Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Which baby is at greatest risk of early-onset group B streptococcal infection?
After the membranes rupture, the nurse sees the umbilical cord protruding from the vagina. What is the first action?
A child weighing 15 kg is prescribed 4 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?
The prescription is 4700 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
Infuse 1500 mL over 12 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
1000 mL was ordered over 8 hours. After 5 hours you find that 410 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?
Answer: D · A baby of a GBS-positive mother with no antibiotics
GBS colonisation, no intrapartum antibiotics, prolonged rupture of membranes, maternal fever and prematurity increase the risk. Intrapartum IV antibiotics greatly lower early-onset GBS disease.
Answer: B · Call for help and lift the presenting part off the cord with a gloved hand
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: V = 1.2 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.
On this 10 mL syringe every small line is 0.2 mL.
Answer: V = 0.94 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.
On this 1 mL syringe every small line is 0.01 mL.
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.
At the bedside you round to the nearest whole drop: 42 gtt/min.
Answer: Δ = 9.333 %
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.
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
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