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
Which nursing record entry is the best example of objective documentation?
A"Ate half of lunch; drank 200 mL of water."
B"Ate well, as usual."
C"Seemed to enjoy the meal."
D"Had a good appetite today and enjoyed lunch."
2.Nursing fundamentalsHard
A patient spills hot tea on their forearm. What is the best immediate first aid?
ACover it with butter or a greasy cream
BCool the burn under cool running water for about 20 minutes
CPut ice or an ice pack directly on the burn for about 10 minutes
DPop any blisters to let the heat escape
3.Infection control & patient safetyMedium
A patient has botulism after eating contaminated food. Which precautions are needed?
ADroplet precautions
BAirborne precautions
CStandard precautions
DContact precautions
4.Infection control & patient safetyHard
A patient with suspected sepsis has orders for blood cultures and an IV antibiotic. What is the correct order of actions?
AGive the antibiotic and take the cultures an hour later
BGive the antibiotic first so that treatment starts, and take the cultures the next day
CWait for the culture results before starting the antibiotic
DDraw the blood cultures first, then give the antibiotic without delay
5.Prioritization & delegationMedium
Which scheduled medication is the most time-critical?
AA daily multivitamin tablet due at 08:00
BRapid-acting insulin due with a breakfast tray that has arrived
CA daily cholesterol-lowering statin tablet due with breakfast at 08:00
DA daily stool softener due with breakfast
6.Prioritization & delegationHard
Which patient’s planned discharge should the nurse question?
AA patient with pneumonia who has been without fever for 48 hours on oral antibiotics
BA patient two days after surgery with a new heart rate of 112/min and a temperature of 38.4 °C
CA patient after a hernia repair who is passing urine and eating
DA patient with a stable cast who is walking safely with crutches
7.Clinical nursingMedium
Under the Mental Capacity Act 2005 (England and Wales), which principle applies?
AA person must be assumed to have capacity unless it is shown that they lack it
BA diagnosis of dementia means the person lacks capacity for all decisions
CCapacity is decided by the next of kin, who must sign a form for every decision
DEveryone over 75 is assumed to lack capacity
8.Clinical nursingHard
A patient is admitted with suspected meningococcal disease. Which infection control measure is usually needed?
ADroplet precautions until 24 hours of effective antibiotics have been given
BAirborne precautions with a negative-pressure room for the whole hospital stay
CNo precautions, because it is not contagious
DIsolation only after the patient has gone home
9.Lab values & electrolytesMedium
A patient with type 2 diabetes starts prednisone each morning. When is the glucose most likely to be highest?
AAt midnight only
BThe glucose will not change
CIn the early morning, before the dose
DIn the afternoon and evening
10.Lab values & electrolytesHard
Which finding most strongly suggests that a patient’s raised creatinine is due to acute kidney injury rather than long-standing chronic kidney disease?
AThe patient has small kidneys on an ultrasound scan
BThe patient has long-standing anemia
CThe creatinine was normal three days ago and has doubled since
DThe patient has had a high creatinine for many years
11.PharmacologyMedium
Why is aspirin avoided in children and teenagers with viral illnesses such as flu or chickenpox?
AIt causes severe, permanent hearing loss in young children
BIt stops the vaccine from working
CIt causes grey baby syndrome
DIt is linked to Reye's syndrome, which harms the liver and brain
12.PharmacologyHard
A woman has received a high-dose oxytocin infusion with large volumes of hypotonic fluid for many hours. She now has a headache, confusion and a low serum sodium. What is the most likely cause?
AExcessive salt in the infusion fluid
BAn allergic reaction to oxytocin causing brain swelling
CWater intoxication from the antidiuretic effect of oxytocin
DNormal tiredness after a long labour
13.Med-surg: cardiovascular & respiratoryMedium
Why are beta-blockers often started after a myocardial infarction?
AThey reduce cholesterol in the blood
BThey raise the heart rate to improve blood flow to the muscle
CThey lower the heart's oxygen demand and reduce arrhythmias
DThey dissolve the clot that is blocking the coronary artery
14.Med-surg: cardiovascular & respiratoryHard
After a car crash, a patient is severely breathless with absent breath sounds on the right, a deviated trachea, distended neck veins and BP 76/40 mmHg. What is the immediate management?
AA chest X-ray to confirm the diagnosis before any treatment
BInsertion of a urinary catheter to monitor output
CLying the patient flat with the legs raised
DUrgent needle or finger decompression of the right chest
15.Med-surg: neuro, endocrine & renalMedium
What is the main purpose of continuous bladder irrigation after a transurethral resection of the prostate (TURP)?
ATo treat a urinary infection after the operation
BTo give the patient extra fluids
CTo stop blood clots from blocking the catheter
DTo measure the size of the bladder
16.Med-surg: neuro, endocrine & renalHard
A patient on peritoneal dialysis notices that less fluid drains out than was put in. They have not opened their bowels for four days, and the effluent is clear. What is the most likely cause?
ABacterial peritonitis
BDialysate given too cold
CConstipation obstructing outflow
DNormal absorption with no action needed
17.Med-surg: GI, perioperative & oncologyMedium
Which statement about feeding in mild acute pancreatitis fits current guidance?
AFood is withheld until the amylase is back to normal
BOral feeding can restart early, once pain and nausea allow
CPatients must stay nil by mouth for at least three weeks to rest the pancreas
DPatients should be fed only by parenteral nutrition
18.Med-surg: GI, perioperative & oncologyHard
A patient arrives in the anaesthetic room without an identity band. What should the nurse do?
AProceed and add a band once in recovery
BUse the spare identity band from the front of the patient's notes folder
CStop and confirm identity, then apply a band
DProceed because the patient can say their name
19.Maternity & obstetric nursingMedium
Why do newborns become cold so easily?
ATheir blood is thicker than adult blood
BThey cannot produce heat at all
CThey have a large surface area and little fat
DThey sweat more than adults
20.Maternity & obstetric nursingHard
A newborn whose mother had a fever and prolonged rupture of membranes is well at birth. Why does the nurse monitor this baby closely?
AThe baby is likely to be post-term
BThe baby has a higher risk of hip dysplasia
CThe baby will certainly develop jaundice
DThe baby has a higher risk of early sepsis
21.Pediatric nursingMedium
A 3-year-old who used to speak in short sentences has stopped talking and no longer responds to her name. What is the most important point?
ALoss of previously gained skills at any age needs prompt assessment
BIt means the child is tired and should be seen in a year
CIt is normal regression at this age
DLanguage develops in sudden spurts, so this is expected
22.Pediatric nursingHard
A 6-year-old with sickle cell disease has a temperature of 39.0 °C. Why is this treated as urgent?
AFever is the normal start of every pain crisis
BFever means a sickling crisis has started, so the child needs a blood transfusion straight away to replace the damaged cells
CChildren with sickle cell disease have reduced spleen function and are at high risk of serious bacterial infection
DIt is not urgent; fever is common in all children
23.Mental health nursingMedium
Which preparation is usual before electroconvulsive therapy (ECT)?
AFasting for several hours, because a brief general anaesthetic is given
BEating a large meal to prevent low blood sugar during the seizure
CNo preparation, because the patient stays fully awake during ECT
DStopping all regular medicines for 2 weeks before the first treatment
24.Mental health nursingHard
A woman arrives in the emergency department after a sexual assault and has a cut on her head that is bleeding. What is the priority?
AAsk her for a detailed account of the assault before any care
BAssess and treat her physical injuries, then offer forensic examination with her consent
CCall the police and wait until they arrive before doing anything else, so that no evidence is lost by mistake
DCollect forensic evidence before treating any injuries
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 1:40 PM. Which entry is the same time on the 24-hour clock? Click it.
1:40 PM
101:40
213:40
312:40
414:40
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An order reads 3 mcg/kg/min for a patient who weighs 71 kg. Express the dose rate D in mg/h. Round to two decimal places.
3 mcg/kg/min71 kg
D = mg/h
27.Dosage calculationsMedium
A vial contains 1 g of powder. The label says: add 9.6 mL of water for injection to give a total volume of 10 mL. The prescription is 240 mg. What volume V of the reconstituted solution do you give?
1 g+ 9.6 mL → 10 mL240 mg
V = mL
28.Dosage calculationsHard
You must prepare 500 mL of a 5% (w/v) solution from a 50% (w/v) stock solution. How much water W must be added to the stock?
C₁ = 50%C₂ = 5%V₂ = 500 mL
W = mL
29.IV infusion ratesMedium
A drip runs at 40 gtt/min through a set of 60 gtt/mL. How many millilitres V does the patient receive in 4 hours?
40 gtt/min60 gtt/mL4 h
V = mL
30.IV infusion ratesHard
A bag contains 2 g of a drug in 500 mL. The order is 3 mg per minute. At what rate R do you set the pump, in mL/h?
2 g/500 mL3 mg/min
R = mL/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).
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 11:00 at 100 mL/h. After 4 hours the rate is changed to 60 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
1000 mL100 mL/h · 4 h60 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 149/min and a blood pressure of 150/83 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.
HR 149/minBP 150/83 mmHg
SI =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 9/min, SpO₂ 98% on room air, blood pressure 78/46 mmHg, pulse 50/min, alert, temperature 37.8 °C. Which clinical risk group does the patient fall into? Click it.
RR 9SpO₂ 98%airSBP 78HR 50AT 37.8 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: A · "Ate half of lunch; drank 200 mL of water."
Why this is the answer
Objective entries describe what was observed or measured. Vague or judgemental phrases such as "good" or "as usual" cannot be checked or compared.
Answer
A · "Ate half of lunch; drank 200 mL of water."
2.Nursing fundamentals
Answer: B · Cool the burn under cool running water for about 20 minutes
Why this is the answer
Cool running water for about 20 minutes reduces pain and depth of injury. Ice can damage tissue further, grease holds heat in, and blisters are left intact to protect the skin.
Answer
B · Cool the burn under cool running water for about 20 minutes
3.Infection control & patient safety
Answer: C · Standard precautions
Why this is the answer
Botulism is caused by a toxin and does not spread from person to person, so standard precautions are used. Suspected cases are reported to public health at once.
Answer
C · Standard precautions
4.Infection control & patient safety
Answer: D · Draw the blood cultures first, then give the antibiotic without delay
Why this is the answer
Cultures are drawn before the first antibiotic dose so the organism can still be grown and identified. The antibiotic is then given promptly, because delay increases the risk of death in sepsis.
Answer
D · Draw the blood cultures first, then give the antibiotic without delay
5.Prioritization & delegation
Answer: B · Rapid-acting insulin due with a breakfast tray that has arrived
Why this is the answer
Rapid-acting insulin is given with a meal; giving it late or without food can cause high or low blood glucose. The other daily medicines can be given a little later without harm.
Answer
B · Rapid-acting insulin due with a breakfast tray that has arrived
6.Prioritization & delegation
Answer: B · A patient two days after surgery with a new heart rate of 112/min and a temperature of 38.4 °C
Why this is the answer
A new fever and tachycardia after surgery can signal infection or another complication, so the nurse should assess and raise the concern before discharge. The other patients are stable and meeting expected goals.
Answer
B · A patient two days after surgery with a new heart rate of 112/min and a temperature of 38.4 °C
7.Clinical nursing
Answer: A · A person must be assumed to have capacity unless it is shown that they lack it
Why this is the answer
The Act begins by presuming capacity. Capacity is decision-specific and time-specific, and people must be given all practicable help to make their own decision.
Answer
A · A person must be assumed to have capacity unless it is shown that they lack it
8.Clinical nursing
Answer: A · Droplet precautions until 24 hours of effective antibiotics have been given
Why this is the answer
Neisseria meningitidis spreads through droplets and close contact. Droplet precautions are used until 24 hours of effective antibiotics, and public health arranges prophylaxis for close contacts.
Answer
A · Droplet precautions until 24 hours of effective antibiotics have been given
9.Lab values & electrolytes
Answer: D · In the afternoon and evening
Why this is the answer
A morning dose of prednisone raises glucose mainly in the afternoon and evening, with a smaller effect overnight. Glucose monitoring and insulin plans often target these times, and doses are adjusted when the steroid is tapered.Checked against:Blood Glucose Test · MedlinePlus (NIH) (2024)
Answer
D · In the afternoon and evening
10.Lab values & electrolytes
Answer: C · The creatinine was normal three days ago and has doubled since
Why this is the answer
A rapid rise from a normal baseline over days is the hallmark of acute kidney injury. Long-standing raised values, small kidneys and chronic anemia point to chronic kidney disease.Checked against:Acute Kidney Injury · StatPearls (NCBI Bookshelf) (2026)
Answer
C · The creatinine was normal three days ago and has doubled since
11.Pharmacology
Answer: D · 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
D · It is linked to Reye's syndrome, which harms the liver and brain
12.Pharmacology
Answer: C · Water intoxication from the antidiuretic effect of oxytocin
Why this is the answer
Oxytocin has antidiuretic activity at high doses. With large volumes of fluid this can cause water retention and dilutional hyponatraemia, so fluid balance and sodium are monitored.
Answer
C · Water intoxication from the antidiuretic effect of oxytocin
13.Med-surg: cardiovascular & respiratory
Answer: C · They lower the heart's oxygen demand and reduce arrhythmias
Why this is the answer
Beta-blockers slow the heart and reduce contractility, lowering myocardial oxygen demand, and protect against arrhythmias. They are particularly beneficial when the ejection fraction is reduced. They are used cautiously in heart block, severe bradycardia, acute heart failure and asthma.
Answer
C · They lower the heart's oxygen demand and reduce arrhythmias
14.Med-surg: cardiovascular & respiratory
Answer: D · Urgent needle or finger decompression of the right chest
Why this is the answer
These signs indicate a tension pneumothorax, which causes obstructive shock. It is decompressed immediately (needle or finger thoracostomy) without waiting for an X-ray, followed by a chest drain. The nurse gives high-flow oxygen and calls for senior help.
Answer
D · Urgent needle or finger decompression of the right chest
15.Med-surg: neuro, endocrine & renal
Answer: C · To stop blood clots from blocking the catheter
Why this is the answer
After TURP, the raw prostate bed bleeds, and clots can block the catheter and cause retention and bladder spasms. Continuous irrigation through a three-way catheter keeps the drainage flowing.
Answer
C · To stop blood clots from blocking the catheter
16.Med-surg: neuro, endocrine & renal
Answer: C · Constipation obstructing outflow
Why this is the answer
Poor outflow is often caused by constipation, catheter kinking or catheter displacement. Changing position, checking clamps and tubing and treating constipation often help; it should be reported. If it persists, imaging checks the catheter position. Clear effluent makes peritonitis less likely.
Answer
C · Constipation obstructing outflow
17.Med-surg: GI, perioperative & oncology
Answer: B · Oral feeding can restart early, once pain and nausea allow
Why this is the answer
Early oral or enteral feeding helps maintain the gut barrier and reduces infection compared with prolonged nil by mouth or parenteral nutrition. In mild pancreatitis, a low-fat diet is usually restarted as soon as tolerated; enzyme levels need not be normal first.
Answer
B · Oral feeding can restart early, once pain and nausea allow
18.Med-surg: GI, perioperative & oncology
Answer: C · Stop and confirm identity, then apply a band
Why this is the answer
Correct identification before anaesthesia prevents wrong-patient surgery. The process stops until identity is confirmed with the patient and records and a band is applied, following the checklist.
Answer
C · Stop and confirm identity, then apply a band
19.Maternity & obstetric nursing
Answer: C · They have a large surface area and little fat
Why this is the answer
Newborns have a large surface area relative to body mass, little subcutaneous fat and thin skin with blood vessels near the surface. They rely on brown fat and cannot shiver effectively.
Answer
C · They have a large surface area and little fat
20.Maternity & obstetric nursing
Answer: D · The baby has a higher risk of early sepsis
Why this is the answer
Maternal fever, prolonged rupture of membranes and intra-amniotic infection are risk factors for early-onset sepsis. Many protocols require observation of vital signs and feeding, and sometimes blood tests or antibiotics.
Answer
D · The baby has a higher risk of early sepsis
21.Pediatric nursing
Answer: A · Loss of previously gained skills at any age needs prompt assessment
Why this is the answer
Regression, the loss of language, social or motor skills, is always a red flag and needs prompt developmental and medical assessment.
Answer
A · Loss of previously gained skills at any age needs prompt assessment
22.Pediatric nursing
Answer: C · Children with sickle cell disease have reduced spleen function and are at high risk of serious bacterial infection
Why this is the answer
Repeated infarction damages the spleen early in childhood (functional asplenia), so encapsulated bacteria can cause overwhelming sepsis. Fever needs urgent assessment and usually antibiotics.
Answer
C · Children with sickle cell disease have reduced spleen function and are at high risk of serious bacterial infection
23.Mental health nursing
Answer: A · Fasting for several hours, because a brief general anaesthetic is given
Why this is the answer
ECT is given under brief general anaesthesia with a muscle relaxant, so pre-procedure fasting is needed. Vital signs, consent and removal of dentures, jewellery and nail varnish are checked as per policy.
Answer
A · Fasting for several hours, because a brief general anaesthetic is given
24.Mental health nursing
Answer: B · Assess and treat her physical injuries, then offer forensic examination with her consent
Why this is the answer
Medical care for injuries comes first. Forensic examination is offered, explained and carried out only with consent, and the nurse supports the survivor's control over each step.
Answer
B · Assess and treat her physical injuries, then offer forensic examination with her consent
25.Nursing math & unit conversions
Answer: 13:40
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
1 PM → 1 + 12 = 13
Answer
13:40
Answer
13:40
26.Nursing math & unit conversions
Answer: D = 12.78 mg/h
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.
Set up the chain
D = 3 mcg/kg/min × 71 kg × (60 min/1 h) × (1 mg/1000 mcg)
Calculate
D = 3·71·60/1000 = 12.78 mg/h
Answer
D = 12.78 mg/h
27.Dosage calculations
Answer: V = 2.4 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
1000 mg/10 mL = 100 mg/mL
Volume
V = 240/100 = 2.4 mL
Answer
V = 2.4 mL
28.Dosage calculations
Answer: W = 450 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 = 5·500/50 = 50 mL
Water to add
W = 500 − 50 = 450 mL
Answer
W = 450 mL
29.IV infusion rates
Answer: V = 160 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
40·60/60 = 40 mL/h
Volume
V = 40·4 = 160 mL
Answer
V = 160 mL
30.IV infusion rates
Answer: R = 45 mL/h
Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).
Concentration
2000 mg/500 mL = 4 mg/mL
Dose per hour
3·60 = 180 mg/h
Pump rate
R = 180/4 = 45 mL/h
Answer
R = 45 mL/h
31.IV fluids & fluid balance
Answer: B = 1050 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: 100 + 250 + 300 = 650 mL
IV infusion: 125·12 = 1500 mL
IV antibiotic: 1·100 = 100 mL
total intake = 2250 mL
Total output
375 + 475 + 350 = 1200 mL
Balance
B = 2250 − 1200 = 1050 mL
Answer
B = 1050 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: t = 14 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
1000 − 400 = 600 mL left
Second part
600/60 = 10 h
Total time
t = 4 + 10 = 14 h
Answer
t = 14 h
That is about 14 h 00 min, so the bag runs out at about 01:00.
33.Clinical assessment scores
Answer: SI = 0.99
Blood pressure values: pulse pressure PP = SBP − DBP. Mean arterial pressure MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3, an estimate based on the heart spending about two thirds of each beat in diastole at a normal heart rate (less accurate when the heart rate is fast); a MAP of at least about 65 mmHg is a common target for organ perfusion. The shock index SI = heart rate/SBP is normally about 0.5–0.7; a value above about 1 is a warning sign of shock.
Shock index
SI = 149/150 = 0.9933 ≈ 0.99
Answer
SI = 0.99
Above the usual 0.5–0.7.
34.Clinical assessment scores
Answer: medium
NEWS2 (National Early Warning Score 2, Royal College of Physicians 2017): score each of the seven parameters with the chart (respiration rate, SpO₂ on scale 1, air or supplemental oxygen, systolic blood pressure, pulse, consciousness on the ACVPU scale and temperature) and add the scores. Clinical risk: 0–4 low; a score of 3 in any single parameter low–medium; 5–6 medium; 7 or more high. A total of 5 or more needs an urgent response.
Score each parameter
RR 9/min → 1
SpO₂ 98% → 0
on air → 0
SBP 78 mmHg → 3
HR 50/min → 1
alert (A) → 0
T 37.8 °C → 0
Total and red scores
NEWS2 = 1 + 0 + 0 + 3 + 1 + 0 + 0 = 5
At least one parameter scores 3.
Risk group
medium
Answer
medium
A total of 5 or more calls for an urgent clinical response.
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