Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
A woman at 39 weeks with a healthy pregnancy asks about walking in early labour. What is the best advice?
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 child weighing 16 kg is prescribed 20 mg/kg of a drug. The stock solution contains 40 mg/mL. Draw up the dose: what volume V do you give?
The prescription is 4450 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
500 mL was ordered over 12 hours. After 4 hours you find that 380 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?
1000 mL was ordered over 6 hours. After 2 hours you find that 850 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 · Walking and upright positions can help progress
Upright positions and mobility in the first stage can shorten labour and reduce the need for epidurals. She can choose positions that feel comfortable.
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 = 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 = 0.89 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: R = 47.5 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.
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
Answer: Δ = 27.5 %
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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