Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
A 20-month-old drinks about 1.5 litres of cow's milk a day and eats little solid food. He is pale and tired. What is the most likely problem?
A 2-month-old is brought in with bruises on both cheeks. The parent says the baby "bumps into things". What should the nurse do?
Practice exercise (made-up values, not clinical guidance). A bag contains 25 000 units of heparin in 500 mL. The order is 12 units/kg/h for a patient who weighs 55 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 patient who weighs 93 kg has an order for norepinephrine at 4 mcg/min. The bag contains 4 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 total intake I in mL. Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 07:30 at 80 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 · Iron-deficiency anaemia
Large volumes of cow's milk are low in iron, reduce appetite for iron-rich foods and can cause small losses of blood from the gut. Toddlers who drink too much milk are a classic group for iron-deficiency anaemia; milk is usually limited to about 500 mL a day.
Answer: D · Document the findings objectively and follow the safeguarding procedure to report the concern
Bruising in a non-mobile infant is a strong warning sign of abuse, and the history does not match the baby's development. The nurse documents facts, keeps the child safe and follows the safeguarding procedure.
Answer: R = 13.2 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 = 15 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: I = 1510 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 = 4.3 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 4 h 16 min, so the bag runs out at about 11:46.
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