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The Safe Administration of Medication

Exam (SAME) is designed to assess


your ability to safely prepare medications
and calculate drug dosages.

SAME
Safe Administration of
Medications Exam
A Review of Dosage Calculations,
Preparation, and Administration
Version 2.1

Created by Dean N. Haspela BS,CES; BS,RN


University of Massachusetts Boston
College of Nursing and Health Sciences
SAME version 2.1.
Haspela 2004

Success on the SAME depends on


learning from the text book,
attendance at a med/math review session
and review with this packet.
For information about med/math review sessions:
Look online at www.cnhs.umb.edu,
check your email, or the bulletin boards
outside of CNHS.
Table of Contents
Math Review
Fractions, Decimals, and Rounding
Conversions
Ratio-Proportions
Basic Problem Solving and Resources
Adult Medication Administration Review
Oral Medications: Tablets and Capsules
Oral Medications: Liquids and Elixers
Injections: Types, Sizes, Amounts, Sizes
Injections: Calculations
Intravenous Medications: Drip and Pump Rates
Pediatrics
Conversions
24 Hour Dose Calculations
Divided Doses
Therapeutic Ranges
Basic Problem Solving and Salient Pediatric Tips
Pediatric IV Calculations..
Reconstitution
Appendix
Prohibited Medical Abbreviations
Answers to Practice Problems..

2-4
5
6
7
8-11
12-13
14-15
16-17
18-21
23-24
25
26
27
28
29
30
31
32-68

-1-

Fractions and Decimals


Nurses need to understand fractions to be able to understand
and implement medication orders.
A fraction is used to describe a portion of a number.
For example: 1/8 means 1 of 8 pieces
5/60 means 5 of 60 pieces
Remember that any number over the same number is equal to
one.
For example: 60/60 = 1
4/4 = 1
Remember that any number over 1 is equal to that number.
For example: 60/1 is the same as 60
25/1 = 25
You can convert a fraction into a decimal by dividing the
bottom number (denominator) into the top number
(numerator).
For example: 1/2 = 0.5 because 2 goes into 1
0.5 times or 1 divided by 2 is
equal to 0.5
1/4 = 0.25 because 4 goes into 1
0.25 times or 1 divided by 4 is
equal to 0.25

Example
3/25 is equal to ____ of 25 pieces?
The numerator describes how many parts there are in
the denominator. So, 3/25 means 3 of 25 pieces.
250/250 is equal to ____?
Any number over that same number is equal to 1. So,
250/250 = 1.
1/4 is equal to:
a) 4 b) 0.5 c) 1 d) 0.25
A fraction can be expressed as a decimal by dividing
the denominator into the numerator. So, when you
divide 4 into 1 you get d) 0.25

You Try
1) 2/50 is equal to ____.
2) 4/1 is equal to ____.
3) 60/60 is equal to ____.
4) 1/2 is equal to ____.
5) 25/400 is equal to ____.
6) 15/60 is equal to ____.

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Haspela 2004

-2-

Decimals

Example

When you are working with decimals you should think of the
decimal point as the divider between whole amounts and
fractional amounts.
X
X
X
X
.
X
X
X
X
Ten thousandths

Thousandths

Hundreths

Tenths

Decimal Point

Ones

Tens

Hundreds

Thousands

If you multiply any number by 10 the result is the same as


moving the decimal place to the right one place.
For example: 250.50 x 10 = 2505.0

If you multiply any number by 100 you will need to


move the decimal point 2 places to the right.
If you multiply any number by 1000 you will need to
move the decimal point 3 places to the right.

If you divide any number by 10 the result is the same as


moving the decimal place to the left one place
For example: 125.25 / 10 = 12.525

125.00 x 10 = 1250.0
325.50 / 10 = 32.550
450.677 x 1000 = 450677
1546.286 / 1000 = 1.546286
Hint: Let the zeros be your guide.
When multiplying by a factor of 10 (10, 100, 1,000, 10,000,
etc) the number of spaces the decimal point moves is equal
to the number of zeros you see after the one.
Just remember that divide means
to the left and multiply means to the right!

You Try
7) 350.60 x 10 = ____.
8) 4.256 / 100 = ____.
9) 500 / 1000 = ____.
10) 125.5 x 100 = ____.

If you divide any number by 100 you will need to


move the decimal point 2 places to the left.
If you divide any number by 1000 you will need to
move the decimal point 3 places to the left.

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Haspela 2004

-3-

Rounding
Sometimes a number has many numbers to the right of the
decimal point. So, we use rounding to make the number easier
to use.
Remember: in this review packet we always use decimals out
to the hundredths point. Any result that has thousandths or
more needs to be rounded.
For example: 10.054 needs rounding
255.25 does not need rounding
Look for the thousandths.
Find the number in the thousandths place. This is
the number that is 3 places to the right of the
decimal place.
Round UP: round up if the number is greater than
or equal to 5
Round DOWN: round down if the number is less
than 5. When you decide to round down the
number in the hundredths place just stays the
same.

Examples

2.256 = 2.26
You round up in this example. The 6 is in the
hundredths place and is greater than or equal to
5soround the 5 up to a 6 and the answer is 2.26.

Example
100.257 needs to be rounded up to 100.26
1.24 is a number out to the hundredths so it should not be
rounded
2.542 needs to be rounded down to 2.54
60.255 needs to be rounded up to 60.26

You Try
11) 500.259 = ____.
12) 285.001 = ____.
13) 1.2555 = ____.
14) 45.509 = ____.

10.542 = 10.54
You round down in this example. The 2 is in the
hundredths place and is less than 5sothe 4
that is in hundredths place stays the same and the
answer is 10.54.
SAME version 2.1.
Haspela 2004

-4-

Conversions
Medications are often ordered in larger or smaller units than
those held in stock. So, as a nurse you will need to convert
metric units.
1 gram (g) = 1000 milligrams (mg)
1 milligram (mg) = 1000 micrograms (mcg)
1 microgram (mcg) = 0.001 milligrams (mg)
1 milligram (mg) = 0.001 gram (g)
The nurse will frequently need to convert metric
measurements into household measurements to help patients
understand how to take medications or so that the nurse can
understand what the patient is describing.
2.2 pounds (lb) = 1 kilogram(kg)
1 tablespoon (tbsp) = 15 milliliters(ml)
3 teaspoons(tsp) = 15 milliliters(ml)
1 cup(C) = 240 milliliters(ml)
8 ounces(oz) = 240 milliliters(ml)
1 teaspoon(tsp) = 5 milliliters(ml)
1 cup(C) = 8 ounces(oz)
16 ounces(oz) = 1 pound(lb)
1 ouncs(oz) = 30milliliters(ml)
DONT FORGET!!
When referring to volumes you
will see cc and/or ml REMEMBER that 1ml = 1cc.
You will see these units used interchangeably.

Example
ORDER:
STOCK:
GIVE:

Give 0.005mg levothyroxine PO once daily


10mcg tablets of levothyroxine
tablet one daily by mouth

ORDER:
STOCK:
GIVE:

Give 2T tussin PO every eight hours


500ml bottle of tussin
30ml every 8 hours by mouth

ORDER:
STOCK:
GIVE:

Give 0.5mg lorazepam PO three times a day


1mg tablets of lorazepam
tablet of lorazepam 3 times a day by mouth

Your patient says they weigh 124 pounds. How many


kilograms is this? 124lbs/ 2.2 = 56.36kg

You Try
15) How many pounds is 60kg?
16) How many kg is 225lbs?
17) How many ml are there in cup?
18) How many ml are there in 4oz.?
19) How many mg are there in 24g?
20) How many mcg are there in 0.5mg?

THROUGHOUT THIS PACKET WE WILL USE ml

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-5-

Ratio-Proportions
A ratio is a comparison of two numbers. For example, the
ratio of 1 to 4 is most often represented by the fraction .
Another example of a ratio is 5 to 6 and this is most often
represented by the fraction 5/6.
A ratio might be used by a nurse to explain a relationship
between two things. For example, for every 1 tablet there are
5 milligrams. This might be written as a ratio like this:
1 tab
5mg
When two ratios are compared to each other it is called a
proportion. A proportion looks like two fractions with an
equal sign between them. A proportion might look like this:
1
= 4
4
16
Remember because there is an equal sign between the
two fractions the fractions are equal to each other. In the
above example this means that is equivalent to 4/16.
If one piece of information is missing you can use a
proportion to solve a problem by cross-multiplying.
For example:
QUESTION: In one pill there are 4mg.
So, how many pills make 16 mg?
= X_
1) Set up a proportion
1
like this
4
16
2) Cross multiply like this: (4) x (X) = (1) x (16)
3) Solve for X like this:
4) The answer is then:
SAME version 2.1.
Haspela 2004

Example
In 3mL there are 6mg of Morphine Sulfate. How many mg
are there in 1mL?
1) Set up a proportion
3ml
= 1ml_
like this:
6mg
Xmg
2) Cross multiply like this: (3) x (X) = (1) x (6)
3) Solve for X like this:
4) The answer is then:

X = (1) x (6)
3
X=2

REMEMBER: When you are setting up a proportion


the units of numerators must match and the units of
the denominators must match. If they dont you CAN
NOT proceed. In the above example ml is the
numerator in both ratios and mg is the denominator in
both ratios.

You Try
21) How many mg are in 3ml if 1ml has 5mg?
22) If there are 25mg in one tablet then how many mg are
there in 3 tablets?
23) In one tablet there is 100mg. How many pills make up
50mg?
24) How many mg are there in 10ml if 1ml has 2.5mg?

X = (1) x (16)
4
X=4
-6-

Basic Problem Solving and Resources


There are 4 basic steps to solving any medication problem.
1)
2)
3)
4)

Read.
Stop & Think.
Solve.
Check & Question.

READ

Read the whole question or


medication order.
STOP & THINK What is this question asking?
What is the order asking to administer?
Is the order complete?
Is there missing or extra information?
SOLVE
Solve the problem by using the
correct formula or proportion.
Go slow. Write out your work.
Check your answer for accuracy.
CHECK &
QUESTION
Does the answer make sense?
Is the answer feasible?
Use common sense.

Example

A nurse draws up 50 units of regular insulin into a syringe


and has another nurse verify that it was done correctly
prior to administration.

A nurse calculates the rate to set an IV pump at. Before


starting the pump she has a pharmacist verify that the rate
calculation is correct.

A nurse reads a medication order and determines that 12


tablets need to be given. Because this number seems odd
and unlikely, she checks a drug reference book and finds
that the order was written incorrectly. The ordering
physician is then contacted to correct and clarify the
incorrectly written order.

There are many resources available to you to help check and


question your answers. Some of these include:

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Haspela 2004

Drug Reference Books


Physicians Desk Reference (PDR)
Pharmacy/Pharmacist
Checking with another Nurse
Checking with a Clinical Instructor

In fourteen-hundred-ninety-two
Columbus sailed the ocean blue.
How did he get so smart anyway?
He did it by following basics of problem solving. He
thought about his questions, solved them carefully, and
was not afraid to question the feasibility of his answers.

-7-

Oral Medications: Tablets and Capsules


Ratio-Proportion Method
The oral form of medications is the most commonly
prescribed type. It includes tablets, capsules, and liquid
medications.

Example
ORDER:
Decadron 1.5mg PO twice a day
STOCK:
tablets labeled 0.75mg
How many tablets do you administer?

The safest practice is to administer the fewest number


of undivided tablets as possible.
Capsules are not intended to be cut or split. The
capsule dose must match the ordered dose.

1) Set up a proportion
like this
2) Cross multiply like this:
3) Solve for X like this:

You can solve tablet and capsule problems by using ratios and
proportions.
REMEMBER: When you are setting up a proportion
the units of numerators must match and the units of
the denominators must match. If they dont you CAN
NOT proceed. (i.e. you might need to convert grams
to milligrams or pounds to kilograms so that the units
will match)
For example:
ORDER:
STOCK:

50mg Toprol XL PO once daily


Toprol XL tablets labeled 25mg

3) Solve for X like this:


4) The answer is then:

X = (1) x (50)
25
X = 2 tablets

X = (1) x (1.5)
0.75
X = 2 tablets

You Try
25.

1) Set up a proportion
1 tab
= X tab_
like this
25mg
50mg
2) Cross multiply like this: (25) x (X) = (1) x (50)

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Haspela 2004

4) The answer is then:

_1 tab
= X tab_
0.75mg
1.5mg
(0.75) x (X) = (1) x (1.5)

26.
27.
28.

ORDER:
prednisone 10mg PO three times a day
STOCK:
tablets labeled 2.5mg
How many tablets do you administer?
ORDER:
Tylenol 650mg PO every eight hours
STOCK:
tablets labeled 325mg
How many tablets do you administer?
ORDER:
digoxin 0.125mg PO at 4pm daily
STOCK:
tablets labeled 0.25mg (scored)
How many tablets do you administer?
ORDER:
diphenhydramine 50mg PO every 8
hours
STOCK:
capsules labeled 25mg
How many capsules do you administer?

-8-

Oral Medications: Tablets and Capsules


Formula Method
Some people prefer to use a formula instead of using the
ratio-proportion method. This page shows you how to do the
exact same problems/examples by using a formula.

Example
ORDER:
Decadron 1.5mg PO twice a day
STOCK:
tablets labeled 0.75mg
How many tablets do you administer?
_D_ x Q = Correct dose to administer
H

Regardless of using the ratio-proportion method or the


formula method you will get the exact same answer. Try
both ways and then stick with the one that works best for you.

1.5mg x 1 whole tablet = 2 tablets


0.75mg
ANSWER:

The formula that you will need is:


_D_ x Q = Correct dose to administer
H
D = Desired dose or doctors order
H = The strength that you have or
the strength on the container
Q = The unit the drug is manufactured in
Consider this example
ORDER:
STOCK:

50mg Toprol XL PO QD
Toprol XL tablets labeled 25mg
50mg x 1 whole tablet = 2 tablets
25mg

The answer is: administer 2 tablets of Toprol XL by mouth


once daily.

SAME version 2.1.


Haspela 2004

Administer 2 tablets twice a day by mouth

Tip: Q or the unit the drug comes in will


always be 1 when using tablets or capsules.
The stock for oral solid drugs is always 1.

You Try
29.
30.
31.
32.

ORDER:
prednisone 10mg PO three times a day
STOCK:
tablets labeled 2.5mg
How many tablets do you administer?
ORDER:
Tylenol 650mg PO every 8 hours
STOCK:
tablets labeled 325mg
How many tablets do you administer?
ORDER:
digoxin 0.125mg PO at 4pm daily
STOCK:
tablets labeled 0.25mg (scored)
How many tablets do you administer?
ORDER:
diphenhydramine 50mg PO every 8
hours
STOCK:
capsules labeled 25mg
How many capsules do you administer?

-9-

Oral Medications: Tablets and Capsules


Formula Method
Did you notice something about all the examples on the last 2
pages? All the measurements were in the same system of
measure. Unfortunately, when nurses interpret drug orders the
units ordered may not match the units you have on hand.
Consider this problem
ORDER:
synthroid 300mcg PO once a day
STOCK:
tablets labeled 0.1mg (scored)
How many tablets will you administer?
Notice that the units ordered are in mcg and the units in stock
are mg. Before you can use the formula you must first convert
into the same units of measure. You can do this by using a
proportion.
First,
Second,

ORDER:
synthroid 300mcg PO once daily
STOCK:
tablets labeled 0.1mg (scored)
How many tablets will you administer?
First, convert to same units of measure
1000mcg = X mcg
1mg
0.1mg

cross multiply like this

_D_ x Q = Correct dose to administer


H
300mcg x 1 whole tablet = 3 tablets
100mcg
ANSWER:
Administer 3 tablets once a day by mouth

You Try
33.
34.

(1000mcg) x (0.1mg) = (1mg) x (X mcg)


Fourth,

Solve for X like this

Fifth,

(1000 mcg) x (0.1mg) = X = 100 mcg


1mg

Sixth,

Now that the units are in the same measure you


can use the formula to get the answer - just
like you did on the last page. (See example to
the top right)

SAME version 2.1.


Haspela 2004

then.1000 mcg x 0.1mg = X = 100 mcg


1mg

Now that the units are the same you can solve the problem. If
you use the formula is will look like this:

remember that there are 1000mcg in 1 mg.


set up a proportion to solve for x like this
1000mcg = X mcg
1mg
0.1mg

Third,

Example

35.
36.

ORDER:
amoxicillin 1.5g PO every 8 hours
STOCK:
capsules labeled 250mg
How many capsules do you administer?
ORDER:
ethchlorvynol 2000mg PO at bedtime
STOCK:
capsules labeled 1g
How many capsules do you administer?
ORDER:
digoxin 0.5mg PO once a day
STOCK:
tablets labeled 125mcg
How many tablets do you administer?
ORDER:
carvedilol 6.25mg PO twice a day
STOCK:
capsules labeled 6250mcg
How many capsules do you administer?

- 10 -

Oral Medications: Tablets and Capsules


Ratio-Proportion Method
Once again you can solve using either the ratio-proportion
method or the formula method. This page uses the exact same
examples as on the last page but uses the ratio-proportion
method to solve.
Consider this problem
ORDER:
synthroid 300mcg PO once a day
STOCK:
tablets labeled 0.1mg (scored)
How many tablets will you administer?

Example
ORDER:
synthroid 300mcg PO once daily
STOCK:
tablets labeled 0.1mg (scored)
How many tablets will you administer?
First, convert to same units of measure
1000mcg = X mcg
1mg
0.1mg

Now that the units are the same you can solve the problem. If
you use the ratio-proportion method is will look like this:
1) Set up a proportion
like this
2) Cross multiply like this:

Notice that the units ordered are in mcg and the units in stock
are mg. Before you can use the formula you must first convert
into the same units of measure. You can do this by using a
proportion.
First,
Second,

remember that there are 1000mcg in 1 mg.


set up a proportion to solve for x like this
1000mcg = X mcg
1mg
0.1mg

Third,

cross multiply like this


1000mcg x 0.1mg = 1mg x X mcg

Fourth,

Solve for X like this

Fifth,

1000 mcg x 0.1mg = X = 100 mcg


1mg

Sixth,

Now that the units are in the same measure you


can use the formula to get the answer - just
like you did on the last page. (See example to
the top right)

SAME version 2.1.


Haspela 2004

then.1000 mcg x 0.1mg = X = 100 mcg


1mg

_1 tab
= X tab_
100mcg
300mcg
(100) x (X) = (1) x (300)

3) Solve for X like this:

X = (1) x (300)
100

4) The answer is then:

X = 3 tablets

You Try
37.
38.
39.
40.

ORDER:
amoxicillin 1.5g PO every 8 hours
STOCK:
capsules labeled 250mg
How many capsules do you administer?
ORDER:
ethchlorvynol 2000mg PO at bedtime
STOCK:
capsules labeled 1g
How many capsules do you administer?
ORDER:
digoxin 0.5mg PO once daily
STOCK:
tablets labeled 125mcg
How many tablets do you administer?
ORDER:
carvedilol 6.25mg PO twice daily
STOCK:
capsules labeled 6250mcg
How many capsules do you administer?

- 11 -

Oral Medications: Liquids and Elixers


Ratio-Proportion Method
Calculations for liquids and elixirs can be solved in the same
manner as with tablets and capsules. You can use either the
ratio-proportion method or the formula method.
On this page we review the ratio-proportion method. Dont
forget to make sure that the units in the numerators are the
same and the units in the denominators are the same.
Consider this example

Example
ORDER:
amoxicillin oral suspension 500mg PO Q8H
STOCK:
amoxicillin oral suspension 1g per 10ml
How many ml do you administer?
First, convert to same units of measure:
1000mg = X mg
1g
1g

Then, solve the problem using the formula


= X ml_
1) Set up a proportion
_10ml
like this
1000mg
500mg
2) Cross multiply like this: (1000)x(X) = (10)x(500)

ORDER:
cloxacillin sodium 0.25g PO every 6 hours
STOCK:
cloxacillin sodium 125mg per 5ml
How many ml do you administer?
First, convert to same units of measure
1000mg = X mg
1g
0.25g

then.1000mg x 0.25g = X = 250mg


1g

3) Solve for X like this:


4) The answer is then:
41.

Then, solve the problem using the ratio-proportion method:


1) Set up a proportion
_5ml
= X ml_
like this
125mg
250mg
2) Cross multiply like this: (125) x (X) = (5) x (250)
3) Solve for X like this:
4) The answer is then:

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Haspela 2004

X = (5) x (250)
125
X = 10 ml

then.1000mg x 1g = X = 1000mg
1g

42.

43.

44.

X = (10) x (500)
1000
X = 5 ml

You Try
hydrocortisone cypionate oral
suspension 0.03g PO every 6 hours
STOCK:
liquid labeled 10mg per 5ml
How many ml do you administer?
ORDER:
cephalex in oral suspension
0.35g PO every 6 hours
STOCK:
liquid labeled 125mg per 5ml
How many ml do you administer?
ORDER:
erythromycin susp. 0.75g PO 4 times
a day
STOCK:
liquid labeled 250mg per 5ml
How many ml do you administer?
ORDER:
penicillin V potassium 0.6g PO
every 6 hours
STOCK:
liquid labeled 250mg per 5ml
How many ml do you administer?

ORDER:

- 12 -

Oral Medications: Liquids and Elixers


Formula Method
This page presents the exact same examples and practice
problems as on the last page, but uses the formula method
instead of the ratio-proportion method.
The formula that you will need is:
_D_ x Q = Correct dose to administer
H
D = Desired dose or doctors order
H = The strength that you have or
the strength on the container
Q = Unit the drug is manufactured in
Remember: When calculating doses for liquids and elixirs
the unit that the drug comes in (Q) will change. Read the
label to determine these values. (An example of this
might be 10mg in 2ml or 250mg in 500ml)
Consider this example.
ORDER:
cloxacillin sodium 0.25g PO every 6 hours
STOCK:
cloxacillin sodium 125mg per 5ml
How many ml do you administer?

Example
ORDER:

amoxicillin oral suspension 500mg PO every 8


hours
STOCK:
amoxicillin oral suspension 1g per 10ml
How manyml do you administer?
First, convert to same units of measure
1000mg = X mg
1g
1g

Then, solve the problem using the formula


500mg x 10ml = 5ml
1000mg
ANSWER:
45.

46.

47.

First, convert to same units of measure


1000mg = X mg
1g
0.25g

then.1000mg x 0.25g = X = 250mg


1g

Then, solve the problem using the formula


250mg x 5ml = 10ml
125mg
SAME version 2.1.
Haspela 2004

then.1000mg x 1g = X = 1000mg
1g

48.

Administer 5ml of the oral suspension by

You Try
hydrocortisone cypionate oral
susp. 0.03g PO once every 6 hours
STOCK:
liquid labeled 10mg per 5ml
How many ml do you administer?
ORDER:
cephalex in oral suspension
0.35g PO every 6 hours
STOCK:
liquid labeled 125mg per 5ml
How many ml do you administer?
ORDER:
erythromycin susp. 0.75g PO 4 times
a day
STOCK:
liquid labeled 250mg per 5ml
How many ml do you administer?
ORDER:
penicillin V potassium 0.6g PO every
6 hours
STOCK:
liquid labeled 250mg per 5ml
How many ml do you administer?

ORDER:

- 13 -

Injections: Types, Sizes, Amounts, and Sites

Example
1) True or False: Administer 2ml IM to a 2 month old infant.

All syringes generally have the same appearance. The parts


include:
Syringe itself with gradations/lines on it
Needle (some screw on or push on)
Plunger
Safety guard (some needles have a system that covers
the needle after its use to prevent needle sticks)
Remember that different syringes
have different gradations!

Answers: 1) F 2) F 3) T 4) T 5) F 6) F

Heres a look at syringes based on


sites, sizes, and volumes.

SQ

IM

ID
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Haspela 2004

Syringe
Size

Needle
Guage

Needle
Length

Maximum
Injectable
Volume

1ml, U50
insulin, or
U100 insulin
syringes

25 27
guage

3/8 5/8
inches

0.5 1ml

1 1
inches

Adult:3ml
Child or
small
adult:2ml
Small
children:1ml

2-5ml for
adult and 12ml for child

19 23
guage

1ml tuberculin
syringe

26 27
guage

3/8 5/8
inches

2) True or False: Administer 1.5ml IM with a 1 inch, 26


guage needle.
3) True or False: Administer 0.25ml SQ with a 3/8 inch
needle that is 26 guage
4) True or False: Administer 0.5ml IM with a 1 inch
20 guage needle
5) True or False: Administer 0.5ml ID with a 3/8 inch
needle that is 26 guage
6) True or False: Administer 3ml to an adult with a 1ml
syringe that is 1 inch in length and 19 guage

0.1 0.3 ml

You Try
49.

True or False:
Administer 1ml SQ with a 5ml syringe that is 3/8
inches and 26 guage

50.

True or False:
Administer 25units insulin with a U100 syringe that is
3/8 inches in length and 27 guage

51.

True or False:
Administer a TB test by injecting 0.2ml of test
solution with a 1ml tuberculin syringe that is 5/8
inches in length and 26 guage

52.

True or False:
Administer 3ml SQ to an adult using a 1 inch
needle that is 20 guage
- 14 -

Injections
Liquid medications are sterile solutions or suspensions.
Sterile technique must be maintained when preparing
injections. Each syringe has different gradations on it.

Example
2.5ml is marked on the following syringe.

In a 1ml syringe, each gradation equals 0.01ml.


0.25ml is marked on the following syringe.

In a 3ml syringe, each gradation equals 0.1ml.

88 Units is marked on the following syringe.

You Try
Insulin syringes come in two types. Each line in a U-50
syringe is equal to 1 unit and the whole syringe holds 0.5ml.
Each line in a U-100 syringe is equal to 1 unit and the whole
syringe holds 1ml.

53. Mark 1.2ml on the following syringe.

54. Mark 12 units on the following syringe.

55. Mark 0.75ml on the following syringe

Please note that due to computerized formatting the


lines on some of these examples may be inaccurate.

SAME version 2.1.


Haspela 2004

- 15 -

Injections: Ratio-Proportion Method


You can use either the ratio-proportion method or the formula
method to solve injection problems. This page demonstrates
the ratio-proportion method. Try it this way and then try it
using the formula method on the next page. Choose the one
that works the best for you and stick with that one method.
ORDER:
STOCK:

X = (1) x (5)
10

4) The answer is then:

X = ml or 0.5ml

Administer 0.5ml of intramuscular morphine


sufate. Select a 1 to 3 ml syringe for precision.

Tip: Selecting the Correct Syringe Sizes.


The best syringe to use will closely match the
volume of fluid you are administering.
Remember that the degree of accuracy when
calculating injections is based on the syringe
used.
Only use large syringes with large volumes.
Larger syringes have fewer gradation lines and
therefore are less precise.
Only use small syringes with small volumes.
Smaller syringes have more gradation lines and
therefore are able to deliver very precise
amounts.

SAME version 2.1.


Haspela 2004

1) Set up a proportion
like this
2) Cross multiply like this:

1 ml
= X ml_
10mg
5mg
(10) x (X) = (1) x (5)

3) Solve for X like this:

ORDER:
metoprolol 25mg IV push stat
STOCK:
ampule labeled 50mg per 5 ml
How many ml will you draw up into a syringe?
What size syringe is ideal?

5mg Morphine Sulfate IM


liquid labeled 10mg per 1ml

1) Set up a proportion
like this
2) Cross multiply like this:

ANSWER:

Example

5 ml
= X ml_
50mg
25mg
(50) x (X) = (5) x (25)

3) Solve for X like this:

X = (5) x (25)
50

4) The answer is then:

X = 2.5 ml

ANSWER:

Administer 2.5 ml of metoprolol IV push now.


Use a 3ml syringe.

You Try
56.

ORDER: meperidine 75mg IM every 4 hours


STOCK: meperidine 50mg per ml
How many ml will you draw up into a syringe?

57.

ORDER: phenergan 15mg IM every 4-6 hours PRN;


nausea
STOCK: PHENERGAN 50mg per ml
How many ml will you draw up into a syringe?

58.

ORDER: nebcin 60mg IV every 8 hours


STOCK: nebcin 80mg per 2ml
How many ml will you draw up into a syringe?

59.

ORDER: vitamin B12 1000micrograms IM once a day


STOCK: vitamin B12 5000 micrograms per 1ml
How many ml will you draw up into a syringe?
- 16 -

Injections: Formula Method


This page shows the exact same examples as on the last page
but it uses the formula method to solve the problems.
The formulas that you will need is:
_D_ x Q = Correct dose to administer
H
D = Desired dose or doctors order
H = The strength that you have or
the strength on the container
Q = Unit the drug is manufactured in
ORDER:
STOCK:

5mg Morphine Sulfate IM


liquid labeled 10mg per 1 ml

Example
ORDER:
metoprolol 25mg IV push stat
STOCK:
ampule labeled 50mg per 5 ml
How many ml will you draw up into a syringe?
What size syringe is ideal?
25mg x 5 ml = 2.5 ml
50mg
ANSWER:

Administer 2.5 ml of metoprolol IV push now

5mg x 1ml = 0.5 ml


10mg
ANSWER:

Administer 0.5 ml of intramuscular morphine


sufate. Select a 1 to 3 cc syringe for precision.

Tip: Selecting the Correct Syringe Sizes.


The best syringe to use will closely match the
volume of fluid you are administering.
Remember that the degree of accuracy when
calculating injections is based on the syringe
used.
Only use large syringes with large volumes.
Larger syringes have fewer gradation lines and
therefore are less precise.
Only use small syringes with small volumes.
Smaller syringes have more gradation lines and
therefore are able to deliver very precise
amounts.

SAME version 2.1.


Haspela 2004

You Try
60.

ORDER: meperidine 75mg IM every 4 hours


STOCK: meperidine 50mg per ml
How many mL will you draw up into a syringe?

61.

ORDER: phenergan 15mg IM every 4 6 hours


PRN; nausea
STOCK: PHENERGAN 50mg per ml
How many ml will you draw up into a syringe?

62.

ORDER: nebcin 60mg IV every 8 hours


STOCK: nebcin 80mg per 2ml
How many ml will you draw up into a syringe?

63.

ORDER: vitamin B12 1000micrograms IM once a day


STOCK: vitamin B12 5000 micrograms per 1 ml
How many ml will you draw up into a syringe?
- 17 -

Intravenous Medications: Drip Rates


Intravenous (IV) medications are more complex because they
require the nurse to administer the correct dosages over the
correct amount of time. One way to regulate the infusion of
an IV medication is by calculating the number of drops per
minute. This is called the drip rate.
An IV medication order usually includes three parts:
1) the type of medication to be administered
2) the volume of medication ordered
3) the amount of time the IV medication is to
be administered over (i.e. over 2 hours)
The formula you will need is:
_V_ x DF = Drip Rate
T
V = The volume ordered in ml
T = The number of minutes that the
infusion is to be completed in
DF = The drop factor (rate indicated on
the tubing you are using)
ORDER:
250 ml of NS over 60 minutes
TUBING:
15gtt/ml
What is the drip rate you will set?
Set up the problem using the formula above. 250 ml is the
volume. 60 min is the time in minutes. 15gtt/ml is the drop
factor of the tubing that you are using.
250ml x 15gtt = 62.5 or 63 gtt per minute
60min
1ml
ANSWER:
Adjust the roller clamp on the IV line to a rate
of 63 drops per minute. This will administer a
total of 250 ml in about 60 minutes.
SAME version 2.1.
Haspela 2004

Example
ORDER:
450ml of NS over 6 hours
TUBING:
15gtt/ml
What is the drip rate you will set?
First convert the hours to minutes like this:
6 hours x 60 minutes = 360 minutes
Then plug the numbers into the formula:
450 ml x 15gtt = 18.75 or 19 gtts per minute
360min
1ml
In this example the time (T) was 6 hours. Remember that you
need to convert this to minutes when plugging the numbers
into the formula. 6 hours x 60 minutes = 360 minutes.
The answer 18.75 gtts was rounded up to 19 gtts. You must
round the answer to the nearest whole number because it is
impossible to count fractions or portions of drops.

You Try
64.

ORDER:
2 L of NS over 24 hours
TUBING:
10gtt/ml
What is the drip rate you will set?

65.

ORDER:
250ml of NS over 30 minutes
TUBING:
15gtt/ml
What is the drip rate you will set?

66.

ORDER:

1 gram of Magnesium
Sulfate in 100ml of NS over 2 hrs
TUBING:
60gtt/ml
What is the drip rate you will set?

- 18 -

Intravenous Medications: Drip Rates


Frequently intravenous medication orders are written
to infuse over a large number of hours. This can make the
math difficult especially if you are unable to use a
calculator.
This page shows you how to simplify the numbers so
that the math is a bit easier. This is done by adding one step.
Lets consider this problem
ORDER:
450 ml of normal saline over 6 hours
TUBING:
15gtts / ml
What is the drip rate that you will set?
First.
Second.

Third.

Determine ml / hr like this:


450 ml = 75 ml / hour
6 hours
Use the formula that is shown on the last page:
_V_ x DF = Drip Rate
T
V = The volume ordered in ml
T = The time the infusion is to
occur over
DF = The drop factor (rate
indicated on the tubing)
75 ml x 15 gtts = 18.75 gtts
60 min
ml
min
Round 18.75 up to 19 gtts / min

REMEMBER: You can use the method described on this


page OR the method described on the last page. The only
difference is that there is less calculation to do. Pick the
one that is easier for you and stick with it!

SAME version 2.1.


Haspela 2004

Example
ORDER:
3000 ml of D10W over 24 hours
TUBING:
15 gtts / ml
What is the drip rate that you will set?
First.
Second.

Third.

Determine ml / hr like this:


3000 ml = 125 ml / hour
24 hours
Use the formula like this:
V_ x DF = Drip Rate
T
125 ml x 15 gtts = 31.25 gtts
60 min
ml
min
Round 31.25 down to 31 gtts / min

You Try
67. ORDER: 4000ml of Lactated Ringers over 24 hours
TUBING: 15 gtts / ml
What is the drip rate that you will set?
68. ORDER: 2000ml of Normal Saline over 10 hours
TUBING: 15 gtts / ml
What is the drip rate that you will set?
69. ORDER: 2000ml of Normal Saline over 6 hours
TUBING: 10 gtts / ml
What is the drip rate that you will set?
70. ORDER: 4000ml of Lactated Ringers over 48 hours
TUBING: 10 gtts / ml
What is the drip rate that you will set?
- 19 -

Intravenous Medications: Pump Rates


Pumps are frequently used in the hospital setting because they
safely administer a medication at a reliable and consistent
rate. Pumps offer the ability to strictly regulate the infusion.
The most common type of pump requires that you perform
calculations so that they determine the number of ml that are
infused over an hour. This is called the pump rate.

Example
ORDER:
150 ml of NS over 20 minutes
How many ml/hour will you set the pump at?
1) Use the formula like this:
150ml = Pump rate
20min
The answer is then 7.5 ml/minute.

IV medications to be administered with pumps


contain 3 parts:
1) the type of medication to be administered
2) the volume of medication ordered
3) the amount of time the IV medication is to
be administered over (i.e. over 2 hours)
The formula you will need is:
_V_ = Pump Rate
T
V = The volume ordered in ml
T = The number of hours that the
infusion is to be completed in
PR = Pump rate in ml/hour
ORDER:

NS 250ml IV over the next 2 hours by infusion


pump
250 ml
2 hours

ANSWER:

x ml
hour

x = 125 ml/hour. You should set the pump rate


to 125 ml per hour.

2) REMEMBER that the pump needs to be set


to ml/hour. The answer that we just got is
in ml/minute. You MUST convert to
ml/hour like this:

ANSWER:

7.5 ml x 60 minutes = 450ml


min
hour
Set the pump rate at 450 ml/hour. This will
administer 150 ml of NS over 20 minutes.

You Try
What would you set the pump rate (ml/hour) in the following
examples?
71.
ORDER:
1 gram of vancomycin over 60 minutes
STOCK:
2 grams of vancomycin in 500ml of NS
72.

ORDER:
STOCK:

2 grams of magnesium sulfate IV over


20 minutes
2000mg of magnesium sulfate in 100ml

73.

ORDER
STOCK:

50mg furosemide per hour IV


500mg furosemide in 250ml bag of NS

74.

ORDER:

cefmetazole 4grams IV over 30


minutes
cefmetazole 4 grams in 100ml of NS

STOCK:
SAME version 2.1.
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- 20 -

Intravenous Medications: Pump Rates

Example

Sometimes when you read an order for an IV medication that


requires the use of a pump you will first need to determine the
volume.

ORDER:
STOCK:

Consider this example


ORDER:
1000 units of heparin an hour
STOCK:
250ml bag containing 25,000 units of heparin

First determine how many ml you will need. Use a proportion


to figure this out:
_250 ml
= __X ml__
25,000 units
1300 units

First, remember the formula:


_V_ =
PR (ml/hr)
T
V = The volume ordered in ml
T = The number of hours that the
infusion is to be completed in
PR = Pump rate in ml/hour
Next, notice that first you must determine the volume (V)
ordered in ml. This order asks us to administer 1000 units of
heparin. Use a proportion to figure this out
_250 ml
= X ml_
25,000 units
1000 units
(250 ml) x (1000 units) = (25,000 units) x (X ml)
(250 ml) x (1000 units) = x
25,000 units

SAME version 2.1.


Haspela 2004

250 ml x 1300 units = 25,000 units x X ml


x = 13 ml
250 ml x 1300 units = x
25,000 units
Finally, plug in your answer to the formula above.
_13 ml_ = 13 ml/hour
1 hour

You Try
What would you set the pump rate (ml/hour) in the following
examples?
75.

ORDER:
STOCK:

76.

ORDER:
STOCK:

77.

ORDER:
STOCK:

78.

ORDER:

x = 10 ml

Finally, plug in your answer to the formula above.


_10 ml_ = 10 ml/hour
1 hour
ANSWER:
Set the pump at 10 ml / hour.

1300 units of Heparin an hour


250 ml bag containing 25,000 units of heparin

STOCK:

1200 units of heparin per hour


250 ml bag containing 25,000 units of
heparin
1550 units of heparin per hour
250 ml bag containing 25,000 units of
heparin
3 units an hour of insulin
100 units of insulin in 100 ml bag of NS
2 grams of Magnesium Sulfate over 2
hours
2 grams of Magnesium Sulfate in
100 ml of D5W
- 21 -

SAME
A Review of Dosage Calculations,
Preparation, and Administration
Version 2.1

PEDIATRIC FOCUS

Administration of medications to children and


infants can be tricky. Here are a few tips:
; Dont forget the 6 rights: patient, drug, dose, route,
time, documentation.
; With pediatrics, the dose is frequently based on
weight. This means that you may need to calculate the
correct dose of medication for each pediatric patient.
; Household measurements (like tbsp., cups, or ounces)
are frequently used. You may need to convert
measures to metric while doing calculations.
; Pediatric patients cant be expected to take the same
amounts of elixirs or the same size pills as adults. Find
out if the pharmacy has more appropriate pill and
elixir concentrations for your pediatric patients.
; Pediatric intravenous medications are calculated in the
same way that you calculate for an adult, except,
pediatrics frequently uses tubing that is 60gtts/ml
instead of 15gtts/ml or 10gtts/ml.

University of Massachusetts Boston


College of Nursing and Health Sciences
www.cnhs.umb.edu

SAME version 2.1.


Haspela 2004

; Pumps help the nurse to ensure precision in IV


medication administration to pediatrics. They are
commonly used.

- 22 -

PEDIATRICS: Conversions
Pediatric drug calculations commonly use household
measurement.
Therefore, it is important that the nurse understand how to
convert between household units and metric units.

Example
1. A mother says she gave her child 1 tablespoons of
robitussion. How many ml is this?
1 tbsp = 1.5 tbsp
15ml
Xml

(1.5) x (15)
1

22.5ml

2. A doctors order explains that a child should drink 240 ml


of Pedialyte 4 times a day. How might you easily tell a
parent to follow these instructions?
Remember these household conversions:
2.2 pounds (lbs) = 1 kilogram(kg)
16 ounces(oz) = 1 pound(lb)
1milliliter (ml) = 1cc
1 tablespoon (tbsp) = 15 milliliters (ml)
3 teaspoons(tsp) = 15 milliliters(ml)
1 cup(C) = 240 milliliters(ml)

Since there are 240 ml in one cup it might be


easier for a parent to know that their child
needs to drink 4 cups of Pedialyte a day
instead of 960 ml a day.

You Try
79. There are _____ml in 1 cups
80. There are _____ml in 3 teaspoons
81. 15ml is the same as _____ teaspoons or ______
tablespoons

8 fluid ounces(oz) = 240 milliliters(ml)


1 teaspoon(tsp) = 5 milliliters(ml)
1 cup(C) = 8 fluid ounces(oz)

872. There are _____ ounces in 1 pound and _____ml in 16


ounces
83. _____ ounces is equal to 375ml

1 fluid ounce(oz) = 30 milliliters (ml)

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- 23 -

PEDIATRICS: Conversions
The most accurate and common way to calculate pediatric
dosages is by using mg/kg/day. Often a childs weight is
recorded in pounds and ounces. Therefore, you must first
convert the ounces to pounds and then convert pounds to
kilograms.
Remember the following conversion factors:
There are 16 ounces in a pound.
There are 2.2 pounds in 1 kilogram.
For example. Consider a child who is 14 pounds 4 ounces.
How many kilograms is this child?

Example
How many kilograms is equal to 45 pounds 2 ounces?
1. Convert the ounces like this: 2/16 = 0.125
2. Add 0.125 to 45 to get 45.125 pounds
3. Convert to kilograms like this: 45.125/2.2
4. Answer: 20.511 kilograms. Round to 20.51kg
Convert 24 pounds 15 ounces to kilograms.
1. Convert the ounces like this: 15/16 = 0.937
2. Add 0.937 to 24 pounds to get 24.937 pounds
2. Convert to kilograms like this: 24.937/2.2
3. Answer: 11.335 kilograms. Round to 11.34kg

2. First, you need to convert ounces to pounds by


dividing the number of ounces by the number 16
(because there are 16 ounces in a pound):
4 ounces = 0.25 pounds
16
3. Add 0.25 pounds to 14 pounds to get 14.25
pounds.
4. Third, you need to convert pounds to kilograms.
We just figured out that 14 pounds 4 ounces is the
same thing as saying 14.25 pounds. So, divide this
by 2.2 to find out how many kilograms the child
weighs.
14.25 pounds =
6.477 kilograms
2.2
5. Finally, round off to two decimal places and the
correct answer is 6.48 kilograms.

SAME version 2.1.


Haspela 2004

You Try
84.

8 pounds 4 ounces = ______ pounds


divide by 2.2 = _______ kg

85.

20 pounds 8 ounces = ______ pounds


divide by 2.2 = ______ kg

86.

18 pounds 7 ounces = ______ pounds


divide by 2.2 = ______ kg

87.

41 pounds 5 ounces = ______ pounds


divide by 2.2 = _______ kg

- 24 -

PEDIATRICS: Maximum 24 Hour Doses

Because pediatric medications are based on weight, drug


reference books list the maximum dose that is safe to
administer in one day a 24 hour period of time.

The maximum 24 hour dose is NOT the amount that you


may actually give at any one time instead it is the
MAXIMUM SUM or MAXIMUM TOTAL of all the
divided doses given that day that can safely be given.

Example
A child weighs 11 pounds 3 oz. A medication is ordered at
20mg/kg/day. The safe range for this medication is up to
200mg/kg/day.
11 pounds 3 ounces = 11.188 pounds
11.188 pounds / 2.2 = 5.085 kilograms
(20mg) x (5.085 kg) = 101.7 mg / day
101.7 mg/day is within the safe range of this medication.

After determining the maximum 24 hour dose the nurse


will then calculate the amount to be given in each dose.
(For example, if BID dosing is preferred the 24 hour dose
will be divided by two.)

Remember: 200mg/day is the MAXIMUM that is safe


to be given in one day or within a 24 hour period. It is
NOT the amount that you actually administer. To
determine how much to give the patient you must
read the order to see how many times it is to be given
in a day, and calculate the divided dose. See next pg.

Pediatric orders which are written in mg/kg/day require us to


first convert from pounds to kilograms and then to determine
how much drug should be given based on the weight.
For example: Consider a child who weighs 21 pounds 6
ounces and medication is ordered at 15mg/kg/day.
1. First convert to pounds plus ounces to pounds

You Try
88.

The child weighs 21 pounds and 6 ounces. The max


that can be given in 24 hours is 80 mg/kg/day. The
max 24 hour dose dose for this child is _____ mg/day.

89.

The child weighs 42 pounds and 12 ounces. The max


that can be given in 24 hours is is 100 mg/kg/day. The
max 24 hour dose dose for this child is ____ mg/day.

90.

The child weighs 56 pounds and 3 ounces. The max


that can be given in 24 hours is 20 mg/kg/day. The
max 24 hour dose dose for this child is ____ mg/day.

91.

The child weighs 35 pounds and 2 ounces. The max


that can be given in 24 hours is 40 mg/kg/day. The
max 24 hour dose dose for this child is
mg/day.

6 ounces/16 = 0.375 pounds


add 0.375 pounds to 21=21.375pounds
2. Second, convert to kilograms 21.375/2.2 =
9.715 kg
3. Next determine how much medication a day
should be given
(15 mg) x (9.715 kg) = 145.725 mg/day
4. Now round this to 2 decimal places. 145.73mg/day
5. The nurse next determines if the dosage is safe by
comparing ordered and recommended dosages.
Recommended dosages are found in a drug
reference book.
SAME version 2.1.
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- 25 -

PEDIATRICS: Divided Dosages


On the last pages you learned how to calculate daily dosages
based on weight. This calculation is important but
medications are usually given in divided doses a few times
during the day.

Example
For example: You are working with a 54 pound 9 ounce child
and a medication is ordered at 100mg/kg/day and is to be
given in 2 divided doses.
1. First convert from pounds to kilograms:
9 ounces / 16 = 0.562 pounds
54 + 0.562 = 54.562 pounds
54.562 pounds/2.2 = 24.8kg
2. Next you should calculate the pounds per kilogram
per day:
(100 mg) x (24.8 kg) = 2480 mg/day

It is easy to do this. You simply need to divide the mg/day by


the number of times a day that the medication is going to be
administered.
For example: You are working with a 55 pound child and a
medication is ordered at 75mg/kg/day and is to be given in 3
divided doses.

3. Finally, you should calculate the mg in each dose


by dividing the daily dose by 2:
(2480 mg) / 2 = 1240 mg 2 times a day

1. First convert from pounds to kilograms:


55pounds/2.2 = 25kg
2. Next you should calculate the pounds per kilogram per
day:
(75mg) x (25kg) = 1875mg/day
3. Finally, you should calculate the mg in each dose by
dividing the daily dose by 3:
(1875mg) / 3 = 625 mg 3 times a day

SAME version 2.1.


Haspela 2004

You Try
92.

The child weighs 50 kg. The medication is 10


mg/kg/day given in 3 divided doses. Each dose is
_________ mg.

93.

The child weighs 22 pounds. The medication is 40


mg/kg/day given in 4 divided doses. Each dose is
_________ mg.

94.

The child weighs 12 pounds 8 ounces. The


medication is 30 mg/kg/day given every 8 hours. The
total mg dose per day is ______________ mg.
Each dose is _______ mg.

95.

The child weighs 15 pounds 2 ounces. The


medication is given 50 mg/kg/day given in 4 divided
doses. Each dose is ________ mg.
- 26 -

PEDIATRICS: Therapeutic Ranges


Some medications have a range of mg/kg/day recommended
(there is usually a maximum allowable total amount per day
also specified).
Dosages that are over the recommended amounts can be
dangerous.
Dosages that are under the recommended amount can also be
dangerous because they are considered to be subtherapeutic.
Consider this example
A drug reference book indicated that the safe
medication range for this medication is 2535mg/kg/day. You are working with a 35 pound 4
ounce child.
If a medication order asked you to give 425mg once,
would you give it? Is 425mg a safe dose to give?
Solution: You will need to calculate two numbers (the
minimum and maximum safe doses). Then, you can
determine if the dose for this patient falls within the range
(safe) or outside the range (unsafe).
1. Convert pounds and ounces to kg
4 ounces / 16 = 0.25 pounds
0.25 pounds + 35 pounds = 35.25 pounds
35.25 / 2.2 = 16.023 kg
2. Calculate the maximum and minimum doses:
3. Minimum of range:(16.023 kg) x (25mg) =
400.575 mg
Maximum of range:(16.023 kg) x (35mg) =
560.875 mg
4. The order asked you to give 425mg to this 16.02kg
child. Since 425mg falls between 400.575mg and
560.875 425mg is a safe dose to administer.
SAME version 2.1.
Haspela 2004

Example
An order asks you to administer 50mg of a medication to a 6 pound 2
ounce premature infant via a PEG tube. A drug reference book indicated
that the safe medication range for this medication is 10 15 mg/kg/day. Is
50mg a safe dose to give?
1. Convert to kilograms like this:
6 pounds 2 ounces
2 / 16 = 0.125
0.125 + 6 = 6.125 pounds
6.125 pounds / 2.2 = 2.784 kg
2. Calculate the maximum and minimum doses like this:
Minimum of range: (2.784 kg) x (10 mg) = 27.84 kg
Maximum of range: (2.784 kg) x (15 mg) = 41.76 kg
3. The order asked you to give 50mg to this 2.8kg child.
Since 50mg is greater than 42 (the maximum safe
recommended dose) you should NOT give the medication.
This is not a safe dose.
You should contact the ordering physician to discuss
modification to the order.

You Try
You are working with a child who is 26.6kg. Calculate the
maximum and minimum recommended doses for the
following medications:
96. digoxin PO; 20 40 mc g/kg/day
97. paraldehyde IM; 0.15ml/kg/day; not to exceed
5ml/kg/day
98. Ritalin PO; 5mg before breakfast and lunch; increasing
by 5-10mg/week; not to exceed 60mg/day
99. neomycin PO; 50-100mg/kg/day
100. ondasteron IV; up to 0.15mg/kg/day
- 27 -

PEDIATRICS: Tips and Pointers

Example

If you work with an adult population for some time, it is


likely that you will become very familiar with certain drugs,
doses, and routes.

It may become very easy for you to pick out discrepancies,


errors, or inappropriate orders.

However, it is somewhat different with pediatrics. Because


doses are based on weight, doses will vary from patient to
patient. Therefore, following the steps to basic problem
solving becomes even more important:
There are 4 basic steps to solving any medication problem.
1)
2)
3)
4)

READ

Read.
Stop & Think.
Solve.
Check & Question.

Read the whole question or


medication order.
STOP & THINK What is this question asking?
What is the order asking to administer?
Is the order complete?
Is there missing or extra information?
SOLVE
Solve the problem by using the
correct formula or proportion.
Go slow. Write out your work.
Check your answer for accuracy.
CHECK &
QUESTION
Does the answer make sense?
Is the answer feasible?
Use common sense.

SAME version 2.1.


Haspela 2004

Determine the maximum and minimum safe doses for the


medication in the order below.
What is the total daily dose that the order is asking you to
administer?
Is this dose safe? What would you do?

ORDER: Give 625mg of penicillin V potassium PO four


times a day. You are working with a 75lb. child with a
pneumococcal infection. A drug reference book states that the
safe range is 15-50mg/kg/day.
1. 75lbs / 2.2 = 34.09kg
2. Minimum: (34.09kg) x (15mg) = 511.35mg
Maximum:(34.09kg) x (50mg) = 1704.5mg
3. Daily total in order: (625mg) x (4 doses) = 2500mg
4. 2500mg is greater than calculated maximum. This is
NOT a safe dose. Call the ordering physician to
discuss this order. DO NOT administer medication.
You Try
For the orders below:
Determine the maximum and minimum safe doses for the
medication in the order below.
What is the total daily dose that the order is asking you to
administer?
Is this dose safe? What would you do?
101. ORDER: Give 125mg IV Bactrim three times a day. You
are working with a 125lb. child with chronic bronchitis. A drug
reference book states that the safe range is 15-20mg/kg/day.
102. ORDER: Give 125mg amoxicillin PO four times a day.
You are working with a 52 pound 12 ounce child with a
systemic infection. A drug reference book states that the safe
range is 20-40mg/kg/day.

- 28 -

PEDIATRICS: Intravenous Medications

Calculating the drop factor or the pump rate in pediatrics


is done in the same way as for adults.

The main difference with pediatrics is that 60gtt/ml tubing


is used more frequently. This allows the nurse to deliver
more precise amounts of medication to the pediatric
patient.
When you need to calculate the drip rate you
will need to use this formula:
_V_ x DF = Drip Rate
T
V = The volume ordered in ml
T = The number of minutes that the
infusion is to be completed in
DF = The drop factor (rate indicated on
the tubing you are using)

When you are going to use a pump to administer intravenous


medication you will need to use this formula:
_V_ = Pump Rate (ml/hr)
T
V = The volume ordered in ml
T = The number of hours that the
infusion is to be completed in
PR = Pump rate in ml/hour

SAME version 2.1.


Haspela 2004

Example
ORDER: Bactrim 1 gram IV over 1 hour BID
STOCK: 1000mg Bactrim in 100cc NS; 60gtt/ml tubing
What is the drip rate you will set?
100ml x 60gtt = 100 gtts per minute
60min
1ml
ANSWER: Set the roller clamp to 100 gtts/minute
ORDER: Vancomycin 375mg IV over 30 minutes four times
a day
STOCK: 1875mg Vancomycin in 500ml of D5W.
What will you set the pump at?
_100ml_ = x ml
0.5hours
hours
ANSWER:

x = 200 ml/hour.

You Try
103.

ORDER: Bactrim 0.25 grams IV over 30 minutes


STOCK: 500mg Bactrim in 100ml NS; 60gtt tubing
What is the drip rate you will set?

104.

ORDER: Vancomycin 150mg IV over 60 minutes


STOCK: 300mg Vancomycin in 100mL of D5W
What will you set the pump at?

105.

ORDER: NS 50ml IV over 30 minutes


STOCK: NS 100ml; 60gtt tubing
What is the drip rate you will set?

106.

ORDER: Ancef 0.6g IV in 50ml D5NS over 20 min.


STOCK: Ancef 1gram in 100ml
What will you set the pump at?
- 29 -

PEDIATRICS: Reconstitution

Some medications are not stable for long periods of time


and therefore arrive on the unit un-mixed. The nurse
must reconstitute a powdered medication prior to
administering it through the IV. This is call reconstitution.

In this type of medication problem the nurse must add a


specific volume of dilutent to the powder in order to
create a new solution which has a known concentration.

Consider this example:


ORDER:
STOCK:

Penicilin G 800,000 units IV every 4 hours.


Vial that states, Add 9.6 ml of sterile water to
the vial to yield 100,000 units / ml.
How many ml will the nurse withdraw from the vial after it is
reconstituted as indicated on the label?
1) After the nurse adds 9.6 ml of sterile water to the vial the
concentration of the solution will be 100,000
units / ml. (This information is on the label)
2) The order calls for 800,000 units IV every 4 hours.
3) Set up a proportion to solve for X like this:
100,000 units = 800,000 units
1 ml
X ml
4) Cross multiply and solve for X like this:
(100,000 units) x (X ml) = (1 ml) x 800,000 units)
(1 ml) x 800,000 units) = Xml
100,000 units
8 ml = X
ANSWER: The nurse withdraws 8 ml from the bottle. (This
amount contains the ordered 800,000 units of
Penicilin G.
SAME version 2.1.
Haspela 2004

Example
ORDER:
STOCK:

Penicillin G 200,000 units IV every 8 hours


Vial that states, Add 9.6 ml of sterile water to
the vial to yield 100,000 units / ml.
How many ml will the nurse withdraw from the vial after it is
reconstituted as indicated on the label?
1) Set up a proportion to solve for X like this:
100,000 units = 200,000 units
1 ml
X ml
4) Cross multiply and solve for X like this:
(100,000 units) x (X ml) = (1 ml) x 200,000 units)
(1 ml) x 200,000 units) = Xml
100,000 units
2 ml = X
ANSWER: The nurse withdraws 2 ml from the bottle. (This
amount contains the ordered 200,000 units.)

You Try
107.

108.

109.

ORDER: Cefobid 500 mg IM every 6 hours


STOCK: Vial that states, Add 2 ml of dilutent to
equal 2.4 ml of solution which contains 1 gram of
cefobid.
How many ml will the nurse withdraw from the vial after it
is reconstituted as indicated on the label?
ORDER: Oxacillin 500 mg IM every 6 hours
STOCK: Vial that states, Add 5.7 ml sterile water.
each 1.5 ml contains 250mg oxacillin.
How many ml will the nurse administer after it is
reconstituted as indicated on the label?
ORDER: Nafcillin sodium 250 mg IM every 6 hours
STOCK: Vial that states, Add 3.4 ml of sterile or
bacteriostatic water. Each ml contains 1000mg of nafcillin.
How many ml will the nurse withdraw from the vial after it
is reconstituted as indicated on the label?

- 30 -

Prohibited Medical Abbreviations


Some medical abbreviations that you might see can be misleading.
Therefore, JCAHO requirements are mandating changes to ensure
safe written communication. Changing the use of these confusing
abbreviations will cut down on errors. This page reviews some
commonly misused/misinterpreted abbreviations.
Unacceptable
Abbreviation
MS or MSO4

Intended
Meaning
Morphine sulfate

MgSO4

Magnesium
sulfate
1mg

Trailing zeros:
Zero written after
decimal points
(ex. 1.0mg)

0.5mg

Missing leading
zeros:
Zero missing
before decimal
points
(ex. .5mg)
U
IU

Unit
International Unit

ug
QD

microgram
Once daily

QOD

Every other day

Letter d
(ex. x3d)
TIW or tiw

Days (times 3
days)
Three times a
week

Acceptable
Alternative
Use morphine
sulfate
Use magnesium
sulfate
Do not use terminal
zeros for doses
expressed in whole
units (Write
1mg)
Always us zero
before a decimal
point when the
dose is less than a
whole unit (Write
0.5mg
Use unit
Use unit or
international unit
Use mcg
Use daily or
once daily
Use every other
day
Use days or
doses
Do no use this
abbreviation.
Specify which days
of the week,

Example

Example

DO

DONT

DO write 10 units regular


insulin
Do write enteric coated
aspirin 325mg once daily by
mouth
Do write 0.25mg xanax
once daily by mouth
Do write 5mg IM morphine
sulfate for complains of
8/10 pain
Do write every other day

Dont write 10 U regular


insulin
Dont write enteric coated
aspirin 325mg PO QD
Dont write .25mg xanax
PO QD
Dont write 5mg IM
MSO4 for complains of
8/10 pain
Dont write QOD

You Try
See if you can underline all the unacceptable abbreviations.
There are 9 of them in the following short nursing note.
110.

O2 @ 2L/minute NC, 2.0mg MS IV, 3 SL .3mg


nitroglycerine given every 5 minutes, and an EKG was
done. No relief within this first 15 minutes. Patient
continued to complain of 9/10 substernal pain. IV
nitroglycerine was started and titrated up to
200.00ug/min. Blood glucose was checked and result
was 350.0, therefore 10U regular insulin was given SC
in the left abdomen. Lasix 40mg PO QOD changed to
40.0 mg IV now.

Source: BIDMC 4/04

SAME version 2.1.


Haspela 2004

- 31 -

SAME
Answers to practice problems.
Additional practice problems.

This section includes the answers and solutions to the


You Try problems that are found throughout this
packet.
o The left side of each page lists the original
question and provides the answer.
o The right side of each page demonstrates how the
answer was obtained. The mathematical work is
done out for you to see.

Version 2.1

University of Massachusetts Boston


College of Nursing and Health Sciences
www.cnhs.umb.edu

SAME version 2.1.


Haspela 2004

- 32 -

1. 2/50 is equal to __0.04__.

1. 2 divided by 50 = 0.04

2. 4/1 is equal to __4__.

2. 4 divided by 1 = 4

3. 60/60 is equal to _1__.

3. 60 divided by 60 = 1

4. 1/2 is equal to __0.5__.

4. 1 divided by 2 = 0.5

5. 25/400 is equal to
__0.0625__.

5. 25 divided by 400 = 0.0625

6. 15/60 is equal to _0.25___.

6. 15 divided by 60 = 0.25

7. 350.60 x 10 = 3506

7. Multiplying by 10 moves the decimal place once to the right. 3506.00

8. 4.256 / 100 = 0.04256

8. Dividing by 100 moves the decimal place twice to the left. 0.04256

9. 500 / 1000 = 0.5

9. Dividing by 1000 moves the decimal place three places to the left. 0.5

10.

125.5 x 100 = 12550

11.

500.259 = 500.26

12.

285.001 = 285

13.

1.2555 = 1.26

10. Multiplying by 100 moves the decimal place two places to the right.
12550
11. The number in the thousandths place (9) is greater than or equal to 5,
therefore we round the hundredths place up from 5 to a 6. 500.26
12. The number in the thousandths place (1) is less than 5, therefore we
round down and leave the hundredths place number alone. 285
13. The number in the thousandths place (5) is greater than or equal to 5,
therefore we round the hundredths place up from 5 to a 6. 1.26

SAME version 2.1.


Haspela 2004

- 33 -

14. 45.509 = 45.51

14. The number in the thousandths place (9) is greater than or equal to 5,
therefore we round the hundredths place up from 0 to 1. 45.51

15. How many pounds is


60kg? 132 lbs

15.

First.
Second.
Third.
Fourth.

16. How many kg is 225lbs?


102.27 lbs

16.

First.
Second.
Third.
Fourth.

17. How many ml are there in


cup? 120 ml

17.

First.
Second.
Third.
Fourth.

SAME version 2.1.


Haspela 2004

Remember the conversion factor: 1kg = 2.2lbs


Set up a proportion like this:
1 kg = 60 kg
2.2lbs
X lbs
Solve by cross multiplying.
(1 kg) x (X lbs) = (2.2 lbs) x (60 kg)
Solve for X (2.2 lbs) x (60kg) = 132 lbs
1 kg
Remember the conversion factor: 1kg = 2.2lbs
Set up a proportion like this:
1 kg = X kg
2.2lbs
225 lbs
Solve by cross multiplying.
(1 kg) x (225 lbs) = (2.2 lbs) x (X kg)
Solve for X (225 lbs) x (1 kg) = 102.27lbs
2.2 kg
Remember the conversion factor: 1 cup = 240 ml
Set up a proportion like this:
1 cup = cup
240ml
X ml
Solve by cross multiplying.
(240 ml) x (0.5 cup) = (1 cup) x (X ml)
Solve for X (240 ml) x (0.5 cup) = 120 ml
1 cup
- 34 -

18. How many ml are there in


4oz.? 120 ml

18.

First.
Second.
Third.
Fourth.

19. How many mg are there


in 24g? 24,000mg

19.

First.
Second.
Third.
Fourth.

20. How many mcg are there


in 0.5mg? 500mcg

20.

First.
Second.
Third.
Fourth.

SAME version 2.1.


Haspela 2004

Remember the conversion factor: 8 oz. = 240 ml


Set up a proportion like this:
8 oz. = 4 oz.
240ml X ml
Solve by cross multiplying.
(240 ml) x (4 oz.) = (8 oz.) x (X ml)
Solve for X (240 ml) x (4 oz) = 120 ml
8 oz
Remember the conversion factor: 1 gram = 1000 mg
Set up a proportion like this:
1 gram = 24 grams
1000mg
X mg
Solve by cross multiplying.
(1000mg) x (24 grams) = (1 gram) x (X mg)
Solve for X (1000mg) x (24 grams) = 24,000mg
1 gram
Remember the conversion factor: 1 mg = 1000 mcg
Set up a proportion like this:
1 mg = 0.5mg
1000mcg
X mcg
Solve by cross multiplying.
(1000mcg) x (0.5mg) = (1 mg) x (X mcg)
Solve for X (1000mcg) x (0.5 mg) = 500mcg
1 mg

- 35 -

21. How many mg are in 3ml


if 1ml has 5mg? 15ml

21.

First.
Second.
Third .

22. If there are 25mg in one


tablet then how many mg are
there in 3 tablets? 75 mg

22.

First.
Second.
Third .

23. In one tablet there is


100mg. How many pills make
up 50mg? tablet

23.

First.
Second.
Third .

SAME version 2.1.


Haspela 2004

Set up a proportion like this:


1 ml = 3 ml
5mg
X mg
Solve by cross multiplying.
(5mg) x (3ml) = (1 ml) x (X mg)
Solve for X (5mg) x (3ml) = 15ml
1 ml
Set up a proportion like this:
25 mg = X
mg
1 tablet
3 tablets
Solve by cross multiplying.
(25mg) x (3 tablets) = (1 tablet) x (X mg)
Solve for X (25mg) x (3 tablets) = 75 mg
1 tablet
Set up a proportion like this:
1 tablet = X tablet
100 mg
50 mg
Solve by cross multiplying.
(1 tablet) x (50 mg) = (100 mg) x (X tablet)
Solve for X (1 tablet) x (50mg) = tablet
100mg

- 36 -

24. How many mg are there in


10 ml if 1ml has 2.5mg?
25 mg

24.

First.
Second.
Third .

25.
ORDER:

prednisone 10mg
PO three times a
day
STOCK:
tablets labeled
2.5mg
How many tablets do you
administer? 4 tablets

26.
ORDER:

Tylenol 650mg
PO every eight
hours
STOCK:
tablets labeled
325mg
How many tablets do you
administer? 2 tablets
SAME version 2.1.
Haspela 2004

25.

First.
Second.
Third.

26. . First.
Second.
Third.

Set up a proportion like this:


2.5 mg = X mg
1 ml
10 ml
Solve by cross multiplying.
(2.5 mg) x (10 ml) = (1 ml) x (X mg)
Solve for X (2.5 mg) x (10 ml) = 25 mg
1ml
Set up a proportion like this
1 tab
= X tab
2.5 mg
10mg
Solve by cross multiplying.
(1 tab) x (10 mg) = (2.5 mg) x (X)
Solve for X (1 tab) x (10 mg) = 4 tablets
2.5 mg

Set up a proportion like this


1 tab
= X tab
325 mg
650mg
Solve by cross multiplying.
(1 tab) x (650 mg) = (325 mg) x (X)
Solve for X (1 tab) x (650 mg) = 2 tablets
325 mg

- 37 -

27.
ORDER:

27.

digoxin 0.125mg
PO at 4pm daily
STOCK:
tablets labeled
0.25mg (scored)
How many tablets do you
administer? tablet
28.
ORDER:

diphenhydramine
50mg PO every 8
hours
STOCK:
capsules labeled
25mg
How many capsules do you
administer? 2 capsules
29.
ORDER:

prednisone 10mg
PO 3 times a day
tablets labeled

STOCK:
2.5mg
How many tablets do you
administer? 4 tablets

SAME version 2.1.


Haspela 2004

First.
Second.
Third .

28.

First.
Second.
Third .

29.

First.

Second

Set up a proportion like this:


0.125 mg = 0.25 mg
X tablets
1 tablet
Solve by cross multiplying.
(0.125 mg) x (1 tablet) = (X tablets) x (0.25mg)
Solve for X (0.125 mg) x (1 tablet) = 0.5 tablets
0.25 mg
Set up a proportion like this:
50 mg = 25 mg
X capsules 1 tablet
Solve by cross multiplying.
(50 mg) x (1 capsule) = (X capsule) x (25mg)
Solve for X (50 mg) x (1 capsule) = 2 capsules
25 mg
Remember the formula
_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
10 mg x 1 tablet = 4 tablets
2.5 mg

- 38 -

30.
ORDER:

30.

Tylenol 650mg
PO every 8 hours
STOCK:
tablets labeled
325mg
How many tablets do you
administer? 2 tablets

31.
ORDER:

digoxin 0.125mg
PO at 4pm daily
STOCK:
tablets labeled
0.25mg (scored)
How many tablets do you
administer? tablet

32.
ORDER:

diphenhydramine
50mg PO every 8
hours
STOCK:
capsules labeled
25mg
How many tablets do you
administer? 2 capsules
SAME version 2.1.
Haspela 2004

First.

Second

31.

First.

Second

32.

First.

Second

Remember the formula


_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
650 mg x 1 tablet = 2 tablets
325 mg

Remember the formula


_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
0.125 mg x 1 tablet = 1/2 tablets
0.25 mg

Remember the formula


_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
50 mg x 1 capsule = 2 capsules
25 mg

- 39 -

33.
ORDER:

33.

amoxicillin 1.5g
PO every 8 hours
STOCK:
capsules labeled
250mg
How many capsules do you
administer? 6 capsules

First.

Second.

Third.

Fourth
34.
ORDER:

ethchlorvynol
2000mg PO at
bedtime
STOCK:
capsules labeled
1g
How many tablets do you
administer? 2 capsules

34.

First.

Second.
Third.

Fourth

SAME version 2.1.


Haspela 2004

Convert g to mg so that the units in the problem match


Do this by setting up a proportion like this:
1.5 g = 1 g
X mg
1000 mg
Solve for X like this:
(1.5g) x (1000mg) = 1500 mg Dose ordered
1g
in mg
Remember the formula
_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
1500 mg x 1 capsule= 6 capsules
250 mg
Convert mg to g so that the units in the problem match
Do this by setting up a proportion like this:
2000mg = 1000mg
Xg
1g
Solve for X like this:
(2000mg )x(1g) = 2g Dose ordered
1000mg
in g
Remember the formula
_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
2g x 1 capsule= 2 capsules
1g
- 40 -

35.
ORDER:

35.

digoxin 0.5mg
PO once daily
STOCK:
tablets labeled
125mcg
How many tablets do you
administer? 4 tablets

First.

Second.
Third.

Fourth

36.
ORDER:

carvedilol
6.25mg PO twice
a day
STOCK:
capsules labeled
6250 mcg
How many tablets do you
administer? 1 capsule

36.

First.

Second.
Third.

Fourth

SAME version 2.1.


Haspela 2004

Convert mg to mcg so that the units match


Do this by setting up a proportion like this:
1 mg =
0.5 mg
1000mcg
X mcg
Solve for X like this:
(1000mcg) x (0.5mg) = 500 mcg Dose ordered
1mg
in mcg
Remember the formula
_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
500mcg x 1 tablet = 4 tablets
125 mcg
Convert mg to mcg so that the units match
Do this by setting up a proportion like this:
1 mg =
6.25 mg
1000mcg
X mcg
Solve for X like this:
(1000mcg) x (6.25mg) = 6250mcg Dose ordered
1mg
in mcg
Remember the formula
_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
6250mcg x 1 capsule= 1 capsule
6250 mcg
- 41 -

37.
ORDER:

37.

amoxicillin 1.5g
PO every 8 hours
STOCK:
capsules labeled
250 mg
How many tablets do you
administer? 6 capsules

First.

Second.
Third.

Fourth.
Fifth.

38.
ORDER:

ethchlorvynol
2000mg PO at
bedtime
STOCK:
capsules labeled
1g
How many capsules do you
administer? 2 capsules

38.

First.

Second.
Third.

Fourth.
Fifth.

SAME version 2.1.


Haspela 2004

Convert g to mg so that the units match


Do this by setting up a proportion like this:
1 g =
1.5 g
1000mg
X mg
Solve for X like this:
(1000mg) x (1.5g) = 1500 mg Dose ordered
1g
in mg
Now that the units match. Solve the problem
by setting up a proportion like this:
1500mg
= 250 mg
X capsules
1 capsule
Solve by cross multiplying.
(1500mg) x (1 capsule) = (X capsule) x (250mg)
Solve for X (1500mg) x (1 capsule) = 6 capsules
250 mg
Convert g to mg so that the units match
Do this by setting up a proportion like this:
1 g = X g
1000mg
2000 mg
Solve for X like this:
(2000mg) x (1g) = 2 g Dose ordered
1000mg
in grams
Now that the units match. Solve the problem
by setting up a proportion like this:
2g
=
1g
X capsules
1 capsule
Solve by cross multiplying.
(2 g) x (1 capsule) = (X capsule) x (1 g)
Solve for X (2 g) x (1 capsule) = 2 capsules
1g

- 42 -

39.
ORDER:

39.

digoxin 0.5mg
PO once a day
STOCK:
tablets labeled
125mcg
How many tablets do you
administer? 4 tablets

First.

Second.
Third.

Fourth.
Fifth.

40.
ORDER:

carvedilol
6.25mg PO twice
daily
STOCK:
capsules labeled
6250mcg
How many capsules do you
administer? 1 capsule

40.

First.

Second.
Third.

Fourth.
Fifth.

SAME version 2.1.


Haspela 2004

Convert mg to mcg so that the units match


Do this by setting up a proportion like this:
1 mg =
0.5 mg
1000mcg
X mcg
Solve for X like this:
(1000mcg) x (0.5mg) = 500mcg Dose ordered
1mg
in mcg
Now that the units match. Solve the problem
by setting up a proportion like this:
500 mcg =
125 mcg
X tablets
1 tablet
Solve by cross multiplying.
(500mcg) x (1 tablet) = (X tablets) x (125 mcg)
Solve for X (500mcg) x (1 tablet) = 4 tablets
125 mcg
Convert mg to mcg so that the units match
Do this by setting up a proportion like this:
1 mg =
6.25 mg
1000mcg
X mcg
Solve for X like this:
(1000mcg) x (6.25mg) = 6250mcg Dose ordered
1mg
in mcg
Now that the units match. Solve the problem
by setting up a proportion like this:
6250 mcg =
6250 mcg
X capsule
1 capsule
Solve by cross multiplying.
(6250mcg) x (1 capsule) = (X capsule) x (6250 mcg)
Solve for X (6250mcg) x (1 capsule) = 1 capsule
6250 mcg

- 43 -

41.
ORDER:

41.

hydrocortisone
cypionate oral
susp. 0.03 g PO
every 6 hours
STOCK:
liquid labeled
10mg per 5ml
How many ml do you
administer? 15ml

First.

Second:
Third.
Fourth.

42.
ORDER:

cephalex in oral
suspension
0.35g PO every 6
hours
STOCK:
liquid labeled
125mg per 5ml
How many ml do you
administer? 14 ml

Fifth.
42.

First.

Second:
Third.
Fourth.
Fifth.

SAME version 2.1.


Haspela 2004

Convert from g to mg so the units match


Do this by setting up a proportion like this:
0.03g = 1 g
X mg 1000mg
Solve for X like this:
(0.03g) x (1000mcg) = 30mg Dose ordered
1g
in mg
Solve the problem by setting up a proportion like this:
30 mg
= 10 mg
X ml
5 ml
Solve by cross multiplying.
(30 mg) x (5 ml) = (X ml) x (10 mg)
Solve for X (30 mg) x (5 ml) = 15ml
10 mg
Convert from g to mg so the units match
Do this by setting up a proportion like this:
0.35g = 1 g
X mg 1000mg
Solve for X like this:
(0.35g) x (1000mg) = 350mg Dose ordered
1g
in mg
Solve the problem by setting up a proportion like this:
350 mg
= 125 mg
X ml
5 ml
Solve by cross multiplying.
(350 mg) x (5 ml) = (X ml) x (125 mg)
Solve for X (350 mg) x (5 ml) = 14 ml
125 mg
- 44 -

43.
ORDER:

43.

erythromycin
susp. 0.75g PO
four times a day
STOCK:
liquid labeled
250mg per 5ml
How many ml do you
administer? 15 ml

First.

Second:
Third.
Fourth.
Fifth.
44.

44.
ORDER:

penicillin V
potassium 0.6 g
PO every 6 hours
STOCK:
liquid labeled
250mg per 5ml
How many ml do you
administer? 12ml

First.

Second:
Third.
Fourth.
Fifth.

SAME version 2.1.


Haspela 2004

Convert from g to mg so the units match


Do this by setting up a proportion like this:
0.75g = 1 g
X mg 1000mg
Solve for X like this:
(0.75g) x (1000mg) = 750mg Dose ordered
1g
in mg
Solve the problem by setting up a proportion like this:
750 mg
= 250 mg
X ml
5 ml
Solve by cross multiplying.
(750 mg) x (5 ml) = (X ml) x (250 mg)
Solve for X (750 mg) x (5 ml) = 15 ml
250 mg
Convert from g to mg so the units match
Do this by setting up a proportion like this:
0.6g = 1 g
X mg 1000mg
Solve for X like this:
(0.6g) x (1000mg) = 600mg Dose ordered
1g
in mg
Solve the problem by setting up a proportion like this:
600 mg
= 250 mg
X ml
5 ml
Solve by cross multiplying.
(600 mg) x (5 ml) = (X ml) x (250 mg)
Solve for X (600 mg) x (5 ml) = 12 ml
250 mg
- 45 -

45.
ORDER:

45.

hydrocortisone
cypionate oral
susp. 0.03g PO
every 6 hours
STOCK:
liquid labeled
10mg per 5ml
How many ml do you
administer? 15 ml

First.

Second.
Third.

Fourth

46.
ORDER:

cephalex in oral
suspension
0.35g PO every 6
hours
STOCK:
liquid labeled
125mg per 5ml
How many ml do you
administer? 14 ml

46.

First.

Second.
Third.

Fourth

SAME version 2.1.


Haspela 2004

Convert g to mg so that the units match


Do this by setting up a proportion like this:
1 g =
0.03g
1000mg
X mg
Solve for X like this:
(1000 mg) x (0.03g) = 30 mg Dose ordered
1g
in mg
Remember the formula
_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
30 mg x 5 ml = 15ml
10 mg
Convert g to mg so that the units match
Do this by setting up a proportion like this:
1 g =
0.35g
1000mg
X mg
Solve for X like this:
(1000 mg) x (0.35g) = 350 mg Dose ordered
1g
in mg
Remember the formula
_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
350 mg x 5 ml = 14 ml
125 mg

- 46 -

47.
ORDER:

47.

erythromycin
susp. 0.75g PO
four times a day
STOCK:
liquid labeled
250mg per 5ml
How many ml do you
administer? 15 ml

First.

Second.
Third.

Fourth

48.
ORDER:

penicillin V
potassium 0.6g
PO every 6 hours
STOCK:
liquid labeled 250
mg per 5 ml
How many ml do you
administer? 12 ml

48.

First.

Second.
Third.

Fourth

SAME version 2.1.


Haspela 2004

Convert g to mg so that the units match


Do this by setting up a proportion like this:
1 g =
0.75g
1000mg
X mg
Solve for X like this:
(1000 mg) x (0.75g) = 750 mg Dose ordered
1g
in mg
Remember the formula
_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
750 mg x 5 ml = 15ml
250 mg
Convert g to mg so that the units match
Do this by setting up a proportion like this:
1 g =
0.6 g
1000mg
X mg
Solve for X like this:
(1000 mg) x (0.6 g) = 600 mg Dose ordered
1g
in mg
Remember the formula
_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
600 mg x 5 ml = 12 ml
250 mg

- 47 -

49. True or False:


Administer 1ml SQ with a 5
ml syringe that is 3/8 inches
and 26 gauge

49.

False. Administer SQ medications with a 1ml syringe. The needle


gauge and length are correct.

50. True or False:


Administer 25units insulin
with a U100 syringe that is 3/8
inches in length and 27 gauge

50.

True.

51. True or False:


Administer a TB test by
injecting 0.2ml of test solution
with a 1ml tuberculin syringe
that is 5/8 inches in length
and 26 gauge

51.

True.

52. True or False:


Administer 3ml SQ to an adult
using a 1 inch needle that is
20 gauge

52.

False. Maximum volume with SQ injections is 1ml. Maximum


needle length for a SQ injection is 5/8 inches. Minimum needle
gauge for a SQ injection is 25

53. Mark 1.2cc on the


following syringe.

SAME version 2.1.


Haspela 2004

- 48 -

54. Mark 12 units on the


following syringe.

54.

55. Mark 0.75 on the


following syringe

55.

56.
ORDER:

56.

meperidine 75mg
IM every 4 hours
STOCK:
meperidine 50mg
per ml
How many ml will you draw
up into a syringe? 1.5 ml

SAME version 2.1.


Haspela 2004

First.
Second.
Third.

Set up a proportion like this:


75 mg = 50 mg
X ml
1 ml
Solve by cross multiplying.
(75 mg) x (1 ml) = (50 mg) x (X ml)
Solve for X (75 mg) x (1 ml) = 1.5ml
50mg

- 49 -

57.
ORDER:

Phenergan 15mg
IM every 4 6
hours PRN;
nausea
STOCK:
Phenergan 50mg
per ml
How many ml will you draw
up into a syringe? 0.3 ml
58.
ORDER: nebcin 60mg IV
every 8 hours
STOCK:
nebcin 80mg per
2ml
How many mL will you draw
up into a syringe? 1.5ml
59.
ORDER:

vitamin B12 1000


micrograms IM
once a day
STOCK:
vitamin B12 5000
micrograms per
1ml
How many ml will you draw
up into a syringe? 0.2 ml

SAME version 2.1.


Haspela 2004

57.

First.
Second.
Third.

58.

First.
Second.
Third.

59.

First.
Second.
Third.

Set up a proportion like this:


15 mg = 50 mg
X ml
1 ml
Solve by cross multiplying.
(15 mg) x (1 ml) = (50 mg) x (X ml)
Solve for X (15 mg) x (1 ml) = 0.3ml
50mg
Set up a proportion like this:
60 mg = 80 mg
X ml
2 ml
Solve by cross multiplying.
(60 mg) x (2 ml) = (80 mg) x (X ml)
Solve for X (60 mg) x (2 ml) = 1.5ml
80mg
Set up a proportion like this:
1000 mcg = 5000 mcg
X ml
1 ml
Solve by cross multiplying.
(1000 mcg) x (1 ml) = (5000 mcg) x (X ml)
Solve for X (1000 mcg) x (1 ml) = 0.2ml
5000 mcg

- 50 -

60.
ORDER:

60.

meperidine 75mg
IM every 4 hours
STOCK:
meperidine 50mg
per ml
How many ml will you draw
up into a syringe? 1.5 ml
61.
ORDER:

Second.

61.

phenergan 15 mg
IM every 4 6
hours PRN;
nausea
STOCK:
phenergan 50 mg
per ml
How many ml will you draw
up into a syringe? 0.3 ml
62.
ORDER:

nebcin 60mg IV
every 8 hours
STOCK:
nebcin 80mg per
2 ml
How many ml will you draw
up into a syringe? 1.5 ml

SAME version 2.1.


Haspela 2004

First.

First.

Second.

62.

First.

Second.

Remember the formula


_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
75 mg x 1 ml = 1.5 ml
50 mg
Remember the formula
_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
15 mg x 1 ml = 0.3 ml
50 mg

Remember the formula


_D_ x Q = Correct dose to administer
H
Plug in the numbers into the formula
60 mg x 2 ml = 1.5 ml
80 mg

- 51 -

63.
ORDER:

63.

vitamin B12 1000


micrograms IM
once daily
STOCK:
vitamin B12 5000
micrograms per
1ml
How many ml will you draw
up into a syringe? 0.2 ml

64.
ORDER:

2 L of NS over 24
hours
TUBING: 10gtt/ml
What is the drip rate you will
set? 14 gtts/min

First.

Second.

64.

First.

Second.
Third.

65.
ORDER:

250ml of NS over
30 minutes
TUBING: 15gtts/ml
What is the drip rate you will
set? 125 gtts/ml

SAME version 2.1.


Haspela 2004

Fourth.
65.

First.

Second.

Remember the formula


_D_ x Q = Correct dose to administer
H
Plug the numbers into the formula
1000 mg x 1 ml = 0.2ml
5000 mg

Remember the formula


_V_ x DF = Drip Rate
T
Convert L to ml: 2L x 1000ml = 2000ml
Convert hours to minutes: 24hours x 60min =
Plug the numbers into the formula.
2000ml x 10gtt = 13.88gtts/min
1440min
ml
Round up to 14 drops per minute.
Remember the formula
_V_ x DF = Drip Rate
T
Plug the numbers into the formula.
250ml x 15 gtts = 125 gtts/min
30min
ml

- 52 -

66.
ORDER:

1 gram of Magnesium
Sulfate in 100ml of NS
over 2 hrs
TUBING:
60 gtts/ml
What is the drip rate you will set? 50
gtts/min
67.
ORDER:

4000ml of Lactated
Ringers over 24 hrs
TUBING:
15 gtts / ml
What is the drip rate you will set?

42 gtts / min

66.

First.

Second.
67.
First.
Second.

Third.

68.
ORDER:

68.

50 gtts / minute

Second.

2000ml of Normal
Saline over 10 hours
TUBING:
15 gtts / ml
What is the drip rate you will set?

First.

Third.

SAME version 2.1.


Haspela 2004

Remember the formula


V x DF = Drip Rate
T
Plug the numbers into the formula.
100 ml x 60 gtts = 50 gtts/min
120 min
ml

Determine ml / hr like this:


4000 ml = 166.667 ml / hour ( Round to 167 ml / hr)
24 hours
Use the formula like this:
V_ x DF = Drip Rate
T
167 ml x 15 gtts = 41.75 gtts
60 min
ml
min
Round 41.75 up to 42 gtts / min

Determine ml / hr like this:


2000 ml = 200 ml / hour
10 hours
Use the formula like this:
V_ x DF = Drip Rate
T
200 ml x 15 gtts = 50 gtts
60 min
ml
min
50 gtts / minute

- 53 -

69.
ORDER:

69.

56 gtts / min

Second.

2000ml of Normal
Saline over 6 hours
TUBING:
10 gtts / ml
What is the drip rate you will set?

First.

Third.

70.
ORDER:

4000ml of Lactated
Ringers over 48 hours
TUBING:
10 gtts / ml
What is the drip rate you will set?

14 gtts / min

SAME version 2.1.


Haspela 2004

Determine ml / hr like this:


2000 ml = 333.333 ml / hour (Round to 333 ml / hr)
6 hours
Use the formula like this:
V_ x DF = Drip Rate
T
333 ml x 10 gtts = 55.5 gtts
60 min
ml
min
Round 55.5 up to 56 gtts / min

70.
First.

Determine ml / hr like this:


4000 ml = 83.333 ml / hour ( Round to 83 ml/ hr)
48 hours
Second.
Use the formula like this:
V_ x DF = Drip Rate
T
83. ml x 10 gtts = 13.83 gtts
60 min
ml
min
Third. Round 13.83 up to 14 gtts / min

- 54 -

71.
ORDER:

71.

1 gram of
vancomycin over
60 minutes
STOCK:
2 grams of
vancomycin in
500 ml of NS
What would you set the pump
rate to? 250 ml/hour
72.
ORDER:

2 grams of
magnesium
sulfate IV over 20
minutes
STOCK:
2000mg of
magnesium
sulfate in 100 ml
What would you set the pump
rate to? 300 ml/hr

SAME version 2.1.


Haspela 2004

First.

Second.

72.

First.

Second.
Third.

Remember the formula


V = Pump Rate (ml/hr)
T
Plug the numbers into the formula.
250 ml = 250 ml/hour
1 hour

Remember the formula


V = Pump Rate (ml/hr)
T
Plug the numbers into the formula.
100 ml = 5 ml/minute
20 minutes
Change from ml / minute to ml / hour like this:
5 ml x 60 min = 300ml/hour
min

hour

- 55 -

73.
ORDER

73.

50mg furosemide
per hour IV
STOCK:
500mg
furosemide in
250 ml bag of NS
What would you set the pump
rate to? 25 ml/hour

First.

Second.

Third.
Fourth.
Fifth.

74.
ORDER:

cefmetazole
4grams IV over
30 minutes
STOCK:
cefmetazole 4
grams in 100ml
of
NS
What would you set the pump
rate to? 200 ml/hour

SAME version 2.1.


Haspela 2004

74.

First.

Second.

Remember the formula


V = Pump Rate (ml/hr)
T
Determine how many ml there are in one dose:
Set up a proportion like this:
50 mg = 500 mg
X ml
250 ml
Solve by cross multiplying.
(50 mg) x (250 ml) = (X ml) x (500 mg)
Solve for X (50 mg) x (250 ml) = 25 ml
500 mg
Plug the numbers into the formula.
25 ml = 25 ml/hour
1 hours
Remember the formula
V = Pump Rate (ml/hr)
T
Plug the numbers into the formula.
100 ml = 200ml/hour
0.5 hours

- 56 -

75.
ORDER:

75.

1200units of
Heparin per hour
STOCK:
250ml bag
containing 25,000
units of heparin
What would you set the pump
rate (cc/hour)? 12ml/hour

First.

Second.

Third.
Fourth.
Fifth.

76.
ORDER:

1550units of
Heparin per hour
STOCK:
250ml bag
containing 25,000
units of heparin
What would you set the pump
rate (cc/hour)? 15.5 ml/hour

76.

First.

Second.

Third.
Fourth.
Fifth.

SAME version 2.1.


Haspela 2004

Remember the formula


V = Pump Rate (ml/hr)
T
Determine how many ml there are in one dose:
Set up a proportion like this:
1200 units = 25,000 units
X ml
250 ml
Solve by cross multiplying.
(1200 units) x (250 ml) = (X ml) x (25,000 units)
Solve for X (1200 units) x (250 ml) = 12ml
25,000 units
Plug the numbers into the formula.
12 ml = 12ml/hour
1 hours
Remember the formula
V = Pump Rate (ml/hr)
T
Determine how many mL there are in one dose:
Set up a proportion like this:
1550 units = 25,000 units
X ml
250 ml
Solve by cross multiplying.
(1550 units) x (250 ml) = (X ml) x (25,000 units)
Solve for X (1550 units) x (250 ml) = 15.5ml
25,000 units
Plug the numbers into the formula.
15.5 ml = 15.5 ml/hour
1 hours
- 57 -

77.
ORDER:

77.

3 units an hour of
Insulin
STOCK:
100 units of
insulin in 100ml
bag of NS
What would you set the pump
rate (ml/hour)? 3 ml/hour

First.

Second.

Third.
Fourth.
Fifth.

78.
ORDER:

2 g Magnesium
Sulfate over 2
hours
STOCK:
2 g Magnesium
Sulfate in 100mL
of D5W
What would you set the pump
rate (ml/hour)? 50 ml/hour

SAME version 2.1.


Haspela 2004

78.

First.

Second.

Remember the formula


V = Pump Rate (ml/hr)
T
Determine how many ml there are in one dose:
Set up a proportion like this:
3 units = 100 units
X ml
100 ml
Solve by cross multiplying.
(3 units) x (100 ml) = (X ml) x (100 units)
Solve for X (3 units) x (100 ml) = 3 ml
100 units
Plug the numbers into the formula.
3 ml = 3 ml/hour
1 hours
Remember the formula
V = Pump Rate (ml/hr)
T
Plug the numbers into the formula.
100 ml = 50ml/hour
2 hours

- 58 -

79. There are 360 ml in 1


cups

79.

1 cup = 240 ml
of 240 is 120

80. There are 15 ml in 3


teaspoons

80.

1 teaspoon = 5 ml
3 times 5ml = 15ml

81. 15ml is the same as 3


teaspoons or 1 tablespoon.

81.

1 teaspoon = 5ml; 3 teaspoons = 1 tablespoon


3 times 5ml = 15ml

82. There are 16 ounces in 1


pound and 480 ml in 16 fluid
ounces

82.

16 ounces = 1 pound; 8 fluid ounces = 240 ml


1 times 16 ounces = 16 ounces; 240ml times two = 480ml

83. 12.5ounces is equal to


375ml

83.

1 ounce = 30 ml
If you divide 375 by 30 = 12.5 ounces

84. 8 pounds 4 ounces =


8.25 pounds divide by 2.2 =
3.75 kg

84.

First.
Second.
Third.

85. 20 pounds 8 ounces =


20.5 pounds divide by 2.2 =
9.32 kg

85.

First.
Second.
Third.

86. 18 pounds 7 ounces =


18.438 pounds divide by 2.2 =
8.38 kg

86.

First.
Second.
Third.

SAME version 2.1.


Haspela 2004

Convert the ounces like this: 4/16 = 0.25 pounds


Add 0.25 to 8 = 8.25lbs
Convert to kilograms like this: 8.25 pounds / 2.2 = 3.75
kg
Convert the ounces like this: 8/16 = 0.5 pounds
Add 0.5 to 20 = 20.5 pounds
Convert to kilograms like this: 20.5 pounds / 2.2 = 9.32
kg
Convert the ounces like this: 7/16 = 0.438 pounds
Add 0.438 to 18 = 18.438 pounds
Convert to kilograms like this: 18.438 pounds / 2.2 =
8.38 kg.
- 59 -

87. 41 pounds 5 ounces =


41.313 pounds divide by 2.2 =
18.78 kg

87.

First.
Second.
Second.

88.

The child weighs 21


pounds and 6 ounces.
The max that can be
given in 24 hours is 80
mg/kg/day. The max 24
hour dose for this child
is 777.28 mg/day.

88.

First.

The child weighs 42


pounds and 12 ounces.
The max that can be
given in 24 hours is is
100 mg/kg/day. The
max 24 hour dose dose
for this child is 1943.2
mg/day.

89.

The child weighs 56


pounds and 3 ounces.
The max that can be
given in 24 hours is 20
mg/kg/day. The max 24
hour dose dose for this
child is 510.8 mg/day.

90.

89.

90.

SAME version 2.1.


Haspela 2004

Second.
Third.

First.
Second.
Third.

First.
Second.
Third.

Convert the ounces like this: 5/16 = 0.313 pounds


Add 0.313 to 41 = 41.313 pounds
Convert to kilograms like this: 41.313 pounds / 2.2 =
18.779 kg. Round this to 2 places. 18.78 kg.
Convert the ounces like this: 6/16 = 0.375
Then add 0.375 + 21 = 21.375
Convert to kilograms like this: 21.375 / 2.2 = 9.716 kg
(80 mg) x (9.716 kg) x (1 day) = 777.28 mg/day

Convert the ounces like this: 12/16 = 0.75


Then add 0.75 to 42 = 42.75 pounds
Convert to kilograms like this: 42.75 / 2.2 = 19.432 kg
(100 mg) x (19.432 kg) x (1 day) = 1943.2 mg/day

Convert the ounces like this: 3/16 = 0.188


Then add 0.188 to 56 = 56.188 pounds
Convert to kilograms like this: 56.188 / 2.2 = 25.54 kg
(20mg) x (25.54kg) x (1 day) = 510.8 mg/day

- 60 -

91.

92.

The child weighs 35


pounds and 2 ounces.
The max that can be
given in 24 hours is 40
mg/kg/day. The max 24
hour dose dose for this
child is 638.64 mg/day.
The child weighs 50 kg.
The medication is 10
mg/kg/day given in 3
divided doses. Each
dose is 166.67 mg.

91.

First.

Third.

Convert the ounces like this: 2/16 = 0.125


Then add 0.125 to 35 = 35.125
Convert to kilograms like this: 35.125 / 2.2 = 15.9766
kilograms
(40mg) x (15.966 kg) x (1 day) = 638.64 mg/day

92.

First.
Second.

(10mg) x (50kg) = 500mg a day


(500mg) / (3 times a day) = 166.67mg

Second.

93.

The child weighs 22


pounds. The
medication is 40
mg/kg/day given in 4
divided doses. Each
dose is 100 mg.

93.

First.
Second.
Third.

Convert to kilograms like this: 22 / 2.2 = 10 pounds


(40mg) x (10kg) = 400mg a day
(400mg) / (4 times a day) = 100mg

94.

The child weighs 12


pounds 8 ounces. The
medication is 30
mg/kg/day given every
8 hours. The total mg
per day is 170.46 mg.
Each dose is 56.82 mg.

94.

First.

Convert ounces to pounds: 8/16 = 0.5 pounds


Then add 0.5 to 12 = 12.5 pounds.
Convert to pounds to kilograms like this: 12.5pounds /
2.2 = 5.682 kilograms
(30mg) x (5.682kg) = 170.46 mg a day
(170.46 mg) / (3 times a day) = 56.82 mg

SAME version 2.1.


Haspela 2004

Second.
Third.
Fourth

- 61 -

95.

The child weighs 15


pounds 2 ounces. The
medication is given 50
mg/kg/day given in 4
divided doses. Each
dose is 85.94 mg

96. digoxin PO; 20-40


mcg/kg/day
26.6kg child
Max safe dose: 1064mcg/day
Min safe dose: 532mcg/day
97. paraldehyde IM;
0.15ml/kg/day; not to exceed
5ml/kg/day
26.6kg child
Max safe dose: 133ml/day
Min safe dose: 3.99ml/day
98. Ritalin PO; 5mg before
breakfast and lunch;
increasing by 5-10mg/week;
not to exceed 60mg/day
26.6kg child

SAME version 2.1.


Haspela 2004

95.

First.
Second.
Third.
Fourth

Convert ounces to pounds: 2/16 = 0.125pounds


Then add 0.125 to 15 pounds = 15.125
Convert to pounds to kilograms like this: 15.125 / 2.2 =
6.875 kilograms
(50 mg) x (6.875 kg) = 343.75 mg a day
(343.75 mg) / (4 times a day) = 85.938mg Round this
to 85.94 mg for the final answer.

96.

Max: (26.6kg) x (40mcg/kg/day) = 1064 mcg/day.


Min: (26.6kg) x (20mcg/kg/day) = 532mcg/day.

97.

Max: (26.6kg) x (5ml/kg/day) = 133ml/day


Min: (26.6kg) x (0.15ml/kg/day) = 3.99mg/day

98.

Min: The answer is in the problem two 5mg doses. One before
breakfast and one before lunch.
Max: The answer is in the problem not to exceed 60mg/day
(regardless of childs weight).

- 62 -

99. neomycin PO; 50100mg/kg/day


26.6kg child
Max safe dose: 2660mg/day
Min safe dose: 1330mg/day

99.

100. ondasteron IV; up to


0.15mg/kg/day
26.6kg child
Max safe dose: 3.99mg/day
Min safe dose: None to be
clarified. Can start at zero.

100. Max: (26.6kg) x (0.15mg/kg/day) = 3.99mg/day

101. ORDER: Give 125mg


IV Bactrim three times a day.
You are working with a 125lb.
child with chronic bronchitis.
A drug reference book states
that the safe range is 1520mg/kg/day.
Max safe dose:
1136.36 mg/day
Min safe dose:
852.27 mg/day
Total daily dose ordered:
375mg

101. First.
Second.

SAME version 2.1.


Haspela 2004

Max: (26.6kg) x (100mg/kg/day) = 2660mg/day


Min: (26.6kg) x (50mg/kg/day) = 1330mg/day

Third.

Convert from lbs to kg. 125/2.2 = 56.8181 kg


Max: (56.818 kg) x (20 mg/kg/day) = 1136.36 mg/day
Min: (56.818 kg) x (15 mg/kg/day) = 852.27 mg/day
(125 mg) x (3 doses) = 375 mg/day ordered

Is this dose safe?


No it is too little.
What would you do?
Talk with ordering physician to have order corrected.

- 63 -

102. ORDER: Give 125mg


amoxicillin PO four times a
day. You are working with a
52 pound 12 ounce child with
a systemic infection. A drug
reference book states that the
safe range is 20-40mg/kg/day.
Max safe dose:
959.08 mg/day
Min safe dose:
479.54 mg/day
Total daily dose ordered:
500 mg/day

102. First.
Second.

103.
ORDER:

103. First.

Bactrim 0.25 g
IV over 30 min.
STOCK: 500mg Bactrim in
50ml NS; 60gtt tubing
What is the drip rate you will
set? 50 gtts/min

SAME version 2.1.


Haspela 2004

Third

Convert ounces to pounds: 12/16 = 0.75lbs


Convert from lbs to kg. 52.75/2.2 = 23.977 kg
Max: (23.977 kg) x (40 mg/kg/day) = 959.08 mg/day
Min: (23.977 kg) x (20 mg/kg/day) = 479.54 mg/day
(125mg) x (4 doses) = 500mg/day ordered

Is this dose safe?


Yes it is a safe dose. The ordered dose is more than the
minimum safe dose and less than the maximum safe dose.
What would you do?
Administer the medication as ordered.

Remember the formula


_V_ x DF = Drip Rate
T
Second.
Determine how much volume you will need to give
Remember there are 1000mg in a gram so 0.25g = 250mg
Set up a proportion like this:
250mg = 500mg
Xml
50 ml
Third.
Cross multiply to solve:
(250mg) x (50ml) = (500mg) x (Xml)
Fourth.
(250mg) x (50ml) = 25 ml
500 mg
Fifth.
Plug the numbers into the formula.
25 ml x 60gtt = 50 gtts/min
30min
ml
- 64 -

104.
ORDER:

Vancomycin
150mg IV over
60 minutes
STOCK:
300mgVancomycin in 100ml
of D5W
What will you set the pump
at? 50ml/hour

104. First.

Second.

Third.
Fourth.
Fifth.

105.
ORDER:

NS 50 ml IV over
30 minutes
STOCK:
NS 100ml; 60gtt
tubing
What is the drip rate you will
set? 100gtts/minute

SAME version 2.1.


Haspela 2004

105. First.

Second.

Remember the formula


V = Pump Rate (ml/hr)
T
Determine how much volume you will need to give
Set up a proportion like this:
300mg = 150mg
100ml
X
Cross multiply to solve:
(300mg) x (X) = (100ml) x (150mg)
(100ml) x (150mg) = 50ml
300mg
Plug the numbers into the formula.
50 ml = 50ml/hour
1 hour
Remember the formula
_V_ x DF = Drip Rate
T
Plug the numbers into the formula
50ml x 60gtts = 100 gtts/minute
30 min
ml

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106. ORDER: Ancef 0.6g


IV in 50mL D5NS over
20 min.
STOCK: Ancef 1gram
in 100ml
What will you set the
pump at?

106. First.

Second.
Third.
Fourth.
Fifth.

107. ORDER: Cefobid


500mg IM every 6
hours
STOCK: Vial that
states, Add 2 ml of
dilutent to
equal 2.4 ml of solution
which contains 1 gram
of cefobid.
How many ml will the
nurse withdraw from
the vial after it is
reconstituted as
indicated on the label?

SAME version 2.1.


Haspela 2004

107.

Remember the formula


V = Pump Rate (ml/hr)
T
Plug the numbers into the formula
50ml
= Pump rate
20 min
This equals 2.5 ml/minute.
REMEMBER you arent done yet! Pump rate is
usually set in ml/hour. Soyou will need to convert
like this:
2.5 ml x 60min = 150ml/hour
min
1 hour

First.

After the nurse adds 2 ml of dilutent to the vial the


concentration of the solution will be 1 gram / 2.4 ml.
(This information is on the label)
Second.
The order calls for 500 mg IM every 6 hours.
Third.
Convert mg to g to get 0.5 g
Fourth..
Set up a proportion to solve for X like this:
1 gram = 0.5 g
2.4 ml
X ml
Fifth.
Cross multiply and solve for X like this:
(1 gram) x (X ml) = (2.4 ml) x (500 mg)
(2.4 ml) x (0.5 g) = Xml
1 gram
1.2 ml = X
ANSWER: The nurse withdraws 1.2 ml from the bottle. (This
amount contains the ordered 500 mg of Cefobid.
- 66 -

108. ORDER: Oxacillin 500


mg IM every 6 hours
STOCK: Vial that
states, Add 5.7 ml
sterile water.
each 1.5 ml contains
250mg oxacillin.
How many ml will the
nurse administer after it
is reconstituted as
indicated on the label?

108.

109. ORDER: Nafcillin


sodium 250 mg IM
every 6 hours
STOCK: Vial that
states, Add 3.4 ml of
sterile or bacteriostatic
water. Each ml contains
1000mg of nafcillin.
How many ml will the
nurse withdraw from
the vial after it is
reconstituted as
indicated on the label?

109.

SAME version 2.1.


Haspela 2004

First.

After the nurse adds 5.7 ml of sterile water to the


vial the concentration of the solution will be 250
mg / 1.5 ml. (This information is on the label)
Second.
The order calls for 500 mg IM every 6 hours.
Third.
Set up a proportion to solve for X like this:
250 mg = 500 mg
1.5 ml
X ml
Fourth.
Cross multiply and solve for X like this:
(250 mg) x (X ml) = (1.5 ml) x (500 mg)
(1.5 ml) x (500 mg) = Xml
250 mg
3 ml = X
ANSWER: The nurse withdraws 3 ml from the bottle. (This
amount contains the ordered 500 mg of Oxacillin.
First.
After the nurse adds 3.4 ml of sterile or
bacteriostatic water to the vial the concentration
`
of the solution will be 1000mg of naficillin / ml
Second.
The order calls for 250mg of naficillin sodium
Every 6 hours
Third.
Set up a proportion to solve for X like this:
1000 mg = 250mg
1 ml
X ml
Fourth.
Cross multiply and solve for X like this:
(1000 mg) x (X ml) = (1 ml) x (250 mg)
(1 ml) x (250 mg) = X
(1000 mg)
ANSWER: 0.25 ml. The nurse withdraws 0.25 ml from the
Bottle.(This amount contains the ordered 250 mg)
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110. See right


(The underlined items
are errors of nonprefered
abbreviations.)

SAME version 2.1.


Haspela 2004

110.
O2 @ 2L/minute NC, 2.0mg MS IV, 3 SL .3mg nitroglycerine given
every 5 minutes, and an EKG was done. No relief within this first 15
minutes. Patient continued to complain of 9/10 substernal pain. IV
nitroglycerine was started and titrated up to 200.00ug/min. Blood
glucose was checked and result was 350.0, therefore 10U regular
insulin was given SC in the left abdomen. Lasix 40mg PO QOD
changed to 40.0 mg IV now.

- 68 -

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