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
Why must oxygen be prescribed with a target saturation range?
APrescriptions are needed only for oxygen used at home, not in hospital
BIt is a drug, and too much or too little can harm the patient
COxygen is only allowed for surgical patients
DOxygen is expensive and must be counted
2.Nursing fundamentalsHard
An infusion pump alarms "occlusion". What should the nurse check first?
AThe clamps, the tubing for kinks and the cannula site
BThe battery level of the pump
CThe patient's blood glucose level
DThe fluid prescription chart and the infusion rate written on it
3.Infection control & patient safetyMedium
A small spill of blood is found on the floor. How should it be cleaned?
ALeave it until housekeeping arrives the next morning
BWipe it up quickly with a dry cloth using bare hands, then wash the hands well
CCover it with a clean sheet and keep working
DWear gloves, absorb the blood, then clean the area with an approved disinfectant
4.Infection control & patient safetyHard
A patient on airborne precautions for tuberculosis wants to walk in the hallway. What is the best response?
AExplain that they must stay in the room, and offer ways to stay active inside it
BAllow it, as long as the patient wears an N95 respirator in the corridor
CAllow it, as long as they walk quickly
DAllow it, if they avoid the nurses’ station
5.Prioritization & delegationMedium
A patient with severe neutropenia needs a room. Which roommate is the safest choice?
AA patient with C. difficile diarrhea
BA patient with influenza
CA patient after a knee replacement with no signs of infection
DA patient with an infected, draining leg wound
6.Prioritization & delegationHard
During a continuous tube feed, a patient suddenly starts coughing, becomes breathless and the SpO₂ falls. What is the nurse’s first action?
AFlush the tube with 50 mL of water, then continue the feed as before
BIncrease the feed rate so that it finishes sooner
CLie the patient flat so they can rest
DStop the feed, sit the patient upright and assess breathing
7.Clinical nursingMedium
During an IV infusion, the area around the cannula becomes swollen, cool and pale, and the infusion slows. What is likely?
APhlebitis caused by bacterial infection of the vein wall
BFluid overload of the circulation
CAir embolism
DInfiltration of fluid into the surrounding tissue
8.Clinical nursingHard
A patient took a large paracetamol (acetaminophen) overdose six hours ago and says they feel well. Why is treatment still urgent?
BPatients who feel well after six hours never need any treatment at all
CLiver damage develops later, and the antidote works best when given early
DParacetamol damage only shows up in the kidneys, many weeks later
9.Lab values & electrolytesMedium
Which blood collection practice helps prevent hemolysis of the sample?
AForcing blood quickly through a needle into the tube
BGently inverting the tubes instead of shaking them
CLeaving the tourniquet on for at least 3 minutes
DUsing the smallest needle available for every patient
10.Lab values & electrolytesHard
A patient's creatinine was 0.9 mg/dL (80 µmol/L) on admission and is 1.3 mg/dL (115 µmol/L) 36 hours later. Using the common KDIGO criteria, what does this show?
AAcute kidney injury, because it rose by at least 0.3 mg/dL within 48 hours
BChronic kidney disease, because creatinine has risen above baseline
CA laboratory error, because creatinine cannot change within 2 days
DNo kidney injury, because the creatinine is still within the normal range
11.PharmacologyMedium
How does sucralfate help a peptic ulcer heal?
AIt forms a protective coating over the ulcer base
BIt kills Helicobacter pylori directly
CIt blocks histamine H2 receptors in the stomach
DIt neutralises acid by releasing bicarbonate
12.PharmacologyHard
A toddler swallowed many of his mother's iron tablets. He has vomiting and bloody diarrhoea. Which drug may be used to bind iron?
ANaloxone
BDeferoxamine (desferrioxamine)
CAcetylcysteine
DActivated charcoal given by mouth
13.Med-surg: cardiovascular & respiratoryMedium
Which investigation is usually used to confirm a deep vein thrombosis in the leg?
AA plain chest X-ray and an ECG
BCompression duplex ultrasound
CA lung function test
DAn exercise ECG
14.Med-surg: cardiovascular & respiratoryHard
A patient has new chest pain at rest. The ECG shows ST depression, but serial troponins remain normal. Which diagnosis fits best?
AUnstable angina
BStable angina
CST-elevation myocardial infarction
DNon-ST-elevation myocardial infarction
15.Med-surg: neuro, endocrine & renalMedium
How is cerebral perfusion pressure (CPP) calculated?
ADiastolic pressure minus central venous pressure
BMean arterial pressure divided by heart rate
CSystolic arterial pressure plus intracranial pressure
DMean arterial pressure minus intracranial pressure
16.Med-surg: neuro, endocrine & renalHard
A patient with myasthenia gravis is admitted with pneumonia. Which newly prescribed antibiotic should the nurse question?
ABenzylpenicillin
BAmoxicillin
CGentamicin
DCeftriaxone
17.Med-surg: GI, perioperative & oncologyMedium
Which is a recognised cause of anaphylaxis during surgery?
AA warmed blanket
BSterile normal saline
CThe patient's own blood from cell salvage
DChlorhexidine skin preparation
18.Med-surg: GI, perioperative & oncologyHard
A nurse teaches a patient with chronic pancreatitis. Which statement shows a need for further teaching?
A"I'll report increased thirst or passing urine more often."
B"Oily, floating stools may mean my dose needs changing."
C"I should not drink any alcohol."
D"I'll take my enzyme capsules at bedtime."
19.Maternity & obstetric nursingMedium
Why is indomethacin generally not used as a tocolytic after about 32 weeks?
AIt causes severe maternal hypertension
BIt triggers maternal hypoglycaemia
CIt can close the fetal ductus arteriosus too early
DIt stimulates stronger contractions late in pregnancy
20.Maternity & obstetric nursingHard
Six hours after birth, a woman has not passed urine. The fundus is boggy and displaced to the right, and bleeding has increased. Why is this a priority?
AUrine retention only matters after a caesarean birth, not after a vaginal one
BIt shows that the epidural is still working well
CA full bladder is a sign of normal recovery
DA full bladder prevents the uterus from contracting and increases bleeding
21.Pediatric nursingMedium
A child with suspected appendicitis is waiting for surgery. Which action must the nurse avoid?
AGiving IV fluids as prescribed
BKeeping the child nil by mouth
CRegular pain assessment
DPutting a heat pad on the abdomen
22.Pediatric nursingHard
A 15-year-old in traction for a femur fracture is withdrawn and irritable. Which intervention best fits his developmental stage?
AAsk his parents to stay with him at all times and make decisions for him
BArrange contact with friends and let him control parts of his daily routine
CSet a strict timetable for him that staff decide without his input
DMove him to a room with toddlers so the ward is less lonely
23.Mental health nursingMedium
Which communication approach is best for a patient with moderate dementia?
ASpeak loudly and quickly so that the patient stays alert
BAsk several questions together to save time
CUse abstract language and long explanations so the patient feels respected
DUse short, simple sentences and give one instruction at a time
24.Mental health nursingHard
On a mental health ward, which task is most appropriate for the nurse to delegate to a healthcare assistant?
AAccompanying a stable patient to the dining room and recording his food intake
BTeaching a patient about the side effects of lithium
CCarrying out the full admission suicide risk assessment of a newly admitted patient
DEvaluating whether a PRN medicine given an hour ago has worked
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 12:10 AM. Which entry is the same time on the 24-hour clock? Click it.
12:10 AM
100:10
201:10
324:10
412:10
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 21:30 and finishes at 08:15 the next morning (24-hour clock). How many minutes t did it run?
21:3008:15
t = min
27.Dosage calculationsMedium
A vial contains 2 g of powder. The label says: add 7.4 mL of water for injection to give a total volume of 8 mL. The prescription is 750 mg. What volume V of the reconstituted solution do you give?
2 g+ 7.4 mL → 8 mL750 mg
V = mL
28.Dosage calculationsHard
An infusion contains 25000 units of a drug in 500 mL. The prescription is 1500 units per hour. At what rate R do you set the pump, in mL/h?
25000 units/500 mL1500 units/h
R = mL/h
29.IV infusion ratesMedium
Infuse 1000 mL over 10 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute.
1000 mL10 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 40 gtt/min through a set of 15 gtt/mL. There are 600 mL left in the bag. How many hours t until it is empty? Round to one decimal place.
40 gtt/min15 gtt/mL600 mL
t = h
31.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). A bag contains 12 500 units of heparin in 250 mL. The order is 15 units/kg/h for a patient who weighs 68 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
12 500 units/250 mL15 units/kg/h68 kg
R = mL/h
32.Pediatric & critical-care dosingHard
Practice exercise (made-up values, not clinical guidance). A bag contains dobutamine 500 mg in 250 mL. The order is 12.5 mcg/kg/min for a patient who weighs 75 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
500 mg/250 mL12.5 mcg/kg/min75 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 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 08:30 and runs by pump at 100 mL/h. How many mL V are left in the bag at 10:30?
1000 mL100 mL/h08:30 → 10:30
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 18/min, SpO₂ 97% on supplemental oxygen, blood pressure 124/74 mmHg, pulse 104/min, alert, temperature 37.4 °C. What is the NEWS2 total score?
RR 18SpO₂ 97%O₂SBP 124HR 104AT 37.4 °C
NEWS2 =
36.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). At 1 minute after birth, a practice newborn has blue or pale skin all over, no heartbeat, no response to stimulation, limp limbs with no muscle tone and no breathing. Score the APGAR and click how the score is interpreted.
1reassuring
2moderately abnormal
3low
37.Arterial blood gas interpretationMedium
Practice values: Na⁺ 133 mmol/L, glucose 25.2 mmol/L and urea 8.9 mmol/L. Calculate the serum osmolality Osm = 2·Na⁺ + glucose + urea to the nearest whole number.
Na⁺ 133 mmol/Lglucose 25.2 mmol/Lurea 8.9 mmol/L
Osm = mOsm/kg
38.Arterial blood gas interpretationHard
Practice values: Na⁺ 136, Cl⁻ 110, HCO₃⁻ 10 mmol/L and albumin 16 g/L. Find the albumin-corrected anion gap AGc = AG + 0.25·(40 − albumin).
This lead II strip shows atrial flutter. How many flutter waves per QRS complex are there (the n of n:1 conduction)?
lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
flutter waves per QRS =
40.ECG rhythm strip interpretationHard
Interpret this lead II strip. Which interpretation can you defend from this single strip? Click your answer.
lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
1third-degree (complete) AV block
2second-degree AV block type I (Wenckebach)
32:1 AV block (type undetermined)
4second-degree AV block type II
3Solutions
1.Nursing fundamentals
Answer: B · It is a drug, and too much or too little can harm the patient
Why this is the answer
Oxygen is treated as a medicine. A target range guides the nurse to adjust the flow, avoiding both hypoxaemia and harm from excess oxygen, for example in patients who retain CO₂.
Answer
B · It is a drug, and too much or too little can harm the patient
2.Nursing fundamentals
Answer: A · The clamps, the tubing for kinks and the cannula site
Why this is the answer
An occlusion alarm means the flow is blocked, for example by a closed clamp, kinked tubing, a bent arm or a blocked cannula. The nurse checks from the bag to the patient.
Answer
A · The clamps, the tubing for kinks and the cannula site
3.Infection control & patient safety
Answer: D · Wear gloves, absorb the blood, then clean the area with an approved disinfectant
Why this is the answer
Blood spills are cleaned promptly by staff wearing gloves. The blood is absorbed with disposable material, then the area is cleaned and disinfected with a hospital disinfectant, and waste goes into clinical waste.
Answer
D · Wear gloves, absorb the blood, then clean the area with an approved disinfectant
4.Infection control & patient safety
Answer: A · Explain that they must stay in the room, and offer ways to stay active inside it
Why this is the answer
Patients on airborne precautions stay in the negative-pressure room with the door closed, leaving only for essential tests while wearing a surgical mask. The nurse explains why and helps the patient cope with confinement.
Answer
A · Explain that they must stay in the room, and offer ways to stay active inside it
5.Prioritization & delegation
Answer: C · A patient after a knee replacement with no signs of infection
Why this is the answer
A neutropenic patient cannot fight infection well, so the roommate must not have a transmissible infection. A clean postoperative patient is the safest choice; ideally the neutropenic patient has a single room.
Answer
C · A patient after a knee replacement with no signs of infection
6.Prioritization & delegation
Answer: D · Stop the feed, sit the patient upright and assess breathing
Why this is the answer
Coughing, breathlessness and a falling saturation during tube feeding suggest aspiration or a displaced tube. The feed is stopped at once, the patient is sat upright, the airway and breathing are assessed, suction and oxygen are used as needed and the provider is informed. Tube position is checked before any feed restarts.
Answer
D · Stop the feed, sit the patient upright and assess breathing
7.Clinical nursing
Answer: D · Infiltration of fluid into the surrounding tissue
Why this is the answer
Infiltration causes cool, swollen, pale skin. Stop the infusion and remove the cannula. If the fluid is a vesicant, this is extravasation and needs specific management.
Answer
D · Infiltration of fluid into the surrounding tissue
8.Clinical nursing
Answer: C · Liver damage develops later, and the antidote works best when given early
Why this is the answer
Paracetamol overdose may cause few early symptoms, but liver failure can develop over days. Acetylcysteine is most effective when started early, guided by timed paracetamol levels.
Answer
C · Liver damage develops later, and the antidote works best when given early
9.Lab values & electrolytes
Answer: B · Gently inverting the tubes instead of shaking them
Why this is the answer
Hemolysis falsely raises potassium and affects other results. It is reduced by gentle inversion of tubes, avoiding very small needles, avoiding strong suction or forcing blood through a needle, and keeping tourniquet time short.
Answer
B · Gently inverting the tubes instead of shaking them
10.Lab values & electrolytes
Answer: A · Acute kidney injury, because it rose by at least 0.3 mg/dL within 48 hours
Why this is the answer
KDIGO defines AKI as a creatinine rise of at least 0.3 mg/dL (26.5 µmol/L) within 48 hours, a rise to 1.5 times baseline within 7 days, or urine output below 0.5 mL/kg/h for 6 hours. A result inside the reference range can still be a significant rise.
Answer
A · Acute kidney injury, because it rose by at least 0.3 mg/dL within 48 hours
11.Pharmacology
Answer: A · It forms a protective coating over the ulcer base
Why this is the answer
Sucralfate forms a gel-like barrier that sticks to the ulcer and protects it from acid and pepsin. It is taken on an empty stomach and can reduce the absorption of other drugs taken at the same time.
Answer
A · It forms a protective coating over the ulcer base
12.Pharmacology
Answer: B · Deferoxamine (desferrioxamine)
Why this is the answer
Iron poisoning can cause GI bleeding, shock, metabolic acidosis and liver failure. Deferoxamine chelates iron and is used in serious poisoning; activated charcoal does not bind iron.
Answer
B · Deferoxamine (desferrioxamine)
13.Med-surg: cardiovascular & respiratory
Answer: B · Compression duplex ultrasound
Why this is the answer
Compression ultrasound shows whether a deep vein is compressible and whether flow is normal; a vein containing clot does not compress. A low clinical probability with a negative D-dimer can rule out DVT without imaging.
Answer
B · Compression duplex ultrasound
14.Med-surg: cardiovascular & respiratory
Answer: A · Unstable angina
Why this is the answer
Unstable angina is new, worsening or rest angina without a troponin rise. It is an acute coronary syndrome and is managed urgently because it can progress to infarction. Stable angina is predictable and exertional. NSTEMI has a rising troponin.
Answer
A · Unstable angina
15.Med-surg: neuro, endocrine & renal
Answer: D · Mean arterial pressure minus intracranial pressure
Why this is the answer
CPP = MAP − ICP. A CPP of at least about 60 mmHg is usually targeted in adults with brain injury. If ICP rises or MAP falls, CPP falls and the brain becomes ischaemic.
Answer
D · Mean arterial pressure minus intracranial pressure
16.Med-surg: neuro, endocrine & renal
Answer: C · Gentamicin
Why this is the answer
Aminoglycosides such as gentamicin can impair neuromuscular transmission and trigger a myasthenic crisis. Fluoroquinolones, magnesium and some other drugs carry similar warnings. The nurse checks with the prescriber before giving it.
Answer
C · Gentamicin
17.Med-surg: GI, perioperative & oncology
Answer: D · Chlorhexidine skin preparation
Why this is the answer
Common causes of perioperative anaphylaxis include neuromuscular blockers, antibiotics, chlorhexidine and latex. Allergies are documented, and suspected reactions are investigated afterwards.
Answer
D · Chlorhexidine skin preparation
18.Med-surg: GI, perioperative & oncology
Answer: D · "I'll take my enzyme capsules at bedtime."
Why this is the answer
Pancreatic enzymes must be taken with meals and snacks to digest them. Alcohol must be avoided, steatorrhoea suggests under-replacement, and thirst or polyuria can signal diabetes from loss of islet cells.
Answer
D · "I'll take my enzyme capsules at bedtime."
19.Maternity & obstetric nursing
Answer: C · It can close the fetal ductus arteriosus too early
Why this is the answer
Indomethacin inhibits prostaglandin synthesis. In the fetus this can cause premature closure of the ductus arteriosus and reduced fetal urine output with oligohydramnios, risks that increase with gestational age.
Answer
C · It can close the fetal ductus arteriosus too early
20.Maternity & obstetric nursing
Answer: D · A full bladder prevents the uterus from contracting and increases bleeding
Why this is the answer
A distended bladder pushes the uterus up and aside, causing atony and more bleeding. Help her to void, or catheterise per order, then reassess the fundus and the bleeding.
Answer
D · A full bladder prevents the uterus from contracting and increases bleeding
21.Pediatric nursing
Answer: D · Putting a heat pad on the abdomen
Why this is the answer
Heat on the abdomen and laxatives or enemas are avoided in suspected appendicitis because they can increase the risk of perforation. Nil by mouth, IV fluids, analgesia and close monitoring are appropriate.
Answer
D · Putting a heat pad on the abdomen
22.Pediatric nursing
Answer: B · Arrange contact with friends and let him control parts of his daily routine
Why this is the answer
Adolescents are working on identity and independence, and peers are very important. Hospital stay threatens both, so contact with friends, privacy and choices about routines help him cope.
Answer
B · Arrange contact with friends and let him control parts of his daily routine
23.Mental health nursing
Answer: D · Use short, simple sentences and give one instruction at a time
Why this is the answer
Simple, one-step instructions, calm tone, eye contact and enough time to respond support understanding. Questions with yes/no or limited choices are easier to answer than open, complex ones.
Answer
D · Use short, simple sentences and give one instruction at a time
24.Mental health nursing
Answer: A · Accompanying a stable patient to the dining room and recording his food intake
Why this is the answer
Routine, predictable tasks with stable patients, such as escorting and recording intake, can be delegated. Assessment, care planning, teaching and evaluation require the nurse's judgement.
Answer
A · Accompanying a stable patient to the dining room and recording his food intake
25.Nursing math & unit conversions
Answer: 00:10
24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.
Convert the hour
12 AM → 00
Answer
00:10
Answer
00:10
26.Nursing math & unit conversions
Answer: t = 645 min
24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.
Before midnight
21:30 → 24:00 = 150 min
After midnight
00:00 → 08:15 = 495 min
Total
t = 150 + 495 = 645 min
Answer
t = 645 min
27.Dosage calculations
Answer: V = 3 mL
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 after mixing
2000 mg/8 mL = 250 mg/mL
Volume
V = 750/250 = 3 mL
Answer
V = 3 mL
28.Dosage calculations
Answer: R = 30 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
25000/500 = 50 units/mL
Pump rate
R = 1500/50 = 30 mL/h
Answer
R = 30 mL/h
29.IV infusion rates
Answer: R = 25 gtt/min
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Time in minutes
10·60 = 600 min
Drip rate
R = 1000·15/600 = 25 gtt/min
Answer
R = 25 gtt/min
30.IV infusion rates
Answer: t = 3.8 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
40·60/15 = 160 mL/h
Time left
t = 600/160 = 3.75 ≈ 3.8 h
Answer
t = 3.8 h
31.Pediatric & critical-care dosing
Answer: R = 20.4 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
15·68 = 1 020 units/h
Concentration
12 500/250 = 50 units/mL
Pump rate
R = 1020/50 = 20.4 mL/h
Answer
R = 20.4 mL/h
32.Pediatric & critical-care dosing
Answer: R = 28.1 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
500 mg = 500 000 mcg
500 000/250 = 2000 mcg/mL
Dose per minute and per hour
12.5·75 = 937.5 mcg/min
937.5·60 = 56250 mcg/h
Pump rate
R = 56250/2000 = 28.13 ≈ 28.1 mL/h
Answer
R = 28.1 mL/h
33.IV fluids & fluid balance
Answer: B = 305 mL
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Total intake
oral: 350 + 100 = 450 mL
ice chips: 200/2 = 100 mL
IV infusion: 100·8 = 800 mL
IV antibiotic: 1·50 = 50 mL
total intake = 1400 mL
Total output
175 + 200 + 450 + 200 + 70 = 1095 mL
Balance
B = 1400 − 1095 = 305 mL
Answer
B = 305 mL
Positive: more fluid went in than came out.
34.IV fluids & fluid balance
Answer: V = 800 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
08:30 → 10:30 = 2 h
Volume infused
100·2 = 200 mL
Volume left
V = 1000 − 200 = 800 mL
Answer
V = 800 mL
35.Clinical assessment scores
Answer: NEWS2 = 3
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 18/min → 0
SpO₂ 97% → 0
on oxygen → 2
SBP 124 mmHg → 0
HR 104/min → 1
alert (A) → 0
T 37.4 °C → 0
Add
NEWS2 = 0 + 0 + 2 + 0 + 1 + 0 + 0 = 3
Answer
NEWS2 = 3
36.Clinical assessment scores
Answer: low
APGAR score: five signs, each scored 0, 1 or 2, checked at 1 and 5 minutes after birth. Appearance (colour): blue or pale 0, pink body with blue extremities 1, pink all over 2. Pulse: absent 0, below 100/min 1, 100/min or more 2. Grimace (reflex irritability): none 0, grimace 1, cry, cough or sneeze 2. Activity (tone): limp 0, some flexion 1, active movement 2. Respiration: absent 0, slow or irregular with a weak cry 1, good with a strong cry 2. A total of 7–10 is reassuring, 4–6 moderately abnormal and 0–3 low.
Score each sign
Appearance: blue or pale skin all over → 0
Pulse: 0 → 0
Grimace: no response to stimulation → 0
Activity: limp limbs with no muscle tone → 0
Respiration: no breathing → 0
Add
APGAR = 0 + 0 + 0 + 0 + 0 = 0
Interpretation
0 → low
Answer
low
37.Arterial blood gas interpretation
Answer: Osm = 300 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 = 2·133 + 25.2 + 8.9 = 300.1 ≈ 300 mOsm/kg
Answer
Osm = 300 mOsm/kg
38.Arterial blood gas interpretation
Answer: AGc = 22 mmol/L
Expected compensation: in metabolic acidosis Winter’s formula predicts PaCO₂ = 1.5·HCO₃⁻ + 8 ± 2 mmHg; a measured value above that range points to an additional respiratory acidosis, below it to an additional respiratory alkalosis. The anion gap AG = Na⁺ − (Cl⁻ + HCO₃⁻), normally about 8–12 mmol/L, separates high-gap from normal-gap metabolic acidosis; low albumin hides a high gap (add 2.5 per g/dL that albumin is below 4.0). The delta ratio (AG − 12)/(24 − HCO₃⁻) between about 0.8 and 2 fits a pure high-gap acidosis (some texts use 1 instead of 0.8), below that an added normal-gap acidosis, and above 2 an added metabolic alkalosis.
Anion gap
AG = 136 − (110 + 10) = 16
Correction for albumin
16 + 0.25·(40 − 16) = 22 mmol/L
Answer
AGc = 22 mmol/L
Above about 12 after correction: a high anion gap.
39.ECG rhythm strip interpretation
Answer: flutter waves per QRS = 4
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.
Flutter waves
F–F = 5 small boxes = 0.20 s → 1500 ÷ 5 = 300 per minute
QRS complexes
R–R = 20 small boxes = 0.80 s → 1500 ÷ 20 = 75 per minute
conduction ratio = 300 ÷ 75 = 4:1
Answer
flutter waves per QRS = 4
40.ECG rhythm strip interpretation
Answer: 2:1 AV block (type undetermined)
2:1 AV block: with two P waves for every QRS, no two conducted P waves follow each other, so you cannot see whether the PR would lengthen (type I) or stay constant (type II) before a non-conducted P wave. From one strip it is called a 2:1 AV block; a longer strip or a change in the conduction ratio decides the type. A narrow QRS makes type I more likely and a wide QRS type II, but neither proves it.
Five steps
1. Rate: R–R = 42 small boxes, 1500 ÷ 42 ≈ 36 per minute.
2. Rhythm: regular, every R–R is 1.68 s.
3. P waves: upright and regular (P–P 0.84 s, 71 per minute), two for every QRS.
4. PR interval: constant at 0.16 s in the conducted beats.
5. QRS: 0.14 s, wide (0.12 s or more).
Why the type stays open
Every second P wave is not conducted, so no two conducted beats follow each other and a lengthening PR could never show.
2:1 AV block (type undetermined)
Answer
2:1 AV block (type undetermined)
A narrow QRS makes type I more likely and a wide QRS type II, but only a longer strip or a change in the conduction ratio decides.
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