Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
What is a "reactive" non-stress test?
A woman in her first antenatal visit discloses that her partner hits her. What is the most appropriate nursing action?
A vial contains 1 g of powder. The label says: add 9.6 mL of water for injection to give a total volume of 10 mL. The prescription is 100 mg. What volume V of the reconstituted solution do you give?
An infusion contains 25000 units of a drug in 1000 mL. The prescription is 1000 units per hour. At what rate R do you set the pump, in mL/h?
1000 mL was ordered over 8 hours. After 5 hours you find that 490 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?
An infusion of 25 mg in 250 mL runs at 24 mL/h. How many micrograms per minute D does the patient receive?
Answer: C · At least 2 fetal heart rate accelerations within 20 minutes
A reactive non-stress test shows at least two qualifying accelerations in 20 minutes and indicates fetal well-being. A non-reactive test needs further testing, such as a biophysical profile.
Answer: A · Talk with her alone, assess her safety and offer support
Intimate partner violence often begins or worsens in pregnancy. The nurse should talk to her alone, assess safety, document carefully and offer support and local resources, without confronting the partner.
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: R = 40 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 = 163.3 mL/h
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.
Answer: D = 40 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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