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
How should the opening of a stoma bag be cut?
ASmaller than the stoma so it grips it tightly
BMuch larger than the stoma so that the edge never rubs against it
CIn any shape, as long as the bag sticks
DTo fit closely around the stoma without pressing on it
2.Nursing fundamentalsHard
In a patient with sepsis, what does a raised blood lactate suggest?
AThe infection has been cured
BThe patient has eaten recently
CThe tissues are not getting enough oxygen
DThe kidneys are making too much urine
3.Infection control & patient safetyMedium
After teaching a patient about a new medication, how does the nurse best check understanding?
AAsk the family whether they understood the teaching
BGive a printed leaflet about the drug and assume the patient will read it at home
CAsk “Do you understand?” and accept a yes
DAsk the patient to explain in their own words how and when to take it
4.Infection control & patient safetyHard
During a disaster, the hospital needs to free beds quickly. Which patient is the best candidate for early discharge?
AA patient admitted overnight for observation who is now stable with normal tests
BA patient on a ventilator in the intensive care unit who is slowly improving
CA patient with ongoing chest pain awaiting cardiac tests
DA patient on an IV heparin infusion that is still being adjusted
5.Prioritization & delegationMedium
A patient taking warfarin has an INR of 5.2 and no signs of bleeding. What should the nurse do?
AHold the warfarin dose and inform the provider
BGive the usual dose and recheck the INR next month
CGive a double dose to correct the result
DEncourage the patient to take aspirin for pain
6.Prioritization & delegationHard
A patient’s serum potassium is 6.1 mEq/L. Which of the patient’s medications should the nurse question first?
AHydrochlorothiazide
BOmeprazole
CSpironolactone
DFurosemide
7.Clinical nursingMedium
An older patient is at high risk of falls on the ward. Which nursing action is most appropriate?
ARestrict the patient to bed at all times
BKeep the call bell and belongings within reach and review medicines that cause drowsiness
CUse bed rails for every patient automatically
DRemove the patient's glasses to prevent breakage
8.Clinical nursingHard
A patient has a high fever with rigors, jaundice and right upper quadrant pain. Which condition is most likely?
AAcute appendicitis
BSimple biliary colic
CAscending cholangitis
DGastro-oesophageal reflux disease
9.Lab values & electrolytesMedium
A patient on hemodialysis has an arteriovenous (AV) fistula in the left arm. Where should the nurse draw routine blood samples?
AFrom the right arm
BFrom the left wrist
CFrom the left hand
DFrom the fistula
10.Lab values & electrolytesHard
A 68-year-old man has fatigue, a hemoglobin of 9.8 g/dL (98 g/L), an MCV of 72 fL and a low ferritin. He eats a normal diet. What is the most important next step?
AGive iron and do no further tests at all
BRepeat the blood count in one year
CStart vitamin B12 injections
DLook for a source of blood loss in the gut
11.PharmacologyMedium
After several years of levodopa treatment, which problem is common?
ASevere hypoglycaemia after each dose
BComplete and permanent loss of all Parkinson's symptoms
CDyskinesias and "on–off" fluctuations in response
DPermanent hearing loss
12.PharmacologyHard
A nurse gave a patient ten times the prescribed dose of hydromorphone. The patient is currently alert. What is the most appropriate sequence of actions?
AMonitor closely, have naloxone ready, inform the prescriber and report
BGive another dose later to balance it out
CChange the chart so that it shows the correct dose, and continue to monitor
DSay nothing because the patient is alert
13.Med-surg: cardiovascular & respiratoryMedium
A patient has a raised B-type natriuretic peptide (BNP or NT-proBNP). What does this mainly reflect?
AIschaemic damage to the heart muscle
BDamage to skeletal muscle after a fall
CInflammation of the liver from congestion
DStretch and pressure overload of the ventricles
14.Med-surg: cardiovascular & respiratoryHard
A patient with obstructive sleep apnoea who uses CPAP at home is having surgery. Which plan is safest after the operation?
AGive extra opioids so the patient sleeps through the night
BLeave the CPAP machine at home, as it is not needed while in hospital
CUse their CPAP machine and monitor closely, using opioids with caution
DNurse the patient lying flat on their back to keep the airway open
15.Med-surg: neuro, endocrine & renalMedium
A patient has had a calcium oxalate kidney stone. Which advice best helps prevent another?
ADrink plenty of fluid so the urine stays pale
BCut all calcium out of the diet
CDrink only a little to avoid diluting the urine
DTake extra vitamin C supplements
16.Med-surg: neuro, endocrine & renalHard
A patient with a severe head injury does not open the eyes, and in response to pain the arms extend and rotate inwards with the legs extended. What does this indicate?
AA normal withdrawal response to a painful stimulus
BExtensor (decerebrate) posturing: severe brainstem injury
CA focal seizure that will stop without any treatment
DFlexor (decorticate) posturing, a sign of mild cortical injury
17.Med-surg: GI, perioperative & oncologyMedium
After a spinal anaesthetic, which nursing check is particularly important?
AReturn of leg sensation and movement, and passing urine
BPeak flow before and after each meal
CPupil reaction every five minutes for the next full day
DBlood glucose every 15 minutes overnight
18.Med-surg: GI, perioperative & oncologyHard
After a high-voltage electrical injury, a patient's urine is dark red-brown. What does this suggest and what is the usual aim?
AMyoglobin from muscle damage; a higher urine output target
BA urinary infection; send a sample and wait for the result
CNormal concentrated urine; restrict fluids
DBleeding from the bladder; stop all fluids
19.Maternity & obstetric nursingMedium
Obesity before pregnancy (BMI 40) most increases the risk of which pregnancy complication?
ALow birth weight from overnutrition
BGestational diabetes
CPlacenta praevia only
DHyperemesis gravidarum
20.Maternity & obstetric nursingHard
A newborn is cold-stressed. Which complications should the nurse anticipate?
AHypoglycaemia, hypoxia and metabolic acidosis
BHypercalcaemia and seizures only
CHyperglycaemia, polycythaemia and hypertension
DFever, diarrhoea and dehydration
21.Pediatric nursingMedium
A child with type 1 diabetes has a stomach bug and is eating very little. What is the correct advice about insulin?
AGive double the usual insulin to prevent ketones
BStop all insulin until the child is eating normally again, then restart at the usual dose
CKeep giving insulin, check glucose and ketones more often and follow the sick-day plan
DGive insulin only if the child is vomiting
22.Pediatric nursingHard
A parent asks why the HPV vaccine is offered in early adolescence (at about 11 to 13 years, depending on the country). Which answer is best?
AIt is only effective if given in the first year of secondary school, before exams start
BIt is given at this age because it prevents chickenpox in adolescence
CIt works best before any exposure to the virus, and young adolescents respond strongly
DChildren of this age are already likely to have the virus, so it treats the infection
23.Mental health nursingMedium
Which effects of methadone should the nurse monitor for?
AHair loss, weight loss and a painful red rash on the face
BAgranulocytosis and a sore throat
CHypertensive crisis after eating aged cheese
DRespiratory depression, sedation and a prolonged QT interval
24.Mental health nursingHard
A patient on suicide precautions asks for his razor to shave. What is the most appropriate response?
AFollow policy, for example by supervising the shave or offering an electric razor
BLet another patient lend him a razor so that staff do not need to be involved and he can keep his privacy
CGive him the razor, because he has the right to his own belongings
DRefuse, and tell him he cannot shave at all while in hospital
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 3:40 AM. Which entry is the same time on the 24-hour clock? Click it.
3:40 AM
102:40
203:40
304:40
415:40
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A serum creatinine result is 3.7 mg/dL. Using 1 mg/dL = 88.4 µmol/L for creatinine, find c in µmol/L to the nearest whole number.
3.7 mg/dL1 mg/dL = 88.4 µmol/L
c = µmol/L
27.Dosage calculationsMedium
A vial contains 2 g of powder. The label says: add 9.2 mL of water for injection to give a total volume of 10 mL. The prescription is 300 mg. What volume V of the reconstituted solution do you give?
2 g+ 9.2 mL → 10 mL300 mg
V = mL
28.Dosage calculationsHard
You must prepare 100 mL of a 2% (w/v) solution from a 25% (w/v) stock solution. What volume of stock V₁ do you need?
C₁ = 25%C₂ = 2%V₂ = 100 mL
V₁ = mL
29.IV infusion ratesMedium
Infuse 500 mL over 8 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
500 mL8 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 20 gtt/min through a set of 15 gtt/mL. There are 400 mL left in the bag. How many hours t until it is empty?
20 gtt/min15 gtt/mL400 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.
milk: 240 mLjelly: 100 mLtea: 150 mLIV infusion: 100 mL/h × 12 hIV antibiotic: 2 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 08:45 and runs by pump at 50 mL/h. How many mL V are left in the bag at 16:15?
1000 mL50 mL/h08:45 → 16:15
V = mL
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 only incomprehensible sounds such as moaning 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). A practice patient is assessed with the Braden scale: sensory perception: completely limited; moisture: constantly moist; activity: walks frequently; mobility: no limitation; nutrition: very poor; friction and shear: problem. Use the bands 19–23 not at risk, 15–18 mild, 13–14 moderate, 10–12 high and 9 or below very high. Click the risk level.
1not at risk
2mild risk
3moderate risk
4high risk
5very high risk
3Solutions
1.Nursing fundamentals
Answer: D · To fit closely around the stoma without pressing on it
Why this is the answer
The opening should fit snugly so stoma output does not reach the skin, but not so tight that it damages the stoma. Stomas shrink in the weeks after surgery, so the size is re-measured.
Answer
D · To fit closely around the stoma without pressing on it
2.Nursing fundamentals
Answer: C · The tissues are not getting enough oxygen
Why this is the answer
When tissues are poorly perfused they switch to anaerobic metabolism and produce lactate. A raised lactate in sepsis signals higher risk and the need for urgent treatment.
Answer
C · The tissues are not getting enough oxygen
3.Infection control & patient safety
Answer: D · Ask the patient to explain in their own words how and when to take it
Why this is the answer
With teach-back, the patient explains the information in their own words, which shows whether the teaching worked. A yes to “Do you understand?” does not confirm understanding.
Answer
D · Ask the patient to explain in their own words how and when to take it
4.Infection control & patient safety
Answer: A · A patient admitted overnight for observation who is now stable with normal tests
Why this is the answer
In a surge, stable patients who could be safely cared for at home are discharged first. Patients who are unstable or need close monitoring or titrated infusions must stay.
Answer
A · A patient admitted overnight for observation who is now stable with normal tests
5.Prioritization & delegation
Answer: A · Hold the warfarin dose and inform the provider
Why this is the answer
An INR well above target raises the risk of serious bleeding. The nurse holds the dose, informs the provider and watches for bleeding. Without bleeding, holding warfarin is usually enough at this level; vitamin K is mainly used for very high INRs or bleeding.
Answer
A · Hold the warfarin dose and inform the provider
6.Prioritization & delegation
Answer: C · Spironolactone
Why this is the answer
Spironolactone is a potassium-sparing diuretic and can raise potassium further. Furosemide and thiazides tend to lower potassium, and omeprazole does not usually affect it.
Answer
C · Spironolactone
7.Clinical nursing
Answer: B · Keep the call bell and belongings within reach and review medicines that cause drowsiness
Why this is the answer
Falls prevention includes assessing risk factors, reviewing sedating drugs, providing glasses, footwear and walking aids, keeping essentials in reach and supporting toileting.
Answer
B · Keep the call bell and belongings within reach and review medicines that cause drowsiness
8.Clinical nursing
Answer: C · Ascending cholangitis
Why this is the answer
Fever, jaundice and right upper quadrant pain (Charcot's triad) suggest infection of an obstructed bile duct. It can rapidly cause sepsis and needs antibiotics and biliary drainage.
Answer
C · Ascending cholangitis
9.Lab values & electrolytes
Answer: A · From the right arm
Why this is the answer
Venipuncture, blood pressure readings and IV lines are avoided in the arm with an AV fistula or graft, to prevent damage, clotting and infection of the access. Only the dialysis team uses the access, for dialysis.
Answer
A · From the right arm
10.Lab values & electrolytes
Answer: D · Look for a source of blood loss in the gut
Why this is the answer
Iron deficiency in an older man or a postmenopausal woman suggests chronic blood loss, often from the gastrointestinal tract, including colorectal cancer. Iron is started, but endoscopy or colonoscopy is needed to find the cause.
Answer
D · Look for a source of blood loss in the gut
11.Pharmacology
Answer: C · Dyskinesias and "on–off" fluctuations in response
Why this is the answer
Long-term levodopa use often leads to motor fluctuations, with periods of good control and periods of stiffness, and to dyskinesias at peak dose. Dose timing and add-on drugs are adjusted to manage this.
Answer
C · Dyskinesias and "on–off" fluctuations in response
12.Pharmacology
Answer: A · Monitor closely, have naloxone ready, inform the prescriber and report
Why this is the answer
The patient may become sedated and develop respiratory depression later, so close monitoring and a ready antidote are needed. The prescriber is informed, the patient is told honestly, and the error is reported to improve the system.
Answer
A · Monitor closely, have naloxone ready, inform the prescriber and report
13.Med-surg: cardiovascular & respiratory
Answer: D · Stretch and pressure overload of the ventricles
Why this is the answer
Natriuretic peptides are released by ventricular myocytes in response to wall stretch. A normal level makes heart failure unlikely; a raised level supports the diagnosis and reflects severity. Levels can also be raised in renal failure and older age. Troponin, not BNP, reflects myocardial necrosis.
Answer
D · Stretch and pressure overload of the ventricles
14.Med-surg: cardiovascular & respiratory
Answer: C · Use their CPAP machine and monitor closely, using opioids with caution
Why this is the answer
Sedatives and opioids worsen airway collapse in OSA. Patients should bring and use their CPAP after surgery, be monitored with pulse oximetry, have opioid-sparing analgesia where possible and be nursed semi-upright or on their side.
Answer
C · Use their CPAP machine and monitor closely, using opioids with caution
15.Med-surg: neuro, endocrine & renal
Answer: A · Drink plenty of fluid so the urine stays pale
Why this is the answer
High fluid intake is the most important measure for preventing stones. Dietary calcium is usually not restricted, because it binds oxalate in the gut. High-dose vitamin C can increase oxalate.
Answer
A · Drink plenty of fluid so the urine stays pale
16.Med-surg: neuro, endocrine & renal
Answer: B · Extensor (decerebrate) posturing: severe brainstem injury
Why this is the answer
Abnormal extension to pain (GCS motor score 2) indicates severe injury at or near the brainstem and carries a worse prognosis than abnormal flexion (decorticate posturing, motor score 3). Any new abnormal posturing needs immediate escalation.
Answer
B · Extensor (decerebrate) posturing: severe brainstem injury
17.Med-surg: GI, perioperative & oncology
Answer: A · Return of leg sensation and movement, and passing urine
Why this is the answer
The nurse monitors the level of the block, recovery of leg movement and sensation, BP and bladder function. Urinary retention is common, and early mobilisation is only safe once motor function returns.
Answer
A · Return of leg sensation and movement, and passing urine
18.Med-surg: GI, perioperative & oncology
Answer: A · Myoglobin from muscle damage; a higher urine output target
Why this is the answer
Electrical injury can cause extensive muscle breakdown, releasing myoglobin that can damage the kidneys. A higher urine output target is set, with fluids titrated and creatine kinase and kidney function monitored.
Answer
A · Myoglobin from muscle damage; a higher urine output target
19.Maternity & obstetric nursing
Answer: B · Gestational diabetes
Why this is the answer
Obesity raises the risks of gestational diabetes, pre-eclampsia, venous thromboembolism, macrosomia, caesarean birth and stillbirth. Early glucose testing and VTE risk assessment are often recommended.
Answer
B · Gestational diabetes
20.Maternity & obstetric nursing
Answer: A · Hypoglycaemia, hypoxia and metabolic acidosis
Why this is the answer
Cold stress raises metabolic rate, using up glucose and oxygen. This can cause hypoglycaemia, hypoxia, anaerobic metabolism with metabolic acidosis and increased pulmonary vascular resistance.
Answer
A · Hypoglycaemia, hypoxia and metabolic acidosis
21.Pediatric nursing
Answer: C · Keep giving insulin, check glucose and ketones more often and follow the sick-day plan
Why this is the answer
Stress hormones during illness raise blood glucose and the risk of ketoacidosis. Insulin is never stopped; glucose and ketones are checked more often, fluids are encouraged and doses are adjusted according to the sick-day rules.
Answer
C · Keep giving insulin, check glucose and ketones more often and follow the sick-day plan
22.Pediatric nursing
Answer: C · It works best before any exposure to the virus, and young adolescents respond strongly
Why this is the answer
HPV is passed on through sexual contact, so vaccination is most effective before any exposure. Younger adolescents also produce a strong antibody response. The vaccine protects against HPV types that cause cervical and other cancers and genital warts.
Answer
C · It works best before any exposure to the virus, and young adolescents respond strongly
23.Mental health nursing
Answer: D · Respiratory depression, sedation and a prolonged QT interval
Why this is the answer
Methadone can cause respiratory depression, especially when starting or with other sedatives, and it can prolong the QT interval. It has a long half-life, so toxicity can build up over several days.
Answer
D · Respiratory depression, sedation and a prolonged QT interval
24.Mental health nursing
Answer: A · Follow policy, for example by supervising the shave or offering an electric razor
Why this is the answer
Patients at risk still need hygiene and dignity. Policies usually allow supervised use of sharps or safer alternatives, which balance safety with respect.
Answer
A · Follow policy, for example by supervising the shave or offering an electric razor
25.Nursing math & unit conversions
Answer: 03:40
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
03:40
Answer
03:40
26.Nursing math & unit conversions
Answer: c = 327 µmol/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 = 3.7·88.4 = 327.1 ≈ 327 µmol/L
Answer
c = 327 µmol/L
27.Dosage calculations
Answer: V = 1.5 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.
Concentration after mixing
2000 mg/10 mL = 200 mg/mL
Volume
V = 300/200 = 1.5 mL
Answer
V = 1.5 mL
28.Dosage calculations
Answer: V₁ = 8 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 = 2·100/25 = 8 mL
Answer
V₁ = 8 mL
29.IV infusion rates
Answer: R = 21 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
8·60 = 480 min
Drip rate
R = 500·20/480 = 20.83 ≈ 21 gtt/min
Answer
R = 21 gtt/min
At the bedside you round to the nearest whole drop: 21 gtt/min.
30.IV infusion rates
Answer: t = 5 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
20·60/15 = 80 mL/h
Time left
t = 400/80 = 5 h
Answer
t = 5 h
31.IV fluids & fluid balance
Answer: I = 1790 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: 240 + 100 + 150 = 490 mL
IV infusion: 100·12 = 1200 mL
IV antibiotic: 2·50 = 100 mL
I = 1790 mL
Answer
I = 1790 mL
32.IV fluids & fluid balance
Answer: V = 625 mL
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.
Elapsed time
08:45 → 16:15 = 7.5 h
Volume infused
50·7.5 = 375 mL
Volume left
V = 1000 − 375 = 625 mL
Answer
V = 625 mL
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 only incomprehensible sounds such as moaning → 2
M: no movement at all → 1
Add
GCS = 1 + 2 + 1 = 4
Severity
GCS 4 → severe
Answer
severe
34.Clinical assessment scores
Answer: high risk
Braden scale: six subscales for pressure-injury risk. Sensory perception, moisture, activity, mobility and nutrition score 1 to 4, from the worst level (1) to no problem (4); friction and shear scores 1 to 3. The total runs from 6 to 23, and a lower total means a higher risk. Common bands: 19–23 not at risk, 15–18 mild risk, 13–14 moderate risk, 10–12 high risk and 9 or below very high risk.