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 shouts at the nurse that nobody has told them when their operation will be. What is the best first response?
ATell the patient to stop shouting or leave the ward
BArgue back that the staff are very busy
CStay calm, listen and acknowledge their frustration
DWalk away until the patient calms down by themselves
2.Nursing fundamentalsHard
A patient on regular morphine is very drowsy, has pinpoint pupils and is breathing 8 times a minute. What is the priority?
ACall for help, support breathing, withhold the opioid and prepare naloxone as per protocol
BGive a strong cup of coffee
CGive the next morphine dose as prescribed
DLet the patient sleep and recheck in four hours
3.Infection control & patient safetyMedium
When should a nurse use an extinguisher on a fire?
ANever; only firefighters may use fire extinguishers
BAlways, even before the alarm has been raised, to save time
COnly if the fire is small, the alarm is raised and the exit is clear
DWhenever there is smoke, even if the exit is blocked
4.Infection control & patient safetyHard
A child with chickenpox is admitted. Which staff member is the best choice to care for the child?
AA nurse with documented immunity to varicella
BA nurse who has never had chickenpox or the vaccine
CA nurse who is pregnant and unsure of her immunity
DA student nurse with unknown immunity
5.Prioritization & delegationMedium
A patient is admitted with diabetic ketoacidosis. Which prescribed treatment is usually started first?
ASubcutaneous long-acting insulin only, given once
BIV isotonic fluid such as 0.9% sodium chloride
CA high-carbohydrate meal
DOral potassium tablets
6.Prioritization & delegationHard
A chemical cleaning fluid splashes into a patient’s eye. What should the nurse do first?
AGive antibiotic eye drops first
BRub the eye gently with a clean tissue to remove the chemical
CFlush the eye with plenty of water or saline straight away
DCover the eye with a dry patch and wait for the provider
7.Clinical nursingMedium
Why are patients encouraged to use an incentive spirometer after abdominal surgery?
ATo strengthen the abdominal muscles around the wound
BTo lower their heart rate before mobilising
CTo encourage deep breaths that prevent atelectasis and chest infection
DTo measure their lung function so the result can go in the discharge letter
8.Clinical nursingHard
A patient with severe ulcerative colitis develops abdominal distension, fever and tachycardia, and the number of stools falls. What complication should be suspected?
AToxic megacolon
BRecovery from the colitis
CConstipation from dehydration
DCoeliac disease
9.Lab values & electrolytesMedium
When blood is drawn from a central venous catheter, why is a small volume of blood usually discarded first, according to policy?
ATo remove blood clots that form in all central lines
BTo avoid diluting the sample with flush or infusion fluid
CTo check that the catheter tip is still in the right vein
DTo lower the patient's hemoglobin for a blood transfusion
10.Lab values & electrolytesHard
A patient with a heart murmur and fever has three sets of blood cultures, taken hours apart, all growing the same Streptococcus species. What does this suggest?
APersistent bacteremia, as in infective endocarditis
BContamination of all three samples during collection
CA urinary tract infection that has spread to the skin
DA normal finding in patients with heart murmurs
11.PharmacologyMedium
A patient takes theophylline for COPD. Which advice is most important?
AAvoid potassium-rich foods such as bananas
BLimit coffee, tea and cola, because caffeine adds to the side effects
CTake extra doses when short of breath
DDrink plenty of grapefruit juice each morning to improve absorption
12.PharmacologyHard
A woman with epilepsy who takes an antiepileptic drug plans to become pregnant. Which advice is standard?
ATake folic acid before conception and seek specialist review of her medication
BStop all antiepileptic drugs straight away as soon as she stops contraception
CNo change is needed, as antiepileptics carry no risk in pregnancy
DAvoid folic acid because it lowers drug levels
13.Med-surg: cardiovascular & respiratoryMedium
What is the main problem in heart failure with preserved ejection fraction?
AA blocked pulmonary artery
BA dilated ventricle that cannot contract strongly
CA stiff ventricle that fills poorly in diastole
DA leaking aortic valve
14.Med-surg: cardiovascular & respiratoryHard
Two adults with cystic fibrosis are admitted to the same ward. What is the correct infection-control plan?
AUse standard precautions only, as CF is not infectious
BLet them share physiotherapy sessions and equipment
CNurse them in separate single rooms and keep them apart
DPut them in the same bay so they can support each other
15.Med-surg: neuro, endocrine & renalMedium
Which group of drugs is a well-known cause of SIADH and hyponatraemia, especially in older people?
APenicillin antibiotics
BSSRI antidepressants
CBulk-forming laxatives
DProton pump inhibitors
16.Med-surg: neuro, endocrine & renalHard
During haemodialysis, a patient's BP falls to 80/50 mmHg and they feel dizzy and sick. What is the most appropriate first nursing action?
AGive the patient's usual antihypertensive dose straight away
BIncrease the fluid removal rate so the session ends sooner
CSit the patient upright and encourage a short walk
DLie the patient flat, reduce fluid removal and get help
17.Med-surg: GI, perioperative & oncologyMedium
Why are patients with diabetes often placed early on the operating list?
ABecause their surgery always takes longer than others
BTo shorten fasting and reduce swings in blood glucose
CBecause they need to go home before midday
DBecause their wounds heal faster in the morning
18.Med-surg: GI, perioperative & oncologyHard
A nurse teaches a patient going home between chemotherapy cycles. Which statement shows a need for further teaching?
A"I'll wash my hands often and avoid people with infections."
B"I'll check my temperature whenever I feel hot, shivery or unwell."
C"If I get a fever, I'll take paracetamol and see if it settles."
D"I'll keep the emergency number and call if I feel shivery."
19.Maternity & obstetric nursingMedium
A woman says she uses cannabis daily to manage nausea in pregnancy. What is the best nursing response?
AAdvise her to switch to tobacco instead
BTell her that cannabis is a natural remedy and safe in pregnancy
CExplain the risks without judgement and offer safer treatments
DRefuse to continue her care until she stops
20.Maternity & obstetric nursingHard
Why is weighing blood-soaked pads better than visual estimation of postpartum blood loss?
AWeighing tells you the cause of the bleeding
BVisual estimates always overestimate blood loss
CWeighing is faster than looking
DVisual estimates underestimate large losses
21.Pediatric nursingMedium
How should anti-sickness medicine be given to a child receiving chemotherapy that often causes vomiting?
AOnly if the child asks for it
BOnly after the child has already vomited at least twice
COnly at night, when the child is asleep
DBefore the chemotherapy starts and then regularly
22.Pediatric nursingHard
A 5-year-old with leukaemia tells the nurse she is ill because she was naughty. What is the best response?
AAgree that being good may help her get better faster
BReassure her clearly that nothing she did or thought made her ill
CIgnore the remark, as she is too young to understand
DExplain the cell biology of leukaemia to her in detail
23.Mental health nursingMedium
A woman was assaulted 10 days ago. She has nightmares, avoids the area and feels detached. According to DSM-5, which diagnosis fits the timing best?
AGeneralised anxiety disorder
BAcute stress disorder
CPost-traumatic stress disorder
DAdjustment disorder with anxiety
24.Mental health nursingHard
A patient with capacity has signed consent for a course of ECT. After two sessions, she says she wants to stop. What is correct?
AShe can withdraw her consent at any time, and her decision must be respected and reported to the team
BShe can only stop if her family agrees
CHer signed consent becomes binding after the first session, so the agreed course must now be completed
DShe must complete the course once she has signed
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose calculation for an injection gives 11.1365 mL. The rule in this exercise is that volumes of 1 mL or more are rounded to the nearest tenth of a mL. What value x do you record?
11.1365 mL
x = mL
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 22:10 and finishes at 03:30 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.
22:1003:30
t = h
27.Dosage calculationsMedium
A child weighing 14 kg is prescribed 5 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?
14 kg5 mg/kg25 mg/mL
V = mL
28.Dosage calculationsHard
A patient is 136 cm tall and weighs 47 kg. The prescription is 60 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.
136 cm47 kg60 mg/m²
D = mg
29.IV infusion ratesMedium
Infuse 1500 mL over 6 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
1500 mL6 h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 200 mg of a drug in 100 mL and runs at 5 mL/h. How many milligrams per hour D does the patient receive?
200 mg/100 mL5 mL/h
D = mg/h
31.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 500 mL bag was started at 12:00 and runs by pump at 120 mL/h. How many mL V are left in the bag at 13:00?
500 mL120 mL/h12:00 → 13:00
V = mL
33.Clinical assessment scoresMedium
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: impaired; mental status: knows own limits. Find the Morse total MFS.
0–125
MFS =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). At 1 minute after birth, a practice newborn has blue or pale skin all over, a heart rate of 65/min, no response to stimulation, some flexion of the arms and legs and slow, irregular breathing with a weak cry. Score the APGAR and click how the score is interpreted.
1reassuring
2moderately abnormal
3low
3Solutions
1.Nursing fundamentals
Answer: C · Stay calm, listen and acknowledge their frustration
Why this is the answer
Listening calmly and acknowledging feelings often de-escalates anger. The nurse then finds out the answer or explains what will happen next. Staff safety is maintained throughout.
Answer
C · Stay calm, listen and acknowledge their frustration
2.Nursing fundamentals
Answer: A · Call for help, support breathing, withhold the opioid and prepare naloxone as per protocol
Why this is the answer
Reduced consciousness, slow breathing and pinpoint pupils suggest opioid toxicity. The nurse should get help, maintain the airway and give oxygen as needed, stop further opioids and use naloxone as prescribed by protocol.
Answer
A · Call for help, support breathing, withhold the opioid and prepare naloxone as per protocol
3.Infection control & patient safety
Answer: C · Only if the fire is small, the alarm is raised and the exit is clear
Why this is the answer
Staff may attempt to put out a small, contained fire once people are safe and the alarm has been raised, keeping an exit behind them. Otherwise, they close doors and evacuate.
Answer
C · Only if the fire is small, the alarm is raised and the exit is clear
4.Infection control & patient safety
Answer: A · A nurse with documented immunity to varicella
Why this is the answer
Staff with proven immunity, from vaccination or past infection, should care for patients with varicella. Non-immune staff, especially pregnant staff, risk infection and can spread the virus to other patients.
Answer
A · A nurse with documented immunity to varicella
5.Prioritization & delegation
Answer: B · IV isotonic fluid such as 0.9% sodium chloride
Why this is the answer
Patients with DKA are severely dehydrated, so IV isotonic fluid is started first. IV insulin follows, with close monitoring of potassium, which can fall quickly.
Answer
B · IV isotonic fluid such as 0.9% sodium chloride
6.Prioritization & delegation
Answer: C · Flush the eye with plenty of water or saline straight away
Why this is the answer
Chemical eye injuries are treated by immediate, continuous irrigation with large amounts of water or saline. Delay, rubbing or a patch allows more damage.
Answer
C · Flush the eye with plenty of water or saline straight away
7.Clinical nursing
Answer: C · To encourage deep breaths that prevent atelectasis and chest infection
Why this is the answer
Shallow breathing after surgery lets alveoli collapse, causing atelectasis and pneumonia. Deep-breathing exercises with an incentive spirometer help keep the lungs expanded.
Answer
C · To encourage deep breaths that prevent atelectasis and chest infection
8.Clinical nursing
Answer: A · Toxic megacolon
Why this is the answer
Toxic megacolon is acute dilatation of the inflamed colon with systemic toxicity, and it can perforate. Reduced stool frequency with worsening distension is a warning sign needing urgent surgical review.
Answer
A · Toxic megacolon
9.Lab values & electrolytes
Answer: B · To avoid diluting the sample with flush or infusion fluid
Why this is the answer
Central lines contain flush solution or infused fluids, which can dilute the sample or add glucose, heparin or electrolytes. Infusions are paused and an initial volume is discarded (or reinfused per policy) before the sample is drawn; then the line is flushed.
Answer
B · To avoid diluting the sample with flush or infusion fluid
10.Lab values & electrolytes
Answer: A · Persistent bacteremia, as in infective endocarditis
Why this is the answer
Several positive cultures with the same organism, taken at different times, show continuous bacteremia, typical of infective endocarditis. Echocardiography is done and prolonged IV antibiotics are started. Contamination usually affects only one bottle.Checked against:Blood culture · MedlinePlus (NIH) (2025)
Answer
A · Persistent bacteremia, as in infective endocarditis
11.Pharmacology
Answer: B · Limit coffee, tea and cola, because caffeine adds to the side effects
Why this is the answer
Theophylline has a narrow therapeutic range, and caffeine adds stimulant effects such as tachycardia, restlessness and insomnia. Toxicity can cause arrhythmias and seizures, so blood levels may be monitored.
Answer
B · Limit coffee, tea and cola, because caffeine adds to the side effects
12.Pharmacology
Answer: A · Take folic acid before conception and seek specialist review of her medication
Why this is the answer
Folic acid before and in early pregnancy reduces the risk of neural tube defects. Medication should be reviewed before conception, but drugs should not be stopped suddenly because uncontrolled seizures are also dangerous.
Answer
A · Take folic acid before conception and seek specialist review of her medication
13.Med-surg: cardiovascular & respiratory
Answer: C · A stiff ventricle that fills poorly in diastole
Why this is the answer
In HFpEF, the left ventricle is stiff and relaxes poorly, so filling pressures rise and cause congestion even though the ejection fraction is normal. It is common in older people with hypertension, diabetes and obesity. HFrEF is mainly a problem of contraction.
Answer
C · A stiff ventricle that fills poorly in diastole
14.Med-surg: cardiovascular & respiratory
Answer: C · Nurse them in separate single rooms and keep them apart
Why this is the answer
People with CF are colonised with organisms such as Pseudomonas aeruginosa and Burkholderia cepacia complex that can pass between patients and worsen outcomes. They are cared for in single rooms and kept apart, without sharing equipment or sessions.
Answer
C · Nurse them in separate single rooms and keep them apart
15.Med-surg: neuro, endocrine & renal
Answer: B · SSRI antidepressants
Why this is the answer
SSRIs such as sertraline and citalopram can cause SIADH, particularly in older adults. Carbamazepine, some antipsychotics and some chemotherapy drugs are other causes. Sodium is checked if symptoms appear.
Answer
B · SSRI antidepressants
16.Med-surg: neuro, endocrine & renal
Answer: D · Lie the patient flat, reduce fluid removal and get help
Why this is the answer
Intradialytic hypotension is common. Positioning, reducing or pausing ultrafiltration and giving a small saline bolus as per protocol usually restore the blood pressure. Antihypertensives are often held before dialysis in patients prone to hypotension, as prescribed.
Answer
D · Lie the patient flat, reduce fluid removal and get help
17.Med-surg: GI, perioperative & oncology
Answer: B · To shorten fasting and reduce swings in blood glucose
Why this is the answer
Shorter fasting reduces the risk of hypoglycaemia and makes it easier to restart normal eating and medicines. Glucose is monitored, and a variable-rate insulin infusion may be used for longer fasts.
Answer
B · To shorten fasting and reduce swings in blood glucose
18.Med-surg: GI, perioperative & oncology
Answer: C · "If I get a fever, I'll take paracetamol and see if it settles."
Why this is the answer
Fever or feeling unwell during the nadir may mean neutropenic sepsis, which needs urgent assessment and antibiotics within an hour. Patients must call the emergency line straight away, not wait at home.
Answer
C · "If I get a fever, I'll take paracetamol and see if it settles."
19.Maternity & obstetric nursing
Answer: C · Explain the risks without judgement and offer safer treatments
Why this is the answer
Cannabis in pregnancy is associated with low birth weight and possible effects on brain development. The nurse discusses the risks without judgement, offers safer antiemetics and support and continues care.
Answer
C · Explain the risks without judgement and offer safer treatments
20.Maternity & obstetric nursing
Answer: D · Visual estimates underestimate large losses
Why this is the answer
Quantitative measurement by weighing pads and drapes is more accurate. Visual estimates tend to underestimate heavy bleeding, which can delay treatment.
Answer
D · Visual estimates underestimate large losses
21.Pediatric nursing
Answer: D · Before the chemotherapy starts and then regularly
Why this is the answer
Antiemetics work best when given before chemotherapy and on a regular schedule, not only after vomiting begins. Uncontrolled vomiting can also cause anticipatory nausea with later treatments.
Answer
D · Before the chemotherapy starts and then regularly
22.Pediatric nursing
Answer: B · 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
B · Reassure her clearly that nothing she did or thought made her ill
23.Mental health nursing
Answer: B · Acute stress disorder
Why this is the answer
Acute stress disorder lasts from 3 days to 1 month after a trauma. If symptoms last longer than 1 month, PTSD is diagnosed. ICD-11 does not have this diagnosis and describes an acute stress reaction as a normal response rather than a disorder.
Answer
B · Acute stress disorder
24.Mental health nursing
Answer: A · She can withdraw her consent at any time, and her decision must be respected and reported to the team
Why this is the answer
A person with capacity can withdraw consent at any time. The nurse informs the team, who discuss the decision with her. Treatment without consent is only possible under specific legal conditions.
Answer
A · She can withdraw her consent at any time, and her decision must be respected and reported to the team
25.Nursing math & unit conversions
Answer: x = 11.1 mL
Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.
Digit in the tenths place
11.1365 → 1
Only the next digit decides
11.1365 → 3
3 is 4 or less, so 1 stays.
The digits after it (65) are ignored: round once, never step by step.
Round
x = 11.1 mL
Answer
x = 11.1 mL
26.Nursing math & unit conversions
Answer: t = 5.33 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
22:10 → 24:00 = 110 min
After midnight
00:00 → 03:30 = 210 min
Total
110 + 210 = 320 min
t = 320/60 = 5.333 ≈ 5.33 h
Answer
t = 5.33 h
27.Dosage calculations
Answer: V = 2.8 mL
Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.
Dose from body weight
D = 5·14 = 70 mg
Volume
V = 70/25 = 2.8 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 2.8 mL
28.Dosage calculations
Answer: D = 79.95 mg
Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).
Body surface area
BSA = √(136·47/3600) = √1.776 = 1.332 m²
Dose
D = 60·1.332 = 79.95 mg
Answer
D = 79.95 mg
29.IV infusion rates
Answer: R = 42 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
6·60 = 360 min
Drip rate
R = 1500·10/360 = 41.67 ≈ 42 gtt/min
Answer
R = 42 gtt/min
At the bedside you round to the nearest whole drop: 42 gtt/min.
30.IV infusion rates
Answer: D = 10 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
200/100 = 2 mg/mL
Dose rate
D = 2·5 = 10 mg/h
Answer
D = 10 mg/h
31.IV fluids & fluid balance
Answer: B = 950 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.
Total intake
oral: 200 + 250 = 450 mL
ice chips: 200/2 = 100 mL
IV infusion: 100·12 = 1200 mL
IV antibiotic: 2·50 = 100 mL
total intake = 1850 mL
Total output
250 + 175 + 200 + 275 = 900 mL
Balance
B = 1850 − 900 = 950 mL
Answer
B = 950 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: V = 380 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
12:00 → 13:00 = 1 h
Volume infused
120·1 = 120 mL
Volume left
V = 500 − 120 = 380 mL
Answer
V = 380 mL
33.Clinical assessment scores
Answer: MFS = 20
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: impaired → 20
mental status: knows own limits → 0
Add
Morse total = 0 + 0 + 0 + 0 + 20 + 0 = 20
Answer
MFS = 20
34.Clinical assessment scores
Answer: low
APGAR score: five signs, each scored 0, 1 or 2, checked at 1 and 5 minutes after birth. Appearance (colour): blue or pale 0, pink body with blue extremities 1, pink all over 2. Pulse: absent 0, below 100/min 1, 100/min or more 2. Grimace (reflex irritability): none 0, grimace 1, cry, cough or sneeze 2. Activity (tone): limp 0, some flexion 1, active movement 2. Respiration: absent 0, slow or irregular with a weak cry 1, good with a strong cry 2. A total of 7–10 is reassuring, 4–6 moderately abnormal and 0–3 low.
Score each sign
Appearance: blue or pale skin all over → 0
Pulse: 65/min → 1
Grimace: no response to stimulation → 0
Activity: some flexion of the arms and legs → 1
Respiration: slow, irregular breathing with a weak cry → 1
Add
APGAR = 0 + 1 + 0 + 1 + 1 = 3
Interpretation
3 → low
Answer
low
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