-hour clock? Click it.
3:15 AM
115:15
203:15
304:15
402:15
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A blood glucose result is 378 mg/dL. Using 1 mmol/L = 18 mg/dL for glucose, find c in mmol/L. Round to one decimal place.
378 mg/dL1 mmol/L = 18 mg/dL
c = mmol/L
27.Dosage calculationsMedium
A patient weighs 25 kg. The prescribed dose is 25 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?
25 kg25 mg/kg/day4× per day
D = mg
28.Dosage calculationsHard
A child weighing 18 kg is prescribed 15 mg/kg per dose of an oral suspension that contains 125 mg in 5 mL. What volume V do you give?
18 kg15 mg/kg125 mg/5 mL
V = mL
29.IV infusion ratesMedium
Infuse 500 mL over 12 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 mL12 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
500 mL was ordered over 8 hours. After 3 hours you find that 360 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: 360 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 patient weighs 109 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 75 mL/h. At 09:30, 200 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL200 mL infused75 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 121/min and a blood pressure of 125/81 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.
HR 121/minBP 125/81 mmHg
SI =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: no; secondary diagnosis: no; ambulatory aid: none, bed rest or nurse assists; IV therapy or saline lock: no; gait: weak; mental status: knows own limits. Using the cut-offs 0–24 low, 25–44 moderate and 45 or more high, click the fall-risk level.
1low risk
2moderate risk
3high risk
3Solutions
1.Nursing fundamentals
Answer: C · On admission, or as early as possible
Why this is the answer
Starting discharge planning early allows time for teaching, equipment, referrals and support at home, reducing delays and readmissions.
Answer
C · On admission, or as early as possible
2.Nursing fundamentals
Answer: B · Urine output rises and the heart rate falls towards normal
Why this is the answer
With effective fluid replacement, perfusion improves: urine output increases, the heart rate settles and the blood pressure stabilises. Watching for fluid overload is also important.
Answer
B · Urine output rises and the heart rate falls towards normal
3.Infection control & patient safety
Answer: B · A trained sitter or video monitoring with staff nearby
Why this is the answer
Close observation by a sitter or video monitoring allows staff to step in quickly, without restricting the patient. It is often combined with reorientation and family presence.
Answer
B · A trained sitter or video monitoring with staff nearby
4.Infection control & patient safety
Answer: C · Decontaminate them outside, with staff wearing appropriate PPE
Why this is the answer
Contaminated patients are decontaminated outside the department so the chemical is not brought inside to harm staff and other patients. Staff doing this wear PPE suited to the hazard.
Answer
C · Decontaminate them outside, with staff wearing appropriate PPE
5.Prioritization & delegation
Answer: D · Keep the head of the bed raised to at least 30 degrees
Why this is the answer
Raising the head of the bed to at least 30 degrees during and after feeding lowers the risk of reflux and aspiration. Lying flat greatly increases the risk.
Answer
D · Keep the head of the bed raised to at least 30 degrees
6.Prioritization & delegation
Answer: B · Do not palpate the abdomen
Why this is the answer
Palpating a Wilms tumor can rupture the capsule and spread cancer cells. A sign is often put on the bed to warn staff not to palpate the abdomen.
Answer
B · Do not palpate the abdomen
7.Clinical nursing
Answer: D · To monitor whether the infection is spreading or improving
Why this is the answer
Marking the margin helps staff see whether the redness is spreading despite treatment, which may mean antibiotics need review. The limb is also elevated and observations monitored.
Answer
D · To monitor whether the infection is spreading or improving
8.Clinical nursing
Answer: C · Lowering the sodium too fast can cause cerebral oedema
Why this is the answer
In chronic hypernatraemia, brain cells adapt by holding extra solutes. If sodium falls too quickly, water moves into brain cells and causes cerebral oedema, so correction is controlled.
Answer
C · Lowering the sodium too fast can cause cerebral oedema
9.Lab values & electrolytes
Answer: C · A common stress response to surgery that is monitored
Why this is the answer
A mild leukocytosis is common after surgery because of tissue injury and the stress response. It is monitored along with temperature and wound assessment. A rising count after several days, or fever, suggests infection.Checked against:WBC count · MedlinePlus (NIH) (2025)
Answer
C · A common stress response to surgery that is monitored
10.Lab values & electrolytes
Answer: C · Past infection that has resolved, with immunity
Why this is the answer
The vaccine contains only surface antigen, so vaccination produces anti-HBs alone. A positive anti-HBc shows past or current infection; with HBsAg negative and anti-HBs positive, the infection has cleared and the person is immune.Checked against:Hepatitis Testing · MedlinePlus (NIH)
Answer
C · Past infection that has resolved, with immunity
11.Pharmacology
Answer: D · Blocking the vitamin K-dependent synthesis of clotting factors
Why this is the answer
Warfarin inhibits vitamin K epoxide reductase, reducing synthesis of factors II, VII, IX and X. It is monitored with the INR and reversed with vitamin K.
Answer
D · Blocking the vitamin K-dependent synthesis of clotting factors
12.Pharmacology
Answer: B · 20 mL/h
Why this is the answer
25,000 units ÷ 500 mL = 50 units/mL, and 1,000 units/h ÷ 50 units/mL = 20 mL/h. Heparin is a high-alert drug, so the calculation and pump settings are independently double-checked.
Answer
B · 20 mL/h
13.Med-surg: cardiovascular & respiratory
Answer: B · The fourth intercostal space just right of the sternum
Why this is the answer
V1 is placed in the fourth intercostal space at the right sternal edge, and V2 at the left sternal edge. V4 is in the fifth intercostal space in the mid-clavicular line, and V6 in the mid-axillary line at the same level. Wrong placement can mimic or hide changes.
Answer
B · The fourth intercostal space just right of the sternum
14.Med-surg: cardiovascular & respiratory
Answer: B · A vasovagal reaction
Why this is the answer
Vasovagal reactions cause bradycardia, pallor, sweating and fainting, and resolve quickly when lying flat. Anaphylaxis usually causes tachycardia, airway or breathing problems and often skin changes, and does not settle on its own. If in doubt, treat as anaphylaxis.
Answer
B · A vasovagal reaction
15.Med-surg: neuro, endocrine & renal
Answer: D · Wait to give the insulin until the meal arrives
Why this is the answer
Rapid-acting insulin begins to work within about 15 minutes, so giving it without food risks hypoglycaemia. It is given just before or with the meal. Basal insulin is not affected by meal delays.
Answer
D · Wait to give the insulin until the meal arrives
16.Med-surg: neuro, endocrine & renal
Answer: D · Advise not stopping it suddenly and urgent specialist review
Why this is the answer
Valproate is highly teratogenic (neural tube defects and neurodevelopmental problems), and its use in people who could become pregnant is tightly restricted. However, stopping antiseizure medication suddenly risks status epilepticus. Urgent specialist review to plan a safer alternative, plus folic acid supplementation, is needed.
Answer
D · Advise not stopping it suddenly and urgent specialist review
17.Med-surg: GI, perioperative & oncology
Answer: A · It increases bleeding, wound infection and heart complications
Why this is the answer
Even mild hypothermia impairs clotting, increases surgical site infection and cardiac events, and causes shivering and discomfort. Forced-air warming, warmed fluids and covering the patient help prevent it.
Answer
A · It increases bleeding, wound infection and heart complications
18.Med-surg: GI, perioperative & oncology
Answer: C · Use the spill kit with PPE, clean up, bag as cytotoxic waste and report
Why this is the answer
Cytotoxic spills are managed using a dedicated spill kit with gloves, gown, eye protection and a mask as needed. The spill is contained, absorbed and cleaned from the outside in, waste is placed in labelled cytotoxic waste and the incident is reported.
Answer
C · Use the spill kit with PPE, clean up, bag as cytotoxic waste and report
19.Maternity & obstetric nursing
Answer: C · Necrotising enterocolitis
Why this is the answer
Necrotising enterocolitis mainly affects preterm babies. Signs include abdominal distension, bilious aspirates, bloody stools and instability. Feeds are stopped and the baby is urgently reviewed. Breast milk lowers the risk.
Answer
C · Necrotising enterocolitis
20.Maternity & obstetric nursing
Answer: A · Correct the dehydration with IV fluids and electrolytes as prescribed
Why this is the answer
These are signs of hyperemesis gravidarum with dehydration. IV fluids, electrolyte replacement, antiemetics and vitamin supplements such as thiamine as prescribed are the priority.
Answer
A · Correct the dehydration with IV fluids and electrolytes as prescribed
21.Pediatric nursing
Answer: A · Give the prescribed rescue medicine and call for emergency help
Why this is the answer
A seizure lasting 5 minutes or more is treated as possible status epilepticus. Rescue medicine such as buccal or intranasal midazolam, or rectal or intranasal diazepam, is given according to the care plan, and emergency help is called. The child is never restrained and nothing is put in the mouth.
Answer
A · Give the prescribed rescue medicine and call for emergency help
22.Pediatric nursing
Answer: D · Reassure her clearly that nothing she did or thought made her ill
Why this is the answer
Preoperational children use magical thinking and may believe illness is a punishment for bad behaviour or thoughts. Clear, repeated reassurance in simple language reduces guilt and fear.
Answer
D · Reassure her clearly that nothing she did or thought made her ill
23.Mental health nursing
Answer: C · Provide a quiet, low-stimulation environment and keep staff and patient safe
Why this is the answer
PCP can cause agitation, violence, psychosis, nystagmus and hypertension. Reducing stimulation and keeping enough staff present for safety are key; "talking down" is less effective than with other hallucinogens.
Answer
C · Provide a quiet, low-stimulation environment and keep staff and patient safe
24.Mental health nursing
Answer: D · Assess her physically, including vital signs, and get an ECG according to policy, before assuming it is panic
Why this is the answer
Physical causes such as a heart attack or pulmonary embolism must be ruled out. "Diagnostic overshadowing", assuming symptoms are psychiatric, is a common and dangerous error.
Answer
D · Assess her physically, including vital signs, and get an ECG according to policy, before assuming it is panic
25.Nursing math & unit conversions
Answer: 03:15
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.
Convert the hour
3 AM → 03
Answer
03:15
Answer
03:15
26.Nursing math & unit conversions
Answer: c = 21 mmol/L
Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.
Convert
c = 378/18 = 21 mmol/L
Answer
c = 21 mmol/L
27.Dosage calculations
Answer: D = 156.3 mg
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.
Total per day
25·25 = 625 mg
Per dose
D = 625/4 = 156.3 mg
Answer
D = 156.3 mg
28.Dosage calculations
Answer: V = 10.8 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
15·18 = 270 mg
Volume
V = (270/125)·5 = 10.8 mL
Answer
V = 10.8 mL
29.IV infusion rates
Answer: R = 10 gtt/min
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Time in minutes
12·60 = 720 min
Drip rate
R = 500·15/720 = 10.42 ≈ 10 gtt/min
Answer
R = 10 gtt/min
At the bedside you round to the nearest whole drop: 10 gtt/min.
30.IV infusion rates
Answer: Δ = 15.2 %
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 = 360/5 = 72 mL/h
Percentage change
Δ = (72 − 62.5)/62.5·100% = 15.2%
Answer
Δ = 15.2%
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
31.IV fluids & fluid balance
Answer: U = 1.58 mL/kg/h
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 urine
325 + 425 + 350 + 275 = 1375 mL
Per kilogram per hour
U = 1375/(109·8) = 1.577 ≈ 1.58 mL/kg/h
Answer
U = 1.58 mL/kg/h
32.IV fluids & fluid balance
Answer: t = 4 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Volume left
500 − 200 = 300 mL
Time
t = 300/75 = 4 h
Answer
t = 4 h
That is about 4 h 00 min, so the bag runs out at about 13:30.
33.Clinical assessment scores
Answer: SI = 0.97
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 = 121/125 = 0.968 ≈ 0.97
Answer
SI = 0.97
Above the usual 0.5–0.7.
34.Clinical assessment scores
Answer: low risk
Morse fall scale: six items. History of falling: no 0, yes 25. Secondary diagnosis: no 0, yes 15. Ambulatory aid: none, bed rest or nurse assistance 0; crutches, cane or walker 15; holding on to furniture 30. IV therapy or saline lock: no 0, yes 20. Gait: normal, bed rest or wheelchair 0; weak 10; impaired 20. Mental status: knows own limits 0; overestimates or forgets limits 15. The total runs from 0 to 125. Risk cut-offs differ between hospitals; a common set is 0–24 low, 25–44 moderate and 45 or more high.
Score each item
history of falling in the last 3 months: no → 0
secondary diagnosis: no → 0
ambulatory aid: none, bed rest or nurse assists → 0
IV therapy or saline lock: no → 0
gait: weak → 10
mental status: knows own limits → 0
Add
Morse total = 0 + 0 + 0 + 0 + 10 + 0 = 10
Risk level
10 → low risk
Answer
low risk
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