Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
How should the nurse measure the heart rate of a 9-month-old?
A 5-year-old with leukaemia tells the nurse she is ill because she was naughty. What is the best response?
Practice exercise (made-up values, not clinical guidance). A bag contains 25 000 units of heparin in 500 mL. The order is 18 units/kg/h for a patient who weighs 57 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 400 mg in 250 mL. The order is 5 mcg/kg/min for a patient who weighs 99 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 8-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).
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 80 mL/h. At 07:30, 300 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
Answer: C · Count the apical pulse for a full minute
In infants and children under about 2 years, the apical pulse is counted with a stethoscope for a full minute. Their rates are fast and may vary with breathing, so short counts are inaccurate.
Answer: D · Reassure her clearly that nothing she did or thought made her ill
Preoperational children use magical thinking and may believe illness is a punishment for bad behaviour or thoughts. Clear, repeated reassurance in simple language reduces guilt and fear.
Answer: R = 20.5 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 = 18.6 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 = −170 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.
Negative: the patient lost more fluid than went in.
Answer: t = 2.5 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 2 h 30 min, so the bag runs out at about 10:00.
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