Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Which finding in a newborn suggests Hirschsprung disease?
A boy with haemophilia A bumps his head hard on a table. He seems well. What should the nurse advise?
Practice exercise (made-up values, not clinical guidance). An infusion contains 50 units of regular insulin in 50 mL. The order is 0.05 units/kg/h for a patient who weighs 94 kg. Find the pump rate R in mL/h. Round to one decimal place.
Practice exercise (made-up values, not clinical guidance). A patient who weighs 85 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 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL.
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 13:15 and runs by pump at 60 mL/h. How many mL V are left in the bag at 18:45?
Answer: D · Failure to pass meconium within 48 hours of birth
Delayed passage of meconium, abdominal distension and bilious vomiting suggest Hirschsprung disease. Older children may have chronic constipation and ribbon-like stools.
Answer: D · Seek urgent care, as factor replacement may be needed before symptoms appear
Intracranial bleeding is the most dangerous bleed in haemophilia and can develop hours after injury. Any significant head injury needs urgent assessment and usually prompt factor replacement. Aspirin is avoided because it impairs platelet function.
Answer: R = 4.7 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: 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: I = 1370 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: V = 670 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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