Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
The nurse uses a blood pressure cuff that is too small for a child's arm. What effect will this have?
A child with leukaemia and a very high white cell count starts chemotherapy. Which blood results suggest tumour lysis syndrome?
Practice exercise (made-up values, not clinical guidance). A bag contains 25 000 units of heparin in 500 mL. The order is 16 units/kg/h for a patient who weighs 89 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 dobutamine 500 mg in 250 mL. The order is 12.5 mcg/kg/min for a patient who weighs 95 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 fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 120 mL/h. At 06:30, 350 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
Answer: A · The reading will be falsely high
A cuff that is too small gives falsely high readings, and one that is too large gives falsely low readings. The bladder width should be about 40% of the arm circumference.
Answer: C · High potassium, high phosphate, high uric acid and low calcium
Rapid breakdown of tumour cells releases potassium, phosphate and nucleic acids (forming uric acid); phosphate binds calcium, lowering it. This can cause arrhythmias and kidney failure, so hydration, allopurinol or rasburicase and close monitoring are used.
Answer: R = 28.5 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 = 35.6 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 = 610 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.
Positive: more fluid went in than came out.
Answer: t = 5.4 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 5 h 25 min, so the bag runs out at about 11:55.
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