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
Why is a slide sheet used to move a patient up the bed?
AIt warms the patient during the move
BIt keeps the bed clean during the move
CIt lets one nurse lift the patient alone
DIt reduces friction and shear on the skin
2.Nursing fundamentalsHard
A patient with new swallowing difficulty is prescribed a modified-release tablet. What should the nurse do?
ACut the tablet into quarters and give the pieces one at a time with water
BContact the prescriber or pharmacist for a suitable alternative
CCrush the tablet and mix it with yoghurt
DOmit the medicine without telling anyone
3.Infection control & patient safetyMedium
Why should a child’s weight be recorded only in kilograms?
AChildren weigh less, so smaller units are needed
BScales that show kilograms are always more accurate than those that show pounds
CKilograms are easier for parents to remember
DMixing up pounds and kilograms can lead to large dosing errors
4.Infection control & patient safetyHard
A patient with suspected pertussis needs to stay in a shared bay because no single room is free. What is the most appropriate arrangement while infection control is contacted?
APlace the patient next to an immunocompromised patient
BUse no precautions at all until a single room becomes free
CUse airborne precautions with an N95 respirator for everyone
DCurtains drawn, over 1 meter (3 feet) of space, masks for close contact
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 tell the nurse if she becomes very sleepy or hard to wake.”
C“I will press the button for her while she is asleep so she stays comfortable.”
D“The pump has limits set by the nurse so she cannot get too much at once.”
6.Prioritization & delegationHard
During START triage, a non-walking adult breathes 28 times a minute, has no radial pulse and has a capillary refill of 4 seconds. Which category is the victim given?
AGreen (minor)
BYellow (delayed), because the respiratory rate is under 30/min
CBlack (expectant)
DRed (immediate)
7.Clinical nursingMedium
What is one advantage of a direct oral anticoagulant (DOAC) such as apixaban compared with warfarin?
AIt has no risk of bleeding
BIt does not need routine INR monitoring
CIt is safe in all patients with severe kidney failure
DIt never interacts with other drugs
8.Clinical nursingHard
A nurse is unsure whether a prescribed dose of a high-risk drug is correct. What is the safest action?
AAsk the patient whether the dose looks the same as usual and give it
BWithhold it and check with the prescriber or pharmacist first
CGive half the dose as a compromise until the doctor is available
DGive the dose because the doctor has signed the prescription
9.Lab values & electrolytesMedium
A patient on a heparin infusion has blood in the urine and an aPTT far above the target. The nurse stops the infusion and informs the provider. Which antidote should the nurse anticipate?
AProtamine sulfate
BNaloxone
CVitamin K (phytonadione)
DCalcium gluconate
10.Lab values & electrolytesHard
A patient has sudden episodes of severe headache, sweating, palpitations and very high blood pressure. Which test is most useful to look for the cause?
APlasma free metanephrines
BSerum TSH and free T4
CFasting lipid profile
DSerum calcium only
11.PharmacologyMedium
Why is simvastatin traditionally taken in the evening?
AIt is short-acting, and cholesterol synthesis peaks at night
BIt must be taken with the largest meal of the day
CIt is inactivated by sunlight during the day
DIt causes too much drowsiness to be taken in the morning
12.PharmacologyHard
A patient on long-term prednisolone has been vomiting for two days and could not take her tablets. She is now hypotensive and confused, with low sodium and high potassium. What is the most urgent treatment?
AIV insulin with glucose only
BIV hydrocortisone and IV fluids
CIV furosemide
DOral prednisolone with a glass of water
13.Med-surg: cardiovascular & respiratoryMedium
A patient who had a leg amputation says they feel burning pain in the missing foot. What is the best response?
AAdvise that it will be ignored until it stops
BTell the patient the pain must be imaginary as the foot has gone
CExplain that phantom limb pain is real and arrange treatment
DExplain that burning pain in the missing foot shows wound infection
14.Med-surg: cardiovascular & respiratoryHard
A ventilated patient with severe ARDS is to be turned prone. What is the main reason, and the key nursing risk?
AIt treats infection; the risk is fever
BIt lowers the blood pressure; the main risk is rebound hypertension
CIt improves oxygenation; risks are pressure injury and tube displacement
DIt improves digestion and gut motility; the main risk is constipation
15.Med-surg: neuro, endocrine & renalMedium
A stroke patient with dysphagia has been started on a modified diet. Which action best reduces the risk of aspiration?
ASit the patient fully upright for meals and for a while afterwards
BLay the patient flat straight after meals so they can rest and digest
CFeed quickly so the patient does not tire during the meal
DGive fluids through a straw so they flow more slowly
16.Med-surg: neuro, endocrine & renalHard
A patient's potassium is 7.1 mmol/L, and the ECG shows peaked T waves and broad QRS complexes. What is the first treatment?
AOral potassium binder
BIV furosemide
CIV calcium gluconate
DOral sodium bicarbonate
17.Med-surg: GI, perioperative & oncologyMedium
Which complication is more typical of Crohn's disease than of ulcerative colitis?
ADisease that is cured by removing the colon
BBleeding only from the rectum
CInflammation limited to the rectal lining
DFistulas between the bowel and other organs
18.Med-surg: GI, perioperative & oncologyHard
On day 5 after bowel resection, a patient has a fever, tachycardia and worsening abdominal pain, and the drain contains brown, faeculent fluid. What is most likely?
AA normal day 5 recovery
BPostoperative constipation
CA urinary tract infection
DAn anastomotic leak
19.Maternity & obstetric nursingMedium
A newborn baby girl has a small amount of blood-tinged vaginal discharge on day 3. What should the nurse tell the parents?
AIt is caused by maternal hormones
BIt means the baby has a bleeding disorder
CIt is a sign of sexual abuse
DIt shows a urinary tract infection
20.Maternity & obstetric nursingHard
A newborn whose mother had a fever and prolonged rupture of membranes is well at birth. Why does the nurse monitor this baby closely?
AThe baby has a higher risk of hip dysplasia
BThe baby is likely to be post-term
CThe baby has a higher risk of early sepsis
DThe baby will certainly develop jaundice
21.Pediatric nursingMedium
Which signs suggest a child is ready to start toilet training?
ABeing able to walk
BReaching the first birthday and being able to walk, whether or not the child shows any interest
CStaying dry for about 2 hours, showing interest and being able to follow simple instructions
DSaying the first word
22.Pediatric nursingHard
Which child is most appropriate to assign to a practical (enrolled) nurse?
AAn infant with bronchiolitis who needs more and more oxygen
BA 7-year-old 2 days after an appendicectomy, stable on oral analgesia
CA 5-year-old just back from tonsillectomy who keeps swallowing
DA 9-year-old newly admitted with diabetic ketoacidosis on an insulin infusion
23.Mental health nursingMedium
Why are tricyclic antidepressants particularly dangerous in overdose?
AThey have no effects in overdose
BThey can cause fatal cardiac arrhythmias and seizures
CThey cause only mild drowsiness
DThey lower blood pressure only slightly and rarely need treatment
24.Mental health nursingHard
Which patient has the highest risk of suicide?
AA 45-year-old man with well-controlled hypertension who works full time
BA 72-year-old widowed man with alcohol dependence who has a gun at home and a plan
CA 30-year-old woman with mild anxiety who has a supportive family
DA 20-year-old student with exam stress who has no thoughts of suicide and good friends
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A drip-rate calculation gives 148.586 gtt/min. The rule in this exercise is that drip rates are rounded to the nearest whole drop. What value x do you record?
148.586 gtt/min
x = gtt/min
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 23:35 and finishes at 05:15 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.
23:3505:15
t = h
27.Dosage calculationsMedium
A patient weighs 60 kg and is prescribed 10 mg/kg as a single dose. Find the dose D in mg.
60 kg10 mg/kg
D = mg
28.Dosage calculationsHard
You must prepare 1000 mL of a 1% (w/v) solution from a 10% (w/v) stock solution. What volume of stock V₁ do you need?
C₁ = 10%C₂ = 1%V₂ = 1000 mL
V₁ = mL
29.IV infusion ratesMedium
1000 mL was ordered over 12 hours. After 9 hours you find that 290 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?
1000 mL / 12 hafter 9 h: 290 mL
R = mL/h
30.IV infusion ratesHard
A bag contains 250 mg of a drug in 500 mL and runs at 8 mL/h. How many milligrams per hour D does the patient receive?
250 mg/500 mL8 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 patient weighs 76 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 50 mL/h. At 07:00, 250 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL250 mL infused50 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 11, with E3 and V4. What motor score M was recorded, and which response does it describe? Give the number.
GCS 11E3V4
M =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 70 mmHg. A patient’s systolic pressure is 116 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 70 mmHg?
MAP 70 mmHgSBP 116 mmHg
DBP = mmHg
3Solutions
1.Nursing fundamentals
Answer: D · It reduces friction and shear on the skin
Why this is the answer
Slide sheets let the patient glide rather than be dragged, protecting the skin from friction and shear and reducing strain on staff.
Answer
D · It reduces friction and shear on the skin
2.Nursing fundamentals
Answer: B · Contact the prescriber or pharmacist for a suitable alternative
Why this is the answer
Crushing a modified-release tablet can release the full dose at once and cause toxicity. The prescriber or pharmacist can suggest a liquid, a patch or another drug, and any omitted dose is documented.
Answer
B · Contact the prescriber or pharmacist for a suitable alternative
3.Infection control & patient safety
Answer: D · Mixing up pounds and kilograms can lead to large dosing errors
Why this is the answer
Pediatric doses are often calculated per kilogram. A weight recorded in pounds but read as kilograms gives a dose more than twice as high, so weight is recorded and used only in kilograms.
Answer
D · Mixing up pounds and kilograms can lead to large dosing errors
4.Infection control & patient safety
Answer: D · Curtains drawn, over 1 meter (3 feet) of space, masks for close contact
Why this is the answer
Droplet precautions focus on distance, masks and barriers. A single room is preferred, so infection control is contacted. Placing the patient near a vulnerable patient would be dangerous.
Answer
D · Curtains drawn, over 1 meter (3 feet) of space, masks for close contact
5.Prioritization & delegation
Answer: C · “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
C · “I will press the button for her while she is asleep so she stays comfortable.”
6.Prioritization & delegation
Answer: D · Red (immediate)
Why this is the answer
A rate under 30/min passes the breathing check, but an absent radial pulse or a capillary refill over 2 seconds fails the perfusion check, so the victim is immediate (red). Stopping after the breathing check is the trap.
Answer
D · Red (immediate)
7.Clinical nursing
Answer: B · It does not need routine INR monitoring
Why this is the answer
DOACs have predictable effects so INR monitoring is not needed. They still cause bleeding, have some interactions and need kidney function checked.
Answer
B · It does not need routine INR monitoring
8.Clinical nursing
Answer: B · Withhold it and check with the prescriber or pharmacist first
Why this is the answer
Nurses must understand any drug they administer. If a dose seems wrong, they should check with the prescriber or pharmacist and document the action.
Answer
B · Withhold it and check with the prescriber or pharmacist first
9.Lab values & electrolytes
Answer: A · Protamine sulfate
Why this is the answer
Protamine sulfate binds heparin and reverses its effect quickly. Unfractionated heparin has a short half-life, so stopping the infusion is the first step. Vitamin K reverses warfarin, not heparin.
Answer
A · Protamine sulfate
10.Lab values & electrolytes
Answer: A · Plasma free metanephrines
Why this is the answer
These episodes suggest pheochromocytoma, a tumor of the adrenal medulla that releases catecholamines. Plasma free metanephrines (or 24-hour urine metanephrines) are the main screening tests. Hyperthyroidism can cause similar symptoms but usually without these bursts of severe hypertension.
Answer
A · Plasma free metanephrines
11.Pharmacology
Answer: A · It is short-acting, and cholesterol synthesis peaks at night
Why this is the answer
The liver makes most cholesterol overnight, and short-acting statins such as simvastatin work best when taken in the evening. Atorvastatin and rosuvastatin can be taken at any time of day.
Answer
A · It is short-acting, and cholesterol synthesis peaks at night
12.Pharmacology
Answer: B · IV hydrocortisone and IV fluids
Why this is the answer
This suggests an adrenal crisis triggered by missed steroids and illness. Treatment is immediate IV or IM hydrocortisone, IV fluids with glucose as needed, and treating the cause.
Answer
B · IV hydrocortisone and IV fluids
13.Med-surg: cardiovascular & respiratory
Answer: C · Explain that phantom limb pain is real and arrange treatment
Why this is the answer
Phantom limb pain is common after amputation and arises from changes in nerves and the brain. It is real and treated with analgesia, including drugs for neuropathic pain, plus measures such as mirror therapy. It does not mean infection.
Answer
C · Explain that phantom limb pain is real and arrange treatment
14.Med-surg: cardiovascular & respiratory
Answer: C · It improves oxygenation; risks are pressure injury and tube displacement
Why this is the answer
Prone positioning improves ventilation–perfusion matching and oxygenation and improves survival in severe ARDS. Turning needs a trained team. Risks include accidental extubation or line removal and pressure damage to the face, chest and knees, so careful positioning and skin checks are essential.
Answer
C · It improves oxygenation; risks are pressure injury and tube displacement
15.Med-surg: neuro, endocrine & renal
Answer: A · Sit the patient fully upright for meals and for a while afterwards
Why this is the answer
Sitting upright during and after meals helps food pass safely and reduces reflux and aspiration. Small mouthfuls, unhurried feeding and the textures advised by the speech and language therapist are also important.
Answer
A · Sit the patient fully upright for meals and for a while afterwards
16.Med-surg: neuro, endocrine & renal
Answer: C · IV calcium gluconate
Why this is the answer
ECG changes mean the heart is at risk. IV calcium is given first to stabilise the myocardium, followed by insulin with glucose (and often nebulised salbutamol) to shift potassium into cells. Binders or dialysis then remove it.
Answer
C · IV calcium gluconate
17.Med-surg: GI, perioperative & oncology
Answer: D · Fistulas between the bowel and other organs
Why this is the answer
Transmural inflammation in Crohn's disease can create fistulas, abscesses and strictures. Ulcerative colitis is mucosal, and removing the colon and rectum is curative.
Answer
D · Fistulas between the bowel and other organs
18.Med-surg: GI, perioperative & oncology
Answer: D · An anastomotic leak
Why this is the answer
Leakage at the join in the bowel causes peritonitis and sepsis, usually a few days after surgery. Faeculent drain fluid makes it very likely. It needs urgent surgical review, sepsis care and often return to theatre.
Answer
D · An anastomotic leak
19.Maternity & obstetric nursing
Answer: A · It is caused by maternal hormones
Why this is the answer
Pseudomenstruation is caused by withdrawal of maternal hormones after birth and resolves within days. Swollen breasts in either sex have the same cause.
Answer
A · It is caused by maternal hormones
20.Maternity & obstetric nursing
Answer: C · The baby has a higher risk of early sepsis
Why this is the answer
Maternal fever, prolonged rupture of membranes and intra-amniotic infection are risk factors for early-onset sepsis. Many protocols require observation of vital signs and feeding, and sometimes blood tests or antibiotics.
Answer
C · The baby has a higher risk of early sepsis
21.Pediatric nursing
Answer: C · Staying dry for about 2 hours, showing interest and being able to follow simple instructions
Why this is the answer
Readiness signs include bladder control for a few hours, awareness of a wet nappy, interest in the toilet and the ability to sit, walk and follow simple instructions, usually between about 18 months and 3 years.
Answer
C · Staying dry for about 2 hours, showing interest and being able to follow simple instructions
22.Pediatric nursing
Answer: B · A 7-year-old 2 days after an appendicectomy, stable on oral analgesia
Why this is the answer
Practical or enrolled nurses usually care for stable children with predictable outcomes. Children who are unstable, newly admitted with a complex condition or showing signs of deterioration need a registered nurse's assessment.
Answer
B · A 7-year-old 2 days after an appendicectomy, stable on oral analgesia
23.Mental health nursing
Answer: B · They can cause fatal cardiac arrhythmias and seizures
Why this is the answer
Tricyclic overdose causes arrhythmias, a widened QRS, hypotension, seizures and coma. For patients at risk of suicide, prescriptions may be limited in quantity.
Answer
B · They can cause fatal cardiac arrhythmias and seizures
24.Mental health nursing
Answer: B · A 72-year-old widowed man with alcohol dependence who has a gun at home and a plan
Why this is the answer
Older age, male sex, being widowed, substance misuse, access to lethal means and a specific plan all raise suicide risk. Having several factors together greatly increases the overall risk.
Answer
B · A 72-year-old widowed man with alcohol dependence who has a gun at home and a plan
25.Nursing math & unit conversions
Answer: x = 149 gtt/min
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 ones place
148.586 → 8
Only the next digit decides
148.586 → 5
5 is 5 or more, so round 8 up.
The digits after it (86) are ignored: round once, never step by step.
Round
x = 149 gtt/min
Answer
x = 149 gtt/min
26.Nursing math & unit conversions
Answer: t = 5.67 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
23:35 → 24:00 = 25 min
After midnight
00:00 → 05:15 = 315 min
Total
25 + 315 = 340 min
t = 340/60 = 5.667 ≈ 5.67 h
Answer
t = 5.67 h
27.Dosage calculations
Answer: D = 600 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.
Dose
10·60 = 600 mg
Answer
D = 600 mg
28.Dosage calculations
Answer: V₁ = 100 mL
Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.
Volume of stock
V₁ = 1·1000/10 = 100 mL
Answer
V₁ = 100 mL
29.IV infusion rates
Answer: R = 96.67 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
1000/12 = 83.33 mL/h
New rate
R = 290/3 = 96.67 mL/h
Answer
R = 96.67 mL/h
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
30.IV infusion rates
Answer: D = 4 mg/h
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Concentration
250/500 = 0.5 mg/mL
Dose rate
D = 0.5·8 = 4 mg/h
Answer
D = 4 mg/h
31.IV fluids & fluid balance
Answer: U = 1.51 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
175 + 375 + 500 + 325 = 1375 mL
Per kilogram per hour
U = 1375/(76·12) = 1.508 ≈ 1.51 mL/kg/h
Answer
U = 1.51 mL/kg/h
32.IV fluids & fluid balance
Answer: t = 5 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 − 250 = 250 mL
Time
t = 250/50 = 5 h
Answer
t = 5 h
That is about 5 h 00 min, so the bag runs out at about 12:00.
33.Clinical assessment scores
Answer: M = 4
Glasgow Coma Scale: add the best response in three areas. Eye opening E: 4 spontaneous, 3 to sound or speech, 2 to pressure, 1 none. Verbal V: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Motor M: 6 obeys commands, 5 localises, 4 normal flexion (withdraws), 3 abnormal flexion, 2 extension, 1 none. The total runs from 3 to 15. After a head injury, 13–15 is usually called mild, 9–12 moderate and 3–8 severe.
Motor score
M = 11 − 3 − 4 = 4
M4: withdraws the limb from pressure (normal flexion)
Answer
M = 4
34.Clinical assessment scores
Answer: DBP = 47 mmHg
Blood pressure values: pulse pressure PP = SBP − DBP. Mean arterial pressure MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3, an estimate based on the heart spending about two thirds of each beat in diastole at a normal heart rate (less accurate when the heart rate is fast); a MAP of at least about 65 mmHg is a common target for organ perfusion. The shock index SI = heart rate/SBP is normally about 0.5–0.7; a value above about 1 is a warning sign of shock.
Rearrange
DBP = (3·MAP − SBP)/2
Substitute
DBP = (3·70 − 116)/2 = 94/2 = 47 mmHg
Answer
DBP = 47 mmHg
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