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 the correct order of techniques when assessing the abdomen?
AInspection, auscultation, percussion, palpation
BPalpation, inspection, auscultation, percussion
CAuscultation, palpation, inspection, percussion
DInspection, palpation, percussion, auscultation
2.Nursing fundamentalsHard
An older woman has been lying on the floor at home all night after a fall. Which complications should the nurse look for in particular?
AHair loss and nail damage
BHigh blood sugar and a raised temperature from lying still
CSunburn and dehydration from sweating
DPressure damage, hypothermia and muscle breakdown
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 is safe at any stage of pregnancy
CMMR should be given as soon as possible in the first trimester to protect the baby
DMMR is only given to pregnant women who work in hospitals
4.Infection control & patient safetyHard
An 82-year-old patient is prescribed diphenhydramine at bedtime for sleep. Why should the nurse raise this with the prescriber?
AIt is strongly anticholinergic and can cause confusion and falls in older adults
BIt is only available as an IV drug and cannot be given by mouth at bedtime
CIt is too weak to help an older person sleep
DIt raises blood pressure in most older adults
5.Prioritization & delegationMedium
A drowsy patient has an arterial blood gas with pH 7.30, PaCO₂ 58 mmHg (7.7 kPa) and HCO₃⁻ 25 mEq/L (mmol/L). Which problem is the priority?
APoor ventilation causing carbon dioxide to build up
BToo much bicarbonate from antacids
CHyperventilation caused by anxiety
DLoss of bicarbonate from the bowel through severe diarrhea
6.Prioritization & delegationHard
A patient with a head injury has a pupil on one side that is now large and does not react to light. What should the nurse do?
ADocument it, because pupils often differ slightly after a head injury
BReport it at once, as it may mean the brain is being compressed
CRecheck it at the next routine observation in four hours
DDim the room lights so the pupil can get smaller
7.Clinical nursingMedium
Which of these is a non-drug measure that can help relieve pain?
AKeeping the patient awake all night
BRestricting visitors completely
CRepositioning and distraction
DTelling the patient that the pain is not real
8.Clinical nursingHard
A patient with a small leg wound has severe pain out of proportion to the skin changes, rapidly spreading redness and signs of sepsis. What should be suspected?
ASimple cellulitis that will settle with oral antibiotics
BNecrotising fasciitis
CAn allergic reaction to the dressing
DA superficial bruise
9.Lab values & electrolytesMedium
During a red cell transfusion, when are serious acute reactions most likely, so the nurse stays with the patient?
AIn the first 15 minutes
BThe next morning
CAfter about 2 hours
DAfter the last drop is given
10.Lab values & electrolytesHard
A patient with a calcium of 6.8 mg/dL (1.7 mmol/L) suddenly develops noisy breathing and a hoarse voice. What does this suggest?
AA common cold that started this morning
BA normal response that will pass without treatment
CLaryngospasm, an emergency needing urgent help and IV calcium
DAnxiety about the blood results, which needs calm reassurance
11.PharmacologyMedium
Why are benzodiazepines used with great caution in older people?
AThey cause severe high blood pressure in older people
BThey are not absorbed from the gut after age 65
CThey cause permanent hearing loss in older people
DThey raise the risk of confusion, falls and fractures
12.PharmacologyHard
Which heart failure drug improves symptoms and reduces hospital admissions but has not been shown to reduce mortality?
AA mineralocorticoid receptor antagonist such as spironolactone
BDigoxin
CA beta blocker such as bisoprolol
DAn ACE inhibitor
13.Med-surg: cardiovascular & respiratoryMedium
How does ezetimibe lower cholesterol?
AIt reduces absorption of cholesterol from the gut
BIt blocks cholesterol production by enzymes in the liver
CIt increases cholesterol loss in the urine
DIt dissolves plaques already in the arteries
14.Med-surg: cardiovascular & respiratoryHard
A nurse receives handover on four patients. Which patient should be seen first?
AA patient on day 1 after surgery who is newly restless, RR 30/min, SpO₂ 88% on 4 L/min
BA patient with asthma who wants a reliever inhaler before a walk
CA patient with pneumonia on IV antibiotics who now has a temperature of 38.2 °C
DA patient with COPD on 1 L/min whose SpO₂ has been 89% and stable throughout the night
15.Med-surg: neuro, endocrine & renalMedium
A patient on peritoneal dialysis has gained weight and has higher glucose levels. Which part of the treatment is the likely cause?
AAir entering the abdomen during exchanges
BGlucose absorbed from the dialysis fluid
CProtein lost into the dialysis fluid
DSodium lost into the dialysis fluid
16.Med-surg: neuro, endocrine & renalHard
A nurse teaches a patient with CKD and a high potassium about diet. Which statement shows a need for further teaching?
A"I will keep bananas and dried fruit to a minimum."
B"I will boil my potatoes and throw away the water."
C"I will check food labels for added salt when I go shopping."
D"I will use a salt substitute instead of ordinary salt."
17.Med-surg: GI, perioperative & oncologyMedium
A patient with a new colostomy asks what to eat at home. Which advice is most appropriate?
AEat only liquids until the stoma is removed
BDrink as little fluid as possible to reduce output
CEat a normal, balanced diet and introduce foods gradually
DAvoid all fruit and vegetables for the rest of their life
18.Med-surg: GI, perioperative & oncologyHard
The skin around a patient's ileostomy is red, raw and weeping, and the pouch leaks often. What is the most likely cause?
AAn allergy to the stool itself, which needs steroids
BOutput on the skin, often from a poorly fitting appliance
CA normal reaction that needs no change in care
DIschaemia of the stoma, which needs urgent surgery
19.Maternity & obstetric nursingMedium
When the Moro reflex is tested, the baby moves only one arm. What could this suggest?
AHearing loss in the ear on that side
BA clavicle fracture or nerve injury
CA normal finding in all term babies
DLow blood glucose only
20.Maternity & obstetric nursingHard
A breastfeeding mother asks whether she can have a progestin-only implant before discharge. Which reply is best?
AImplants contain oestrogen, which is safe in breastfeeding
BShe should wait until she stops breastfeeding before using any method
CProgestin-only methods are compatible with breastfeeding
DAny hormonal contraception will stop her milk supply
21.Pediatric nursingMedium
A newborn with suspected oesophageal atresia is drooling frothy saliva. What is the immediate nursing care?
AKeep the baby nil by mouth, raise the head and suction the upper pouch as needed
BLay the baby flat and give the next feed slowly through a teat
CGive a full feed by bottle and observe for vomiting afterwards
DOffer small sips of sterile water to check whether the baby can swallow
22.Pediatric nursingHard
A child with sickle cell disease has new chest pain, cough, fever and an oxygen saturation of 90%. What should the nurse suspect?
AAnxiety about being in hospital
BNormal pain from a limb crisis
CA mild cold
DAcute chest syndrome, an emergency
23.Mental health nursingMedium
A patient taking phenelzine, an MAOI, is being taught before discharge. Which statement shows a need for further teaching?
A"I'll tell any new doctor or dentist that I take an MAOI."
B"I'll avoid aged cheese and cured meats."
C"A sudden severe headache is a reason to get help straight away."
D"I can take any cold and flu remedy from the pharmacy."
24.Mental health nursingHard
For which patient is electroconvulsive therapy (ECT) most likely to be considered?
AA patient with a personality disorder who self-harms when stressed
BA patient with a first episode of mild depression who has not yet tried any other treatment
CA patient with severe psychotic depression who has stopped eating and drinking
DA patient with mild anxiety before exams
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A dose is charted at 1:50 AM. Which entry is the same time on the 24-hour clock? Click it.
1:50 AM
102:50
213:50
301:50
400:50
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). A prescription reads 1 tbsp of an oral suspension three times a day for 7 days. The suspension comes in 100 mL bottles. Using 1 tbsp = 15 mL, how many whole bottles N must be supplied so the course is complete?
1 tbspthree times a day7 days100 mL1 tbsp = 15 mL
N =
27.Dosage calculationsMedium
A patient weighs 15 kg. The prescribed dose is 5 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?
15 kg5 mg/kg/day4× per day
D = mg
28.Dosage calculationsHard
The prescription is 2600 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
2600 units5000 units/mL
V = mL
29.IV infusion ratesMedium
Infuse 500 mL over 5 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
500 mL5 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 750 mL left in the bag. How many hours t until it is empty? Round to one decimal place.
42 gtt/min15 gtt/mL750 mL
t = h
31.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). A bag contains 20 000 units of heparin in 500 mL. The order is 16 units/kg/h for a patient who weighs 78 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
20 000 units/500 mL16 units/kg/h78 kg
R = mL/h
32.Pediatric & critical-care dosingHard
Practice exercise (made-up values, not clinical guidance). A patient who weighs 63 kg has an order for nitroglycerin at 5 mcg/min. The bag contains 25 mg in 250 mL. Find the pump rate R in mL/h. Round to one decimal place.
25 mg/250 mL5 mcg/min63 kg
R = mL/h
33.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL. Count ice chips as half their volume.
soup: 150 mLtea: 150 mLice chips: 120 mLIV infusion: 80 mL/h × 12 hIV antibiotic: 1 × 50 mL
I = mL
34.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 07:00 at 100 mL/h. After 3 hours the rate is changed to 60 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
500 mL100 mL/h · 3 h60 mL/h
t = h
35.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 9, with E2 and V4. What motor score M was recorded, and which response does it describe? Give the number.
GCS 9E2V4
M =
36.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: no; secondary diagnosis: yes; ambulatory aid: crutches, cane or walker; IV therapy or saline lock: no; gait: normal, bed rest or wheelchair; mental status: overestimates or forgets limits. Using the cut-offs 0–24 low, 25–44 moderate and 45 or more high, click the fall-risk level.
1low risk
2moderate risk
3high risk
37.Arterial blood gas interpretationMedium
A practice gas shows PaCO₂ 30 mmHg (4.0 kPa). Use the rule that in chronic respiratory alkalosis HCO₃⁻ falls by 5 mmol/L for every 10 mmHg that PaCO₂ is below 40, starting from HCO₃⁻ 24 mmol/L, to find the expected HCO₃⁻.
A practice gas shows a metabolic alkalosis with HCO₃⁻ 42 mmol/L. Use expected PaCO₂ = 0.7·HCO₃⁻ + 21 to find the expected PaCO₂.
HCO₃⁻ 42 mmol/L
PaCO₂ = mmHg
39.ECG rhythm strip interpretationMedium
Interpret this lead II rhythm strip. Which rhythm is it? Click your answer.
lead II, 25 mm/s, 10 mm/mV1 small box = 0.04 s, 1 large box = 0.20 sstrip length 6 s
1sinus bradycardia
2sinus tachycardia
3first-degree AV block
4junctional rhythm
40.ECG rhythm strip interpretationHard
Identify the rhythm on this lead II 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
1ventricular tachycardia
2atrial flutter, 2:1 conduction
3sinus tachycardia
4ventricular fibrillation
3Solutions
1.Nursing fundamentals
Answer: A · Inspection, auscultation, percussion, palpation
Why this is the answer
In the abdomen the nurse listens before touching, because percussion and palpation can change bowel sounds. In other body systems palpation and percussion come before auscultation.
Answer
A · Inspection, auscultation, percussion, palpation
2.Nursing fundamentals
Answer: D · Pressure damage, hypothermia and muscle breakdown
Why this is the answer
A long lie causes pressure injury, hypothermia, dehydration and rhabdomyolysis, which can damage the kidneys. The patient is assessed carefully for these as well as for fractures.
Answer
D · Pressure damage, hypothermia and muscle breakdown
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: A · It is strongly anticholinergic and can cause confusion and falls in older adults
Why this is the answer
First-generation antihistamines such as diphenhydramine are on the Beers list because they cause confusion, constipation, urinary retention and falls in older adults. Safer approaches to sleep should be discussed.
Answer
A · It is strongly anticholinergic and can cause confusion and falls in older adults
5.Prioritization & delegation
Answer: A · Poor ventilation causing carbon dioxide to build up
Why this is the answer
A low pH with a high PaCO₂ and normal bicarbonate is respiratory acidosis. The patient is not breathing out enough carbon dioxide, so the priority is to support ventilation and escalate.
Answer
A · Poor ventilation causing carbon dioxide to build up
6.Prioritization & delegation
Answer: B · Report it at once, as it may mean the brain is being compressed
Why this is the answer
A newly fixed, dilated pupil suggests pressure on the third cranial nerve from rising intracranial pressure or a bleed. It is a neurological emergency that needs immediate escalation.
Answer
B · Report it at once, as it may mean the brain is being compressed
7.Clinical nursing
Answer: C · Repositioning and distraction
Why this is the answer
Positioning, heat or cold where safe, relaxation, distraction and explanation can all reduce pain alongside analgesics.
Answer
C · Repositioning and distraction
8.Clinical nursing
Answer: B · Necrotising fasciitis
Why this is the answer
Necrotising fasciitis spreads rapidly along fascia; severe pain, systemic toxicity and fast progression are key warning signs. It is a surgical emergency needing urgent debridement and IV antibiotics.
Answer
B · Necrotising fasciitis
9.Lab values & electrolytes
Answer: A · In the first 15 minutes
Why this is the answer
Acute hemolytic and anaphylactic reactions usually appear early, so the transfusion is started slowly and the nurse stays with the patient for about the first 15 minutes, checking vital signs before, during and after according to policy.
Answer
A · In the first 15 minutes
10.Lab values & electrolytes
Answer: C · Laryngospasm, an emergency needing urgent help and IV calcium
Why this is the answer
Severe hypocalcemia can cause spasm of the larynx, which blocks the airway. The nurse calls for urgent help, supports the airway and prepares IV calcium gluconate as prescribed, with cardiac monitoring.Checked against:Hypocalcemia (StatPearls) · StatPearls (NCBI Bookshelf) (2026)
Answer
C · Laryngospasm, an emergency needing urgent help and IV calcium
11.Pharmacology
Answer: D · They raise the risk of confusion, falls and fractures
Why this is the answer
Older people are more sensitive to benzodiazepines and often eliminate them more slowly. Sedation, unsteadiness and confusion raise the risk of falls and fractures.
Answer
D · They raise the risk of confusion, falls and fractures
12.Pharmacology
Answer: B · Digoxin
Why this is the answer
ACE inhibitors (or ARBs/ARNI), beta blockers, mineralocorticoid antagonists and SGLT2 inhibitors reduce mortality in heart failure with reduced ejection fraction. Digoxin improves symptoms and reduces admissions without reducing mortality.
Answer
B · Digoxin
13.Med-surg: cardiovascular & respiratory
Answer: A · It reduces absorption of cholesterol from the gut
Why this is the answer
Ezetimibe blocks the intestinal cholesterol transporter (NPC1L1), so less dietary and biliary cholesterol is absorbed and LDL falls. It is often added to a statin. Statins act by inhibiting HMG-CoA reductase in the liver.
Answer
A · It reduces absorption of cholesterol from the gut
14.Med-surg: cardiovascular & respiratory
Answer: A · A patient on day 1 after surgery who is newly restless, RR 30/min, SpO₂ 88% on 4 L/min
Why this is the answer
New restlessness, tachypnoea and hypoxaemia despite oxygen suggest acute deterioration such as a PE, pneumonia or bleeding, so this patient is seen first. SpO₂ 89% is within target for a stable COPD patient, a mild fever on antibiotics is expected, and the asthma patient is well.
Answer
A · A patient on day 1 after surgery who is newly restless, RR 30/min, SpO₂ 88% on 4 L/min
15.Med-surg: neuro, endocrine & renal
Answer: B · Glucose absorbed from the dialysis fluid
Why this is the answer
Standard PD fluids contain glucose to pull water out by osmosis. Some glucose is absorbed, adding calories and raising blood glucose. Glucose monitoring and diet advice are needed, and other solutions may be used.
Answer
B · Glucose absorbed from the dialysis fluid
16.Med-surg: neuro, endocrine & renal
Answer: D · "I will use a salt substitute instead of ordinary salt."
Why this is the answer
Salt substitutes often contain potassium chloride, which can cause dangerous hyperkalaemia in CKD. Patients should reduce salt without using these products. Boiling vegetables and limiting high-potassium foods are correct.
Answer
D · "I will use a salt substitute instead of ordinary salt."
17.Med-surg: GI, perioperative & oncology
Answer: C · Eat a normal, balanced diet and introduce foods gradually
Why this is the answer
People with a colostomy can usually eat a normal diet. Foods are reintroduced gradually to see how each one affects gas, odour and output, and regular meals and fluids help.
Answer
C · Eat a normal, balanced diet and introduce foods gradually
18.Med-surg: GI, perioperative & oncology
Answer: B · Output on the skin, often from a poorly fitting appliance
Why this is the answer
Irritant dermatitis from leaking effluent is the commonest peristomal skin problem, particularly with ileostomies. The stoma is remeasured, the aperture and appliance (for example a convex base or seal) adjusted and skin protection used, ideally with stoma nurse input. Raw skin also makes the appliance stick less, worsening leaks.
Answer
B · Output on the skin, often from a poorly fitting appliance
19.Maternity & obstetric nursing
Answer: B · A clavicle fracture or nerve injury
Why this is the answer
The Moro reflex should be bilateral and symmetrical. An absent response on one side suggests clavicle fracture or brachial plexus palsy, both linked with shoulder dystocia and large babies.
Answer
B · A clavicle fracture or nerve injury
20.Maternity & obstetric nursing
Answer: C · Progestin-only methods are compatible with breastfeeding
Why this is the answer
Progestin-only methods such as implants, injections and pills do not have a clinically important effect on milk supply. Oestrogen-containing methods are usually avoided in the first weeks.
Answer
C · Progestin-only methods are compatible with breastfeeding
21.Pediatric nursing
Answer: A · Keep the baby nil by mouth, raise the head and suction the upper pouch as needed
Why this is the answer
Nothing is given by mouth because it would pool and be inhaled. The head is raised and a tube in the upper pouch is used for continuous or frequent suction, while the baby is prepared for surgery.
Answer
A · Keep the baby nil by mouth, raise the head and suction the upper pouch as needed
22.Pediatric nursing
Answer: D · Acute chest syndrome, an emergency
Why this is the answer
Acute chest syndrome causes chest pain, fever, respiratory symptoms, hypoxia and new changes on the chest X-ray. It is a leading cause of death in sickle cell disease and needs urgent treatment.
Answer
D · Acute chest syndrome, an emergency
23.Mental health nursing
Answer: D · "I can take any cold and flu remedy from the pharmacy."
Why this is the answer
Decongestants such as pseudoephedrine are sympathomimetics and can cause a hypertensive crisis with MAOIs. Patients should check any new medicine, including over-the-counter remedies, with a pharmacist or prescriber.
Answer
D · "I can take any cold and flu remedy from the pharmacy."
24.Mental health nursing
Answer: C · A patient with severe psychotic depression who has stopped eating and drinking
Why this is the answer
ECT is effective for severe depression, especially with psychotic features, high suicide risk or refusal of food and fluids, when a rapid response is needed. It is not a first choice for mild conditions.
Answer
C · A patient with severe psychotic depression who has stopped eating and drinking
25.Nursing math & unit conversions
Answer: 01:50
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
1 AM → 01
Answer
01:50
Answer
01:50
26.Nursing math & unit conversions
Answer: N = 4
Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.
Total volume
15 mL × 3 × 7 = 315 mL
Bottles
315/100 = 3.15 → N = 4
Answer
N = 4
27.Dosage calculations
Answer: D = 18.75 mg
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Total per day
5·15 = 75 mg
Per dose
D = 75/4 = 18.75 mg
Answer
D = 18.75 mg
28.Dosage calculations
Answer: V = 0.52 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.
Volume
V = 2600/5000 = 0.52 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.52 mL
29.IV infusion rates
Answer: R = 17 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
5·60 = 300 min
Drip rate
R = 500·10/300 = 16.67 ≈ 17 gtt/min
Answer
R = 17 gtt/min
At the bedside you round to the nearest whole drop: 17 gtt/min.
30.IV infusion rates
Answer: t = 4.5 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 = 750/168 = 4.464 ≈ 4.5 h
Answer
t = 4.5 h
31.Pediatric & critical-care dosing
Answer: R = 31.2 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
16·78 = 1 248 units/h
Concentration
20 000/500 = 40 units/mL
Pump rate
R = 1248/40 = 31.2 mL/h
Answer
R = 31.2 mL/h
32.Pediatric & critical-care dosing
Answer: R = 3 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
25 000/250 = 100 mcg/mL
Dose per hour
The order is per minute for the whole patient, so the weight is not needed.
5·60 = 300 mcg/h
Pump rate
R = 300/100 = 3 mL/h
Answer
R = 3 mL/h
33.IV fluids & fluid balance
Answer: I = 1370 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.
Add the intake
oral: 150 + 150 = 300 mL
ice chips: 120/2 = 60 mL
IV infusion: 80·12 = 960 mL
IV antibiotic: 1·50 = 50 mL
I = 1370 mL
Answer
I = 1370 mL
34.IV fluids & fluid balance
Answer: t = 6.3 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
100·3 = 300 mL
500 − 300 = 200 mL left
Second part
200/60 = 3.333 h
Total time
t = 3 + 3.333 = 6.333 ≈ 6.3 h
Answer
t = 6.3 h
That is about 6 h 20 min, so the bag runs out at about 13:20.
35.Clinical assessment scores
Answer: M = 3
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.
Motor score
M = 9 − 2 − 4 = 3
M3: abnormal flexion of the arms (decorticate posture)
Answer
M = 3
36.Clinical assessment scores
Answer: high risk
Morse fall scale: six items. History of falling: no 0, yes 25. Secondary diagnosis: no 0, yes 15. Ambulatory aid: none, bed rest or nurse assistance 0; crutches, cane or walker 15; holding on to furniture 30. IV therapy or saline lock: no 0, yes 20. Gait: normal, bed rest or wheelchair 0; weak 10; impaired 20. Mental status: knows own limits 0; overestimates or forgets limits 15. The total runs from 0 to 125. Risk cut-offs differ between hospitals; a common set is 0–24 low, 25–44 moderate and 45 or more high.
Score each item
history of falling in the last 3 months: no → 0
secondary diagnosis: yes → 15
ambulatory aid: crutches, cane or walker → 15
IV therapy or saline lock: no → 0
gait: normal, bed rest or wheelchair → 0
mental status: overestimates or forgets limits → 15
Add
Morse total = 0 + 15 + 15 + 0 + 0 + 15 = 45
Risk level
45 → high risk
Answer
high risk
37.Arterial blood gas interpretation
Answer: HCO₃⁻ = 19 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.
Change in PaCO₂
|30 − 40| = 10 mmHg → 1 × 10 mmHg
Expected HCO₃⁻
HCO₃⁻ = 24 − 5·1 = 19 mmol/L
Answer
HCO₃⁻ = 19 mmol/L
38.Arterial blood gas interpretation
Answer: PaCO₂ = 50.4 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
0.7·42 + 21 = 50.4 mmHg
Answer
PaCO₂ = 50.4 mmHg
The rise has a limit: PaCO₂ rarely goes above about 55 mmHg from compensation alone.
39.ECG rhythm strip interpretation
Answer: first-degree AV block
Rhythm criteria (lead II): sinus rhythm has an upright P wave before every QRS, a constant PR of 0.12–0.20 s and a narrow QRS: normal sinus rhythm at 60–100/min, sinus bradycardia below 60, sinus tachycardia above 100. Atrial fibrillation: no P waves, a fibrillatory baseline and an irregularly irregular R–R. Atrial flutter: sawtooth flutter waves at about 250–350/min with a fixed conduction ratio such as 2:1 or 4:1. First-degree AV block: sinus rhythm with a constant PR above 0.20 s. Junctional rhythm: narrow QRS at 40–60/min with absent or inverted P waves (PR below 0.12 s, or P after the QRS). A PVC is an early, wide (0.12 s or more), bizarre QRS without a P wave, with the T wave in the opposite direction and usually a full compensatory pause; in bigeminy every second beat is a PVC.
Five steps
1. Rate: R–R = 25 small boxes, 1500 ÷ 25 ≈ 60 per minute.
2. Rhythm: regular, every R–R is 1.00 s.
3. P waves: upright, one before every QRS, all alike.
4. PR interval: 0.26 s, constant, longer than 0.20 s.
5. QRS: 0.08 s, narrow (below 0.12 s).
Interpretation
first-degree AV block
Answer
first-degree AV block
40.ECG rhythm strip interpretation
Answer: ventricular tachycardia
Ventricular rhythms: ventricular tachycardia is a run of three or more wide (0.12 s or more) complexes in a row at more than 100/min, usually 150–250/min, regular, without related P waves. Ventricular fibrillation is a chaotic, irregular waveform with no identifiable P waves, QRS complexes or T waves and no countable rate. Asystole is an almost flat line with no ventricular activity; a flat line is always confirmed by checking the patient, the leads and the gain and a second lead. In resuscitation guidelines VF and pulseless VT are the shockable rhythms and asystole is not.
Five steps
1. Rate: R–R = 10 small boxes, 1500 ÷ 10 ≈ 150 per minute.
2. Rhythm: regular, every R–R is 0.40 s.
3. P waves: none identifiable.
4. PR interval: not measurable.
5. QRS: 0.16 s, wide (0.12 s or more).
Interpretation
ventricular tachycardia
Answer
ventricular tachycardia
In resuscitation guidelines VF and pulseless VT are the shockable rhythms. This is identification practice only.
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