Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Which injury in an infant is most suggestive of physical abuse?
A child with sickle cell disease has new chest pain, cough, fever and an oxygen saturation of 90%. What should the nurse suspect?
Practice exercise (made-up values, not clinical guidance). An infusion contains 250 units of regular insulin in 250 mL. The order is 0.05 units/kg/h for a patient who weighs 66 kg. Find the pump rate R in mL/h. Round to one decimal place.
Practice exercise (made-up values, not clinical guidance). A bag contains dobutamine 250 mg in 250 mL. The order is 7.5 mcg/kg/min for a patient who weighs 107 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL. Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 11:30 at 120 mL/h. After 3 hours the rate is changed to 60 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
Answer: B · Posterior rib fractures
Posterior rib fractures in infants are highly suggestive of abuse because they usually result from forceful squeezing of the chest. Bruises on the shins and grazes are common in mobile children.
Answer: C · Acute chest syndrome, an emergency
Acute chest syndrome causes chest pain, fever, respiratory symptoms, hypoxia and new changes on the chest X-ray. It is a leading cause of death in sickle cell disease and needs urgent treatment.
Answer: R = 3.3 mL/h
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: R = 48.2 mL/h
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 = 1450 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 = 13.7 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 13 h 40 min, so the bag runs out at about 01:10.
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