Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
A child with type 1 diabetes has a stomach bug and is eating very little. What is the correct advice about insulin?
A 6-year-old is prescribed codeine for pain after a tonsillectomy. What should the nurse do?
Practice exercise (made-up values, not clinical guidance). A practice protocol calls for a heparin bolus of 80 units/kg for a patient who weighs 65 kg. The vial contains 5 000 units/mL. What volume V do you draw up? Round to one decimal place.
Practice exercise (made-up values, not clinical guidance). A dobutamine infusion of 500 mg in 250 mL runs at 11 mL/h. The patient weighs 54 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL.
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 150 mL/h. At 17:30, 50 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
Answer: C · Keep giving insulin, check glucose and ketones more often and follow the sick-day plan
Stress hormones during illness raise blood glucose and the risk of ketoacidosis. Insulin is never stopped; glucose and ketones are checked more often, fluids are encouraged and doses are adjusted according to the sick-day rules.
Answer: B · Question the order with the prescriber before giving it
Codeine is contraindicated in children under 12 and after tonsillectomy or adenoidectomy in children under 18, because of fatal respiratory depression in ultra-rapid metabolisers. The nurse should question the order.
Answer: V = 1 mL
Heparin and insulin infusions: concentration = units in the bag/bag volume (units/mL). Pump rate (mL/h) = units per hour/concentration, and units per hour = mL/h × concentration. For a weight-based order, units/h = units/kg/h × weight first. A bolus volume = units needed/vial strength. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Answer: D = 6.8 mcg/kg/min
Titrated drips: first find the concentration in mcg/mL (mg × 1000/mL). For a weight-based order, mcg/min = mcg/kg/min × weight. Then mL/h = mcg/min × 60/concentration. Working backwards, mcg/kg/min = mL/h × concentration/(60 × weight). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Answer: I = 800 mL
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Answer: t = 3 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
That is about 3 h 00 min, so the bag runs out at about 20:30.
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