Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
What should the nurse do before giving a dose of digoxin to an infant?
Which IV fluid is usually used for a fluid bolus in a child with shock?
Practice exercise (made-up values, not clinical guidance). An infusion of 100 units of regular insulin in 250 mL runs at 2 mL/h. How many units per hour D does the patient receive?
Practice exercise (made-up values, not clinical guidance). A patient who weighs 60 kg has an order for norepinephrine at 10 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 8-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 500 mL bag runs by pump at 150 mL/h. At 11:30, 300 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
Answer: B · Count the apical pulse for a full minute and check it against the prescribed limits
Digoxin slows the heart rate and has a narrow therapeutic range. The apical pulse is counted for a full minute before each dose, and the dose is withheld and reported if the rate is below the limit set by the prescriber or local policy.
Answer: D · An isotonic crystalloid such as 0.9% sodium chloride
Isotonic crystalloids such as 0.9% sodium chloride or balanced solutions are used for boluses because they expand intravascular volume. Hypotonic fluids such as 5% glucose move into cells and can cause hyponatraemia and brain swelling.
Answer: D = 0.8 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 = 37.5 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 = 1010 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 = 1.3 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 1 h 20 min, so the bag runs out at about 12:50.
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