Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Which nursing precaution applies to a child with a suspected Wilms tumour (nephroblastoma)?
Which child should the nurse see first?
Practice exercise (made-up values, not clinical guidance). A practice protocol calls for a heparin bolus of 60 units/kg for a patient who weighs 90 kg. The vial contains 1 000 units/mL. What volume V do you draw up? Round to one decimal place.
Practice exercise (made-up values, not clinical guidance). A patient who weighs 63 kg has an order for nitroglycerin at 5 mcg/min. The bag contains 25 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 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).
Practice exercise (made-up values, not clinical guidance). A 500 mL bag was started at 06:15 and runs by pump at 50 mL/h. How many mL V are left in the bag at 10:45?
Answer: B · Avoid palpating the abdomen
Palpating the abdomen could rupture the tumour capsule and spread cancer cells. A sign over the bed often warns staff not to palpate.
Answer: D · A 4-year-old with asthma who can say only one or two words between breaths
Being unable to speak in sentences is a sign of severe or life-threatening asthma and needs immediate treatment. The other children have mild illness or are responding to treatment.
Answer: V = 5.4 mL
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 = 3 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: B = 285 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 = 275 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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