Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
A woman 1 day after birth has a blood pressure of 150/96 mmHg and a headache. She had normal blood pressures in pregnancy. What should the nurse do?
A woman at 31 weeks with contractions has a negative fetal fibronectin test. What does this result mean?
A child weighing 6 kg is prescribed 15 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 129.8 lb. The prescription is 0.5 mg/kg as a single dose, and the stock contains 200 mg in 5 mL. Using 1 kg = 2.2 lb, what volume V do you give? Round to two decimal places.
Infuse 500 mL over 8 hours with a giving set of 60 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
500 mL was ordered over 6 hours. After 3 hours you find that 320 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: B · Report it and assess for postpartum pre-eclampsia
New hypertension with a headache after birth can be postpartum pre-eclampsia, even with normal readings in pregnancy. The nurse reports it, checks urine protein and symptoms and follows the protocol.
Answer: A · Birth within the next 1 to 2 weeks is unlikely
Fetal fibronectin is a protein that binds the membranes to the uterine lining. A negative result has a high negative predictive value, meaning birth within 7 to 14 days is unlikely; a positive result is less predictive.
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 = 0.74 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 = 63 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: 63 gtt/min.
Answer: Δ = 28 %
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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