Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Which group of findings suggests Kawasaki disease?
A 7-year-old has a high fever, refuses to bear weight and has a warm, very tender area over the lower tibia. Which plan is most likely?
Practice exercise (made-up values, not clinical guidance). An infusion of 100 units of regular insulin in 250 mL runs at 10 mL/h. How many units per hour D does the patient receive?
Practice exercise (made-up values, not clinical guidance). A patient who weighs 61 kg has an order for nitroglycerin at 20 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 51 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 infusion starts at 14:30 at 150 mL/h. After 2 hours the rate is changed to 100 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
Answer: C · Fever for at least 5 days, red eyes without discharge, cracked red lips and swollen hands and feet
Kawasaki disease causes persistent fever plus features such as non-purulent conjunctivitis, red cracked lips and strawberry tongue, rash, swollen hands and feet and enlarged neck lymph nodes. The other options describe croup, chickenpox and roseola.
Answer: A · Blood cultures and prompt IV antibiotics for possible osteomyelitis
Acute osteomyelitis in children is most often caused by Staphylococcus aureus. Blood cultures are taken and IV antibiotics started promptly, followed by a long course to prevent bone damage and chronic infection.
Answer: D = 4 units/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 = 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.
The order is per minute for the whole patient, so the weight is not needed.
Answer: U = 1.47 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: t = 9 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 9 h 00 min, so the bag runs out at about 23:30.
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