Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
How can acute rheumatic fever be prevented?
A healthy breastfed baby has lost 7% of her birth weight on day 3. What is the best interpretation?
Practice exercise (made-up values, not clinical guidance). A practice protocol calls for a heparin bolus of 70 units/kg for a patient who weighs 60 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 70 kg has an order for norepinephrine at 10 mcg/min. The bag contains 8 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 93 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 13:00 at 100 mL/h. After 2 hours the rate is changed to 150 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: B · By prompt antibiotic treatment of streptococcal sore throat
Rheumatic fever is an immune reaction following group A streptococcal throat infection. Treating strep throat with a full course of antibiotics prevents it and the heart valve damage it can cause.
Answer: B · This is within the usual range; observe a feed and follow the weight
Newborns commonly lose up to about 7–10% of birth weight in the first days and usually regain it by about 2 weeks. At this level, observing a feed, checking latch and nappy output and rechecking weight are appropriate.
Answer: V = 4.2 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 = 18.8 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 = 1.21 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 = 7.3 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 7 h 20 min, so the bag runs out at about 20:20.
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