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
Read the pH: below 7.35 is acidosis, above 7.45 alkalosis.
Find the value that explains it: PaCO₂ moving opposite to the pH is respiratory, HCO₃⁻ moving with the pH is metabolic.
Look at the other value: normal means uncompensated, abnormal in the compensating direction means partial compensation, and a normal pH with both abnormal means full compensation.
In a metabolic acidosis, compare PaCO₂ with Winter’s formula, 1.5·HCO₃⁻ + 8 ± 2, and calculate the anion gap Na⁺ − (Cl⁻ + HCO₃⁻).
Check a high anion gap with the delta ratio and, when albumin is low, with the corrected gap.
ECG rhythm strip interpretation
Paper (25 mm/s, 10 mm/mV)
1 small box = 0.04 s, 1 large box = 0.20 s, 10 mm = 1 mV
Heart rate, regular rhythm
300 ÷ large boxes = 1500 ÷ small boxes = 60 ÷ RR (s)
Heart rate, irregular rhythm
QRS complexes in 6 s × 10
Normal PR interval
0.12–0.20 s
Normal QRS duration
< 0.12 s
QTc (Bazett)
QT/√RR
QTc (Fridericia)
QT/∛RR
QTc (Framingham)
QT + 154·(1 − RR)
Sinus rates
bradycardia < 60, normal 60–100, tachycardia > 100 /min
Escape rates
junctional 40–60, ventricular 20–40 /min
Fast rhythms
SVT 150–250 /min (narrow), VT > 100 /min (wide)
Method
Rate: for a regular rhythm divide 300 by the large boxes or 1500 by the small boxes between two R waves; for an irregular rhythm count the QRS complexes in 6 seconds and multiply by 10.
Rhythm: compare the R–R intervals. Equal is regular; a repeating pattern is regularly irregular; no pattern at all is irregularly irregular.
P waves: is there an upright P wave in lead II before every QRS, all alike? Look for fibrillatory or sawtooth waves, inverted P waves and P waves without a QRS.
PR interval: from the start of P to the start of the QRS, normally 0.12–0.20 s and constant. Watch whether it lengthens, stays fixed before a dropped beat, or varies at random.
QRS duration: below 0.12 s is narrow; 0.12 s or more is wide. Then name the rhythm, and for the QT use QTc = QT/√RR (Bazett) with times in seconds.
2Practice problems
1.Nursing fundamentalsMedium
Which measure is appropriate for a patient with a fever who feels hot and uncomfortable?
AExtra blankets to make the patient sweat it out
BRestricting fluids so the patient sweats less during the fever
CLight bedclothes, plenty of fluids and a prescribed antipyretic
DAn ice bath until the patient shivers
2.Nursing fundamentalsHard
A patient with suspected pulmonary tuberculosis has to go to the X-ray department. What is correct?
AThe patient cannot leave the room under any circumstances
BThe patient wears a surgical mask during transport
CNo precautions are needed outside the ward
DThe patient wears a respirator and staff wear nothing
3.Infection control & patient safetyMedium
Why are blood cultures usually taken from two separate venipuncture sites?
ABecause each site tests a different antibiotic
BTo make the results come back faster from the laboratory
CTo help tell a true infection from skin contamination
DTo reduce the total amount of blood taken
4.Infection control & patient safetyHard
A nurse has worked three long shifts in a row and feels exhausted. The manager asks the nurse to stay for another shift. What is the most appropriate response?
AAgree without telling anyone about the fatigue
BExplain that fatigue would make care unsafe and decline the extra shift
CAgree, but skip the independent medication checks to save energy on the shift
DAgree and drink extra coffee to stay alert
5.Prioritization & delegationMedium
A patient with heart failure gained 2 kg (about 4 lb) since yesterday and is more breathless when lying down. What should the nurse do first?
ARecord the weight on the chart and recheck it at the next weekly weigh-in
BLay the patient flat to help them breathe more easily
CEncourage extra fluids to correct the weight change
DAssess the lungs, oxygen saturation and swelling, then inform the provider
6.Prioritization & delegationHard
Four stable patients need routine morning care. To reduce the spread of infection, which patient should the nurse visit first?
AA patient with influenza on droplet precautions
BA patient with an MRSA wound infection
CA patient with neutropenia after chemotherapy
DA patient with C. difficile diarrhea
7.Clinical nursingMedium
Which side effects are common after high doses of salbutamol (albuterol)?
ABradycardia and drowsiness
BConstipation and urinary retention
CTremor and a fast heart rate
DHair loss and weight gain
8.Clinical nursingHard
A patient with hyperkalaemia is given IV insulin with glucose. What is the purpose, and what must be monitored?
ATo treat hidden diabetes; HbA1c must be checked daily
BTo remove potassium from the body; urine output must be stopped for a time
CTo shift potassium into cells; blood glucose must be monitored for hypoglycaemia
DTo protect the heart muscle directly; the patient must be kept nil by mouth
9.Lab values & electrolytesMedium
A healthy woman at 28 weeks of pregnancy has a mildly lower hemoglobin than before pregnancy, with a normal MCV and ferritin. What is the most likely explanation?
APlasma volume rises more than red cell mass, diluting the blood
BIron is being lost through the kidneys during the pregnancy
CPregnancy hormones stop the bone marrow from making red cells
DThe fetus is destroying the mother's red cells in the circulation
10.Lab values & electrolytesHard
A patient with ongoing hemolytic anemia has an HbA1c of 4.6%, but home glucose readings are often 180–220 mg/dL (10–12 mmol/L). What best explains the gap?
AHemolysis makes the HbA1c test read too high
BThe patient has true, well-controlled diabetes
CShort red cell life span lowers the HbA1c falsely
DThe home glucose meter is reading falsely high
11.PharmacologyMedium
When does oseltamivir give the most benefit in influenza?
AOnly after a bacterial pneumonia has developed
BWhen started within 48 hours of the first symptoms
COnly after symptoms have lasted at least one week
DAt any time, as the timing makes no difference
12.PharmacologyHard
Carboprost is a prostaglandin used for postpartum haemorrhage. In which woman should it be avoided?
AA woman who is breastfeeding
BA woman with iron deficiency anaemia
CA woman with asthma
DA woman who had a vaginal birth
13.Med-surg: cardiovascular & respiratoryMedium
A patient has episodes of severe headache, sweating and palpitations with very high blood pressure. Which rare cause should be considered?
APhaeochromocytoma
BAortic stenosis
CAsthma
DStable angina
14.Med-surg: cardiovascular & respiratoryHard
Three days after an MI, a patient faints on the commode while straining hard to open the bowels. The heart rate was 42/min at the time. What is the most likely mechanism?
AA new pulmonary embolism
BLow blood glucose from fasting
CA vagal response to straining
DAn allergic reaction to the commode
15.Med-surg: neuro, endocrine & renalMedium
Why should antiepileptic drugs not be stopped suddenly?
AStopping them suddenly causes a dangerous rise in blood pressure
BThe drugs build up in the body and become toxic after stopping
CStopping them suddenly causes permanent damage to the liver and kidneys
DSudden withdrawal can trigger seizures, including status epilepticus
16.Med-surg: neuro, endocrine & renalHard
A 66-year-old smoker has had two episodes of painless red urine. Urine cultures are negative. Which plan is most appropriate?
AAdvise more fluids and review in a year
BUrgent referral for cystoscopy and imaging
CAnother course of antibiotics for a UTI
DReassure him, because the blood has stopped
17.Med-surg: GI, perioperative & oncologyMedium
A patient takes co-codamol at home (a combination tablet sold under different names in different countries). Why should the nurse check this before giving regular paracetamol (acetaminophen)?
ACo-codamol stops paracetamol from working
BIt already contains paracetamol, so overdose could occur
CParacetamol and codeine cause a severe allergic reaction when combined
DCo-codamol must be stopped a week before any paracetamol
18.Med-surg: GI, perioperative & oncologyHard
During a nerve block, a patient reports a metallic taste and ringing in the ears, then has a seizure. Besides calling for help and supporting the airway, which specific treatment is given?
AIV dantrolene
BIV lipid emulsion
CIV naloxone
DIV glucose 50%
19.Maternity & obstetric nursingMedium
Which findings are typical of placental abruption?
AAbdominal pain, a firm or rigid uterus and dark red bleeding
BItching of the palms and soles
CPainless bright red bleeding with a soft, relaxed, non-tender uterus
DLeaking clear fluid without contractions
20.Maternity & obstetric nursingHard
A woman with postpartum psychosis is being admitted with her baby to a mother and baby unit. Which statement is accurate?
AIt only occurs in women who were depressed in pregnancy
BIt is an emergency that usually starts within two weeks
CIt usually begins several months or years after the birth
DIt is the same as the baby blues and resolves without treatment
21.Pediatric nursingMedium
Which nursing action is correct for a newborn receiving phototherapy?
AApply a moisturising lotion to the skin before each session to prevent drying under the lights
BCover the eyes, expose as much skin as possible and monitor temperature and hydration
CStop feeds during phototherapy so that bilirubin falls faster
DKeep the baby fully dressed under the lights to prevent heat loss
22.Pediatric nursingHard
A formula-fed infant is diagnosed with cow's milk protein allergy. Which formula is usually advised?
AAn extensively hydrolysed formula
BA lactose-free cow's milk formula
CA goat's milk formula
DA rice milk drink fortified with calcium
23.Mental health nursingMedium
A patient lies awake in bed for hours worrying about not sleeping. Which stimulus control advice is correct?
ALook at the clock often to check how much sleep is being lost
BStay in bed and watch television or use a phone until sleep finally comes
CIf still awake after about 20 minutes, get up, do something calm and return when sleepy
DDo vigorous exercise in the bedroom until tired enough to fall asleep straight away
24.Mental health nursingHard
A patient says, "I don't have a drinking problem. I only drink at weekends, like everyone else." He drinks heavily every weekend. Which approach fits his stage of change best?
ARefer him straight to a residential detox programme
BHelp him set a quit date for next week
COffer non-judgemental information and explore how drinking affects his life
DDiscuss detailed strategies to prevent a relapse after he has stopped drinking
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A drip-rate calculation gives 39.374 gtt/min. The rule in this exercise is that drip rates are rounded to the nearest whole drop. What value x do you record?
39.374 gtt/min
x = gtt/min
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A prescription reads 1 tsp of an oral suspension every 6 hours for 14 days. Using 1 tsp = 5 mL, how many mL V are needed for the whole course?
1 tspevery 6 hours14 days1 tsp = 5 mL
V = mL
27.Dosage calculationsMedium
A child weighing 33 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?
33 kg10 mg/kg50 mg/mL
V = mL
28.Dosage calculationsHard
A child weighing 12 kg is prescribed 20 mg/kg per dose of an oral suspension that contains 40 mg in 1 mL. What volume V do you give?
12 kg20 mg/kg40 mg/1 mL
V = mL
29.IV infusion ratesMedium
A drip runs at 35 gtt/min through a set of 15 gtt/mL. How many millilitres V does the patient receive in 6 hours?
35 gtt/min15 gtt/mL6 h
V = mL
30.IV infusion ratesHard
A drip runs at 28 gtt/min through a set of 20 gtt/mL. There are 300 mL left in the bag. How many hours t until it is empty? Round to one decimal place.
28 gtt/min20 gtt/mL300 mL
t = h
31.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). A practice protocol calls for a heparin bolus of 80 units/kg for a patient who weighs 97 kg. The vial contains 5 000 units/mL. What volume V do you draw up? Round to one decimal place.
80 units/kg97 kg5 000 units/mL
V = mL
32.Pediatric & critical-care dosingHard
Practice exercise (made-up values, not clinical guidance). A bag contains dopamine 800 mg in 500 mL. The order is 10 mcg/kg/min for a patient who weighs 53 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
800 mg/500 mL10 mcg/kg/min53 kg
R = mL/h
33.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 patient weighs 78 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 1000 mL infusion starts at 08:00 at 80 mL/h. After 3 hours the rate is changed to 50 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 mL80 mL/h · 3 h50 mL/h
t = h
35.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 28/min, SpO₂ 99% on room air, blood pressure 142/86 mmHg, pulse 58/min, alert, temperature 38.8 °C. What is the NEWS2 total score?
RR 28SpO₂ 99%airSBP 142HR 58AT 38.8 °C
NEWS2 =
36.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: completely limited; moisture: rarely moist; activity: walks occasionally; mobility: no limitation; nutrition: adequate; friction and shear: potential problem. Use the bands 19–23 not at risk, 15–18 mild, 13–14 moderate, 10–12 high and 9 or below very high. Click the risk level.
1not at risk
2mild risk
3moderate risk
4high risk
5very high risk
37.Arterial blood gas interpretationMedium
A practice arterial blood gas shows pH 7.22, PaCO₂ 61 mmHg (8.1 kPa) and HCO₃⁻ 24 mmol/L. The primary disorder is respiratory acidosis. How far is it compensated? Click your answer.
pH 7.22PaCO₂ 61 mmHg (8.1 kPa)HCO₃⁻ 24 mmol/L
1uncompensated
2partially compensated
3fully compensated
38.Arterial blood gas interpretationHard
Practice values: Na⁺ 143, Cl⁻ 109, HCO₃⁻ 15 mmol/L and albumin 38 g/L. Find the albumin-corrected anion gap AGc = AG + 0.25·(40 − albumin).
Measure the QT interval and the R–R interval on this regular lead II strip, then calculate the rate-corrected QTc with Fridericia’s formula QTc = QT/∛RR (both in seconds). Give the answer in seconds to three decimals.
lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
QTc = s
40.ECG rhythm strip interpretationHard
This lead II strip shows a conduction problem between the atria and the ventricles. Which rhythm is it? Click your answer.
lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
1second-degree AV block type II
2first-degree AV block
3third-degree (complete) AV block
4second-degree AV block type I (Wenckebach)
3Solutions
1.Nursing fundamentals
Answer: C · Light bedclothes, plenty of fluids and a prescribed antipyretic
Why this is the answer
Light clothing, fluids and antipyretics such as paracetamol (acetaminophen) increase comfort and replace fluid lost through sweating. Very cold sponging causes shivering, which produces heat.
Answer
C · Light bedclothes, plenty of fluids and a prescribed antipyretic
2.Nursing fundamentals
Answer: B · The patient wears a surgical mask during transport
Why this is the answer
When an airborne-precaution patient must leave the room, they wear a surgical mask to contain respiratory secretions. Staff in close contact still wear respirators as per policy, and the receiving department is informed.
Answer
B · The patient wears a surgical mask during transport
3.Infection control & patient safety
Answer: C · To help tell a true infection from skin contamination
Why this is the answer
If the same organism grows from both sets, it is more likely to be a true bloodstream infection. Growth in only one set may be contamination from the skin.
Answer
C · To help tell a true infection from skin contamination
4.Infection control & patient safety
Answer: B · Explain that fatigue would make care unsafe and decline the extra shift
Why this is the answer
Long hours and fatigue increase errors and injuries. Nurses have a professional responsibility to judge whether they are fit to work safely and to say so clearly.
Answer
B · Explain that fatigue would make care unsafe and decline the extra shift
5.Prioritization & delegation
Answer: D · Assess the lungs, oxygen saturation and swelling, then inform the provider
Why this is the answer
A rapid weight gain with orthopnea suggests fluid overload and worsening heart failure. The nurse assesses breathing and fluid status and informs the provider, who may adjust the diuretic.
Answer
D · Assess the lungs, oxygen saturation and swelling, then inform the provider
6.Prioritization & delegation
Answer: C · A patient with neutropenia after chemotherapy
Why this is the answer
When urgency is equal, the nurse cares for the most vulnerable patient first and patients with transmissible infections last. This lowers the risk of carrying organisms to an immunocompromised patient.
Answer
C · A patient with neutropenia after chemotherapy
7.Clinical nursing
Answer: C · Tremor and a fast heart rate
Why this is the answer
Salbutamol is a beta2-agonist and can cause tremor, tachycardia and palpitations. High doses can also lower serum potassium.
Answer
C · Tremor and a fast heart rate
8.Clinical nursing
Answer: C · To shift potassium into cells; blood glucose must be monitored for hypoglycaemia
Why this is the answer
Insulin drives potassium into cells, temporarily lowering serum levels. Glucose is given to prevent hypoglycaemia, but glucose monitoring is still needed for several hours.
Answer
C · To shift potassium into cells; blood glucose must be monitored for hypoglycaemia
9.Lab values & electrolytes
Answer: A · Plasma volume rises more than red cell mass, diluting the blood
Why this is the answer
In pregnancy, plasma volume increases by more than red cell mass, so the hemoglobin falls slightly (physiologic or dilutional anemia). Iron deficiency is still common in pregnancy and is checked with the MCV and ferritin.Checked against:Anemia · StatPearls (NCBI Bookshelf) (2026)
Answer
A · Plasma volume rises more than red cell mass, diluting the blood
10.Lab values & electrolytes
Answer: C · Short red cell life span lowers the HbA1c falsely
Why this is the answer
HbA1c reflects glucose attached to hemoglobin over the red cell life span. In hemolysis, red cells are younger and have less time to bind glucose, so HbA1c is falsely low. Glucose monitoring or other markers are used instead.Checked against:The A1C Test & Diabetes · NIDDK (NIH) (2018); Hemoglobin A1C (HbA1c) Test · MedlinePlus (NIH) (2025)
Answer
C · Short red cell life span lowers the HbA1c falsely
11.Pharmacology
Answer: B · 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
B · When started within 48 hours of the first symptoms
12.Pharmacology
Answer: C · A woman with asthma
Why this is the answer
Carboprost is a PGF2-alpha analogue that can cause bronchospasm. Oxytocin is first-line, and carboprost is avoided in asthma.
Answer
C · A woman with asthma
13.Med-surg: cardiovascular & respiratory
Answer: A · Phaeochromocytoma
Why this is the answer
Phaeochromocytoma is a catecholamine-secreting tumour, usually of the adrenal medulla. Classic features are paroxysmal headache, sweating, palpitations and hypertension. It is diagnosed with plasma or urine metanephrines.
Answer
A · Phaeochromocytoma
14.Med-surg: cardiovascular & respiratory
Answer: C · A vagal response to straining
Why this is the answer
Straining (the Valsalva manoeuvre) can cause a vagal bradycardia and a fall in cardiac output, leading to syncope. After an MI, stool softeners, adequate fluids and avoiding straining are advised. The event is still reported and the patient assessed for arrhythmia or ischaemia.
Answer
C · A vagal response to straining
15.Med-surg: neuro, endocrine & renal
Answer: D · Sudden withdrawal can trigger seizures, including status epilepticus
Why this is the answer
Stopping antiepileptics abruptly can cause rebound seizures, which may be prolonged. Changes are made gradually under medical supervision, and missed doses should be avoided.
Answer
D · Sudden withdrawal can trigger seizures, including status epilepticus
16.Med-surg: neuro, endocrine & renal
Answer: B · Urgent referral for cystoscopy and imaging
Why this is the answer
Painless visible haematuria in an older smoker, with no infection, must be investigated urgently for bladder or kidney cancer. Intermittent bleeding does not mean the cause has gone.
Answer
B · Urgent referral for cystoscopy and imaging
17.Med-surg: GI, perioperative & oncology
Answer: B · It already contains paracetamol, so overdose could occur
Why this is the answer
Co-codamol combines codeine and paracetamol. Giving extra paracetamol can exceed the maximum daily dose and cause liver damage, so all sources of paracetamol are counted.
Answer
B · It already contains paracetamol, so overdose could occur
18.Med-surg: GI, perioperative & oncology
Answer: B · IV lipid emulsion
Why this is the answer
These are signs of local anaesthetic systemic toxicity. The injection is stopped, help is called, the airway is secured and seizures are treated. IV lipid emulsion is the specific treatment, especially if the circulation is affected.
Answer
B · IV lipid emulsion
19.Maternity & obstetric nursing
Answer: A · Abdominal pain, a firm or rigid uterus and dark red bleeding
Why this is the answer
Abruption causes pain, uterine tenderness and rigidity, and dark bleeding. The bleeding can be hidden behind the placenta, so blood loss may be much larger than what is visible.
Answer
A · Abdominal pain, a firm or rigid uterus and dark red bleeding
20.Maternity & obstetric nursing
Answer: B · It is an emergency that usually starts within two weeks
Why this is the answer
Postpartum psychosis is rare but serious, typically starting suddenly within the first two weeks with mania, confusion, hallucinations or delusions. Bipolar disorder is a major risk factor. Urgent treatment is needed to keep mother and baby safe.
Answer
B · It is an emergency that usually starts within two weeks
21.Pediatric nursing
Answer: B · Cover the eyes, expose as much skin as possible and monitor temperature and hydration
Why this is the answer
Phototherapy works on bilirubin in the skin, so maximal skin should be exposed while the eyes are shielded. Babies can lose extra fluid and become too warm or cold, so temperature, hydration and feeding are monitored; lotions can cause burns.
Answer
B · Cover the eyes, expose as much skin as possible and monitor temperature and hydration
22.Pediatric nursing
Answer: A · An extensively hydrolysed formula
Why this is the answer
Extensively hydrolysed formulas contain milk proteins broken into small pieces that rarely trigger allergy; amino acid formulas are used for severe cases. Lactose-free formula still contains cow's milk protein, goat's milk proteins cross-react, and rice milk is unsuitable for infants.
Answer
A · An extensively hydrolysed formula
23.Mental health nursing
Answer: C · If still awake after about 20 minutes, get up, do something calm and return when sleepy
Why this is the answer
Stimulus control strengthens the bed as a cue for sleep. Getting up when unable to sleep, using the bed only for sleep and intimacy, and keeping a regular wake time are key parts.
Answer
C · If still awake after about 20 minutes, get up, do something calm and return when sleepy
24.Mental health nursing
Answer: C · Offer non-judgemental information and explore how drinking affects his life
Why this is the answer
In precontemplation, the aim is to raise awareness without confrontation, for example by giving personalised feedback and exploring the pros and cons. Action-focused plans fit later stages.
Answer
C · Offer non-judgemental information and explore how drinking affects his life
25.Nursing math & unit conversions
Answer: x = 39 gtt/min
Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.
Digit in the ones place
39.374 → 9
Only the next digit decides
39.374 → 3
3 is 4 or less, so 9 stays.
The digits after it (74) are ignored: round once, never step by step.
Round
x = 39 gtt/min
Answer
x = 39 gtt/min
26.Nursing math & unit conversions
Answer: V = 280 mL
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.
Volume per dose
1 tsp = 1·5 = 5 mL
Whole course
V = 5 mL × 4/day × 14 = 280 mL
Answer
V = 280 mL
27.Dosage calculations
Answer: V = 6.6 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 = 10·33 = 330 mg
Volume
V = 330/50 = 6.6 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 6.6 mL
28.Dosage calculations
Answer: V = 6 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.
Dose from weight
20·12 = 240 mg
Volume
V = (240/40)·1 = 6 mL
Answer
V = 6 mL
29.IV infusion rates
Answer: V = 840 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
35·60/15 = 140 mL/h
Volume
V = 140·6 = 840 mL
Answer
V = 840 mL
30.IV infusion rates
Answer: t = 3.6 h
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Rate in mL/h
28·60/20 = 84 mL/h
Time left
t = 300/84 = 3.571 ≈ 3.6 h
Answer
t = 3.6 h
31.Pediatric & critical-care dosing
Answer: V = 1.6 mL
Heparin and insulin infusions: concentration = units in the bag/bag volume (units/mL). Pump rate (mL/h) = units per hour/concentration, and units per hour = mL/h × concentration. For a weight-based order, units/h = units/kg/h × weight first. A bolus volume = units needed/vial strength. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Units needed
80·97 = 7 760 units
Volume
V = 7760/5000 = 1.552 ≈ 1.6 mL
Answer
V = 1.6 mL
32.Pediatric & critical-care dosing
Answer: R = 19.9 mL/h
Titrated drips: first find the concentration in mcg/mL (mg × 1000/mL). For a weight-based order, mcg/min = mcg/kg/min × weight. Then mL/h = mcg/min × 60/concentration. Working backwards, mcg/kg/min = mL/h × concentration/(60 × weight). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Concentration
800 mg = 800 000 mcg
800 000/500 = 1600 mcg/mL
Dose per minute and per hour
10·53 = 530 mcg/min
530·60 = 31800 mcg/h
Pump rate
R = 31800/1600 = 19.88 ≈ 19.9 mL/h
Answer
R = 19.9 mL/h
33.IV fluids & fluid balance
Answer: U = 1.2 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
425 + 375 + 175 + 150 = 1125 mL
Per kilogram per hour
U = 1125/(78·12) = 1.202 ≈ 1.2 mL/kg/h
Answer
U = 1.2 mL/kg/h
34.IV fluids & fluid balance
Answer: t = 18.2 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
80·3 = 240 mL
1000 − 240 = 760 mL left
Second part
760/50 = 15.2 h
Total time
t = 3 + 15.2 = 18.2 h
Answer
t = 18.2 h
That is about 18 h 12 min, so the bag runs out at about 02:12.
35.Clinical assessment scores
Answer: NEWS2 = 4
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 28/min → 3
SpO₂ 99% → 0
on air → 0
SBP 142 mmHg → 0
HR 58/min → 0
alert (A) → 0
T 38.8 °C → 1
Add
NEWS2 = 3 + 0 + 0 + 0 + 0 + 0 + 1 = 4
Answer
NEWS2 = 4
36.Clinical assessment scores
Answer: mild risk
Braden scale: six subscales for pressure-injury risk. Sensory perception, moisture, activity, mobility and nutrition score 1 to 4, from the worst level (1) to no problem (4); friction and shear scores 1 to 3. The total runs from 6 to 23, and a lower total means a higher risk. Common bands: 19–23 not at risk, 15–18 mild risk, 13–14 moderate risk, 10–12 high risk and 9 or below very high risk.
Score each subscale
sensory perception: completely limited → 1
moisture: rarely moist → 4
activity: walks occasionally → 3
mobility: no limitation → 4
nutrition: adequate → 3
friction and shear: potential problem → 2
Add
Braden total = 1 + 4 + 3 + 4 + 3 + 2 = 17
Risk level
17 → mild risk
Answer
mild risk
37.Arterial blood gas interpretation
Answer: uncompensated
Reading a blood gas (ROME): first the pH: below 7.35 is acidaemia, above 7.45 alkalaemia. Then find the value that explains it. PaCO₂ (normal 35–45 mmHg, 4.7–6.0 kPa) is the respiratory part and moves Opposite to the pH in a respiratory disorder; HCO₃⁻ (normal 22–26 mmol/L) is the metabolic part and moves in the same direction as the pH (Respiratory Opposite, Metabolic Equal). The other value shows the compensation: normal means uncompensated; abnormal in the direction that pulls the pH back while the pH is still abnormal means partially compensated; a normal pH with both values abnormal means fully compensated. Ranges differ slightly between laboratories; these are practice values.
ROME, value by value
pH 7.22: acidaemia (below 7.35)
PaCO₂ 61 mmHg: high (35–45)
HCO₃⁻ 24 mmol/L: normal (22–26)
Compensation
uncompensated
Answer
uncompensated
38.Arterial blood gas interpretation
Answer: AGc = 19.5 mmol/L
Expected compensation: in metabolic acidosis Winter’s formula predicts PaCO₂ = 1.5·HCO₃⁻ + 8 ± 2 mmHg; a measured value above that range points to an additional respiratory acidosis, below it to an additional respiratory alkalosis. The anion gap AG = Na⁺ − (Cl⁻ + HCO₃⁻), normally about 8–12 mmol/L, separates high-gap from normal-gap metabolic acidosis; low albumin hides a high gap (add 2.5 per g/dL that albumin is below 4.0). The delta ratio (AG − 12)/(24 − HCO₃⁻) between about 0.8 and 2 fits a pure high-gap acidosis (some texts use 1 instead of 0.8), below that an added normal-gap acidosis, and above 2 an added metabolic alkalosis.
Anion gap
AG = 143 − (109 + 15) = 19
Correction for albumin
19 + 0.25·(40 − 38) = 19.5 mmol/L
Answer
AGc = 19.5 mmol/L
Above about 12 after correction: a high anion gap.
39.ECG rhythm strip interpretation
Answer: QTc = 0.432 s
QT and QTc: the QT interval runs from the start of the QRS complex to the end of the T wave. It shortens as the heart rate rises, so it is corrected for rate with the R–R interval in seconds: Bazett QTc = QT/√RR and Fridericia QTc = QT/∛RR. Bazett is the formula most textbooks use; it over-corrects at fast rates, where Fridericia is preferred. Limits differ between references: a QTc above about 0.45 s in men or 0.46 s in women is usually called prolonged, and above 0.50 s markedly prolonged.
Measure
QT = 10.5 × 0.04 = 0.42 s
RR = 23 × 0.04 = 0.92 s
Fridericia’s formula
QTc = 0.42/∛0.92 = 0.42/0.9726 = 0.432 s
Answer
QTc = 0.432 s
Within the usual limits (about 0.45 s for men, 0.46 s for women). (432 ms)
40.ECG rhythm strip interpretation
Answer: second-degree AV block type I (Wenckebach)
AV blocks: march out the P waves and check which ones are followed by a QRS. First-degree: every P conducted, PR constant and above 0.20 s. Second-degree type I (Mobitz I, Wenckebach): the PR lengthens from beat to beat until one P wave is not conducted, then the cycle starts again (group beating). Second-degree type II (Mobitz II): the PR of the conducted beats stays constant, and P waves are suddenly not conducted; the QRS is often wide. Third-degree (complete) block: P waves and QRS complexes are each regular but independent, the PR varies at random and the atrial rate is faster than the escape rate (junctional 40–60/min with a narrow QRS, ventricular 20–40/min with a wide QRS). A 2:1 block cannot be called type I or type II from one strip.
Five steps
1. Rate: 4 QRS complexes in 6 s, × 10 = 40 per minute.
2. Rhythm: regularly irregular, the QRS complexes come in groups separated by a pause (group beating).
3. P waves: upright and regular (P–P 1.00 s, 60 per minute); one P in every 3 is not followed by a QRS.
4. PR interval: lengthens 0.18 → 0.30 s, then a P wave is not conducted.
5. QRS: 0.06 s, narrow (below 0.12 s).
Interpretation
second-degree AV block type I (Wenckebach)
Answer
second-degree AV block type I (Wenckebach)
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