Multi-Step Numeracy Word Problems for the NMC CBT

Everything so far in Part A has been one calculation per question. Real CBT papers spend their hardest marks differently: two or three of those calculations chained inside one stem. A weight-based dose that becomes a volume. A daily total that divides into doses and then into tablets. Nothing new, just joins.

The method is unglamorous:

1. Read the final sentence first. It names the thing you’re actually asked for, and its unit.
2. Break the stem into single steps. Convert. Calculate the dose. Convert the dose into volume, tablets or rate.
3. Write every intermediate result on the whiteboard, with its unit attached.

The unit tells you when to stop. If the question wants mL and your latest number is in mg, you’re not finished. This matters because the exam’s favourite wrong option in multi-step questions is your own intermediate answer. Calculate 480 mg correctly, see 480 among the options, click it, lose the mark. The 480 was real; it just wasn’t the volume the question asked for.

Worked example, full chain

A 24 kg child, prescribed 30 mg/kg/day in three divided doses, syrup 120 mg/5 mL. Volume per dose?

• Daily total: 30 × 24 = 720 mg.
• Per dose: 720 ÷ 3 = 240 mg.
• Volume: (240 ÷ 120) × 5 = 10 mL.

Three lines, three chances to stop early, and the options will include 720-flavoured and un-multiplied numbers at every exit. The written trail is your defence: each line is small enough to verify at a glance, which chained calculator work never is.

The decoy step

A meaner variant includes a calculation you don’t need. A 15 mg/kg dose for 60 kg diluted into 250 mL and run over one hour: the dose works out at 900 mg, and none of that matters, because 250 mL over one hour is 250 mL/hour regardless. Candidates trained to compute everything compute the 900, then look for somewhere to use it. The final sentence had already defined the task. Scenery is allowed in exam stems; read for the question, not the numbers.

Pacing

Part A gives you 15 questions inside the same sitting as the 105+ clinical questions, and multi-step items take three times as long as conversions. The economics are simple: bank the one-step marks fast (conversions, BMI, tablets), then give multi-step questions the unhurried two minutes they need. An unfinished chain is a guaranteed lost mark; a slow, written one almost never is.

Five chained questions below, including one decoy. Then the last chapter of Part A: a mixed exam-style set with no topic labels to help you.