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.
falls 25, diagnosis 15, aid 15/30, IV 20, gait 10/20, mental status 15
NEWS2 risk
0–4 low; single 3 low–medium; 5–6 medium; ≥ 7 high
Mean arterial pressure
MAP = (SBP + 2·DBP)/3 = DBP + PP/3
Pulse pressure and shock index
PP = SBP − DBP, SI = HR/SBP
Body mass index
BMI = kg/m² = 703·lb/in²
Method
Find the score sheet that the question uses and its range (GCS 3–15, APGAR 0–10, Braden 6–23, Morse 0–125).
Score every item separately, matching the description to its level.
Add the item scores and check that the total lies inside the range.
Apply the cut-offs: for NEWS2 also look for any single parameter scoring 3.
For derived values use MAP = (SBP + 2·DBP)/3, PP = SBP − DBP, SI = HR/SBP and BMI = kg/m².
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.
2Practice problems
1.Oxygen therapy & respiratory calculationsMedium
Practice exercise (made-up values, not clinical guidance). A ventilated patient who meets the other Berlin criteria for ARDS has PaO₂ 63 mmHg (8.4 kPa) on 30% oxygen with a PEEP of 10 cmH₂O. Calculate the P/F ratio and click the ARDS severity.
PaO₂ 63 mmHg (8.4 kPa)FiO₂ 30%PEEP 10 cmH₂O
1above 300: no ARDS grade
2mild
3moderate
4severe
2.Oxygen therapy & respiratory calculationsHard
Practice exercise (made-up values, not clinical guidance). A patient on high-flow nasal oxygen has SpO₂ 89% on FiO₂ 0.8 and a respiratory rate of 29/min. Find the ROX index ROX = (SpO₂/FiO₂)/RR, with SpO₂ in percent and FiO₂ as a fraction. Round to two decimal places.
SpO₂ 89%FiO₂ 0.8RR 29/min
ROX =
3.Arterial blood gas interpretationMedium
A practice arterial blood gas shows pH 7.19, PaCO₂ 38 mmHg (5.1 kPa) and HCO₃⁻ 14 mmol/L. The primary disorder is metabolic acidosis. How far is it compensated? Click your answer.
pH 7.19PaCO₂ 38 mmHg (5.1 kPa)HCO₃⁻ 14 mmol/L
1uncompensated
2partially compensated
3fully compensated
4.Arterial blood gas interpretationHard
At sea level, a practice gas taken on 35% oxygen shows PaO₂ 81 mmHg (10.8 kPa) and PaCO₂ 38 mmHg (5.1 kPa). Use PAO₂ = FiO₂·(760 − 47) − PaCO₂/0.8 to find the A–a gradient.
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: completely limited; moisture: very moist; activity: walks occasionally; mobility: slightly limited; nutrition: adequate; friction and shear: problem. Find the Braden total B.
6–23
B =
6.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: slightly limited; moisture: occasionally moist; activity: walks frequently; mobility: no limitation; nutrition: excellent; friction and shear: problem. Use the bands 19–23 not at risk, 15–18 mild, 13–14 moderate, 10–12 high and 9 or below very high. Click the risk level.
1not at risk
2mild risk
3moderate risk
4high risk
5very high risk
7.Med-surg: cardiovascular & respiratoryMedium
How is the jugular venous pressure usually assessed?
APatient sitting upright with the arms raised above the head
BPatient reclined at 45° with the head turned slightly to the left
CPatient standing with the neck flexed forward
DPatient lying completely flat with the head turned to the right
8.Med-surg: cardiovascular & respiratoryHard
Which task for a stable patient with heart failure can the registered nurse most appropriately delegate to a healthcare assistant (unlicensed assistive personnel)?
ADeciding whether to give the furosemide dose
BAssessing lung sounds for new crackles
CMeasuring and recording the morning weight
DTeaching the patient about a low-salt diet
3Solutions
1.Oxygen therapy & respiratory calculations
Answer: mild
P/F ratio and ARDS (Berlin definition): P/F = PaO₂ (mmHg)/FiO₂ (as a fraction). With PEEP or CPAP of at least 5 cmH₂O, ARDS is graded mild for 200 < P/F ≤ 300, moderate for 100 < P/F ≤ 200 and severe for P/F ≤ 100 mmHg. The other Berlin criteria (onset within a week, bilateral opacities, not fully explained by heart failure) must also be met. PaO₂ in kPa × 7.5 gives mmHg. The ROX index (SpO₂/FiO₂)/respiratory rate is used to follow patients on high-flow nasal oxygen.
P/F ratio
P/F = 63/0.3 = 210 mmHg
Berlin severity
mild
Answer
mild
2.Oxygen therapy & respiratory calculations
Answer: ROX = 3.84
P/F ratio and ARDS (Berlin definition): P/F = PaO₂ (mmHg)/FiO₂ (as a fraction). With PEEP or CPAP of at least 5 cmH₂O, ARDS is graded mild for 200 < P/F ≤ 300, moderate for 100 < P/F ≤ 200 and severe for P/F ≤ 100 mmHg. The other Berlin criteria (onset within a week, bilateral opacities, not fully explained by heart failure) must also be met. PaO₂ in kPa × 7.5 gives mmHg. The ROX index (SpO₂/FiO₂)/respiratory rate is used to follow patients on high-flow nasal oxygen.
SpO₂/FiO₂
89/0.8 = 111.3
ROX
ROX = 111.3/29 = 3.836 ≈ 3.84
Answer
ROX = 3.84
Below 4.88: in studies a low ROX was linked with a higher chance of needing intubation.
3.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 7.19: acidaemia (below 7.35)
PaCO₂ 38 mmHg: normal (35–45)
HCO₃⁻ 14 mmol/L: low (22–26)
Compensation
Clinically, also check the expected compensation: Winter’s formula expects PaCO₂ 27–31 mmHg, so the measured 38 mmHg points to an additional respiratory acidosis (a mixed disorder). The answer above is the ROME exam classification.
uncompensated
Answer
uncompensated
4.Arterial blood gas interpretation
Answer: A–a gradient = 121 mmHg
Derived values: calculated serum osmolality is 2·Na⁺ + glucose + urea with all values in mmol/L (2·Na⁺ + glucose/18 + BUN/2.8 with glucose and BUN in mg/dL); normal is about 275–295 mOsm/kg. The P/F ratio is PaO₂ divided by FiO₂ as a fraction. The alveolar oxygen pressure is PAO₂ = FiO₂·(760 − 47) − PaCO₂/0.8 mmHg at sea level, and the A–a gradient is PAO₂ − PaO₂.
Braden scale: six subscales for pressure-injury risk. Sensory perception, moisture, activity, mobility and nutrition score 1 to 4, from the worst level (1) to no problem (4); friction and shear scores 1 to 3. The total runs from 6 to 23, and a lower total means a higher risk. Common bands: 19–23 not at risk, 15–18 mild risk, 13–14 moderate risk, 10–12 high risk and 9 or below very high risk.
Score each subscale
sensory perception: completely limited → 1
moisture: very moist → 2
activity: walks occasionally → 3
mobility: slightly limited → 3
nutrition: adequate → 3
friction and shear: problem → 1
Add
Braden total = 1 + 2 + 3 + 3 + 3 + 1 = 13
Answer
B = 13
6.Clinical assessment scores
Answer: not at risk
Braden scale: six subscales for pressure-injury risk. Sensory perception, moisture, activity, mobility and nutrition score 1 to 4, from the worst level (1) to no problem (4); friction and shear scores 1 to 3. The total runs from 6 to 23, and a lower total means a higher risk. Common bands: 19–23 not at risk, 15–18 mild risk, 13–14 moderate risk, 10–12 high risk and 9 or below very high risk.
Score each subscale
sensory perception: slightly limited → 3
moisture: occasionally moist → 3
activity: walks frequently → 4
mobility: no limitation → 4
nutrition: excellent → 4
friction and shear: problem → 1
Add
Braden total = 3 + 3 + 4 + 4 + 4 + 1 = 19
Risk level
19 → not at risk
Answer
not at risk
7.Med-surg: cardiovascular & respiratory
Answer: B · Patient reclined at 45° with the head turned slightly to the left
Why this is the answer
With the patient at 45°, the vertical height of the pulsation in the right internal jugular vein above the sternal angle is estimated. A height above about 3–4 cm suggests raised right-sided pressure, as in right heart failure or fluid overload.
Answer
B · Patient reclined at 45° with the head turned slightly to the left
8.Med-surg: cardiovascular & respiratory
Answer: C · Measuring and recording the morning weight
Why this is the answer
Weighing a stable patient is a routine, measurable task that can be delegated, with the result reported to the nurse. Assessment, patient teaching and clinical decisions about medicines require the registered nurse's judgement and cannot be delegated.