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
What is a portable bladder scanner used for?
ATaking a sterile sample of urine for culture without a catheter
BDetecting kidney stones
CChecking the urine for blood and protein
DMeasuring how much urine is in the bladder without a catheter
2.Nursing fundamentalsHard
A patient has been taught how to prevent constipation. Which statement shows a need for further teaching?
A"I'll go to the toilet when I first feel the urge."
B"I'll take a strong laxative every day just in case."
C"I'll eat more fruit, vegetables and wholegrains."
D"I'll drink plenty of fluids during the day."
3.Infection control & patient safetyMedium
Why must visible dirt be removed from equipment before it is disinfected?
ADirt makes the disinfectant react and work too strongly on the surface
BOrganic matter can shield organisms and weaken the disinfectant
CCleaning first is only needed for metal items
DDisinfectants only work on wet surfaces
4.Infection control & patient safetyHard
A nurse arrives at the scene of a fire in a corridor and the fire is spreading. Patients are in nearby rooms. What should the nurse do after raising the alarm?
AClose doors and move patients in danger horizontally behind fire doors
BTake patients to the ground floor in the nearest elevator
COpen all doors and windows to let the smoke escape
DTry to put out the spreading fire alone with an extinguisher
5.Prioritization & delegationMedium
Which patient should a nurse see first after report?
AA patient who wants help to shower before visitors arrive
BA patient with a new cast who says the foot feels numb and the toes are cool
CA patient with osteoarthritis who reports stiffness every morning
DA patient on a diuretic who has passed 400 mL of urine since 08:00
6.Prioritization & delegationHard
Which finding after a laparoscopic cholecystectomy is expected and needs only reassurance and comfort measures?
AA heart rate of 125/min with a falling blood pressure
BYellow skin with dark urine on the second day
CRight shoulder pain from the gas used during surgery
DIncreasing abdominal pain with a temperature of 39 °C
7.Clinical nursingMedium
Which technique is correct when suctioning through a tracheostomy?
AKeep suctioning for at least a minute each time to clear all the secretions
BApply suction only while withdrawing the catheter, for no more than about 10–15 seconds
CApply suction continuously while inserting the catheter as far as it will go
DSuction every 15 minutes whether or not secretions are present
8.Clinical nursingHard
A patient with suspected meningitis has fever, neck stiffness and a non-blanching rash. What is the priority?
AUrgent review and immediate antibiotics, without waiting for tests
BGive paracetamol for the fever and review the patient tomorrow
CWait for the lumbar puncture result before starting any treatment
DDim the lights, encourage rest and recheck observations in four hours
9.Lab values & electrolytesMedium
When should blood cultures be taken for a patient with suspected sepsis?
ABefore the first antibiotic dose, without delaying it much
BAt any time, since antibiotics do not affect the result
CAfter the first three doses of antibiotics
DOnly if the fever lasts more than three days
10.Lab values & electrolytesHard
A patient has taken metformin for 8 years and now has numbness in the feet, a hemoglobin of 10.2 g/dL (102 g/L) and an MCV of 108 fL. Which deficiency is most likely?
AVitamin D (calciferol) deficiency
BIron deficiency from gut loss
CVitamin K deficiency
DVitamin B12 deficiency
11.PharmacologyMedium
Which rule applies to intravenous potassium chloride?
AIt may be given intramuscularly if there is no IV access
BIt must be diluted and given as an infusion, never as an IV push
CIt is mixed into blood products to save time
DIt is given as a rapid IV push to correct low levels quickly
12.PharmacologyHard
A patient who takes propranolol has anaphylaxis and does not respond to repeated adrenaline doses. Which drug may help?
AOral cetirizine alone
BGlucagon
CNaloxone
DMore propranolol
13.Med-surg: cardiovascular & respiratoryMedium
After coronary artery bypass surgery through a median sternotomy, which instruction is usually given for the first several weeks?
AAvoid heavy lifting and pushing up with the arms
BAvoid walking until the stitches are removed
CLift the arms above the head often to stretch the chest
DSleep only on the stomach to protect the wound
14.Med-surg: cardiovascular & respiratoryHard
A nurse is reviewing four telemetry patients. Which rhythm needs attention first?
AFirst-degree heart block with a stable blood pressure and no symptoms
BSinus bradycardia of 54/min in a patient who is asleep and comfortable
CRate-controlled atrial fibrillation at 82/min
DRepeated runs of ventricular tachycardia in a patient who feels dizzy
15.Med-surg: neuro, endocrine & renalMedium
Which complication of haemodialysis causes headache, nausea, restlessness and sometimes seizures, especially in the first sessions?
AVenous air embolism through the lines
BBacterial peritonitis
CDialysis disequilibrium syndrome
DDialysate hypoglycaemia
16.Med-surg: neuro, endocrine & renalHard
A patient's corrected calcium is 1.7 mmol/L (about 6.8 mg/dL). Which ECG change is most typical?
AST elevation in all leads
BA prolonged QT interval
CA shortened QT interval
DTall, peaked T waves
17.Med-surg: GI, perioperative & oncologyMedium
Which monitoring is especially important for a patient receiving parenteral nutrition?
APupil size and limb strength
BBlood glucose and signs of line infection
CBowel sounds and stool colour only
DPeak flow and visual acuity
18.Med-surg: GI, perioperative & oncologyHard
A patient with a permanent pacemaker is booked for surgery using monopolar diathermy. Why must the team know?
APacemakers stop all bleeding during surgery
BDiathermy can interfere with the pacemaker's function
CThe pacemaker will always be removed during surgery
DThe patient cannot have any anaesthetic at all
19.Maternity & obstetric nursingMedium
Which statement about the lactational amenorrhoea method (LAM) is correct?
AIt is reliable even when the baby is formula-fed at night
BIt becomes more reliable after the periods return
CIt works for as long as the mother breastfeeds at all
DIt needs full breastfeeding, no periods and a baby under 6 months
20.Maternity & obstetric nursingHard
A woman 1 day after a caesarean asks how to hold her baby for breastfeeding without pressure on her wound. Which position is best?
ALying flat on her back with the baby on her abdomen
BThe cradle hold with the baby across the incision
CThe football (rugby) hold or side-lying
DStanding up while breastfeeding
21.Pediatric nursingMedium
A child with ITP has a low platelet count. Which advice is correct?
AUse a hard toothbrush and floss firmly to keep the gums healthy
BTake aspirin for any pain to thin the blood
CPlay rugby and football as normal to stay active
DAvoid contact sports and medicines such as ibuprofen and aspirin
22.Pediatric nursingHard
The nurse has taught the parents of a child with sickle cell disease. Which statement shows a need for further teaching?
A"In summer she can drink less so she doesn't need the toilet at school."
B"We'll call the hospital straight away if she has a fever."
C"We'll learn how to feel her tummy for an enlarged spleen."
D"We'll dress her warmly before she goes out in cold weather."
23.Mental health nursingMedium
The wife of a man with alcohol dependence organises her life around his drinking, hides it from others and neglects her own needs. What does this pattern suggest?
ACodependency
BLearned helplessness in the patient
CDelirium tremens
DEnabling by the healthcare team
24.Mental health nursingHard
An older woman living with her son looks thin and unkempt. She says her son "looks after the money" and she is often hungry. What should the nurse do?
AIgnore it, because family finances are a private matter
BTell her that she must move out of her son's home at once and stay with friends until the matter is sorted out
CTalk to her privately, document the findings and raise an adult safeguarding concern
DAsk the son in front of her whether he is stealing her money
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A newborn weighs 7 lb 5 oz. Using 1 lb = 16 oz and 1 kg = 2.2 lb, find the weight m in kilograms. Round to two decimal places.
7 lb 5 oz1 lb = 16 oz1 kg = 2.2 lb
m = kg
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 17:55 and finishes at 08:00 the next morning (24-hour clock). How many minutes t did it run?
17:5508:00
t = min
27.Dosage calculationsMedium
A patient weighs 30 kg. The prescribed dose is 20 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?
30 kg20 mg/kg/day4× per day
D = mg
28.Dosage calculationsHard
A patient is 153 cm tall and weighs 43 kg. The prescription is 25 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.
153 cm43 kg25 mg/m²
D = mg
29.IV infusion ratesMedium
Infuse 1500 mL over 10 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute.
1500 mL10 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 400 mg of a drug in 250 mL and runs at 12 mL/h. How many milligrams per hour D does the patient receive?
400 mg/250 mL12 mL/h
D = mg/h
31.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). An infusion of 250 units of regular insulin in 250 mL runs at 15 mL/h. How many units per hour D does the patient receive?
250 units/250 mL15 mL/h
D = units/h
32.Pediatric & critical-care dosingHard
Practice exercise (made-up values, not clinical guidance). A bag contains dopamine 400 mg in 250 mL. The order is 15 mcg/kg/min for a patient who weighs 89 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
400 mg/250 mL15 mcg/kg/min89 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 IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss).
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 150 mL/h. At 09:30, 150 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL150 mL infused150 mL/h
t = h
35.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 105/min and a blood pressure of 150/83 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.
HR 105/minBP 150/83 mmHg
SI =
36.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 20/min, SpO₂ 98% on room air, blood pressure 222/134 mmHg, pulse 58/min, alert, temperature 38.4 °C. Which clinical risk group does the patient fall into? Click it.
RR 20SpO₂ 98%airSBP 222HR 58AT 38.4 °C
1low
2low–medium
3medium
4high
37.Arterial blood gas interpretationMedium
A practice gas shows a metabolic acidosis with HCO₃⁻ 18 mmol/L. Use Winter’s formula to find the expected PaCO₂ (the centre of the range) in mmHg.
HCO₃⁻ 18 mmol/L
PaCO₂ = mmHg
38.Arterial blood gas interpretationHard
A practice gas shows a metabolic acidosis: pH 7.32, PaCO₂ 32 mmHg (4.3 kPa), HCO₃⁻ 16 mmol/L. Compare the measured PaCO₂ with Winter’s formula. Click your interpretation.
pH 7.32PaCO₂ 32 mmHg (4.3 kPa)HCO₃⁻ 16 mmol/L
1appropriate compensation
2added respiratory acidosis
3added respiratory alkalosis
39.ECG rhythm strip interpretationMedium
This lead II strip shows sinus rhythm with one pause. Measure the pause, the R–R interval across it, in seconds.
lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
pause = s
40.ECG rhythm strip interpretationHard
Identify the rhythm on this lead II strip. 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
1asystole
2torsades de pointes
3atrial fibrillation
4ventricular fibrillation
3Solutions
1.Nursing fundamentals
Answer: D · Measuring how much urine is in the bladder without a catheter
Why this is the answer
A bladder scanner uses ultrasound to estimate bladder volume, for example after a patient has voided. It helps detect retention and avoids unnecessary catheterisation.
Answer
D · Measuring how much urine is in the bladder without a catheter
2.Nursing fundamentals
Answer: B · "I'll take a strong laxative every day just in case."
Why this is the answer
Fluids, fibre, activity and responding to the urge prevent constipation. Taking stimulant laxatives every day without need is not advised and can lead to dependence and electrolyte problems.
Answer
B · "I'll take a strong laxative every day just in case."
3.Infection control & patient safety
Answer: B · Organic matter can shield organisms and weaken the disinfectant
Why this is the answer
Blood, secretions and soil protect organisms and can inactivate disinfectants. Cleaning is always done first, followed by disinfection or sterilization as required.
Answer
B · Organic matter can shield organisms and weaken the disinfectant
4.Infection control & patient safety
Answer: A · Close doors and move patients in danger horizontally behind fire doors
Why this is the answer
Closing doors slows the spread of smoke and fire. Patients in immediate danger are moved horizontally to a safe area behind fire doors, followed by further evacuation if needed. Elevators are not used, and a spreading fire is left to firefighters.
Answer
A · Close doors and move patients in danger horizontally behind fire doors
5.Prioritization & delegation
Answer: B · A patient with a new cast who says the foot feels numb and the toes are cool
Why this is the answer
Numbness and cool toes under a cast suggest compromised circulation, possibly compartment syndrome, which can cause permanent damage within hours. The other findings are expected or routine.
Answer
B · A patient with a new cast who says the foot feels numb and the toes are cool
6.Prioritization & delegation
Answer: C · Right shoulder pain from the gas used during surgery
Why this is the answer
Gas used to inflate the abdomen irritates the diaphragm and causes referred shoulder pain, which settles in a day or two. Jaundice, fever with worsening pain and signs of shock suggest complications.
Answer
C · Right shoulder pain from the gas used during surgery
7.Clinical nursing
Answer: B · Apply suction only while withdrawing the catheter, for no more than about 10–15 seconds
Why this is the answer
Suctioning only on withdrawal and keeping it brief reduces hypoxia and mucosal damage. Suction is performed when needed, not routinely, and the patient is pre-oxygenated if required.
Answer
B · Apply suction only while withdrawing the catheter, for no more than about 10–15 seconds
8.Clinical nursing
Answer: A · Urgent review and immediate antibiotics, without waiting for tests
Why this is the answer
Bacterial meningitis and meningococcal sepsis progress rapidly. Antibiotics should not be delayed for tests such as lumbar puncture.
Answer
A · Urgent review and immediate antibiotics, without waiting for tests
9.Lab values & electrolytes
Answer: A · Before the first antibiotic dose, without delaying it much
Why this is the answer
Blood cultures are taken before antibiotics, because even one dose can prevent bacteria from growing and hide the cause. Antibiotics should still be started quickly, ideally within an hour.Checked against:Sepsis · MedlinePlus (NIH) (2024)
Answer
A · Before the first antibiotic dose, without delaying it much
10.Lab values & electrolytes
Answer: D · Vitamin B12 deficiency
Why this is the answer
Long-term metformin reduces vitamin B12 absorption in the gut. B12 deficiency causes macrocytic anemia and peripheral neuropathy, which can be mistaken for diabetic neuropathy. Periodic B12 testing is recommended for long-term users.Checked against:Vitamin B Test · MedlinePlus (NIH) (2026)
Answer
D · Vitamin B12 deficiency
11.Pharmacology
Answer: B · It must be diluted and given as an infusion, never as an IV push
Why this is the answer
Concentrated potassium given as a bolus can cause fatal cardiac arrhythmias. It is always diluted and given at a controlled rate, usually with an infusion pump.
Answer
B · It must be diluted and given as an infusion, never as an IV push
12.Pharmacology
Answer: B · Glucagon
Why this is the answer
Beta blockers can make anaphylaxis more severe and resistant to adrenaline. Glucagon acts through its own receptor to increase heart rate and contractility, bypassing the blocked beta receptors.
Answer
B · Glucagon
13.Med-surg: cardiovascular & respiratory
Answer: A · Avoid heavy lifting and pushing up with the arms
Why this is the answer
The sternum is wired and takes weeks to heal. Patients are advised to avoid heavy lifting, pulling and pushing with the arms, and to support the chest with a pillow when coughing. Walking is encouraged as part of cardiac rehabilitation.
Answer
A · Avoid heavy lifting and pushing up with the arms
14.Med-surg: cardiovascular & respiratory
Answer: D · Repeated runs of ventricular tachycardia in a patient who feels dizzy
Why this is the answer
Symptomatic runs of VT can degenerate into VF or pulseless VT and need immediate assessment, electrolytes and treatment. Sinus bradycardia during sleep, controlled AF and first-degree heart block with stable observations are usually not urgent.
Answer
D · Repeated runs of ventricular tachycardia in a patient who feels dizzy
15.Med-surg: neuro, endocrine & renal
Answer: C · Dialysis disequilibrium syndrome
Why this is the answer
Rapid removal of urea from the blood creates an osmotic gradient, so water moves into brain cells, causing cerebral oedema. It is prevented by shorter, gentler first sessions.
Answer
C · Dialysis disequilibrium syndrome
16.Med-surg: neuro, endocrine & renal
Answer: B · A prolonged QT interval
Why this is the answer
Hypocalcaemia prolongs the QT interval, which can lead to dangerous arrhythmias. A short QT is seen in hypercalcaemia, and peaked T waves are typical of hyperkalaemia.
Answer
B · A prolonged QT interval
17.Med-surg: GI, perioperative & oncology
Answer: B · Blood glucose and signs of line infection
Why this is the answer
PN can cause hyperglycaemia and electrolyte disturbance, and the central line is a route for bloodstream infection. Glucose, electrolytes, fluid balance, weight and temperature are monitored closely.
Answer
B · Blood glucose and signs of line infection
18.Med-surg: GI, perioperative & oncology
Answer: B · Diathermy can interfere with the pacemaker's function
Why this is the answer
Electrical interference from monopolar diathermy can inhibit or reprogram pacemakers and defibrillators. The team plans ahead, for example using bipolar diathermy, placing the plate carefully or having the device checked.
Answer
B · Diathermy can interfere with the pacemaker's function
19.Maternity & obstetric nursing
Answer: D · It needs full breastfeeding, no periods and a baby under 6 months
Why this is the answer
LAM is effective only if the mother is fully or nearly fully breastfeeding day and night, her periods have not returned and the baby is under 6 months. Ovulation can occur before the first period.
Answer
D · It needs full breastfeeding, no periods and a baby under 6 months
20.Maternity & obstetric nursing
Answer: C · The football (rugby) hold or side-lying
Why this is the answer
The football hold places the baby along her side, and side-lying avoids any pressure on the abdomen. A pillow over the wound also helps.
Answer
C · The football (rugby) hold or side-lying
21.Pediatric nursing
Answer: D · Avoid contact sports and medicines such as ibuprofen and aspirin
Why this is the answer
While platelets are low, the child should avoid contact sports and activities with a high risk of head injury, and avoid NSAIDs and aspirin, which impair platelet function. A soft toothbrush is used, and parents report any heavy bleeding.
Answer
D · Avoid contact sports and medicines such as ibuprofen and aspirin
22.Pediatric nursing
Answer: A · "In summer she can drink less so she doesn't need the toilet at school."
Why this is the answer
Dehydration promotes sickling, so children with sickle cell disease need plenty of fluids, especially in hot weather and during exercise. Seeking help for fever, avoiding cold and checking the spleen are correct.
Answer
A · "In summer she can drink less so she doesn't need the toilet at school."
23.Mental health nursing
Answer: A · Codependency
Why this is the answer
Codependency describes a family member whose life becomes centred on the other person's addiction, often with caretaking, covering up and neglect of self. Support groups such as Al-Anon can help.
Answer
A · Codependency
24.Mental health nursing
Answer: C · Talk to her privately, document the findings and raise an adult safeguarding concern
Why this is the answer
Signs of financial abuse and neglect require a private conversation, careful documentation and reporting through safeguarding procedures. Confrontation could increase the risk to her.
Answer
C · Talk to her privately, document the findings and raise an adult safeguarding concern
25.Nursing math & unit conversions
Answer: m = 3.32 kg
Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.
Ounces to pounds
5 oz/16 = 0.3125 lb
7 + 0.3125 = 7.313 lb
Pounds to kilograms
m = 7.313/2.2 = 3.324 ≈ 3.32 kg
Answer
m = 3.32 kg
26.Nursing math & unit conversions
Answer: t = 845 min
24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.
Before midnight
17:55 → 24:00 = 365 min
After midnight
00:00 → 08:00 = 480 min
Total
t = 365 + 480 = 845 min
Answer
t = 845 min
27.Dosage calculations
Answer: D = 150 mg
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.
Total per day
20·30 = 600 mg
Per dose
D = 600/4 = 150 mg
Answer
D = 150 mg
28.Dosage calculations
Answer: D = 33.8 mg
Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).
Body surface area
BSA = √(153·43/3600) = √1.827 = 1.352 m²
Dose
D = 25·1.352 = 33.8 mg
Answer
D = 33.8 mg
29.IV infusion rates
Answer: R = 50 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 = 1500·20/600 = 50 gtt/min
Answer
R = 50 gtt/min
30.IV infusion rates
Answer: D = 19.2 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
400/250 = 1.6 mg/mL
Dose rate
D = 1.6·12 = 19.2 mg/h
Answer
D = 19.2 mg/h
31.Pediatric & critical-care dosing
Answer: D = 15 units/h
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.
Concentration
250/250 = 1 units/mL
Units per hour
D = 15·1 = 15 units/h
Answer
D = 15 units/h
32.Pediatric & critical-care dosing
Answer: R = 50.1 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
400 mg = 400 000 mcg
400 000/250 = 1600 mcg/mL
Dose per minute and per hour
15·89 = 1335 mcg/min
1335·60 = 80100 mcg/h
Pump rate
R = 80100/1600 = 50.06 ≈ 50.1 mL/h
Answer
R = 50.1 mL/h
33.IV fluids & fluid balance
Answer: B = 1205 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: 150 + 240 = 390 mL
IV infusion: 125·12 = 1500 mL
IV antibiotic: 1·100 = 100 mL
total intake = 1990 mL
Total output
200 + 325 + 200 + 60 = 785 mL
Balance
B = 1990 − 785 = 1205 mL
Answer
B = 1205 mL
Positive: more fluid went in than came out.
34.IV fluids & fluid balance
Answer: t = 5.7 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 − 150 = 850 mL
Time
t = 850/150 = 5.667 ≈ 5.7 h
Answer
t = 5.7 h
That is about 5 h 40 min, so the bag runs out at about 15:10.
35.Clinical assessment scores
Answer: SI = 0.7
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 = 105/150 = 0.7
Answer
SI = 0.7
Within or below the usual 0.5–0.7.
36.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 20/min → 0
SpO₂ 98% → 0
on air → 0
SBP 222 mmHg → 3
HR 58/min → 0
alert (A) → 0
T 38.4 °C → 1
Total and red scores
NEWS2 = 0 + 0 + 0 + 3 + 0 + 0 + 1 = 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.
37.Arterial blood gas interpretation
Answer: PaCO₂ = 35 mmHg
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.
Winter’s formula
PaCO₂ = 1.5·18 + 8 = 35 mmHg
range: 33–37 mmHg
Answer
PaCO₂ = 35 mmHg
38.Arterial blood gas interpretation
Answer: appropriate compensation
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.
Expected PaCO₂
1.5·16 + 8 = 32 → 30–34 mmHg
Compare
measured: 32 mmHg → appropriate compensation
Answer
appropriate compensation
39.ECG rhythm strip interpretation
Answer: pause = 2.2 s
Narrow-complex tachycardia and pauses: supraventricular tachycardia (SVT) is a regular tachycardia at about 150–250/min with narrow QRS complexes; the P waves are usually not visible because they are hidden in the QRS complex or the T wave. Sinus tachycardia in an adult at rest is usually below about 150/min and has a visible P wave before every QRS; atrial flutter with 2:1 conduction often runs at about 150/min and shows sawtooth waves. In sinus arrest the sinus node stops firing for a moment: a pause with no P wave and no QRS whose length is not a whole number of P–P cycles (a pause of exactly two or three cycles points to sinus exit block instead).
Measure
55 small boxes from R to R across the pause
Convert
pause = 55 × 0.04 s = 2.2 s
Compare with P–P
2.20 ÷ 0.92 ≈ 2.4 P–P cycles, not a whole number
Answer
pause = 2.2 s
No P wave appears in the pause, and the pause is not a whole number of P–P cycles: sinus arrest. A pause of exactly two or three cycles would point to sinus exit block.
40.ECG rhythm strip interpretation
Answer: ventricular fibrillation
Ventricular rhythms: ventricular tachycardia is a run of three or more wide (0.12 s or more) complexes in a row at more than 100/min, usually 150–250/min, regular, without related P waves. Ventricular fibrillation is a chaotic, irregular waveform with no identifiable P waves, QRS complexes or T waves and no countable rate. Asystole is an almost flat line with no ventricular activity; a flat line is always confirmed by checking the patient, the leads and the gain and a second lead. In resuscitation guidelines VF and pulseless VT are the shockable rhythms and asystole is not.
Five steps
1. Rate: no countable ventricular rate.
2. Rhythm: chaotic, no repeating pattern.
3. P waves: none identifiable.
4. PR interval: not measurable.
5. QRS: no QRS complexes.
Interpretation
ventricular fibrillation
Answer
ventricular fibrillation
In resuscitation guidelines VF and pulseless VT are the shockable rhythms. This is identification practice only.
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