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 child has had many hospital admissions with unexplained symptoms. They occur only when the mother is present and stop when the child is apart from her. What should the nurse consider?
Practice exercise (made-up values, not clinical guidance). A practice protocol calls for a heparin bolus of 70 units/kg for a patient who weighs 58 kg. The vial contains 5 000 units/mL. What volume V do you draw up? Round to two decimal places.
Practice exercise (made-up values, not clinical guidance). A bag contains dobutamine 250 mg in 250 mL. The order is 5 mcg/kg/min for a patient who weighs 94 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 fluid balance B = intake − output in mL (a negative answer means a net loss).
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 125 mL/h. At 11:00, 800 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
Answer: D · 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: A · Fabricated or induced illness; follow safeguarding procedures
Fabricated or induced illness (formerly Munchausen syndrome by proxy) is a form of abuse in which a carer invents or causes illness. Careful objective documentation and early involvement of the safeguarding team are essential; the carer should not be confronted alone.
Answer: V = 0.81 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 = 28.2 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: B = −295 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.
Negative: the patient lost more fluid than went in.
Answer: t = 1.6 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 1 h 36 min, so the bag runs out at about 12:36.
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