Maternity Nursing: cram pack

Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.

New problemsBack to the course

In the print window, choose “Save as PDF” to keep a copy on your device.

1Formulas and methods

Maternity & obstetric nursing

Method

  1. Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
  2. Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
  3. Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
  4. Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.

Dosage calculations

Dose from strength
volume = dose / strength
Weight-based dose
dose = mg/kg × body weight
Tablets
number = dose / tablet strength
Units
1 g = 1000 mg, 1 mg = 1000 mcg

Method

  1. Convert the ordered dose and the stock strength to the same unit.
  2. Use desired over have times quantity: (D/H) × Q.
  3. For weight-based doses, multiply by the weight in kg first, then divide the daily dose by the number of doses.
  4. Estimate first and check that the answer is reasonable.

IV infusion rates

Pump rate
mL/h = volume (mL)/time (h)
Drip rate
drops/min = volume (mL) × drop factor / time (min)
Infusion time
time (h) = volume (mL)/rate (mL/h)

Method

  1. Pump rate in mL/h: volume divided by time in hours.
  2. Drip rate in drops/min: volume × drop factor divided by time in minutes.
  3. For time remaining: volume left divided by the rate.
  4. Round as the question or the equipment requires.

2Practice problems

1.Maternity & obstetric nursingMedium

Which newborn complication is linked to poorly controlled gestational diabetes?

  1. AMacrosomia (a large baby) and birth injury
  2. BCongenital rubella
  3. CA very small baby with growth restriction in most cases
  4. DRh disease of the newborn
2.Maternity & obstetric nursingHard

After the membranes rupture, the nurse sees the umbilical cord protruding from the vagina. What is the first action?

  1. AGently push the cord back into the vagina
  2. BAsk the woman to push with the next contraction
  3. CCall for help and lift the presenting part off the cord with a gloved hand
  4. DCover the cord with a dry towel, keep her lying flat and wait for the doctor
3.Dosage calculationsMedium
024681010 mL

A child weighing 8 kg is prescribed 10 mg/kg of a drug. The stock solution contains 10 mg/mL. Draw up the dose: what volume V do you give?

8 kg10 mg/kg10 mg/mL
V = mL
4.Dosage calculationsHard
20k units1000 mL? mL/h800 units/h

An infusion contains 20000 units of a drug in 1000 mL. The prescription is 800 units per hour. At what rate R do you set the pump, in mL/h?

20000 units/1000 mL800 units/h
R = mL/h
5.IV infusion ratesMedium
V = ?20 gtt/mL35 gtt/min6 h

A drip runs at 35 gtt/min through a set of 20 gtt/mL. How many millilitres V does the patient receive in 6 hours?

35 gtt/min20 gtt/mL6 h
V = mL
6.IV infusion ratesHard
2 g250 mL? mL/h0.5 mg/min

A bag contains 2 g of a drug in 250 mL. The order is 0.5 mg per minute. At what rate R do you set the pump, in mL/h?

2 g/250 mL0.5 mg/min
R = mL/h

3Solutions

1.Maternity & obstetric nursing

Answer: A · Macrosomia (a large baby) and birth injury

Why this is the answer

Fetal hyperinsulinaemia promotes growth, so macrosomia, shoulder dystocia and birth injury are more likely, together with neonatal hypoglycaemia and respiratory problems.

Answer

A · Macrosomia (a large baby) and birth injury
2.Maternity & obstetric nursing

Answer: C · Call for help and lift the presenting part off the cord with a gloved hand

Why this is the answer

Relieve the pressure on the cord by keeping the presenting part off it, call for urgent help and use a knee–chest or head-down position. Do not try to replace the cord; if it is outside, it can be covered with warm, moist saline gauze. Birth is usually expedited.

Answer

C · Call for help and lift the presenting part off the cord with a gloved hand
3.Dosage calculations

Answer: V = 8 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.

Dose from body weight

D = 10·8 = 80 mg

Volume

V = 80/10 = 8 mL

On the syringe

On this 10 mL syringe every small line is 0.2 mL.

Answer

V = 8 mL
4.Dosage calculations

Answer: R = 40 mL/h

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.

Concentration

20000/1000 = 20 units/mL

Pump rate

R = 800/20 = 40 mL/h

Answer

R = 40 mL/h
5.IV infusion rates

Answer: V = 630 mL

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

35·60/20 = 105 mL/h

Volume

V = 105·6 = 630 mL

Answer

V = 630 mL
6.IV infusion rates

Answer: R = 3.75 mL/h

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

Concentration

2000 mg/250 mL = 8 mg/mL

Dose per hour

0.5·60 = 30 mg/h

Pump rate

R = 30/8 = 3.75 mL/h

Answer

R = 3.75 mL/h

ExamProblems · examproblems.com/courses/maternity-nursing