Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Which precaution applies to a child with haemophilia?
Which newborn should the nurse assess first?
Practice exercise (made-up values, not clinical guidance). A bag contains 12 500 units of heparin in 250 mL. The order is 14 units/kg/h for a patient who weighs 104 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 patient who weighs 89 kg has an order for nitroglycerin at 15 mcg/min. The bag contains 50 mg in 250 mL. Find the pump rate R 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. Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 500 mL bag was started at 06:45 and runs by pump at 80 mL/h. How many mL V are left in the bag at 10:15?
Answer: A · Avoid intramuscular injections and rectal temperatures where possible
Avoid procedures and drugs that cause bleeding: intramuscular injections, rectal temperatures, aspirin and NSAIDs. A joint bleed is treated with factor replacement, rest, ice, compression and elevation.
Answer: A · A 2-hour-old with grunting, nasal flaring and a respiratory rate of 74/min
Grunting, nasal flaring and tachypnoea (above about 60/min) are signs of respiratory distress and need immediate assessment. Milia, acrocyanosis in the first days and mild jaundice after 24 hours in a well-feeding baby are common and expected.
Answer: R = 29.1 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 = 4.5 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.
The order is per minute for the whole patient, so the weight is not needed.
Answer: I = 1270 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: V = 220 mL
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.
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