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 the correct order of techniques when assessing the abdomen?
AInspection, auscultation, percussion, palpation
BAuscultation, palpation, inspection, percussion
CInspection, palpation, percussion, auscultation
DPalpation, inspection, auscultation, percussion
2.Nursing fundamentalsHard
Before giving a PRN dose of oral morphine, which assessment is most important?
AThe respiratory rate and level of sedation
BThe patient's blood glucose level
CThe patient's weight and height, recorded on admission
DThe patient's last bowel movement
3.Infection control & patient safetyMedium
Which part of a sterile surgical gown is considered sterile once it is on?
AOnly the back of the gown, which nobody touches
BThe whole gown, including the back, the collar and the area below the waist
CThe front from the neck down to the knees
DThe front from chest to the level of the sterile field, and the sleeves
4.Infection control & patient safetyHard
A woman in late pregnancy is choking and cannot speak or cough. Which technique should the rescuer use?
AAbdominal thrusts
BBack blows only
CBlind finger sweeps
DChest thrusts
5.Prioritization & delegationMedium
A nurse cannot read part of a medication order. What should the nurse do?
AContact the prescriber to clarify the order before giving the drug
BAsk another nurse to guess what the order most likely says, then give it
CSkip the drug and not tell anyone until the next ward round
DGive the usual dose of the drug the nurse thinks was meant
6.Prioritization & delegationHard
A day after a femur fracture, a young patient becomes confused and breathless, with small red spots on the chest. What should the nurse suspect?
AAlcohol withdrawal
BNormal pain after a fracture
CFat embolism syndrome
DAn allergic reaction to the cast
7.Clinical nursingMedium
What is the first-line drug treatment for anaphylaxis?
AInhaled steroid
BIntramuscular adrenaline
CIntravenous paracetamol
DOral antihistamine such as cetirizine
8.Clinical nursingHard
A patient admitted after a fall takes many regular medicines. Which safety step on admission helps prevent medication errors?
APrescribing only the medicines that the patient can remember taking
BStopping all regular medicines until the day the patient is discharged
CDoubling the doses to make up for any missed while at home
DMedicines reconciliation against reliable sources, such as primary care records
9.Lab values & electrolytesMedium
A patient with chronic kidney disease has a magnesium of 3.8 mEq/L (1.9 mmol/L). Which product is the most likely cause?
AExcess alcohol use over many years
BLoop diuretics such as furosemide
CProton pump inhibitors taken long term
DMagnesium-containing laxatives or antacids
10.Lab values & electrolytesHard
A patient with schizophrenia drinks very large amounts of water each day. Sodium is 121 mEq/L, and the urine is very dilute (urine osmolality 70 mOsm/kg). Which explanation fits best?
ASyndrome of inappropriate ADH
BPrimary (psychogenic) polydipsia
CHyperosmolar hyperglycemic state
DCentral diabetes insipidus
11.PharmacologyMedium
In which patient is bupropion contraindicated?
AA patient with a seizure disorder or an eating disorder
BA patient who wants to stop smoking
CA patient with high blood cholesterol and a family history of it
DA patient with seasonal allergies
12.PharmacologyHard
The thalidomide disaster of the late 1950s and early 1960s is best known for which effect, and what did it lead to?
ADeafness in children; the end of animal testing
BHeart attacks in older adults; the start of generic medicines
CSevere limb defects in babies; stricter drug testing and regulation
DLiver failure in adults; the ban of all sedatives
13.Med-surg: cardiovascular & respiratoryMedium
Which pneumonia severity score uses confusion, urea, respiratory rate, blood pressure and age?
ACHA₂DS₂-VASc
BWells score
CCURB-65
DNEWS2
14.Med-surg: cardiovascular & respiratoryHard
Hours after surgery to restore blood flow to an ischaemic leg, the patient has severe calf pain that is worse when the toes are moved passively, and the calf feels tense. What should the nurse suspect?
ACompartment syndrome from reperfusion swelling
BCramp from lying still in bed
CA superficial thrombophlebitis of the long saphenous vein
DExpected postoperative pain from the leg wound
15.Med-surg: neuro, endocrine & renalMedium
A patient who has had type 1 diabetes for 30 years says they no longer feel the warning signs of a hypo. What is this called?
AThe dawn phenomenon
BDiabetic ketoacidosis
CInsulin resistance
DHypoglycaemia unawareness
16.Med-surg: neuro, endocrine & renalHard
A patient on long-term high-dose prednisolone is three days after bowel surgery. They report only mild abdominal pain, but the heart rate has risen to 115/min and the temperature is 37.4 °C. Why should the nurse be especially concerned?
AThe mild pain shows that the bowel is healing as expected
BSteroids cause tachycardia in all patients, so no action is needed
CSteroids can mask fever, pain and peritonism, hiding complications
DSteroids protect against infection, so sepsis is very unlikely
17.Med-surg: GI, perioperative & oncologyMedium
Which statement best describes tolerance to opioids?
AThe patient has a compulsive craving for more of the drug
BThe drug no longer causes any constipation
CThe patient has developed an allergy to the drug
DA higher dose is needed over time for the same effect
18.Med-surg: GI, perioperative & oncologyHard
After a fall, a patient with advanced dementia is agitated, grimacing and guarding the hip, and cannot rate the pain. What should the nurse do?
AWait until a relative can confirm the pain
BGive a sedative to treat the agitation and avoid giving any analgesia
CUse an observational pain tool, give analgesia and reassess
DAssume there is no pain because none is reported
19.Maternity & obstetric nursingMedium
Parents ask why their baby is having a pulse oximetry check on the right hand and a foot. What is the reason?
ATo measure the baby's blood pressure
BTo screen for hearing loss
CTo screen for critical congenital heart disease
DTo check the baby's blood glucose
20.Maternity & obstetric nursingHard
A labouring woman has frequent contractions on oxytocin: 6 in 10 minutes over the last half hour. The fetal heart rate tracing is normal. What is the most appropriate action?
AReduce or stop the oxytocin per protocol and inform the provider
BIncrease the oxytocin to complete labour faster
CNo action is needed because the fetal heart rate is normal
DAsk her to push to shorten labour
21.Pediatric nursingMedium
When is the best time to tell a 2-year-old about an upcoming procedure?
AThe day before, with a detailed explanation
BNot at all, to avoid upsetting the child beforehand
CJust before it happens, in simple, concrete words
DAbout a week before, so there is time to get used to it
22.Pediatric nursingHard
A mother says her 3-month-old broke his thigh bone by crawling off the bed. What should concern the nurse?
AThe explanation does not fit the baby's stage of development
BThe fracture is too small to need treatment and will heal by itself
CBabies of this age often crawl and fall
DThigh fractures are common in young infants with soft bones
23.Mental health nursingMedium
A patient stopped paroxetine suddenly a few days ago. She now has dizziness, irritability, flu-like symptoms and brief "electric shock" feelings. What is the most likely cause?
AA relapse of her depression into a severe psychotic depression
BNeuroleptic malignant syndrome
CAntidepressant discontinuation syndrome
DSerotonin syndrome
24.Mental health nursingHard
A woman who is being abused by her partner says she will not leave him. What is the most appropriate response?
ATell her that she must leave him today or the nurse cannot help her
BCall her partner to discuss his behaviour with him
CRespect her decision, give information about support services and help her make a safety plan
DTell her that if she stays and is hurt again, it will be her own fault because she was warned about the risks
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 12:10 PM. Which entry is the same time on the 24-hour clock? Click it.
12:10 PM
124:10
213:10
312:10
400:10
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A blood glucose result is 3.5 mmol/L. Using 1 mmol/L = 18 mg/dL for glucose, find c in mg/dL to the nearest whole number.
3.5 mmol/L1 mmol/L = 18 mg/dL
c = mg/dL
27.Dosage calculationsMedium
A patient weighs 80 kg. The prescribed dose is 25 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?
80 kg25 mg/kg/day3× per day
D = mg
28.Dosage calculationsHard
A child weighing 12 kg is prescribed 12.5 mg/kg per dose of an oral suspension that contains 200 mg in 5 mL. What volume V do you give? Round to one decimal place.
12 kg12.5 mg/kg200 mg/5 mL
V = mL
29.IV infusion ratesMedium
A drip runs at 20 gtt/min through a set of 15 gtt/mL. How many millilitres V does the patient receive in 12 hours?
20 gtt/min15 gtt/mL12 h
V = mL
30.IV infusion ratesHard
A bag contains 100 mg of a drug in 250 mL and runs at 5 mL/h. How many milligrams per hour D does the patient receive?
100 mg/250 mL5 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 10 mL/h. How many units per hour D does the patient receive?
250 units/250 mL10 mL/h
D = units/h
32.Pediatric & critical-care dosingHard
Practice exercise (made-up values, not clinical guidance). A bag contains dopamine 800 mg in 500 mL. The order is 6 mcg/kg/min for a patient who weighs 90 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
800 mg/500 mL6 mcg/kg/min90 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 100 mL/h. At 21:00, 50 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL50 mL infused100 mL/h
t = h
35.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: completely limited; moisture: very moist; activity: walks frequently; mobility: completely immobile; nutrition: adequate; friction and shear: problem. Find the Braden total B.
6–23
B =
36.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: no; secondary diagnosis: yes; ambulatory aid: none, bed rest or nurse assists; IV therapy or saline lock: no; gait: normal, bed rest or wheelchair; mental status: knows own limits. Using the cut-offs 0–24 low, 25–44 moderate and 45 or more high, click the fall-risk level.
1low risk
2moderate risk
3high risk
37.Arterial blood gas interpretationMedium
Practice values: Na⁺ 129 mmol/L, glucose 17.4 mmol/L and urea 4.7 mmol/L. Calculate the serum osmolality Osm = 2·Na⁺ + glucose + urea to the nearest whole number.
Na⁺ 129 mmol/Lglucose 17.4 mmol/Lurea 4.7 mmol/L
Osm = mOsm/kg
38.Arterial blood gas interpretationHard
A practice gas shows a respiratory acidosis: pH 7.26, PaCO₂ 71 mmHg (9.5 kPa), HCO₃⁻ 31 mmol/L. Use the rules ‘HCO₃⁻ rises 1 mmol/L per 10 mmHg (acute) or 3.5 mmol/L per 10 mmHg (chronic)’ to classify it. Click your answer.
pH 7.26PaCO₂ 71 mmHg (9.5 kPa)HCO₃⁻ 31 mmol/L
1acute
2chronic
3acute on chronic
39.ECG rhythm strip interpretationMedium
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 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: A · Inspection, auscultation, percussion, palpation
Why this is the answer
In the abdomen the nurse listens before touching, because percussion and palpation can change bowel sounds. In other body systems palpation and percussion come before auscultation.
Answer
A · Inspection, auscultation, percussion, palpation
2.Nursing fundamentals
Answer: A · The respiratory rate and level of sedation
Why this is the answer
Opioids can cause sedation and respiratory depression. Checking breathing and alertness before each dose, as well as the pain score, keeps the patient safe.
Answer
A · The respiratory rate and level of sedation
3.Infection control & patient safety
Answer: D · The front from chest to the level of the sterile field, and the sleeves
Why this is the answer
Only the front of the gown from chest to the level of the sterile field and the sleeves from above the elbow to the cuffs are sterile. The back, the neckline and anything below the sterile field are non-sterile.
Answer
D · The front from chest to the level of the sterile field, and the sleeves
4.Infection control & patient safety
Answer: D · Chest thrusts
Why this is the answer
For people in late pregnancy or who are very obese, chest thrusts replace abdominal thrusts because the rescuer cannot get around the abdomen effectively. Blind finger sweeps can push the object deeper.
Answer
D · Chest thrusts
5.Prioritization & delegation
Answer: A · Contact the prescriber to clarify the order before giving the drug
Why this is the answer
An unclear order must be clarified with the prescriber before the medication is given. Guessing or ignoring the order can harm the patient.
Answer
A · Contact the prescriber to clarify the order before giving the drug
6.Prioritization & delegation
Answer: C · Fat embolism syndrome
Why this is the answer
Fat embolism syndrome usually appears 24–72 hours after a long bone fracture, with breathing problems, confusion and a petechial rash. It needs oxygen and urgent escalation.
Answer
C · Fat embolism syndrome
7.Clinical nursing
Answer: B · Intramuscular adrenaline
Why this is the answer
Adrenaline IM into the thigh (for adults typically 0.5 mg, i.e. 0.5 mL of 1 mg/mL; US guidance 0.3–0.5 mg) is first line, repeated after 5 minutes if needed. Antihistamines and steroids are not first-line treatments.
Answer
B · Intramuscular adrenaline
8.Clinical nursing
Answer: D · Medicines reconciliation against reliable sources, such as primary care records
Why this is the answer
Medicines reconciliation compares several sources to produce an accurate medication list. It finds omissions, duplications and errors, and is especially important in older people with polypharmacy.
Answer
D · Medicines reconciliation against reliable sources, such as primary care records
9.Lab values & electrolytes
Answer: D · Magnesium-containing laxatives or antacids
Why this is the answer
In kidney failure, magnesium from milk of magnesia, magnesium citrate or magnesium-containing antacids can build up to toxic levels. Patients with CKD are taught to avoid these products. Diuretics, PPIs and alcohol cause low magnesium.Checked against:Magnesium Blood Test · MedlinePlus (NIH) (2023)
Answer
D · Magnesium-containing laxatives or antacids
10.Lab values & electrolytes
Answer: B · Primary (psychogenic) polydipsia
Why this is the answer
In primary polydipsia, ADH is appropriately suppressed, so the kidneys make very dilute urine, but the intake exceeds what they can excrete. In SIADH the urine is inappropriately concentrated. Fluid restriction and close sodium monitoring are needed.Checked against:Osmolality urine test · MedlinePlus (NIH) (2025); Syndrome of inappropriate antidiuretic hormone secretion · MedlinePlus (NIH) (2025)
Answer
B · Primary (psychogenic) polydipsia
11.Pharmacology
Answer: A · A patient with a seizure disorder or an eating disorder
Why this is the answer
Bupropion increases the risk of seizures, especially with bulimia or anorexia, where electrolyte disturbances are common. It is used for depression and as a smoking cessation aid.
Answer
A · A patient with a seizure disorder or an eating disorder
12.Pharmacology
Answer: C · Severe limb defects in babies; stricter drug testing and regulation
Why this is the answer
Thalidomide caused limb malformations (phocomelia) in thousands of babies. The disaster led to stricter rules on testing drugs for safety, including in pregnancy, and to systems for reporting adverse reactions.
Answer
C · Severe limb defects in babies; stricter drug testing and regulation
13.Med-surg: cardiovascular & respiratory
Answer: C · CURB-65
Why this is the answer
CURB-65 gives one point each for Confusion, Urea >7 mmol/L, Respiratory rate ≥30/min, low Blood pressure (systolic <90 or diastolic ≤60 mmHg) and age ≥65. Higher scores mean higher mortality and the need for hospital or critical care.
Answer
C · CURB-65
14.Med-surg: cardiovascular & respiratory
Answer: A · Compartment syndrome from reperfusion swelling
Why this is the answer
When blood flow returns to ischaemic muscle, swelling can raise pressure in a fascial compartment. Pain out of proportion and pain on passive stretch are early signs; pulses may remain until late. It is reported urgently, as fasciotomy may be needed. The limb is kept at heart level, not raised high.
Answer
A · Compartment syndrome from reperfusion swelling
15.Med-surg: neuro, endocrine & renal
Answer: D · Hypoglycaemia unawareness
Why this is the answer
Long duration of diabetes and frequent hypos reduce the adrenaline response, so warning symptoms are lost. This greatly increases the risk of severe hypos. Strict avoidance of hypos for some weeks can partly restore awareness, and glucose sensors with alarms help.
Answer
D · Hypoglycaemia unawareness
16.Med-surg: neuro, endocrine & renal
Answer: C · Steroids can mask fever, pain and peritonism, hiding complications
Why this is the answer
Long-term steroids blunt fever, pain and abdominal rigidity, so an anastomotic leak, abscess or perforation may present only with subtle signs such as tachycardia. The nurse should assess thoroughly and escalate early. These patients also need steroid cover around surgery to prevent adrenal crisis.
Answer
C · Steroids can mask fever, pain and peritonism, hiding complications
17.Med-surg: GI, perioperative & oncology
Answer: D · A higher dose is needed over time for the same effect
Why this is the answer
Tolerance is a reduced response to the same dose over time. Physical dependence means withdrawal occurs if the drug is stopped suddenly. Neither is the same as addiction (opioid use disorder), which involves compulsive use despite harm.
Answer
D · A higher dose is needed over time for the same effect
18.Med-surg: GI, perioperative & oncology
Answer: C · Use an observational pain tool, give analgesia and reassess
Why this is the answer
In dementia, pain often appears as agitation or guarding. An observational tool supports assessment; analgesia is given and effect reassessed. The hip is also assessed for injury such as a fracture.
Answer
C · Use an observational pain tool, give analgesia and reassess
19.Maternity & obstetric nursing
Answer: C · To screen for critical congenital heart disease
Why this is the answer
Pulse oximetry screening compares oxygen saturation in the right hand (pre-ductal) and a foot (post-ductal). A low reading or a significant difference can indicate critical congenital heart disease.
Answer
C · To screen for critical congenital heart disease
20.Maternity & obstetric nursing
Answer: A · Reduce or stop the oxytocin per protocol and inform the provider
Why this is the answer
More than 5 contractions in 10 minutes is tachysystole. Even with a normal tracing, the oxytocin is reduced or stopped according to protocol because the fetus may soon become compromised.
Answer
A · Reduce or stop the oxytocin per protocol and inform the provider
21.Pediatric nursing
Answer: C · Just before it happens, in simple, concrete words
Why this is the answer
Toddlers do not understand future time, so preparation long in advance only creates anxiety. A short, honest explanation immediately before, with a parent present and a comfort object, works best.
Answer
C · Just before it happens, in simple, concrete words
22.Pediatric nursing
Answer: A · The explanation does not fit the baby's stage of development
Why this is the answer
A 3-month-old cannot crawl, and femur fractures in non-mobile infants are rare without major force. A history that does not match the injury or the child's development is a key indicator of possible abuse, so safeguarding procedures are followed.
Answer
A · The explanation does not fit the baby's stage of development
23.Mental health nursing
Answer: C · Antidepressant discontinuation syndrome
Why this is the answer
Stopping an SSRI or SNRI suddenly, especially one with a short half-life such as paroxetine, can cause discontinuation symptoms. Antidepressants should be reduced gradually under medical guidance.
Answer
C · Antidepressant discontinuation syndrome
24.Mental health nursing
Answer: C · Respect her decision, give information about support services and help her make a safety plan
Why this is the answer
Adults have the right to make their own decisions. Many survivors leave and return several times. The nurse documents carefully, provides resources and a safety plan, and keeps the door open for future help.
Answer
C · Respect her decision, give information about support services and help her make a safety plan
25.Nursing math & unit conversions
Answer: 12:10
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
12 PM → 12
Answer
12:10
Answer
12:10
26.Nursing math & unit conversions
Answer: c = 63 mg/dL
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 = 3.5·18 = 63 mg/dL
Answer
c = 63 mg/dL
27.Dosage calculations
Answer: D = 666.7 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
25·80 = 2000 mg
Per dose
D = 2000/3 = 666.7 mg
Answer
D = 666.7 mg
28.Dosage calculations
Answer: V = 3.8 mL
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Dose from weight
12.5·12 = 150 mg
Volume
V = (150/200)·5 = 3.75 ≈ 3.8 mL
Answer
V = 3.8 mL
29.IV infusion rates
Answer: V = 960 mL
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Rate in mL/h
20·60/15 = 80 mL/h
Volume
V = 80·12 = 960 mL
Answer
V = 960 mL
30.IV infusion rates
Answer: D = 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
100/250 = 0.4 mg/mL
Dose rate
D = 0.4·5 = 2 mg/h
Answer
D = 2 mg/h
31.Pediatric & critical-care dosing
Answer: D = 10 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 = 10·1 = 10 units/h
Answer
D = 10 units/h
32.Pediatric & critical-care dosing
Answer: R = 20.3 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
800 mg = 800 000 mcg
800 000/500 = 1600 mcg/mL
Dose per minute and per hour
6·90 = 540 mcg/min
540·60 = 32400 mcg/h
Pump rate
R = 32400/1600 = 20.25 ≈ 20.3 mL/h
Answer
R = 20.3 mL/h
33.IV fluids & fluid balance
Answer: B = 340 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 + 120 = 440 mL
IV infusion: 100·12 = 1200 mL
IV antibiotic: 2·50 = 100 mL
total intake = 1740 mL
Total output
275 + 400 + 250 + 475 = 1400 mL
Balance
B = 1740 − 1400 = 340 mL
Answer
B = 340 mL
Positive: more fluid went in than came out.
34.IV fluids & fluid balance
Answer: t = 9.5 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 − 50 = 950 mL
Time
t = 950/100 = 9.5 h
Answer
t = 9.5 h
That is about 9 h 30 min, so the bag runs out at about 06:30.
35.Clinical assessment scores
Answer: B = 12
Braden scale: six subscales for pressure-injury risk. Sensory perception, moisture, activity, mobility and nutrition score 1 to 4, from the worst level (1) to no problem (4); friction and shear scores 1 to 3. The total runs from 6 to 23, and a lower total means a higher risk. Common bands: 19–23 not at risk, 15–18 mild risk, 13–14 moderate risk, 10–12 high risk and 9 or below very high risk.
Score each subscale
sensory perception: completely limited → 1
moisture: very moist → 2
activity: walks frequently → 4
mobility: completely immobile → 1
nutrition: adequate → 3
friction and shear: problem → 1
Add
Braden total = 1 + 2 + 4 + 1 + 3 + 1 = 12
Answer
B = 12
36.Clinical assessment scores
Answer: low risk
Morse fall scale: six items. History of falling: no 0, yes 25. Secondary diagnosis: no 0, yes 15. Ambulatory aid: none, bed rest or nurse assistance 0; crutches, cane or walker 15; holding on to furniture 30. IV therapy or saline lock: no 0, yes 20. Gait: normal, bed rest or wheelchair 0; weak 10; impaired 20. Mental status: knows own limits 0; overestimates or forgets limits 15. The total runs from 0 to 125. Risk cut-offs differ between hospitals; a common set is 0–24 low, 25–44 moderate and 45 or more high.
Score each item
history of falling in the last 3 months: no → 0
secondary diagnosis: yes → 15
ambulatory aid: none, bed rest or nurse assists → 0
IV therapy or saline lock: no → 0
gait: normal, bed rest or wheelchair → 0
mental status: knows own limits → 0
Add
Morse total = 0 + 15 + 0 + 0 + 0 + 0 = 15
Risk level
15 → low risk
Answer
low risk
37.Arterial blood gas interpretation
Answer: Osm = 280 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 = 2·129 + 17.4 + 4.7 = 280.1 ≈ 280 mOsm/kg
Answer
Osm = 280 mOsm/kg
38.Arterial blood gas interpretation
Answer: acute on chronic
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 HCO₃⁻
acute: 24 + 1·3.1 = 27.1 mmol/L
chronic: 24 + 3.5·3.1 = 34.85 mmol/L
Compare
measured: 31 mmol/L → acute on chronic
Answer
acute on chronic
39.ECG rhythm strip interpretation
Answer: QTc = 0.413 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 × 0.04 = 0.36 s
RR = 19 × 0.04 = 0.76 s
Bazett’s formula
QTc = 0.36/√0.76 = 0.36/0.8718 = 0.413 s
Answer
QTc = 0.413 s
Within the usual limits (about 0.45 s for men, 0.46 s for women). (413 ms)
40.ECG rhythm strip interpretation
Answer: rate
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 = 32 small boxes, 1500 ÷ 32 ≈ 47 per minute.
2. Rhythm: regular, every R–R is 1.28 s.
3. P waves: upright, one before every QRS, all alike.
4. PR interval: 0.12 s, constant, within 0.12–0.20 s.
5. QRS: 0.08 s, narrow (below 0.12 s).
First abnormal step
rate → sinus bradycardia
Answer
rate
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