Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
A woman on day 3 after a caesarean has calf pain, swelling and warmth in one leg. What should the nurse do?
The nurse must deliver a baby before the provider arrives. As the head crowns, what should the nurse do?
A dose of 100 mg is needed from a 1% (w/v) solution. What volume V contains this dose?
An infusion contains 20000 units of a drug in 250 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 2 hours you find that 980 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 20 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 · Report it promptly and avoid massaging the leg
One-sided calf pain, swelling and warmth suggest deep vein thrombosis, and the postnatal period is a high-risk time. The leg should not be massaged, and the provider should be informed for urgent assessment.
Answer: B · Apply gentle pressure to the head to slow the birth
Gentle pressure on the fetal head, with the woman panting, slows birth and reduces perineal tearing and rapid pressure changes in the fetal skull. The nurse then checks for a nuchal cord and supports the baby's body.
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.
Answer: R = 18.75 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 = 163.3 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.
This is more than a 25% increase: most hospitals require you to contact the prescriber instead of catching up, and to assess the patient for fluid overload.
Answer: t = 9.4 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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