Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
How is a child usually positioned for a lumbar puncture?
Which treatment is not routinely recommended for a typical infant with bronchiolitis?
Practice exercise (made-up values, not clinical guidance). An infusion contains 250 units of regular insulin in 250 mL. The order is 0.1 units/kg/h for a patient who weighs 91 kg. Find the pump rate R in mL/h. Round to one decimal place.
Practice exercise (made-up values, not clinical guidance). A patient who weighs 100 kg has an order for nitroglycerin at 40 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 patient weighs 48 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 13:00 and runs by pump at 100 mL/h. How many mL V are left in the bag at 20:30?
Answer: D · On the side, curled up with knees drawn up and head bent forward
Curling the child on the side (or sitting and bending forward) flexes the spine and widens the spaces between lumbar vertebrae for the needle. A nurse holds the child gently and monitors breathing, as tight flexion can compromise the airway in infants.
Answer: C · Bronchodilators or corticosteroids
Guidelines advise supportive care for bronchiolitis: oxygen when needed, fluids or feeding support and suction of blocked noses. Bronchodilators, steroids and antibiotics have not been shown to help typical cases and are not routinely used.
Answer: R = 9.1 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 = 12 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 = 2.67 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 = 250 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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