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 should the same pain scale be used each time a patient's pain is assessed?
ASo scores can be compared to see whether pain is improving
BBecause only one scale is valid for adults
CBecause using different pain scales on one patient is against the law
DSo the patient learns the right answer to give
2.Nursing fundamentalsHard
A patient who now lacks capacity made a valid, applicable advance decision refusing a specific life-sustaining treatment. What should staff do (England and Wales)?
AIgnore it, because only verbal wishes count
BAsk the family to overrule it
CFollow the advance decision and not give that treatment
DGive the treatment because the patient cannot decide now
3.Infection control & patient safetyMedium
During routine handwashing with soap and water (medical asepsis), how are the hands held?
ATouching the inside of the sink for support
BHigher than the elbows, so water runs down the arms
CLevel with the shoulders, away from the sink
DLower than the elbows, so water runs off the fingertips
4.Infection control & patient safetyHard
A patient is admitted with acute diarrhea, and C. difficile is suspected. The test result is pending. When should contact precautions start?
AAfter three days of diarrhea
BOnly when the test result comes back positive
CStraight away, without waiting for the test result
DOnly if the patient develops a fever
5.Prioritization & delegationMedium
During an IV vancomycin infusion, a patient develops flushing and itching of the face and neck. What should the nurse do first?
AIgnore it, because flushing is always harmless and passes
BSpeed up the infusion to finish it quickly
CApply a warm compress to the face and neck
DStop or slow the infusion and inform the provider
6.Prioritization & delegationHard
A patient with known abdominal aortic aneurysm suddenly has severe back pain, a pulsing mass in the abdomen and a falling blood pressure. What should the nurse do?
ACall for emergency help at once and prepare for urgent surgery
BPalpate the mass firmly to check its size and spread
CGive an oral analgesic and reassess the patient in about one hour
DEncourage the patient to walk to ease the back pain
7.Clinical nursingMedium
A patient with heart failure has pink, frothy sputum and crackles throughout both lungs. What is happening?
AAcute pulmonary oedema
BUpper gastrointestinal bleeding
CPneumothorax
DAsthma attack
8.Clinical nursingHard
In triage, which patient should be seen first?
AA patient with noisy breathing and swollen lips after eating peanuts
BA patient asking for a repeat prescription
CA patient with a sprained ankle and mild swelling
DA patient with a two-day history of sore throat
9.Lab values & electrolytesMedium
In the US, when is a pregnant woman without known risk factors usually screened for gestational diabetes?
AAt about 6–8 weeks of pregnancy
BAt about 38–40 weeks of pregnancy
COnly after the baby is born
DAt about 24–28 weeks of pregnancy
10.Lab values & electrolytesHard
A patient taking an SGLT2 inhibitor has nausea and fast breathing. Glucose 190 mg/dL (10.5 mmol/L), pH 7.15, bicarbonate 10 mEq/L, blood ketones high. What is the most likely diagnosis?
AHyperosmolar hyperglycemic state
BSimple fasting ketosis only
CEuglycemic diabetic ketoacidosis
DRespiratory acidosis from COPD
11.PharmacologyMedium
When does oseltamivir give the most benefit in influenza?
AWhen started within 48 hours of the first symptoms
BOnly after a bacterial pneumonia has developed
CAt any time, as the timing makes no difference
DOnly after symptoms have lasted at least one week
12.PharmacologyHard
Before starting long-term bisphosphonate treatment, a patient is advised to have a dental check-up. Why?
AThey are linked to osteonecrosis of the jaw after dental surgery
BBisphosphonates cause severe gum overgrowth
CBisphosphonates dissolve tooth enamel within weeks
DBisphosphonates stain the teeth black if taken for many years
13.Med-surg: cardiovascular & respiratoryMedium
A woman with hypertension who takes lisinopril says she is planning a pregnancy. What should the nurse advise?
AContinue lisinopril, as it is the safest blood pressure drug in pregnancy
BStop all blood pressure treatment straight away without telling anyone
CDiscuss switching medicine with the prescriber before trying to conceive
DDouble the dose to protect the baby from high blood pressure
14.Med-surg: cardiovascular & respiratoryHard
An adult inhales a peanut while laughing and now has a persistent cough and wheeze on one side. Where is the peanut most likely to have lodged?
AThe right main bronchus
BThe left main bronchus
CThe nasal cavity
DThe oesophagus
15.Med-surg: neuro, endocrine & renalMedium
Which nursing action helps most to prevent and manage delirium in an older inpatient?
AUse glasses and hearing aids and reorient the patient often
BMove the patient to a different room each day for variety
CRestrain the patient so that they do not wander off the ward
DKeep the lights on all night so the patient can see clearly
16.Med-surg: neuro, endocrine & renalHard
A day after a total thyroidectomy, a patient has tingling lips, a positive Chvostek's sign and a corrected calcium of 1.85 mmol/L (about 7.4 mg/dL). What does the nurse expect?
AA loop diuretic to remove the extra calcium
BIV calcium gluconate and monitoring for laryngospasm
CIV potassium chloride and a fluid restriction
DOral levothyroxine, with a recheck of the calcium in a month
17.Med-surg: GI, perioperative & oncologyMedium
What is often the earliest sign of malignant hyperthermia during anaesthesia?
AFlushed skin with a falling CO₂ level
BAn unexplained rise in end-tidal CO₂
CA slowing heart rate and low blood pressure
DA steady fall in body temperature
18.Med-surg: GI, perioperative & oncologyHard
Why is folinic acid (leucovorin) given after high-dose methotrexate?
ATo rescue normal cells from methotrexate toxicity
BTo prevent hair loss during treatment
CTo treat the patient's anaemia only
DTo increase the anticancer effect on the tumour
19.Maternity & obstetric nursingMedium
A woman is about to get out of bed for the first time after birth. What should the nurse do?
AAsk her to stand quickly to reduce dizziness
BHelp her sit, then stand slowly with support
CWait until day 3 before letting her stand
DLet her walk alone so she feels independent
20.Maternity & obstetric nursingHard
Just after delivery of the placenta, a woman suddenly has severe pain, heavy bleeding and shock. No fundus can be felt abdominally and a mass is seen at the vulva. What is most likely?
AAmniotic fluid embolism
BUterine atony
CUterine inversion
DCervical laceration
21.Pediatric nursingMedium
How can acute rheumatic fever be prevented?
ABy routine MMR vaccination in infancy
BBy avoiding dairy products and cold drinks during every cold or cough
CBy prompt antibiotic treatment of streptococcal sore throat
DBy giving aspirin for every fever
22.Pediatric nursingHard
Which child is most appropriate to assign to a practical (enrolled) nurse?
AAn infant with bronchiolitis who needs more and more oxygen
BA 9-year-old newly admitted with diabetic ketoacidosis on an insulin infusion
CA 5-year-old just back from tonsillectomy who keeps swallowing
DA 7-year-old 2 days after an appendicectomy, stable on oral analgesia
23.Mental health nursingMedium
A patient with schizophrenia says, "The voices are telling me I'm evil." Which response is best?
A"Let's not talk about the voices for now. Tell me about your family and your plans instead."
B"If you hear voices, you must be very ill."
C"I don't hear the voices, but I can see they are upsetting you. What are they saying to you?"
D"The voices aren't real, so just ignore them."
24.Mental health nursingHard
A patient who believes he is a famous religious leader becomes upset when other patients laugh at him. What is the most appropriate nursing action?
AAgree that he is the religious leader so that he feels respected
BProtect him from ridicule, avoid arguing and focus on real activities
CEncourage the other patients to explain why the belief is wrong
DAsk him to prove his identity in front of the group, so that the laughing stops
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 35.4 °C. Convert it to degrees Fahrenheit T with °F = °C × 9/5 + 32. Round to one decimal place.
35.4 °C
T = °F
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A prescription reads ½ tsp of an oral suspension four times a day for 7 days. The suspension comes in 50 mL bottles. Using 1 tsp = 5 mL, how many whole bottles N must be supplied so the course is complete?
½ tspfour times a day7 days50 mL1 tsp = 5 mL
N =
27.Dosage calculationsMedium
A child weighing 16 kg is prescribed 10 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?
16 kg10 mg/kg25 mg/mL
V = mL
28.Dosage calculationsHard
You must prepare 100 mL of a 0.5% (w/v) solution from a 10% (w/v) stock solution. What volume of stock V₁ do you need?
C₁ = 10%C₂ = 0.5%V₂ = 100 mL
V₁ = mL
29.IV infusion ratesMedium
Infuse 1500 mL over 10 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute.
1500 mL10 h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 500 mg of a drug in 250 mL and runs at 15 mL/h. How many milligrams per hour D does the patient receive?
500 mg/250 mL15 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 8-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).
water: 350 mLjelly: 120 mLIV infusion: 80 mL/h × 8 hIV antibiotic: 2 × 50 mLurine: 300 mLurine: 300 mL
B = mL
32.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 50 mL/h. At 17:00, 650 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL650 mL infused50 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury opens the eyes only to pressure (a painful stimulus), talks in sentences but is confused and shows as the best motor response: moves a hand to the site of pressure (localises). Work out the GCS and classify the head injury by it. Click your answer.
1mild
2moderate
3severe
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). At 1 minute after birth, a practice newborn has pink skin all over, a heart rate of 80/min, a cry, cough or sneeze when stimulated, active movement and good breathing with a strong cry. Score the APGAR and click how the score is interpreted.
1reassuring
2moderately abnormal
3low
3Solutions
1.Nursing fundamentals
Answer: A · So scores can be compared to see whether pain is improving
Why this is the answer
Using one tool consistently lets the team see trends and judge whether treatment works. The tool chosen should suit the patient's age and ability to communicate.
Answer
A · So scores can be compared to see whether pain is improving
2.Nursing fundamentals
Answer: C · Follow the advance decision and not give that treatment
Why this is the answer
A valid and applicable advance decision has the same effect as a refusal by a patient with capacity. Refusals of life-sustaining treatment must be written, signed, witnessed and state that they apply even if life is at risk.
Answer
C · Follow the advance decision and not give that treatment
3.Infection control & patient safety
Answer: D · Lower than the elbows, so water runs off the fingertips
Why this is the answer
For routine handwashing, hands are held lower than the elbows so dirty water flows off the fingertips into the sink, not up the arms. For a surgical scrub, the opposite applies.
Answer
D · Lower than the elbows, so water runs off the fingertips
4.Infection control & patient safety
Answer: C · Straight away, without waiting for the test result
Why this is the answer
Precautions start on suspicion, because the patient can spread spores while the test is pending. The patient is placed in a single room with contact precautions, and soap-and-water hand washing is used.
Answer
C · Straight away, without waiting for the test result
5.Prioritization & delegation
Answer: D · Stop or slow the infusion and inform the provider
Why this is the answer
Flushing of the upper body during vancomycin is usually an infusion reaction related to the rate. The nurse stops or slows the infusion, assesses for anaphylaxis and informs the provider.
Answer
D · Stop or slow the infusion and inform the provider
6.Prioritization & delegation
Answer: A · Call for emergency help at once and prepare for urgent surgery
Why this is the answer
Sudden severe back or abdominal pain with hypotension in a patient with an aneurysm suggests rupture, which is fatal without urgent surgery. The mass should not be palpated firmly.
Answer
A · Call for emergency help at once and prepare for urgent surgery
7.Clinical nursing
Answer: A · Acute pulmonary oedema
Why this is the answer
Acute pulmonary oedema causes severe breathlessness, crackles and frothy sputum. Sit the patient up, give oxygen and call urgently for medical help; diuretics are commonly given.
Answer
A · Acute pulmonary oedema
8.Clinical nursing
Answer: A · A patient with noisy breathing and swollen lips after eating peanuts
Why this is the answer
Stridor and lip swelling suggest anaphylaxis with airway compromise, which is immediately life-threatening. The others can safely wait.
Answer
A · A patient with noisy breathing and swollen lips after eating peanuts
9.Lab values & electrolytes
Answer: D · At about 24–28 weeks of pregnancy
Why this is the answer
Placental hormones increase insulin resistance in the second half of pregnancy, so US guidance recommends screening all women at 24–28 weeks, with earlier testing for those with risk factors. In the UK, NICE recommends an oral glucose tolerance test at 24–28 weeks only for women with risk factors.Checked against:Glucose screening tests during pregnancy · MedlinePlus (NIH) (2026); Gestational diabetes · MedlinePlus (NIH) (2026)
Answer
D · At about 24–28 weeks of pregnancy
10.Lab values & electrolytes
Answer: C · Euglycemic diabetic ketoacidosis
Why this is the answer
SGLT2 inhibitors can cause DKA with only mildly raised glucose because glucose is lost in the urine. Ketones and acidosis must be checked in any unwell patient on these drugs, even with a near-normal glucose.Checked against:Ketones blood test · MedlinePlus (NIH) (2025)
Answer
C · Euglycemic diabetic ketoacidosis
11.Pharmacology
Answer: A · When started within 48 hours of the first symptoms
Why this is the answer
Neuraminidase inhibitors work best early, while the virus is multiplying. Started within 48 hours, they shorten illness; in high-risk or hospitalised patients they may still be given later.
Answer
A · When started within 48 hours of the first symptoms
12.Pharmacology
Answer: A · They are linked to osteonecrosis of the jaw after dental surgery
Why this is the answer
Osteonecrosis of the jaw is a rare but serious adverse effect, mostly after invasive dental work. Dental problems are treated before starting, and good oral hygiene is maintained.
Answer
A · They are linked to osteonecrosis of the jaw after dental surgery
13.Med-surg: cardiovascular & respiratory
Answer: C · Discuss switching medicine with the prescriber before trying to conceive
Why this is the answer
ACE inhibitors and ARBs are contraindicated in pregnancy because they can damage fetal kidneys and cause other harm. Women of childbearing age should be counselled and switched to a suitable alternative, such as labetalol or nifedipine, before conception or as soon as pregnancy is confirmed.
Answer
C · Discuss switching medicine with the prescriber before trying to conceive
14.Med-surg: cardiovascular & respiratory
Answer: A · The right main bronchus
Why this is the answer
Inhaled foreign bodies most often enter the right main bronchus and right lower lobe, because the right bronchus is wider, shorter and more vertical. Signs include a unilateral wheeze, reduced breath sounds and recurrent infection. Bronchoscopy is used for removal.
Answer
A · The right main bronchus
15.Med-surg: neuro, endocrine & renal
Answer: A · Use glasses and hearing aids and reorient the patient often
Why this is the answer
Non-drug measures are the mainstay of delirium care: glasses and hearing aids, clocks and calendars, familiar faces, good sleep, hydration, mobility and treating the cause. Restraints and frequent moves make delirium worse.
Answer
A · Use glasses and hearing aids and reorient the patient often
16.Med-surg: neuro, endocrine & renal
Answer: B · IV calcium gluconate and monitoring for laryngospasm
Why this is the answer
Symptomatic hypocalcaemia is treated with IV calcium gluconate, followed by oral calcium and often vitamin D. Severe hypocalcaemia can cause laryngospasm, seizures and arrhythmias, so the airway and ECG are monitored.
Answer
B · IV calcium gluconate and monitoring for laryngospasm
17.Med-surg: GI, perioperative & oncology
Answer: B · An unexplained rise in end-tidal CO₂
Why this is the answer
Malignant hyperthermia is an inherited reaction to volatile anaesthetics and suxamethonium. Early signs include rising end-tidal CO₂, tachycardia and muscle rigidity (often the masseter); high temperature is often a late sign. Treatment is stopping trigger agents and giving dantrolene.
Answer
B · An unexplained rise in end-tidal CO₂
18.Med-surg: GI, perioperative & oncology
Answer: A · To rescue normal cells from methotrexate toxicity
Why this is the answer
Methotrexate inhibits dihydrofolate reductase. Timed folinic acid bypasses this block in normal cells, reducing toxicity such as mucositis and myelosuppression, while methotrexate levels and kidney function are monitored.
Answer
A · To rescue normal cells from methotrexate toxicity
19.Maternity & obstetric nursing
Answer: B · Help her sit, then stand slowly with support
Why this is the answer
Orthostatic hypotension is common after birth. The nurse helps her sit at the edge of the bed, dangle her legs, then stand slowly with assistance and stays close in case she feels faint.
Answer
B · Help her sit, then stand slowly with support
20.Maternity & obstetric nursing
Answer: C · Uterine inversion
Why this is the answer
An absent fundus on palpation with a mass in the vagina and shock suggest uterine inversion. Help is called immediately, oxytocin is stopped and the uterus is replaced as soon as possible by the medical team.
Answer
C · Uterine inversion
21.Pediatric nursing
Answer: C · By prompt antibiotic treatment of streptococcal sore throat
Why this is the answer
Rheumatic fever is an immune reaction following group A streptococcal throat infection. Treating strep throat with a full course of antibiotics prevents it and the heart valve damage it can cause.
Answer
C · By prompt antibiotic treatment of streptococcal sore throat
22.Pediatric nursing
Answer: D · A 7-year-old 2 days after an appendicectomy, stable on oral analgesia
Why this is the answer
Practical or enrolled nurses usually care for stable children with predictable outcomes. Children who are unstable, newly admitted with a complex condition or showing signs of deterioration need a registered nurse's assessment.
Answer
D · A 7-year-old 2 days after an appendicectomy, stable on oral analgesia
23.Mental health nursing
Answer: C · "I don't hear the voices, but I can see they are upsetting you. What are they saying to you?"
Why this is the answer
The nurse does not argue or agree, but states their own reality, shows empathy and asks about the content, especially command hallucinations that could put the patient or others at risk.
Answer
C · "I don't hear the voices, but I can see they are upsetting you. What are they saying to you?"
24.Mental health nursing
Answer: B · Protect him from ridicule, avoid arguing and focus on real activities
Why this is the answer
Arguing or agreeing strengthens a delusion. The nurse protects the patient's dignity, responds to his feelings and focuses on real, present activities and concerns.
Answer
B · Protect him from ridicule, avoid arguing and focus on real activities
25.Nursing math & unit conversions
Answer: T = 95.7 °F
Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.
Multiply by 9/5
35.4·9/5 = 63.72
Add 32
T = 63.72 + 32 = 95.72 ≈ 95.7 °F
Answer
T = 95.7 °F
26.Nursing math & unit conversions
Answer: N = 2
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.
Total volume
2.5 mL × 4 × 7 = 70 mL
Bottles
70/50 = 1.4 → N = 2
Answer
N = 2
27.Dosage calculations
Answer: V = 6.4 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 = 10·16 = 160 mg
Volume
V = 160/25 = 6.4 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 6.4 mL
28.Dosage calculations
Answer: V₁ = 5 mL
Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.
Volume of stock
V₁ = 0.5·100/10 = 5 mL
Answer
V₁ = 5 mL
29.IV infusion rates
Answer: R = 25 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
10·60 = 600 min
Drip rate
R = 1500·10/600 = 25 gtt/min
Answer
R = 25 gtt/min
30.IV infusion rates
Answer: D = 30 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
500/250 = 2 mg/mL
Dose rate
D = 2·15 = 30 mg/h
Answer
D = 30 mg/h
31.IV fluids & fluid balance
Answer: B = 610 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: 350 + 120 = 470 mL
IV infusion: 80·8 = 640 mL
IV antibiotic: 2·50 = 100 mL
total intake = 1210 mL
Total output
300 + 300 = 600 mL
Balance
B = 1210 − 600 = 610 mL
Answer
B = 610 mL
Positive: more fluid went in than came out.
32.IV fluids & fluid balance
Answer: t = 7 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
1000 − 650 = 350 mL
Time
t = 350/50 = 7 h
Answer
t = 7 h
That is about 7 h 00 min, so the bag runs out at about 00:00.
33.Clinical assessment scores
Answer: moderate
Glasgow Coma Scale: add the best response in three areas. Eye opening E: 4 spontaneous, 3 to sound or speech, 2 to pressure, 1 none. Verbal V: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Motor M: 6 obeys commands, 5 localises, 4 normal flexion (withdraws), 3 abnormal flexion, 2 extension, 1 none. The total runs from 3 to 15. After a head injury, 13–15 is usually called mild, 9–12 moderate and 3–8 severe.
Score each area
E: opens the eyes only to pressure (a painful stimulus) → 2
V: talks in sentences but is confused → 4
M: moves a hand to the site of pressure (localises) → 5
Add
GCS = 2 + 4 + 5 = 11
Severity
GCS 11 → moderate
Answer
moderate
34.Clinical assessment scores
Answer: reassuring
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: pink skin all over → 2
Pulse: 80/min → 1
Grimace: a cry, cough or sneeze when stimulated → 2
Activity: active movement → 2
Respiration: good breathing with a strong cry → 2
Add
APGAR = 2 + 1 + 2 + 2 + 2 = 9
Interpretation
9 → reassuring
Answer
reassuring
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