Medical-surgical nursing is the care of adults with medical illnesses or undergoing surgery, and Medical-Surgical Nursing I is the first course in it. It covers perioperative care, fluid and electrolyte balance, intravenous therapy and the respiratory, cardiovascular, gastrointestinal, renal, endocrine and haematological systems. This page works the IV calculations nursing exams test and maps each system. FLN Tutors (Freelancer Network) also offers one-to-one help. Matched to a verified specialist who knows your course, your university's marking criteria, and your deadline.
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FLN offers one-to-one online Medical-Surgical Nursing I tutoring with verified subject specialists. Sessions focus on core theory, clinical application and exam preparation, including Medical-Surgical Nursing, Preoperative Nursing Care, Postoperative Nursing Care and Fluid and Electrolyte Balance, using your own course material, so you understand the subject and can apply it yourself.
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Medical-surgical nursing (med-surg) is the largest area of adult nursing: caring for adults admitted with medical conditions or before and after surgery. Courses split it into parts, and the split used on FLN Tutors follows most syllabi:
| Part | Focus |
|---|---|
| Medical-Surgical Nursing I (this page) | Perioperative care, fluids and electrolytes, IV therapy; respiratory, cardiovascular, gastrointestinal, renal, endocrine and haematological disorders |
| Medical-Surgical Nursing II | Neurological and musculoskeletal disorders, oncology, emergency and critical care, burns |
In India, Medical-Surgical Nursing I and II are named courses in the B.Sc Nursing programme. In the US and UK the same content is taught as med-surg or adult nursing modules; see adult health nursing for acute assessment tools such as the Glasgow Coma Scale.
*Educational content only. It is not clinical advice: follow your placement's policies and your supervisor's instructions for real patients.*
| Phase | Main nursing tasks |
|---|---|
| Pre-operative | Consent checked, fasting instructions, allergies, baseline observations, skin preparation, removal of jewellery and prostheses, pre-operative checklist, patient education |
| Intra-operative | Safe positioning, asepsis, swab and instrument counts, the WHO Surgical Safety Checklist |
| Post-operative | Airway and breathing, observations against the early warning score, pain, wound and drains, fluid balance, nausea, early mobilisation |
Many hospitals follow a fasting rule of about six hours for food and two hours for clear fluids before elective surgery, but local policy and the anaesthetist's instructions decide. Detailed theatre care is covered in perioperative nursing, and post-operative complications in adult health nursing.
Body water is split between intracellular fluid (about two-thirds) and extracellular fluid (about one-third, as interstitial fluid and plasma). Nurses monitor balance through intake and output, weight, observations and blood results.
| Electrolyte | Typical adult reference range | Low level may cause | High level may cause |
|---|---|---|---|
| Sodium | 135 to 145 mmol/L | Confusion, headache, seizures | Thirst, confusion, seizures |
| Potassium | about 3.5 to 5.0 mmol/L | Muscle weakness, cramps, arrhythmias | Arrhythmias, muscle weakness |
| Calcium (adjusted) | about 2.2 to 2.6 mmol/L | Tingling, muscle spasm | Thirst, constipation, confusion |
| Magnesium | about 0.7 to 1.0 mmol/L | Tremor, arrhythmias | Weakness, low blood pressure |
Ranges vary slightly between laboratories, so always use your own laboratory's values. Arterial blood gases are summarised by pH 7.35 to 7.45, PaCO2 4.7 to 6.0 kPa (35 to 45 mmHg) and bicarbonate 22 to 26 mmol/L; step-by-step ABG interpretation is worked in critical care nursing.
All examples are fictional practice questions.
1. 1,000 mL over 8 hours. On a pump, rate = volume / time = 1,000 / 8 = 125 mL/h. By gravity, drops per minute = volume (mL) x drop factor (drops/mL) / time (minutes). With a 20 drops/mL giving set: 1,000 x 20 / 480 = 41.67, so 42 drops/min. With a 15 drops/mL set: 1,000 x 15 / 480 = 31 drops/min. With a 60 drops/mL microdrip set, drops/min equals mL/h: 125 drops/min.
2. A small-volume infusion. 100 mL over 30 minutes with a 20 drops/mL set: 100 x 20 / 30 = 66.67, so 67 drops/min.
3. When will it finish? 750 mL remain and the pump runs at 100 mL/h. Time = 750 / 100 = 7.5 hours, so an infusion checked at 08:00 finishes at about 15:30.
4. Maintenance fluid by weight. UK NICE guidance (CG174) suggests about 25 to 30 mL/kg/day of water for routine maintenance in adults. For a 70 kg patient that is 70 x 25 = 1,750 mL to 70 x 30 = 2,100 mL per 24 hours, or about 73 to 88 mL/h. Prescribing is the prescriber's decision; the calculation shows how the numbers are reached.
5. Anion gap. Sodium 140, chloride 104, bicarbonate 24 mmol/L: anion gap = 140 - (104 + 24) = 12 mmol/L, within the range often quoted, although reference values vary by laboratory.
Round drops per minute to whole drops, keep units on every line, and check the answer is sensible: a litre over eight hours should never come out at 400 drops a minute.
| System | Common conditions studied | Nursing focus |
|---|---|---|
| Respiratory | Asthma, COPD, pneumonia, tuberculosis | Oxygen therapy, inhaler technique, sputum and SpO2 monitoring |
| Cardiovascular | Hypertension, coronary artery disease, myocardial infarction, heart failure | Observations, fluid restriction, daily weights, ECG basics |
| Gastrointestinal | Peptic ulcer, inflammatory bowel disease, liver cirrhosis, bowel obstruction | Nutrition, stoma care, fluid balance |
| Renal and urinary | Urinary tract infection, kidney stones, kidney disease | Intake and output, catheter care, electrolyte monitoring |
| Endocrine | Diabetes mellitus, thyroid disorders | Blood glucose monitoring, insulin, patient education |
| Haematological | Anaemia, deep vein thrombosis, bleeding disorders | Transfusion checks, anticoagulant monitoring, VTE prevention |
For each condition, examiners expect pathophysiology in brief, signs and symptoms, investigations, medical treatment and, above all, the nursing care, ideally as a care plan. Revising by system also helps with scenario questions, because you can move straight from the likely condition to its priority nursing problems, the observations you would take, the medicines involved and the information the patient needs before discharge.
| Investigation | What it shows | Nursing role |
|---|---|---|
| Full blood count | Haemoglobin, white cells, platelets | Recognise anaemia, infection or bleeding risk; report abnormal results |
| Urea and electrolytes | Kidney function, sodium, potassium | Link results to fluids, diuretics and IV therapy |
| Blood glucose and HbA1c | Current and longer-term glucose control | Capillary glucose monitoring, hypo- and hyperglycaemia recognition |
| 12-lead ECG | Heart rhythm and ischaemia | Correct electrode placement, recognising when to escalate |
| Chest X-ray | Lungs, heart size, fluid | Positioning, safety, follow-up of results |
| Peak flow and spirometry | Airway obstruction | Technique coaching, recording best of three |
| Urinalysis and urine culture | Infection, protein, glucose, blood | Clean-catch technique, timely labelling |
| Endoscopy and imaging | Gastrointestinal bleeding, obstruction, masses | Fasting, consent, bowel preparation, post-procedure observations |
In written answers, connect each result to a nursing action: what you would observe, document, report or teach. A list of normal values on its own earns few marks; showing what a change means for the patient earns many more.
Use fictional or fully anonymised patients, and keep medical diagnoses separate from nursing problems. For care-plan models and reflective writing, see nursing help.
From the assignments and exam answers our tutors see most often:
| Country | Where this content appears |
|---|---|
| India | B.Sc Nursing Medical-Surgical Nursing I (Adult) and II; GNM medical-surgical nursing papers |
| US | Med-surg courses across the ADN and BSN; NCLEX-RN questions; the med-surg nursing certification after practice |
| UK | Adult nursing modules mapped to the NMC standards of proficiency |
| Australia | Acute care and medical-surgical units in the Bachelor of Nursing |
The free OpenStax textbook *Medical-Surgical Nursing* is a useful companion to your course text.
A tutor can work through IV and drip-rate calculations, explain fluid and electrolyte problems, and help you structure care plans and case studies for each body system. For the second course, see Medical-Surgical Nursing II; for practical skills, see clinical nursing skills.
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Medical-surgical nursing is the care of adults who are in hospital with medical conditions or who are having surgery. It is the largest area of adult nursing and covers assessment, care before and after operations, fluid and medicine management, and nursing care for disorders of every major body system.
Medical-Surgical Nursing I usually covers perioperative care, fluids and electrolytes, IV therapy and the respiratory, cardiovascular, gastrointestinal, renal, endocrine and blood disorders. Medical-Surgical Nursing II moves on to neurological, musculoskeletal and cancer care, emergencies, critical care and burns. Exact splits vary by university.
Many students find it one of the most demanding because it covers so many conditions and combines pathophysiology, pharmacology and nursing care. It becomes manageable when you learn a fixed pattern for each condition, practise calculations regularly and build care plans system by system rather than memorising isolated facts.
A pre-operative checklist usually confirms identity and consent, fasting time, allergies, baseline observations, removal of jewellery, dentures and prostheses, site marking, completed investigations and that essential medicines have been given or withheld as prescribed. Each item is checked and signed before the patient leaves the ward for theatre.
Many hospitals use a rule of about six hours without food and two hours without clear fluids before elective surgery under anaesthesia. The exact instructions depend on local policy, the procedure and the anaesthetist, so nurses always follow the instructions given for that patient rather than a general rule.
Multiply the volume to be infused in millilitres by the drop factor of the giving set in drops per millilitre, then divide by the time in minutes. The answer is drops per minute, rounded to a whole number. For a pump, simply divide the volume by the time in hours.
On a pump, set 1,000 divided by 8, which is 125 millilitres per hour. By gravity with a 20 drops per millilitre set, multiply 1,000 by 20 and divide by 480 minutes to get about 42 drops per minute. A 15 drops per millilitre set needs about 31 drops per minute.
The drop factor is the number of drops that make one millilitre for a particular giving set, and it is printed on the packaging. Standard adult sets are often 15 or 20 drops per millilitre, while microdrip or paediatric sets give 60 drops per millilitre, so always check the set before calculating.
UK NICE guidance suggests about 25 to 30 millilitres of water per kilogram per day for routine maintenance in adults, alongside set amounts of sodium, potassium, chloride and glucose. For a 70 kilogram adult that is roughly 1,750 to 2,100 millilitres a day, but the prescriber decides the actual regimen.
The anion gap is the difference between measured positive and negative ions in the blood, usually sodium minus the sum of chloride and bicarbonate. It helps identify the cause of metabolic acidosis: a raised gap suggests extra acids such as ketones or lactate, while a normal gap points to bicarbonate loss.
Low potassium, or hypokalaemia, can cause muscle weakness, cramps, fatigue, constipation and abnormal heart rhythms. The ECG may show flattened T waves and U waves. Nurses watch for it in patients on diuretics, with vomiting or diarrhoea, or receiving insulin, and report results outside the laboratory range.
Most syllabi cover the respiratory, cardiovascular, gastrointestinal, renal and urinary, endocrine and haematological systems in the first course, together with perioperative care, fluids and electrolytes and intravenous therapy. Neurological, musculoskeletal and cancer care are usually left for the second course.
Start with a brief, anonymised patient summary, then explain the condition and how it affects the patient, identify two or three priority nursing problems, and set out goals, interventions with referenced rationales and evaluation for each. Finish with reflection on what you learned and how it will change your practice.
Daily weights are the most reliable bedside measure of fluid gain or loss, because one litre of fluid weighs about one kilogram. In heart failure, a rapid rise in weight can signal fluid retention before swelling or breathlessness becomes obvious, so weights are taken at the same time each day on the same scales.
Yes. A tutor can work through IV calculations, fluid and electrolyte questions, care plans and case studies across each body system with you. This is educational support only, not clinical advice, and you complete and submit your own assessed work in line with your university's academic integrity rules.
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