Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
Prioritization & delegation
Method
Ask what will harm the patient soonest if nothing is done.
Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
Assess before you act unless it is an emergency; then choose the step the others depend on.
For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.
Lab values & electrolytes
Method
Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
Link the value to its typical signs and to the drugs and conditions that cause it.
Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.
Med-surg: cardiovascular & respiratory
Method
Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
Choose the safe first action, then escalate and reassess.
Med-surg: neuro, endocrine & renal
Method
Check the glucose in every patient with new confusion, weakness or a seizure.
Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.
Med-surg: GI, perioperative & oncology
Method
Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.
Maternity & obstetric nursing
Method
Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.
Pediatric nursing
Method
Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
Match the action to the development stage and involve the family.
Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.
Mental health nursing
Method
Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
Respect rights: the least restrictive option, consent and confidentiality with its limits.
Nursing math & unit conversions
Metric steps
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
Weight and length
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
Household measures
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
falls 25, diagnosis 15, aid 15/30, IV 20, gait 10/20, mental status 15
NEWS2 risk
0–4 low; single 3 low–medium; 5–6 medium; ≥ 7 high
Mean arterial pressure
MAP = (SBP + 2·DBP)/3 = DBP + PP/3
Pulse pressure and shock index
PP = SBP − DBP, SI = HR/SBP
Body mass index
BMI = kg/m² = 703·lb/in²
Method
Find the score sheet that the question uses and its range (GCS 3–15, APGAR 0–10, Braden 6–23, Morse 0–125).
Score every item separately, matching the description to its level.
Add the item scores and check that the total lies inside the range.
Apply the cut-offs: for NEWS2 also look for any single parameter scoring 3.
For derived values use MAP = (SBP + 2·DBP)/3, PP = SBP − DBP, SI = HR/SBP and BMI = kg/m².
2Practice problems
1.Nursing fundamentalsMedium
Why does long-term immobility increase the risk of kidney stones?
AThe kidneys stop producing urine during bed rest
BLying flat makes the kidneys produce extra uric acid
CPatients on bed rest drink too much fluid
DCalcium released from bone raises the calcium in the urine
2.Nursing fundamentalsHard
A patient says they have no pain, but grimaces and holds their side whenever they move. What should the nurse do?
ARecord "no pain" and take no further action
BExplore the difference gently and assess the pain further
CTell the patient they are not being honest
DGive the strongest analgesic available straight away
3.Infection control & patient safetyMedium
Sterile saline is spilled on a sterile drape that lies on a non-sterile table. What does this mean?
AThe field is contaminated, because moisture can carry organisms through the drape
BThe field becomes sterile again when it dries
COnly the wet part is contaminated, so items can be moved to the dry part
DThe field stays sterile, because saline is sterile
4.Infection control & patient safetyHard
A patient’s white cell differential shows a raised eosinophil count. Which cause is most consistent with this finding?
ABone marrow suppression from chemotherapy
BA viral infection such as a cold
CAn acute bacterial infection
DAn allergic reaction or a parasitic infection
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 admitted with suspected appendicitis says the pain suddenly got better, but now the abdomen is rigid and the heart rate is rising. What does this suggest?
AThe patient’s analgesic has finally started to work
BThe appendix may have ruptured, causing peritonitis
CThe pain has moved to a different, harmless place
DThe appendicitis is getting better without surgery
7.Clinical nursingMedium
Which statement about storing insulin is correct?
AInsulin should be kept in direct sunlight
BAll insulin should be stored in the freezer to keep it fresh
CUnopened insulin is kept in the fridge and must not be frozen
DInsulin never expires once opened
8.Clinical nursingHard
A patient with severe asthma becomes quiet, with a "silent chest", exhaustion and a falling respiratory rate. What does this indicate?
ANormal recovery after a nebuliser
BImprovement of the attack as the bronchospasm settles and the airways relax
CAnxiety only
DLife-threatening asthma with impending respiratory arrest
9.Lab values & electrolytesMedium
A vancomycin trough level is above the target range. Which adverse effect is the main concern?
AA raised platelet count (thrombocytosis)
BConstipation and bloating
CKidney damage (nephrotoxicity)
DLow blood glucose (hypoglycemia)
10.Lab values & electrolytesHard
Four drug levels are reported. Which patient should the nurse assess first?
ALithium 1.8 mEq/L with a new coarse tremor
BPhenytoin 15 mcg/mL with no symptoms
CDigoxin 1.0 ng/mL with a pulse of 72/min
DValproate 75 mcg/mL with no symptoms
11.PharmacologyMedium
A patient takes low-dose weekly methotrexate for rheumatoid arthritis. Which monitoring is needed?
AWeekly INR checks and a monthly ECG to check the heart rhythm
BRegular blood count, liver and kidney function tests
CMonthly hearing tests
DDaily blood glucose checks
12.PharmacologyHard
A pregnant woman develops a deep vein thrombosis. Which anticoagulant is usually preferred?
ARivaroxaban, a direct oral factor Xa inhibitor
BAspirin alone
CLow-molecular-weight heparin, such as enoxaparin
DWarfarin
13.Med-surg: cardiovascular & respiratoryMedium
Which feature of a COPD exacerbation most suggests that antibiotics are needed?
AAn increase in purulent (green or yellow) sputum
BA dry, tickly cough with no sputum at all for a day
CA mild sore throat that lasted for one day only
DA clear runny nose
14.Med-surg: cardiovascular & respiratoryHard
A patient with a valid, documented do-not-attempt-CPR decision (DNACPR in the UK, DNR or DNAR in the US) is found in cardiac arrest. What should the nurse do?
AStart CPR but use only chest compressions
BNot start CPR, call for support, and provide dignity and comfort
CStart full CPR because the patient's family is not present
DCall the arrest team and let them decide whether to resuscitate
15.Med-surg: neuro, endocrine & renalMedium
A patient receives phenytoin through a nasogastric tube along with continuous enteral feed. Which issue should the nurse know about?
AThe feed can reduce phenytoin absorption, so the feed is often paused around the dose
BPhenytoin makes the feed curdle, so the two must never be used in one patient
CPhenytoin must be crushed and mixed into the feed bag
DThe feed increases phenytoin levels and causes toxicity within hours
16.Med-surg: neuro, endocrine & renalHard
A patient with Parkinson's disease becomes agitated and confused at night. Which newly prescribed drug should the nurse question?
AParacetamol (acetaminophen)
BLactulose
CMelatonin
DHaloperidol
17.Med-surg: GI, perioperative & oncologyMedium
Which approach to red cell transfusion in a stable patient with a GI bleed fits current evidence?
ANever transfuse, whatever the haemoglobin or the symptoms
BTransfuse two units routinely before every endoscopy
CA restrictive threshold, often around 70 g/L, in most stable patients
DTransfuse everyone to keep the haemoglobin above 150 g/L at all times
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 keep the emergency number and call if I feel shivery."
B"If I get a fever, I'll take paracetamol and see if it settles."
C"I'll wash my hands often and avoid people with infections."
D"I'll check my temperature whenever I feel hot, shivery or unwell."
19.Maternity & obstetric nursingMedium
Which behaviour shows positive early bonding between mother and newborn?
ACalling the baby "it" and not looking at it
BAvoiding holding the baby during the first day
CAsking staff to keep the baby in the nursery at all times
DFace-to-face eye contact and talking to the baby
20.Maternity & obstetric nursingHard
A woman has a postpartum haemorrhage. Which nursing action should be done first while help is coming?
AMassage the fundus and look for the source
BGive the baby a bath to free the mother's time
CWeigh the used pads and record the total
DDocument the estimated blood loss in the notes
21.Pediatric nursingMedium
Which finding suggests developmental dysplasia of the hip in an infant?
ABowed legs in a toddler
BEqual leg length, symmetrical skin folds and full, easy abduction of both hips
CA barking cough
DAsymmetric skin folds of the thighs or buttocks and limited hip abduction
22.Pediatric nursingHard
During treatment for diabetic ketoacidosis, a 9-year-old becomes irritable, complains of a headache and then becomes drowsy. What should the nurse suspect?
ANormal tiredness after treatment
BCerebral oedema, an emergency
CThe child is hungry
DHypoglycaemia caused by the fluids
23.Mental health nursingMedium
A patient taking clozapine complains of drooling, especially at night. How should the nurse respond?
AExplain that it is a sign of an allergic reaction to the medicine
BRecognise it as a common side effect, report it and suggest a towel on the pillow
CTell him that it means the clozapine dose is too low and needs to be increased
DStop the clozapine immediately, because this is a sign of agranulocytosis
24.Mental health nursingHard
An 80-year-old surgical patient becomes confused overnight, with fluctuating attention and pulling at his IV line. He was well oriented on admission. What is the most appropriate interpretation?
ABad behaviour that needs restraint immediately
BProbable delirium: look for an underlying physical cause and inform the team
CNormal ageing that needs no action
DRapid progression of dementia that cannot be treated, so no further tests are needed
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 97.2 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.
97.2 °F
T = °C
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion delivers 12 mcg/min. Express this dose rate D in mg/h.
12 mcg/min1 h = 60 min1 mg = 1000 mcg
D = mg/h
27.Dosage calculationsMedium
A child weighing 30 kg is prescribed 10 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?
30 kg10 mg/kg50 mg/mL
V = mL
28.Dosage calculationsHard
The prescription is 540 micrograms. The ampoule contains 2 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
540 mcg2 mg/mL
V = mL
29.IV infusion ratesMedium
A drip runs at 40 gtt/min through a set of 15 gtt/mL. How many millilitres V does the patient receive in 3 hours?
40 gtt/min15 gtt/mL3 h
V = mL
30.IV infusion ratesHard
A bag contains 1 g of a drug in 500 mL. The order is 1 mg per minute. At what rate R do you set the pump, in mL/h?
1 g/500 mL1 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 8-hour shift. The patient weighs 76 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 80 mL/h. At 17:30, 250 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL250 mL infused80 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 61/min and a blood pressure of 132/86 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.
HR 61/minBP 132/86 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 7/min, SpO₂ 99% on room air, blood pressure 118/70 mmHg, pulse 48/min, alert, temperature 37.0 °C. Which clinical risk group does the patient fall into? Click it.
RR 7SpO₂ 99%airSBP 118HR 48AT 37.0 °C
1low
2low–medium
3medium
4high
3Solutions
1.Nursing fundamentals
Answer: D · Calcium released from bone raises the calcium in the urine
Why this is the answer
Without weight-bearing, bone releases calcium, and urine also drains less well when lying flat. Mobilisation and adequate fluids reduce the risk.
Answer
D · Calcium released from bone raises the calcium in the urine
2.Nursing fundamentals
Answer: B · Explore the difference gently and assess the pain further
Why this is the answer
When cues conflict, the nurse looks further. Patients may play pain down for many reasons, such as not wanting to bother staff or fearing side effects.
Answer
B · Explore the difference gently and assess the pain further
3.Infection control & patient safety
Answer: A · The field is contaminated, because moisture can carry organisms through the drape
Why this is the answer
Liquid soaking through a drape can carry organisms up from the non-sterile surface below. The field is considered contaminated and is set up again.
Answer
A · The field is contaminated, because moisture can carry organisms through the drape
4.Infection control & patient safety
Answer: D · An allergic reaction or a parasitic infection
Why this is the answer
Eosinophils rise in allergic conditions such as asthma and drug reactions and in parasitic infections. Acute bacterial infection mainly raises neutrophils, and viral infection often raises lymphocytes.
Answer
D · An allergic reaction or a parasitic infection
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: B · The appendix may have ruptured, causing peritonitis
Why this is the answer
A sudden ease in pain followed by a rigid abdomen and a rising pulse can mean rupture and peritonitis. This is a surgical emergency, so the nurse reports at once.
Answer
B · The appendix may have ruptured, causing peritonitis
7.Clinical nursing
Answer: C · Unopened insulin is kept in the fridge and must not be frozen
Why this is the answer
Unopened insulin is refrigerated; in-use pens or vials are usually kept at room temperature for a limited time stated by the manufacturer. Frozen or overheated insulin must be discarded.
Answer
C · Unopened insulin is kept in the fridge and must not be frozen
8.Clinical nursing
Answer: D · Life-threatening asthma with impending respiratory arrest
Why this is the answer
A silent chest, exhaustion, cyanosis and confusion are life-threatening signs. The patient needs immediate senior and critical care input.
Answer
D · Life-threatening asthma with impending respiratory arrest
9.Lab values & electrolytes
Answer: C · Kidney damage (nephrotoxicity)
Why this is the answer
High vancomycin levels are linked to acute kidney injury and, less often, hearing damage. The nurse reports the result before the next dose and checks the creatinine and urine output.
Answer
C · Kidney damage (nephrotoxicity)
10.Lab values & electrolytes
Answer: A · Lithium 1.8 mEq/L with a new coarse tremor
Why this is the answer
A lithium level of 1.8 mEq/L with a coarse tremor suggests toxicity, which can progress to confusion and seizures. The digoxin, phenytoin and valproate levels are within commonly cited ranges and the patients are stable.
Answer
A · Lithium 1.8 mEq/L with a new coarse tremor
11.Pharmacology
Answer: B · Regular blood count, liver and kidney function tests
Why this is the answer
Methotrexate can cause bone marrow suppression and liver damage, and poor kidney function raises its levels. Blood tests are regular, alcohol is limited and folic acid is usually given on another day.
Answer
B · Regular blood count, liver and kidney function tests
12.Pharmacology
Answer: C · Low-molecular-weight heparin, such as enoxaparin
Why this is the answer
Heparins are large molecules that do not cross the placenta. Warfarin is teratogenic, and direct oral anticoagulants are not recommended in pregnancy.
Answer
C · Low-molecular-weight heparin, such as enoxaparin
13.Med-surg: cardiovascular & respiratory
Answer: A · An increase in purulent (green or yellow) sputum
Why this is the answer
Antibiotics are usually considered when sputum becomes more purulent, especially with more breathlessness or sputum volume, or signs of pneumonia. Many exacerbations are viral. Oral corticosteroids and increased bronchodilators are also used.
Answer
A · An increase in purulent (green or yellow) sputum
14.Med-surg: cardiovascular & respiratory
Answer: B · Not start CPR, call for support, and provide dignity and comfort
Why this is the answer
A valid do-not-attempt-CPR decision means CPR is not attempted. Other appropriate care continues, the senior team and family are informed and the patient is cared for with dignity. Nurses should check that the decision is valid and applies to the situation.
Answer
B · Not start CPR, call for support, and provide dignity and comfort
15.Med-surg: neuro, endocrine & renal
Answer: A · The feed can reduce phenytoin absorption, so the feed is often paused around the dose
Why this is the answer
Enteral feeds can bind phenytoin and greatly reduce how much is absorbed. Local protocols usually pause the feed before and after the dose and flush the tube. Drug levels are monitored.
Answer
A · The feed can reduce phenytoin absorption, so the feed is often paused around the dose
16.Med-surg: neuro, endocrine & renal
Answer: D · Haloperidol
Why this is the answer
Haloperidol is a dopamine antagonist and can severely worsen parkinsonian symptoms. Metoclopramide is avoided for the same reason. Causes of delirium should be looked for, and specialist advice is needed if a drug is required.
Answer
D · Haloperidol
17.Med-surg: GI, perioperative & oncology
Answer: C · A restrictive threshold, often around 70 g/L, in most stable patients
Why this is the answer
Restrictive transfusion (often at a haemoglobin of about 70 g/L, with a target of 70–90 g/L, or a higher threshold in cardiovascular disease) is associated with better outcomes in many GI bleeding patients than liberal transfusion. Massive haemorrhage is managed by major haemorrhage protocols.
Answer
C · A restrictive threshold, often around 70 g/L, in most stable patients
18.Med-surg: GI, perioperative & oncology
Answer: B · "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
B · "If I get a fever, I'll take paracetamol and see if it settles."
19.Maternity & obstetric nursing
Answer: D · Face-to-face eye contact and talking to the baby
Why this is the answer
En face positioning, touching, talking in a high-pitched voice and calling the baby by name are positive bonding behaviours. Persistent avoidance needs further assessment and support.
Answer
D · Face-to-face eye contact and talking to the baby
20.Maternity & obstetric nursing
Answer: A · Massage the fundus and look for the source
Why this is the answer
The first priority is to stop the bleeding: massage a boggy fundus, check for tears, empty the bladder and give uterotonics per protocol. Weighing pads gives a more accurate blood loss but comes after life-saving actions.
Answer
A · Massage the fundus and look for the source
21.Pediatric nursing
Answer: D · Asymmetric skin folds of the thighs or buttocks and limited hip abduction
Why this is the answer
Signs include asymmetric skin folds, limited abduction, an apparently shorter leg and positive Ortolani or Barlow tests. Treatment in infancy often uses a Pavlik harness.
Answer
D · Asymmetric skin folds of the thighs or buttocks and limited hip abduction
22.Pediatric nursing
Answer: B · Cerebral oedema, an emergency
Why this is the answer
Headache, changes in behaviour or consciousness, and a slowing heart rate during DKA treatment suggest cerebral oedema. It needs urgent medical review and treatment.
Answer
B · Cerebral oedema, an emergency
23.Mental health nursing
Answer: B · Recognise it as a common side effect, report it and suggest a towel on the pillow
Why this is the answer
Hypersalivation is a common, unpleasant effect of clozapine, often worse at night. It can be embarrassing and affect adherence, so it is reported; treatments are available, and the nurse also watches for aspiration risk.
Answer
B · Recognise it as a common side effect, report it and suggest a towel on the pillow
24.Mental health nursing
Answer: B · Probable delirium: look for an underlying physical cause and inform the team
Why this is the answer
Acute, fluctuating confusion suggests delirium, often caused by infection, pain, drugs, dehydration, urinary retention or hypoxia. It is a medical emergency; the cause is treated and the patient is kept safe with non-drug measures first.
Answer
B · Probable delirium: look for an underlying physical cause and inform the team
25.Nursing math & unit conversions
Answer: T = 36.2 °C
Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.
Subtract 32
97.2 − 32 = 65.2
Multiply by 5/9
T = 65.2·5/9 = 36.22 ≈ 36.2 °C
Answer
T = 36.2 °C
26.Nursing math & unit conversions
Answer: D = 0.72 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 = 12 mcg/min × (60 min/1 h) × (1 mg/1000 mcg)
Calculate
D = 12·60/1000 = 0.72 mg/h
Answer
D = 0.72 mg/h
27.Dosage calculations
Answer: V = 6 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 = 10·30 = 300 mg
Volume
V = 300/50 = 6 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 6 mL
28.Dosage calculations
Answer: V = 0.27 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.
Same units
2 mg/mL = 2000 mcg/mL
Volume
V = 540/2000 = 0.27 mL
Answer
V = 0.27 mL
29.IV infusion rates
Answer: V = 480 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
40·60/15 = 160 mL/h
Volume
V = 160·3 = 480 mL
Answer
V = 480 mL
30.IV infusion rates
Answer: R = 30 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
1000 mg/500 mL = 2 mg/mL
Dose per hour
1·60 = 60 mg/h
Pump rate
R = 60/2 = 30 mL/h
Answer
R = 30 mL/h
31.IV fluids & fluid balance
Answer: U = 1.64 mL/kg/h
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Total urine
450 + 200 + 350 = 1000 mL
Per kilogram per hour
U = 1000/(76·8) = 1.645 ≈ 1.64 mL/kg/h
Answer
U = 1.64 mL/kg/h
32.IV fluids & fluid balance
Answer: t = 3.1 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Volume left
500 − 250 = 250 mL
Time
t = 250/80 = 3.125 ≈ 3.1 h
Answer
t = 3.1 h
That is about 3 h 08 min, so the bag runs out at about 20:38.
33.Clinical assessment scores
Answer: SI = 0.46
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 = 61/132 = 0.4621 ≈ 0.46
Answer
SI = 0.46
Within or below the usual 0.5–0.7.
34.Clinical assessment scores
Answer: low–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 7/min → 3
SpO₂ 99% → 0
on air → 0
SBP 118 mmHg → 0
HR 48/min → 1
alert (A) → 0
T 37.0 °C → 0
Total and red scores
NEWS2 = 3 + 0 + 0 + 0 + 1 + 0 + 0 = 4
At least one parameter scores 3.
Risk group
low–medium
Answer
low–medium
A single score of 3 needs an urgent review even when the total is low.
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