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
In the UK SSKIN care bundle for pressure ulcer prevention, what does "K" stand for?
AKeep moving
BKeep clean
CKeep warm
DKeep dry
2.Nursing fundamentalsHard
A nurse develops vomiting and diarrhoea during a norovirus outbreak. When can they usually return to work (UK guidance)?
A48 hours after the symptoms have stopped
BThe next shift, if they feel well enough
CAs soon as the vomiting stops
DAfter a full week, whatever the symptoms
3.Infection control & patient safetyMedium
A patient has orthostatic hypotension. Which teaching helps to prevent falls?
ASit on the edge of the bed for a short time before standing up slowly
BGet out of bed quickly so the dizziness passes sooner
CStand up straight after a hot shower to increase blood flow
DAvoid drinking fluids in the morning to reduce trips to the toilet
4.Infection control & patient safetyHard
A nurse teaches a patient with neutropenia about preventing infection at home. Which statement shows a need for further teaching?
A“I will wash my hands often and ask visitors to do the same.”
B“I will check my temperature and call if I have a fever.”
C“I will avoid crowds and people who have colds.”
D“I can clean the cat’s litter box if I wear a face mask.”
5.Prioritization & delegationMedium
A nurse teaches a patient to use an incentive spirometer. Which statement shows a need for further teaching?
A“I will try to hold my breath for a few seconds at the top.”
B“I will use it several times every hour while awake.”
C“I will blow into it as hard and fast as I can.”
D“I will breathe in slowly and deeply through the mouthpiece.”
6.Prioritization & delegationHard
A patient is receiving IV potassium chloride through a peripheral line and complains of burning at the site, which looks red. What does the nurse do first?
AIncrease the infusion rate to finish the dose sooner
BStop the infusion and assess the IV site
CTell the patient that burning is expected and continue
DApply a warm pack and continue the infusion
7.Clinical nursingMedium
Which adverse effects should be monitored for in a patient receiving IV gentamicin?
AConstipation and urinary retention
BHair loss and weight gain
CHyperglycaemia and tremor
DKidney damage and hearing loss
8.Clinical nursingHard
A potassium result of 6.9 mmol/L comes back on a well patient with a normal ECG, and the laboratory reports that the sample was haemolysed. What is the best action?
AStart a potassium supplement
BRepeat the blood test promptly, as haemolysis can falsely raise potassium
CGive IV insulin and glucose straight away
DIgnore the result because the patient looks well and the ECG is normal
9.Lab values & electrolytesMedium
Why must vitamin B12 deficiency be ruled out before treating macrocytic anemia with folic acid alone?
AFolic acid makes B12 deficiency anemia much worse within a few days
BFolic acid can fix the anemia while B12-related nerve damage continues
CFolic acid blocks the absorption of all B12 from the diet
DFolic acid causes iron overload when B12 levels are low
10.Lab values & electrolytesHard
A patient in DKA is receiving IV fluids and insulin. The glucose has fallen to about 220 mg/dL (12.2 mmol/L), but the anion gap is still high. What change would the nurse expect?
AAdd dextrose to the IV fluids and continue the insulin
BGive an IV bolus of sodium bicarbonate at once
CStop the insulin infusion because the glucose is near normal
DStop the IV fluids and start oral fluids only
11.PharmacologyMedium
Which early signs suggest systemic toxicity from a local anaesthetic?
AHeavy sweating, salivation and diarrhoea
BNumbness around the mouth, metallic taste and tinnitus
CItchy rash and swelling only at the injection site
DPinpoint pupils and slow, shallow breathing
12.PharmacologyHard
Which finding most favours serotonin syndrome over neuroleptic malignant syndrome?
AA very high creatine kinase
BRapid onset with hyperreflexia and clonus
CRecent start of an antipsychotic drug
DSlow onset over days with lead-pipe rigidity
13.Med-surg: cardiovascular & respiratoryMedium
What is the main difference between CPAP and bilevel NIV (often called BiPAP)?
ABilevel NIV adds a higher inspiratory pressure, helping remove CO₂
BCPAP is given only through a tracheostomy
CCPAP is mainly used to lower a raised PaCO₂ in COPD exacerbations
DBilevel NIV gives oxygen only, without any positive airway pressure
14.Med-surg: cardiovascular & respiratoryHard
Which approach to chest drain removal is commonly taught?
ARemove it slowly while the patient takes a long, deep breath in
BRemove it with the suction still running at full power
CRemove it during a held breath or expiration, then seal the site
DRemove it and leave the site open to drain for a day
15.Med-surg: neuro, endocrine & renalMedium
A patient is due a rapid-acting insulin dose before lunch, but the meal trays are delayed. What should the nurse do?
AGive the insulin with a glass of water instead
BWait to give the insulin until the meal arrives
COmit the dose entirely for the rest of the day
DGive the insulin now and the meal when it comes
16.Med-surg: neuro, endocrine & renalHard
A patient has episodes of severe headache, sweating, palpitations and very high blood pressure. Which condition should be considered?
ADiabetes insipidus
BAddison's disease
CHypothyroidism
DPhaeochromocytoma
17.Med-surg: GI, perioperative & oncologyMedium
Which drug class is commonly used to reduce acid after endoscopic treatment of a bleeding peptic ulcer?
AH1 antihistamines such as cetirizine
BBeta-blockers
CLoop diuretics
DProton pump inhibitors
18.Med-surg: GI, perioperative & oncologyHard
A patient's platelet count is 18 × 109/L (18,000/µL). Which order should the nurse question?
ADaily full blood count
BA soft diet with mouthwashes
COral paracetamol for headache
DAn intramuscular injection
19.Maternity & obstetric nursingMedium
What should parents be taught about the water for a newborn's bath?
ALeave the baby briefly if the water is only shallow
BCheck that it is warm, not hot, before the baby goes in
CUse very hot water so that germs on the skin are killed
DAdd adult bubble bath to soften the baby's skin
20.Maternity & obstetric nursingHard
A woman with a placenta praevia at 35 weeks is waiting for a planned caesarean. Which activity should she avoid?
ALying on her side
BSexual intercourse
CEating a normal diet
DGentle walking
21.Pediatric nursingMedium
In a child with hypovolaemic shock, which finding is usually a late sign?
AProlonged capillary refill
BTachycardia
CLow blood pressure
DCool extremities
22.Pediatric nursingHard
A child with sickle cell disease has new chest pain, cough, fever and an oxygen saturation of 90%. What should the nurse suspect?
AAnxiety about being in hospital
BAcute chest syndrome, an emergency
CNormal pain from a limb crisis
DA mild cold
23.Mental health nursingMedium
Which pattern suggests premenstrual dysphoric disorder?
AMild bloating the day before a period, without any mood changes
BMood symptoms that begin only after the menopause and last for several years
CMarked mood symptoms in the week before menstruation that improve within a few days after it starts
DLow mood throughout the whole month that is not linked to the menstrual cycle
24.Mental health nursingHard
For the last 3 years a man has had frequent periods of mildly raised mood and periods of low mood. None has been severe enough to count as hypomania or a major depressive episode. Which diagnosis fits best?
ACyclothymic disorder
BBipolar II disorder
CBipolar I disorder
DMajor depressive disorder
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 02:45 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.
02:45
12:45 AM
21:45 AM
32:45 PM
44:45 AM
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A maintenance infusion runs at 50 mL/h without a break. How many litres V does it deliver in 24 hours?
50 mL/h24 h
V = L
27.Dosage calculationsMedium
A patient weighs 15 kg. The prescribed dose is 2 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?
15 kg2 mg/kg/day3× per day
D = mg
28.Dosage calculationsHard
An infusion contains 25000 units of a drug in 1000 mL. The prescription is 2000 units per hour. At what rate R do you set the pump, in mL/h?
25000 units/1000 mL2000 units/h
R = mL/h
29.IV infusion ratesMedium
500 mL was ordered over 10 hours. After 6 hours you find that 230 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?
500 mL / 10 hafter 6 h: 230 mL
R = mL/h
30.IV infusion ratesHard
A bag contains 4 g of a drug in 500 mL. The order is 4 mg per minute. At what rate R do you set the pump, in mL/h?
4 g/500 mL4 mg/min
R = mL/h
31.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). A practice protocol calls for a heparin bolus of 70 units/kg for a patient who weighs 100 kg. The vial contains 5 000 units/mL. What volume V do you draw up? Round to one decimal place.
70 units/kg100 kg5 000 units/mL
V = mL
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 10 mcg/kg/min for a patient who weighs 105 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
800 mg/500 mL10 mcg/kg/min105 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 patient weighs 67 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 bag was started at 06:30 and runs by pump at 60 mL/h. How many mL V are left in the bag at 14:30?
1000 mL60 mL/h06:30 → 14:30
V = mL
35.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 20/min, SpO₂ 99% on room air, blood pressure 96/58 mmHg, pulse 82/min, alert, temperature 35.0 °C. What is the NEWS2 total score?
RR 20SpO₂ 99%airSBP 96HR 82AT 35.0 °C
NEWS2 =
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: yes; secondary diagnosis: yes; ambulatory aid: holds on to furniture; IV therapy or saline lock: yes; gait: weak; 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
A practice gas shows a metabolic acidosis with HCO₃⁻ 14 mmol/L. Use Winter’s formula to find the expected PaCO₂ (the centre of the range) in mmHg.
HCO₃⁻ 14 mmol/L
PaCO₂ = mmHg
38.Arterial blood gas interpretationHard
Practice values: Na⁺ 141, Cl⁻ 98 and HCO₃⁻ 13 mmol/L. Calculate the delta ratio (AG − 12)/(24 − HCO₃⁻), using AG = Na⁺ − (Cl⁻ + HCO₃⁻). Give two decimals.
Na⁺ 141 mmol/LCl⁻ 98 mmol/LHCO₃⁻ 13 mmol/L
delta ratio =
39.ECG rhythm strip interpretationMedium
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 arrhythmia
2atrial fibrillation
3atrial flutter, 2:1 conduction
4atrial flutter, 4:1 conduction
40.ECG rhythm strip interpretationHard
This lead II strip shows second-degree AV block type I (Wenckebach). Measure the PR interval of the last conducted beat before a non-conducted P wave (the longest PR), in seconds.
lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
longest PR = s
3Solutions
1.Nursing fundamentals
Answer: A · Keep moving
Why this is the answer
SSKIN stands for Surface, Skin inspection, Keep moving, Incontinence and moisture, and Nutrition and hydration. Regular repositioning relieves pressure on the skin.
Answer
A · Keep moving
2.Nursing fundamentals
Answer: A · 48 hours after the symptoms have stopped
Why this is the answer
People can still shed norovirus after symptoms settle, so staff usually stay off work until 48 hours symptom-free. This helps stop outbreaks spreading on wards.
Answer
A · 48 hours after the symptoms have stopped
3.Infection control & patient safety
Answer: A · Sit on the edge of the bed for a short time before standing up slowly
Why this is the answer
Changing position slowly, dangling the legs first and getting up with help give the circulation time to adjust. Rapid standing, heat and dehydration make orthostatic hypotension worse.
Answer
A · Sit on the edge of the bed for a short time before standing up slowly
4.Infection control & patient safety
Answer: D · “I can clean the cat’s litter box if I wear a face mask.”
Why this is the answer
Immunocompromised patients should avoid cleaning litter boxes and other animal waste, because of organisms such as Toxoplasma. Another person should do it. The other statements are correct.
Answer
D · “I can clean the cat’s litter box if I wear a face mask.”
5.Prioritization & delegation
Answer: C · “I will blow into it as hard and fast as I can.”
Why this is the answer
An incentive spirometer is used by breathing in slowly and deeply, then holding the breath briefly. Blowing into it does not expand the lungs.
Answer
C · “I will blow into it as hard and fast as I can.”
6.Prioritization & delegation
Answer: B · Stop the infusion and assess the IV site
Why this is the answer
Pain and redness suggest phlebitis or infiltration. The nurse stops the infusion, assesses the site and informs the provider. Continuing the infusion, or giving it faster, increases tissue damage.
Answer
B · Stop the infusion and assess the IV site
7.Clinical nursing
Answer: D · Kidney damage and hearing loss
Why this is the answer
Gentamicin is nephrotoxic and ototoxic. Blood levels and renal function are monitored, and any tinnitus, dizziness or hearing change is reported.
Answer
D · Kidney damage and hearing loss
8.Clinical nursing
Answer: B · Repeat the blood test promptly, as haemolysis can falsely raise potassium
Why this is the answer
Haemolysis in the tube releases intracellular potassium, giving a falsely high reading. The result still needs prompt repeating and review, because true hyperkalaemia cannot be excluded.
Answer
B · Repeat the blood test promptly, as haemolysis can falsely raise potassium
9.Lab values & electrolytes
Answer: B · Folic acid can fix the anemia while B12-related nerve damage continues
Why this is the answer
Folic acid can improve the blood picture in B12 deficiency but does not prevent nerve damage. Giving folate alone can therefore mask the deficiency while neurological damage progresses. Both levels are checked before treatment.
Answer
B · Folic acid can fix the anemia while B12-related nerve damage continues
10.Lab values & electrolytes
Answer: A · Add dextrose to the IV fluids and continue the insulin
Why this is the answer
The glucose usually falls before the ketoacidosis resolves. Dextrose is added so insulin can continue, clearing ketones without causing hypoglycemia, until the anion gap closes. Stopping insulin too early lets ketoacidosis return.
Answer
A · Add dextrose to the IV fluids and continue the insulin
11.Pharmacology
Answer: B · Numbness around the mouth, metallic taste and tinnitus
Why this is the answer
Local anaesthetic toxicity starts with central nervous system signs such as perioral numbness, metallic taste, tinnitus and agitation. It can progress to seizures, arrhythmias and cardiac arrest.
Answer
B · Numbness around the mouth, metallic taste and tinnitus
12.Pharmacology
Answer: B · Rapid onset with hyperreflexia and clonus
Why this is the answer
Serotonin syndrome develops within hours of a serotonergic drug and causes clonus, hyperreflexia, agitation, dilated pupils and diarrhoea. NMS develops over days after a dopamine antagonist, with lead-pipe rigidity and slow reflexes.
Answer
B · Rapid onset with hyperreflexia and clonus
13.Med-surg: cardiovascular & respiratory
Answer: A · Bilevel NIV adds a higher inspiratory pressure, helping remove CO₂
Why this is the answer
CPAP gives one continuous pressure that splints the airways and alveoli open, improving oxygenation (for example in pulmonary oedema or OSA). Bilevel NIV adds a higher inspiratory pressure that supports ventilation, so it is used for hypercapnic respiratory failure such as COPD exacerbations.
Answer
A · Bilevel NIV adds a higher inspiratory pressure, helping remove CO₂
14.Med-surg: cardiovascular & respiratory
Answer: C · Remove it during a held breath or expiration, then seal the site
Why this is the answer
Many guidelines suggest removing the tube at the end of a deep breath held (Valsalva) or during expiration, so that the pressure in the chest is positive. The wound is closed with a suture or occlusive dressing, the patient monitored for recurrent pneumothorax and a chest X-ray done if indicated. Analgesia beforehand is good practice.
Answer
C · Remove it during a held breath or expiration, then seal the site
15.Med-surg: neuro, endocrine & renal
Answer: B · Wait to give the insulin until the meal arrives
Why this is the answer
Rapid-acting insulin begins to work within about 15 minutes, so giving it without food risks hypoglycaemia. It is given just before or with the meal. Basal insulin is not affected by meal delays.
Answer
B · Wait to give the insulin until the meal arrives
16.Med-surg: neuro, endocrine & renal
Answer: D · Phaeochromocytoma
Why this is the answer
Phaeochromocytoma is a catecholamine-secreting tumour, usually of the adrenal medulla. It causes episodic hypertension, headache, sweating and tachycardia. Before surgery, alpha-blockade is started before any beta-blocker, because beta-blockade alone can cause a hypertensive crisis.
Answer
D · Phaeochromocytoma
17.Med-surg: GI, perioperative & oncology
Answer: D · Proton pump inhibitors
Why this is the answer
PPIs raise gastric pH, stabilising clots and reducing rebleeding after endoscopic treatment of ulcer bleeding. H. pylori is tested for and eradicated, and NSAIDs are stopped where possible.
Answer
D · Proton pump inhibitors
18.Med-surg: GI, perioperative & oncology
Answer: D · An intramuscular injection
Why this is the answer
IM injections can cause haematomas in severe thrombocytopenia. Rectal procedures, NSAIDs and aspirin are also avoided. The nurse checks with the prescriber and the oral or IV route is used where possible.
Answer
D · An intramuscular injection
19.Maternity & obstetric nursing
Answer: B · Check that it is warm, not hot, before the baby goes in
Why this is the answer
Bath water should be comfortably warm, about 37 °C (98.6 °F), checked with a thermometer or the elbow, and the baby is never left alone, even in shallow water. Plain water or a mild baby cleanser is used. Some guidance, such as in the US, advises sponge baths until the cord stump has fallen off.
Answer
B · Check that it is warm, not hot, before the baby goes in
20.Maternity & obstetric nursing
Answer: B · Sexual intercourse
Why this is the answer
Women with placenta praevia are advised to avoid intercourse and anything inserted into the vagina because it may cause bleeding. They should report any bleeding or contractions straight away.
Answer
B · Sexual intercourse
21.Pediatric nursing
Answer: C · Low blood pressure
Why this is the answer
Children maintain blood pressure through vasoconstriction and tachycardia until a large volume is lost. Hypotension means decompensated shock and impending collapse.
Answer
C · Low blood pressure
22.Pediatric nursing
Answer: B · Acute chest syndrome, an emergency
Why this is the answer
Acute chest syndrome causes chest pain, fever, respiratory symptoms, hypoxia and new changes on the chest X-ray. It is a leading cause of death in sickle cell disease and needs urgent treatment.
Answer
B · Acute chest syndrome, an emergency
23.Mental health nursing
Answer: C · Marked mood symptoms in the week before menstruation that improve within a few days after it starts
Why this is the answer
In PMDD, symptoms such as irritability, low mood, anxiety and mood swings occur in the final week before menses, improve after onset and are minimal in the week after. Symptoms should be confirmed with daily ratings over at least two cycles.
Answer
C · Marked mood symptoms in the week before menstruation that improve within a few days after it starts
24.Mental health nursing
Answer: A · Cyclothymic disorder
Why this is the answer
Cyclothymic disorder involves at least 2 years (1 year in young people) of many hypomanic and depressive symptoms that do not meet full criteria for hypomanic or major depressive episodes.
Answer
A · Cyclothymic disorder
25.Nursing math & unit conversions
Answer: 2:45 AM
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
02 → 2 AM
Answer
2:45 AM
Answer
2:45 AM
26.Nursing math & unit conversions
Answer: V = 1.2 L
Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.
Volume in a day
50 mL/h × 24 h = 1200 mL
In litres
V = 1200/1000 = 1.2 L
Answer
V = 1.2 L
27.Dosage calculations
Answer: D = 10 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
2·15 = 30 mg
Per dose
D = 30/3 = 10 mg
Answer
D = 10 mg
28.Dosage calculations
Answer: R = 80 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
25000/1000 = 25 units/mL
Pump rate
R = 2000/25 = 80 mL/h
Answer
R = 80 mL/h
29.IV infusion rates
Answer: R = 57.5 mL/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.
Original rate
500/10 = 50 mL/h
New rate
R = 230/4 = 57.5 mL/h
Answer
R = 57.5 mL/h
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
30.IV infusion rates
Answer: R = 30 mL/h
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
4000 mg/500 mL = 8 mg/mL
Dose per hour
4·60 = 240 mg/h
Pump rate
R = 240/8 = 30 mL/h
Answer
R = 30 mL/h
31.Pediatric & critical-care dosing
Answer: V = 1.4 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
70·100 = 7 000 units
Volume
V = 7000/5000 = 1.4 mL
Answer
V = 1.4 mL
32.Pediatric & critical-care dosing
Answer: R = 39.4 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
10·105 = 1050 mcg/min
1050·60 = 63000 mcg/h
Pump rate
R = 63000/1600 = 39.38 ≈ 39.4 mL/h
Answer
R = 39.4 mL/h
33.IV fluids & fluid balance
Answer: U = 1.09 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
175 + 450 + 250 = 875 mL
Per kilogram per hour
U = 875/(67·12) = 1.088 ≈ 1.09 mL/kg/h
Answer
U = 1.09 mL/kg/h
34.IV fluids & fluid balance
Answer: V = 520 mL
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Elapsed time
06:30 → 14:30 = 8 h
Volume infused
60·8 = 480 mL
Volume left
V = 1000 − 480 = 520 mL
Answer
V = 520 mL
35.Clinical assessment scores
Answer: NEWS2 = 5
NEWS2 (National Early Warning Score 2, Royal College of Physicians 2017): score each of the seven parameters with the chart (respiration rate, SpO₂ on scale 1, air or supplemental oxygen, systolic blood pressure, pulse, consciousness on the ACVPU scale and temperature) and add the scores. Clinical risk: 0–4 low; a score of 3 in any single parameter low–medium; 5–6 medium; 7 or more high. A total of 5 or more needs an urgent response.
Score each parameter
RR 20/min → 0
SpO₂ 99% → 0
on air → 0
SBP 96 mmHg → 2
HR 82/min → 0
alert (A) → 0
T 35.0 °C → 3
Add
NEWS2 = 0 + 0 + 0 + 2 + 0 + 0 + 3 = 5
Answer
NEWS2 = 5
36.Clinical assessment scores
Answer: high 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: yes → 25
secondary diagnosis: yes → 15
ambulatory aid: holds on to furniture → 30
IV therapy or saline lock: yes → 20
gait: weak → 10
mental status: knows own limits → 0
Add
Morse total = 25 + 15 + 30 + 20 + 10 + 0 = 100
Risk level
100 → high risk
Answer
high risk
37.Arterial blood gas interpretation
Answer: PaCO₂ = 29 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 = 1.5·14 + 8 = 29 mmHg
range: 27–31 mmHg
Answer
PaCO₂ = 29 mmHg
38.Arterial blood gas interpretation
Answer: delta ratio = 1.636
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 = 141 − (98 + 13) = 30
Delta ratio
(30 − 12)/(24 − 13) = 18/11 = 1.636
Answer
delta ratio = 1.636
Between 1 and 2: a pure high anion gap acidosis.
39.ECG rhythm strip interpretation
Answer: atrial fibrillation
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: 8 QRS complexes in 6 s, × 10 = 80 per minute.
2. Rhythm: irregularly irregular, R–R from 0.52 to 1.02 s with no pattern.
3. P waves: none; the baseline shows small irregular fibrillatory waves.
4. PR interval: not measurable.
5. QRS: 0.08 s, narrow (below 0.12 s).
Interpretation
atrial fibrillation
Answer
atrial fibrillation
40.ECG rhythm strip interpretation
Answer:longest PR = 0.32 s
AV blocks: march out the P waves and check which ones are followed by a QRS. First-degree: every P conducted, PR constant and above 0.20 s. Second-degree type I (Mobitz I, Wenckebach): the PR lengthens from beat to beat until one P wave is not conducted, then the cycle starts again (group beating). Second-degree type II (Mobitz II): the PR of the conducted beats stays constant, and P waves are suddenly not conducted; the QRS is often wide. Third-degree (complete) block: P waves and QRS complexes are each regular but independent, the PR varies at random and the atrial rate is faster than the escape rate (junctional 40–60/min with a narrow QRS, ventricular 20–40/min with a wide QRS). A 2:1 block cannot be called type I or type II from one strip.
March out the P waves
P–P = 0.96 s, regular; one P wave in every 3 is not conducted
PR in each group
PR₁ = 0.20 s, PR₂ = 0.32 s
Answer
longest PR = 0.32 s
The biggest step in PR comes between the first and second beats of a group; later steps are smaller, which is why the R–R intervals shorten before the pause.
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.