Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
A school-age child with asthma uses an inhaled corticosteroid every day. What should the nurse teach?
A 3-month-old has large, flat, blue-grey patches over the lower back and buttocks. The parents say they have been there since birth. What is the best action?
Practice exercise (made-up values, not clinical guidance). A bag contains 25 000 units of heparin in 250 mL. The order is 18 units/kg/h for a patient who weighs 98 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 80 kg has an order for norepinephrine at 6 mcg/min. The bag contains 8 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 patient weighs 59 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 bag was started at 11:00 and runs by pump at 60 mL/h. How many mL V are left in the bag at 14:30?
Answer: D · Rinse the mouth after each dose and use a spacer
Inhaled corticosteroids are preventers, used daily. Rinsing the mouth reduces the risk of oral thrush and hoarseness, and a spacer improves delivery to the lungs. A short-acting reliever is used for attacks.
Answer: D · Document them with size and location as congenital dermal melanocytosis (Mongolian spots)
Congenital dermal melanocytosis is a common benign birthmark, especially in babies with darker skin. Careful documentation from early on helps prevent it later being mistaken for bruising; the marks usually fade during childhood.
Answer: R = 17.6 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 = 11.3 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: U = 2.65 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: V = 790 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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