Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
How can a cephalhaematoma be told apart from caput succedaneum?
A woman with pre-eclampsia has repeated blood pressures of 168/112 mmHg 15 minutes apart. What is the appropriate action?
A child weighing 36 kg is prescribed 2.5 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?
A child weighing 12 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 120 mg in 5 mL. What volume V do you give?
500 mL was ordered over 8 hours. After 2 hours you find that 470 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 bag contains 250 mg of a drug in 100 mL and runs at 8 mL/h. How many milligrams per hour D does the patient receive?
Answer: D · A cephalhaematoma does not cross the suture lines
Caput is oedema of the scalp, present at birth, crossing sutures and resolving within days. A cephalhaematoma is a subperiosteal bleed limited by the sutures; it appears after birth, lasts weeks and can increase jaundice.
Answer: B · Notify the provider promptly so antihypertensive treatment can be started without delay
Severe-range hypertension (160 systolic or 110 diastolic or more) in pregnancy raises the risk of stroke and must be treated urgently, ideally within an hour, with drugs such as labetalol, hydralazine or nifedipine as prescribed.
Answer: V = 1.8 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 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 = 78.33 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: D = 20 mg/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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