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
When should blood cultures be taken in a patient with suspected sepsis?
AOnly if the temperature rises above 40 °C
BBefore antibiotics are given, as long as this does not delay them
CAfter the patient has recovered from the infection
DOnly after three days of antibiotics, to see if they are working
2.Nursing fundamentalsHard
A patient on regular paracetamol (acetaminophen) also takes an over-the-counter cold and flu remedy. Why is this a concern?
ACold remedies stop paracetamol from working, so the pain will not be controlled
BMany cold remedies also contain paracetamol, risking liver damage
CThere is no concern, as cold remedies contain no drugs
DParacetamol makes cold remedies cause drowsiness
3.Infection control & patient safetyMedium
Which PPE does a nurse wear when giving an IV chemotherapy drug?
AA surgical mask and no gloves
BTwo pairs of chemotherapy-tested gloves and a disposable impermeable gown
COne pair of standard latex gloves, changed after the infusion is started
DA reusable cloth gown and one pair of gloves
4.Infection control & patient safetyHard
A patient is admitted with acute diarrhea, and C. difficile is suspected. The test result is pending. When should contact precautions start?
AOnly when the test result comes back positive
BAfter three days of diarrhea
CStraight away, without waiting for the test result
DOnly if the patient develops a fever
5.Prioritization & delegationMedium
A patient has a new plaster cast that is still drying. How should the nurse handle it?
ABy covering it tightly with a plastic sheet
BWith the fingertips, pressing firmly to test it
CBy resting it directly on a hard surface
DWith the palms of the hands, not the fingertips
6.Prioritization & delegationHard
A visitor on the ward becomes threatening and shows a knife. What is the nurse’s priority?
AArgue with the visitor to persuade them to leave
BTry to take the knife away from the visitor straight away before anyone is hurt
CIgnore the visitor and carry on with patient care
DMove away to safety, keep others away and call security or the police
7.Clinical nursingMedium
What is the recommended first aid for a thermal burn?
AApply ice directly to the burn until the pain stops completely
BCool it under cool running water for about 20 minutes
CSpread butter or oil over the burn
DBurst any blisters to release the fluid
8.Clinical nursingHard
A nurse notices that a wrong dose of a drug was prepared but was caught before it was given. What should be done?
ASay nothing, because no harm reached the patient
BDiscipline the nurse who prepared it on the spot in front of colleagues
CReport it as a near miss through the incident reporting system
DTell only the patient's family
9.Lab values & electrolytesMedium
A patient with chronic kidney disease receives an erythropoiesis-stimulating agent such as epoetin alfa. Which assessments are most important?
AHemoglobin and blood pressure
BLiver enzymes and bilirubin
CSerum amylase and lipase
DSerum glucose and ketones
10.Lab values & electrolytesHard
A patient started methimazole for hyperthyroidism 6 weeks ago and now has a fever and a severe sore throat. Which action is most important?
ACheck the TSH and double the dose if it is still low
BAdvise the patient to continue the drug and drink more fluid
CGive the next dose and suggest warm salt-water gargles for comfort
DHold the drug and arrange an urgent white cell and neutrophil count
11.PharmacologyMedium
A woman taking tamoxifen should report which symptom promptly?
AUnusual vaginal bleeding or a painful swollen leg
BMild hot flushes, especially at night, in the first months
CMild tiredness in the afternoon
DSlightly dry skin
12.PharmacologyHard
Before starting long-term bisphosphonate treatment, a patient is advised to have a dental check-up. Why?
ABisphosphonates dissolve tooth enamel within weeks
BBisphosphonates stain the teeth black if taken for many years
CThey are linked to osteonecrosis of the jaw after dental surgery
DBisphosphonates cause severe gum overgrowth
13.Med-surg: cardiovascular & respiratoryMedium
After an arterial blood gas sample is taken from the radial artery, what should the nurse do?
AMassage the site to help the bruising fade
BBend the wrist sharply upwards to stop the bleeding
CApply firm pressure to the site for several minutes
DLeave the site uncovered without pressure
14.Med-surg: cardiovascular & respiratoryHard
A patient receiving noradrenaline (norepinephrine) through a peripheral cannula has pale, cold skin around the site. What should the nurse do?
AIncrease the rate so the drug enters the vein faster and leaks less
BStop it at that site, inform the team and follow the extravasation policy
CContinue the infusion, as this is expected
DMassage the area firmly to spread the drug out into the surrounding tissue
15.Med-surg: neuro, endocrine & renalMedium
A patient has hypertension that is hard to control and a persistently low potassium, without taking diuretics. Which condition should be considered?
APrimary hypothyroidism
BPrimary hyperaldosteronism (Conn's)
CPrimary adrenal insufficiency (Addison's)
DCranial diabetes insipidus
16.Med-surg: neuro, endocrine & renalHard
A patient arrives five hours after the onset of a stroke. A CT angiogram shows a blockage of a large artery in the brain. What is the most appropriate next step?
ANo treatment, because the time for any reperfusion has passed
BUrgent referral for assessment for mechanical thrombectomy
CGive aspirin and plan a review on the ward tomorrow
DStart IV alteplase immediately without further imaging
17.Med-surg: GI, perioperative & oncologyMedium
Which nursing care helps a new skin graft take?
AMassaging the graft firmly several times a day
BRemoving the dressing every hour to look at it
CEncouraging the patient to exercise the area straight away
DKeeping the area still and avoiding shearing forces
18.Med-surg: GI, perioperative & oncologyHard
Why is an SGLT2 inhibitor such as dapagliflozin usually withheld before surgery?
AIt makes the patient's potassium dangerously high
BIt causes the surgical wound to bleed more
CIt interacts with all general anaesthetic gases and stops them working
DIt raises the risk of ketoacidosis, even with near-normal glucose
19.Maternity & obstetric nursingMedium
An Rh-negative woman has just given birth to an Rh-positive baby. When should anti-D immunoglobulin be given?
AOnly if the baby develops jaundice
BWithin 72 hours of birth
CBefore the next pregnancy only
DWithin 2 weeks of birth
20.Maternity & obstetric nursingHard
The nurse must deliver a baby before the provider arrives. As the head crowns, what should the nurse do?
APush the head back to delay the birth
BAsk the woman to cross her legs tightly until help comes
CApply gentle pressure to the head to slow the birth
DPull firmly on the head to speed the birth
21.Pediatric nursingMedium
A child with respiratory distress becomes bradycardic. What does this mean?
AA side effect of the oxygen therapy
BA sign of severe hypoxia and possible imminent cardiac arrest
CThe child is recovering and calming down
DA normal response to sleep
22.Pediatric nursingHard
Only one negative-pressure room is available. Which child should be placed in it?
AA child with RSV bronchiolitis
BA child with norovirus gastroenteritis and vomiting
CA child with impetigo
DA child with suspected measles
23.Mental health nursingMedium
Which nurse statement is most consistent with motivational interviewing?
A"What would be different for you if you drank less?"
B"If you don't stop drinking now, you'll die."
C"You're an alcoholic, and you need to admit it."
D"I've decided that you need to stop drinking completely."
24.Mental health nursingHard
A patient who has worked well with the nurse for three weeks becomes angry and refuses to attend their sessions after being told that discharge is planned for next week. What is the best interpretation?
AThe patient has developed a new psychotic illness
BThe nurse has made an error and should cancel the discharge
CThe patient no longer needs the sessions and should be discharged at once
DThe patient is reacting to the coming end of the relationship
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 14:15 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.
14:15
12:15 AM
24:15 PM
31:15 PM
42:15 PM
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 18:55 and finishes at 07:50 the next morning (24-hour clock). How many hours t did it run? Give the answer in hours as a decimal, rounded to two decimal places.
18:5507:50
t = h
27.Dosage calculationsMedium
How many milligrams of drug m are in 50 mL of a 1% (w/v) solution?
1% w/v50 mL
m = mg
28.Dosage calculationsHard
An infusion contains 20000 units of a drug in 250 mL. The prescription is 2000 units per hour. At what rate R do you set the pump, in mL/h?
20000 units/250 mL2000 units/h
R = mL/h
29.IV infusion ratesMedium
Infuse 1500 mL over 12 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
1500 mL12 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
An infusion of 50 mg in 250 mL runs at 5 mL/h. How many micrograms per minute D does the patient receive?
50 mg/250 mL5 mL/h
D = mcg/min
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 90 kg. The vial contains 1 000 units/mL. What volume V do you draw up? Round to one decimal place.
60 units/kg90 kg1 000 units/mL
V = mL
32.Pediatric & critical-care dosingHard
Practice exercise (made-up values, not clinical guidance). A dobutamine infusion of 250 mg in 250 mL runs at 17 mL/h. The patient weighs 98 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.
250 mg/250 mL17 mL/h98 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 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 50 mL/h. At 12:00, 550 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL550 mL infused50 mL/h
t = h
35.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury opens the eyes spontaneously, says inappropriate, random words and shows as the best motor response: moves a hand to the site of pressure (localises). Work out the GCS and classify the head injury by it. Click your answer.
1mild
2moderate
3severe
36.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 70 mmHg. A patient’s systolic pressure is 108 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 70 mmHg?
MAP 70 mmHgSBP 108 mmHg
DBP = mmHg
37.Arterial blood gas interpretationMedium
A practice gas shows a metabolic acidosis with HCO₃⁻ 6 mmol/L. Use Winter’s formula to find the expected PaCO₂ (the centre of the range) in mmHg.
HCO₃⁻ 6 mmol/L
PaCO₂ = mmHg
38.Arterial blood gas interpretationHard
Practice values: Na⁺ 136, Cl⁻ 112, HCO₃⁻ 11 mmol/L and albumin 34 g/L. Find the albumin-corrected anion gap AGc = AG + 0.25·(40 − albumin).
Interpret this lead II rhythm strip. Which rhythm is it? 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
1sinus tachycardia
2first-degree AV block
3normal sinus rhythm
4sinus bradycardia
40.ECG rhythm strip interpretationHard
Interpret this lead II strip with the five steps in order: rate, rhythm, P waves, PR interval, QRS duration. At which step do you find the first abnormal finding? Click it.
lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
1rate
2rhythm
3P waves
4PR interval
5QRS duration
3Solutions
1.Nursing fundamentals
Answer: B · Before antibiotics are given, as long as this does not delay them
Why this is the answer
Taking cultures first gives the best chance of identifying the organism. They are collected with strict asepsis, but antibiotics must not be delayed in sepsis.
Answer
B · Before antibiotics are given, as long as this does not delay them
2.Nursing fundamentals
Answer: B · Many cold remedies also contain paracetamol, risking liver damage
Why this is the answer
Paracetamol is in many combination products. Taking several at once can push the total over the safe daily maximum and cause liver damage, so patients are taught to check labels.
Answer
B · Many cold remedies also contain paracetamol, risking liver damage
3.Infection control & patient safety
Answer: B · Two pairs of chemotherapy-tested gloves and a disposable impermeable gown
Why this is the answer
Hazardous drugs can be absorbed through the skin or inhaled. Staff wear double chemotherapy-tested gloves and a disposable, low-permeability gown, with eye and face protection if splashing is possible.
Answer
B · Two pairs of chemotherapy-tested gloves and a disposable impermeable gown
4.Infection control & patient safety
Answer: C · Straight away, without waiting for the test result
Why this is the answer
Precautions start on suspicion, because the patient can spread spores while the test is pending. The patient is placed in a single room with contact precautions, and soap-and-water hand washing is used.
Answer
C · Straight away, without waiting for the test result
5.Prioritization & delegation
Answer: D · With the palms of the hands, not the fingertips
Why this is the answer
A wet plaster cast can be dented by fingertips, causing pressure points under the cast. It is handled with the palms, supported on pillows and left uncovered to dry.
Answer
D · With the palms of the hands, not the fingertips
6.Prioritization & delegation
Answer: D · Move away to safety, keep others away and call security or the police
Why this is the answer
In a threat involving a weapon, staff keep a safe distance, protect patients where possible and call security or the police. Trying to disarm the person puts staff at serious risk.
Answer
D · Move away to safety, keep others away and call security or the police
7.Clinical nursing
Answer: B · Cool it under cool running water for about 20 minutes
Why this is the answer
Cooling with running water for around 20 minutes limits tissue damage and pain. Ice can cause further injury, and the patient should be kept warm while the burn is cooled.
Answer
B · Cool it under cool running water for about 20 minutes
8.Clinical nursing
Answer: C · Report it as a near miss through the incident reporting system
Why this is the answer
Near misses are reported so that causes can be studied and systems improved. A just, open culture encourages reporting without blame.
Answer
C · Report it as a near miss through the incident reporting system
9.Lab values & electrolytes
Answer: A · Hemoglobin and blood pressure
Why this is the answer
Epoetin stimulates red cell production. Hemoglobin is monitored, because raising it too high increases the risk of hypertension, stroke and thrombosis. Blood pressure is monitored, and iron stores are checked, since iron is needed for a good response.Checked against:Erythropoietin Stimulating Agents · StatPearls (NCBI Bookshelf) (2024)
Answer
A · Hemoglobin and blood pressure
10.Lab values & electrolytes
Answer: D · Hold the drug and arrange an urgent white cell and neutrophil count
Why this is the answer
Methimazole and propylthiouracil can cause agranulocytosis, often in the first months of therapy. Fever or sore throat must be reported at once; the drug is held and a CBC with differential is checked. Infection is treated urgently if neutrophils are low.
Answer
D · Hold the drug and arrange an urgent white cell and neutrophil count
11.Pharmacology
Answer: A · Unusual vaginal bleeding or a painful swollen leg
Why this is the answer
Tamoxifen has oestrogen-like effects on the uterus and clotting, increasing the risk of endometrial cancer and venous thromboembolism. Hot flushes are common and expected.
Answer
A · Unusual vaginal bleeding or a painful swollen leg
12.Pharmacology
Answer: C · They are linked to osteonecrosis of the jaw after dental surgery
Why this is the answer
Osteonecrosis of the jaw is a rare but serious adverse effect, mostly after invasive dental work. Dental problems are treated before starting, and good oral hygiene is maintained.
Answer
C · They are linked to osteonecrosis of the jaw after dental surgery
13.Med-surg: cardiovascular & respiratory
Answer: C · Apply firm pressure to the site for several minutes
Why this is the answer
Firm pressure for at least about 5 minutes (longer in patients on anticoagulants or with clotting problems) prevents a haematoma. The hand is checked for colour and circulation. The sample is processed promptly.
Answer
C · Apply firm pressure to the site for several minutes
14.Med-surg: cardiovascular & respiratory
Answer: B · Stop it at that site, inform the team and follow the extravasation policy
Why this is the answer
Extravasated noradrenaline causes intense local vasoconstriction and tissue necrosis. The infusion is stopped at that site (with a plan to continue elsewhere, since the patient depends on it), the team is informed and the local extravasation protocol is followed. Vasopressors are given through a central line where possible.
Answer
B · Stop it at that site, inform the team and follow the extravasation policy
15.Med-surg: neuro, endocrine & renal
Answer: B · Primary hyperaldosteronism (Conn's)
Why this is the answer
Excess aldosterone causes sodium and water retention (hypertension) and potassium loss (hypokalaemia). Primary hyperaldosteronism is a common secondary cause of hypertension and is screened for with the aldosterone-to-renin ratio. Addison's disease causes the opposite pattern.
Answer
B · Primary hyperaldosteronism (Conn's)
16.Med-surg: neuro, endocrine & renal
Answer: B · Urgent referral for assessment for mechanical thrombectomy
Why this is the answer
IV thrombolysis is usually given within 4.5 hours of onset. Mechanical thrombectomy for a large vessel occlusion can be done later, typically up to 6 hours and in selected patients up to 24 hours, based on imaging. Time still matters, so referral is urgent.
Answer
B · Urgent referral for assessment for mechanical thrombectomy
17.Med-surg: GI, perioperative & oncology
Answer: D · Keeping the area still and avoiding shearing forces
Why this is the answer
Grafts need close contact with the wound bed to gain a new blood supply. Immobilisation, careful dressings and avoiding friction, shearing and collections under the graft help it take.
Answer
D · Keeping the area still and avoiding shearing forces
18.Med-surg: GI, perioperative & oncology
Answer: D · It raises the risk of ketoacidosis, even with near-normal glucose
Why this is the answer
SGLT2 inhibitors can cause euglycaemic diabetic ketoacidosis around fasting and surgery. They are usually paused before surgery as advised, and ketones are checked if the patient becomes unwell.
Answer
D · It raises the risk of ketoacidosis, even with near-normal glucose
19.Maternity & obstetric nursing
Answer: B · Within 72 hours of birth
Why this is the answer
Anti-D is given within 72 hours of the birth of an Rh-positive baby, after a test confirms the mother is not already sensitised. It is not needed if the baby is Rh-negative.
Answer
B · Within 72 hours of birth
20.Maternity & obstetric nursing
Answer: C · Apply gentle pressure to the head to slow the birth
Why this is the answer
Gentle pressure on the fetal head, with the woman panting, slows birth and reduces perineal tearing and rapid pressure changes in the fetal skull. The nurse then checks for a nuchal cord and supports the baby's body.
Answer
C · Apply gentle pressure to the head to slow the birth
21.Pediatric nursing
Answer: B · A sign of severe hypoxia and possible imminent cardiac arrest
Why this is the answer
In children, bradycardia caused by hypoxia is an ominous, pre-arrest sign. It needs immediate airway and breathing support and an emergency call.
Answer
B · A sign of severe hypoxia and possible imminent cardiac arrest
22.Pediatric nursing
Answer: D · A child with suspected measles
Why this is the answer
Negative-pressure rooms are for airborne infections such as measles, chickenpox and tuberculosis. RSV mainly needs contact (and often droplet) precautions, impetigo contact precautions and norovirus contact precautions with strict hand hygiene.
Answer
D · A child with suspected measles
23.Mental health nursing
Answer: A · "What would be different for you if you drank less?"
Why this is the answer
Motivational interviewing uses open questions that invite the person to explore their own reasons for change. Labelling, threats and directives tend to increase resistance.
Answer
A · "What would be different for you if you drank less?"
24.Mental health nursing
Answer: D · The patient is reacting to the coming end of the relationship
Why this is the answer
Anger, withdrawal or return of symptoms are common responses to termination. The nurse acknowledges the feelings, reviews progress and helps the patient prepare for the ending.
Answer
D · The patient is reacting to the coming end of the relationship
25.Nursing math & unit conversions
Answer: 2:15 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
14 − 12 = 2 → PM
Answer
2:15 PM
Answer
2:15 PM
26.Nursing math & unit conversions
Answer: t = 12.92 h
24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.
Before midnight
18:55 → 24:00 = 305 min
After midnight
00:00 → 07:50 = 470 min
Total
305 + 470 = 775 min
t = 775/60 = 12.92 h
Answer
t = 12.92 h
27.Dosage calculations
Answer: m = 500 mg
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% = 1 g/100 mL = 10 mg/mL
Mass of drug
m = 10·50 = 500 mg
Answer
m = 500 mg
28.Dosage calculations
Answer: R = 25 mL/h
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.
Concentration
20000/250 = 80 units/mL
Pump rate
R = 2000/80 = 25 mL/h
Answer
R = 25 mL/h
29.IV infusion rates
Answer: R = 31 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
12·60 = 720 min
Drip rate
R = 1500·15/720 = 31.25 ≈ 31 gtt/min
Answer
R = 31 gtt/min
At the bedside you round to the nearest whole drop: 31 gtt/min.
30.IV infusion rates
Answer: D = 16.67 mcg/min
Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).
Concentration
50000 mcg/250 mL = 200 mcg/mL
Dose per hour
5·200 = 1000 mcg/h
Dose per minute
D = 1000/60 = 16.67 mcg/min
Answer
D = 16.67 mcg/min
31.Pediatric & critical-care dosing
Answer: V = 5.4 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
60·90 = 5 400 units
Volume
V = 5400/1000 = 5.4 mL
Answer
V = 5.4 mL
32.Pediatric & critical-care dosing
Answer: D = 2.9 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
250 000/250 = 1000 mcg/mL
Micrograms per minute
17·1000 = 17000 mcg/h
17000/60 = 283.3 mcg/min
Per kilogram
D = 283.3/98 = 2.891 ≈ 2.9 mcg/kg/min
Answer
D = 2.9 mcg/kg/min
33.IV fluids & fluid balance
Answer: B = 520 mL
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Total intake
oral: 150 + 150 + 100 = 400 mL
IV infusion: 75·12 = 900 mL
IV antibiotic: 1·100 = 100 mL
total intake = 1400 mL
Total output
425 + 375 + 80 = 880 mL
Balance
B = 1400 − 880 = 520 mL
Answer
B = 520 mL
Positive: more fluid went in than came out.
34.IV fluids & fluid balance
Answer: t = 9 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 − 550 = 450 mL
Time
t = 450/50 = 9 h
Answer
t = 9 h
That is about 9 h 00 min, so the bag runs out at about 21:00.
35.Clinical assessment scores
Answer: moderate
Glasgow Coma Scale: add the best response in three areas. Eye opening E: 4 spontaneous, 3 to sound or speech, 2 to pressure, 1 none. Verbal V: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Motor M: 6 obeys commands, 5 localises, 4 normal flexion (withdraws), 3 abnormal flexion, 2 extension, 1 none. The total runs from 3 to 15. After a head injury, 13–15 is usually called mild, 9–12 moderate and 3–8 severe.
Score each area
E: opens the eyes spontaneously → 4
V: says inappropriate, random words → 3
M: moves a hand to the site of pressure (localises) → 5
Add
GCS = 4 + 3 + 5 = 12
Severity
GCS 12 → moderate
Answer
moderate
36.Clinical assessment scores
Answer: DBP = 51 mmHg
Blood pressure values: pulse pressure PP = SBP − DBP. Mean arterial pressure MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3, an estimate based on the heart spending about two thirds of each beat in diastole at a normal heart rate (less accurate when the heart rate is fast); a MAP of at least about 65 mmHg is a common target for organ perfusion. The shock index SI = heart rate/SBP is normally about 0.5–0.7; a value above about 1 is a warning sign of shock.
Rearrange
DBP = (3·MAP − SBP)/2
Substitute
DBP = (3·70 − 108)/2 = 102/2 = 51 mmHg
Answer
DBP = 51 mmHg
37.Arterial blood gas interpretation
Answer: PaCO₂ = 17 mmHg
Expected compensation: in metabolic acidosis Winter’s formula predicts PaCO₂ = 1.5·HCO₃⁻ + 8 ± 2 mmHg; a measured value above that range points to an additional respiratory acidosis, below it to an additional respiratory alkalosis. The anion gap AG = Na⁺ − (Cl⁻ + HCO₃⁻), normally about 8–12 mmol/L, separates high-gap from normal-gap metabolic acidosis; low albumin hides a high gap (add 2.5 per g/dL that albumin is below 4.0). The delta ratio (AG − 12)/(24 − HCO₃⁻) between about 0.8 and 2 fits a pure high-gap acidosis (some texts use 1 instead of 0.8), below that an added normal-gap acidosis, and above 2 an added metabolic alkalosis.
Winter’s formula
PaCO₂ = 1.5·6 + 8 = 17 mmHg
range: 15–19 mmHg
Answer
PaCO₂ = 17 mmHg
38.Arterial blood gas interpretation
Answer: AGc = 14.5 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 − (112 + 11) = 13
Correction for albumin
13 + 0.25·(40 − 34) = 14.5 mmol/L
Answer
AGc = 14.5 mmol/L
Above about 12 after correction: a high anion gap.
39.ECG rhythm strip interpretation
Answer: first-degree AV block
Rhythm criteria (lead II): sinus rhythm has an upright P wave before every QRS, a constant PR of 0.12–0.20 s and a narrow QRS: normal sinus rhythm at 60–100/min, sinus bradycardia below 60, sinus tachycardia above 100. Atrial fibrillation: no P waves, a fibrillatory baseline and an irregularly irregular R–R. Atrial flutter: sawtooth flutter waves at about 250–350/min with a fixed conduction ratio such as 2:1 or 4:1. First-degree AV block: sinus rhythm with a constant PR above 0.20 s. Junctional rhythm: narrow QRS at 40–60/min with absent or inverted P waves (PR below 0.12 s, or P after the QRS). A PVC is an early, wide (0.12 s or more), bizarre QRS without a P wave, with the T wave in the opposite direction and usually a full compensatory pause; in bigeminy every second beat is a PVC.
Five steps
1. Rate: R–R = 22 small boxes, 1500 ÷ 22 ≈ 68 per minute.
2. Rhythm: regular, every R–R is 0.88 s.
3. P waves: upright, one before every QRS, all alike.
4. PR interval: 0.28 s, constant, longer than 0.20 s.
5. QRS: 0.10 s, narrow (below 0.12 s).
Interpretation
first-degree AV block
Answer
first-degree AV block
40.ECG rhythm strip interpretation
Answer: P waves
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 = 22 small boxes, 1500 ÷ 22 ≈ 68 per minute.
2. Rhythm: regular, every R–R is 0.88 s.
3. P waves: inverted, just before each QRS.
4. PR interval: 0.10 s, shorter than 0.12 s.
5. QRS: 0.08 s, narrow (below 0.12 s).
First abnormal step
P waves → accelerated junctional rhythm
Answer
P waves
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