Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Before surgery for a myelomeningocele, how should the newborn's sac be protected?
Newborn pulse oximetry screening shows 97% in the right hand and 91% in the foot. What does this mean?
Practice exercise (made-up values, not clinical guidance). A bag contains 25 000 units of heparin in 500 mL. The order is 15 units/kg/h for a patient who weighs 81 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 82 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 was started at 13:30 and runs by pump at 120 mL/h. How many mL V are left in the bag at 17:00?
Answer: A · Cover it with a sterile, moist, non-adherent dressing and position the baby prone
A sterile moist dressing prevents drying and infection, and the prone position keeps pressure off the sac. Latex precautions are also important because these children often develop latex allergy.
Answer: C · An abnormal screen that must be followed up promptly under the screening protocol
The right hand reflects pre-ductal blood and the foot post-ductal blood. A difference of more than 3%, or a reading below about 95% in both limbs, is an abnormal screen. Depending on the protocol this means a prompt repeat test or immediate medical review, with echocardiography if it persists, because it can signal critical congenital heart disease.
Answer: R = 24.3 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 = 15.4 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 = 680 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: V = 580 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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