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 nurse gives a patient analgesia for pain. What is the next important step?
AWait until the next day to ask about the pain
BRecord the dose and assume the pain is gone unless the patient complains
CReassess the pain after the drug has had time to work
DGive a second dose straight away
2.Nursing fundamentalsHard
Why is lifting a patient by placing your hands under their armpits (the "drag lift") considered unsafe?
AIt takes too long compared with using a hoist or slide sheet
BIt is only unsafe for children
CIt can injure the patient's shoulders and the nurse's back
DIt is unsafe only when the patient is wearing a gown
3.Infection control & patient safetyMedium
A nurse wants to set up a sterile field in the morning for a procedure that will take place after lunch. What is correct?
ASet it up in the morning and ask a colleague to check it once
BSet it up in the morning and cover it with a clean towel until the procedure starts
CSet it up in the morning and leave it uncovered in an empty room
DSet it up just before the procedure, because a waiting field may become contaminated
4.Infection control & patient safetyHard
Who should mark the operative site before surgery?
AThe admitting clerk, using the information written on the consent form
BThe patient, alone, using a marker pen at home on the night before surgery
CThe person who will perform the procedure, with the patient involved where possible
DAny member of the operating room team after anesthesia starts
5.Prioritization & delegationMedium
Which newborn finding needs prompt reporting?
ABluish hands and feet in the first hours
BMild jaundice that first appears on the third day
CMilia (small white spots) on the nose
DJaundice that appears within the first 24 hours
6.Prioritization & delegationHard
Several patients on a unit develop diarrhea within two days. What should the nurse do first?
AMove the affected patients into shared rooms with other patients to free up beds
BPlace affected patients on contact precautions and inform infection control
CWait to see if more patients become unwell
DGive all patients antidiarrheal drugs without assessment
7.Clinical nursingMedium
Why is blood pressure monitored closely in a patient with an epidural infusion?
ABlood pressure readings show whether the catheter is infected
BEpidurals always cause severe hypertension that needs regular treatment
CThe epidural pump uses the blood pressure to set the rate
DThe local anaesthetic can block sympathetic nerves and cause hypotension
8.Clinical nursingHard
A patient who has had a kidney stone is taught about prevention. Which statement shows a need for further teaching?
A"I will drink less water so I don't need to pass urine as often."
B"I will try to pass pale urine."
C"I will aim to drink plenty of fluids spread through every day."
D"I will follow the diet advice for my stone type."
9.Lab values & electrolytesMedium
An older adult with chronic kidney disease starts trimethoprim-sulfamethoxazole for a urinary tract infection. Which electrolyte should be monitored closely?
ASodium, because the drug causes heavy sodium retention
BCalcium, because the drug binds calcium in the gut
CPotassium, because trimethoprim can raise it
DChloride, because the drug causes chloride loss
10.Lab values & electrolytesHard
A patient taking apixaban asks why they do not need regular INR tests like their neighbor on warfarin. What is the best explanation?
AThe INR is checked secretly together with the other routine blood tests
BApixaban does not actually thin the blood
CApixaban is monitored with an aPTT every day instead
DIts effect is predictable, so routine clotting tests are not needed
11.PharmacologyMedium
A patient with diabetes is sweaty and shaky. Blood glucose is 3.0 mmol/L (54 mg/dL). The patient is awake and can swallow. What should the nurse do first?
AGive 15–20 g of fast-acting carbohydrate, such as juice
BGive the next scheduled dose of insulin
CGive a large meal high in fat and protein to keep glucose up for longer
DGive intramuscular glucagon at once
12.PharmacologyHard
Beta-lactam antibiotics show time-dependent killing. What does this mean for administration?
ADoses can be given at any time as long as the daily total is right
BDoses should be given on time at evenly spaced intervals
CDoses should be given only when the patient has a fever
DA single very large daily dose works best
13.Med-surg: cardiovascular & respiratoryMedium
A patient's ankle–brachial pressure index (ABPI) is 0.6. What does this suggest?
ASignificant peripheral arterial disease
BStiff, calcified arteries that read falsely high
CA deep vein thrombosis
DNormal leg circulation
14.Med-surg: cardiovascular & respiratoryHard
After positive end-expiratory pressure (PEEP) is increased on a ventilated patient, the blood pressure falls. What is the most likely reason?
APEEP lowers the blood oxygen level
BHigher chest pressure reduces venous return to the heart
CPEEP causes immediate blood loss from the alveolar capillaries
DPEEP directly weakens the heart muscle and its contraction
15.Med-surg: neuro, endocrine & renalMedium
An 85-year-old care home resident becomes newly confused and is falling more often. A UTI is one possibility. Why?
AUrinary infections always cause a high fever in older adults
BA UTI cannot occur in people over 80
CConfusion is the only symptom of a UTI at any age
DOlder adults often show infection as confusion
16.Med-surg: neuro, endocrine & renalHard
Two days after a C5 spinal cord injury, a patient is anxious, with a respiratory rate of 30/min and a falling vital capacity. What should the nurse do?
AEscalate urgently: cord oedema may cause respiratory failure
BGive a sedative to slow the breathing and ease the anxiety
CRecheck the vital capacity again in about 12 hours
DLie the patient flat with the head tilted back to open the airway
17.Med-surg: GI, perioperative & oncologyMedium
Which patient is at highest risk of refeeding syndrome?
AA healthy adult after an overnight fast for minor surgery
BA patient with a normal BMI eating three meals a day
CAn underweight patient who has eaten very little for 10 days
DA patient who missed one lunch because of a scan
18.Med-surg: GI, perioperative & oncologyHard
Hours after an epidural catheter is removed, a patient on an anticoagulant develops back pain and worsening leg weakness. What should be suspected?
AA urinary tract infection causing back pain
BA sacral pressure ulcer causing referred leg pain
CAn epidural haematoma, needing emergency review and MRI
DNormal wearing-off of the epidural block over the day
19.Maternity & obstetric nursingMedium
A newborn's blood glucose is low but the baby is well and able to feed. What is the usual first step?
AFeed the baby and recheck the glucose
BGive the baby plain water by bottle
CWithhold feeds and observe for 6 hours
DGive IV insulin immediately
20.Maternity & obstetric nursingHard
A woman with a placenta praevia at 35 weeks is waiting for a planned caesarean. Which activity should she avoid?
AGentle walking
BEating a normal diet
CLying on her side
DSexual intercourse
21.Pediatric nursingMedium
A child has impetigo. Which advice helps to stop it spreading?
AShare flannels and towels so the whole family is treated
BCover the crusts with a thick layer of petroleum jelly and leave them
CUse separate towels, wash hands often and keep nails short
DPick the crusts off daily so the skin heals faster
22.Pediatric nursingHard
A 3-year-old who was toilet trained starts wetting the bed during a hospital stay. The parents are worried. What should the nurse say?
AThis proves the child has a serious kidney disease
BThe child should be put back into nappies permanently, and toilet training should not be tried again for years
CRegression is a common response to the stress of hospital and usually passes; do not punish the child
DThe child is being naughty and should be told off
23.Mental health nursingMedium
A patient says, "I'm worthless. Nobody cares about me." Which response is most therapeutic?
A"Let's talk about something more cheerful."
B"You're feeling that no one cares about you. Tell me more."
C"You shouldn't say such things."
D"That's not true; everyone here cares about you."
24.Mental health nursingHard
A woman who is being abused by her partner says she will not leave him. What is the most appropriate response?
ARespect her decision, give information about support services and help her make a safety plan
BTell her that she must leave him today or the nurse cannot help her
CTell her that if she stays and is hurt again, it will be her own fault because she was warned about the risks
DCall her partner to discuss his behaviour with him
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 40.2 °C. Convert it to degrees Fahrenheit T with °F = °C × 9/5 + 32. Round to one decimal place.
40.2 °C
T = °F
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A prescription reads ½ tsp of an oral suspension every 6 hours for 10 days. The suspension comes in 150 mL bottles. Using 1 tsp = 5 mL, how many whole bottles N must be supplied so the course is complete?
½ tspevery 6 hours10 days150 mL1 tsp = 5 mL
N =
27.Dosage calculationsMedium
A patient weighs 45 kg and is prescribed 20 mg/kg as a single dose. Find the dose D in mg.
45 kg20 mg/kg
D = mg
28.Dosage calculationsHard
The prescription is 2880 micrograms. The ampoule contains 4 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
2880 mcg4 mg/mL
V = mL
29.IV infusion ratesMedium
An infusion is ordered at 30 mL/h, but no pump is available. It runs by gravity through a giving set of 20 gtt/mL. Find the drip rate R in drops per minute.
30 mL/h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 20 gtt/min through a set of 60 gtt/mL. There are 300 mL left in the bag. How many hours t until it is empty?
20 gtt/min60 gtt/mL300 mL
t = h
31.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). A bag contains 20 000 units of heparin in 500 mL. The order is 15 units/kg/h for a patient who weighs 108 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
20 000 units/500 mL15 units/kg/h108 kg
R = mL/h
32.Pediatric & critical-care dosingHard
Practice exercise (made-up values, not clinical guidance). A dopamine infusion of 800 mg in 500 mL runs at 25 mL/h. The patient weighs 83 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.
800 mg/500 mL25 mL/h83 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 8-hour shift. The patient weighs 98 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 500 mL bag runs by pump at 80 mL/h. At 18:00, 150 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL150 mL infused80 mL/h
t = h
35.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 89/min and a blood pressure of 86/52 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.
HR 89/minBP 86/52 mmHg
SI =
36.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). An adult weighs 51 kg and is 157 cm tall. Calculate the BMI and click the WHO weight category.
51 kg157 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 7.43, PaCO₂ 28 mmHg (3.7 kPa) and HCO₃⁻ 18 mmol/L. The primary disorder is respiratory alkalosis. How far is it compensated? Click your answer.
pH 7.43PaCO₂ 28 mmHg (3.7 kPa)HCO₃⁻ 18 mmol/L
1uncompensated
2partially compensated
3fully compensated
38.Arterial blood gas interpretationHard
At sea level, a practice gas taken on 21% oxygen shows PaO₂ 89 mmHg (11.9 kPa) and PaCO₂ 34 mmHg (4.5 kPa). Use PAO₂ = FiO₂·(760 − 47) − PaCO₂/0.8 to find the A–a gradient.
Measure the QT interval and the R–R interval on this regular lead II strip, then calculate the rate-corrected QTc with Bazett’s formula QTc = QT/√RR (both in seconds). Give the answer in seconds to three decimals.
lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
QTc = s
40.ECG rhythm strip interpretationHard
This lead II strip shows an AV block, so the atria and the ventricles beat at different rates. The QRS complexes are regular: find the ventricular rate in beats per minute (1500 method, whole number).
lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
ventricular rate = bpm
3Solutions
1.Nursing fundamentals
Answer: C · Reassess the pain after the drug has had time to work
Why this is the answer
Pain should be reassessed after an interval that matches the drug and route. This shows whether the treatment works and whether side effects such as sedation have appeared.
Answer
C · Reassess the pain after the drug has had time to work
2.Nursing fundamentals
Answer: C · It can injure the patient's shoulders and the nurse's back
Why this is the answer
The drag lift puts high strain on the patient's shoulder joints and skin and on the handler's spine. Patients who cannot move themselves should be moved with slide sheets, standing aids or hoists.
Answer
C · It can injure the patient's shoulders and the nurse's back
3.Infection control & patient safety
Answer: D · Set it up just before the procedure, because a waiting field may become contaminated
Why this is the answer
The longer a sterile field is exposed, the more likely it is to be contaminated, and an unattended field cannot be considered sterile. It is prepared just before use.
Answer
D · Set it up just before the procedure, because a waiting field may become contaminated
4.Infection control & patient safety
Answer: C · The person who will perform the procedure, with the patient involved where possible
Why this is the answer
Under the Universal Protocol, the site is marked by the person performing the procedure, or an authorized delegate, ideally while the patient is awake and can confirm it. This helps prevent wrong-site surgery.
Answer
C · The person who will perform the procedure, with the patient involved where possible
5.Prioritization & delegation
Answer: D · Jaundice that appears within the first 24 hours
Why this is the answer
Jaundice in the first 24 hours is not physiological and may point to hemolysis or infection. Mild jaundice after the first day, milia and acrocyanosis are common, expected findings.
Answer
D · Jaundice that appears within the first 24 hours
6.Prioritization & delegation
Answer: B · Place affected patients on contact precautions and inform infection control
Why this is the answer
A cluster of diarrhea may be an outbreak, for example of C. difficile or norovirus. Contact precautions and early notification of infection control limit spread.
Answer
B · Place affected patients on contact precautions and inform infection control
7.Clinical nursing
Answer: D · The local anaesthetic can block sympathetic nerves and cause hypotension
Why this is the answer
Epidural local anaesthetic can cause vasodilation and hypotension. Nurses also monitor sedation, respiratory rate, block height, motor function and the catheter site.
Answer
D · The local anaesthetic can block sympathetic nerves and cause hypotension
8.Clinical nursing
Answer: A · "I will drink less water so I don't need to pass urine as often."
Why this is the answer
A high fluid intake dilutes urine and is the most important general measure to prevent stones. Dietary advice depends on the stone's composition.
Answer
A · "I will drink less water so I don't need to pass urine as often."
9.Lab values & electrolytes
Answer: C · Potassium, because trimethoprim can raise it
Answer: D · Its effect is predictable, so routine clotting tests are not needed
Why this is the answer
Direct oral anticoagulants such as apixaban have predictable effects at fixed doses, so routine INR testing is not needed. Kidney and liver function, adherence and signs of bleeding are monitored, and the INR does not reliably measure their effect.
Answer
D · Its effect is predictable, so routine clotting tests are not needed
11.Pharmacology
Answer: A · Give 15–20 g of fast-acting carbohydrate, such as juice
Why this is the answer
Conscious hypoglycaemia is treated with 15–20 g of fast-acting carbohydrate, with glucose rechecked after about 15 minutes. Fat slows absorption, and glucagon is kept for patients who cannot swallow.
Answer
A · Give 15–20 g of fast-acting carbohydrate, such as juice
12.Pharmacology
Answer: B · Doses should be given on time at evenly spaced intervals
Why this is the answer
For beta-lactams, efficacy depends on the time the drug level stays above the minimum inhibitory concentration. Evenly spaced, on-time doses, or extended infusions, support this.
Answer
B · Doses should be given on time at evenly spaced intervals
13.Med-surg: cardiovascular & respiratory
Answer: A · Significant peripheral arterial disease
Why this is the answer
An ABPI of roughly 1.0–1.3 is normal, and below 0.9 indicates peripheral arterial disease; lower values mean more severe disease. A value above about 1.3 suggests calcified, incompressible vessels, common in diabetes, and is unreliable.
Answer
A · Significant peripheral arterial disease
14.Med-surg: cardiovascular & respiratory
Answer: B · Higher chest pressure reduces venous return to the heart
Why this is the answer
PEEP keeps alveoli open and improves oxygenation, but higher intrathoracic pressure impedes venous return, reducing preload and cardiac output, especially in hypovolaemic patients. The team may give fluid or adjust PEEP. High pressures also risk barotrauma.
Answer
B · Higher chest pressure reduces venous return to the heart
15.Med-surg: neuro, endocrine & renal
Answer: D · Older adults often show infection as confusion
Why this is the answer
In older adults, infections such as UTI may present with delirium, falls or reduced mobility rather than dysuria or fever. Other causes of delirium must also be considered, and urine tests alone can mislead.
Answer
D · Older adults often show infection as confusion
16.Med-surg: neuro, endocrine & renal
Answer: A · Escalate urgently: cord oedema may cause respiratory failure
Why this is the answer
Cord oedema in the days after a cervical injury can extend to C3–C5, weakening the diaphragm. A falling vital capacity, rising respiratory rate and anxiety signal impending respiratory failure, and early critical care input is needed. Sedation would depress breathing further.
Answer
A · Escalate urgently: cord oedema may cause respiratory failure
17.Med-surg: GI, perioperative & oncology
Answer: C · An underweight patient who has eaten very little for 10 days
Why this is the answer
Risk factors include a low BMI, little or no intake for over 5 days, significant weight loss, alcohol misuse and low electrolytes before feeding. These patients start nutrition slowly with electrolyte monitoring.
Answer
C · An underweight patient who has eaten very little for 10 days
18.Med-surg: GI, perioperative & oncology
Answer: C · An epidural haematoma, needing emergency review and MRI
Why this is the answer
Increasing motor weakness, numbness, back pain or bladder dysfunction with an epidural or after removal, especially with anticoagulants, can indicate an epidural haematoma or abscess. It is an emergency: urgent anaesthetic review and MRI, with surgical decompression if needed, to prevent permanent paralysis.
Answer
C · An epidural haematoma, needing emergency review and MRI
19.Maternity & obstetric nursing
Answer: A · Feed the baby and recheck the glucose
Why this is the answer
For mild, asymptomatic hypoglycaemia, early feeding and buccal glucose gel are used, with glucose rechecked per protocol. Symptomatic or persistent hypoglycaemia needs IV glucose.
Answer
A · Feed the baby and recheck the glucose
20.Maternity & obstetric nursing
Answer: D · 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
D · Sexual intercourse
21.Pediatric nursing
Answer: C · Use separate towels, wash hands often and keep nails short
Why this is the answer
Impetigo spreads easily by touch. Good hand hygiene, separate towels, short nails and avoiding scratching or picking reduce spread, along with the prescribed antibiotic or antiseptic treatment.
Answer
C · Use separate towels, wash hands often and keep nails short
22.Pediatric nursing
Answer: C · Regression is a common response to the stress of hospital and usually passes; do not punish the child
Why this is the answer
Temporary regression is common in hospitalised young children. Accept it without punishment, keep familiar routines and praise the child; skills usually return after discharge.
Answer
C · Regression is a common response to the stress of hospital and usually passes; do not punish the child
23.Mental health nursing
Answer: B · "You're feeling that no one cares about you. Tell me more."
Why this is the answer
Reflection acknowledges the feeling and encourages the patient to continue. Contradicting, disapproving or changing the subject blocks communication.
Answer
B · "You're feeling that no one cares about you. Tell me more."
24.Mental health nursing
Answer: A · Respect her decision, give information about support services and help her make a safety plan
Why this is the answer
Adults have the right to make their own decisions. Many survivors leave and return several times. The nurse documents carefully, provides resources and a safety plan, and keeps the door open for future help.
Answer
A · Respect her decision, give information about support services and help her make a safety plan
25.Nursing math & unit conversions
Answer: T = 104.4 °F
Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.
Multiply by 9/5
40.2·9/5 = 72.36
Add 32
T = 72.36 + 32 = 104.4 °F
Answer
T = 104.4 °F
26.Nursing math & unit conversions
Answer: N = 1
Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.
Total volume
2.5 mL × 4 × 10 = 100 mL
Bottles
100/150 = 0.6667 → N = 1
Answer
N = 1
27.Dosage calculations
Answer: D = 900 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.
Dose
20·45 = 900 mg
Answer
D = 900 mg
28.Dosage calculations
Answer: V = 0.72 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.
Same units
4 mg/mL = 4000 mcg/mL
Volume
V = 2880/4000 = 0.72 mL
Answer
V = 0.72 mL
29.IV infusion rates
Answer: R = 10 gtt/min
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Millilitres per minute
30/60 = 0.5 mL/min
Drip rate
R = 0.5·20 = 10 gtt/min
Answer
R = 10 gtt/min
30.IV infusion rates
Answer: t = 15 h
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Rate in mL/h
20·60/60 = 20 mL/h
Time left
t = 300/20 = 15 h
Answer
t = 15 h
31.Pediatric & critical-care dosing
Answer: R = 40.5 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
15·108 = 1 620 units/h
Concentration
20 000/500 = 40 units/mL
Pump rate
R = 1620/40 = 40.5 mL/h
Answer
R = 40.5 mL/h
32.Pediatric & critical-care dosing
Answer: D = 8 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
800 000/500 = 1600 mcg/mL
Micrograms per minute
25·1600 = 40000 mcg/h
40000/60 = 666.7 mcg/min
Per kilogram
D = 666.7/83 = 8.032 ≈ 8 mcg/kg/min
Answer
D = 8 mcg/kg/min
33.IV fluids & fluid balance
Answer: U = 1.69 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
325 + 325 + 475 + 200 = 1325 mL
Per kilogram per hour
U = 1325/(98·8) = 1.69 mL/kg/h
Answer
U = 1.69 mL/kg/h
34.IV fluids & fluid balance
Answer: t = 4.4 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.
Volume left
500 − 150 = 350 mL
Time
t = 350/80 = 4.375 ≈ 4.4 h
Answer
t = 4.4 h
That is about 4 h 23 min, so the bag runs out at about 22:23.
35.Clinical assessment scores
Answer: SI = 1.03
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.
Shock index
SI = 89/86 = 1.035 ≈ 1.03
Answer
SI = 1.03
1 or more: a warning sign of shock in this practice case.
36.Clinical assessment scores
Answer: healthy weight
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 = 51/1.57² = 20.69
Category
healthy weight
Answer
healthy weight
37.Arterial blood gas interpretation
Answer: fully compensated
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 7.43: within 7.35–7.45
PaCO₂ 28 mmHg: low (35–45)
HCO₃⁻ 18 mmol/L: low (22–26)
Compensation
fully compensated
Answer
fully compensated
38.Arterial blood gas interpretation
Answer: A–a gradient = 18.23 mmHg
Derived values: calculated serum osmolality is 2·Na⁺ + glucose + urea with all values in mmol/L (2·Na⁺ + glucose/18 + BUN/2.8 with glucose and BUN in mg/dL); normal is about 275–295 mOsm/kg. The P/F ratio is PaO₂ divided by FiO₂ as a fraction. The alveolar oxygen pressure is PAO₂ = FiO₂·(760 − 47) − PaCO₂/0.8 mmHg at sea level, and the A–a gradient is PAO₂ − PaO₂.
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 = 12.5 × 0.04 = 0.50 s
RR = 23 × 0.04 = 0.92 s
Bazett’s formula
QTc = 0.50/√0.92 = 0.50/0.9592 = 0.521 s
Answer
QTc = 0.521 s
Above 0.50 s: markedly prolonged. (521 ms)
40.ECG rhythm strip interpretation
Answer: ventricular rate = 38 bpm
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.
Atrial rate
P–P = 20 small boxes = 0.80 s → 1500 ÷ 20 = 75 ≈ 75 per minute
Ventricular rate
R–R = 40 small boxes = 1.60 s → 1500 ÷ 40 = 37.5 ≈ 38 per minute
Answer
ventricular rate = 38 bpm
Answer
ventricular rate = 38 bpm
2:1 AV block: every second P wave is not conducted, so the atrial rate is twice the ventricular rate.
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.