A patient's potassium is 2.9 mmol/L. The order reads KCl 40 mmol in 500 mL 0.9% saline over 1 hour through a peripheral cannula. Hospital policy limits peripheral KCl to 10 mmol/hour. What should the nurse do?

Hold it and clarify the order, as 40 mmol/h is 4 times the limit

Give as ordered, but through a large forearm vein

Give as ordered, because the potassium is low

Give as ordered, with the patient on a cardiac monitor

A woman with severe pre-eclampsia is on maintenance magnesium sulphate. Before the next dose, her knee jerk is absent, RR is 15/min and urine output has been 120 mL in the last 4 hours. What should the nurse do?

Withhold the dose and inform the doctor

Give the dose and recheck the reflex in 4 hours

Give half the dose and repeat the reflex

Give the dose, as RR is above 12/min

Obstetric drugs, IV fluids and electrolytes

8 AIIMS NORCET (Nursing Officer) practice questions on Obstetric drugs, IV fluids and electrolytes, part of Pharmacology. The first 8 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A woman with severe pre-eclampsia has a postpartum haemorrhage from uterine atony. Which uterotonic should be avoided?
1. AMisoprostol
2. BMethylergometrine
3. COxytocin
4. DCarboprost
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Answer: B · Methylergometrine
Methylergometrine contracts vascular smooth muscle as well as the uterus, so it can cause a sharp rise in BP, stroke or eclampsia in a hypertensive woman. It is contraindicated in pre-eclampsia, hypertension and heart disease. Oxytocin is the first-line uterotonic, and misoprostol or carboprost can be added. Carboprost is avoided in asthma, which is not the issue here.
- A: Misoprostol does not raise BP and can be used.
- C: Oxytocin is the first-line drug for PPH and is safe in pre-eclampsia.
- D: Carboprost is avoided in asthma, not in hypertension.
Question 2 · Hard
A patient's potassium is 2.9 mmol/L. The order reads KCl 40 mmol in 500 mL 0.9% saline over 1 hour through a peripheral cannula. Hospital policy limits peripheral KCl to 10 mmol/hour. What should the nurse do?
1. AGive as ordered, but through a large forearm vein
2. BHold it and clarify the order, as 40 mmol/h is 4 times the limit
3. CGive as ordered, because the potassium is low
4. DGive as ordered, with the patient on a cardiac monitor
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Answer: B · Hold it and clarify the order, as 40 mmol/h is 4 times the limit
The ordered rate is 40 mmol in 1 hour, which is four times the 10 mmol/hour peripheral limit in this policy. Rapid potassium can cause fatal arrhythmias and severe pain and phlebitis in a peripheral vein. The nurse does not give it and contacts the prescriber to correct the rate (for example over at least 4 hours). Higher rates need a central line and continuous ECG monitoring in a critical-care setting.
- A: A larger vein does not remove the arrhythmia risk of too fast a rate.
- C: A low potassium does not make an unsafe infusion rate safe.
- D: Monitoring alone does not make four times the policy rate acceptable on a peripheral line.
Question 3 · Medium
A woman with severe pre-eclampsia is on maintenance magnesium sulphate. Before the next dose, her knee jerk is absent, RR is 15/min and urine output has been 120 mL in the last 4 hours. What should the nurse do?
1. AWithhold the dose and inform the doctor
2. BGive the dose and recheck the reflex in 4 hours
3. CGive half the dose and repeat the reflex
4. DGive the dose, as RR is above 12/min
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Answer: A · Withhold the dose and inform the doctor
The patellar reflex disappears early in magnesium toxicity, before respiratory depression. The usual checks before each maintenance dose are a present knee jerk, a respiratory rate of at least 16/min and urine output of at least 30 mL/hour (100 mL in 4 hours). Here the reflex is absent and the respiratory rate is low, so the dose is withheld and the doctor informed. Calcium gluconate is kept ready.
- B: Giving more magnesium with lost reflexes risks respiratory arrest.
- C: Any further dose is held until toxicity is ruled out, not reduced by half.
- D: An absent knee jerk is itself a reason to withhold the dose.
Question 4 · Medium
During oxytocin induction, a woman has 6 contractions in 10 minutes and the fetal heart rate shows late decelerations. What is the nurse's first action?
1. ATurn her flat on her back
2. BStop the oxytocin infusion
3. CPerform an amniotomy
4. DHalve the rate and observe
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Answer: B · Stop the oxytocin infusion
More than 5 contractions in 10 minutes is tachysystole, which reduces placental blood flow, and late decelerations show fetal hypoxia. Stopping the oxytocin is the first step, because its half-life is short and contractions ease within minutes. The woman is turned onto her left side, given oxygen and IV fluids, and the doctor is called; a tocolytic such as terbutaline may be ordered. Continuous CTG is maintained.
- A: Lying supine compresses the vena cava and worsens fetal hypoxia.
- C: Amniotomy augments labour and does not relieve hyperstimulation.
- D: Halving the rate leaves the drug acting while the fetus is hypoxic.
Question 5 · Easy
A woman at 30 weeks is in threatened preterm labour. Which drug may be given as a tocolytic to delay delivery?
1. ANifedipine
2. BOxytocin
3. CMethylergometrine
4. DMisoprostol
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Answer: A · Nifedipine
Nifedipine is a calcium-channel blocker that relaxes uterine smooth muscle, and it is a widely used oral tocolytic in India. Tocolysis aims to delay delivery for about 48 hours, so that antenatal corticosteroids can mature the fetal lungs and the woman can be moved to a centre with a NICU. The nurse watches for hypotension, flushing, headache and tachycardia. Misoprostol, oxytocin and methylergometrine all stimulate the uterus.
- B: Oxytocin induces and augments contractions.
- C: Methylergometrine causes sustained uterine contraction and is used for PPH.
- D: Misoprostol is a prostaglandin that ripens the cervix and contracts the uterus.
Question 6 · Easy
Which of these IV fluids is a colloid?
1. A0.9% sodium chloride
2. B5% dextrose
3. CHuman albumin 5%
4. DRinger lactate
Answer and explanation in LearnFree account
Question 7 · Hard
A 10 mL ampoule of 15% w/v potassium chloride is to be added to a bag. Taking the molar mass of KCl as 74.5 g/mol, about how many mmol of potassium does the ampoule contain?
1. A10 mmol
2. B40 mmol
3. C20 mmol
4. D15 mmol
Answer and explanation in LearnFree account
Question 8 · Medium
Which IV fluid should be avoided in a patient with a head injury and raised intracranial pressure?
1. A3% hypertonic saline
2. BRinger lactate
3. C0.9% sodium chloride
4. D5% dextrose in water
Answer and explanation in LearnFree account

Obstetric drugs, IV fluids and electrolytes

A woman with severe pre-eclampsia has a postpartum haemorrhage from uterine atony. Which uterotonic should be avoided?

A patient's potassium is 2.9 mmol/L. The order reads KCl 40 mmol in 500 mL 0.9% saline over 1 hour through a peripheral cannula. Hospital policy limits peripheral KCl to 10 mmol/hour. What should the nurse do?

A woman with severe pre-eclampsia is on maintenance magnesium sulphate. Before the next dose, her knee jerk is absent, RR is 15/min and urine output has been 120 mL in the last 4 hours. What should the nurse do?

During oxytocin induction, a woman has 6 contractions in 10 minutes and the fetal heart rate shows late decelerations. What is the nurse's first action?

A woman at 30 weeks is in threatened preterm labour. Which drug may be given as a tocolytic to delay delivery?

Which of these IV fluids is a colloid?

A 10 mL ampoule of 15% w/v potassium chloride is to be added to a bag. Taking the molar mass of KCl as 74.5 g/mol, about how many mmol of potassium does the ampoule contain?

Which IV fluid should be avoided in a patient with a head injury and raised intracranial pressure?