Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Which newborn is at greatest risk of hypoglycaemia in the first hours after birth?
A woman at 36 weeks with pre-eclampsia reports new pain under the right ribs and nausea. How should the nurse respond?
A prefilled syringe of epinephrine (adrenaline) is labelled 1:10 000 (0.1 mg/mL). The prescription is 1 mg IV in cardiac arrest. What volume V do you give?
An infusion contains 25000 units of a drug in 500 mL. The prescription is 1500 units per hour. At what rate R do you set the pump, in mL/h?
1000 mL was ordered over 8 hours. After 3 hours you find that 750 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?
A drip runs at 30 gtt/min through a set of 15 gtt/mL. There are 750 mL left in the bag. How many hours t until it is empty? Round to one decimal place.
Answer: D · A large baby of a mother with diabetes
High maternal glucose crosses the placenta and the fetus makes extra insulin. After the cord is cut, the glucose supply stops but the insulin stays high. Preterm, small and cold babies are also at risk.
Answer: C · Report it urgently as a possible sign of liver involvement or HELLP syndrome
Right upper quadrant or epigastric pain in pre-eclampsia suggests liver swelling or HELLP syndrome and is a severe feature. It needs urgent medical review, blood tests (platelets, liver enzymes) and close monitoring.
Answer: V = 10 mL
Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.
US labels now state mg/mL (1 mg/mL = 1:1000; 0.1 mg/mL = 1:10 000). Never give 1 mg/mL epinephrine IV push.
Answer: R = 30 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.
Answer: R = 150 mL/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.
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
Answer: t = 6.3 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.
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