Fundamentals of Nursing and Basic Nursing Skills
Fundamentals items reward precision: exact ranges, exact sequences, exact calculations. The paper often pairs a skill with a safety check, such as which observation must be made before a nasogastric feed, or which action invalidates a sterile field. Read the stem for the word first or before, and answer the safety step rather than the task itself.
Vital signs and monitoring
- Adult resting values: respiratory rate 12 to 20 per minute, pulse 60 to 100 per minute, blood pressure below 120/80 with hypertension defined from 140/90, oral temperature 36.5 to 37.5 degrees Celsius, oxygen saturation 95 percent or above on air.
- Avoid blood pressure measurement in an arm with an arteriovenous fistula, lymphoedema, or on the side of a mastectomy with axillary clearance.
- Avoid rectal temperature in neutropenia, diarrhoea, and after rectal or prostatic surgery.
Asepsis and standard precautions
- WHO 5 Moments: before patient contact, before an aseptic procedure, after body fluid exposure risk, after patient contact, and after touching patient surroundings.
- Sterile field rules: keep it above waist level and within view. Anything below waist level or outside the field is contaminated. Do not turn away from the field.
- Don personal protective equipment in the order gown, mask, goggles, gloves. Remove gloves, goggles, gown, mask, then perform hand hygiene.
Fluid balance and calculations
- Drip rate in drops per minute equals volume in millilitres multiplied by drop factor, divided by time in minutes.
- Intake includes intravenous flushes, ice and enteral water. Output includes urine, drains and vomit. Insensible loss is estimated, never measured.
Worked example
Order: 500 mL of sodium chloride 0.9 percent over 4 hours, giving set drop factor 20 drops per millilitre. Calculate the rate. Reasoning: convert to minutes, 4 multiplied by 60 equals 240 minutes. Then 500 multiplied by 20 equals 10,000 drops. Divide 10,000 by 240, giving 41.7 drops per minute, rounded to 42. Cross-check: 125 mL per hour, so roughly 42 drops per minute is plausible. A rate of 21 or 84 would indicate a factor-of-two error.
Traps that cost marks
- Estimating urine output from a wet pad instead of measuring it.
- Calling blanchable erythema a pressure injury. Blanchable redness is not a pressure injury and must not be staged.
- Using alcohol hand rub when hands are visibly soiled, or for Clostridioides difficile, where soap and water are required.