Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
Prioritization & delegation
Method
Ask what will harm the patient soonest if nothing is done.
Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
Assess before you act unless it is an emergency; then choose the step the others depend on.
For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.
Lab values & electrolytes
Method
Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
Link the value to its typical signs and to the drugs and conditions that cause it.
Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.
Med-surg: cardiovascular & respiratory
Method
Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
Choose the safe first action, then escalate and reassess.
Med-surg: neuro, endocrine & renal
Method
Check the glucose in every patient with new confusion, weakness or a seizure.
Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.
Med-surg: GI, perioperative & oncology
Method
Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.
Maternity & obstetric nursing
Method
Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.
Pediatric nursing
Method
Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
Match the action to the development stage and involve the family.
Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.
Mental health nursing
Method
Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
Respect rights: the least restrictive option, consent and confidentiality with its limits.
Nursing math & unit conversions
Metric steps
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
Weight and length
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
Household measures
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
Read the pH: below 7.35 is acidosis, above 7.45 alkalosis.
Find the value that explains it: PaCO₂ moving opposite to the pH is respiratory, HCO₃⁻ moving with the pH is metabolic.
Look at the other value: normal means uncompensated, abnormal in the compensating direction means partial compensation, and a normal pH with both abnormal means full compensation.
In a metabolic acidosis, compare PaCO₂ with Winter’s formula, 1.5·HCO₃⁻ + 8 ± 2, and calculate the anion gap Na⁺ − (Cl⁻ + HCO₃⁻).
Check a high anion gap with the delta ratio and, when albumin is low, with the corrected gap.
ECG rhythm strip interpretation
Paper (25 mm/s, 10 mm/mV)
1 small box = 0.04 s, 1 large box = 0.20 s, 10 mm = 1 mV
Heart rate, regular rhythm
300 ÷ large boxes = 1500 ÷ small boxes = 60 ÷ RR (s)
Heart rate, irregular rhythm
QRS complexes in 6 s × 10
Normal PR interval
0.12–0.20 s
Normal QRS duration
< 0.12 s
QTc (Bazett)
QT/√RR
QTc (Fridericia)
QT/∛RR
QTc (Framingham)
QT + 154·(1 − RR)
Sinus rates
bradycardia < 60, normal 60–100, tachycardia > 100 /min
Escape rates
junctional 40–60, ventricular 20–40 /min
Fast rhythms
SVT 150–250 /min (narrow), VT > 100 /min (wide)
Method
Rate: for a regular rhythm divide 300 by the large boxes or 1500 by the small boxes between two R waves; for an irregular rhythm count the QRS complexes in 6 seconds and multiply by 10.
Rhythm: compare the R–R intervals. Equal is regular; a repeating pattern is regularly irregular; no pattern at all is irregularly irregular.
P waves: is there an upright P wave in lead II before every QRS, all alike? Look for fibrillatory or sawtooth waves, inverted P waves and P waves without a QRS.
PR interval: from the start of P to the start of the QRS, normally 0.12–0.20 s and constant. Watch whether it lengthens, stays fixed before a dropped beat, or varies at random.
QRS duration: below 0.12 s is narrow; 0.12 s or more is wide. Then name the rhythm, and for the QT use QTc = QT/√RR (Bazett) with times in seconds.
2Practice problems
1.Nursing fundamentalsMedium
A patient's blood pressure is much higher than in all previous readings. What is the best first step?
ATell the patient they are having a stroke
BRecord it and give an extra dose of the blood pressure tablet
CRecheck it, making sure the technique and cuff size are correct
DIgnore it, as it must be a machine error
2.Nursing fundamentalsHard
A patient says, "I've bought nicotine patches and I'm stopping smoking on Monday." Which stage of change is this?
APreparation
BAction
CMaintenance
DContemplation
3.Infection control & patient safetyMedium
Which nursing care reduces the risk of ventilator-associated pneumonia?
ARegular oral care to reduce bacteria in the mouth
BLying the patient flat for most of the day
CChanging the ventilator circuit every few hours
DLeaving secretions in the mouth to protect the airway
4.Infection control & patient safetyHard
Several patients on a ward develop vomiting and diarrhea within two days, and a norovirus outbreak is suspected. What should the nurse do first?
AMove the affected patients to different wards so that fewer people are exposed
BWait for all the stool results to come back before taking any action
CNotify the infection prevention team and place affected patients on contact precautions
DAsk visitors to bring in bottled water for all patients
5.Prioritization & delegationMedium
An older patient with dementia is restless at night and keeps trying to get out of bed. Which measure should the nurse try first?
AGive a sedative from the as-needed list without first assessing the patient
BApply wrist restraints for the rest of the night
CRaise all four bed rails so the patient cannot climb out
DCheck for pain, thirst or a full bladder, and offer toileting
6.Prioritization & delegationHard
After a head injury, a patient passes large amounts of very dilute urine, is thirsty and has a rising serum sodium. Which condition is most likely?
ADiabetes insipidus
BAcute kidney injury with oliguria
CSIADH
DDiabetic ketoacidosis
7.Clinical nursingMedium
Which group of symptoms suggests hypercalcaemia?
AWeight gain, feeling cold and a slow pulse
BSweating, tremor and sudden hunger
CTingling lips, muscle cramps and spasms of the hands and feet
DThirst, constipation, confusion and abdominal pain
8.Clinical nursingHard
A patient has a blood pressure of 220/130 mmHg with headache, confusion and visual disturbance. Why is the blood pressure lowered in a controlled way rather than as fast as possible?
ARapid lowering always causes the hypertension to come back much worse
BRapid lowering causes hyperglycaemia
CA sudden drop can reduce blood flow to the brain, heart and kidneys
DBlood pressure cannot be lowered with drugs
9.Lab values & electrolytesMedium
A patient with central diabetes insipidus starts desmopressin. Which laboratory result is most important to monitor for an adverse effect?
ASerum sodium, which may fall too low
BSerum glucose, which may rise very high
CSerum potassium, which may rise too high
DSerum calcium, which may rise too high
10.Lab values & electrolytesHard
A young woman with frequent self-induced vomiting has swollen salivary glands. Which laboratory pattern is most likely?
ALow potassium, high bicarbonate and high amylase
BLow sodium, low bicarbonate and high lipase
CHigh calcium, high phosphate and high glucose
DHigh potassium, low bicarbonate and low amylase
11.PharmacologyMedium
Why is aspirin avoided in children and teenagers with viral illnesses such as flu or chickenpox?
AIt stops the vaccine from working
BIt causes severe, permanent hearing loss in young children
CIt causes grey baby syndrome
DIt is linked to Reye's syndrome, which harms the liver and brain
12.PharmacologyHard
Which strategy is most effective at preventing errors with IV insulin infusions?
AAn independent double check and a smart pump with a drug library
BPreparing insulin infusions in advance and leaving them unlabelled
CUsing insulin syringes to measure large IV volumes
DWriting "U" for units on the order
13.Med-surg: cardiovascular & respiratoryMedium
A patient has pneumonia in the right lung only. In which side-lying position will oxygenation usually be best?
ALying on the right side, with the affected lung down
BFlat on the back with no pillows
CLying on the left side, with the healthy lung down
DProne with the head down
14.Med-surg: cardiovascular & respiratoryHard
A nurse is planning care for four patients. Which patient should be assessed first?
AA patient with a venous ulcer due for a dressing change
BA patient with stable heart failure waiting for the daily weight
CA patient with COPD whose SpO₂ fell from 90% to 83% with new drowsiness
DA patient with controlled hypertension asking about salt
15.Med-surg: neuro, endocrine & renalMedium
A patient with AKI has a urinary catheter that drains nothing. Which quick bedside check helps rule out a post-renal cause?
AGive a large bolus of IV fluid straight away
BEncourage the patient to drink two litres of water
CCheck the catheter for kinks or blockage and do a bladder scan
DSend a urine sample for culture and wait for the laboratory result
16.Med-surg: neuro, endocrine & renalHard
A patient who has taken prednisolone daily for years is vomiting and cannot keep tablets down. What should the nurse do?
AOmit the steroid until the vomiting stops
BEscalate urgently for steroid by injection
CGive the next dose with a glass of milk
DGive the tablets again after every vomit
17.Med-surg: GI, perioperative & oncologyMedium
Why is IV albumin often given after a large-volume paracentesis?
ATo treat infection in the ascitic fluid
BTo replace the clotting factors and platelets lost in the drained fluid
CTo raise the blood glucose after the procedure
DTo prevent low blood pressure and kidney injury from fluid shifts
18.Med-surg: GI, perioperative & oncologyHard
Which group of signs suggests that a patient is entering the last days of life?
AClearer thinking and increased movement
BReduced intake, mottled skin and changes in breathing
CHigh blood pressure and very fast weight gain
DRising appetite, more energy and normal skin colour and warmth
19.Maternity & obstetric nursingMedium
Why is an indwelling catheter placed before a caesarean birth?
ATo collect a urine sample for culture
BTo prevent postpartum haemorrhage
CTo keep the bladder empty during surgery
DTo measure the baby's fluid balance
20.Maternity & obstetric nursingHard
A labouring woman has had an epidural for 3 hours. The fundus is displaced and a bulge is seen above the pubic bone. What should the nurse do?
APrepare her for an emergency caesarean
BIncrease the rate of the epidural
CCheck for bladder distension and empty the bladder
DStart an oxytocin infusion
21.Pediatric nursingMedium
How should oral rehydration solution be given to a child with mild to moderate dehydration who is vomiting?
AOnly after the vomiting has stopped for 24 hours, to avoid further losses
BAs one large drink every few hours
CIn small amounts, frequently, for example with a spoon or syringe
DMixed with fruit juice to improve the taste
22.Pediatric nursingHard
A boy with haemophilia A bumps his head hard on a table. He seems well. What should the nurse advise?
AWatch him at home for a week and bring him in only if he vomits or has a headache
BNo action is needed, because head bleeds are rare in haemophilia
CSeek urgent care, as factor replacement may be needed before symptoms appear
DGive aspirin for the pain and apply ice to the bump
23.Mental health nursingMedium
When should blood be taken to measure a patient's lithium level?
A1 hour after the last dose
BImmediately after the morning dose
CAbout 12 hours after the last dose
DAt any time of day, since it makes no difference
24.Mental health nursingHard
The parent of a child recently diagnosed with autism asks, "Did his vaccines cause this?" What is the most accurate response?
A"We don't know, so it is best to stop all of his other vaccines."
B"Large studies have found no link between vaccines and autism."
C"Autism is caused by cold and distant parenting styles in early childhood."
D"Yes, the MMR vaccine is a proven cause of autism."
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 37.4 °C. Convert it to degrees Fahrenheit T with °F = °C × 9/5 + 32. Round to one decimal place.
37.4 °C
T = °F
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion delivers 12 mg/h. Express this dose rate D in mcg/min. Round to one decimal place.
12 mg/h1 mg = 1000 mcg1 h = 60 min
D = mcg/min
27.Dosage calculationsMedium
A child weighing 34 kg is prescribed 2 mg/kg of a drug. The stock solution contains 20 mg/mL. Draw up the dose: what volume V do you give?
34 kg2 mg/kg20 mg/mL
V = mL
28.Dosage calculationsHard
The prescription is 860 micrograms. The ampoule contains 2 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
860 mcg2 mg/mL
V = mL
29.IV infusion ratesMedium
An infusion is ordered at 40 mL/h, but no pump is available. It runs by gravity through a giving set of 60 gtt/mL. Find the drip rate R in drops per minute.
40 mL/h60 gtt/mL
R = gtt/min
30.IV infusion ratesHard
An infusion of 50 mg in 250 mL runs at 18 mL/h. How many micrograms per minute D does the patient receive?
50 mg/250 mL18 mL/h
D = mcg/min
31.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). An infusion of 50 units of regular insulin in 50 mL runs at 3 mL/h. How many units per hour D does the patient receive?
50 units/50 mL3 mL/h
D = units/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 4 mL/h. The patient weighs 73 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.
800 mg/500 mL4 mL/h73 kg
D = mcg/kg/min
33.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The patient weighs 64 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 19:00 at 125 mL/h. After 4 hours the rate is changed to 200 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
1000 mL125 mL/h · 4 h200 mL/h
t = h
35.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury does not open the eyes at all, makes only incomprehensible sounds such as moaning and shows as the best motor response: abnormal flexion of the arms (decorticate posture). 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). An adult weighs 97 kg and is 165 cm tall. Calculate the BMI and click the WHO weight category.
97 kg165 cm
1underweight
2healthy weight
3overweight
4obesity class I
5obesity class II
6obesity class III
37.Arterial blood gas interpretationMedium
Practice values: Na⁺ 148 mmol/L, glucose 6.4 mmol/L and urea 22.4 mmol/L. Calculate the serum osmolality Osm = 2·Na⁺ + glucose + urea to the nearest whole number.
Na⁺ 148 mmol/Lglucose 6.4 mmol/Lurea 22.4 mmol/L
Osm = mOsm/kg
38.Arterial blood gas interpretationHard
At sea level, a practice gas taken on 28% oxygen shows PaO₂ 85 mmHg (11.3 kPa) and PaCO₂ 46 mmHg (6.1 kPa). Use PAO₂ = FiO₂·(760 − 47) − PaCO₂/0.8 to find the A–a gradient.
Measure the QT interval on this lead II strip, in seconds.
lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
QT = s
40.ECG rhythm strip interpretationHard
This lead II strip shows a conduction problem between the atria and the ventricles. 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
1third-degree (complete) AV block
2first-degree AV block
3junctional rhythm
4second-degree AV block type I (Wenckebach)
3Solutions
1.Nursing fundamentals
Answer: C · Recheck it, making sure the technique and cuff size are correct
Why this is the answer
Unexpected findings are validated before action. If the repeat reading is still high, the nurse assesses for symptoms and reports it.
Answer
C · Recheck it, making sure the technique and cuff size are correct
2.Nursing fundamentals
Answer: A · Preparation
Why this is the answer
In preparation the person intends to act soon and has taken small steps, such as buying patches. Action begins when they actually stop smoking.
Answer
A · Preparation
3.Infection control & patient safety
Answer: A · Regular oral care to reduce bacteria in the mouth
Why this is the answer
Oral care, including tooth brushing, reduces the bacteria that can be aspirated around the endotracheal tube. It is part of ventilator care along with head elevation and sedation review.
Answer
A · Regular oral care to reduce bacteria in the mouth
4.Infection control & patient safety
Answer: C · Notify the infection prevention team and place affected patients on contact precautions
Why this is the answer
Early reporting lets infection prevention organize testing, cohorting, closing of the ward if needed, cleaning with suitable agents and soap-and-water hand hygiene. Moving patients around can spread the outbreak.
Answer
C · Notify the infection prevention team and place affected patients on contact precautions
5.Prioritization & delegation
Answer: D · Check for pain, thirst or a full bladder, and offer toileting
Why this is the answer
Patients with dementia may not be able to say what they need. Checking for pain, thirst or the need to void often relieves restlessness; restraints, full bed rails and sedation have risks and are not first choices.
Answer
D · Check for pain, thirst or a full bladder, and offer toileting
6.Prioritization & delegation
Answer: A · Diabetes insipidus
Why this is the answer
Damage to the pituitary or hypothalamus can stop the release of antidiuretic hormone, causing diabetes insipidus. The patient loses water, so urine is dilute and sodium rises; SIADH causes the opposite.
Answer
A · Diabetes insipidus
7.Clinical nursing
Answer: D · Thirst, constipation, confusion and abdominal pain
Why this is the answer
High calcium causes polyuria and thirst, constipation, abdominal pain, kidney stones and confusion. Tingling and cramps suggest low calcium instead.
Answer
D · Thirst, constipation, confusion and abdominal pain
8.Clinical nursing
Answer: C · A sudden drop can reduce blood flow to the brain, heart and kidneys
Why this is the answer
In a hypertensive emergency, autoregulation in vital organs is reset to higher pressures. Lowering BP too fast can cause ischaemia, so it is reduced gradually under close monitoring.
Answer
C · A sudden drop can reduce blood flow to the brain, heart and kidneys
9.Lab values & electrolytes
Answer: A · Serum sodium, which may fall too low
Why this is the answer
Desmopressin acts like ADH, so the kidneys retain water. If the patient drinks too much, water retention can cause hyponatremia, which may lead to confusion and seizures. Sodium, weight and fluid balance are monitored.
Answer
A · Serum sodium, which may fall too low
10.Lab values & electrolytes
Answer: A · Low potassium, high bicarbonate and high amylase
Why this is the answer
Repeated vomiting causes hypokalemia and metabolic alkalosis (high bicarbonate) from the loss of stomach acid. Enlarged salivary glands can raise salivary amylase. Hypokalemia can cause dangerous arrhythmias, so it is monitored and corrected.Checked against:Bulimia · MedlinePlus (NIH) (2026)
Answer
A · Low potassium, high bicarbonate and high amylase
11.Pharmacology
Answer: D · It is linked to Reye's syndrome, which harms the liver and brain
Why this is the answer
Aspirin given during viral infections in young people is associated with Reye's syndrome, causing acute encephalopathy and liver failure. Paracetamol or ibuprofen is used for fever instead.
Answer
D · It is linked to Reye's syndrome, which harms the liver and brain
12.Pharmacology
Answer: A · An independent double check and a smart pump with a drug library
Why this is the answer
Independent double checks, standard concentrations and smart pumps with dose limits reduce insulin errors. "U" for units is avoided because it can be misread as a zero.
Answer
A · An independent double check and a smart pump with a drug library
13.Med-surg: cardiovascular & respiratory
Answer: C · Lying on the left side, with the healthy lung down
Why this is the answer
Blood flow goes preferentially to the dependent lung. Placing the healthy lung down matches more blood to the well-ventilated lung, improving oxygenation ("good lung down"). Exceptions include a lung abscess or bleeding, when the affected lung is placed down to protect the healthy one.
Answer
C · Lying on the left side, with the healthy lung down
14.Med-surg: cardiovascular & respiratory
Answer: C · A patient with COPD whose SpO₂ fell from 90% to 83% with new drowsiness
Why this is the answer
A falling saturation with new drowsiness suggests acute respiratory failure, possibly with hypercapnia, and needs immediate assessment. The other patients are stable and their needs can wait briefly.
Answer
C · A patient with COPD whose SpO₂ fell from 90% to 83% with new drowsiness
15.Med-surg: neuro, endocrine & renal
Answer: C · Check the catheter for kinks or blockage and do a bladder scan
Why this is the answer
A blocked or kinked catheter or a distended bladder can cause or mimic anuria. Checking the tubing, flushing or changing the catheter as permitted and performing a bladder scan quickly identify obstruction. Ultrasound of the kidneys looks for higher obstruction such as hydronephrosis.
Answer
C · Check the catheter for kinks or blockage and do a bladder scan
16.Med-surg: neuro, endocrine & renal
Answer: B · Escalate urgently for steroid by injection
Why this is the answer
Patients on long-term steroids depend on them. If tablets cannot be absorbed, they can develop an adrenal crisis. Parenteral hydrocortisone is needed, following sick-day guidance.
Answer
B · Escalate urgently for steroid by injection
17.Med-surg: GI, perioperative & oncology
Answer: D · To prevent low blood pressure and kidney injury from fluid shifts
Why this is the answer
Removing large volumes of ascites can lead to hypotension and kidney injury as fluid moves from the blood into the abdomen. Albumin keeps fluid in the circulation; BP and urine output are monitored.
Answer
D · To prevent low blood pressure and kidney injury from fluid shifts
18.Med-surg: GI, perioperative & oncology
Answer: B · Reduced intake, mottled skin and changes in breathing
Why this is the answer
Signs include increasing drowsiness, reduced intake, mottled cool peripheries, changes in breathing such as pauses, and noisy secretions. Recognising them allows care to focus on comfort and family support.
Answer
B · Reduced intake, mottled skin and changes in breathing
19.Maternity & obstetric nursing
Answer: C · To keep the bladder empty during surgery
Why this is the answer
An empty bladder reduces the risk of bladder injury during surgery and allows urine output to be monitored. It is usually removed once the woman can walk.
Answer
C · To keep the bladder empty during surgery
20.Maternity & obstetric nursing
Answer: C · Check for bladder distension and empty the bladder
Why this is the answer
Epidurals block bladder sensation, so the bladder can overfill. A full bladder can slow descent of the fetus and cause injury. The nurse should encourage voiding or catheterise per protocol.
Answer
C · Check for bladder distension and empty the bladder
21.Pediatric nursing
Answer: C · In small amounts, frequently, for example with a spoon or syringe
Why this is the answer
Small, frequent sips are usually tolerated even with vomiting. Juice and fizzy drinks contain too much sugar and too little salt and can worsen diarrhoea.
Answer
C · In small amounts, frequently, for example with a spoon or syringe
22.Pediatric nursing
Answer: C · Seek urgent care, as factor replacement may be needed before symptoms appear
Why this is the answer
Intracranial bleeding is the most dangerous bleed in haemophilia and can develop hours after injury. Any significant head injury needs urgent assessment and usually prompt factor replacement. Aspirin is avoided because it impairs platelet function.
Answer
C · Seek urgent care, as factor replacement may be needed before symptoms appear
23.Mental health nursing
Answer: C · About 12 hours after the last dose
Why this is the answer
Lithium levels are drawn about 12 hours after the last dose, usually in the morning before the next dose, so results can be compared with the target range.
Answer
C · About 12 hours after the last dose
24.Mental health nursing
Answer: B · "Large studies have found no link between vaccines and autism."
Why this is the answer
Large, well-conducted studies have found no link between vaccines and autism, and the paper that first claimed a link was retracted. Autism is a neurodevelopmental condition with strong genetic contributions.
Answer
B · "Large studies have found no link between vaccines and autism."
25.Nursing math & unit conversions
Answer: T = 99.3 °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
37.4·9/5 = 67.32
Add 32
T = 67.32 + 32 = 99.32 ≈ 99.3 °F
Answer
T = 99.3 °F
26.Nursing math & unit conversions
Answer: D = 200 mcg/min
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.
Set up the chain
D = 12 mg/h × (1000 mcg/1 mg) × (1 h/60 min)
Calculate
D = 12000/60 = 200 mcg/min
Answer
D = 200 mcg/min
27.Dosage calculations
Answer: V = 3.4 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.
Dose from body weight
D = 2·34 = 68 mg
Volume
V = 68/20 = 3.4 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 3.4 mL
28.Dosage calculations
Answer: V = 0.43 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
2 mg/mL = 2000 mcg/mL
Volume
V = 860/2000 = 0.43 mL
Answer
V = 0.43 mL
29.IV infusion rates
Answer: R = 40 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
40/60 = 0.6667 mL/min
Drip rate
R = 0.6667·60 = 40 gtt/min
Answer
R = 40 gtt/min
With a microdrip set (60 gtt/mL), gtt/min equals mL/h.
30.IV infusion rates
Answer: D = 60 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
18·200 = 3600 mcg/h
Dose per minute
D = 3600/60 = 60 mcg/min
Answer
D = 60 mcg/min
31.Pediatric & critical-care dosing
Answer: D = 3 units/h
Heparin and insulin infusions: concentration = units in the bag/bag volume (units/mL). Pump rate (mL/h) = units per hour/concentration, and units per hour = mL/h × concentration. For a weight-based order, units/h = units/kg/h × weight first. A bolus volume = units needed/vial strength. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Concentration
50/50 = 1 units/mL
Units per hour
D = 3·1 = 3 units/h
Answer
D = 3 units/h
32.Pediatric & critical-care dosing
Answer: D = 1.5 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
4·1600 = 6400 mcg/h
6400/60 = 106.7 mcg/min
Per kilogram
D = 106.7/73 = 1.461 ≈ 1.5 mcg/kg/min
Answer
D = 1.5 mcg/kg/min
33.IV fluids & fluid balance
Answer: U = 1.92 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
375 + 150 + 500 + 450 = 1475 mL
Per kilogram per hour
U = 1475/(64·12) = 1.921 ≈ 1.92 mL/kg/h
Answer
U = 1.92 mL/kg/h
34.IV fluids & fluid balance
Answer: t = 6.5 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
First part
125·4 = 500 mL
1000 − 500 = 500 mL left
Second part
500/200 = 2.5 h
Total time
t = 4 + 2.5 = 6.5 h
Answer
t = 6.5 h
That is about 6 h 30 min, so the bag runs out at about 01:30.
35.Clinical assessment scores
Answer: severe
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: does not open the eyes at all → 1
V: makes only incomprehensible sounds such as moaning → 2
M: abnormal flexion of the arms (decorticate posture) → 3
Add
GCS = 1 + 2 + 3 = 6
Severity
GCS 6 → severe
Answer
severe
36.Clinical assessment scores
Answer: obesity class II
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 = 97/1.65² = 35.63
Category
obesity class II
Answer
obesity class II
37.Arterial blood gas interpretation
Answer: Osm = 325 mOsm/kg
Derived values: calculated serum osmolality is 2·Na⁺ + glucose + urea with all values in mmol/L (2·Na⁺ + glucose/18 + BUN/2.8 with glucose and BUN in mg/dL); normal is about 275–295 mOsm/kg. The P/F ratio is PaO₂ divided by FiO₂ as a fraction. The alveolar oxygen pressure is PAO₂ = FiO₂·(760 − 47) − PaCO₂/0.8 mmHg at sea level, and the A–a gradient is PAO₂ − PaO₂.
Calculated osmolality
Osm = 2·148 + 6.4 + 22.4 = 324.8 ≈ 325 mOsm/kg
Answer
Osm = 325 mOsm/kg
38.Arterial blood gas interpretation
Answer: A–a gradient = 57.14 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
10.5 small boxes from the start of the QRS to the end of the T wave
Convert
QT = 10.5 × 0.04 s = 0.42 s
Answer
QT = 0.42 s
A rough rule: at normal rates the QT should be less than half the R–R interval (here R–R = 0.68 s).
40.ECG rhythm strip interpretation
Answer: third-degree (complete) AV block
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.
Five steps
1. Rate: R–R = 42 small boxes, 1500 ÷ 42 ≈ 36 per minute.
2. Rhythm: R–R regular (1.68 s) and P–P regular (0.64 s), but the two are independent.
3. P waves: upright and regular at 94 per minute, but not linked to the QRS complexes; some hide in a QRS or a T wave.
4. PR interval: varies from beat to beat; there is no fixed relation.
5. QRS: 0.14 s, wide (0.12 s or more).
Interpretation
third-degree (complete) AV block
Answer
third-degree (complete) AV block
Type II and third-degree blocks are the ones that can suddenly progress, so textbooks rank them as more serious than type I.
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