Maternity Nursing: cram pack

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

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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

When performing the first Leopold manoeuvre, what is the nurse trying to identify?

  1. AThe amount of amniotic fluid
  2. BWhich side the fetal back lies on
  3. CWhether the head has entered the pelvis
  4. DWhich fetal part lies in the fundus
2.Maternity & obstetric nursingHard

A pregnant woman with chronic hypertension takes lisinopril. Why should the nurse alert the prescriber?

  1. AACE inhibitors cause neural tube defects only in the third trimester
  2. BACE inhibitors can harm fetal kidney development and are avoided in pregnancy
  3. CLisinopril is the first-choice antihypertensive in pregnancy
  4. DLisinopril will cause her blood pressure to rise in pregnancy
3.Dosage calculationsMedium
80 kg20 mg/kg/day3× per dayD = ? mg

A patient weighs 80 kg. The prescribed dose is 20 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?

80 kg20 mg/kg/day3× per day
D = mg
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 1.64 mg. The ampoule contains 4000 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

1.64 mg4000 mcg/mL
V = mL
5.IV infusion ratesMedium
250 mL60 gtt/mL6 h? gtt/min

Infuse 250 mL over 6 hours with a giving set of 60 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

250 mL6 h60 gtt/mL
R = gtt/min
6.IV infusion ratesHard
750 mL20 gtt/mL25 gtt/mint = ? h

A drip runs at 25 gtt/min through a set of 20 gtt/mL. There are 750 mL left in the bag. How many hours t until it is empty?

25 gtt/min20 gtt/mL750 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: D · Which fetal part lies in the fundus

Why this is the answer

The first Leopold manoeuvre palpates the fundus: a firm round head or a softer, irregular breech. The second finds the back and limbs, the third the presenting part and the fourth the degree of head flexion and descent.

Answer

D · Which fetal part lies in the fundus
2.Maternity & obstetric nursing

Answer: B · ACE inhibitors can harm fetal kidney development and are avoided in pregnancy

Why this is the answer

ACE inhibitors are fetotoxic, especially in the second and third trimesters, causing fetal kidney damage and oligohydramnios. Labetalol, nifedipine or methyldopa are used instead.

Answer

B · ACE inhibitors can harm fetal kidney development and are avoided in pregnancy
3.Dosage calculations

Answer: D = 533.3 mg

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.

Total per day

20·80 = 1600 mg

Per dose

D = 1600/3 = 533.3 mg

Answer

D = 533.3 mg
4.Dosage calculations

Answer: V = 0.41 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.

Same units

1.64 mg = 1640 mcg

Volume

V = 1640/4000 = 0.41 mL

Answer

V = 0.41 mL
5.IV infusion rates

Answer: R = 42 gtt/min

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.

Time in minutes

6·60 = 360 min

Drip rate

R = 250·60/360 = 41.67 ≈ 42 gtt/min

Answer

R = 42 gtt/min

At the bedside you round to the nearest whole drop: 42 gtt/min.

6.IV infusion rates

Answer: t = 10 h

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

25·60/20 = 75 mL/h

Time left

t = 750/75 = 10 h

Answer

t = 10 h

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