Maternity Nursing: cram pack

Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.

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1Formulas and methods

Maternity & obstetric nursing

Method

  1. Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
  2. Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
  3. Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
  4. Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.

Dosage calculations

Dose from strength
volume = dose / strength
Weight-based dose
dose = mg/kg × body weight
Tablets
number = dose / tablet strength
Units
1 g = 1000 mg, 1 mg = 1000 mcg

Method

  1. Convert the ordered dose and the stock strength to the same unit.
  2. Use desired over have times quantity: (D/H) × Q.
  3. For weight-based doses, multiply by the weight in kg first, then divide the daily dose by the number of doses.
  4. Estimate first and check that the answer is reasonable.

IV infusion rates

Pump rate
mL/h = volume (mL)/time (h)
Drip rate
drops/min = volume (mL) × drop factor / time (min)
Infusion time
time (h) = volume (mL)/rate (mL/h)

Method

  1. Pump rate in mL/h: volume divided by time in hours.
  2. Drip rate in drops/min: volume × drop factor divided by time in minutes.
  3. For time remaining: volume left divided by the rate.
  4. Round as the question or the equipment requires.

2Practice problems

1.Maternity & obstetric nursingMedium

A woman on day 3 after a caesarean has calf pain, swelling and warmth in one leg. What should the nurse do?

  1. AEncourage her to do vigorous leg exercises
  2. BReport it promptly and avoid massaging the leg
  3. CApply a heating pad and reassess tomorrow
  4. DMassage the calf to relieve the cramp
2.Maternity & obstetric nursingHard

A woman in labour has a breech presentation and her membranes rupture. What should the nurse check first?

  1. AHer blood glucose level
  2. BThe colour of her urine
  3. CThe baby's sex on ultrasound
  4. DThe fetal heart rate and for cord prolapse
3.Dosage calculationsMedium
12 kg5 mg/kg/day3× per dayD = ? mg

A patient weighs 12 kg. The prescribed dose is 5 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?

12 kg5 mg/kg/day3× per day
D = mg
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 1800 micrograms. The ampoule contains 2 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

1800 mcg2 mg/mL
V = mL
5.IV infusion ratesMedium
V = ?20 gtt/mL25 gtt/min4 h

A drip runs at 25 gtt/min through a set of 20 gtt/mL. How many millilitres V does the patient receive in 4 hours?

25 gtt/min20 gtt/mL4 h
V = mL
6.IV infusion ratesHard
610 mLleft? mL/h3 h left

1000 mL was ordered over 6 hours. After 3 hours you find that 610 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?

1000 mL / 6 hafter 3 h: 610 mL
Δ = %

3Solutions

1.Maternity & obstetric nursing

Answer: B · Report it promptly and avoid massaging the leg

Why this is the answer

One-sided calf pain, swelling and warmth suggest deep vein thrombosis, and the postnatal period is a high-risk time. The leg should not be massaged, and the provider should be informed for urgent assessment.

Answer

B · Report it promptly and avoid massaging the leg
2.Maternity & obstetric nursing

Answer: D · The fetal heart rate and for cord prolapse

Why this is the answer

In breech presentations, the presenting part fits the pelvis less snugly, so cord prolapse is more likely after rupture of the membranes. The fetal heart rate is checked immediately and a vaginal examination done if indicated.

Answer

D · The fetal heart rate and for cord prolapse
3.Dosage calculations

Answer: D = 20 mg

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.

Total per day

5·12 = 60 mg

Per dose

D = 60/3 = 20 mg

Answer

D = 20 mg
4.Dosage calculations

Answer: V = 0.9 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.

Same units

2 mg/mL = 2000 mcg/mL

Volume

V = 1800/2000 = 0.9 mL

Answer

V = 0.9 mL
5.IV infusion rates

Answer: V = 300 mL

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.

Rate in mL/h

25·60/20 = 75 mL/h

Volume

V = 75·4 = 300 mL

Answer

V = 300 mL
6.IV infusion rates

Answer: Δ = 22 %

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.

Original rate

1000/6 = 166.7 mL/h

New rate

R = 610/3 = 203.3 mL/h

Percentage change

Δ = (203.3 − 166.7)/166.7·100% = 22%

Answer

Δ = 22%

Many hospitals allow such an adjustment up to 25% without a new order; check local policy.

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