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 medicines reconciliation on admission?
AOrdering new stock from the pharmacy
BChanging all the patient's medicines to hospital brands
CGetting an accurate list of the medicines taken before admission
DCounting the tablets in the ward drug trolley at the start of each shift
2.Nursing fundamentalsHard
In a patient with sepsis, what does a raised blood lactate suggest?
AThe kidneys are making too much urine
BThe patient has eaten recently
CThe tissues are not getting enough oxygen
DThe infection has been cured
3.Infection control & patient safetyMedium
How tight should a wrist restraint be?
ALoose enough for the patient’s hand to slip out
BTight enough to slow the pulse at the wrist
CAs tight as possible so the patient cannot move the arm
DLoose enough to fit two fingers between the restraint and the skin
4.Infection control & patient safetyHard
A patient on long-term high-dose corticosteroids asks for the nasal spray influenza vaccine. What should the nurse explain?
APeople on steroids should never have any influenza vaccine
BThe nasal spray is a live vaccine, so the injected inactivated vaccine is used instead
CThe nasal spray is the best choice for people on steroids, because it is not injected
DEither type is fine, as long as it is given in the morning
5.Prioritization & delegationMedium
During START triage at a mass-casualty scene, a victim can walk to the designated area when asked. Which category is the victim given?
ARed (immediate)
BYellow (delayed)
CBlack (expectant)
DGreen (minor)
6.Prioritization & delegationHard
Four laboratory results come back at once. Which one should the nurse report first?
AGlucose 180 mg/dL after a meal in a patient with diabetes
BHemoglobin 6.5 g/dL (65 g/L) in a patient with a GI bleed
CCreatinine 1.3 mg/dL in an older adult, unchanged from last week
DPotassium 3.4 mEq/L in a patient on a diuretic
7.Clinical nursingMedium
Why is an urgent brain scan needed before thrombolysis for a suspected stroke?
ATo confirm the patient's age
BTo rule out bleeding in the brain
CTo check for brain tumours only
DTo measure the size of the ventricles
8.Clinical nursingHard
A postoperative patient on IV fluids has a sodium of 128 mmol/L and is becoming confused. Which fluid could make this worse if given in large amounts?
A0.9% sodium chloride
B5% glucose (D5W)
CHuman albumin solution
DHartmann's solution (similar to lactated Ringer's)
9.Lab values & electrolytesMedium
A patient with schizophrenia is starting clozapine. Which laboratory value must be monitored regularly?
ASerum amylase
BSerum lithium level
CInternational normalized ratio
DAbsolute neutrophil count
10.Lab values & electrolytesHard
Four laboratory results arrive. Which one should the nurse act on first?
AGlucose 140 mg/dL (7.8 mmol/L) after a meal in a patient with diabetes
BPotassium 6.6 mEq/L in a patient with CKD who has new muscle weakness
CSodium 137 mEq/L in a patient admitted with pneumonia yesterday
DHemoglobin 11.8 g/dL (118 g/L) in a patient with chronic kidney disease
11.PharmacologyMedium
Which factor increases the risk of lithium toxicity?
ATaking the dose with food
BDrinking extra water
CA high-salt diet
DDehydration
12.PharmacologyHard
Which strategy is most effective at preventing errors with IV insulin infusions?
AUsing insulin syringes to measure large IV volumes
BPreparing insulin infusions in advance and leaving them unlabelled
CWriting "U" for units on the order
DAn independent double check and a smart pump with a drug library
13.Med-surg: cardiovascular & respiratoryMedium
Virchow's triad describes three factors that promote venous thrombosis. Which patient factor represents venous stasis?
ADamage to a vein during hip surgery
BImmobility after major surgery
CAn inherited clotting disorder
DTaking an oestrogen-containing pill
14.Med-surg: cardiovascular & respiratoryHard
During a cardiac arrest, the monitor shows an organised rhythm, but there is no pulse. What should the team do?
AStop CPR, because an organised rhythm on the monitor means recovery
BGive adenosine to slow the rhythm down
CContinue CPR and give adrenaline (epinephrine), as the rhythm is non-shockable
DDeliver an unsynchronised shock at once and then check the pulse
15.Med-surg: neuro, endocrine & renalMedium
A patient has taken metformin for many years and now has tingling feet and a low haemoglobin. Which blood test is most relevant?
AVitamin B12 level
BSerum amylase
CBlood alcohol level
DThyroid antibodies
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?
AUrgent referral for cystoscopy and imaging
BAnother course of antibiotics for a UTI
CReassure him, because the blood has stopped
DAdvise more fluids and review in a year
17.Med-surg: GI, perioperative & oncologyMedium
Which approach to red cell transfusion in a stable patient with a GI bleed fits current evidence?
ATransfuse everyone to keep the haemoglobin above 150 g/L at all times
BA restrictive threshold, often around 70 g/L, in most stable patients
CNever transfuse, whatever the haemoglobin or the symptoms
DTransfuse two units routinely before every endoscopy
18.Med-surg: GI, perioperative & oncologyHard
A patient with small bowel obstruction has a nasogastric tube draining 2 L a day. Which nursing focus is most important?
AClamping the tube for long periods to save the stomach fluid
BGiving oral fluids freely to replace what the tube removes
CAccurate fluid balance with IV replacement and electrolyte checks
DRemoving the tube once 1 L has drained to prevent losses
19.Maternity & obstetric nursingMedium
When performing the first Leopold manoeuvre, what is the nurse trying to identify?
AWhich side the fetal back lies on
BWhich fetal part lies in the fundus
CThe amount of amniotic fluid
DWhether the head has entered the pelvis
20.Maternity & obstetric nursingHard
Why does the ductus arteriosus normally close after birth?
AThe cord is cut, which closes it directly
BPressure in the pulmonary artery rises
CRising prostaglandins and falling oxygen levels
DRising oxygen levels and falling prostaglandins
21.Pediatric nursingMedium
Which advice best prevents dog bites in young children?
ALet the child hug the dog while it eats so it gets used to children
BTeach the child to stare into the dog's eyes to show who is in charge
CNever leave a young child alone with a dog, even the family pet
DChoose a small breed, as small dogs never bite
22.Pediatric nursingHard
A 6-week-old is admitted with suspected pertussis. What is the main nursing concern?
AApnoea and cyanosis during or after coughing spells
BA rash spreading from the face to the trunk
CHigh blood pressure from the coughing
DConstipation from reduced feeding
23.Mental health nursingMedium
In the mental status examination, which finding is recorded under thought content?
ALoose associations
BFlight of ideas
CObsessions and delusions
DPressured speech
24.Mental health nursingHard
A community nurse visits an older woman with hoarding disorder whose home is so cluttered that the exits are blocked. What is the most appropriate approach?
ATell her that she will be evicted unless everything is thrown away today
BWork with her to clear the exits first, then agree a gradual plan together
CIgnore the clutter, because it is her own home
DArrange for the whole house to be cleared while she is out
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 17:55 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.
17:55
15:55 PM
25:55 AM
37:55 PM
44:55 PM
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A prescription reads ½ tbsp of an oral suspension three times a day for 14 days. The suspension comes in 100 mL bottles. Using 1 tbsp = 15 mL, how many whole bottles N must be supplied so the course is complete?
½ tbspthree times a day14 days100 mL1 tbsp = 15 mL
N =
27.Dosage calculationsMedium
A child weighing 16 kg is prescribed 4 mg/kg of a drug. The stock solution contains 40 mg/mL. Draw up the dose: what volume V do you give?
16 kg4 mg/kg40 mg/mL
V = mL
28.Dosage calculationsHard
A patient is 126 cm tall and weighs 44 kg. The prescription is 25 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.
126 cm44 kg25 mg/m²
D = mg
29.IV infusion ratesMedium
Infuse 250 mL over 6 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
250 mL6 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 20 gtt/min through a set of 20 gtt/mL. There are 400 mL left in the bag. How many hours t until it is empty? Round to one decimal place.
20 gtt/min20 gtt/mL400 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 60 units/kg for a patient who weighs 69 kg. The vial contains 5 000 units/mL. What volume V do you draw up? Round to two decimal places.
60 units/kg69 kg5 000 units/mL
V = mL
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 12 mcg/kg/min for a patient who weighs 56 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
400 mg/250 mL12 mcg/kg/min56 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 total intake I in mL. Count ice chips as half their volume.
soup: 250 mLjelly: 120 mLice chips: 200 mLIV infusion: 60 mL/h × 12 hIV antibiotic: 1 × 50 mL
I = mL
34.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 13:00 and runs by pump at 125 mL/h. How many mL V are left in the bag at 16:00?
1000 mL125 mL/h13:00 → 16:00
V = mL
35.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 10, with E3 and V3. What motor score M was recorded, and which response does it describe? Give the number.
GCS 10E3V3
M =
36.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 149 kg and is 173 cm tall. Calculate the BMI and click the WHO weight category.
149 kg173 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
37.Arterial blood gas interpretationMedium
A practice gas shows PaCO₂ 70 mmHg (9.3 kPa). Use the rule that in acute respiratory acidosis HCO₃⁻ rises by 1 mmol/L for every 10 mmHg that PaCO₂ is above 40, starting from HCO₃⁻ 24 mmol/L, to find the expected HCO₃⁻.
Measure the QT interval and the R–R interval on this regular lead II strip, then calculate the rate-corrected QTc with Bazett’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. Which interpretation can you defend from this single 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
12:1 AV block (type undetermined)
2first-degree AV block
3third-degree (complete) AV block
4second-degree AV block type II
3Solutions
1.Nursing fundamentals
Answer: C · Getting an accurate list of the medicines taken before admission
Why this is the answer
Medicines reconciliation compares the patient's own medicines with what is prescribed in hospital, using several sources, so that changes are intended and errors are avoided.
Answer
C · Getting an accurate list of the medicines taken before admission
2.Nursing fundamentals
Answer: C · The tissues are not getting enough oxygen
Why this is the answer
When tissues are poorly perfused they switch to anaerobic metabolism and produce lactate. A raised lactate in sepsis signals higher risk and the need for urgent treatment.
Answer
C · The tissues are not getting enough oxygen
3.Infection control & patient safety
Answer: D · Loose enough to fit two fingers between the restraint and the skin
Why this is the answer
Being able to slip two fingers under the restraint keeps it secure without cutting off circulation or damaging the skin. Circulation, sensation and skin are checked often.
Answer
D · Loose enough to fit two fingers between the restraint and the skin
4.Infection control & patient safety
Answer: B · The nasal spray is a live vaccine, so the injected inactivated vaccine is used instead
Why this is the answer
The nasal spray influenza vaccine contains live, weakened virus and is avoided in immunosuppressed people. The inactivated injectable vaccine is safe and recommended for them.
Answer
B · The nasal spray is a live vaccine, so the injected inactivated vaccine is used instead
5.Prioritization & delegation
Answer: D · Green (minor)
Why this is the answer
Victims who can walk are tagged green and directed away first. They are reassessed later, because some may have injuries that get worse.
Answer
D · Green (minor)
6.Prioritization & delegation
Answer: B · Hemoglobin 6.5 g/dL (65 g/L) in a patient with a GI bleed
Why this is the answer
A hemoglobin of 6.5 g/dL (65 g/L) in a bleeding patient shows severe anemia and may need urgent transfusion. The other results are mildly abnormal or stable.
Answer
B · Hemoglobin 6.5 g/dL (65 g/L) in a patient with a GI bleed
7.Clinical nursing
Answer: B · To rule out bleeding in the brain
Why this is the answer
A CT scan distinguishes haemorrhagic from ischaemic stroke. Clot-busting drugs are only given when bleeding has been excluded and other criteria are met.
Answer
B · To rule out bleeding in the brain
8.Clinical nursing
Answer: B · 5% glucose (D5W)
Why this is the answer
The glucose in 5% glucose is metabolised, leaving free water that dilutes the plasma sodium further. Postoperative patients often have raised ADH, so large volumes of hypotonic fluid can cause dangerous hyponatraemia.
Answer
B · 5% glucose (D5W)
9.Lab values & electrolytes
Answer: D · Absolute neutrophil count
Why this is the answer
Clozapine can cause severe neutropenia (agranulocytosis), so the ANC is checked before starting and regularly during treatment. A sore throat, fever or other sign of infection must be reported at once.
Answer
D · Absolute neutrophil count
10.Lab values & electrolytes
Answer: B · Potassium 6.6 mEq/L in a patient with CKD who has new muscle weakness
Why this is the answer
A potassium of 6.6 mEq/L with weakness can cause life-threatening arrhythmias. The nurse arranges cardiac monitoring and informs the provider at once. Mild anemia in CKD and a mildly raised glucose after a meal are expected; the sodium is normal.Checked against:High potassium level · MedlinePlus (NIH) (2025)
Answer
B · Potassium 6.6 mEq/L in a patient with CKD who has new muscle weakness
11.Pharmacology
Answer: D · Dehydration
Why this is the answer
When the body is short of water or sodium, the kidney reabsorbs more lithium, so its level rises. Thiazides, ACE inhibitors and NSAIDs can have the same effect.
Answer
D · Dehydration
12.Pharmacology
Answer: D · An independent double check and a smart pump with a drug library
Why this is the answer
Independent double checks, standard concentrations and smart pumps with dose limits reduce insulin errors. "U" for units is avoided because it can be misread as a zero.
Answer
D · An independent double check and a smart pump with a drug library
13.Med-surg: cardiovascular & respiratory
Answer: B · Immobility after major surgery
Why this is the answer
Virchow's triad is stasis of blood, vessel wall injury and hypercoagulability. Immobility, long journeys and heart failure cause stasis. Surgery and trauma injure vessel walls. Oestrogen, cancer, pregnancy and inherited thrombophilias increase coagulability.
Answer
B · Immobility after major surgery
14.Med-surg: cardiovascular & respiratory
Answer: C · Continue CPR and give adrenaline (epinephrine), as the rhythm is non-shockable
Why this is the answer
Pulseless electrical activity is a non-shockable rhythm. Treatment is high-quality CPR, adrenaline as soon as possible and repeated, and a search for reversible causes (the 4 Hs and 4 Ts, such as hypoxia, hypovolaemia, tension pneumothorax and tamponade). Shocks are only for VF and pulseless VT.
Answer
C · Continue CPR and give adrenaline (epinephrine), as the rhythm is non-shockable
15.Med-surg: neuro, endocrine & renal
Answer: A · Vitamin B12 level
Why this is the answer
Long-term metformin can lower vitamin B12 absorption, causing anaemia and neuropathy that may be mistaken for diabetic neuropathy. B12 levels are checked, especially when symptoms appear.
Answer
A · Vitamin B12 level
16.Med-surg: neuro, endocrine & renal
Answer: A · 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
A · Urgent referral for cystoscopy and imaging
17.Med-surg: GI, perioperative & oncology
Answer: B · A restrictive threshold, often around 70 g/L, in most stable patients
Why this is the answer
Restrictive transfusion (often at a haemoglobin of about 70 g/L, with a target of 70–90 g/L, or a higher threshold in cardiovascular disease) is associated with better outcomes in many GI bleeding patients than liberal transfusion. Massive haemorrhage is managed by major haemorrhage protocols.
Answer
B · A restrictive threshold, often around 70 g/L, in most stable patients
18.Med-surg: GI, perioperative & oncology
Answer: C · Accurate fluid balance with IV replacement and electrolyte checks
Why this is the answer
Large NG losses cause dehydration, hypokalaemia and a hypochloraemic metabolic alkalosis. The aspirate is measured and recorded, replaced IV as prescribed (often with potassium-containing crystalloid), and urea, creatinine and electrolytes are checked at least daily. Oral fluids would increase the losses and vomiting risk.
Answer
C · Accurate fluid balance with IV replacement and electrolyte checks
19.Maternity & obstetric nursing
Answer: B · Which fetal part lies in the fundus
Why this is the answer
The first Leopold manoeuvre palpates the fundus: a firm round head or a softer, irregular breech. The second finds the back and limbs, the third the presenting part and the fourth the degree of head flexion and descent.
Answer
B · Which fetal part lies in the fundus
20.Maternity & obstetric nursing
Answer: D · Rising oxygen levels and falling prostaglandins
Why this is the answer
Higher blood oxygen and lower prostaglandin levels after birth cause the ductus arteriosus to constrict. Prostaglandin infusions are used to keep it open in duct-dependent heart defects.
Answer
D · Rising oxygen levels and falling prostaglandins
21.Pediatric nursing
Answer: C · Never leave a young child alone with a dog, even the family pet
Why this is the answer
Most dog bites to young children are from familiar dogs, often to the face. Constant supervision, teaching children not to disturb dogs that are eating or sleeping and not to hug or stare at dogs reduces the risk.
Answer
C · Never leave a young child alone with a dog, even the family pet
22.Pediatric nursing
Answer: A · Apnoea and cyanosis during or after coughing spells
Why this is the answer
Young infants with pertussis are at high risk of apnoea, cyanosis, exhaustion and feeding problems. They need close cardiorespiratory monitoring, suction equipment at hand and droplet precautions.
Answer
A · Apnoea and cyanosis during or after coughing spells
23.Mental health nursing
Answer: C · Obsessions and delusions
Why this is the answer
Thought content covers delusions, obsessions, phobias and suicidal or homicidal thoughts. Thought process (form) covers loose associations, tangentiality and flight of ideas.
Answer
C · Obsessions and delusions
24.Mental health nursing
Answer: B · Work with her to clear the exits first, then agree a gradual plan together
Why this is the answer
Forced clear-outs cause great distress and the clutter usually returns. Collaborative, gradual work focusing first on safety, such as fire exits and fall risks, with involvement of relevant services, is more effective.
Answer
B · Work with her to clear the exits first, then agree a gradual plan together
25.Nursing math & unit conversions
Answer: 5:55 PM
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.
Convert the hour
17 − 12 = 5 → PM
Answer
5:55 PM
Answer
5:55 PM
26.Nursing math & unit conversions
Answer: N = 4
Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.
Total volume
7.5 mL × 3 × 14 = 315 mL
Bottles
315/100 = 3.15 → N = 4
Answer
N = 4
27.Dosage calculations
Answer: V = 1.6 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 = 4·16 = 64 mg
Volume
V = 64/40 = 1.6 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 1.6 mL
28.Dosage calculations
Answer: D = 31.02 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 = √(126·44/3600) = √1.54 = 1.241 m²
Dose
D = 25·1.241 = 31.02 mg
Answer
D = 31.02 mg
29.IV infusion rates
Answer: R = 10 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
6·60 = 360 min
Drip rate
R = 250·15/360 = 10.42 ≈ 10 gtt/min
Answer
R = 10 gtt/min
At the bedside you round to the nearest whole drop: 10 gtt/min.
30.IV infusion rates
Answer: t = 6.7 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
20·60/20 = 60 mL/h
Time left
t = 400/60 = 6.667 ≈ 6.7 h
Answer
t = 6.7 h
31.Pediatric & critical-care dosing
Answer: V = 0.83 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
60·69 = 4 140 units
Volume
V = 4140/5000 = 0.828 ≈ 0.83 mL
Answer
V = 0.83 mL
32.Pediatric & critical-care dosing
Answer: R = 25.2 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
12·56 = 672 mcg/min
672·60 = 40320 mcg/h
Pump rate
R = 40320/1600 = 25.2 mL/h
Answer
R = 25.2 mL/h
33.IV fluids & fluid balance
Answer: I = 1240 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.
Add the intake
oral: 250 + 120 = 370 mL
ice chips: 200/2 = 100 mL
IV infusion: 60·12 = 720 mL
IV antibiotic: 1·50 = 50 mL
I = 1240 mL
Answer
I = 1240 mL
34.IV fluids & fluid balance
Answer: V = 625 mL
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.
Elapsed time
13:00 → 16:00 = 3 h
Volume infused
125·3 = 375 mL
Volume left
V = 1000 − 375 = 625 mL
Answer
V = 625 mL
35.Clinical assessment scores
Answer: M = 4
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.
Motor score
M = 10 − 3 − 3 = 4
M4: withdraws the limb from pressure (normal flexion)
Answer
M = 4
36.Clinical assessment scores
Answer: obesity class III
Body mass index: BMI = weight (kg)/height (m)², with the height converted to metres first. With pounds and inches, BMI = 703 × weight (lb)/height (in)². WHO adult categories: below 18.5 underweight, 18.5–24.9 healthy weight, 25.0–29.9 overweight, 30.0–34.9 obesity class I, 35.0–39.9 obesity class II and 40 or more obesity class III.
BMI
BMI = 149/1.73² = 49.78
Category
obesity class III
Answer
obesity class III
37.Arterial blood gas interpretation
Answer: HCO₃⁻ = 27 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.
Change in PaCO₂
|70 − 40| = 30 mmHg → 3 × 10 mmHg
Expected HCO₃⁻
HCO₃⁻ = 24 + 1·3 = 27 mmol/L
Answer
HCO₃⁻ = 27 mmol/L
38.Arterial blood gas interpretation
Answer: AGc = 15.75 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 = 136 − (106 + 16) = 14
Correction for albumin
14 + 0.25·(40 − 33) = 15.75 mmol/L
Answer
AGc = 15.75 mmol/L
Above about 12 after correction: a high anion gap.
39.ECG rhythm strip interpretation
Answer: QTc = 0.396 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 = 9.5 × 0.04 = 0.38 s
RR = 23 × 0.04 = 0.92 s
Bazett’s formula
QTc = 0.38/√0.92 = 0.38/0.9592 = 0.396 s
Answer
QTc = 0.396 s
Within the usual limits (about 0.45 s for men, 0.46 s for women). (396 ms)
40.ECG rhythm strip interpretation
Answer: 2:1 AV block (type undetermined)
2:1 AV block: with two P waves for every QRS, no two conducted P waves follow each other, so you cannot see whether the PR would lengthen (type I) or stay constant (type II) before a non-conducted P wave. From one strip it is called a 2:1 AV block; a longer strip or a change in the conduction ratio decides the type. A narrow QRS makes type I more likely and a wide QRS type II, but neither proves it.
Five steps
1. Rate: R–R = 42 small boxes, 1500 ÷ 42 ≈ 36 per minute.
2. Rhythm: regular, every R–R is 1.68 s.
3. P waves: upright and regular (P–P 0.84 s, 71 per minute), two for every QRS.
4. PR interval: constant at 0.20 s in the conducted beats.
5. QRS: 0.14 s, wide (0.12 s or more).
Why the type stays open
Every second P wave is not conducted, so no two conducted beats follow each other and a lengthening PR could never show.
2:1 AV block (type undetermined)
Answer
2:1 AV block (type undetermined)
A narrow QRS makes type I more likely and a wide QRS type II, but only a longer strip or a change in the conduction ratio decides.
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