Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
A breastfed infant has gastroenteritis with mild dehydration. What should the nurse advise?
Which bedside check is recommended before each feed to confirm the position of a child's nasogastric tube?
Practice exercise (made-up values, not clinical guidance). A bag contains 25 000 units of heparin in 250 mL. The order is 14 units/kg/h for a patient who weighs 79 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). A bag contains dopamine 800 mg in 500 mL. The order is 5 mcg/kg/min for a patient who weighs 84 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 patient weighs 61 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 11:30 at 75 mL/h. After 4 hours the rate is changed to 150 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: C · Continue breastfeeding, and give oral rehydration solution as advised
Breastfeeding should continue during gastroenteritis, with oral rehydration solution added when there are signs of dehydration. Withholding feeds slows recovery and juice can worsen diarrhoea.
Answer: D · Check that aspirate from the tube is acidic, using the pH limit in local policy
Testing the pH of aspirate is the recommended bedside check before each use in many guidelines (UK NHS guidance uses a pH of 5.5 or below). An X-ray is the most reliable method and is used to confirm initial placement in many settings, including most US hospitals, or when no suitable aspirate is obtained. The air "whoosh" and bubble tests are unreliable and can miss a tube in the lungs.
Answer: R = 11.1 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 = 15.8 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: U = 2.41 mL/kg/h
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 = 8.7 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 8 h 40 min, so the bag runs out at about 20:10.
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