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?
One hour after a vaginal birth, the fundus is firm at the umbilicus, but there is a steady trickle of bright red blood. What is the most likely cause?
A prefilled syringe of epinephrine (adrenaline) is labelled 1:10 000 (0.1 mg/mL). The prescription is 0.5 mg IV in cardiac arrest. What volume V do you give?
The prescription is 360 units of a drug that comes as 1000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
A drip runs at 50 gtt/min through a set of 15 gtt/mL. How many millilitres V does the patient receive in 2 hours?
1500 mL was ordered over 10 hours. After 8 hours you find that 340 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: C · 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 · A tear of the cervix, vagina or perineum
Continuous bright red bleeding with a firm uterus suggests trauma (laceration), which needs inspection and repair. Atony would make the uterus soft, and normal lochia does not flow in a steady stream.
Answer: V = 5 mL
Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.
US labels now state mg/mL (1 mg/mL = 1:1000; 0.1 mg/mL = 1:10 000). Never give 1 mg/mL epinephrine IV push.
Answer: V = 0.36 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 1 mL syringe every small line is 0.01 mL.
Answer: V = 400 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.
Answer: Δ = 13.33 %
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.
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
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