Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
A woman's epidural has just been inserted. Which nursing action is a priority in the next hours?
At 4 hours, a newborn's temperature is 37.9 °C (100.2 °F). He is wrapped in three blankets under a heater. What should the nurse do first?
A vial contains 2 g of powder. The label says: add 9.2 mL of water for injection to give a total volume of 10 mL. The prescription is 200 mg. What volume V of the reconstituted solution do you give?
The prescription is 0.78 mg. The ampoule contains 1000 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
An infusion is ordered at 100 mL/h, but no pump is available. It runs by gravity through a giving set of 15 gtt/mL. Find the drip rate R in drops per minute.
An infusion of 50 mg in 500 mL runs at 30 mL/h. How many micrograms per minute D does the patient receive?
Answer: D · Check her blood pressure and bladder often
Epidurals cause sympathetic block, so hypotension is common. They also reduce the urge to void, so the bladder is checked and catheterised if needed. Lateral positions avoid aortocaval compression.
Answer: C · Remove extra layers and recheck
Overheating from heavy wrapping or a heater can raise a newborn's temperature. The nurse removes extra layers, rechecks the temperature soon and assesses for signs of infection if it stays high.
Answer: V = 1 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: V = 0.78 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 = 25 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: D = 50 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).
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