Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
What should the nurse do before giving a dose of digoxin to an infant?
A child recovering from acute rheumatic fever with heart involvement asks why she needs regular penicillin for years. What is the best answer?
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 78 kg. The vial contains 1 000 units/mL. What volume V do you draw up? 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 2.5 mcg/kg/min for a patient who weighs 103 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 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 75 mL/h. At 20:30, 50 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
Answer: A · Count the apical pulse for a full minute and check it against the prescribed limits
Digoxin slows the heart rate and has a narrow therapeutic range. The apical pulse is counted for a full minute before each dose, and the dose is withheld and reported if the rate is below the limit set by the prescriber or local policy.
Answer: B · To prevent new strep infections that could cause further attacks and more valve damage
Recurrent episodes of rheumatic fever follow new group A streptococcal infections and worsen rheumatic heart disease. Long-term secondary prophylaxis with penicillin prevents these infections; it does not reverse existing damage.
Answer: V = 6.2 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: R = 15.5 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 = 1650 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 = 6 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 6 h 00 min, so the bag runs out at about 02:30.
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