Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Which diet is usually advised for a child with nephrotic syndrome while there is oedema?
A conscious 10-year-old with type 1 diabetes is shaky and sweaty, with a blood glucose of 3.2 mmol/L. What is the first action?
Practice exercise (made-up values, not clinical guidance). A bag contains 25 000 units of heparin in 500 mL. The order is 14 units/kg/h 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). A dobutamine infusion of 250 mg in 250 mL runs at 6 mL/h. The patient weighs 57 kg. What dose D in mcg/kg/min is the patient receiving? 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 total intake I in mL. Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 125 mL/h. At 20:00, 200 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
Answer: D · No added salt
During the oedematous phase, salt is limited to reduce fluid retention, and fluids may be restricted if advised. Protein is not stopped; a normal, balanced intake for age is usually recommended.
Answer: B · Give a fast-acting carbohydrate by mouth and recheck the glucose after about 15 minutes
A conscious child with hypoglycaemia needs fast-acting carbohydrate, such as glucose tablets or juice, then a recheck after about 15 minutes, then a longer-acting carbohydrate snack once recovered. Glucagon is for a child who cannot take anything by mouth.
Answer: R = 27.7 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: D = 1.8 mcg/kg/min
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: I = 1330 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.
Answer: t = 2.4 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 2 h 24 min, so the bag runs out at about 22:24.
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