Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
A woman 4 hours after birth has severe perineal pain and pressure. Her fundus is firm, lochia is normal, and her heart rate is rising. What should the nurse suspect?
A newborn's bilirubin is rising quickly at 30 hours despite phototherapy, and the baby is lethargic with an arched back and high-pitched cry. What does this suggest?
A prefilled syringe of epinephrine (adrenaline) is labelled 1:10 000 (0.1 mg/mL). The prescription is 1 mg IV in cardiac arrest. What volume V do you give?
A child weighing 8 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 40 mg in 1 mL. What volume V do you give?
Infuse 500 mL over 12 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
A bag contains 500 mg of a drug in 50 mL and runs at 20 mL/h. How many milligrams per hour D does the patient receive?
Answer: A · A vulvar or vaginal haematoma
A haematoma causes severe pain and pressure out of proportion to the birth, often with a firm uterus and normal lochia. Signs of hidden blood loss such as tachycardia must be reported.
Answer: B · Acute bilirubin encephalopathy
Lethargy, poor feeding, hypertonia with arching and a high-pitched cry are signs of acute bilirubin encephalopathy. An urgent exchange transfusion may be needed to prevent permanent kernicterus.
Answer: V = 10 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 = 2 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 = 10 gtt/min
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.
At the bedside you round to the nearest whole drop: 10 gtt/min.
Answer: D = 200 mg/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.
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