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
What is a portable bladder scanner used for?
ADetecting kidney stones
BTaking a sterile sample of urine for culture without a catheter
CMeasuring how much urine is in the bladder without a catheter
DChecking the urine for blood and protein
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
A woman who is pregnant asks for the MMR vaccine because she is not immune to rubella. What is correct?
AMMR is a live vaccine and is not given during pregnancy, but can be given after delivery
BMMR should be given as soon as possible in the first trimester to protect the baby
CMMR is safe at any stage of pregnancy
DMMR is only given to pregnant women who work in hospitals
4.Infection control & patient safetyHard
A night nurse suggests restraining a calm but wandering patient “so we can manage with fewer staff tonight”. Which response is correct?
ARestraints are acceptable if removed in the morning
BRestraint is never for staff convenience; use rounding or a sitter
CRestraints are acceptable if the family agrees to them in writing first
DRestraints are acceptable at night when staffing is low
5.Prioritization & delegationMedium
A nurse teaches a patient who uses home oxygen. Which statement shows a need for further teaching?
A“I will put up no-smoking signs at the front door and in my room.”
B“My husband can smoke in my room if the window is open.”
C“I will keep the oxygen away from the gas stove.”
D“I will not use oil-based creams on my face.”
6.Prioritization & delegationHard
A day after a femur fracture, a young patient becomes confused and breathless, with small red spots on the chest. What should the nurse suspect?
AAlcohol withdrawal
BAn allergic reaction to the cast
CFat embolism syndrome
DNormal pain after a fracture
7.Clinical nursingMedium
How is Helicobacter pylori infection usually treated?
AAntacids alone, taken after every meal for a month
BSurgery to remove the stomach
CA combination of antibiotics with a proton pump inhibitor
DA single dose of paracetamol and a bland diet for a week
8.Clinical nursingHard
An older patient has fallen several times since starting a new medicine. Which drug group is most likely to contribute?
AEmollient creams applied to the legs
BBenzodiazepine sleeping tablets
CVitamin D supplements
DLubricating eye drops
9.Lab values & electrolytesMedium
A woman with hyperemesis gravidarum has vomited for 3 days. Which urine finding would the nurse expect?
ARed cell casts
BNitrites
CKetones
DBilirubin
10.Lab values & electrolytesHard
A patient has sudden episodes of severe headache, sweating, palpitations and very high blood pressure. Which test is most useful to look for the cause?
AFasting lipid profile
BPlasma free metanephrines
CSerum TSH and free T4
DSerum calcium only
11.PharmacologyMedium
How do ACE inhibitors lower blood pressure?
AThey block beta-1 receptors in the heart
BThey block L-type calcium channels in vascular smooth muscle cells
CThey block the conversion of angiotensin I to angiotensin II
DThey increase sodium reabsorption in the kidney
12.PharmacologyHard
Some receptors show activity even without an agonist. How does an inverse agonist differ from a neutral antagonist at such receptors?
AIt has no effect when given alone
BIt destroys the receptor permanently
CIt increases activity above the baseline
DIt reduces activity below the baseline level
13.Med-surg: cardiovascular & respiratoryMedium
How do clopidogrel and ticagrelor work?
AThey directly inhibit thrombin in the plasma
BThey inhibit the vitamin K-dependent clotting factors in the liver
CThey block the platelet ADP (P2Y12) receptor
DThey dissolve fibrin in existing clots
14.Med-surg: cardiovascular & respiratoryHard
Shortly after a thoracentesis, a patient becomes breathless with sharp chest pain and reduced breath sounds on the same side. What complication is most likely?
ARe-accumulation of the effusion
BPulmonary embolism from the leg
CInfection at the puncture site
DPneumothorax
15.Med-surg: neuro, endocrine & renalMedium
Which nursing care is most important for a patient with diabetes insipidus?
AWeighing the patient once a month
BA strict fluid restriction to reduce the amount of urine passed
CGiving a loop diuretic to clear extra fluid
DStrict fluid balance, daily weight and free access to water
16.Med-surg: neuro, endocrine & renalHard
During haemodialysis, a patient's BP falls to 80/50 mmHg and they feel dizzy and sick. What is the most appropriate first nursing action?
ALie the patient flat, reduce fluid removal and get help
BIncrease the fluid removal rate so the session ends sooner
CGive the patient's usual antihypertensive dose straight away
DSit the patient upright and encourage a short walk
17.Med-surg: GI, perioperative & oncologyMedium
Which change suggests that a burn wound is becoming infected?
ADry, healing skin with mild itching
BLess exudate on each dressing change
CA partial-thickness burn becoming deeper, with new discolouration
DThe wound becoming pink and a little smaller at each dressing change
18.Med-surg: GI, perioperative & oncologyHard
A patient arrives in the anaesthetic room without an identity band. What should the nurse do?
AProceed because the patient can say their name
BProceed and add a band once in recovery
CUse the spare identity band from the front of the patient's notes folder
DStop and confirm identity, then apply a band
19.Maternity & obstetric nursingMedium
Why is a baby of a mother with poorly controlled diabetes often large?
ADiabetes always prolongs the pregnancy
BThe mother's insulin crosses the placenta
CFetal hyperinsulinaemia acts as a growth hormone
DThe baby inherits a gene for large size
20.Maternity & obstetric nursingHard
A woman with gestational diabetes was on insulin during pregnancy. What change in her insulin needs is expected right after birth?
AThey fall quickly, so glucose is monitored and insulin is often stopped
BThey stay the same for 6 weeks
CThey double because of the stress of birth, so the insulin dose is increased
DShe will need lifelong insulin
21.Pediatric nursingMedium
A child with a myelomeningocele has a neurogenic bladder. Which management is usual?
ARestricting fluids to reduce urine volume
BClean intermittent catheterisation
CWaiting for bladder control to develop naturally
DA permanent catheter left in place for life
22.Pediatric nursingHard
Which finding in a 9-month-old requires the most prompt developmental follow-up?
AThe baby cannot yet walk
BThe baby uses only one hand and ignores the other
CThe baby is shy with strangers
DThe baby cannot yet say clear words
23.Mental health nursingMedium
A patient who has just been admitted says, "I don't want to talk to anyone." What is the best initial nursing approach?
AAsk a series of direct questions until he answers
BTell the patient that talking is required to be discharged
CSpend short, regular periods with the patient without forcing conversation
DLeave the patient alone until he asks to talk
24.Mental health nursingHard
On the second day after his last drink, a patient has a marked tremor, sees insects on the walls, a heart rate of 124/min, a blood pressure of 170/100 mmHg and heavy sweating. What is the priority?
AGive him a small amount of alcohol to settle the symptoms, then let him sleep it off in a quiet side room with the door closed
BTreat it as possible delirium tremens: get urgent medical help, give benzodiazepines as prescribed and keep him safe
CRestrict his fluid intake
DExplain that the insects are not real and leave him to rest
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose calculation for an injection gives 14.6055 mL. The rule in this exercise is that volumes of 1 mL or more are rounded to the nearest tenth of a mL. What value x do you record?
14.6055 mL
x = mL
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). An infusion starts at 19:45 and finishes at 04:25 the next morning (24-hour clock). How many minutes t did it run?
19:4504:25
t = min
27.Dosage calculationsMedium
A vial contains 500 mg of powder. The label says: add 9.6 mL of water for injection to give a total volume of 10 mL. The prescription is 100 mg. What volume V of the reconstituted solution do you give?
500 mg+ 9.6 mL → 10 mL100 mg
V = mL
28.Dosage calculationsHard
The prescription is 2.2 mg. The ampoule contains 4000 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
2.2 mg4000 mcg/mL
V = mL
29.IV infusion ratesMedium
Infuse 1500 mL over 4 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
1500 mL4 h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
A drip runs at 42 gtt/min through a set of 15 gtt/mL. There are 200 mL left in the bag. How many hours t until it is empty? Round to one decimal place.
42 gtt/min15 gtt/mL200 mL
t = h
31.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). A practice protocol calls for a heparin bolus of 60 units/kg for a patient who weighs 93 kg. The vial contains 5 000 units/mL. What volume V do you draw up? Round to one decimal place.
60 units/kg93 kg5 000 units/mL
V = mL
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 56 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/min56 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 patient weighs 106 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 120 mL/h. At 06:30, 50 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL50 mL infused120 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: extension of the arms and legs (abnormal extension). 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 48 kg and is 175 cm tall. Calculate the BMI and click the WHO weight category.
48 kg175 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 7.60, PaCO₂ 38 mmHg (5.1 kPa) and HCO₃⁻ 36 mmol/L. The primary disorder is metabolic alkalosis. How far is it compensated? Click your answer.
pH 7.60PaCO₂ 38 mmHg (5.1 kPa)HCO₃⁻ 36 mmol/L
1uncompensated
2partially compensated
3fully compensated
38.Arterial blood gas interpretationHard
A practice gas shows a metabolic alkalosis with HCO₃⁻ 36 mmol/L. Use expected PaCO₂ = 0.7·HCO₃⁻ + 21 to find the expected PaCO₂.
HCO₃⁻ 36 mmol/L
PaCO₂ = mmHg
39.ECG rhythm strip interpretationMedium
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 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 · Measuring how much urine is in the bladder without a catheter
Why this is the answer
A bladder scanner uses ultrasound to estimate bladder volume, for example after a patient has voided. It helps detect retention and avoids unnecessary catheterisation.
Answer
C · Measuring how much urine is in the bladder without a catheter
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 · MMR is a live vaccine and is not given during pregnancy, but can be given after delivery
Why this is the answer
Live vaccines such as MMR and varicella are not given during pregnancy. A non-immune woman is vaccinated after delivery, and pregnancy is avoided for a period after vaccination.
Answer
A · MMR is a live vaccine and is not given during pregnancy, but can be given after delivery
4.Infection control & patient safety
Answer: B · Restraint is never for staff convenience; use rounding or a sitter
Why this is the answer
Restraint is allowed only to protect the patient or others from immediate harm when less restrictive measures have failed, never for convenience or discipline. Rounding, a bed alarm, a sitter and a calm environment are alternatives.
Answer
B · Restraint is never for staff convenience; use rounding or a sitter
5.Prioritization & delegation
Answer: B · “My husband can smoke in my room if the window is open.”
Why this is the answer
Oxygen supports combustion, so no one may smoke near it, even with a window open. Keeping it away from flames and avoiding oil-based products are correct.
Answer
B · “My husband can smoke in my room if the window is open.”
6.Prioritization & delegation
Answer: C · Fat embolism syndrome
Why this is the answer
Fat embolism syndrome usually appears 24–72 hours after a long bone fracture, with breathing problems, confusion and a petechial rash. It needs oxygen and urgent escalation.
Answer
C · Fat embolism syndrome
7.Clinical nursing
Answer: C · A combination of antibiotics with a proton pump inhibitor
Why this is the answer
Eradication therapy combines a PPI with two antibiotics for a set course. Completing the course is important for success.
Answer
C · A combination of antibiotics with a proton pump inhibitor
8.Clinical nursing
Answer: B · Benzodiazepine sleeping tablets
Why this is the answer
Sedatives, hypnotics, antipsychotics and drugs that lower blood pressure increase falls risk. A medication review is part of every falls assessment.
Answer
B · Benzodiazepine sleeping tablets
9.Lab values & electrolytes
Answer: C · Ketones
Why this is the answer
Prolonged vomiting and poor intake lead to fat breakdown and ketonuria, along with dehydration and electrolyte loss such as hypokalemia. Urine ketones help assess severity and response to IV fluids and antiemetics.Checked against:Ketones urine test · MedlinePlus (NIH) (2025)
Answer
C · Ketones
10.Lab values & electrolytes
Answer: B · Plasma free metanephrines
Why this is the answer
These episodes suggest pheochromocytoma, a tumor of the adrenal medulla that releases catecholamines. Plasma free metanephrines (or 24-hour urine metanephrines) are the main screening tests. Hyperthyroidism can cause similar symptoms but usually without these bursts of severe hypertension.Checked against:Pheochromocytoma · MedlinePlus (NIH) (2024)
Answer
B · Plasma free metanephrines
11.Pharmacology
Answer: C · They block the conversion of angiotensin I to angiotensin II
Why this is the answer
ACE inhibitors (such as ramipril) reduce angiotensin II, causing vasodilation and less aldosterone. They also reduce bradykinin breakdown, which explains the dry cough.
Answer
C · They block the conversion of angiotensin I to angiotensin II
12.Pharmacology
Answer: D · It reduces activity below the baseline level
Why this is the answer
A neutral antagonist simply blocks agonists and leaves baseline activity unchanged. An inverse agonist stabilises the inactive receptor state, so constitutive activity falls below baseline.
Answer
D · It reduces activity below the baseline level
13.Med-surg: cardiovascular & respiratory
Answer: C · They block the platelet ADP (P2Y12) receptor
Why this is the answer
Clopidogrel, prasugrel and ticagrelor block the P2Y12 ADP receptor on platelets, reducing aggregation. With aspirin, they form dual antiplatelet therapy after acute coronary syndromes and stents. Warfarin inhibits vitamin K-dependent factors; dabigatran inhibits thrombin.
Answer
C · They block the platelet ADP (P2Y12) receptor
14.Med-surg: cardiovascular & respiratory
Answer: D · Pneumothorax
Why this is the answer
Pneumothorax is a common complication of thoracentesis, caused by the needle puncturing the lung or air entering the chest. The nurse assesses the patient, gives oxygen and informs the team, who will arrange a chest X-ray. An effusion re-accumulates over days, and infection appears later.
Answer
D · Pneumothorax
15.Med-surg: neuro, endocrine & renal
Answer: D · Strict fluid balance, daily weight and free access to water
Why this is the answer
Patients with DI can become dehydrated and hypernatraemic quickly. Strict input and output, daily weights, sodium monitoring and access to water are essential. Desmopressin replaces the missing ADH in cranial DI.
Answer
D · Strict fluid balance, daily weight and free access to water
16.Med-surg: neuro, endocrine & renal
Answer: A · Lie the patient flat, reduce fluid removal and get help
Why this is the answer
Intradialytic hypotension is common. Positioning, reducing or pausing ultrafiltration and giving a small saline bolus as per protocol usually restore the blood pressure. Antihypertensives are often held before dialysis in patients prone to hypotension, as prescribed.
Answer
A · Lie the patient flat, reduce fluid removal and get help
17.Med-surg: GI, perioperative & oncology
Answer: C · A partial-thickness burn becoming deeper, with new discolouration
Why this is the answer
Signs of burn wound infection include conversion to a deeper burn, new dark or green discolouration, increasing pain, offensive exudate, spreading redness and systemic signs such as fever or tachycardia.
Answer
C · A partial-thickness burn becoming deeper, with new discolouration
18.Med-surg: GI, perioperative & oncology
Answer: D · Stop and confirm identity, then apply a band
Why this is the answer
Correct identification before anaesthesia prevents wrong-patient surgery. The process stops until identity is confirmed with the patient and records and a band is applied, following the checklist.
Answer
D · Stop and confirm identity, then apply a band
19.Maternity & obstetric nursing
Answer: C · Fetal hyperinsulinaemia acts as a growth hormone
Why this is the answer
Maternal glucose crosses the placenta, so the fetal pancreas makes extra insulin, which promotes growth and fat storage. After birth this extra insulin continues and can cause neonatal hypoglycaemia.
Answer
C · Fetal hyperinsulinaemia acts as a growth hormone
20.Maternity & obstetric nursing
Answer: A · They fall quickly, so glucose is monitored and insulin is often stopped
Why this is the answer
The placenta produced the hormones that caused insulin resistance. After birth, glucose usually returns to normal, so insulin is often stopped and glucose is checked. She needs a glucose test some weeks after birth and long-term screening for type 2 diabetes.
Answer
A · They fall quickly, so glucose is monitored and insulin is often stopped
21.Pediatric nursing
Answer: B · Clean intermittent catheterisation
Why this is the answer
Damage to the spinal nerves causes a bladder that does not empty fully, risking infection and kidney damage. Clean intermittent catheterisation several times a day, taught to parents and later to the child, is the usual approach.
Answer
B · Clean intermittent catheterisation
22.Pediatric nursing
Answer: B · The baby uses only one hand and ignores the other
Why this is the answer
A clear hand preference before about 18 months can indicate weakness on the other side, for example in cerebral palsy. Not walking, stranger wariness and no clear words are typical at 9 months.
Answer
B · The baby uses only one hand and ignores the other
23.Mental health nursing
Answer: C · Spend short, regular periods with the patient without forcing conversation
Why this is the answer
Short, frequent, predictable contacts show acceptance and help build trust. Forcing conversation increases anxiety, while leaving the patient alone can reinforce withdrawal.
Answer
C · Spend short, regular periods with the patient without forcing conversation
24.Mental health nursing
Answer: B · Treat it as possible delirium tremens: get urgent medical help, give benzodiazepines as prescribed and keep him safe
Why this is the answer
Hallucinations, autonomic instability and tremor 48–96 hours after the last drink suggest delirium tremens, a medical emergency. Treatment includes benzodiazepines, fluids, thiamine, close monitoring and a safe, calm environment.
Answer
B · Treat it as possible delirium tremens: get urgent medical help, give benzodiazepines as prescribed and keep him safe
25.Nursing math & unit conversions
Answer: x = 14.6 mL
Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.
Digit in the tenths place
14.6055 → 6
Only the next digit decides
14.6055 → 0
0 is 4 or less, so 6 stays.
The digits after it (55) are ignored: round once, never step by step.
Round
x = 14.6 mL
Answer
x = 14.6 mL
26.Nursing math & unit conversions
Answer: t = 520 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
19:45 → 24:00 = 255 min
After midnight
00:00 → 04:25 = 265 min
Total
t = 255 + 265 = 520 min
Answer
t = 520 min
27.Dosage calculations
Answer: V = 2 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
500 mg/10 mL = 50 mg/mL
Volume
V = 100/50 = 2 mL
Answer
V = 2 mL
28.Dosage calculations
Answer: V = 0.55 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
2.2 mg = 2200 mcg
Volume
V = 2200/4000 = 0.55 mL
Answer
V = 0.55 mL
29.IV infusion rates
Answer: R = 63 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
4·60 = 240 min
Drip rate
R = 1500·10/240 = 62.5 ≈ 63 gtt/min
Answer
R = 63 gtt/min
At the bedside you round to the nearest whole drop: 63 gtt/min.
30.IV infusion rates
Answer: t = 1.2 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
42·60/15 = 168 mL/h
Time left
t = 200/168 = 1.19 ≈ 1.2 h
Answer
t = 1.2 h
31.Pediatric & critical-care dosing
Answer: V = 1.1 mL
Heparin and insulin infusions: concentration = units in the bag/bag volume (units/mL). Pump rate (mL/h) = units per hour/concentration, and units per hour = mL/h × concentration. For a weight-based order, units/h = units/kg/h × weight first. A bolus volume = units needed/vial strength. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Units needed
60·93 = 5 580 units
Volume
V = 5580/5000 = 1.116 ≈ 1.1 mL
Answer
V = 1.1 mL
32.Pediatric & critical-care dosing
Answer: R = 21 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
12.5·56 = 700 mcg/min
700·60 = 42000 mcg/h
Pump rate
R = 42000/2000 = 21 mL/h
Answer
R = 21 mL/h
33.IV fluids & fluid balance
Answer: U = 1.18 mL/kg/h
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Total urine
175 + 425 + 225 + 175 = 1000 mL
Per kilogram per hour
U = 1000/(106·8) = 1.179 ≈ 1.18 mL/kg/h
Answer
U = 1.18 mL/kg/h
34.IV fluids & fluid balance
Answer: t = 3.8 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 − 50 = 450 mL
Time
t = 450/120 = 3.75 ≈ 3.8 h
Answer
t = 3.8 h
That is about 3 h 45 min, so the bag runs out at about 10:15.
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: extension of the arms and legs (abnormal extension) → 2
Add
GCS = 1 + 2 + 2 = 5
Severity
GCS 5 → severe
Answer
severe
36.Clinical assessment scores
Answer: underweight
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 = 48/1.75² = 15.67
Category
underweight
Answer
underweight
37.Arterial blood gas interpretation
Answer: uncompensated
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 7.60: alkalaemia (above 7.45)
PaCO₂ 38 mmHg: normal (35–45)
HCO₃⁻ 36 mmol/L: high (22–26)
Compensation
Clinically, also check the expected compensation: for a metabolic alkalosis PaCO₂ ≈ 0.7·HCO₃⁻ + 21 = 44.2–48.2 mmHg, so the measured 38 mmHg points to an additional respiratory alkalosis (a mixed disorder). The answer above is the ROME exam classification.
uncompensated
Answer
uncompensated
38.Arterial blood gas interpretation
Answer: PaCO₂ = 46.2 mmHg
Expected compensation: in metabolic acidosis Winter’s formula predicts PaCO₂ = 1.5·HCO₃⁻ + 8 ± 2 mmHg; a measured value above that range points to an additional respiratory acidosis, below it to an additional respiratory alkalosis. The anion gap AG = Na⁺ − (Cl⁻ + HCO₃⁻), normally about 8–12 mmol/L, separates high-gap from normal-gap metabolic acidosis; low albumin hides a high gap (add 2.5 per g/dL that albumin is below 4.0). The delta ratio (AG − 12)/(24 − HCO₃⁻) between about 0.8 and 2 fits a pure high-gap acidosis (some texts use 1 instead of 0.8), below that an added normal-gap acidosis, and above 2 an added metabolic alkalosis.
Expected PaCO₂
0.7·36 + 21 = 46.2 mmHg
Answer
PaCO₂ = 46.2 mmHg
The rise has a limit: PaCO₂ rarely goes above about 55 mmHg from compensation alone.
39.ECG rhythm strip interpretation
Answer: QT = 0.46 s
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
11.5 small boxes from the start of the QRS to the end of the T wave
Convert
QT = 11.5 × 0.04 s = 0.46 s
Answer
QT = 0.46 s
A rough rule: at normal rates the QT should be less than half the R–R interval (here R–R = 0.88 s).
40.ECG rhythm strip interpretation
Answer: ventricular rate = 36 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 = 21 small boxes = 0.84 s → 1500 ÷ 21 = 71.43 ≈ 71 per minute
Ventricular rate
R–R = 42 small boxes = 1.68 s → 1500 ÷ 42 = 35.71 ≈ 36 per minute
Answer
ventricular rate = 36 bpm
Answer
ventricular rate = 36 bpm
2:1 AV block: every second P wave is not conducted, so the atrial rate is twice the ventricular rate.
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