Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Which factors help start the newborn's first breath?
Ten days after birth, a woman phones to say her bleeding has suddenly become heavy and bright red with clots, with lower abdominal pain and a temperature of 38.2 °C (100.8 °F). Which response is most appropriate?
A child weighing 14 kg is prescribed 20 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?
A patient weighs 103.4 lb. The prescription is 5 mg/kg as a single dose, and the stock contains 40 mg in 1 mL. Using 1 kg = 2.2 lb, what volume V do you give? Round to one decimal place.
Infuse 250 mL over 6 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
A bag contains 1 g of a drug in 250 mL. The order is 4 mg per minute. At what rate R do you set the pump, in mL/h?
Answer: D · Chemical, thermal, mechanical and sensory cues
Falling oxygen and rising carbon dioxide (chemical), cooler air (thermal), recoil of the chest after the birth canal (mechanical) and touch, light and sound (sensory) trigger the first breaths.
Answer: B · Ask her to come in now; retained tissue or infection is possible
Heavy bleeding between 24 hours and 12 weeks after birth is a secondary postpartum haemorrhage. With pain and fever it suggests retained placental tissue or endometritis, which needs same-day assessment and possibly ultrasound, antibiotics or evacuation. Tampons are avoided in the postnatal period.
Answer: V = 5.6 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 = 5.9 mL
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 = 14 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: 14 gtt/min.
Answer: R = 60 mL/h
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).
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