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?
ALet go quickly and call for help
BEase them gently to the floor while protecting their head
CTry to hold them upright with your arms around their chest
DGrab them under the armpits and lift them
2.Nursing fundamentalsHard
Why is the level of sedation a useful early warning in a patient on opioids?
ASedation means the opioid dose is too low
BSedation shows that the pain has completely gone and the dose is right
CIncreasing sedation usually comes before respiratory depression
DSedation only occurs after the breathing has stopped
3.Infection control & patient safetyMedium
Which patient has the highest risk of a burn from a heating pad?
AA patient recovering from a cold
BA healthy young adult with a strained muscle
CA patient with diabetic peripheral neuropathy
DA patient with a sprained wrist who is fully alert
4.Infection control & patient safetyHard
A confused patient keeps pulling at a nasogastric tube. Which approach should be tried first?
ALess restrictive measures, such as reorientation and a sitter
BRemoving the tube without consulting the team
CWrist restraints straight away to protect the tube
DA sedative so that the patient sleeps quietly through the night
5.Prioritization & delegationMedium
Which patient should the RN see first after receiving a report from the night nurse?
ADay 3 after bowel surgery, wants a shower and hair wash before breakfast
BDay 2 after bowel surgery, asking to start a soft diet
CDay 1 after bowel surgery, new chest pain and heart rate 110/min
DDay 4 after bowel surgery, waiting for discharge teaching
6.Prioritization & delegationHard
A patient is going home on a new oral anticoagulant. There is only a short time for teaching. Which topic is most important?
ASigns of bleeding and when to seek help
BHow to cook low-fat meals
CWhich television programs help with relaxation
DHow to choose comfortable walking shoes
7.Clinical nursingMedium
Which group of features is typical of nephrotic syndrome?
APolyuria, thirst and weight loss
BBlood in the urine, high blood pressure and reduced urine output only
CHeavy proteinuria, low serum albumin and oedema
DSevere loin pain and fever
8.Clinical nursingHard
A severely hypothermic patient is in cardiac arrest. Why is resuscitation usually continued until they are rewarmed?
AAdrenaline works better in cold patients
BThe cold protects the brain, so recovery may be possible after long resuscitation
CCold patients cannot be defibrillated at all, so CPR is the only possible treatment
DHypothermia always causes brain death quickly
9.Lab values & electrolytesMedium
A patient's eGFR has fallen to 24 mL/min/1.73 m². Which prescribed drug should the nurse question before giving it?
AAcetaminophen (paracetamol)
BInsulin glargine
CMetformin
DLevothyroxine
10.Lab values & electrolytesHard
A patient receiving IV magnesium sulfate has a respiratory rate of 9/min and absent patellar reflexes. After stopping the infusion, which medication should the nurse expect to give?
AProtamine sulfate
BCalcium gluconate
CPotassium chloride
DSodium bicarbonate
11.PharmacologyMedium
Why is aspirin avoided in children and teenagers with viral illnesses such as flu or chickenpox?
AIt causes grey baby syndrome
BIt is linked to Reye's syndrome, which harms the liver and brain
CIt causes severe, permanent hearing loss in young children
DIt stops the vaccine from working
12.PharmacologyHard
A patient starting sertraline is taught about the drug. Which statement shows a need for further teaching?
A"It may take a few weeks to feel the full effect."
B"If I feel better after a week, I can stop taking it."
C"I may have some nausea at first."
D"I will tell someone if I have thoughts of harming myself."
13.Med-surg: cardiovascular & respiratoryMedium
Which history is a contraindication to thrombolysis for a STEMI?
AA previous appendicectomy many years ago
BA previous haemorrhagic stroke
CTreated high blood pressure
DMild asthma controlled with inhalers
14.Med-surg: cardiovascular & respiratoryHard
A patient with heart failure has gained 2.5 kg in three days, has new crackles at both bases and now sleeps on four pillows. BP 138/84 mmHg, SpO₂ 93% on air. What is the priority?
ALay the patient flat to rest the heart and lower demand
BRecord the weight and check it again at the end of the next week
CSit the patient up, assess fully and report the fluid overload
DEncourage extra oral fluids to protect the kidneys
15.Med-surg: neuro, endocrine & renalMedium
A patient has a nephrostomy tube. Which finding needs urgent action?
AA dry, intact dressing at the site
BLight pink urine on the first day after insertion
CSteady urine drainage into the bag
DDrainage that stops suddenly with new loin pain
16.Med-surg: neuro, endocrine & renalHard
A patient with acute ischaemic stroke is not a thrombolysis candidate. On day 1 the BP is 190/100 mmHg with no other emergency. What is generally appropriate?
AGive nitrate spray every 5 minutes until below 120 mmHg
BAvoid aggressive lowering and follow the stroke team's targets
CLie the patient flat and give a large fluid bolus
DLower it rapidly to 110/70 mmHg with IV drugs
17.Med-surg: GI, perioperative & oncologyMedium
A patient on enteral feeding develops diarrhoea. What should the nurse review first?
AThe patient's eye drops and skin creams
BThe colour of the feeding bag label
CThe patient's mobility aids and walking distance
DThe medicine chart, including laxatives and antibiotics
18.Med-surg: GI, perioperative & oncologyHard
A category (stage) 4 pressure ulcer is now healing and shallower. How should it be documented according to standard guidance?
AAs a category 1 pressure ulcer now
BAs a category 2 pressure ulcer now
CAs a healing category 4 pressure ulcer
DAs a fully healed ulcer that can be removed from the record
19.Maternity & obstetric nursingMedium
Low-dose aspirin may be prescribed from early pregnancy to a woman with a high risk of:
AHyperemesis gravidarum
BPlacenta praevia
CPre-eclampsia
DGestational diabetes
20.Maternity & obstetric nursingHard
A fetus has severe oligohydramnios from the second trimester. Which complication is a major concern for the newborn?
AMacrosomia
BNeonatal hypoglycaemia
CNeural tube defect
DPulmonary hypoplasia
21.Pediatric nursingMedium
A child with respiratory distress becomes bradycardic. What does this mean?
AThe child is recovering and calming down
BA sign of severe hypoxia and possible imminent cardiac arrest
CA side effect of the oxygen therapy
DA normal response to sleep
22.Pediatric nursingHard
Which order should the nurse question for a child with neutropenia after chemotherapy?
AMonitor the temperature by the axillary or oral route
BPerform careful hand hygiene before every contact
CReport a temperature of 38 °C or more immediately
DMeasure the temperature rectally every 4 hours
23.Mental health nursingMedium
A patient is switching from an MAOI to an SSRI. What is essential?
AA washout period of about 2 weeks before starting the SSRI
BDouble the SSRI dose at the start
CTake both drugs together for a month
DStart the SSRI the same day
24.Mental health nursingHard
A depressed patient says, "I don't enjoy anything any more, so there's no point in doing anything." Which intervention best reflects behavioural activation?
APlan small, scheduled activities with him and review how he felt afterwards
BEncourage him to rest in bed as much as possible until the medicine works
CWait until his mood improves before suggesting activities
DTell him that his thoughts are irrational and he should stop thinking that way
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 40.3 °C. Convert it to degrees Fahrenheit T with °F = °C × 9/5 + 32. Round to one decimal place.
40.3 °C
T = °F
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A maintenance infusion runs at 100 mL/h without a break. How many litres V does it deliver in 24 hours?
100 mL/h24 h
V = L
27.Dosage calculationsMedium
A patient weighing 20 kg has a body surface area of 0.94 m². The prescription is 20 mg/m². Find the dose D in mg.
20 kgBSA = 0.94 m²20 mg/m²
D = mg
28.Dosage calculationsHard
You must prepare 100 mL of a 0.5% (w/v) solution from a 20% (w/v) stock solution. How much water W must be added to the stock?
C₁ = 20%C₂ = 0.5%V₂ = 100 mL
W = mL
29.IV infusion ratesMedium
A drip runs at 20 gtt/min through a set of 20 gtt/mL. How many millilitres V does the patient receive in 3 hours?
20 gtt/min20 gtt/mL3 h
V = mL
30.IV infusion ratesHard
A drip runs at 30 gtt/min through a set of 60 gtt/mL. There are 300 mL left in the bag. How many hours t until it is empty?
30 gtt/min60 gtt/mL300 mL
t = 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.
Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 09:30 at 100 mL/h. After 4 hours the rate is changed to 80 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
500 mL100 mL/h · 4 h80 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury does not open the eyes at all, makes no sounds and shows as the best motor response: no movement at all. Work out the GCS and classify the head injury by it. Click your answer.
1mild
2moderate
3severe
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 108 kg and is 168 cm tall. Calculate the BMI and click the WHO weight category.
108 kg168 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
3Solutions
1.Nursing fundamentals
Answer: B · 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
B · Ease them gently to the floor while protecting their head
2.Nursing fundamentals
Answer: C · Increasing sedation usually comes before respiratory depression
Why this is the answer
Patients usually become drowsy before their breathing slows dangerously. Checking sedation with a simple scale alongside respiratory rate allows early action.
Answer
C · Increasing sedation usually comes before respiratory depression
3.Infection control & patient safety
Answer: C · A patient with diabetic peripheral neuropathy
Why this is the answer
Reduced sensation, as in peripheral neuropathy, prevents a person from feeling heat damage. Patients with poor sensation, poor circulation or confusion need very close monitoring if heat is used at all.
Answer
C · A patient with diabetic peripheral neuropathy
4.Infection control & patient safety
Answer: A · Less restrictive measures, such as reorientation and a sitter
Why this is the answer
Less restrictive measures are tried first: reorientation, checking for causes such as pain, securing the tube out of sight and having someone stay with the patient. Restraints or sedatives are used only if these fail and the patient is at risk, with an order.
Answer
A · Less restrictive measures, such as reorientation and a sitter
5.Prioritization & delegation
Answer: C · Day 1 after bowel surgery, new chest pain and heart rate 110/min
Why this is the answer
New chest pain and tachycardia after surgery could be a myocardial infarction or pulmonary embolism. This patient needs immediate assessment; the others have routine needs.
Answer
C · Day 1 after bowel surgery, new chest pain and heart rate 110/min
6.Prioritization & delegation
Answer: A · Signs of bleeding and when to seek help
Why this is the answer
The main risk of anticoagulants is bleeding, so the patient must know the signs, such as black stools or blood in the urine, and when to seek help. Other topics can follow later.
Answer
A · Signs of bleeding and when to seek help
7.Clinical nursing
Answer: C · Heavy proteinuria, low serum albumin and oedema
Why this is the answer
In nephrotic syndrome, damaged glomeruli leak protein, so albumin falls and fluid moves into tissues, causing oedema. Cholesterol is often raised too.
Answer
C · Heavy proteinuria, low serum albumin and oedema
8.Clinical nursing
Answer: B · The cold protects the brain, so recovery may be possible after long resuscitation
Why this is the answer
Hypothermia reduces the brain's oxygen needs, and good recoveries have occurred after long resuscitation. Death is usually not confirmed until the patient has been rewarmed, unless injuries are clearly not survivable.
Answer
B · The cold protects the brain, so recovery may be possible after long resuscitation
9.Lab values & electrolytes
Answer: C · Metformin
Why this is the answer
Metformin is cleared by the kidneys, and it is contraindicated when the eGFR is below 30 mL/min/1.73 m² because of the risk of lactic acidosis. Insulin doses may also need adjustment, but insulin is not contraindicated.
Answer
C · Metformin
10.Lab values & electrolytes
Answer: B · Calcium gluconate
Why this is the answer
Absent reflexes and slow breathing indicate magnesium toxicity. The infusion is stopped, the provider is called, the airway and breathing are supported, and IV calcium gluconate is given as prescribed to counteract magnesium.
Answer
B · Calcium gluconate
11.Pharmacology
Answer: B · It is linked to Reye's syndrome, which harms the liver and brain
Why this is the answer
Aspirin given during viral infections in young people is associated with Reye's syndrome, causing acute encephalopathy and liver failure. Paracetamol or ibuprofen is used for fever instead.
Answer
B · It is linked to Reye's syndrome, which harms the liver and brain
12.Pharmacology
Answer: B · "If I feel better after a week, I can stop taking it."
Why this is the answer
Antidepressants are continued for months after improvement to prevent relapse, and are tapered when stopped. Early nausea, delayed benefit and monitoring for suicidal thoughts are correct points.
Answer
B · "If I feel better after a week, I can stop taking it."
13.Med-surg: cardiovascular & respiratory
Answer: B · A previous haemorrhagic stroke
Why this is the answer
Absolute contraindications include any previous intracranial haemorrhage, recent ischaemic stroke, active internal bleeding, suspected aortic dissection and recent major trauma or surgery. Thrombolysis is used when primary PCI cannot be delivered in time.
Answer
B · A previous haemorrhagic stroke
14.Med-surg: cardiovascular & respiratory
Answer: C · Sit the patient up, assess fully and report the fluid overload
Why this is the answer
Rapid weight gain with crackles and orthopnoea indicates fluid overload and worsening heart failure. Sitting upright reduces venous return and eases breathing. The nurse completes an assessment (oxygen trend, fluid balance, oedema) and escalates so the prescriber can adjust diuretics. More fluid or lying flat would worsen congestion.
Answer
C · Sit the patient up, assess fully and report the fluid overload
15.Med-surg: neuro, endocrine & renal
Answer: D · Drainage that stops suddenly with new loin pain
Why this is the answer
A sudden stop in drainage with pain suggests the tube is blocked or dislodged, so the kidney is obstructed again. The nurse checks for kinks and escalates urgently. Fever or rigors may signal infection.
Answer
D · Drainage that stops suddenly with new loin pain
16.Med-surg: neuro, endocrine & renal
Answer: B · Avoid aggressive lowering and follow the stroke team's targets
Why this is the answer
After ischaemic stroke, the penumbra depends on blood pressure for perfusion. Unless thrombolysis is planned or there is another emergency (such as aortic dissection or acute heart failure), guidelines often accept higher pressures early (for example treating only above 220/120 mmHg in some guidance). Targets are set by the stroke team.
Answer
B · Avoid aggressive lowering and follow the stroke team's targets
17.Med-surg: GI, perioperative & oncology
Answer: D · The medicine chart, including laxatives and antibiotics
Why this is the answer
Diarrhoea on enteral feeds is often caused by drugs such as antibiotics, laxatives and liquid medicines containing sorbitol, or by infection such as C. difficile. The feed is not stopped automatically; the cause is investigated.
Answer
D · The medicine chart, including laxatives and antibiotics
18.Med-surg: GI, perioperative & oncology
Answer: C · As a healing category 4 pressure ulcer
Why this is the answer
Pressure ulcers are not "reverse staged" because granulation tissue does not replace the muscle, fat and dermis that were lost. The wound is described as a healing category 4 ulcer.
Answer
C · As a healing category 4 pressure ulcer
19.Maternity & obstetric nursing
Answer: C · Pre-eclampsia
Why this is the answer
Low-dose aspirin started around 12 weeks reduces the risk of pre-eclampsia in women at high risk, such as those with previous pre-eclampsia, chronic hypertension or kidney disease.
Answer
C · Pre-eclampsia
20.Maternity & obstetric nursing
Answer: D · Pulmonary hypoplasia
Why this is the answer
Amniotic fluid is breathed in and out by the fetus and is needed for lung growth. Prolonged severe oligohydramnios causes pulmonary hypoplasia and limb contractures from compression.
Answer
D · Pulmonary hypoplasia
21.Pediatric nursing
Answer: B · A sign of severe hypoxia and possible imminent cardiac arrest
Why this is the answer
In children, bradycardia caused by hypoxia is an ominous, pre-arrest sign. It needs immediate airway and breathing support and an emergency call.
Answer
B · A sign of severe hypoxia and possible imminent cardiac arrest
22.Pediatric nursing
Answer: D · Measure the temperature rectally every 4 hours
Why this is the answer
Rectal temperatures, enemas and suppositories are avoided in neutropenia because they can injure the mucosa and allow bacteria into the blood. Fever in neutropenia is an emergency.
Answer
D · Measure the temperature rectally every 4 hours
23.Mental health nursing
Answer: A · A washout period of about 2 weeks before starting the SSRI
Why this is the answer
Combining an MAOI with an SSRI can cause serotonin syndrome. A washout of about 2 weeks is usual after stopping an MAOI, and a longer gap (about 5 weeks) is needed when switching from fluoxetine to an MAOI because of its long half-life.
Answer
A · A washout period of about 2 weeks before starting the SSRI
24.Mental health nursing
Answer: A · Plan small, scheduled activities with him and review how he felt afterwards
Why this is the answer
Behavioural activation is based on the idea that activity improves mood, not the other way round. Scheduling achievable, meaningful activities and reviewing the effect breaks the cycle of withdrawal and low mood.
Answer
A · Plan small, scheduled activities with him and review how he felt afterwards
25.Nursing math & unit conversions
Answer: T = 104.5 °F
Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.
Multiply by 9/5
40.3·9/5 = 72.54
Add 32
T = 72.54 + 32 = 104.5 °F
Answer
T = 104.5 °F
26.Nursing math & unit conversions
Answer: V = 2.4 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.
Volume in a day
100 mL/h × 24 h = 2400 mL
In litres
V = 2400/1000 = 2.4 L
Answer
V = 2.4 L
27.Dosage calculations
Answer: D = 18.8 mg
Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).
Dose
D = 20·0.94 = 18.8 mg
Answer
D = 18.8 mg
28.Dosage calculations
Answer: W = 97.5 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 = 0.5·100/20 = 2.5 mL
Water to add
W = 100 − 2.5 = 97.5 mL
Answer
W = 97.5 mL
29.IV infusion rates
Answer: V = 180 mL
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.
Rate in mL/h
20·60/20 = 60 mL/h
Volume
V = 60·3 = 180 mL
Answer
V = 180 mL
30.IV infusion rates
Answer: t = 10 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.
Rate in mL/h
30·60/60 = 30 mL/h
Time left
t = 300/30 = 10 h
Answer
t = 10 h
31.IV fluids & fluid balance
Answer: I = 2020 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: 120 + 350 + 200 = 670 mL
ice chips: 200/2 = 100 mL
IV infusion: 100·12 = 1200 mL
IV antibiotic: 1·50 = 50 mL
I = 2020 mL
Answer
I = 2020 mL
32.IV fluids & fluid balance
Answer: t = 5.3 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
100·4 = 400 mL
500 − 400 = 100 mL left
Second part
100/80 = 1.25 h
Total time
t = 4 + 1.25 = 5.25 ≈ 5.3 h
Answer
t = 5.3 h
That is about 5 h 15 min, so the bag runs out at about 14:45.
33.Clinical assessment scores
Answer: severe
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.
Score each area
E: does not open the eyes at all → 1
V: makes no sounds → 1
M: no movement at all → 1
Add
GCS = 1 + 1 + 1 = 3
Severity
GCS 3 → severe
Answer
severe
34.Clinical assessment scores
Answer: obesity class II
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 = 108/1.68² = 38.27
Category
obesity class II
Answer
obesity class II
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