Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
A woman is 5 days after birth. She cries often, sleeps poorly when the baby sleeps and feels she is a bad mother. What should the nurse do?
A labouring woman refuses a recommended caesarean for fetal distress after a full explanation. She has decision-making capacity. What should the nurse do?
How many milligrams of drug m are in 100 mL of a 2% (w/v) solution?
A child weighing 16 kg is prescribed 15 mg/kg per dose of an oral suspension that contains 200 mg in 5 mL. What volume V do you give?
A drip runs at 30 gtt/min through a set of 60 gtt/mL. How many millilitres V does the patient receive in 3 hours?
1000 mL was ordered over 6 hours. After 3 hours you find that 640 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 · Screen further for depression and self-harm
Insomnia even when the baby sleeps and feelings of worthlessness can point to depression. The nurse should screen further, including asking directly about self-harm, and arrange follow-up.
Answer: D · Respect her decision, document it and inform the team
A woman with capacity has the right to refuse treatment, even if this may harm the fetus. The nurse ensures she has understood, documents the discussion, continues care and informs the team.
Answer: m = 2000 mg
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.
Answer: V = 6 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: V = 90 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 = 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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