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
A patient with right-sided weakness is moving from bed to chair. Where should the chair be placed?
AOn the patient's right side, close to the bed
BAcross the room so the patient can practise walking
CAt the foot of the bed facing away
DOn the patient's left side, close to the bed
2.Nursing fundamentalsHard
A patient with capacity tells the nurse they do not want the operation their family keeps pushing for. What is the nurse's best action?
ATell the patient to follow the family's advice
BLet the family decide, as they know the patient best
CSupport the patient to tell the team their wishes
DSay nothing to avoid a conflict with the family
3.Infection control & patient safetyMedium
A nurse’s hands are dry and cracked from frequent hand hygiene. What is the best approach?
AUse any lotion from home, whatever its contents
BWear gloves all day instead of cleaning the hands between patients
CUse the hand lotion approved by the facility to keep the skin intact
DStop hand hygiene until the skin heals
4.Infection control & patient safetyHard
A hospital will introduce new infusion pumps and wants to find out how the process could fail before any harm occurs. Which method fits best?
ARoot cause analysis (RCA) of the new pumps
BFailure mode and effects analysis (FMEA)
CAn incident report for each new pump
DA morbidity and mortality meeting
5.Prioritization & delegationMedium
Which postoperative patient should the nurse see first?
ADressing soaked with bright red blood and a heart rate rising to 118/min
BWants help with washing her hair before her visitors arrive this afternoon
CPain of 4/10 one hour after an oral analgesic
DAsking when the urinary catheter will be removed
6.Prioritization & delegationHard
Which patient is the most appropriate to assign to an LPN/LVN?
AA patient on a new IV medication that needs frequent titration
BA patient with a tracheostomy placed this morning who is coughing up blood
CA patient who has just arrived from the emergency department with pneumonia and confusion
DA patient with a long-standing tracheostomy who needs routine suctioning and care
7.Clinical nursingMedium
During a red cell transfusion, when are serious acute reactions most likely to start?
AAfter the third unit only
BIn the first 15 minutes
COnly after the unit has finished
DAbout 24 hours later
8.Clinical nursingHard
A patient with a central venous catheter suddenly becomes breathless and hypotensive while the line is being disconnected with the patient sitting up. What complication is most likely?
AHypoglycaemia
BPhlebitis
CAir embolism
DPneumonia
9.Lab values & electrolytesMedium
A patient's potassium is 7.0 mEq/L. Which ECG change would the nurse expect?
AFlattened T waves
BTall, peaked T waves
CProminent U waves
DDelta waves before the QRS
10.Lab values & electrolytesHard
An aPTT result is extremely high, but the nurse learns that the sample was taken from the arm where the heparin infusion runs. What is the best action?
AGive protamine at once to reverse the heparin
BAccept the result and halve the infusion rate
CRequest a new sample from the opposite arm before the dose is adjusted
DStop the heparin infusion permanently and inform the provider
11.PharmacologyMedium
An IV site is cool, swollen and pale, and the infusion is running slowly. What should the nurse do?
AApply a tight bandage over the site
BStop the infusion, remove the cannula and elevate the limb
CFlush the cannula forcefully with saline
DIncrease the infusion rate to push through and clear the blockage
12.PharmacologyHard
Why may omeprazole be avoided in a patient taking clopidogrel?
AIt inhibits CYP2C19, so less clopidogrel is converted to its active form
BIt increases clopidogrel absorption from the gut and causes bleeding
CIt binds clopidogrel in the stomach and makes it insoluble
DIt speeds up kidney excretion of clopidogrel
13.Med-surg: cardiovascular & respiratoryMedium
Which investigation is most often used to confirm a pulmonary embolism?
AAbdominal ultrasound
BCT pulmonary angiography
CPeak flow measurement
DSputum culture
14.Med-surg: cardiovascular & respiratoryHard
Twelve hours after a coronary stent, a patient has sudden severe chest pain again with new ST elevation in the same leads. What is the most likely cause?
AAcute stent thrombosis
BNormal pain from the procedure site
CPericarditis from the catheter
DIndigestion from the hospital meal
15.Med-surg: neuro, endocrine & renalMedium
Which statement about long-acting basal insulin such as glargine is correct?
AIt is mixed with rapid-acting insulin in the same syringe
BIt is given only after large meals to cover the carbohydrate
CIn type 1 diabetes it is continued even when the patient is not eating
DIt has a sharp peak in action about 30 minutes after injection
16.Med-surg: neuro, endocrine & renalHard
A 22-year-old with type 1 diabetes has glucose 28 mmol/L, ketones 5.2 mmol/L, pH 7.10 and potassium 5.9 mmol/L. Which statement about potassium is correct?
ATotal-body potassium is low, and the level will fall with treatment
BTotal-body potassium is high, so a potassium binder is needed now
CThe insulin should be withheld to keep the potassium level stable
DPotassium need not be rechecked once insulin has been started
17.Med-surg: GI, perioperative & oncologyMedium
What is the main treatment for a venous leg ulcer with an adequate arterial supply?
ASurgery to amputate the limb
BStrong oral antibiotics for all ulcers
CCompression therapy
DKeeping the leg hanging down all day
18.Med-surg: GI, perioperative & oncologyHard
A patient with facial burns from a house fire was talking normally on arrival. Two hours later, the voice is hoarse and there is stridor. What should the nurse do?
ACall for urgent anaesthetic help, as the airway is swelling
BGive a warm drink to soothe the throat
CEncourage the patient to rest the voice and reassess tomorrow
DLay the patient flat to help them sleep
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 screen for critical congenital heart disease
BTo check the baby's blood glucose
CTo screen for hearing loss
DTo measure the baby's blood pressure
20.Maternity & obstetric nursingHard
A woman 2 hours after birth asks for help to the bathroom. She had an epidural that is now off. What is the main safety concern?
ALeg weakness or numbness causing a fall
BIncreased lochia from walking
CReopening of the epidural site
DFainting from low blood glucose only
21.Pediatric nursingMedium
Which snack is safest for a 2-year-old?
AWhole grapes from the fruit bowl
BA handful of whole peanuts
CA small bowl of popcorn
DSmall pieces of soft cooked vegetables
22.Pediatric nursingHard
Which practice most reduces the risk of errors with high-alert medicines such as insulin or opioid infusions in children?
AChecking the dose only when the drug is given for the first time
BAsking the child's parent to look at the syringe and confirm that the dose looks right
CRounding doses up to the nearest whole number to keep things simple
DAn independent double check by a second nurse before giving the medicine
23.Mental health nursingMedium
How should a patient take sublingual buprenorphine-naloxone tablets?
AChew the tablet quickly and then swallow it with juice so that it reaches the stomach faster
BLet the tablet dissolve completely under the tongue without chewing or swallowing it
CCrush the tablet and mix it with a spoonful of soft food such as yoghurt
DSwallow the tablet whole with a large glass of water
24.Mental health nursingHard
A patient who is detained under mental health legislation refuses his prescribed oral antipsychotic. What is the correct general principle?
ATreatment without consent is lawful only under the conditions and procedures set by the law
BThe refusal must always be accepted, even if the law allows treatment without consent
CDetained patients have no right to refuse any treatment at all
DThe nurse may hide the medicine in his food without any further process
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 12:00 PM. Which entry is the same time on the 24-hour clock? Click it.
12:00 PM
112:00
213:00
324:00
400:00
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 1½ tbsp of liquid supplement, 1½ cups of tea, 8 fl oz of juice. Using the equivalents given, find the total oral intake V in mL.
1 tbsp = 15 mL1 cup = 8 fl oz = 240 mL1 fl oz = 30 mL
V = mL
27.Dosage calculationsMedium
A prefilled syringe of epinephrine (adrenaline) is labelled 1:10 000 (0.1 mg/mL). The prescription is 1 mg IV in cardiac arrest. What volume V do you give?
1:10 0001 mg
V = mL
28.Dosage calculationsHard
The prescription is 660 units of a drug that comes as 1000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
660 units1000 units/mL
V = mL
29.IV infusion ratesMedium
Infuse 500 mL over 8 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
500 mL8 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A bag contains 250 mg of a drug in 500 mL and runs at 12 mL/h. How many milligrams per hour D does the patient receive?
250 mg/500 mL12 mL/h
D = mg/h
31.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). A bag contains 25 000 units of heparin in 500 mL. The order is 14 units/kg/h for a patient who weighs 109 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
25 000 units/500 mL14 units/kg/h109 kg
R = mL/h
32.Pediatric & critical-care dosingHard
Practice exercise (made-up values, not clinical guidance). A dobutamine infusion of 500 mg in 250 mL runs at 21 mL/h. The patient weighs 53 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.
500 mg/250 mL21 mL/h53 kg
D = mcg/kg/min
33.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The patient weighs 84 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 11:00 at 120 mL/h. After 4 hours the rate is changed to 50 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
1000 mL120 mL/h · 4 h50 mL/h
t = h
35.Clinical assessment scoresMedium
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: yes; secondary diagnosis: no; ambulatory aid: none, bed rest or nurse assists; IV therapy or saline lock: no; gait: normal, bed rest or wheelchair; mental status: overestimates or forgets limits. Find the Morse total MFS.
0–125
MFS =
36.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 83 kg and is 161 cm tall. Calculate the BMI and click the WHO weight category.
83 kg161 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
37.Arterial blood gas interpretationMedium
A practice arterial blood gas shows pH 7.07, PaCO₂ 39 mmHg (5.2 kPa) and HCO₃⁻ 11 mmol/L. The primary disorder is metabolic acidosis. How far is it compensated? Click your answer.
pH 7.07PaCO₂ 39 mmHg (5.2 kPa)HCO₃⁻ 11 mmol/L
1uncompensated
2partially compensated
3fully compensated
38.Arterial blood gas interpretationHard
Practice values: Na⁺ 138, Cl⁻ 105, HCO₃⁻ 14 mmol/L and albumin 20 g/L. Find the albumin-corrected anion gap AGc = AG + 0.25·(40 − albumin).
Measure the QT interval and the R–R interval on this regular lead II strip, then calculate the rate-corrected QTc with Fridericia’s formula QTc = QT/∛RR (both in seconds). Give the answer in seconds to three decimals.
lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
QTc = s
40.ECG rhythm strip interpretationHard
Identify the rhythm on this lead II strip. Click your answer.
lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
1ventricular fibrillation
2atrial flutter, 2:1 conduction
3idioventricular rhythm
4torsades de pointes
3Solutions
1.Nursing fundamentals
Answer: D · On the patient's left side, close to the bed
Why this is the answer
Placing the chair on the strong side lets the patient pivot and bear weight on the stronger leg, making the transfer safer.
Answer
D · On the patient's left side, close to the bed
2.Nursing fundamentals
Answer: C · Support the patient to tell the team their wishes
Why this is the answer
As an advocate the nurse makes sure the patient's own wishes are heard. A competent adult decides about their treatment, and the family's views do not override this.
Answer
C · Support the patient to tell the team their wishes
3.Infection control & patient safety
Answer: C · Use the hand lotion approved by the facility to keep the skin intact
Why this is the answer
Cracked skin is harder to clean and harbors more organisms. Facility-approved lotions help keep the skin healthy without reducing the effect of hand antiseptics such as chlorhexidine.
Answer
C · Use the hand lotion approved by the facility to keep the skin intact
4.Infection control & patient safety
Answer: B · Failure mode and effects analysis (FMEA)
Why this is the answer
FMEA is a proactive method that looks at each step of a process, asks how it could fail and what the effect would be, and changes the process in advance. Root cause analysis is used after an event has happened.
Answer
B · Failure mode and effects analysis (FMEA)
5.Prioritization & delegation
Answer: A · Dressing soaked with bright red blood and a heart rate rising to 118/min
Why this is the answer
Heavy fresh bleeding with a rising heart rate suggests hemorrhage and early shock. The other patients have routine needs that can wait.
Answer
A · Dressing soaked with bright red blood and a heart rate rising to 118/min
6.Prioritization & delegation
Answer: D · A patient with a long-standing tracheostomy who needs routine suctioning and care
Why this is the answer
Routine tracheostomy care for a stable, long-term patient fits the LPN/LVN role in most settings. Fresh or bleeding tracheostomies, new admissions and titrated IV drugs need RN assessment.
Answer
D · A patient with a long-standing tracheostomy who needs routine suctioning and care
7.Clinical nursing
Answer: B · In the first 15 minutes
Why this is the answer
Severe reactions such as ABO incompatibility and anaphylaxis usually begin early. The patient should be watched closely in the first 15 minutes, with observations repeated as per local policy.
Answer
B · In the first 15 minutes
8.Clinical nursing
Answer: C · Air embolism
Why this is the answer
Air embolism can occur when a central line is open to air. Clamp the line, lay the patient on the left side with head down if possible, give high-flow oxygen and call for help.
Answer
C · Air embolism
9.Lab values & electrolytes
Answer: B · Tall, peaked T waves
Why this is the answer
Hyperkalemia first causes tall, peaked T waves, then a prolonged PR interval, loss of P waves and a wide QRS, which can lead to ventricular fibrillation or asystole. U waves and flat T waves are signs of hypokalemia.Checked against:High potassium level · MedlinePlus (NIH) (2025); Potassium test · MedlinePlus (NIH) (2025)
Answer
B · Tall, peaked T waves
10.Lab values & electrolytes
Answer: C · Request a new sample from the opposite arm before the dose is adjusted
Why this is the answer
Blood drawn from the infusion arm contains heparin from the drip, so the aPTT is falsely high. A sample from the other arm gives a true result. Changing the dose on a false result could cause clotting.Checked against:Partial Thromboplastin Time (PTT) Test · MedlinePlus (NIH) (2026)
Answer
C · Request a new sample from the opposite arm before the dose is adjusted
11.Pharmacology
Answer: B · Stop the infusion, remove the cannula and elevate the limb
Why this is the answer
These signs suggest infiltration. The infusion is stopped and the cannula removed, the limb is elevated, and a new cannula is placed elsewhere; vesicant drugs need the extravasation protocol.
Answer
B · Stop the infusion, remove the cannula and elevate the limb
12.Pharmacology
Answer: A · It inhibits CYP2C19, so less clopidogrel is converted to its active form
Why this is the answer
Clopidogrel must be activated by liver enzymes, mainly CYP2C19. Omeprazole inhibits this enzyme and can reduce its antiplatelet effect, so another acid suppressant may be chosen.
Answer
A · It inhibits CYP2C19, so less clopidogrel is converted to its active form
13.Med-surg: cardiovascular & respiratory
Answer: B · CT pulmonary angiography
Why this is the answer
CT pulmonary angiography (CTPA) shows filling defects in the pulmonary arteries. It uses iodinated contrast, so renal function and contrast allergy are checked. A ventilation–perfusion (V/Q) scan is an alternative, for example in pregnancy or renal impairment.
Answer
B · CT pulmonary angiography
14.Med-surg: cardiovascular & respiratory
Answer: A · Acute stent thrombosis
Why this is the answer
Acute stent thrombosis presents with recurrent ischaemic pain and ST elevation, and needs emergency return to the catheter laboratory. Missed antiplatelet doses are a major risk factor, which is why dual antiplatelet adherence is emphasised.
Answer
A · Acute stent thrombosis
15.Med-surg: neuro, endocrine & renal
Answer: C · In type 1 diabetes it is continued even when the patient is not eating
Why this is the answer
Basal insulin covers background needs and has a flat profile. In type 1 diabetes it must continue during illness or fasting (the dose may be adjusted) to prevent DKA. Glargine must not be mixed with other insulins.
Answer
C · In type 1 diabetes it is continued even when the patient is not eating
16.Med-surg: neuro, endocrine & renal
Answer: A · Total-body potassium is low, and the level will fall with treatment
Why this is the answer
In DKA, potassium moves out of cells while the kidneys lose it in the urine, so serum potassium can be normal or high despite a large total deficit. Fluids and insulin lower it quickly. Potassium is monitored closely and replaced once it falls into the normal range, as per protocol.
Answer
A · Total-body potassium is low, and the level will fall with treatment
17.Med-surg: GI, perioperative & oncology
Answer: C · Compression therapy
Why this is the answer
Graduated compression reduces venous hypertension and oedema and speeds healing. Leg elevation, exercise and treating the underlying vein disease also help.
Answer
C · Compression therapy
18.Med-surg: GI, perioperative & oncology
Answer: A · Call for urgent anaesthetic help, as the airway is swelling
Why this is the answer
Progressive hoarseness and stridor after a facial or inhalation burn mean the airway is narrowing. Early intubation by an experienced anaesthetist is needed before swelling makes it impossible. The patient is sat up and given oxygen.
Answer
A · Call for urgent anaesthetic help, as the airway is swelling
19.Maternity & obstetric nursing
Answer: A · 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
A · To screen for critical congenital heart disease
20.Maternity & obstetric nursing
Answer: A · Leg weakness or numbness causing a fall
Why this is the answer
After an epidural, the nurse checks that leg sensation and strength have returned before she stands. Combined with orthostatic hypotension and blood loss, this makes the first walk a high fall risk.
Answer
A · Leg weakness or numbness causing a fall
21.Pediatric nursing
Answer: D · Small pieces of soft cooked vegetables
Why this is the answer
Round, firm foods such as whole grapes, nuts and popcorn can block a young child's airway. Soft foods cut into small pieces are safer, and children should always sit down and be supervised while eating.
Answer
D · Small pieces of soft cooked vegetables
22.Pediatric nursing
Answer: D · An independent double check by a second nurse before giving the medicine
Why this is the answer
Paediatric doses are individualised and often very small, so tenfold errors are a real risk. Independent double checks of the calculation, dose and pump settings for high-alert medicines are a key safety measure.
Answer
D · An independent double check by a second nurse before giving the medicine
23.Mental health nursing
Answer: B · Let the tablet dissolve completely under the tongue without chewing or swallowing it
Why this is the answer
Buprenorphine is poorly absorbed if swallowed, so it is dissolved under the tongue. Naloxone is added to discourage injection, because it is poorly absorbed sublingually but active if injected.
Answer
B · Let the tablet dissolve completely under the tongue without chewing or swallowing it
24.Mental health nursing
Answer: A · Treatment without consent is lawful only under the conditions and procedures set by the law
Why this is the answer
Mental health laws allow some treatments for mental disorder without consent in defined circumstances, with safeguards such as second opinions and time limits. Staff must follow these procedures and record them, and should continue to seek the patient's agreement.
Answer
A · Treatment without consent is lawful only under the conditions and procedures set by the law
25.Nursing math & unit conversions
Answer: 12:00
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
12:00
Answer
12:00
26.Nursing math & unit conversions
Answer: V = 622.5 mL
Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.
Each item in mL
1½ tbsp = 1.5·15 = 22.5 mL
1½ cups = 1.5·240 = 360 mL
8 fl oz = 8·30 = 240 mL
Add
V = 22.5 + 360 + 240 = 622.5 mL
Answer
V = 622.5 mL
27.Dosage calculations
Answer: V = 10 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.
Concentration
1:10 000 = 1 g/10000 mL = 0.1 mg/mL
Volume
V = 1/0.1 = 10 mL
Answer
V = 10 mL
US labels now state mg/mL (1 mg/mL = 1:1000; 0.1 mg/mL = 1:10 000). Never give 1 mg/mL epinephrine IV push.
28.Dosage calculations
Answer: V = 0.66 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.
Volume
V = 660/1000 = 0.66 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.66 mL
29.IV infusion rates
Answer: R = 16 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 = 500·15/480 = 15.63 ≈ 16 gtt/min
Answer
R = 16 gtt/min
At the bedside you round to the nearest whole drop: 16 gtt/min.
30.IV infusion rates
Answer: D = 6 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
250/500 = 0.5 mg/mL
Dose rate
D = 0.5·12 = 6 mg/h
Answer
D = 6 mg/h
31.Pediatric & critical-care dosing
Answer: R = 30.5 mL/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.
Units per hour
14·109 = 1 526 units/h
Concentration
25 000/500 = 50 units/mL
Pump rate
R = 1526/50 = 30.52 ≈ 30.5 mL/h
Answer
R = 30.5 mL/h
32.Pediatric & critical-care dosing
Answer: D = 13.2 mcg/kg/min
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
500 000/250 = 2000 mcg/mL
Micrograms per minute
21·2000 = 42000 mcg/h
42000/60 = 700 mcg/min
Per kilogram
D = 700/53 = 13.21 ≈ 13.2 mcg/kg/min
Answer
D = 13.2 mcg/kg/min
33.IV fluids & fluid balance
Answer: U = 1.49 mL/kg/h
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Total urine
425 + 325 + 375 + 375 = 1500 mL
Per kilogram per hour
U = 1500/(84·12) = 1.488 ≈ 1.49 mL/kg/h
Answer
U = 1.49 mL/kg/h
34.IV fluids & fluid balance
Answer: t = 14.4 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
First part
120·4 = 480 mL
1000 − 480 = 520 mL left
Second part
520/50 = 10.4 h
Total time
t = 4 + 10.4 = 14.4 h
Answer
t = 14.4 h
That is about 14 h 24 min, so the bag runs out at about 01:24.
35.Clinical assessment scores
Answer: MFS = 40
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: yes → 25
secondary diagnosis: no → 0
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: overestimates or forgets limits → 15
Add
Morse total = 25 + 0 + 0 + 0 + 0 + 15 = 40
Answer
MFS = 40
36.Clinical assessment scores
Answer: obesity class I
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 = 83/1.61² = 32.02
Category
obesity class I
Answer
obesity class I
37.Arterial blood gas interpretation
Answer: uncompensated
Reading a blood gas (ROME): first the pH: below 7.35 is acidaemia, above 7.45 alkalaemia. Then find the value that explains it. PaCO₂ (normal 35–45 mmHg, 4.7–6.0 kPa) is the respiratory part and moves Opposite to the pH in a respiratory disorder; HCO₃⁻ (normal 22–26 mmol/L) is the metabolic part and moves in the same direction as the pH (Respiratory Opposite, Metabolic Equal). The other value shows the compensation: normal means uncompensated; abnormal in the direction that pulls the pH back while the pH is still abnormal means partially compensated; a normal pH with both values abnormal means fully compensated. Ranges differ slightly between laboratories; these are practice values.
ROME, value by value
pH 7.07: acidaemia (below 7.35)
PaCO₂ 39 mmHg: normal (35–45)
HCO₃⁻ 11 mmol/L: low (22–26)
Compensation
Clinically, also check the expected compensation: Winter’s formula expects PaCO₂ 22.5–26.5 mmHg, so the measured 39 mmHg points to an additional respiratory acidosis (a mixed disorder). The answer above is the ROME exam classification.
uncompensated
Answer
uncompensated
38.Arterial blood gas interpretation
Answer: AGc = 24 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 = 138 − (105 + 14) = 19
Correction for albumin
19 + 0.25·(40 − 20) = 24 mmol/L
Answer
AGc = 24 mmol/L
Above about 12 after correction: a high anion gap.
39.ECG rhythm strip interpretation
Answer: QTc = 0.385 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 = 24 × 0.04 = 0.96 s
Fridericia’s formula
QTc = 0.38/∛0.96 = 0.38/0.9865 = 0.385 s
Answer
QTc = 0.385 s
Within the usual limits (about 0.45 s for men, 0.46 s for women). (385 ms)
40.ECG rhythm strip interpretation
Answer: torsades de pointes
More ventricular rhythms: torsades de pointes is a polymorphic ventricular tachycardia, usually 150–250/min, in which the wide complexes change in height and twist around the baseline, pointing up for a few beats and then down. Textbooks link it to a prolonged QT interval, and magnesium sulfate is the drug resuscitation guidelines name for it. An idioventricular rhythm is a ventricular escape rhythm: regular, wide QRS (0.12 s or more), no P waves, at 20–40/min (an accelerated idioventricular rhythm runs at 40–100/min). Monomorphic VT has identical wide complexes at more than 100/min. VF is chaotic, without any repeating complex.
Five steps
1. Rate: very fast, the complexes are about 6 small boxes apart (about 250 per minute).
2. Rhythm: fast and roughly regular, but the height and direction of the complexes change in a repeating spindle pattern.
3. P waves: none identifiable.
4. PR interval: not measurable.
5. QRS: wide and polymorphic; the complexes twist around the baseline, pointing up for a few beats and then down.
Interpretation
torsades de pointes
Answer
torsades de pointes
Torsades de pointes is a polymorphic VT linked to a prolonged QT interval. This is identification practice only.
This is independent practice material. ExamProblems is not affiliated with or endorsed by the organisation that runs this exam, and the exam name is used only to describe the content. NCLEX®, NCLEX-RN® and NCLEX-PN® are trademarks of the National Council of State Boards of Nursing, Inc. (NCSBN), which is not affiliated with ExamProblems and does not endorse it or vouch for its accuracy.