Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
On day 1 after birth, a woman's white cell count is mildly raised and she has no symptoms. How should this be interpreted?
A woman at 10 weeks has been vomiting for days, has ketones in her urine, has lost 6% of her body weight and feels dizzy on standing. What is the priority?
An ampoule of epinephrine (adrenaline) is labelled 1:1000 (1 mg/mL). The prescription is 0.3 mg IM for anaphylaxis. What volume V do you draw up?
The prescription is 450 micrograms. The ampoule contains 0.5 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
1500 mL was ordered over 8 hours. After 6 hours you find that 430 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?
An infusion of 400 mg in 500 mL runs at 9 mL/h. How many micrograms per minute D does the patient receive?
Answer: D · It can be normal soon after birth
Leucocytosis is common in labour and the early postnatal period. It must be interpreted with clinical signs such as fever, pain and lochia changes rather than on its own.
Answer: A · Correct the dehydration with IV fluids and electrolytes as prescribed
These are signs of hyperemesis gravidarum with dehydration. IV fluids, electrolyte replacement, antiemetics and vitamin supplements such as thiamine as prescribed are the priority.
Answer: V = 0.3 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: V = 0.9 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.
Answer: R = 215 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: D = 120 mcg/min
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).
ExamProblems · examproblems.com/courses/maternity-nursing