Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
The fundus is boggy, above the umbilicus and displaced to the right. What is the most likely cause?
A pregnant woman with chronic hypertension takes lisinopril. Why should the nurse alert the prescriber?
A child weighing 8 kg is prescribed 20 mg/kg of a drug. The stock solution contains 20 mg/mL. Draw up the dose: what volume V do you give?
An infusion contains 25000 units of a drug in 250 mL. The prescription is 800 units per hour. At what rate R do you set the pump, in mL/h?
An infusion is ordered at 60 mL/h, but no pump is available. It runs by gravity through a giving set of 10 gtt/mL. Find the drip rate R in drops per minute.
1500 mL was ordered over 6 hours. After 4 hours you find that 650 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?
Answer: D · A full bladder
A full bladder lifts and displaces the uterus, usually to the right, and stops it contracting well. Helping the woman to empty her bladder usually lets the fundus return to the midline and firm up.
Answer: C · ACE inhibitors can harm fetal kidney development and are avoided in pregnancy
ACE inhibitors are fetotoxic, especially in the second and third trimesters, causing fetal kidney damage and oligohydramnios. Labetalol, nifedipine or methyldopa are used instead.
Answer: V = 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: R = 8 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 = 10 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.
Answer: Δ = 30 %
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.
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