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
Why does long-term immobility increase the risk of kidney stones?
APatients on bed rest drink too much fluid
BCalcium released from bone raises the calcium in the urine
CThe kidneys stop producing urine during bed rest
DLying flat makes the kidneys produce extra uric acid
2.Nursing fundamentalsHard
An older patient two days after surgery suddenly becomes confused and agitated at night. What is the priority?
AAssume it is new dementia and plan a care home move
BLook for and treat underlying causes such as infection, pain, retention, constipation or medication
CRestrain the patient to the bed
DGive a sedative and recheck in the morning
3.Infection control & patient safetyMedium
A nurse who wears prescription glasses must irrigate a wound where splashing is likely. Which eye protection is suitable?
AGoggles or a face shield worn over the glasses
BNo eye protection, if the nurse stands to one side
CThe glasses with a surgical mask
DThe prescription glasses alone
4.Infection control & patient safetyHard
A nurse asks a colleague to “just glance” at an insulin infusion before starting it. What makes a check truly independent?
AThe second nurse signs the record after the infusion has already been started by the first
BThe first nurse reads the details aloud and the second agrees
CThe second nurse checks the order, drug, dose and pump settings separately without being told the answer
DThe second nurse looks at the bag label from the doorway
5.Prioritization & delegationMedium
A patient with mild dysphagia after a stroke is eating. Which technique helps make swallowing safer?
ADrinking thin fluids quickly through a straw between bites
BLying flat with the head tilted back
CSitting upright with the chin tucked down while swallowing
DTalking while eating to stay alert
6.Prioritization & delegationHard
An infant is choking and cannot cry or breathe. Which technique is correct?
AAbdominal thrusts, as in adults
BA blind finger sweep of the mouth
CHolding the infant upside down by the feet
DBack blows and chest thrusts
7.Clinical nursingMedium
Modern wound care generally aims to keep a healing wound bed:
AMoist but not wet
BCompletely dry and open to the air
CSoaked in antiseptic solution every day
DTightly packed with dry gauze
8.Clinical nursingHard
A nurse teaches a patient with a new ileostomy. Which statement shows a need for further teaching?
A"I will drink extra fluids when it is hot."
B"My stoma should look pink or red and moist."
C"I will empty the bag when it is about a third to half full."
D"My output will be firm and formed like before."
9.Lab values & electrolytesMedium
A patient taking empagliflozin (an SGLT2 inhibitor) has glucose in the urine but a normal blood glucose. What is the best interpretation?
AUncontrolled diabetes needing insulin
BA sign of kidney failure
CA urinary tract infection
DAn expected effect of the drug
10.Lab values & electrolytesHard
A patient stopped long-term prednisone suddenly a week ago. Now: blood pressure 78/46 mm Hg, sodium 128 mEq/L, potassium 4.6 mEq/L, glucose 58 mg/dL (3.2 mmol/L). Which condition is most likely?
APrimary hyperaldosteronism (Conn syndrome)
BCushing syndrome from steroid excess
CAcute adrenal insufficiency (adrenal crisis)
DSyndrome of inappropriate ADH (SIADH)
11.PharmacologyMedium
Why is a progestogen added to oestrogen in hormone replacement therapy for a woman who still has her uterus?
ATo protect against endometrial hyperplasia and cancer
BTo reduce hot flushes much more than oestrogen alone can
CTo prevent breast cancer completely
DTo lower the risk of blood clots to zero
12.PharmacologyHard
During general anaesthesia with a volatile agent and suxamethonium (succinylcholine), a patient develops muscle rigidity, rising end-tidal CO2 and a fast-rising temperature. Which drug is the specific treatment?
ADantrolene
BNaloxone
CNeostigmine
DParacetamol
13.Med-surg: cardiovascular & respiratoryMedium
A patient with asthma uses their reliever inhaler more than three times a week. What does this suggest?
AAsthma control is poor and treatment needs review
BAsthma is well controlled with the current plan
CThe reliever no longer works and should be stopped
DThe preventer inhaler is no longer needed
14.Med-surg: cardiovascular & respiratoryHard
A patient being treated for infective endocarditis of the mitral valve suddenly develops slurred speech and weakness of the right arm. What is the most likely cause?
AA side effect of the IV antibiotic on the nerves
BAn embolus from a valve vegetation causing a stroke
CLow blood glucose from a reduced appetite
DA migraine aura triggered by the fever
15.Med-surg: neuro, endocrine & renalMedium
After a lumbar discectomy, which finding should the nurse report promptly?
AStiffness when getting out of bed
BMild pain at the wound site
CA dry, intact wound dressing
DNew weakness or numbness in the legs
16.Med-surg: neuro, endocrine & renalHard
A haemodialysis patient with a tunnelled central venous catheter develops fever and rigors soon after dialysis starts. What should the nurse suspect and do?
ACatheter-related bloodstream infection; stop, take cultures and escalate
BNormal reaction to dialysis; continue and give paracetamol only
CDialysis disequilibrium; speed up dialysis to finish sooner
DAir embolism; tilt the patient head-up and continue
17.Med-surg: GI, perioperative & oncologyMedium
Which statement about multimodal analgesia is correct?
AOnly one analgesic should ever be given at any one time
BSeveral different opioids are combined for a stronger overall effect
CIt is a method used only for long-term chronic pain
DDrugs with different actions are combined to reduce opioid needs
18.Med-surg: GI, perioperative & oncologyHard
A colleague suggests giving a saline injection to see whether a patient's pain is "real". What is the best response?
ADeceptive placebos are unethical and do not show pain is "fake"
BIt should be done only for patients with chronic pain
CIt is a good idea, as long as the patient is not told about it afterwards
DIt is acceptable if a senior nurse gives the saline
19.Maternity & obstetric nursingMedium
The first day of a woman's last menstrual period was 10 March. Using Naegele's rule, what is her estimated date of birth?
A17 June
B17 December
C10 January
D3 December
20.Maternity & obstetric nursingHard
A deceleration lasts 3 minutes before the baseline recovers. How is this classified?
AA variable acceleration
BAn early deceleration
CA prolonged deceleration
DA change of baseline
21.Pediatric nursingMedium
When is the risk of bleeding after a tonsillectomy highest?
AOnly after 3 weeks, when the throat is fully healed
BThe risk stays exactly the same on every day for the first month
CIn the first 24 hours and again about 5 to 10 days later
DOnly during the first 2 hours after surgery
22.Pediatric nursingHard
A 4-year-old has a high fever, is drooling, sitting forward with the neck extended and looks anxious. What should the nurse do first?
ATake a throat swab to identify the organism
BInsert an IV cannula before calling for help
CKeep the child calm and upright with the parent, and call a team skilled in airway management
DLie the child flat and use a tongue depressor to look into the throat and confirm the swelling
23.Mental health nursingMedium
A patient with psychosis says, "There's a man standing in the corner." The nurse sees no one there. Which response uses presenting reality?
A"I don't see anyone in the corner, but I know it seems real to you."
B"The man will go away if you ignore him."
C"That's just your illness talking, so there's nothing to worry about. Try to think of something else."
D"What does the man in the corner look like?"
24.Mental health nursingHard
Which patient has the highest risk of suicide?
AA 72-year-old widowed man with alcohol dependence who has a gun at home and a plan
BA 20-year-old student with exam stress who has no thoughts of suicide and good friends
CA 45-year-old man with well-controlled hypertension who works full time
DA 30-year-old woman with mild anxiety who has a supportive family
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 97.8 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.
97.8 °F
T = °C
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A serum creatinine result is 0.5 mg/dL. Using 1 mg/dL = 88.4 µmol/L for creatinine, find c in µmol/L to the nearest whole number.
0.5 mg/dL1 mg/dL = 88.4 µmol/L
c = µmol/L
27.Dosage calculationsMedium
A patient weighs 18 kg and is prescribed 25 mg/kg as a single dose. Find the dose D in mg.
18 kg25 mg/kg
D = mg
28.Dosage calculationsHard
You must prepare 100 mL of a 2% (w/v) solution from a 50% (w/v) stock solution. How much water W must be added to the stock?
C₁ = 50%C₂ = 2%V₂ = 100 mL
W = mL
29.IV infusion ratesMedium
Infuse 1000 mL over 8 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
1000 mL8 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 100 mg of a drug in 500 mL and runs at 15 mL/h. How many milligrams per hour D does the patient receive?
100 mg/500 mL15 mL/h
D = mg/h
31.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). An infusion of 50 units of regular insulin in 50 mL runs at 15 mL/h. How many units per hour D does the patient receive?
50 units/50 mL15 mL/h
D = units/h
32.Pediatric & critical-care dosingHard
Practice exercise (made-up values, not clinical guidance). A patient who weighs 72 kg has an order for nitroglycerin at 5 mcg/min. The bag contains 25 mg in 250 mL. Find the pump rate R in mL/h. Round to one decimal place.
25 mg/250 mL5 mcg/min72 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). Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 100 mL/h. At 06:30, 650 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL650 mL infused100 mL/h
t = h
35.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury opens the eyes spontaneously, talks in sentences but is confused and shows as the best motor response: obeys commands. Work out the GCS and classify the head injury by it. Click your answer.
1mild
2moderate
3severe
36.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 16/min, SpO₂ 91% on room air, blood pressure 150/90 mmHg, pulse 88/min, alert, temperature 37.4 °C. Which clinical risk group does the patient fall into? Click it.
RR 16SpO₂ 91%airSBP 150HR 88AT 37.4 °C
1low
2low–medium
3medium
4high
37.Arterial blood gas interpretationMedium
Practice values: Na⁺ 131 mmol/L, glucose 27.2 mmol/L and urea 7.2 mmol/L. Calculate the serum osmolality Osm = 2·Na⁺ + glucose + urea to the nearest whole number.
Na⁺ 131 mmol/Lglucose 27.2 mmol/Lurea 7.2 mmol/L
Osm = mOsm/kg
38.Arterial blood gas interpretationHard
A practice gas shows pH 7.31, PaCO₂ 31 mmHg (4.1 kPa) and HCO₃⁻ 15 mmol/L, with Na⁺ 143 and Cl⁻ 93 mmol/L. Use the anion gap and the delta ratio to click the best interpretation.
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
Interpret this lead II strip with the five steps in order: rate, rhythm, P waves, PR interval, QRS duration. At which step do you find the first abnormal finding? Click it.
lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
1rate
2rhythm
3P waves
4PR interval
5QRS duration
3Solutions
1.Nursing fundamentals
Answer: B · Calcium released from bone raises the calcium in the urine
Why this is the answer
Without weight-bearing, bone releases calcium, and urine also drains less well when lying flat. Mobilisation and adequate fluids reduce the risk.
Answer
B · Calcium released from bone raises the calcium in the urine
2.Nursing fundamentals
Answer: B · Look for and treat underlying causes such as infection, pain, retention, constipation or medication
Why this is the answer
Acute confusion should be treated as delirium until shown otherwise. Common causes include infection, hypoxia, pain, urinary retention, constipation, dehydration and drugs. Sedation and restraint can make it worse.
Answer
B · Look for and treat underlying causes such as infection, pain, retention, constipation or medication
3.Infection control & patient safety
Answer: A · Goggles or a face shield worn over the glasses
Why this is the answer
Prescription glasses do not protect against splashes from the sides, top or bottom. Goggles or a face shield that fit over them are worn when splashes are likely.
Answer
A · Goggles or a face shield worn over the glasses
4.Infection control & patient safety
Answer: C · The second nurse checks the order, drug, dose and pump settings separately without being told the answer
Why this is the answer
In an independent double check, the second person works through each step on their own, then the two results are compared. Reading the answer aloud or glancing invites confirmation bias.
Answer
C · The second nurse checks the order, drug, dose and pump settings separately without being told the answer
5.Prioritization & delegation
Answer: C · Sitting upright with the chin tucked down while swallowing
Why this is the answer
Sitting upright and tucking the chin narrows the airway entrance and helps food pass into the esophagus. The nurse follows the speech therapist’s plan, which may include thickened fluids.
Answer
C · Sitting upright with the chin tucked down while swallowing
6.Prioritization & delegation
Answer: D · Back blows and chest thrusts
Why this is the answer
For a choking infant, the nurse gives cycles of five back blows and five chest thrusts. Abdominal thrusts are not used in infants, and blind finger sweeps can push the object deeper.
Answer
D · Back blows and chest thrusts
7.Clinical nursing
Answer: A · Moist but not wet
Why this is the answer
A moist wound environment speeds epithelial cell migration and healing. Too much moisture causes maceration, so dressings are chosen to manage exudate.
Answer
A · Moist but not wet
8.Clinical nursing
Answer: D · "My output will be firm and formed like before."
Why this is the answer
Ileostomy output is liquid to porridge-like because it bypasses the colon. The other statements describe correct care: good hydration, emptying the bag before it is too heavy and recognising a healthy stoma.
Answer
D · "My output will be firm and formed like before."
9.Lab values & electrolytes
Answer: D · An expected effect of the drug
Why this is the answer
SGLT2 inhibitors block glucose reabsorption in the proximal tubule, so glycosuria is expected even with normal blood glucose. Urine glucose cannot be used to monitor control in these patients. The drugs also raise the risk of genital infections and DKA.Checked against:Ketones blood test · MedlinePlus (NIH) (2025)
Answer
D · An expected effect of the drug
10.Lab values & electrolytes
Answer: C · Acute adrenal insufficiency (adrenal crisis)
Why this is the answer
Long-term glucocorticoids suppress the body's own cortisol production; stopping them suddenly can cause adrenal crisis. Lack of cortisol causes hypotension, hyponatremia and hypoglycemia. Aldosterone is usually still made, so potassium is often normal; high potassium suggests primary adrenal failure. Treatment is IV hydrocortisone and fluids as prescribed.
Answer
C · Acute adrenal insufficiency (adrenal crisis)
11.Pharmacology
Answer: A · To protect against endometrial hyperplasia and cancer
Why this is the answer
Oestrogen alone causes endometrial proliferation and increases the risk of endometrial cancer. A progestogen protects the endometrium; women without a uterus can take oestrogen alone.
Answer
A · To protect against endometrial hyperplasia and cancer
12.Pharmacology
Answer: A · Dantrolene
Why this is the answer
Malignant hyperthermia is caused by uncontrolled calcium release from the sarcoplasmic reticulum. Dantrolene blocks this release, and the triggering agents are stopped at once.
Answer
A · Dantrolene
13.Med-surg: cardiovascular & respiratory
Answer: A · Asthma control is poor and treatment needs review
Why this is the answer
Needing a reliever often, waking at night with symptoms or limiting activity indicates poorly controlled asthma. Inhaler technique, adherence and triggers should be checked and the regular preventer treatment stepped up.
Answer
A · Asthma control is poor and treatment needs review
14.Med-surg: cardiovascular & respiratory
Answer: B · An embolus from a valve vegetation causing a stroke
Why this is the answer
Vegetations on the mitral or aortic valve can break off and embolise to the brain, kidneys, spleen or limbs. Sudden focal neurological signs suggest an embolic stroke: the nurse calls for urgent help, checks the blood glucose to exclude hypoglycaemia and expects urgent brain imaging. Thrombolysis is generally avoided in endocarditis because of the bleeding risk.
Answer
B · An embolus from a valve vegetation causing a stroke
15.Med-surg: neuro, endocrine & renal
Answer: D · New weakness or numbness in the legs
Why this is the answer
New or worsening leg weakness, numbness or problems passing urine may indicate a haematoma or nerve root compression and need urgent review. Mild wound pain and stiffness are expected.
Answer
D · New weakness or numbness in the legs
16.Med-surg: neuro, endocrine & renal
Answer: A · Catheter-related bloodstream infection; stop, take cultures and escalate
Why this is the answer
Fever and rigors when dialysis starts through a central catheter strongly suggest a catheter-related bloodstream infection. Dialysis is stopped or adjusted per protocol, blood cultures are taken (from the catheter and peripherally), the team is informed and IV antibiotics are started as prescribed. The exit site is inspected.
Answer
A · Catheter-related bloodstream infection; stop, take cultures and escalate
17.Med-surg: GI, perioperative & oncology
Answer: D · Drugs with different actions are combined to reduce opioid needs
Why this is the answer
Multimodal analgesia combines drugs and techniques (paracetamol, NSAIDs where safe, local anaesthetic blocks, opioids) to improve pain relief and reduce opioid side effects. Combining several opioids is not multimodal.
Answer
D · Drugs with different actions are combined to reduce opioid needs
18.Med-surg: GI, perioperative & oncology
Answer: A · Deceptive placebos are unethical and do not show pain is "fake"
Why this is the answer
A placebo response does not mean pain is not real, and giving placebos without consent is deceptive and damages trust. Pain is assessed with the patient and treated according to the plan.
Answer
A · Deceptive placebos are unethical and do not show pain is "fake"
19.Maternity & obstetric nursing
Answer: B · 17 December
Why this is the answer
10 March + 7 days = 17 March; minus 3 months = 17 December. Subtracting the 7 days instead gives 3 December, and adding the 3 months gives 17 June.
Answer
B · 17 December
20.Maternity & obstetric nursing
Answer: C · A prolonged deceleration
Why this is the answer
A prolonged deceleration lasts at least 2 minutes but less than 10. A decrease of 10 minutes or more is a baseline change. The cause, such as hypotension or tachysystole, should be found and corrected.
Answer
C · A prolonged deceleration
21.Pediatric nursing
Answer: C · In the first 24 hours and again about 5 to 10 days later
Why this is the answer
Primary bleeding occurs in the first 24 hours. Secondary bleeding occurs around 5–10 days after surgery, when the scabs come away, so families need to know the warning signs before going home.
Answer
C · In the first 24 hours and again about 5 to 10 days later
22.Pediatric nursing
Answer: C · Keep the child calm and upright with the parent, and call a team skilled in airway management
Why this is the answer
These signs suggest epiglottitis or another upper airway emergency. Avoid distressing interventions, keep the child in their position of comfort and get expert airway help immediately.
Answer
C · Keep the child calm and upright with the parent, and call a team skilled in airway management
23.Mental health nursing
Answer: A · "I don't see anyone in the corner, but I know it seems real to you."
Why this is the answer
Presenting reality calmly states the nurse's own perception while accepting that the experience feels real to the patient. It neither confirms the hallucination nor argues with the patient.
Answer
A · "I don't see anyone in the corner, but I know it seems real to you."
24.Mental health nursing
Answer: A · A 72-year-old widowed man with alcohol dependence who has a gun at home and a plan
Why this is the answer
Older age, male sex, being widowed, substance misuse, access to lethal means and a specific plan all raise suicide risk. Having several factors together greatly increases the overall risk.
Answer
A · A 72-year-old widowed man with alcohol dependence who has a gun at home and a plan
25.Nursing math & unit conversions
Answer: T = 36.6 °C
Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.
Subtract 32
97.8 − 32 = 65.8
Multiply by 5/9
T = 65.8·5/9 = 36.56 ≈ 36.6 °C
Answer
T = 36.6 °C
26.Nursing math & unit conversions
Answer: c = 44 µmol/L
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.
Convert
c = 0.5·88.4 = 44.2 ≈ 44 µmol/L
Answer
c = 44 µmol/L
27.Dosage calculations
Answer: D = 450 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.
Dose
25·18 = 450 mg
Answer
D = 450 mg
28.Dosage calculations
Answer: W = 96 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 = 2·100/50 = 4 mL
Water to add
W = 100 − 4 = 96 mL
Answer
W = 96 mL
29.IV infusion rates
Answer: R = 42 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
8·60 = 480 min
Drip rate
R = 1000·20/480 = 41.67 ≈ 42 gtt/min
Answer
R = 42 gtt/min
At the bedside you round to the nearest whole drop: 42 gtt/min.
30.IV infusion rates
Answer: D = 3 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
100/500 = 0.2 mg/mL
Dose rate
D = 0.2·15 = 3 mg/h
Answer
D = 3 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
50/50 = 1 units/mL
Units per hour
D = 15·1 = 15 units/h
Answer
D = 15 units/h
32.Pediatric & critical-care dosing
Answer: R = 3 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
25 000/250 = 100 mcg/mL
Dose per hour
The order is per minute for the whole patient, so the weight is not needed.
5·60 = 300 mcg/h
Pump rate
R = 300/100 = 3 mL/h
Answer
R = 3 mL/h
33.IV fluids & fluid balance
Answer: B = 565 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: 200 + 120 = 320 mL
ice chips: 200/2 = 100 mL
IV infusion: 75·12 = 900 mL
IV antibiotic: 1·100 = 100 mL
total intake = 1420 mL
Total output
225 + 500 + 130 = 855 mL
Balance
B = 1420 − 855 = 565 mL
Answer
B = 565 mL
Positive: more fluid went in than came out.
34.IV fluids & fluid balance
Answer: t = 3.5 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 = 350/100 = 3.5 h
Answer
t = 3.5 h
That is about 3 h 30 min, so the bag runs out at about 10:00.
35.Clinical assessment scores
Answer: mild
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 spontaneously → 4
V: talks in sentences but is confused → 4
M: obeys commands → 6
Add
GCS = 4 + 4 + 6 = 14
Severity
GCS 14 → mild
Answer
mild
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 16/min → 0
SpO₂ 91% → 3
on air → 0
SBP 150 mmHg → 0
HR 88/min → 0
alert (A) → 0
T 37.4 °C → 0
Total and red scores
NEWS2 = 0 + 3 + 0 + 0 + 0 + 0 + 0 = 3
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: Osm = 296 mOsm/kg
Derived values: calculated serum osmolality is 2·Na⁺ + glucose + urea with all values in mmol/L (2·Na⁺ + glucose/18 + BUN/2.8 with glucose and BUN in mg/dL); normal is about 275–295 mOsm/kg. The P/F ratio is PaO₂ divided by FiO₂ as a fraction. The alveolar oxygen pressure is PAO₂ = FiO₂·(760 − 47) − PaCO₂/0.8 mmHg at sea level, and the A–a gradient is PAO₂ − PaO₂.
Calculated osmolality
Osm = 2·131 + 27.2 + 7.2 = 296.4 ≈ 296 mOsm/kg
Answer
Osm = 296 mOsm/kg
38.Arterial blood gas interpretation
Answer: added metabolic alkalosis
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 − (93 + 15) = 35
Delta ratio
(35 − 12)/(24 − 15) = 2.556
added metabolic alkalosis
Answer
added metabolic alkalosis
39.ECG rhythm strip interpretation
Answer: QTc = 0.438 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 × 0.04 = 0.40 s
RR = 19 × 0.04 = 0.76 s
Fridericia’s formula
QTc = 0.40/∛0.76 = 0.40/0.9126 = 0.438 s
Answer
QTc = 0.438 s
Within the usual limits (about 0.45 s for men, 0.46 s for women). (438 ms)
40.ECG rhythm strip interpretation
Answer: PR interval
Five steps for every strip: 1. rate (300 or 1500 method, or the 6-second method if irregular); 2. rhythm: are the R–R intervals equal; 3. P waves: present, upright in lead II, one before every QRS and all alike; 4. PR interval: 0.12–0.20 s and constant; 5. QRS duration: below 0.12 s. Only after the five steps name the rhythm. Normal sinus rhythm passes all five: 60–100/min, regular, upright P before every QRS, PR 0.12–0.20 s, QRS below 0.12 s.
Five steps
1. Rate: R–R = 18 small boxes, 1500 ÷ 18 ≈ 83 per minute.
2. Rhythm: regular, every R–R is 0.72 s.
3. P waves: upright, one before every QRS, all alike.
4. PR interval: 0.28 s, constant, longer than 0.20 s.
5. QRS: 0.08 s, narrow (below 0.12 s).
First abnormal step
PR interval → first-degree AV block
Answer
PR interval
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