13. During one of the nurse’s hourly assessments, Ana is lethargic,…
13. During one of the nurse’s hourly assessments, Ana is lethargic, her respirations are 8/minute and her DTRs are absent. The nurse identifies this as magnesium sulfate toxicity and after informing the obstetrician the following is ordered: stat magnesium level, stop the magnesium infusion, calcium gluconate, 1 gm IVP over 3 mins. One hour later her magnesium level is 7 mg, therapeutic for preeclampsia (4.7 to 8 mg/dl). The nurse evaluates the intervention. The patient has normal CNS functioning; is alert and oriented; the respiratory rate is 16; DTR 2+, and urine output 75 mL so the magnesium sulfate is restarted at 1 g/hr per provider order. With the same solution of 40 g/liter, at what rate (mL/hr) would the nurse set the infusion pump?
14. Stephanie is admitted to Labor and Delivery for induction of labor. She has an order for Lactated Ringers 1000 mL over 8 hours. At what rate should the nurse program the pump?
15. Stephanie’s cervix is examined, and her Bishop score is 8. The hospitalist orders Pitocin to start at 2mu/min. The Pitocin available is 20 units in 1000 mL Normal Saline. What rate should the infusion pump be set at to start this medication?
16. If the Pitocin available for Stephanie was instead 30 units in 500 mL of Normal Saline, what rate should the infusion pump be set at to start this medication?
17. After beginning the Pitocin at 2mu/min, the obstetrician orders for the Pitocin to be titrated 1-2 mu/min every 30 minutes until contractions are 2-3 minutes apart. The Pitocin available and infusing is 20 units in 1000 mL Normal Saline. How much (mL/hr) will the nurse increase the pump for each milliunit (mu) increased as the Pitocin is titrated?
18. Stephanie’s labor is progressing well and she will be delivering soon. Stephanie has an order for Pitocin 500mu/min over 1 hour for post-delivery bleeding to be administered after delivery of the placenta. The Pitocin available is 30 units in 500 mL Normal Saline. What rate will the nurse anticipate infusing the Pitocin on the infusion pump after delivery?
19. If the nurse gives the postpartum patient a dose of Methylergonovine 400 mcg IM every 5 hours for bleeding, how many mg are administered in 25 hours?
20. A premature baby weighs 2268 g at birth. What does the baby weigh in kg? In pounds?
21. A patient arrives via ambulance after an eclamptic seizure. The hospitalist orders a magnesium sulfate bolus of 2 g over 30 minutes followed by 1 g/hr. Available is 30 g magnesium sulfate in 500 mL of D5W. Figure the bolus dose and the maintenance dose in mL/hr.
• Bolus: The pump is set at ___mL/hr
• Maintenance: The pump is set at ___mL/hr
22. Janna has just had a cesarean and is in the PACU. The anesthesiologist orders hydromorphone 0.2 mg IV every hour as needed (PRN) for pain while the patient is NPO. Janna’s pain is 8/10. The hydromorphone vial reads 0.5 mg/0.5 mL. How many mL will the nurse administer?
23. Janna experiences nausea and vomiting in the PACU and an additional order is received for diphenhydramine 12.5 mg IV. The diphenhydramine vial reads 50 mg/mL. How many mL will the nurse administer?
24. Andi is GBS positive and has a severe allergy to penicillin. The obstetrician orders vancomycin IVPB 20 mg/kg every 8 hours until delivery. Andi weighs 187 lbs.
• What is the appropriate dose for Andi?
• The vancomycin arrives from the pharmacy diluted in 500 mL NS to be administered over 3 hours. At what rate will the nurse set the pump? Round to the nearest 0.01 mL/hr.