Mathematics For Medical Practitioners Drug Calculation

MATHEMATICS FOR MEDICAL PRACTITIONERS
DRUG CALCULATION
DR MUSA MARENA
 Drugs are prescribed by their generic (official) name or trade (brand) names and are
packaged in an average unit dosage
 Tablets and capsules contain a solid concentration of drugs (paracetamol gr x) whereas
solution contain a specific amount of drug (usually gram weight) dissolved in a specific
amount of solution (usually mL‘s or cc‘s) (promethazine 20mg per ml)
 Parenteral medications (IM, SC, IV) are package in vials, ampoules, and pre-measured
syringes. Dosages usually ranges from 1 to 3 ml
 Medication orders refer to drug dosages, so calculation will be necessary if dosage
prescribe is different from available dosage
 Some drugs are measured in units (heparin, insulin, penicillin), and others are in solutions
as mEq (grams per 1ml of solution). Some solutions need to be reconstituted from a`
powder form.
 Infants and children cannot receive the same dose of medication as adult
 Basic Math skills are needed to calculate most dosage and solution problems encounter
today in clinical practice
 Accurate dosage calculation are an essential component of total nursing role in safe
administration of medication
 NURSING STAFF HAVE a range of sophisticated electronic devices at their disposal
for delivering essential drugs, fluids and nutritional therapy to patients in the healthcare
setting.
 Accurate, low-flow-rate, small-volume infusions can be controlled by means of a
syringe pump
 Medium-to-high flow rates can be controlled by a volumetric infusion pump
 Basic fluid replacement can be delivered by the age old method of gravity
infusion – more commonly known as the ‗drip'.
 Gravity infusion relies solely on the user setting up the infusion using a safe and sturdy
drip stand, and then manually adjusting a plastic roller clamp, fitted to a disposable
administration set, to achieve the desired drip rate.
 A controller electronically regulates drop rate by gravity
 An infusion pump consistently exerts pressure against the tubing or the fluid at
preselected rate. Syringe pump exert pressure through the tubing
Barriers to Calculation Success
Top ten reasons why healthcare professionals don‘t think they need to maintain competency in
calculations:
 The computer does it
 The pharmacy does it
 The IV infusion pump does it
 We have charts and tables that do it
 The drug companies take care of it
 We use unit dose
 It‘s just a nursing school exercise
 We have a unit-based pharmacist
 Math is just not one of my strengths
 It‘s not a good use of my time
Responsible professionals cannot afford to become complacent with drug calculations as
they are accountable for all drugs they administer
TYPES OF IV FLUIDS
IV fluids are packaged in sterile plastic bags or glass bottles. It is essential to choose the correct
IV fluid to avoid serious fluid and electrolyte imbalance that may occur from infusing the wrong
solution. Physicians and healthcare providers order IV fluids and the IV flow rate.
If you have any doubt about the correct IV solution, always double-check with another
healthcare professional.
COMMON ABBREVIATIONS FOR IV FLUIDS
ABBREVIATION DEFINITION
D Dextrose
W Water
NS Normal (or isotonic) saline
D5W 5% dextrose in water
0.9% NS 0.9% saline in water (sometimes termed normal saline)
0.45% NS 0.45% saline in water (sometimes termed 1⁄2 normal saline)
0.33% NS 0.33% saline in water (sometimes termed 1⁄3 normal saline)
LR Lactated Ringer’s solution (or Lactated Ringers)
D5NS 5% dextrose in normal saline
KINDS OF IV DRIP FACTORS

IV fluids are administered through infusion sets. These consist of plastic tubing attached at one end to the
IV bag and at the other end to a needle or catheter inserted into a blood vessel. The top of the infusion set
contains a chamber. Sets with a small needle in the chamber are called microdripbecause their drops are
small. To deliver 1 mL of fluid to the patient/client, 60 drops drip in the drip chamber (60 gtt1 mL).
Commonest microdrip sets deliver 60gtt/mL. Others are 50gtt/ml and 40gtt/ml.Infusion sets without a
small needle in the chamber are called macrodrip(Fig. below).
Drops per milliliter differ according to the manufacturer. For example, Baxter-Travenolmacrodrip sets
deliver 10gtt/mL, so10 drops drip in the drip chamber (10gtt 1 mL); Abbott sets deliver 15gtt/mL, so 15
drops drip in the drip chamber (15gtt 1mL). The package label states the drops per milliliter (gtt/mL).
Sometimes the drop factor is also stated on the top part of the chamber. To calculate IV drip rates, you
must know this information.
The tubing for these sets includes a roller clamp (Fig. below) that you can open or close to regulate the
drip rate;
Use a watch or a clock with a second hand to count the number of drops per minute in the chamber (Fig.
below).
The Dial-a-Flow device (sometimes referred to as Dial-a-Flo) is an extension IV tubing that

attaches to the primary IV tubing. It is calibrated in milliliters per hour; you ―dial‖ the rate, and
the device regulates the flow. The roller clamp must be open all the way. Usually, these devices
are not used with an infusion pump. The rate is still an approximate amount, and changes in the
patient/client position can affect the flow rate.
INFUSION PUMPS
Electric infusion pumps also deliver IV fluid. Some are easy to operate; others are more
elaborate. You must enter two pieces of information: the total number of milliliters to be infused
and the number of milliliters per hour. Pumps used in specialty units also allow you to input the
name of the medication, the concentration of the medication, the amount of fluid, and the
patient/client‘s weight. The infusion rate is set in milliliters per hour, and the pump automatically
calculates the dose in milligrams, micrograms etc. There are several manufacturers of IV pumps;
some pumps use regular IV tubing, while other pumps use tubing specific to that IV pump. All
IV pumps allow you to program the primary IV rate, volume to be infused, secondary IV rate,
and total volume that has infused over a period of time. The pump can also calculate the dosage
based on weight. The tubing factor for an IV infusion pump is 60gtt/mL; however, the rate is
stated and programmed as milliliters per hour.
A Buretrol is an IV delivery system with tubing and a chamber that can hold 150mL delivered as microdrip (1mL = 60drops).
(This device is sometimes referred to as a Volutrol.) The top of the Buretrol has a port so that a reservoir of fluid can be added.
The Buretrol is a volume control because no more than 150mL can be infused at one time
.LABELING IVS
Every IV must be labeled so that any professional can check both the fluid that is infusing and
the drip rate. A typical order includes the following information:
 Patient/client name, room, bed number, date, and time
 Order: 500 mL D5W1⁄2NS. Rate: 50 mL/hr.
Many factors can influence this drip rate in gravity infusion once it has been calculated and set.
These include positional problems, temperature and other external factors. However, this method
has no means of alerting staff to impending errors, or any other infusion-related problems.
Furthermore, it is reliant on using the force of gravity to deliver the fluid accurately to the
patient. Apart from fluid viscosity, type of cannula and clinical complications after set up, other
factors can affect the initial rate of infusion. These include static pressure, temperature, fluid
level, patient position and drip factor
Many factors may interfere with the drip rate. When you are not using an infusion pump, gravity
will cause the IV to vary from its starting rate; you will need to observe and assess the infusion
and IV site frequently. You‘ll need to monitor other conditions as well. As the amount of fluid
decreases in the IV bag, pressure changes occur—and they, too, may affect the rate. The
patient/client‘s movements can kink the tube and shut off the flow; they can change the position
of the needle or catheter in the vein. The needle can become lodged against the side of the blood
vessel, thereby altering the flow, or it may be forced out of the vessel, allowing fluid to enter the
tissues (infiltration). (Signs of possible infiltration are swelling, pain, coolness, or pallor at the
insertion site. If you notice any of these signs, discontinue the IV and start a new one at another
insertion site.) Infusion pumps have an alarm system that beeps to alert you when the rate cannot
be maintained or when the infusion is nearly finished. Be sure to check the infusion pump
frequently, and know how to troubleshoot the various alarms.
 STATIC PRESSURE: The pressure (in mmHg) exerted on the fluid varies according to
the height difference between the patient access site and the fluid bag. An optimum
height of one meter above the patient should be sufficient to overcome initial venous
pressure. Should the bag be repositioned after set up, this height difference and
subsequent pressure difference will affect the drip rate.
 TEMPERATURE: Increases in temperature can cause the plastic components in the
roller clamp to lose tension and hence grip on the tubing as it tries to revert to its original
shape and this can adversely affect the drip rate.
 FLUID LEVEL: As the fluid level falls in the bag, the static pressure decreases and
results in a slowdown of the established infusion.
 PATIENT POSITION: The set infusion rate (drip rate) is relative to the position of the
patient and the fluid bag. Should the patient change position then the drip rate can also be
affected.
 DRIP FACTOR: This is usually indicated on each manufacturer‘s giving set package
and is approximately the number of drops equivalent to 1ml water (H2O). Any change in
the type of giving set can affect the drip rate, and staff needs to be aware of the drip
factor for each giving set used in their area of work.
Each patient‘s prescription is delivered from a fluid bag that can vary in size from 50ml to
2litres. An administration set, or giving set, is attached to the clean, sterile port of the fluid bag
and primed ready for the infusion. Once safely connected to the patient‘s cannula, the roller
clamp is slowly opened to establish a flow rate (in drops per minute). This drip rate is calculated
before each infusion and set accordingly. Patients are then monitored throughout the infusion
(mostly every hour) to ensure that the delivery is as expected
To administer the right amount the nurse must have basic mathematical skills to be able calculate
the dosage of medication. This may involve using
 Unit conversion
 Rates
 Proportions
 Ratio
 The nurse observes the three checks and six rights of medication administration.
THREE CHECKS WHEN PREPARING MEDICATIONS
 Read the label:
 Check the drug label with the MAR (medication administration record) when removing
the container or unit-dose package.
 Check the drug label again immediately before pouring or opening the medication, or
preparing the unit-dose.
 Check the drug label once more when replacing the container and/or before giving the
unit-dose to the patient/client.
KNOWLEDGE BASE IN GIVING MEDICATIONS
 Nurses should know the following before giving medications:
• generic and trade names of drugs to be administered
• class, category of drugs to be administered
• average adult or pediatric dose depending on the patient/client population
• routes of administration
• use
• side effects and adverse effects
• contraindications
• nursing implications in administration
• signs of effectiveness
• possible drug interactions
 The nurse should be aware of the patient/client‗s diagnosis and medical history, especially
relative to drugs taken. Be especially alert to over the counter drugs (OTC) or herbal remedies
which patients/clients often do not consider important. Check for drug allergies.
 Assess the patient/client‗s need for drug information. Be prepared to implement and evaluate a
nursing care plan in drug therapy.
SIX RIGHTS BEFORE ADMINISTERING MEDICATIONS

 Right medication
 Right patient/client
 Right dosage
 Right route
 Right time
 Right documentation.
MEDICATION ORDERS GUIDELINES
 Only licensed physicians or health care providers can write orders/prescriptions. Nurse
practitioners are licensed in all states to write orders, although some restrictions apply
and vary state to state.
 Medical students may write orders on charts, but orders must be countersigned by a
house physician before they are legal. Medical students are not licensed.
 In states that allow nurses or paramedical personnel to prescribe drugs, these caregivers
must follow hospital guidelines when carrying out orders.
 Do not carry out an order that is not clear or is illegible. Check with the physician or
healthcare provider who wrote the order—do not assume anything.
 Do not carry out an order if a conflict exists with nursing knowledge. For example,
Demerol (meperidine) 500 mg IM is above the average dose. Check with the physician or
healthcare provider who wrote the order.
 Nursing students should not accept oral or telephone orders. The student should refer the
physician to the instructor or staff nurse.
 Professional nurses may take oral or telephone orders in accord with institutional policy.
The nurse must write these orders on the chart, and the physician or healthcare provider
must sign them within 24 hours. Verbal orders are discouraged, and the physician should
write the order if physically present in the nursing unit.
Physicians and nurse practitioners order medications using the six rights of medication
administration including the:
1. Right patient
2. Right drug
3. Right dosage
4. Right route
5. Right time
6. Right documentation
Right Patient
Many medication errors can be prevented by correctly identifying the right patient. Patients in
the hospital setting wear identification bands, whereas other facilities may use a photograph to
identify the right patient. Regardless of the identification method, the medication order must
correspond to the identification of the patient. Checking identification and asking patients to state
their names assists in reducing medication errors. It is also important to ―listen‖ to the patient. If
the patient states, ―I don‘t take a blue pill,‖ go back and check the medication order for
correctness.
Right Drug
Medications can be ordered using their trade name or generic name.
Examples:
1. Tagamet® or cimetidine
2. Cipro® or ciprofloxacin hydrochloride
It is the responsibility of the nurse to look up a medication before administration to ensure that
the right drug is being administered. It is the responsibility of the nurse to know the
classification of the drug being administered and that the drug corresponds with the patient
diagnosis. Many drugs have similar names.
Example:
1. Celebrex® (an anti-inflammatory)
2. Celexa® (an antidepressant)
It is also the responsibility of the nurse to know the side effects of the drug being administered.
The nurse must be aware of any patient allergies before medication administration to ensure
safety of the patient. Allergies should be clearly recorded on medication records or a patient
should wear an allergy bracelet. Because it is impossible to know all medications, the nurse can
use a nursing drug reference to look up medications to ensure accuracy and prevent medication
errors.
Right Dosage
Medications are available in different dosages. It is the responsibility of the nurse to ensure that
the right dosage is administered. The pharmacy may supply the exact dosage ordered or the
dosage may need to be converted using a common equivalent or calculated based on the weight
of the patient. If the medication must be reconstituted, the correct diluent must be used for
reconstitution. If a patient is to receive a tablet but has difficulty swallowing, the nurse must
obtain an order to have the medication changed to an elixir. Medication orders are to be
administered exactly in the dosage ordered. A nursing drug reference assists with preventing
medication errors by supplying information regarding the dosages of medications that can be
safely administered to a patient based on age and weight.
Right Route
Medications may be administered by different routes including oral (tablets, capsules, or liquid),
parenteral (intradermal, subcutaneous, intramuscular, or intravenous), or cutaneous (skin and
mucous membranes). Improper medication administration techniques (crushing an enteric-coated
tablet, opening a capsule, or giving an injection using the wrong route) are considered
medication errors. A nursing drug reference provides information regarding the routes that can
be safely used to administer medication and eliminate medication errors. It is the responsibility
of the nurse to use this information to safely administer the medication to the patient using the
right route.
Right Time
Medications are ordered and need to be administered at specific times to ensure the effective
absorption of the medication. Failure to administer a medication on time or failure to document
the administration of a medication is a medication error of omission. Some medications are
ordered before meals (ac), after meals (pc), or at bedtime. Other medications may be ordered
based on frequency of time (once a day [qd], twice a day [bid], three times a day [tid], or four
times a day [qid]). A nursing drug reference provides the nurse with the appropriate information
to ensure that the medication is effectively and safely administered to eliminate a medication
error based on adsorption.
Most facilities allow a window of administration that is usually 30 minutes before or 30 minutes
after the prescribed time. It is the responsibility of the nurse to use this information to safely
administer the medication to the patient at the right time.
Once you are able to interpret the important components of an order for medication, you can
perform accurate calculations for the correct drug dosage by using dimensional analysis.
Right Documentation
Documentation is the sixth ―right of medication administration‖ and should be completed as
soon as possible after the administration of the medication. Documentation is an important right
that can prevent medication errors related to over- or under-medication. The general rule of
documentation is ―if you didn‘t chart it . . . you didn‘t do it‖ therefore medication should never
be charted before administration of the medication. Documentation should follow medication
administration and include documentation regarding refusals, delays, and responses (including
adverse effects) of medication administration.
Other rights that are important: the right drug preparation, right expiration date, right assessment, right
evaluation, the right to receive drug education, the right to refuse a drug.
Prerequisite of administrating any drug to a patient is for the nurse to read the label on the
package or bottle of the drug. In order to ensure that administration of medication is safe it is
imperative that the nurse remembers the ‗6 rights‘.
 RIGHT PATIENT: check patient‘s identity against the identification band and
prescription chart.
 RIGHT MEDICINE: check the prescription is legible, signed by an authorized
prescriber and that it matches the label on the medication. It‘s important to ensure the
drug hasn‘t passed the expiratory date and to understand the reasons why the medication
is prescribed and that the patient doesn‘t have any allergies to the medication. Prescriber
should use the generic name rather than a trade name on the prescription.
 RIGHT DOSE: check that correct dosage has been prescribed and carry out any
calculation required to ensure the correct amount administered. Check that the maximum
daily dose has not been exceeded
 RIGHT ROUTE: check prescribed route is appropriate for the patient and suitable
preparation is available.
 RIGHT TIME: check medication is given at the prescribe time and whether should be
before or after meals.
 RIGHT DOCUMENTATION: check the prescription chart is signed to state that the
medication has been given. If not given reason must be documented. The effect observed
or side effect of the drug reported by patient must be documented
Intravenous fluid therapy involves the administration of
 water
 nutrients (dextrose, protein, fats and vitamins)
 electrolytes (e.g. sodium, potassium, chloride)
 blood products
 medications
• A PHYSICIAN’S ORDER for intravenous fluid therapy must include
 the type/name of solution
 the dose
 the unit of dose is expressed as a quantity to be given in unit time and it
includes the following two:
• quantity of solution in mililitres, litres, milligrams, grams,
international units, or equivalent
• unit time period/duration for administration in seconds, minutes or
hours
 the quantity of the solution to be administer or the total time duration of
administering the dose
 infusion rate in milliliters per second, minute or hour or drops per second, minute
or hour) e.g. some institutions or areas (paediatrics)
• THE NURSE is responsible for regulating infusion rate by:
 Calculating flow rate { milliliters per hour (ml/h)}
 Choosing a drop factor and Selecting the appropriate IV set with chosen drop
factor
 Calculating the drip rate (gtt/min) that is needed to deliver the ml/h with the
chosen drop factor.
 Regulating the number of drops entering the drip chamber by using the roller
clamp on the tubing to adjust the flow rate ( count number of drops for one
minute) or the infusion pump
 Regularly checking whether the drip is flowing at the calculated rate i.e. hourly
• The flow rate is regulated either
 manually by straight gravity
 via an electronic infusion pump or controller
 A controller electronically regulates drop rate by gravity
 Whereas an infusion pump consistently exerts pressure against the tubing
or the fluid at preselected rate.
• Intravenous set or intravenous tube has a drip chamber at one end of the IV tubing that
connects the tubing to the IV solution (bag or bottle)
• The IV solution must pass through this drip chamber which has an opening that regulates
the drops/ml (gtts/ml) that enters the tubing.
IV SET/GIVING SET/INFUSION SET: A drop is abbreviated gtt, with gtts used for the
plural. These abbreviations come from gutta, the Latin for drop .The gtt/ml (drop factor), which
varies according to the manufacturer of the tubing will be displayed on the tubing package. The
eye of the dropper greatly influences the actual number of drops required to move 1 mL of fluid
into the drip chamber. Drop factor is the number of drops through the eye of dropper of a given
set that is required to move (infuse) 1ml of the fluid into the drip chamber (i.e. patient). The
label on the tubing box will indicate the dropper capacity of the specific tubing used*. The
calibration of IV tubing in gtt/ml is known as the drop factor. Common macrodrop factors are 10
gtts/mL, 15gtts/mL, 20gtts/mL and the common microdrop factor are 40gtts/ml, 50gtts/ml and
60gtts/mL. Determine drip capacity by choosing the microdrop chamber or macrodrip chamber.
If you are infusing UNDER 60 ML/HR., then choose a MICRO OR MINI DRIP SET which
delivers 40-60gtts/ml.
The SIZE OF CANNULA required will be determined by the type of fluid to be infused and
the size and condition of the patient’s veins. The smallest gauge capable of achieving the
required flow rate should be used (RCN 2010).
The administration sets are constructed so that the orifice in the drip chamber delivers a
predictable number of drops for each milliliter of fluid. The most common sets are called
macrodrip sets. These deliver 10-20drops per ml. These sets do vary, so consult the
manufacturer‘s package for a correct figure. Remember that this figure is correct for regular,
water-type fluids; when very viscous fluids, such as those containing amino acids and fats, are
given, the drops per ml may be fewer. (The figure is usually supplied with the product). Most
manufacturers also supply microdrip sets. These sets deliver 40-60 drops per ml and can be
identified by the fine metal orifice in the drip chamber. Blood administration sets are
characterized by a larger lumen, which delivers fewer drops per ml, and a large built-in filter in
the drip chamber, which removes any clots or precipitates in the blood. Giving set is to replace
every 72hours for safety and prevent entry of microorganism. Blood or parenteral nutrition
giving sets should be change more frequently
*Check tubing package-may be 10, 15, 20 (macrodrip) or 40, 60(microdrip) gtt/ml. Microdrip is
selected if Flow Rate calculated or stated is less than 60 ml/hr.
Patients can receive a medication through a port in an existing IV line. This is called
INTRAVENOUS PIGGYBACK (IVPB): The medication is in a secondary bag. The secondary
bag is higher than the primary bag so that the pressure in the secondary line will be greater than
the pressure in the primary line. Therefore, the secondary medication infuses first. Once the
secondary infusion is completed, the primary line begins to flow. Be sure to keep both lines
open. If you close the primary line, when the secondary IVPB is completed the primary line will
not flow into the vein. A typical IVPB order might read: cimetidine 300 mg IVPB q6h in 50 mL
NS infuse over 30 min. This is an order for an IV piggyback infusion in which 300 mg of the
drug cimetidine diluted in 50 mL of a normal saline solution must infuse in 30 minutes. So, the
patient receives 300 mg of cimetidine in 30minutes via a secondary line, and this dose is
repeated every 6 hours.
A primary IV line (right) and an IVPB (or secondary) line (left). Fluid flows continuously through the primary line into the
patient/client’s vein. At timed intervals, medication placed in an IVPB is attached by tubing to the primary IV for delivery
to the patient/client.
The primary fluid is lowered and the IVPB fluid flows. After the IVPB has infused, the primary fluid begins infusing again.
An IV infusion pump may also be used, where medication in the IVPB is infused through the pump.
Some IV medications are administered not continuously but only intermittently, such as every 4,
6, or 8hours. This route is termed intravenous piggyback or (IVPB). The term admixture refers to
the premixed IVPB.
Most of these drugs are prepared in powder form. The manufacturer specifies the type and
amount of diluent needed to reconstitute the drug; later, you, the nurse, connect the IVPB
(containing the reconstituted drug) by IV tubing to the main IV line. Some IVPB medications
come premixed from the manufacturer.
For other medications, the institutional pharmacy may reconstitute and prepare IVPB solutions in
a sterile environment using a laminar flow hood. This procedure saves nursing time, because
when you are ready to administer the drugs, they have already been prepared, labeled, and
screened for incompatibilities.
Nevertheless, the nurse still bears considerable responsibility: You must check the diluent and
volume.
You must also check the dose and the expiration date of the reconstituted solution; note whether
the
IVPB should be refrigerated before use or whether it can remain at room temperature until hung.
Finally, you must calculate the drip rate and record this information on the IVPB label before
hanging the bag.
CHOOSING THE INFUSION SET
Experience will enable you to judge which IV tubing to use. In clinical settings, the guidelines
below will help you make your choice. An electric infusion pump poses no problem, because it
will deliver the amount programmed. Specialized pumps in neonatal and intensive care units can
deliver 1 mL/hour and even less. Specialized syringe pumps also can deliver less than 1
mL/hour.
When an IV pump is not available, consider these guidelines:
Use microdrip when
• The IV is to be administered over a long period
• A small amount of fluid is to be infused
• The macrodrops per minute are too few (Without an infusion pump, IV fluids flow by gravity.
Blood flowing in the vein exerts a pressure. If the IV is too slow, the pressure of the blood in the
vein may back up into the tubing, where it may clot and cause the IV to stop infusing.)
Use macrodrip when
• The order specifies a large amount of fluid over a short time
• The microdrips per minute are too many, and counting the drip rate becomes too difficult
INFUSION RATE CALCULATION
Generally there are at least three methods employed in medication calculation. These are
dimensional analysis, proportion and formula method. No one method is best for solving every
type of problem. Several good approaches are available, however and one of the best is
dimensional analysis (also called the factor-label or unit factor method) as the name implies, in
dimensional analysis we use the units (dimensions) that are a part of measurements to help solve
(analyze) the problem.
Rule #1 in drug calculations - STICK TO ONE FORMULA!
1: DIMENSIONAL ANALYSIS/DEDUCTION METHOD

Is a process of manipulating units, which are actually descriptions of numbers, to solve mathematical
equations. This method of mathematic problem solving is used in chemistry with great success. The
goal of this approach to drug calculation problem solving is to:
CANCEL OUT UNWANTED UNITS LEAVING ONLY THOSE UNITS YOU
WANTYOUR ANSWER TO BE EXPRESSED AS!
Think of Unit Equivalence as a link that will help you get the desired units you are solving for.
It involves calculating the unknown variable using its units to deduce a formula. (Also known as
factor analysis, factor-label method, or unit-factor method, “chemistry math”). This method
involves the logical sequencing and placement of a series of ratios (termed factors) into an
equation. The ratios are prepared from the given data as well as from selected conversion factors
and contain both arithmetic quantities and their units of measurement. Some terms are inverted
(to their reciprocals) to permit the cancellation of like units in the numerator(s) and
denominator(s) and leave only the desired terms of the answer. One advantage of using
dimensional analysis is the consolidation of several arithmetic steps into a single equation.
The Mathematical Foundation for Dimensional Analysis

Dimensional Analysis relies on two simple mathematical concepts.
Concept 1: When a nonzero quantity is divided by the same amount, the result is 1.
For example:
Because you can also write a division problem in fractional form, you get
Since is a fraction equal to 1, and the word ―unit‖ means one, the fraction is called a unit
fraction.
In the preceding unit fraction, you may cancel the 7s on the top and bottom. That is, you can
divide both numerator and denominator by 7.
Units of measurement are the ―labels,‖ such as inches, feet, minutes, and hours, which are
sometimes written after a number. They are also referred to as dimensions, or simply units. For example,
in the quantity 7 days, days is the unit of measurement.
The equivalent quantities you divide may contain units of measurement.
For example:
Or in fractional form:
In the preceding unit fraction, you may cancel the number 7 and the unit of measurement days on
the top and bottom and obtain the following:
Going one step further, now consider this equivalence:

Because 7 days is the same quantity of time as 1 week, when you divide these quantities, you
must get 1.
So, both and
Or in unit fractional form: and
Other unit fractions can be obtained from the equivalences.

Equivalents for some common units of measurement
12 inches (in) = 1 foot (ft)
2 pints (pt) = 1 quart (qt)
16 ounces (oz) = 1 pound (lb)
60 seconds (sec) = 1 minute (min)
60 minutes (min) = 1 hour (h or hr)
24 hours (h or hr) = 1 day (d)
12 months (mon) = 1 year (yr)
Concept 2 When a quantity is multiplied by 1, the quantity is unchanged.

In the following examples, the quantity 2 weeks will be multiplied by the number 1 and also by
the unit fractions and
Consider the previous line again. This time you cancel the week(s)!
( )
for Some Common Units of Measurement
So,
This shows how to convert a quantity measured in weeks (2 weeks) to an equivalent quantity measured in
days (14 days). With the Dimensional Analysis method, you will be multiplying quantities by unit
fractions in order to convert the units of measure. This procedure demonstrates the basic technique of
Dimensional Analysis.
Many of the problems in dosage calculation require changing a quantity with a single unit of measurement
into an equivalent quantity with a different single unit of measurement; for example, changing 2 weeks to
14 days as was done above. Other problems may involve changing rates of flow to equivalent rates of
flow.
NOTE: Students often say that once you master dimensional analysis, you tend to use it all the time
because it is simpler and more accurate than the other methods
It is important to understand the following four terms that provide the basis for dimensional
analysis.
 Given quantity: the beginning point of the problem commonly the doctor‘s order. the
dose to be given,
 Wanted quantity: the answer to the problem what you desire
 Unit path: the series of conversions necessary to achieve the answer to the problem
 Conversion factors: equivalents necessary to convert between systems of measurement
and to allow unwanted units to be canceled from the problem.
Each conversion factor is a ratio of units that equals 1.
UNIT - a dimension that is given to a number.
For Example - If you are to give 50, you would ask, 50 what? This could be mg, mL, tablets,
teaspoons, etc. (mg, mL, tablets, tsp. are the units)
UNIT EQUIVALENCIES- the value of equivalencies between two units.

For Example: 1 kg = 2.2lbs, 5mL = 1tsp, 30mL = 1ounce,
1gram = 1000mg, 60minutes = 1hour, 15gtt = 1mL, 1grain = 60mg, 1IU=1000mIU
CONVERSION FACTOR- it is a unit equivalency written as a fraction.
(The above is simply stating that 60 mg is equal to 1 grain or 1 grain is equal to 60mg….both mean
the same thing regardless of how they are set up).
Conversion factors are derived from information provided in the dosage problem.
Dimensional analysis is a method of calculation in which a series of ratios or factors, organized
in the form of fractions, are multiplied.
 Factors are two quantities that are related, such as 30 mg in 2 ml.
 In dimensional analysis, factors are expressed as fractions.
 30 mg in 2 mL may be expressed as:
o
 The unit in the denominator of the second fraction must be the same as the unit in the numerator of the first
fraction. Frequently, conversion factors (equivalents) will be needed if the units are not in the same system.
 One unit of measurement is converted to another unit of measurement by means of
conversion factors or unit equivalence. A conversion factor is a unit equivalence
expressed as fraction such as 2.2lb = 1 kg or 1,000 mcg = 1 mg.ie
 Conversion factors link units of measurement of what is desired with units of
measurement of what is available.
 Conversion factors are arranged in the form of a fraction.
o 1,000 mcg = 1 mg may be expressed as:
For example:
Covert 50 lb to kg
The Unit Equivalence (link) is: 2.2 lb = 1 kg
Note: is another way of saying that 2.2 lb = 1 kg
The desired units we are seeking are kg in this example.
Using Dimensional Analysis in the above example, we set the problem up in the following format:
Problem: Covert 50 lb to kg
(lb cancel one another out and we are left with kg, the units we want)
Another way of stating this problem is: How many kg are there in 50 lb? or 50 lb is equal to how
many kg?
In this example, the units of lbs cancel each other out, leaving behind kg (the units we want our
answer to be in). We have eliminated the units we don‘t want and are left with the units we do want.
Note: In Dimensional Analysis we simply multiply straight across first (on both sides of the
horizontal line if applicable) and then divide. There is no cross multiplication or algebra involved in
this method of problem solving.
Note: This approach to drug calculations can be used with every type of problem. This is not true
of other methods.
Remember, drug calculation problems are simply story problems. You have to develop a
mathematical problem from the information that is provided.
Using the Dimensional Analysis approach, this can be accomplished in a few simple steps:
 Determine what it is that is being asked
 Determine what units your answer must be represented in (desired units)
 Determine what the unwanted units are
 Determine what the link (unit equivalence) is (there may be more than one link per problem,
and these conversions may have to be made before the final problem can be set up)
 Set up your problem so that you can eliminate unwanted units to end up with desired units
Apply this method to the problem above: Covert 50 lb to kg

 Determine what it is that is being asked - How many kg are there in 50 lb? or 50 lb is equal to
how many kg?
 Determine what units your answer must be represented in (desired units) - kg is what we are
solving for
 Determine what the unwanted units are - We want to eliminate lb
 Determine what the link is - 2.2 lb = 1 kg
 Set up your problem so that you can eliminate unwanted units to end up with desired units
Problem: Covert 50 lb to kg
lb cancel each other out and you are left with kg (the units we want)
Dimensional analysis also uses the same terms as fractions: numerators and denominators.
 Numerator = the top portion of the problem
 Denominator = the bottom portion of the problem
Some problems will have a given quantity and a wanted quantity that contain only numerators.
Other problems will have a given quantity and a wanted quantity that contain both a numerator
and a denominator.
The problem-solving method of dimensional analysis uses the following five steps.
1. Identify the given quantity in the problem.
2. Identify the wanted quantity in the problem.
3. Establish the unit path from the given quantity to the wanted quantity using equivalents as
conversion factors.
4. Set up the conversion factors to permit cancellation of unwanted units. Carefully choose each
conversion factor and ensure that it is correctly placed in the numerator or denominator portion
of the problem to allow the unwanted units to be canceled from the problem.
5. Multiply the numerators, multiply the denominators, and divide the product of the numerators
by the product of the denominators to provide the numerical value of the wanted quantity.
In solving problems by dimensional analysis, the student unfamiliar with the process should
consider the following steps:
Step 1.Identify the given quantity and its unit of measurement.
Step 2.Identify the wanted unit of the answer.
Step 3.Establish the unit path (to go from the given quantity and its unit to the arithmetic answer
in the wanted unit), and identify the conversion factors needed. This might include:
 (a) A conversion factor for the given quantity and unit, and/or
 (b) A conversion factor to arrive at the wanted unit of the answer.
Step 4.Set up the ratios in the unit path such that cancellation of units of measurement in the
numerators and denominators will retain only the desired unit of the answer.
Step 5.Perform the computation by multiplying the numerators, multiplying the denominators
and dividing the product of the numerators by the product of the denominators.
To create an equation using dimensional analysis:

 Collect all data (variables) for the questions.
 Step 1: draw a long straight line (‗magic line‘) and place an equals to sign at the right end
of the line.
 Figure out what are you solving for (ask yourself what am I solving for?) and write its
unit on the right side of the equals to sign. With space between the equals to sign and the
unit so that the value of unknown variable (what you are looking for) can be written in
the space provided after solving the equation
 Step 2: Identify the first variable to be written on the left side. It can either be:
 The doctor‘s order (given quantity)
 or
 It is determined by the ‗numerator unit‘ of the wanted variable. The numerator
unit of the first variable should be the same as the numerator unit of what we are
solving for.
 The variables are written such that the numerators and their units are on top of the magic
line. The denominator and its unit are below the magic line.
 If the similar unit of the selected variable is the ‗Numerator unit‘ then the variable is
written directly. If the similar unit of the selected variable is the denominator unit then
the variable is written as an inverse so as to position the similar unit as the numerator.
 Step 3: Each subsequent variable is written as a product of the previous variable and the
subsequent variable is determine by
o The denominator unit of the previous variable. A variable with one of its units
similar to the ‗denominator unit‘ of the previous variable is selected as the next
variable. The ‗numerator unit‘ of this selected subsequent variable should be
similar (SI unit) to the ‗denominator unit‘ of the previous variable. If the similar
unit is the numerator unit of the subsequent variable then the subsequent variable
written directly as a multiple. If similar unit is also a denominator in the
subsequent variable then the variable should be written as an inverse so that the
similar unit can be the numerator.
o Conversion factor for the previous variable to be able to cancel out the unwanted
units
 Step 4: More variables are added until all the unwanted units on the left side cancelled
out except the wanted units (one as numerator and other as denominator) similar to those
units of the unknown variable (units of what you are looking for)
 Note check whether each variable needs conversion and convert it(by multiplying it
with a conversion factor) before writing the subsequent variable.
Note if a variable has two units first one is the numerator and the second the denominator.
Multiplying by variable as an inverse is equal to dividing by the variable. So if the
desire unit is in a position opposite to its required position then we inverse the variable.
If drops is the ‗numerator unit‘ of the unknown variable or the ‗denominator unit‘ of the previous
variable, then we need to identify a variable with one of its units as drop to be selected as the
first variable after the equals to sign or as the subsequent variable respectively. Secondly if drops
is the ‗numerator unit‘ of the selected variable then the selected variable be written directly for
the first variable on the left side of the equals to sign but if it‘s the denominator units of the
selected variable then the subsequent variable will be written as an inverse.
The variables are written as a product of one another (multiplication). The next variable to be
multiple is determined by the ‗denominator unit‘ of the previous variable.
EXAMPLE 1
Calculate the drip rate of 3000mls of 5% dextrose over 24hrs using an IV set with drop factor of
20drops/ml?
METHOD 1(SEQUENTIAL METHOD beginning with Given Quantity)
STEP1: Identify the wanted Quantity (unknown variable/ what you are looking for) and its unit.
Step2: Identify the given quantity (doctor‘s order) and its units.
 3000ml in 24hrs
Step 3: Identify unit equivalents or conversion factors and write them as unit equivalents
 (5% dextrose)


Step 4: Draw the magic line
 ----------------------------------
STEP 4a: Write the given quantity with its units at the beginning of the line making sure the
numerator is above the line and denominator is below the line.
STEP4b: Write an equal to sign at the end of the magic line.
STEP4c: Write the units of the wanted variable after the equals-to sign making sure you leave
some space between the equals to sign and the unit of the wanted quantity.
Step5: Place the unit equivalents or conversion factors as a multiple so that one of the
dimensions of the unit equivalents cancelled one of the dimensions of the preceding unit
equivalent. This will help the unwanted units cancel out until tis left with only the dimensions of
the wanted quantity.
Both ml and hrs are unwanted units hence we need a variable with ml to be able to cancel out ml

Variable with ml is:
Hence
Unwanted unit in the equation is hr so we need variable with hr as a unit to cancel out
Variable with hr is
Hence
No unwanted unit left to cancel and all desired units are present
STEP6a: Multiply all the numerators.
Step6b: Multiply all the denominators
Step7: Divide the two values and record it in the space provided
METHOD 2 (SEQUENCIAL METHOD SIMILAR DIMENSIONS)

Step 1: Identify the Wanted Quantity (what are you looking for- ‗wanted quantity‘) is drip rate
(DR) and its units are drops/min. then write equals to sign
Step 2: Numerator unit of the wanted variable is drops hence first variable should have drop as
numerator

Step 3a: Write all the conversion factors as unit equivalents

o
o
o
 variable with drops among unit Equivalents is:
Step 3b: Write variable with similar dimension such that the same dimensions are the numerator
Step3b: Add subsequent unit equivalents as a multiple such that their numerator dimension is
similar to the denominator dimension of the preceding conversion factore in order to cancelled
unwanted dimensions
 variable with ml among Unit Equivalents is:
Cancelling ml will be left with hr which is an unwanted dimension. We need a unit

equivalent with hr to cancel it out
 variable with hrs among the Unit Equivalents is:

Cancelling hr will be left with min which is a wanted dimension. We have also achieved
all the desire dimensions and there is no unwanted unit
Step4a: Multiply all the numerators
Step5: Divide the final values
METHOD 3 (RANDOM METHOD)

Step 1: Unknown variable (what are you looking for- ‗wanted quantity‘) is drip rate (DR) and its
unit is drops/min.
 —―—―—―—― =
Step 2: Write the given quantity with its units at the beginning of the line making sure the
 ------------------------- =
Step 3a: identify conversion factors or unit equivalents


Step 3b: Insert all the conversion factors without order making sure all unnecessary units are
cancelled out

Step3c: Our equation has now same units on both sides of the equation if we cancels like ones
out hence we can now solve the equation.
Step 4: compute your answers by multiplying all the numerator and multiplying all the
denominators then dividing the two results
Gynaecologist performing hysteroscopy uses 1.5% Glycine as distending medium. If the flow
rate is 80ml/min, how many grams of glycine will the infusion into the uterus if the operation
lasted for 3hrs? If the flow rate is change to 100ml/min what is the dose of glycine infusion? If
the drop factor of the IV set is 10drops/ml what is the new drip rate? The assistant changes the
giving set to give 10drops/sec in order to be able to give 150mg/min. what is the new flow rate in
ml/min. what is the drop factor of the new IV set?
METHOD 1(SEQUENTIAL METHOD)

STEP1: Identify the wanted variable (unknown variable/ what you are looking for) and its unit.
 mass grams g
 80ml/min
Step 3: Identify conversion factors and write as unit equivalents.
 1.5% glycine= 1.5g of glycine in 100ml



 ----------------------------------


Step5: Place the unit equivalents or conversion factors so that the unwanted units cancel out
until the wanted units similar to units of wanted quantities are left.
STEP6: Multiply all the numerators.
METHOD 2(SEQUENTIAL- starting with variable whose

dimension is similar to wanted quantity numerator)
STEP1: Identify the wanted variable (unknown variable/ what you are looking for) and write its
dimensions. It begins the equation. Then write equals to sign.
 mass grams g
Step 2: Numerator unit of the wanted variable is drops hence first variable should have drop as
numerator

Step 2: Identify conversion factors and write as unit equivalent
 1.5% glycine = 1.5g of glycine in 100ml of 1.5% glycine solution.




Step3a: Identify a unit equivalent with a dimension similar to the numerator of the dimension of
the wanted quantity (g).
 Is solution concentration
Step3b: Write it after the equals to sign so that the similar dimension is written as the numerator.

Step 4a: continue adding variables by multiplication so that their denominator dimension cancels
out the numerators dimension of the next variable until all the unwanted dimensions are canceled
and the desired dimensions remain
 -
Step4b: Place the unit equivalents or conversion factors so that the unwanted units cancel out
until the wanted units similar to units of wanted quantities are left.
STEP5a: Multiply all the numerators.
Step 6: Divide the two values and record it in the space provided
RANDOM METHOD
STEP1: Identify the wanted variable (unknown variable/ what you are looking for) and its unit.
 mass grams g
 80ml/min
Step 3: Identify conversion factors and write as unit equivalents.

 1.5% glycine= 1.5g of glycine in 100ml


 ----------------------------------
Step5: Place the unit equivalent or conversion factors at random so that the unwanted
dimensions cancel out and required dimensions left.
STEP6: Multiply all the numerators.
USING SEQUENTIAL METHOD (OTHER WAY)

Start with the unit of measurement that is to be calculated:
o For example, to convert mcg to mg, mg are desired, so start with:

Find the quantity with the same unit of measurement or the conversion factor with the same unit
of measurement as what is desired (1 mg = 1,000 mcg) and place this (mg) in the numerator.

 Remember, fractions are set up as the numerator over the denominator:
o
The fractions are arranged so that unwanted units cancel out and desired units remain.
 A single quantity not associated with a related quantity is expressed as a fraction by
placing it in the numerator and placing 1 in the denominator.
o
If mcg are available and mg are desired, arrange the conversion factor such that mcg may be
cancelled out to leave mg remaining:

Cross out the identical units that are across and diagonal:

In dimensional analysis, fractions are multiplied. To multiply fractions, first multiply across the
numerator, and then multiply across the denominator. Finally, divide the numerator by the
denominator.
Equations involving multiple factors are arranged so that the unit of measurement in the
denominator of one factor is placed in the numerator of the following factor and so on.
Unwanted units are then cancelled.
 Remember:
o A single quantity not associated with a related quantity is expressed as a fraction
by placing it in the numerator and placing 1 in the denominator.
o Factors are two quantities that are related. Related quantities are arranged as
fractions.
QUESTION:
An IV of 1000ml of 5% D/0.9% NaCl is started at 8pm. The flow rate is 38drops per minute, and
the drop factor is 10drops per milliliter. At what time will this infusion finish?
ANSWER:
SEQUENTIAL METHOD
( )
Unit equivalences (conversion factors):

Time of finish will be 8pm + 4hr23min= 12:23am
SEQUENTIAL METHOD (OTHER WAY)

( )
RANDOM METHOD
( )
Time of finish will be 8pm + 4hr23min= 12:23am
EXAMPLE
The prescriber writes an order for 1000ml of 5% D/W with 10units of Pitocin (oxytocin). Your
patient must receive 3mU of this drug per minute. Calculate the flow rate in microdrops per
minute.
ANSWER
SQUENTIAL METHOD
( )
( )
RANDOM METHOD
( )
EXAMPLE
Gynaecologist performing hysteroscopy uses 1.5% Glycine as distending medium. If the flow
rate is 80ml/min, how many grams of glycine will the infusion into the uterus if the operation
lasted for 3hrs? If the flow rate is change to 100ml/min what is the dose of glycine infusion? If
the drop factor of the IV set is 10drops/ml what is the new drip rate? The assistant changes the
giving set to give 10drops/sec in order to be able to give 150mg/min. what is the new flow rate in
ml/min. what is the drop factor of the new IV set?
SEQUENTIAL METHOD
Unit equivalents (Conversion Factors)

RANDOM METHOD:
SEQUENTIAL METHOD
Data collection:
( )
(

Data collection:
(
RANDOM METHOD
Data collection:
(
( )
C:
SEQUENTIAL METHOD

Data collection:
RANDOM METHOD
E:
SEQUENTIAL METHOD 1
Unit equivalent (conversion factors)
SEQUENTIAL METHOD 2
RANDOM METHOD
Data collection:
Note because variable available is 1.5g/100ml and variable need should have ml as numerator
hence the variable is inversed. Also changing gram to mg and to cancel both g and mg variable
need is 1g/1000mg, i.e. 1g=1000mg
F:
SQUENTIAL METHOD 1
Wanted quantity drops/ml
Unit equivalents (conversion Factors)

SEQUENTIAL METHOD 2
RANDOM METHOD 3
The physician has ordered 500mL D5W with 10units oxytocin intravenously. Begin at 1mU/min
and then increase by 1mU/min every 30minutes until active labor is achieved. Maximum dose is
28mU/min.
A: Calculate the IV rate (ml/hr) for the beginning infusion
B: Calculate the IV drip rate for the beginning infusion.
C: What is the maximum IV rate(ml/hr) the Pitocin infusion may be set for?
D: What is the maximum IV drip rate the Pitocin infusion may be set for?
A: data
SEQUENTIAL METHOD 2
RANDOM METHOD 3
SEQUENTIAL METHOD 2
D: data
SEQUENTIAL METHOD 2
RANDOM METHOD 3
.
2: PROPORTION
It is the relationship between two ratios. It equates two ratios.
There are two ways of expressing proportions. It use variables with one common unit and based
on their units it relates them through proportion to find the unknown variable. It uses the
common unit between the variable to find the unknown. It is commonly used to calculate drugs
doses and injections. It may sometimes needs multiple steps before the final answer
 PROPOTIONS EXPRESSED AS TWO RATIOS: This uses the relation of the various
variables as proportion to one another. Its works on lot of logic deduction base on how
one variable is related to the next base on their common unit. It is easier for use by those
with poor mathematical skills. It does need the nurse to memorize any formula hence best
for most nurse and health care worker. Example if drop factor 15drops/ml of drop rate is
45drops/min. flow rate in ml/min will be: the common unit between the two known
variables is drops and the unit of the unknown variable is ml/min.
Hence: 15drops :1ml=45drops : x
 PROPORTION EXPRESSED AS TWO FRACTIONS: It is similar to proportion but
put the units into fractions rather than proportion. 15drops/1ml = 45drops/x
In proportion expressed as 15drops:1ml=45drops:3ml. The two inner values are called the
‗means‘ and the outer values are called the ‗extremes‘. The product of the means is equal to the
product of the extremes. I.e. 1ml×45drops=15drops×3ml.
A proportion consists of two ratios of equal value. The ratios are connected by a double colon
(::), which symbolizes the word as. 2 : 3 :: 4 : 6
Read the above proportion: ―Two is to three as four is to six.‖
The first and fourth terms of the proportion are the extremes. The second and third terms are the
means. 2 : 3 :: 4 : 6
2 and 6 are the extremes
3 and 4 are the means
A helpful way to remember the correct location of the extremes and means is
E = The end of the problem
M = The middle of the problem
In a proportion the product of the means equals the product of the extremes because the ratios are
of equal value. This principle may be used to verify your answer in a proportion problem.
3 4 = 12, product of the means
2 6 = 12, product of the extremes
If three terms in the proportions are known and one term is unknown, an x is inserted in the
space for the unknown term. 2 : 3 :: 4 : x
RATIO AND PROPORTIONS
• Ratio is same as fraction
 Use to express a relationship between two units or quantities
 A slash (/) or colon (:) is use to indicate division and both are read as is to or per
 With medication usually refers to weight of drug (i.e. gram) in a quantity of the
solution ( i.e. cc‘s)
 50mg/cc= 50mg of a drug (solute) in 1cc of a liquid (solution)
• A proportion states that two ratios are equal
 In fraction form where two fractions are equal1/3=3/9
 Colon form e.g. 1:3 :: 3:9
• Frequently in dose calculation problems one quantity is known ( i.e. 100mg per mL =
100mg/1mL) and it is necessary to find an unknown quantity because the physician has
ordered something different from what is available ( i.e. 75mg)
In proportion problem the unknown quantity (? mL) to give 75mg is identify as x

Ratio: is the numerical relationship between two dimensions (units). It means part per part it can
be express as
A: B
A/B
Ratio can be converted into fraction which can be converted to decimals which can also be
converted to percentages. Eg
1:2=1/2=0.5=50%
Ratio 1:2 means 1part per 2parts e.g. 20mg/ml means 20mg of solute per ml of solution
SOLVING A SIMPLE PROPORTION PROBLEM

1. Multiply the extremes.
2. Multiply the means.
3. Place the product that includes the x on the left of the equal sign and the product of the known
terms on the right of the equal sign.
4. Divide the product of the known terms by the number next to x. The quotient will be the value
of x.
COLLECT ALL THE DATA FOR THE QUESTION

Step 1: Identify the unknown variable
Step 2: Identify a variable that has one of its unit similar to one of the unit of the unknown
variable.
Step 3: Identify a second known variable that has its numerator unit similar to the other unit of
the selected variable.
Step 4: Relate the two selected variables as a ratio or as a fraction inn order to help in finding the
second unit of the unknown variable.
Step 5: solve for the unknown.
Pitocin (oxytocin) 10 units/1,000 mL RL, start at 0.5mIU/min increases by 1 mIU/min q20

minutes. What is the rate of flow in mL/h for the initial dose of Pitocin? The drop factor is
60mcgtt/ml. Calculate the flow rate in mcgtt/min.
Data collection:
Concentration (C) = 10units/1000ml
Dose (D) = 0.5mIU/min at 1mIU/min
Time (T) =20mins
Flow rate (FR) =?
Drop factor (DF) = 60mcgtt/ml
Drip rate (DR) =?
Step 1: unknown variable is flow rate (FR) and its unit is ml/min
Step 2: variable 10unit/1000ml has one of its unit similar to the unknown variable flow rate.
Step 3: variable 0.5mIU/min has one of its units similar to the identify variable 10IU/1000ml.
Step 4: relate the two variables:
Step 5:
Hence 0.05ml is given in one minute i.e. flow rate is 0.05ml/min.
b.
3: FORMULA METHOD
This uses various formulas in the medication calculation. These formulas need memorization. It
is faster and less tedious if the formula is remembered. In certain instances the nurse (health care
worker) may forget the formula or even memorize the wrong one. This may lead to giving wrong
amount of medication to the patient with detrimental effects
First step is to calculate the flow rate, this value would then give you a crude idea as to whether
to choose microdrop or macrodrop as your drop factor then second step is drip rate can be
calculated by using the product of flow rate and the drop factor. Hence
 STEP ONE: The flow rate is calculated either
 by dividing the total volume (in millilitres) prescribed for the patient by the
number of hours required for the delivery. This gives the flow rate in milliliters
per hour (ml/hr).
( ))
 ( ) ( )
 or by dividing the dose of the medication by the final concentration into which the
drug/ medication is prepared.
( )
 ( ) ( )
 ( ) ( ) ( )
( )
 ( ) ( )
( )
 Dose is amount per unit time. It is calculated by dividing amount of drug

over by the time to give the drug.
( )
( )
( )
 Concentration is the amount of drug per unit volume of the solution. It is

amount of drug divided by the total volume of the solution.
( )
( )
( )
• STEP TWO: The flow rate (ml/hr) is then multiplied by the drip factor of the selected,
chosen or identified giving set(nominal number of drops per ml) to give the drip rate i.e.
the total number of drops required per hour(Dougherty and Lister 2004): note if flow rate
is less than 60ml/hr. a microdrip is chosen.
• To obtain the number of drops required per minute, divide the number of drops per hour
by 60 (number of minutes in 1 hour):
• To calculate (flow rate) milliliters per hour for plain fluids you need two pieces of
information
• The total volume to be infuse in milliliters
• The total time for infusion in hours
• Use this standard formula
•
( )
( )
( )
Example: from question 1 of the problem below we are to give 1000ml D5/RL in 8hrs hence
• To calculate the time of infusion you need

• Total volume of infusion (milliliters)
• Rate of infusion (milliliters/minute or hours)
Use the formula
( )
( )
( )
Example If Doctor ordered that patient should be giving 2L of NS at a rate of 100ml/hr.

• To calculate drops per minute (drip rate), you need
• two pieces of information
• Flow rate
• Drop factor
• Use the formula
( ) ( ) ( )
 Combining all the variable
( )
( ) ( )
( )
Note: variables should be converted to similar units before inserting into the formula.
PERCENT
• Percentage is Always a division of 100
• It means the ―hundredth part‖
• Has a symbol of %
• In solution (combination of solute and solvent) the % means proportion of solute per
portion of the solution. It is can be expressed as weight of solute per hundredth portion of
the solution (weight/volume)or volume of solute per hundredth volume of solution
(volume/volume)
• grams of solute per 100ml or 100cc of solution‖ for (w/v) solutions
• Millilitres of solute per 100ml or 100cc of solution‖ for v/v solutions
 A 5% solution means 5grams of drug (solute) per 100cc (100ml) of solution.
Another way of putting it is every 100ml of the 5% contains 5g od the solute
 0.9% means 0.9g of solute per 100cc of the solution e.g. normal saline
(100cc(100ml) of solution contains 0.9g of NaCl)
 10% means 10g of solute per 100cc (100ml)of solution e.g. 10% glucose means
every 100ml of 10% glucose contains 10g of glucose
 20% means 20g of solute per 100cc (100ml) of solution e.g. 20% mannitol
contains 20g of mannitol for every 100ml of the solution
 50% means 50g of solute per 100cc (100ml) e.g. 50% MgSO4 means every
100ml 0f the 50% MgSO4 contains 50g of MgSO4.
For example question 7 of problem below;
The label on the vial of magnesium sulphate is 50% w/v means every 100ml of the 50% MgSO4
contains 50g of MgSO4.In other words 50g of MgSO4 are contain in100mls of the solution from
the vial.
NOTE: To find the number of mg in each ml of solution multiply the % strength by 10.
e,g. 1%
RATIO STRENGTH
The concentrations of weak solutions are frequently expressed in terms of ratio strength. Because
all percentages are a ratio of parts per hundred, ratio strength is merely another way of
expressing the percentage strength of solutions or liquid preparations (and, less frequently, of
mixtures of solids). For example, 5% means 5 parts per 100 or 5:100. Although 5 parts per 100
designates a ratio strength, it is customary to translate this designation into a ratio, the first figure
of which is 1; thus, 5:100 = 1:20.
When a ratio strength, for example, 1:1000, is used to designate a concentration, it is to be
interpreted as follows:
For solids in liquids=1 g of solute or constituent in 1000 mL of solution or liquid preparation.
• For liquids in liquids = 1 mL of constituent in 1000 mL of solution or liquid preparation.
• For solids in solids = 1 g of constituent in 1000 g of mixture.
The ratio and percentage strengths of any solution or mixture of solids are proportional, and
either is easily converted to the other by the use of proportion.
Some medications like epinephrine are written as 1 in1000, 1in 10000, 1 in 100000 or as 1:1000,
1:10000, 1:100000.
This means 1g of solute in 1000ml of solution, 1g in 10000ml, 1in 100000ml, 1g in 1000000ml
or 1g:1000ml
TITRATING MEDICATIONS
The process of adjusting the dosage of a medication based on patient response is called titration.
Titration is adjustment of the dose, either increasing or decreasing, to attain the desired patient
response. Weaning is a gradual decrease of the dose when the medication is being discontinued.
Orders for titrated medications are often prescribed for critical-care patients. Such orders require
that therapeutic effects, such as pain reduction, be monitored. The dose of the medication must
be adjusted accordingly until the desired effect is achieved. An order for a titrated medication
generally includes a purpose for titrating and a maximum dose. If either the initial dose
or directions for subsequent adjustments of the initial dose are not included in the order, the
medication cannot be given, and you must contact the prescriber. Dosage errors with titrated medications
can quickly result in catastrophic consequences. Therefore, a thorough knowledge of the
particular medication and its proper dosage adjustments is crucial. Dosage increment choices are
medication-specific, and depend on many factors that go beyond the scope of this document.
Suppose an order indicates that a certain drug must be administered with an initial dosage rate
of 10mcg/min, and that the rate should be increased by5mcg/min every 3–5min for chest pain
until response, up to a maximum rate of 30mcg/min. The IV bag has a strength of 50mg/250 ml.
To administer the drug, first determine the IV rate in mL/h for the initial dose rate of 10mcg/min
Sometimes medications must be titrated. That is, the dose of the medication must be adjusted
until the desired therapeutic effect (e.g. blood pressure maintenance, normal blood sugar, normal
heart rate, adequate uterine contractions, pain control etc.) is achieved.
The order is:
Pitocin (oxytocin) start at 1 mU/min IV may increase by 1mU/min q30min until adequate uterine
contractions are achieve to a max of 10mU/min. The IV strength is10 mU/mL.
(a)Calculate the initial pump setting in mL/h.
(b)Construct a titration table for this order
Example doctor orders that a patient in labour with inadequate contractions should be augmented
with oxytocin 5miu/min and increasing the dose by 5miu every 30mins until contractions are 3-5
in 10mins lasting 40-60 seconds and maintain the dose attain to achieve 3-5contractions
in10mins. What will be the flow rate? What will be the drips rate and the increase drip rate at
each 30mins?
To titrate an I.V. drug that is up and running, you can simplify the main equation by using a
single unit of ordered medication. That allows you to determine the infusion rate for a single unit
of medication—whether it‘s 1 mcg, 0.1 mcg, or 0.01 mcg.
Using the original order for nitroprusside 0.5mcg/kg/minute for a patient who weighs 75kg,
here‘s the equation you‘d use to identify the infusion rate for a single unit (0.1mcg) of
medication:
0.1 X 75 X 60
—————= 2.25 ml/hour
200
Calculate the initial I.V. pump infusion rate by multiplying the infusion rate for a single unit of
medication with the ordered amount of drug. The original order was for 0.5mcg/kg/minute; that
equals 5units of ordered medication. Thus:
5 X 2.25 = 11.25 ml/hour.
Titrate the medication by multiplying the infusion rate for a single unit of medication by the
newly desired drug dose, increasing or decreasing the infusion rate as appropriate. For example:
3 X 2.25 = 6.75 ml/hour (0.3mcg/kg/minute)
4 X 2.25 = 9 ml/hour (0.4mcg/kg/minute)
6 X 2.25 = 13.5 ml/hour (0.6mcg/kg/minute)
8 X 2.25 = 18 ml/hour (0.8mcg/kg/minute)
...and so on.
First, calculate the flow rate for a single unit of ordered medication. Then, determine the infusion
pump rate by multiplying that rate by the desired amount of drug that you want to deliver.
Intropin (dopamine) 2mcg/kg/min IVPB, titrate to maintain SBP above 90, increase by 5
mcg/kg/min q 10–30 minutes. Maximum dose 20 mcg/kg/min. Monitor BP and HR q 2–5
minutesduring titration. The label on the 500 mL medication bag states 800mcg/ml and the
patient weighs 175 pounds.
(a) How many mcg/min of Intropin should the patient receive initially?
(b) Calculate the initial pump setting in mL/h.
Pregnancy Category
The U.S. Food and Drug Administration (FDA) has established the following categories for pregnant
women:
A: No risk to the fetus in any trimester
B: No adverse effect demonstrated in animals; no human studies available
C: Studies with animals have shown adverse reactions; no human studies are available; given only after
risks to the fetus have been considered
D: Definite fetal risk exists; may be given despite risk to the fetus if needed for a life-threatening
condition
X: Absolute fetal abnormality; not to be used anytime during pregnancy
FLUID THERAPY
In fluid therapy maintenance is calculated using 4, 2,1 formula (Holliday-Segar‘s Formula):This
was standard looking at maintenance daily fluid requirement of health children
4ml/kg/hr. for first 10kg,
2ml/kg/hr. for next 10kg
1ml/kg/hr. for remaining kilogram weight.
This can be simplified by using formula
( ⁄ ) * ( )+ ⁄ for weight
≥20kg
Example: 65kg women who is nil per Os will require
( )
⁄
Similarly 70kg who had fasted over (night) 8hrs for elective surgery will have deficit of
( )
⁄
Hence total fluid deficit is
BODY SURFACE AREA CALCULATION

Estimating body surface area (BSA), in square meters (m2), is the most accurate way of calculating drug dosages.
There are two ways to estimate BSA. You can use a chart—the West nomogram —or a formula that uses the metric
system but requires a calculator that can perform the square root function.
Most accurate method commonly used in oncology department:
Mosteller‘s rule
√ ( ) ( )
SAFE DOSE
Medications have an upper and a lower safe dosage range used to indicate a safe, total daily
dose. This is very important and emphasis in paediatric. You can find this information on the
drug package insert, a drug reference, or an institutional protocol. You need this information
before you calculate any dose to give to a child.
A nurse must always determine that the ordered dosage is safe before administering the medication!
Always compare the prescribed dosage to the recommended safe dosage range using a reference drug resource
when calculating dosages. You should also use a calculator to double-check your calculations
PAEDIATRIC DOSAGE CALCULATION

Posology ( Greek póso(s) how much + -logy)
the branch of medicine concerned with the determination of appropriate doses of drugs or agents
[ from French posologie, from Greek posos how much]
1. Proportion to age
Young’s formula
( )
The above formula is used for calculating the doses for children less than 12years of age
(1-12years)
Dilling’s formula
( )
The above formula is used for calculating the doses of a child in between 4-20years of
age
Fried’s formula
The above formula is applicable only for infants(less than 1year)

2. Calculation base on body surface area
Catzel rule:
The average body surface area for an adult=1.73m2

Hence
3. Calculation base on body weight:

Clark’s rule
( )
( )
The rule is applicable only when child dose is less than 150lb or 70kg
SOLUTIONS
MAKING PARALLEL DILUTION.
 A dilution consists of adding additional solvent (usually) to a solution to reduce its
concentration.
 1/10 means 1part of solute is combines with 9 parts of solvent to give 10 parts off
solution. I.e. 1part of solute are in 10parts of the solution.
 / means total volume of solution
 : means ratio of combination therefore 1:9 means 1part of solute combines with 9 parts of
solvent
 1/10 is not equal to 1:9
 Parts can be any in unit. A 1ml added to 2ml produces same dilution as 1oz added to 2oz.
 Serial dilution is produce by diluting a dilution rather than going back to the stock
solution each time. They are made because
 A number of dilutions of same dilution factor are desired
 Final concentration is so small that original volume needed to make it can‘t be
accurately measured e.g. 1ml of 1mM solution from stock of 10M.
 Making a 1/10 dilution will bring you closer to the final concentration so that large
amounts can be measure. 1/10 dilution is 1part solute to 9parts water.
 Label your five bottles 10M (stock), 1M, 0.1M, 0.01M and 0.001M
 Add ml of stock to first tube
 Put 900ul of water into the remaining 4 tubes
 Dilution1: 100ul stock combine with 900ul water gives 1M solution
 Dilution2:100ul dilution1 combines with 900ul water gives 0.1M solution
 Dilution3:100ul dilution2 combines with 900ul water gives 0.01M solution
 Dilution4:100ul dilution 3 combines with 900ul water gives 0.001M solution.
TEMPERATURE
Measure either Fahrenheit or centigrade
The relationship of centigrade © and Fahrenheit (F) degrees is
( ) ( )
Where 0C is the number of degree centigrade
0F is the number of degree fahrenheit
UNIT EQUIVALENT (CONVERSION)

In medicine three common measurement systems are usually use. These are
 Metrics system
 Apothecary system
 Household system.
Unit is a dimension that is given to a number.
Unit equivalent is the value of EQUIVALENCE between two units. If expressed as a fraction it
is call unit conversion factor. Conversion between these units uses their unit equivalency.
• Pico10-12
• Nano 10-9
• Micro 10-6 means dividing into million parts
• Milli 10-3 into thousand
• Centi 10-2 into hundred
• Deci 10-1 into ten
• Deka102 multiply by ten
• Kilo 103
• Mega106 multiply by million
• Giga 109
• Tera 1012
• 1cc=1ml
• 1000ml=1L
• 1000g=1kg
• 1000mg=1g
• 1000microgram=1mg
• 1kg=2.2ib
• 1000miu=1iu
• 1teaspoon(tsp.)=5ml
• 1tablespoon(tbsp.)=15ml
• 2.2Ib=1kg
• 1 oz (or floz) = 30 mL
• 1 pt = 500 mL
• 1 qt = 1 L or 1000 mL
• 2.2 lb = 1 kg
• 1 inch = 2.4 or 2.5 cm (centimeters)
• 1 minim 1 gtt
• 1 dr4 mL
• 8 dr1 oz or floz
PROBLEM
A woman is admitted to the labor room with a diagnosis of preterm labor. She states that she has
not seen a physician because this is her third baby and she ―knows what to do while she is
pregnant.‖ Her initial workup indicates a gestational age of 32 weeks, and she tests positive for
Chlamydia and Strep-B. Her vital signs are: T 100° F; P 98; R 18; B/P 140/88mmHg; and the
fetal heart rate is 140–150. The orders include the following:
■ NPO
■ IV fluids: D5/RL 1,000 mL q8h
■ Electronic fetal monitoring
■ Vital signs q4h
■ Dexamethasone 6 mg IM q12h for 2 doses
■ Brethine (terbutaline sulfate) 0.25 mg subcutaneous q30 minutes for 2h
■ Rocephin (ceftriaxone sodium) 250 mg IM stat
■ Penicillin G 5 million units IVPB stat; then 2.5 million units q4h
■ Zithromax (azithromycin) 500 mg IVPB stat and daily for 2 days
1. Calculate the rate of flow for the D5/RL in mL/h.
2. The label on the dexamethasone reads 8 mg/mL. How many milliliters will you administer?
3. The label on the terbutaline reads 1 mg/ml. How many milliliters will you administer?
4. The label on the ceftriaxone states to reconstitute the 1 g vial with 2.1 mL of sterile water for
injection, which results in a strength of 350 mg/mL. How many milliliters will you administer?
5. The instructions state to reconstitute the penicillin G (use the minimum amount of diluent),
add to 100 mL D5W, and infuse in one hour. The drop factor is 10drops/ml. What is the rate of
flow in gtts/min? The label on Penicillin G reads pfizerpen (penicillin G Potassium) for injection
5million units. Additional information 18.2ml diluent added gives 250 000units/ml, 8.2ml
diluent added gives 500 000units/ml and 3.2ml diluent added gives 1 000 000units/ml of
solution.
6. The instructions for the azithromycin state to reconstitute the 500 mg vial with 4.8 mL until
dissolved, and add to 250 mL of D5W and administer over at least 60 minutes. What rate will
you set the infusion pump if you choose to administer the medication over 90 minutes? If drop
factor is 15drops/ml, what is the drip rate?
7. The patient continues to have uterine contractions, and a new order has been written:
Magnesium sulfate 4g IV bolus over 20 minutes, then 1g/h.
The label on the vial of magnesium sulphate is 50% w/v and IV bag states magnesium sulfate 40
g in 1,000 mL.
(a) What is the rate of flow in mL/h for the bolus dose? If the drop factor is 20gtt/mL, determine
the drip rate?
(b) What is the rate of flow in mL/h for the maintenance dose? If the drop factor is 60gtt/min,
determine the flow rate in gtt/min?
© What volume of magnesium sulphate was withdrawn for the bolus and how many mililitres of
magnesium sulphate was place in the IV bag?
The patient continues to have contractions and her membranes rupture. The following orders are
written:
■ Discontinue the magnesium sulfate.
■ Pitocin (oxytocin) 10 units/1,000 mL RL, start at 0.5mIU/min increases by 1 mU/min q20
minutes.
■ Stadol (butorphanol tartrate) 1mg IVP stat.
8. What is the rate of flow in mL/h for the initial dose of Pitocin? The drop factor is 60mcgtt/mL.
Calculate the flow rate in mcgtt/min
9. The Pitocin is infusing at 9 mL/h. How many mU/h is the patient receiving? Find the drip rate
if the drop factor is 10gtt/mL?
What would be the drip rate after 1hr of initiating Pitocin using drop factor of 15
10. The vial of butorphanol tartrate is labeled 2 mg/mL. How many milliliters will you
administer?
Postpartum the woman developed postpartum haemorrhage. The following orders are written
■Massage uterus for contraction q15min, continuous monitoring vitals.
■Pitocin 20unit in 500ml NS, giving at 20miU/min
■Ergometrin 1mg IM stats
■Tablets Misoprostol 800mcg PR stats
■Transfuse 2units of whole blood over 6hours.
11: what is the flow rate of the Pitocin drip? Using IV set of 20drops/ml at what drip rate would
the nurse regular the drip?
12: Label on the Ergometrin ampoule 0.5mg/ml. how many millileters will the nurse administer?
13: Misoprostol packet label 200mg/tablets. How many tablets should be inserted PR?
14: A unit of blood has 400ml. if the blood giving set gives 15drops/ml what rate should theflow
rate hence calculate the drip rate be regulated
3 days later patient develop fever chill rigors foul smelly vaginal discharge and uterine
tenderness. Diagnosis of puerperal sepsis was made and the following order are written
■Tablets paracetamol 1g every 6hours
■IV Clindamycin 900mg every 8hours
■IV Gentamycin 1.5mg/kg every 8hours
■IV 500mlof NS over 30minutes then maintenance of 3liters over the next 24hrs
15: Sachet of paracetamol has 250mg/tablet. How many tablets should the patient receive?
16: Label on the clindamycin vial is 150mg/ml. how many milliters should the patient receive
each dose?
17: Gentamycin vial label 20mg/ml. the patient weighs 65kg. How many milligrams is the
patient supposed to receive hence how many milliliter of gentamycin should be given to the
patient for each dose?
18: If the drop factor of the set is 15drops/ml. what is the flow rate for the maintenance. What
should be the drip rate? If the patient weighs 75kg what should be appropriate maintenance fluid
requirement?
Patient was discharge two weeks after admission.
19. Gynaecologist performing hysteroscopy uses 1.5% Glycine as distending medium. If the
flow rate is 80ml/min, how many grams of glycine will the infusion into the uterus if the
operation lasted for 3hrs? If the flow rate is change to 100ml/min what is the dose of glycine
infusion? If the drop factor of the IV set is 10drops/ml what is the new drip rate? The assistant
changes the giving set to give 10drops/sec in order to be able to give 150mg/min. what is the
new flow rate in ml/min. what is the drop factor of the new IV set?
20. Gynaecologist performing hysteroscopicmetroplasty uses isoosmolar distending medium
containing mannitol 5% and glycine 2.2%. If the flow rate is 90ml/min, what is the dose of
mannitol? How many grams of glycine had been infused after 1hr of the operation?
b. If the doctor increase the dose of mannitol to 8g/min.What is the flow rate of mannitol? What
is the dose of glycine infusing?
c. if the flow rate was adjusted such that the drip rate is 800drops/min, what will be the flow rate
if the drop factor of the IV set is 15drops/ml. what will be the dose of mannitol? How many
grams of glycine had been infused after 2hrs?
d. If the given set was change and drip rate was adjusted to 600drops/min and the dose of glycine
is 11g/min. what is the drop factor of the new IV set? What is the flow rate of glycine? How long
will it take to infuse 40g of glycine? How much volume of fluid will be infused in order to give
80g of mannitol? How many grams of mannitol are there be in 800ml of the iso-osmolar
solution? How many grams of glycine are there in 300ml of the solution?
21. The doctor orders the post-operative patient should receive 150g of glucose as 30% sorbitol
in 24hrs as the daily energy requirement. The drip rate 30drops/min what is the volume of
sorbitol given to the patient? What is the drop factor of the IV set? What is the dose of sorbitol
given to the patient?
Try These for Practice
Test your comprehension after reading the chapter.
1. Order: Tagamet (cimetidine) 300 mg IVPB q6h in 50 mL NS infuse over 30 min. The drop
factor is 20gtt/ml. Find the flow rate in gtt/min.
2. The order is for a continuous infusion of theophylline at a rate of 25 mg/h. It is diluted in 5%
dextrose to produce a concentration of 500 mg per 500 mL. Determine the rate of the infusion in
mL/h.
3. A 500mL D5W solution with 2g of Pronestyl (procainamide HCl) is infusing at 15mL/h via a
volumetric pump. How many mg/h is the patient receiving?
4. Order: Dobutrex (dobutamine) 250 mg in 250 mL of D5W at3.5 mcg/kg/min. Determine the
flow rate in mcgtt/min for a patient who weighs 120 pounds.
5. A patient is receiving heparin 1,200units/hour. The directions for the infusion are, add
“25,000 units of heparin in 250 mL of solution.” Determine the flow rate in mL/h.
Exercises
Reinforce your understanding in class or at home.
1. The patient is to receive 20 mEq of KCl (potassium chloride) in 100 mL of IV fluid at the
rate of 10mEq/h. What is the flow rate in microdrops per minute?
2. The medication order reads: 1,000 mL 5% D/W with 1,000 mg of a drug at1mg/min
Calculate the drip rate in drops per minute if the drop factor is 15 drops/milliliter
3. The prescriber writes an order for 1,000 mL of 5% D/W with 10 units of a drug. Your
patient must receive 30 mU of this drug per minute. Calculate the drip rate in microdrops
per minute.
4. The order is Mefoxin 1 g IVPB q6h in 50 mL over 30 minutes. Read the label for the
premixed Mefoxin inand find the drip rate if the drop factor is 10gtt/ml. The package
insert indicates that the Mefoxin should be infused in 30 minutes.
5. The prescriber ordered: Ancef 1 g IVPB q4h The package insert information is as follows:
Add 50 mL sterile water to the bag of Ancef 1 g and infuse in 30 min. The tubing is
labeled 60 drops per milliliter. Calculate the flow rate in drops per minute for this
antibiotic.
6. A liter of D5/1/4 NS with 10 units of Regular insulin is started at 9:55 A.M. at a rate of
22gtt/min. If the drop factor is 20gtt/min, when will the infusion finish?
7. Calculate the flow rate for each of the following: Give 1000ml of 0.45% NaCl at 200ml/h
A: Drop factor 10gtt/ml
B: Drop factor 15gtt/ml
C: Drop factor 20gtt/ml
D: Drop factor 60gtt/ml
8. Order: Intropin (dopamine) 2 mcg/kg/min IVPB, titrate to maintain SBP above 90,
increase by 5 mcg/kg/min q 10–30 minutes. Maximum dose 20 mcg/kg/min. Monitor BP
and HR q 2–5 minutes during titration. The label on the 500 mL medication bag states
800mcg/ml, and the patient Weighs 175 pounds.
(a) How many mcg/min of Intropin should the patient receive initially?
(b) Calculate the initial pump setting in mL/h.
9. An IVPB of 50mL is to infuse in 30minutes. After 15 minutes, the IV bag contains
40mL. If the drop factor is 20gtt/mL, recalculate the flow rate in gtt/min.
10. A liter of D5/1/4NS with 10units of Regular insulin is started at 9:55 A.M.at a rate of
22gtt/min. If the drop factor is 20gtt/min, when will the infusion finish
11. The physician has ordered 500mL D5W with 2.5units oxytocin intravenously. Begin at
2mU/min and then increase by 2mU/min every 30 minutes until regular contractions
occur. The maximum dose is 20mU/min.
a. Calculate the IV rate (mL/hr.) for the beginning infusion.
b. Calculate the IV drip rate for the beginning infusion.
c. Calculate the maximum IV rate the Pitocin infusion may be set for.
d. Calculate the maximum IV drip rate the Pitocin infusion may be set for
12: The physician has ordered 500mL D5W with 5units oxytocin intravenously. Begin at
5mU/min and then increase by 5mU/min every 30minutes until active labor is achieved.
Maximum dose is 30mU/min.
a. Calculate the IV rate (ml/hr) for the beginning infusion
c. What is the maximum IV rate the Pitocin infusion may be set for?
d. What is the maximum IV drip rate the Pitocin infusion may be set for?
13. The physician has ordered 1000mL D5W with 20units oxytocin intravenously. Begin at
1mU/min and then increase by 1mU/min every 30minutes until regular contractions occur. The
maximum dose is 60mU/min.
a. Calculate the IV rate (mL/h) for the beginning infusion.
c. Calculate the maximum IV rate the Pitocin infusion may be set for.
d. Calculate the maximum IV drip rate the Pitocin infusion may be set for.
14: The physician has ordered 1000mL lactated Ringer‘s with 20g magnesium sulfate. You are
to administer a bolus with 4g/30min, then maintain a continuous infusion at 2g/h.
e. Calculate the IV rate (mL/h) for the bolus order.
f. Calculate the IV drip rate for the bolus order.
g. Calculate the IV rate (mL/h) for the continuous infusion.
h. Calculate the IV drip rate for the continuous infusion.
15: The physician has ordered 500mL lactated Ringer‘s with 10g magnesium sulfate. You are to
administer a bolus with 2g/20min, then maintain a continuous infusion at 1g/h.
a. Calculate the IV rate (mL/h) for the bolus order.
b. Calculate the IV drip rate for the bolus order.
c. Calculate the IV rate (mL/h) for the continuous infusion.
d. Calculate the IV drip rate for the continuous infusion
16: The physician has ordered 1000mL lactated Ringer‘s with 10g magnesium sulfate. You are
to administer a bolus with 2g/30min, then maintain a continuous infusion at 2g/h.
a. Calculate the IV rate (mL/hr.) for the bolus order.
b. Calculate the IV drip rate for the bolus order.
c. Calculate the IV rate (mL/h) for the continuous infusion.
d. Calculate the IV drip rate for the continuous infusion.
RECOMMENDED TEXT
1: CLINICAL CALCULATIONS MADE EASY
SOLVING PROBLEM USING DIMENSIONAL ANALYSIS
GLORIA P. CRAIG, EdD, MSN, RN
2: MEDICAL DOSAGE CALCULATIONS A DIMENSIONAL ANALYSIS APPROACH

JUNE l. OSLEN MS, RN
PROF OF NURSING
ANTHONY PATRICK GIANGRASSO PHD

PROF OF MATHEMATICS
DOLORES M. SHRIMPTON, MA RN
PROF OF NURSING
3; DOSAGE CALCULATION
GLORIA D. PICKAR EdD RN
AMY PICKAR ABERNETHY MD
4:100 DOSAGE CALCULATION PRACTICE AND ANSWERS

5: Drug Calculation For Nurses, Step by step approach
Robert LaPham Heather Agar
6: Calculation of Drug dosage
Sheila J Ogden Linda K Fluharty
7: Henk”s Med-Maths drug dosage calculation, Preparation & administration
Susan Buchhloz
Pharmaceutical Calculation
Howard Ansel
8: Math for nurses, a pocket guide to dosage calculation and drug preparations
Mary Jo Boyer
Booth, Kathyrn, James Whaley, Susan Sienkiewicz, and Jennifer Palmunen. (2012). Math and Dosage Calculations
for Helath Care Professionals. 4th ed. McGraw Hill, n.d. 408-579.
Broyles, Bonita. (2003) Dosage Calculation Practice for Nurses. Canada: Delmar Thomson Learning, n.d. 103-194.
Curren, Ana, and Margaret Witt. Curren’s Math for Meds. 11th ed. Cengage, n.d. Dosage Calculations Made
Incredibly Easy. Springhouse Co., n.d. 289-330
―Facts about the Official ‗Do Not Use‘ List of Abbreviations.‖ Accessed December 8, 2014.
http://www.jointcommission.org/facts_about_the_official_/.
Giangrasso, Anthony, and Dolores Shrimpton. (2013). Dosage Calculations A Multi-Method Approach. Upper
Saddle River, New Jersey: Pearson Education Inc. 309-339.
Kee, Joycee, and Sally Marshall. (2009) Clinical Calculations with Applications to General and Specialty Areas. 6th
ed. Saunders Elsevier, n.d. 287-306.
Koharchik, Linda, Elaine Hardy, Michalene King, and Yitnalem Garibo. ―Evidence-Based Approach to Improve
Nursing Student Dosage Calculation Proficiency.‖ Teaching and Learning in Nursing 9, no. 2 (April 1, 2014): 69–
74. doi:10.1016/j.teln.2013.12.003.
Pickar, Gloria and Abernethy, Amy Pickar (2008). Dosage Calculations. 8th ed. Clifton Park, NY: Thomson Delmar
Learning, n.d. 427-441
Obstetrics & Gynaecology

A 14-year-old patient is admitted to the hospital with weight loss and dehydration secondary to
hyperemesis gravidarum. The orders from the physician include:
 Bed rest with bathroom privileges
 Obtain weight daily
 Vital every 4h
 Test urine for ketones
 Urinalysis, complete blood count, electrolytes, liver enzymes, and bilirubin
 NPO for 48 hr, then advance diet to clear liquid, full liquid, and as tolerated
 IV D5 1–2 NS at 150 mL/hr for 8 hr, then decrease to 100 mL/hr
 Observe for signs of metabolic acidosis, jaundice, or hemorrhage
 Monitor intake and output
 Droperidol (Inapsine) 1 mg IV every 4h prn for nausea
 Metoclopramide (Reglan) 20 mg IV in 50 mL of D5W to infuse over 15 min
 Diphenhydramine (Benadryl) 25 mg IV every 3h prn for nausea
 Dexamethasone (Decadron) 4 mg IV every 6h
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
1. Calculate gtt/min using macrotubing (20 gtt/mL) to infuse 150 mL/hr, then 100 mL/hr.
2. Calculate how many mL of droperidol the patient will receive IV.Supply: 2.5 mg/mL
3. Calculate mL/hr to set the IV pump to infuse metoclopramide (Reglan) 20 mg in 50 mL of D5W to
infuse over 15 min.
4. Calculate how many mL of diphenhydramine (Benadryl) the patient will receive IV. Supply: 10
mg/mL.
5. Calculate how many mL of dexamethasone (Decadron) the patient will receive IV Supply: 4 mg/mL
A nulliparous female is admitted to the hospital with pregnancy-induced hypertension. The orders from
the physician include:
 Complete bed rest in left lateral position
 Insert Foley catheter and check hourly for protein and specific gravity
 Daily weight
 Methyldopa (Aldomet) 250 mg PO tid
 Hydralazine (Apresoline) 5 mg IV every 20 min for blood pressure over 160/100
 Complete blood count, liver enzymes, chemistry panel, clotting studies, type and crossmatch, and
urinalysis
 Magnesium sulfate 4 g in 250 mL D5LR loading dose to infuse over 30 min
 Magnesium sulfate 40 g in 1000 mL LR to infuse at 1 g/hr
 Keep calcium gluconate and intubation equipment at the bedside
 Nifedipine (Procardia) 10 mg sublingual for blood pressure over 160/100 and repeat in 15 min if
needed.
 Keep lights dimmed and maintain a quiet environment
 Monitor blood pressure, pulse, and respiratory rate, fetal heart rate (FHR) contractions every 15
to 30 min, and deep tendon reflexes (DTR) hourly
 Monitor intake and output, proteinuria, presence of headache, visual disturbances, and epigastric
pain hourly
 Restrict hourly fluid intake to 100 to 125 mL/hr
1. Calculate how many tablets of methyldopa (Aldomet) will be given PO. Supply: 500 mg/tablet.
2. Calculate how many mL of hydralazine (Apresoline) will be given IV. Supply: 20 mg/mL.
3. Calculate mL/hr to set the IV pump to infuse magnesium sulfate 4 g in 250 mL D5W loading dose to
infuse over 30 min.
4. Calculate mL/hr to set the IV pump to infuse magnesium sulfate 40 g in 1000 mL LR to infuse at 1
g/hr.
5. Calculate how many capsules of nifedipine (Procardia) will be needed to give the sublingual dose.
Supply: 10 mg/capsule.
A 35-year-old female in the 30th week of gestation is admitted to the hospital in premature labor. The
orders from the physician include:
 Bed rest in left lateral position
 Daily weights
 Continuous fetal monitoring
 Monitor blood pressure, pulse rate, respirations, fetal heart rate, uterine contraction pattern, and
neurologic reflexes
 Keep calcium gluconate at the bedside
 Initiate magnesium sulfate 4 g in 250 mL LR loading dose over 20 min, then 2 g in 250 mL LR at
2 g/hr until contractions stop
 Continue tocolytic therapy with terbutaline (Brethine) 0.25 mg SQ every 30 min for 2 hr after
contractions stop
 Give nifedipine (Procardia) 10 mg sublingual now, then 20 mg PO every 6h after infusion of
magnesium sulfate and contractions have stopped
 Betamethasone 12 mg IM × 2 doses 12 hr apart
 IV LR 1000 mL over 8 hr
1. Calculate mL/hr to set the IV pump to infuse the loading dose magnesium sulfate 4 g in 250 mL LR
over 20 min and the 2 g/hr maintenance dose.
2. Calculate how many mL of terbutaline (Brethine) will be given SQ. Supply: 1 mg/mL.
3. Calculate how many capsules of nifedipine (Procardia) will be given PO every 6h. Supply: 10
mg/capsule.
4. Betamethasone 12 mg IM × 2 doses 12 hr apart. Supply: 6 mg/mL.
5. Calculate mL/hr to set the IV pump to infuse LR 1000 mL over 8 hr.
A 31-year-old female is admitted to the hospital to control severe hemorrhage after a spontaneous
abortion. The orders from the physician include:
 CBC to determine blood loss
 WBC with differential to rule out infection
 Type and crossmatch for 2 units of blood
 Obtain Coombs‘ test to determine Rh status
 Administer Rhogam 300 mcg IM if patient is Rh-negative with a negative indirect Coombs‘ test
 IV D5/0.9% NS at 100 mL/hr
 IV oxytocin (Pitocin) 10 Units infused at 20 mU/min
 Prepare for a dilatation and curettage (D&C)
 Complete bed rest. Monitor bedpan for contents for intrauterine material
 Administer meperidine (Demerol) 50 mg IM every 4h for severe discomfort
 Administer ibuprofen 400 mg PO every 6h for mild discomfort
 Monitor vital signs every 4h for 24 hr
 Monitor urine output
 Note the amount, color, and odor of vaginal bleeding
1. Calculate how many mL of Rhogam the patient will receive. Supply: Rhogam 300 mcg/mL vial.
Administer into the deltoid muscle within 72 hr of abortion.
2. Calculate gtt/min using macrotubing (15 gtt/mL).
3. Calculate how many mL/hr to set the IV pump to infuse oxytocin 10 units. Supply: Oxytocin 10 units
in 500 mL D5/NS.
4. Calculate how many mL of meperidine (Demerol) will be given IM. The prefilled syringe is labeled
100 mg/mL.
Calculate how many tablets of ibuprofen will be given PO. Supply: 200 mg/tablet.
A HIV + patient is admitted to the hospital for C-section delivery. The orders from the physician include:
 Admit to OB in private room
 NPO
 Up ad lib
 CBC and electrolytes
 Type and cross-match for 2 units of blood
 Admission weight 164 lb
 Lactated Ringers IV at 100 mL/hr
 Zidovudine 2 mg/kg IV over 1 hour on admission to labor and delivery then zidovudine
1mg/kg/hr continuous IV infusion beginning 3 hours prior to C-section
 Cefazolin 1 g IVPB × 1 dose 1 hour prior to C-section
 Metoclopramide (Reglan) 10 mg IV push every 6 hours prn for nausea and vomiting
 Hydrocodone 5 mg and acetaminophen 325 mg PO two tablets every 4 hours prn for moderate to
severe pain
 Docusate sodium 100 mg PO two capsules bid
1 Calculate the weight of the patient in kilograms.
1. Calculate how many mL/hr to set the IV pump to infuse zidovudine 2 mg/kg over 1 hour. Supply:
Zidovudine 200 mg/50 mL D5W.
2. Calculate mL/hr to set the IV pump to infuse zidovudine 1 mg/kg/hr. Supply: Zidovudine 400
mg/100 mL D5W.
3. Calculate mL/hr to set the IV pump to infuse cefazolin 1 g IV. Supply: Cefazolin (Ancef) 1000
mg/100 mL D5W to be administered over 30 minutes.
4. Calculate how many mL of metoclopramide 10 mg will be given IV push over 2 minutes. Supply:
Reglan 5 mg/mL.
Paediatrics
An 8-year-old child is admitted to the pediatric hospital with seizures secondary to a head injury
following a fall on the playground. The child‘s weight is 60 lb. The orders from the physician include:
 Admit to pediatric intensive care
 Bed rest in quiet, darken environment
 Complete blood count, chemistry panel, urinalysis, EEG, skull and neck x-ray and CT scan
 Vitals every 2h
 Seizure precautions
 IV D5W/0.45% NS at 500 mL/8 hr
 Phenytoin (Dilantin) 2 mg/kg/min IV
 Diazapam (Valium) 0.3 mg/kg IV push given over 3 minutes every 15–30 min to a total dose of
10 mg, repeat every 2–4 hr for seizure activity following Dilantin administration
 Acetaminophen (Tylenol) 320 mg PO every 4 hours alternating with Ibuprofen 7.5 mg/kg PO
every 6 hours
1. Calculate how many mL/hr to set the IV pump. Supply: D5W/0.45% NS 500 mL.
2. Calculate how many mL/hr to set the IV pump to administer Dilantin. Supply: dilantin 100 mg/50 mL
to be administered over 15 minutes.
3. Calculate how many mL of diazepam will be given IV push over 3 minutes. Supply: diazepam 5
mg/mL.
4. Calculate how many mL of acetaminophen will be given every 4 hours PO. Supply: acetaminophen
100 mg/mL.
5. Calculate how many mL of ibuprofen will be given PO every 6 hours. Supply: ibuprofen 100 mg/5 mL.
A 10-year old child is admitted to the pediatric hospital with fever of unknown origin. The child‘s weight
is 80 lb. The orders from the physician include:
 Admit to the Pediatric Unit
 Complete blood count with differential, chest x-ray, urinalysis, chemistry panel, and sputum
culture
 Vitals every 4 hours
 Acetaminophen (Tylenol) 400 mg PO every 4h alternating with ibuprofen 7.5 mg/kg PO every 6h
 IV D5W/0.45% NS at 500 mL/4 hr
 Unasyn 1500 mg IV every 6h
1. Calculate how many mL of acetaminophen will be given every 4 hours PO. Supply: acetaminophen
500 mg/15 mL.
2. Calculate how many mL of ibuprofen will be given every 6h PO. Supply: ibuprofen 100 mg/5 mL.
3. Calculate how many mL/hr to set the IV pump. Supply: D5W/0.45% NS 500 mL.
4. Calculate the gtt/min using a microtubing (60 gtt/mL).
5. Calculate how many mL/hr to set the IV pump to administer Unasyn. Supply: Unasyn 1.5 g/50 mL
over 30 minutes.
A five-year old child is admitted to the pediatric unit for fluid volume deficit secondary to gastroenteritis.
The child‘s weight is 35 lb. The orders from the physician include:
 Admit to pediatric unit for 24-hour observation
 IV 50 mL/kg 0.9% NS/2.5% dextrose over 4 hr
 Discontinue IV when taking PO fluids without emesis
 Acetaminophen (Tylenol) 400 mg/dose PO every 4 hours alternating with ibuprofen 7.5 mg/kg
PO every 6 hours
 Encourage sips of fluids every 10 minutes if not vomiting, repeated every 15 minutes until able to
consume 30 mL then fluids as tolerated at 1.5 oz/lb/24 hr
 Pedialyte 53 oz/24 hr when tolerating fluids
1. Calculate the mL/hr to set the IV pump to infuse 50 mL/kg/4 hr. Supply: 1000 mL 0.9% NS/2.5%
dextrose.
2. Calculate how many mL of acetaminophen will be given PO. Supply: acetaminophen 100 mg/mL
solution.
3. Calculate how many mL of ibuprofen per dose will be given PO. Supply: ibuprofen 100 mg/5 mL
solution.
4. Calculate how many mL/hr of fluids the child will receive.
5. Calculate how many mL/hr of pedialyte the child will receive.
A child is admitted to the hospital in diabetic ketoacidosis with dehydration and vomiting. The orders
from the physician include:
 Admit to Pediatric ICU
 Blood sugar, electrolytes, urea, creatinine, CBC, HgA1C, and urinalysis
 Vitals every 1 hour
 NPO
 Accurate intake/output
 Hourly blood glucose
 Weigh daily (54 lb when admitted)
 NS IV bolus 10 mL/kg
 NS IV 3.5 mL/kg/hr with KCl 20 mEq/L
 25 units regular insulin/250 mL NS at 0.1 units/kg/hr
 Ondansetron (Zofran) IV push 0.1 mg/kg over 2 minutes
1. Calculate the weight of the child in kilograms.
2. Calculate how many mL the child will receive IV bolus.
3. Calculate mL/hr to set the IV pump to infuse the IV NS with KCl 20 mEq/L.
4. Calculate mL/hr to set the IV pump to infuse regular insulin 0.1 units/kg/hr.Supply: Regular insulin 25
units/250 mL NS.
5. Calculate how many mL of ondansetron 0.1mg/kg will be given IV push over 2minutes. Supply:
Zofran 2 mg/mL.
A child with pneumococcal meningitis is admitted to the hospital. The orders from the physician include:
 Admit to the Pediatric ICU
 CBC, electrolytes, urea, creatinine, liver enzymes, bilirubin, and urinalysis
 Vital signs every 2 hours until stable, then every 4 hours
 Daily weight (44 lb when admitted)
 IV 0.9% normal saline bolus 10 mL/kg followed by D5W/0.45% NS at 50 mL/hr
 Acetaminophen 15 mg/kg/dose PO every 4 hours prn for fever or mild pain
 Ceftriaxone (Rocephin) 50 mg/kg/dose IV every 12 hours three times, then every 24 hours
 Vancomycin 60 mg/kg/day IV divided in four equal doses every 6 hours
1. Calculate the weight of the child in kilograms.
2. Calculate how many mL the child will receive IV bolus.
3. Calculate how many mL/dose of acetaminophen the child will receive from a stock bottle of elixir
labeled acetaminophen 80 mg/2.5 mL.
4. Calculate how many mg/dose of ceftriaxone the child will receive and then calculate mL/hr to set the
IV pump to infuse ceftriaxone. Supply: Premixed IV Rocephin 1 g/50 mL to be administered over 30
minutes.
5. Calculate how many mg/dose of vancomycin the child will receive and then calculate mL/hr to set the
IV pump to infuse vancomycin. Supply: Premixed IV vancomycin 500 mg/100 mL to be administered
over 30 minutes.
A 12-year-old patient is admitted to the hospital with severe abdominal pain in the right lower quadrant.
The orders from the physician include:
 Admit to Pediatric Unit
 Weight 88 lb
 Vitals every 2 hours until stable, then every 4 hours
 Ultrasound for possible ruptured appendix
 CBC with differential
 IV D5W/0.45% NS @ 1000 mL/8 hr
 Clindamycin (Cleocin) 300 mg IV every 6 hours
 Cefotaxime (Claforan) 50 mg/kg IV every 12 hours
 Morphine sulfate 3 mg IV push every 3 to 4 hours prn for severe pain
1. Calculate the weight of the patient in kilograms.
2. Calculate mL/hr to set the IV pump.
3. Calculate mL/hr to set the IV pump to infuse clindamycin 300 mg. Supply: Cleocin 300 mg/50 mL NS
to infuse over 20 minutes.
4. Supply: Claforan 2-g vial to be reconstituted with 10 mL sterile water and further diluted in 50 mL NS
to infuse over 30 minutes. Calculate mL to draw from the vial to mix with 50 mL NS and calculate mL/hr
to set the IV pump to infuse cefotaxime.
5. Calculate the mL of morphine sulfate to be given IV push. Supply: Morphine sulfate 4 mg/mL to be
further diluted in 5 mL sterile water or NS and administered over 4 to 5 minutes.
An 18-month-old child is seen in the nurse practitioner‘s office for reoccurring otitis media and fever. The
child‘s weight is 23 lb. The orders from the nurse practitioner include:
 Amoxicillin 45 mg/kg/day PO in divided doses every 12h
 Acetaminophen (Tylenol) 120 mg PO every 4h alternating with Ibuprofen 5 mg/kg PO every 6h
if temperature is 102.5oF or below and 10 mg/kg if temperature is greater than 102.5oF
 Cetirizine (Zyrtec) 2.5 mg PO every 12h
 Pedialyte 75 mL per kg PO not to exceed more than 100 mL in any 20-minute period during the
first 8 hr
1. Calculate how many mL/dose of amoxicillin will be given PO. Supply: amoxicillin 125 mg/5 mL
solution.
2. Calculate how many mL of acetaminophen (Tylenol) will be given PO for a temperature of 102o.
Supply: acetaminophen 100 mg/mL solution.
3. Calculate how many mL of ibuprofen will be given PO for a temperature of 102o. Supply: ibuprofen
100 mg/5 mL solution.
4. Calculate how many mL of Zyrtec will be given PO. Supply: Zyrtec 1 mg/mL.
5. Calculate how many mL/hr/8 hr of Pedialyte the patient will receive PO during the first 8 h.
A 4-day-old neonate born at 35 weeks‘ gestation (weight 2210 g) is readmitted to the hospital for
treatment of dehydration and jaundice with a bilirubin level of 21 mg/dL. The orders from the physician
include:
 Phototherapy and exchange transfusion through an umbilical venous catheter
 Total and indirect bilirubin levels, electrolytes, complete blood count, and type and crossmatch
 Continuous cardiorespiratory monitoring
 Vitals every 2h
 Albumin 5% infusion 1 g/kg 1 hr before exchange
 Ampicillin 100 mg/kg/dose IV every 12h
 Gentamicin 4 mg/kg/dose IV every 12h
 NPO before exchange, then 120 mL/kg/day formula
 IV D10W 120 mL/kg/day
1. Calculate how many g of albumin the infant will receive before exchange therapy.
2. Calculate how many mg/dose of ampicillin the infant will receive every 12 hr. Calculate how many mL
the infant will receive. Supply: 250 mg/ 5 mL IV push over 5 min.
3. Calculate how many mg/dose of gentamicin the infant will receive every 12 hr. Calculate how many
mL the infant will receive. Supply: 2 mg/mL.
4. Calculate how many mL/day of formula the infant will receive.
5. Calculate how many mL/hr to set the IV pump.
A 13-year-old child (weight 38 kg) with cerebral palsy being cared for in a children‘s facility is admitted
to the hospital for seizure evaluation. The orders from the physician include:
 Complete blood count, chemistry panel, urinalysis, dilantin levels, EEG, and CT scan
 Vitals every 4h
 Seizure precautions
 Lactulose 3 g PO tid
 Valproic acid (Depakote) 30 mg/kg/day PO in three divided doses
 Diazepam (Valium) 2.5 mg PO daily
 Chlorothiazide (Thiazide) 250 mg PO daily
 Phenytoin (Dilantin) 5 mg/kg/day PO in three divided doses
1. Calculate how many mL of lactulose the child will receive. Supply: 10 g/15 mL.
2. Calculate how many tablets of Depakote the child will receive per dose.,Supply: 125 mg/tablet.
3. Calculate how many tablets of diazepam the child will receive per dose. Supply: 5 mg/tablet.
4. Calculate how many tablets of chlorothiazide the child will receive per dose. Supply: 250 mg/tablet.
5. Calculate how many mL of Dilantin the child will receive per dose. Supply: 125 mg/5 mL.
A neonate born at 24 weeks‘ gestation diagnosed with respiratory distress syndrome and respiratory
failure is now 28 weeks‘ gestation (weight 996 g) with bronchopulmonary dysplasia. This child remains
in the Neonatal Intensive Care Unit (NICU) on oxygen therapy and enteral feedings. The orders from the
physician include:
 Complete blood count, chemistry panel, ABGs, chest x-ray, CPPD with nebulizations, glucose
monitoring, caffeine citrate levels, and newborn screen
 NG feedings with Special Care with Iron 120 kcal/kg/day
 Chlorothiazide (Diuril) 10 mg/kg/day PO
 Fer-In-Sol 2 mg/kg/day
 Vitamin E 25 units/kg/day in divided doses every 12h
 Caffeine citrate 5 mg/kg/dose daily
1. Calculate how many total calories the child will receive daily. Calculate how many mL/day the child
will receive. Supply: 24 kcal/oz.
2. Calculate how many mg of chlorothiazide the child will receive daily. Calculate how many mL/day the
child will receive. Supply: 250 mg/5 mL.
3. Calculate how many mg of Fer-In-Sol the child will receive daily. Calculate how many mL/day the
child will receive. Supply: 15 mg/0.6 mL.
4. Calculate how many units/dose of vitamin E the child will receive every 12 hr. Calculate how many
mL/dose the child will receive. Supply: 67 units/mL.
5. Calculate how many mg of caffeine citrate the child will receive daily. Calculate how many mL/dose
the child will receive. Supply: 10 mg/mL.
A neonate born at 32 weeks‘ gestation (weight 2005 g) is admitted to the Neonatal

Intensive Care Unit (NICU) with a diagnosis of sepsis. The orders from the physician include:
 Admit to NICU with continuous cardiorespiratory monitoring
 Complete blood counts, blood and urine cultures, chest x-ray, bilirubin, ABGs, theophylline
levels, and lumbar puncture
 Strict intake and output
 Daily weight
 Vitals every 3h
 NG breast milk diluted with sterile water 120 mL/day with feedings every 3h
 IV D10 and 20% lipids 120 mL/kg/day
 Aminophylline 5 mg/kg IV every 6h
 Cefotaxime (Claforan) 50 mg/kg every 12h
 Vancomycin 10 mg/kg/dose every 12h
1. Calculate how many mL the child will receive with every feeding.
2. Calculate how many mL/hr the child will receive IV.
3. Calculate how many mg of aminophylline the child will receive every 6h. Calculate how many mL/hr
you will set the IV pump. Supply: 50 mg/10 mL to infuse over 5 min.
4. Calculate how many mg of cefotaxime the child will receive every 12 hr. Calculate how many mL/hr
you will set the IV pump. Supply: 40 mg/mL to infuse over 30 min.
5. Calculate how many mg of vancomycin the child will receive every 12 hr. Calculate how many mL/hr
you will set the IV pump.Supply: 5 mg/mL to infuse over 1 hr.
A 14-year-old child is admitted to the hospital with fever of unknown origin (FUO) after chemotherapy
administration. The orders from the physician include:
 Complete blood count with differential, bone marrow aspiration, chemistry panel, PT/PTT, blood
cultures, urinalysis, and type and crossmatch
 Regular diet as tolerated
 Vitals every 4h
 Daily weights
 Type and cross for 2 units PRBCs
 Irradiate all blood products
 Infuse 6 pack of platelets for counts under 20,000
 IV D5W/NS with 20 mEq KCl 1000 mL/8 hr
 Allopurinol 200 mg PO tid
 Fortaz 1 g IV every 6h
 Aztreonam (Azactam) 2 g IV every 12h
 Flagyl 500 mg IV every 8h
 Acetaminophen two tablets every 4h prn
2. Calculate how many tablets of allopurinol will be given PO. Supply: 100 mg/tablet.
3. Calculate how many mL/hr to set the IV pump to infuse Fortaz. Supply: 1-g vial to be diluted with 10
mL of sterile water and further diluted in 50 mL NS to infuse over 30 min.
4. Calculate how many mL of aztreonam to draw from the vial. Supply: 2-g vial to be diluted with 10 mL
of sterile water and further diluted in 100 mL NS to infuse over 60 min.
5. Calculate how many mL/hr to set the IV pump to infuse Flagyl. Supply: 500 mg/100 mL to infuse over
1 hr.
A 2-year-old child weighing 30 lb is admitted to the hospital for severe respiratory distress. The orders
 Complete blood count with differential, electrolytes, blood culture, chest x-ray, and nasal washing

 Continuous pulse oximetry
 IV D5W1–2 NS at 50 mL/hr
 Elevate HOB
 Vitals every 2h
 Contact isolation
 Cardiorespiratory monitor
 Strict intake and output with urine specific gravities
 Acetaminophen elixir
 Aminophylline loading dose of 5 mg/kg to infuse over 30 min and maintenance dose of 0.8
mg/kg/hr
 Ribavirin (Virazole) inhalation therapy × 12 hr/day
 NPO with respiratory rate above 60
 RespiGam 750 mg/kg IV monthly
 Pediapred 1.5 mg/kg/day in three divided doses
 Ampicillin 100 mg/kg/day in divided doses every 6h
1. Calculate how many mL of acetaminophen elixir the patient will receive. Supply: 120 mg/5 mL.
2. Calculate how many mg of aminophylline the patient will receive and the mL/hr to set the IV pump for
the loading dose, then calculate the mL/hr to set the IV pump for the maintenance dose. Supply: 250
mg/100 mL.
3. Calculate how many mg of RespiGam the patient will receive IV on a monthly infusion.
4. Calculate how many mL/dose of Pediapred the patient will receive. Supply: 15 mg/5 mL.
5. Calculate how many mg/dose of ampicillin the patient will receive IV, how many mL to draw from the
vial, and mL/hr to set the IV pump. Supply: 1-g vials to be diluted with 10 mL of NS and further diluted
in 50 mL NS to infuse over 30 min.
A 10-year-old child weighing 65 lb is admitted to the hospital with pulmonary exacerbation. The orders
 Complete blood count with differential, ABGs, chest x-ray, urinalysis, chemistry panel, and
sputum culture
 IV 0.9% normal saline at 75 mL/hr
 Daily weights
 Monitor vitals every 4h
 Oxygen at 2 L/min with pulse oximetry checks to maintain oxygen saturation above 92%
 Pancrease 2 capsules PO with meals and snacks
 High-calorie, high-protein diet
 Multivitamin 1 tablet PO daily
 Tagamet 30 mg/kg/day PO in four divided doses with meals and HS with a snack.
 Clindamycin 10 mg/kg IV every 6h
 Postural drainage and percussion after aerosolized treatments
 Albuterol treatments with 2 inhalations every 4h to 6h
 Terbutaline PO 2.5 mg every 6h
 Tobramycin 1.5 mg/kg every 6h
 Tobramycin peak and trough levels after fourth dose
2. Calculate how many tablets of Tagamet will be given PO with meals and HS snack. Supply: 200
mg/tablet.
3. Calculate how many mg of clindamycin the patient will receive, how many mL to draw from the vial,
and mL/hr to set the IV pump. Supply: 150 mg/mL vial to be further diluted in 50 mL of NS and infused
over 20 min.
4. Calculate how many tablets of terbutaline will be given PO. Supply: 2.5 mg/tablet.
5. Calculate how many mg of tobramycin the patient will receive, how many mL to draw from the vial,
and mL/hr to set the IV pump. Supply: 40 mg/mL vial to be further diluted in 50 mL of NS and infused
over 30 min.
Psychiatrics
A 25-year-old female is brought to the hospital by her friends after she fainted at the PowerShop. Her
friends reported that she has been very sad, withdrawn, and not involved in any of her usual activities for
some time but had suddenly become ―full of energy‖ at the PowerShop. The orders from the physician
include:
 WBC with differential
 BUN and creatinine
 Liver panel
 Lithium levels
 IV 0.9% NS at 75 mL/hr
 Lithium 300 mg PO tid
 Clonazepam 0.5 mg PO bid; increase to 1 mg PO bid after 3 days
 Doxepin 50 mg PO tid
 Intake and output
1. Calculate the gtt/min using macrotubing (20 gtt/mL).
2. Calculate how many capsules of lithium will be given PO. Supply: 150 mg/capsule.
3. Calculate how many tablets of clonazepam will be given PO. Supply: 0.5-mg tablets.
4. Calculate how many tablets of clonazepam will be given PO after 3 days. Supply: 0.5-mg tablets.
5. Calculate how many tablets of doxepin will be given PO. Supply: 25-mg tablets.
A 17-year-old female high school student is admitted by her parents for self -induced starvation,
vomiting, and laxative abuse. The 12-week hospital stay is for management of diet with a 1- to 2-lb/week
weight gain goal. The orders from the physician include:
 DSM-IV evaluation
 Nutritional consult for 1500-calorie diet advance to 3500 calories over 12 weeks
 CBC, platelet count, and sedimentation rate
 WBC with differential
 Electrolytes, BUN, and creatinine
 Liver enzymes
 Urinalysis
 ECG
 Daily weight
 Intake and output

 Olanzapine (Zyprexa) 10 mg PO HS
 Fluoxetine (Prozac) 60 mg/day PO every AM
 Amitriptyline 25 mg PO qid
 Cyproheptadine 32 mg/day PO in 4 divided doses
1. Calculate how many mL/hr to set the IV pump.
2. Calculate how many tablets of olanzapine (Zyprexa) will be given at HS. Supply: 5-mg tablets.
3. Calculate how many mL of fluoxetine (Prozac) will be given PO. Supply: 20 mg/5 mL.
4. Calculate how many tablets of amitriptyline will be given PO. Supply: 10 mg/5 mL.
5. Calculate how many mL of cyproheptadine will be given PO. Supply: 2 mg/5 mL.
A 44-year-old successful businessman with a wife and two children, and diagnosed with clinical
depression, has received several months of treatment with antidepressants and psychotherapy. The
depression has not responded to therapy. He has become suicidal, and he has agreed to try
electroconvulsive therapy (also called ECT). The orders from the physician include:
 Admit for ECT
 CBC and urinalysis
 ECG
 NPO after midnight
 Obtain AM weight
 Obtain baseline vitals 60 min before procedure
 Start IV D5/0.45% at 100 mL/hr
 Administer glycopyrrolate (Robinul) 4.4 mcg/kg IM 30 min preoperatively
 Zoloft 50 mg PO every AM
 Sinequan 25 mg PO tid
 Parnate 30 mg/day PO in 2 divided doses
2. Calculate how many mL of glycopyrrolate (Robinul) will be given IM. Supply: 200 mcg/mL. Patient
weight: 175 lb.
3. Calculate how many tablets of sertraline (Zoloft) will be given PO. Supply: 50-mg tablets.
4. Calculate how many capsules of doxepin (Sinequan) will be given PO. Supply: 25-mg capsules.
5. Calculate how many tablets of tranylcypromine (Parnate) will be given PO. Supply: 10-mg tablets.
Medicine
A patient who is HIV+ and a Jehovah‘s Witness is admitted to the hospital with anemia, fever of
unknown origin, and wasting syndrome with dehydration. The orders from the physician include:
 O2 at 4 L/min per nasal cannula
 IV D5W/1/2 NS at 150 mL/hr
 CD4 and CD8 T-cell subset counts; erythrocyte sedimentation rate; complete blood count; urine,
sputum, and stool cultures; chest x-ray
 Acyclovir 350 mg IV every 8h
 Neupogen 300 mcg SQ daily
 Epogen 100 units/kg SQ three times a week
 Megace 40 mg PO tid
 Zidovudine 100 mg PO every 4h
 Vancomycin 800 mg IV every 6h
 Respiratory treatments with pentamidine
 High-calorie, protein-rich diet in six small meals daily
 Encourage PO fluids to 3 L/day
 Daily AM weight
2. Calculate mL/hr to set the IV pump to infuse acyclovir 350 mg. Supply: 500-mg vial to be
reconstituted with 10 mL sterile water and further diluted in 100 mL D5W to infuse over 1 hr.
3. Calculate how many mL of Neupogen will be given SQ. The vial is labeled 300 mcg/mL.
4. Calculate how many mL of Epogen will be given SQ to the patient weighing 100 lb. The vial is
labeled 4000 units/mL.
5. Calculate how many mL/hr to set the IV pump to infuse vancomycin 800 mg. Supply: 1-g vials to
be reconstituted with 10 mL NS and further diluted in 100 mL D5W to infuse over 60 min.
A patient is admitted to the hospital with ascites, stomach pain, dyspnea, and a history of cirrhosis of the
liver. The orders from the physician include:
 IV D5W/1–2 NS with 20 mEq KCl at 125 mL/hr
 IV Zantac 150 mg/250 mL NS at 11 mL/hr
 Type and crossmatch for 2 units of packed red blood cells, complete blood count, liver panel,
PT/PTT, SMA-12.
 Carafate 1 g every 4h PO
 Vitamin K 10 mg SQ every AM
 Spironolactone 50 mg PO bid
 Lasix 80 mg IV every AM
 Measure abdominal girth every AM
 Sodium restriction to 500 mg/day
 Fluid restriction to 1500 mL/day
2. Calculate the mg/hr of Zantac the patient is receiving.
3. Calculate how many mL of vitamin K the patient will receive SQ from a unit dose labeled 10 mg/mL.
4. Calculate how many tablets of spironolactone the patient will receive from a unit dose labeled 25
mg/tablet.
5. Calculate how many mL of Lasix the patient will receive from a unit dose labeled 10 mg/mL
A 62-year-old executive is experiencing difficulty remembering and performing familiar tasks, problems
with abstract thinking, and changes in mood and behavior. He is hospitalized for evaluation. The orders
 CT of the brain
 EEG and cerebral blood flow studies
 Cerebrospinal fluid analysis
 Urinalysis
 1000 mL IV D5/0.45% NS to infuse over 8 hr
 Donepezil (Aricept) 5 mg PO HS
 Thioridazine (Mellaril) 25 mg PO tid
 Imipramine (Tofranil) 50 mg PO qid
 Temazepam (Restoril) 7.5 mg PO HS
2. Calculate how many tablets of donepezil (Aricept) will be given PO. Supply: 5-mg tablets.
3. Calculate how many tablets of thioridazine (Mellaril) will be given PO. Supply: 25-mg tablets.
4. Calculate how many tablets of imipramine (Tofranil) will be given PO. Supply: 25-mg tablets.
5. Calculate how many tablets of temazepam (Restoril) will be given PO. Supply: 15-mg tablets
A 60-year-old male returns to his nurse practitioner‘s office after 3 months for elevated blood pressure.
Patient‘s weight: 90 kg. The nurse practitioner‘s orders include:
 Continue on low-sodium diet
 Continue to briskly walk 3 to 4 times weekly for 30 minutes
 Maintain a fluid intake of 2 L/day
 Nifedipine (Procardia XL) 60 mg PO once daily for 14 days then return to the office for re-
evaluation
 Docusate sodium (Colace) 100 mg PO bid
 Hydrochlorothiazide (HydroDIURIL) 25 mg daily PO in am with a glass of orange juice
 Report any weight gain of greater than 2 lb/day
 Return appointment in 14 days for re-evaluation of blood pressure
1. Calculate how many mL/meal the patient will need to consume.
2. Calculate how many tablets of nifedipine the patient is taking. Supply: Procardia XL 30 mg/tablets.
3. Calculate how many capsules of docusate sodium the patient is taking. Supply: Colace 100 mg/capsule.
4. Calculate how many tablets of hydrochlorothiazide the patient is taking. Supply: HydroDIURIL 50
mg/tablets.
5. Calculate the weight gain from 90 kg to 95 kg that will be reported to the nurse practitioner in lb.
A 16-year-old is admitted to the medical intensive care unit with diabetic ketoacidosis secondary to fever.
The patient weighs 125 lbs. The orders from the physician include:
 Admit to the medical intensive care unit
 Complete blood count, electrolytes, blood sugar, ABGs, and ECG
 Blood, urine, and sputum cultures
 Electrolytes and blood sugars hourly until stable
 Strict intake and output
 Daily weight
 Vitals hourly ×4 then every 2 hours ×4 then every 4 hr
 IV 0.9% NS 1000 mL/8 hr
 Regular insulin 0.15 units/kg IV bolus followed by the continuous intravenous infusion of regular
insulin 0.1 unit/kg/hr in 0.9% NS
 Change IV fluids to D5W/0.45% NS when plasma glucose falls to under 250 mg/dL at 10
mL/kg/hr
 Ampicillin sodium 500 mg every 6 hr IVPB for 3 days
1. Calculate the mL/hr to set the IV pump to 1000 mL/8 hr. Supply: 0.9% NS 1000 mL.
2. Calculate the mL for the IV bolus to infuse regular insulin at 0.15units/kg. Supply: 250 mL 0.9% NS
with 250 units regular insulin.
3. Calculate the mL/hr to set the IV pump for the continuous infusion of regular insulin at 0.1 unit/kg/hr
in 0.9% NS. Supply: 250 mL 0.9% NS with 250 units regular insulin.
4. Calculate the mL/hr to set the IV pump after the plasma glucose falls to under 250 mg/dL. Supply:
D5W/0.45% NS 1000 mL
5. Calculate the mL/hr to set the IV pump to infuse ampicillin sodium. Supply: ampicillin sodium 1 g/100
mL over 30 min.
A 60-year-old patient is seen at the dialysis center for weekly dialysis treatment. The patient weighs 140
lbs after dialysis. The orders from the physician include:
 Obtain weight three times weekly prior to and after dialysis treatment
 Furosemide 120 mg PO bid
 Metolazone (Zaroxolyn) 10 mg PO daily
 Enalapril maleate (Vasotec) 2.5 mg PO bid
 Epogen 100 units/kg IV three times weekly in venous line following dialysis
 Calcium Carbonate 10 g/day in divided doses with meals
1. Calculate how many tablets of Furosemide the patient is taking. Supply: Furosemide 80 mg/tablets.
2. Calculate how many tablets of Zaroxolyn the patient is taking. Supply: Metolazone 5 mg/tablet.
3. Calculate how many tablets of Vasotec the patient is taking. Supply: Enalapril maleate 2.5 mg/tablets.
4. Calculate how many mL of Epogen the patient should receive three times weekly. Supply: Epogen
4,000 units/mL.
5. Calculate how many tablets/meal of calcium carbonate the patient will receive. Supply: calcium
carbonate 1500 mg/tablets.
A 35-year-old male is admitted to the hospital with signs and symptoms of increased intracranial pressure
secondary to brain metastasis. The patient weighs 75 kg. The orders from the physician include:
 Admit to oncology unit
 IV 0.9% NS 1000 mL/10 hr
 Loading dose of phenytoin (Dilantin) 10 mg/kg IV push (50 mg/min) then Dilantin 100 mg IV
every 8 hr
 Mannitol 0.5 g/kg/10 min IV initial dose followed by Mannitol 0.25 g/kg IV every 4 hr
 Dexamethasone 10 mg IV
 Furosemide 0.5 mg/kg IV push
 Elevate HOB 25–30 degrees to promote intracranial drainage
 Bedrest in a quiet, darkened environment
1. Calculate the mL/hr to set the IV pump to infuse 0.9% NS. Supply: 1000 mL 0.9% NS.
2. Calculate how many mL of Dilantin the patient will receive as a loading dose. Supply: Dilantin
1000mg/20 mL 0.9% NS.
3. Calculate the mL/hr to set the IV pump to infuse the Mannitol ordered every 4 h. Supply: Mannitol 100
g/500 mL D5W.
4. Calculate how many mL of dexamethasone will be given IV push. Supply: Decadron 120 mg/5 mL.
5. Calculate how many mL of furosemide will be given IV push. Supply: furosemide 10 mg/mL.
A patient is admitted to the hospital for chest pain. The orders from the physician include:
 Admit to intensive care unit (ICU)
 IV nitroglycerin 10 mcg/min and increase infusion rate by 10 mcg/min every 10 minutes until
relief of pain (NTG 50 mg/250 mL D5W)
 CK/CKMB and Troponin I at 6 and 10 hours
 CBC, electrolytes, urea, creatinine, and ABGs
 O2 per nasal cannula
 Chest x-ray
 ECG at 6 and 10 hours
 Vitals every 2 hours until stable and then every 4 hours
 ASA 160 mg PO _ 1 (80 mg tablet)
 Morphine 2.5 mg IV administered every 5 minutes until pain subsides (up to a maximum of 20
mg can be given)
1. Calculate mL/hr to set the IV pump to infuse nitroglycerin 10 mcg/min. Supply: Nitroglycerin 50
mg/250 mL D5W.
2. The patient is now receiving 15 mL/hr of nitroglycerin. How many mcg/min is the patient receiving?
3. Calculate how many tablets of ASA the patient will receive from a unit dose of 80 mg/tablet.
4. Calculate how many mL of morphine the patient will receive IV from a vial labeled morphine 5mg/mL.
Mix with 5 mL sterile water for injection and administer over 5 minutes.
5. The patient is still reporting pain at 8 on a scale of 1 to 10 and a third dose of morphine is to be given.
Calculate how many mL of morphine the patient has now received with three doses.
A patient is admitted to the hospital during an acute asthma attack. The orders from the physician include:
 Admit to the Pulmonary Unit
 Vitals every 2 hours until stable, then every 4 hours
 CBC with differential, chemistry panel, and blood gases
 Bedrest in high Fowler‘s position
 IV D5W/1/2 NS at 1000 mL/10 hr
 Levalbuterol (Xopenex) 1.25 mg administered every 4 hours via nebulizer for wheezing (1.25
vials)
 Fluticasone and salmeterol (Advair) 250/50 inhaler every 12 hours
 Weight 176 lb
 Methylprednisolone (Solu-Medrol) 80 mg infused IV push over 3 minutes every 6 hours
 Azithromycin (Zithromax) 500 mg PO on day 1 followed by 250 mg PO daily on days 2 to 5 for a
total dose of 1.5 g
 Cimetidine (Tagamet) 300 mg IV every 6 hours
2. Calculate the weight of the patient in kilograms.
3. Calculate how many mL of Solu-Medrol the patient will receive IV push from an Act-O-Vial System
labeled 125 mg/2 mL.
4. Calculate how many tablets of azithromycin will the patient receive from a unit dose of 250
mg/capsular for the initial dose of 500 mg.
5. Calculate mL/hr to set the IV pump to infuse cimetidine 300 mg IV. Supply: Tagamet 300 mg/50 mL
of D5W and infused over 20 minutes.
A patient is admitted to the hospital with fever, cough, chills, and dyspnea to rule out pneumonia. The
orders from the physician include:
 IV 600 mL D5W every 8h
 Intake/output
 Vitals every 4h
 Complete blood count, electrolytes, chest x-ray, ABGs, sputum specimen, blood cultures, and
bronchoscopy
 Bed rest
 Humidified O2 at 4 L/min per nasal cannula
 High-calorie diet
 Encourage oral fluids of 2000 to 3000 mL/day
 Pulse oximetry every AM
 Clindamycin 400 mg IV every 6h
 Albuterol respiratory treatments
 Guaifenesin 200 mg PO every 4h
 Terbutaline 2.5 mg PO tid
 MS Contrin 30 mg PO every 4h prn
1. Calculate mL/hr to set the IV pump to infuse clindamycin 400 mg. Supply: Clindamycin 600 mg/4 mL
to be further diluted with 50 mL D5W to infuse over 1 hr.
2. Calculate gtt/min to infuse the clindamycin using macrotubing (20 gtt/mL).
3. Calculate how many mL of guaifenesin the patient will receive from a stock bottle labeled 30 mg/tsp.
4. Calculate how many tablets of terbutaline the patient will receive from a unit dose of 5 mg/tablet.
5. Calculate how many tablets of MS Contrin the patient will receive from a unit dose of 30 mg/tablet.
A patient is admitted to the hospital with a rash after an allogeneic bone marrow transplant. The orders
 IV D5W/1–2 NS with 20 mEq KCl/L at 80 mL/hr
 Complete blood count; electrolytes; sputum, urine, and stool cultures; blood cultures ×3; liver
panel; BUN; and creatinine
 Vitals every 4h
 Strict intake/output
 Vancomycin 1 g IV every 6h
 Claforan 1 g IV every 12h
 Erythromycin 800 mg IV every 6h
1. Calculate how many mEq/hr of KCl the patient will receive IV.
2. Calculate mL/hr to set the IV pump to infuse Fortaz 2 g. Supply: Fortaz 2-g vial to be reconstituted
with 10 mL of sterile water and further diluted in 50 mL D5W to infuse over 30 min.
3. Calculate mL/hr to set the IV pump to infuse vancomycin 1 g. Supply: vancomycin 500-mg vial to be
reconstituted with 10 mL of sterile water and further diluted in 100 mL of D5W to infuse over 60 min.
4. Calculate mL/hr to set the IV pump to infuse Claforan 1 g. Supply: Claforan 600 mg/4 mL to be further
diluted with 100 mL D5W to infuse over 1 hr.
5. Calculate mL/hr to set the IV pump to infuse erythromycin 800 mg. Supply: Erythromycin 1-g vial to
be diluted with 20 mL sterile water and further diluted in 250 mL of NS to infuse over 60 min.
A patient is admitted to the hospital with right leg erythema and edema to R/O DVT. The orders from the
physician include:
 Bed rest with right leg elevated
 Warm, moist heat to right leg with Aqua-K pad
 Doppler ultrasonography
 Partial thromboplastin time (PTT) and prothrombin time (PT)
 IV D5W/1–2 NS with 20 mEq KCl at 50 mL/hr
 Heparin 5000 units IV push followed by continuous IV infusion of 1000 units/hr
 Lasix 20 mg IV bid
 Morphine 5 mg IV every 4h
1. Calculate gtt/min using microtubing (60 gtt/mL).
2. Calculate how many mL of heparin the patient will receive IV from a multi dose vial labeled
10,000units/mL.
3. Calculate mL/hr to set the IV pump for the continuous dose of heparin. Heparin supply: 25,000
units/250 mL D5W.
4. Calculate how many mL of Lasix the patient will receive IV from a multidose vial labeled 10 mg/mL.
5. Calculate how many mL of morphine the patient will receive from a syringe labeled 10 mg/mL.
A patient is admitted to the hospital in sickle cell crisis. The orders from the physician include:
 Bed rest with joint support
 Complete blood count, erythrocyte sedimentation rate, serum iron levels, and chest x-ray
 IV D5W/1–2 NS at 150 mL/hr
 Zofran 8 mg IV every 8h
 Morphine sulfate 5 mg IV prn
 Hydrea 10 mg/kg/day PO
 Folic acid 0.5 mg daily PO
 Encourage 3000 mL/daily PO
2. Calculate mL/hr to set the IV pump to infuse Zofran 8 mg. Supply: Zofran 8 mg in 50 mL D5W to
infuse over 15 min.
3. Calculate how many mL of morphine sulfate will be given IV. The syringe is labeled 10 mg/mL.
4. Calculate how many mg/day of Hydrea will be given PO to the patient weighing 125 lb.
5. Calculate how many tablets of folic acid will be given PO. Supply: 1 mg/tablet.
A patient with small cell lung cancer is admitted to the hospital with fever and dehydration.
The orders from the physician include:
 Chest x-ray; complete blood count; electrolytes; blood, urine, and sputum cultures; BUN and
serum creatinine levels; type and cross for 2 units of PRBCs
 IV D5W/1–2 NS 1000 mL with 10 mEq KCl at 125 mL/hr
 units of PRBCs if Hg is below 8
 6 pack of platelets if under 20,000
 Neupogen 5 mcg/kg SQ daily
 Gentamicin 80 mg IV every 8h
 Decadron 8 mg IV daily
 Encourage PO fluids
 Vitals every 4h (call for temperature above 102°F)
1. Calculate gtt/min using macrotubing (20gtt/mL).
2. Calculate how many mcg of Neupogen will be given SQ to a patient weighing 160 lb.
3. Calculate mL/hr to set the IV pump to infuse gentamicin. The vial is labeled 40 mg/mL and is to be
further diluted in 100 mL D5W to infuse over 1 hr.
4. Calculate how many mL of Decadron the patient will receive from a vial labeled dexamethasone 4
mg/mL.
5. Calculate mL/hr to set the IV pump to infuse Fortaz 1 g over 30 minutes. Supply: Fortaz 1 g/50 mL.
A patient is admitted to the hospital with dyspnea and COPD exacerbation. The orders from the physician
include:
 Stat ABGs, chest x-ray, complete blood count, and electrolytes
 IV D5W/1–2 NS 1000 mL/8 hr
 Aminophylline IV loading dose of 5.6 mg/kg over 30 minutes followed by 0.5 mg/kg/hr
continuous IV
 Albuterol respiratory treatments every 4h
 Chest physiotherapy every 4h
 Erythromycin 800 mg IV every 6h
 Bed rest
 High-calorie, protein-rich diet in six small meals daily
 Encourage PO fluids to 3 L/day
2. Calculate mL/hr to set the IV pump for the loading dose of aminophylline for a patient weighing 140lb.
Aminophylline supply: 100 mg/100 mL D5W.
3. Calculate mL/hr to set the IV pump for the continuous dose of aminophyl line for a patient weighing
140 lb. Aminophylline supply: 1 g/250 mL D5W.
4. Calculate mL/hr to set the IV pump to infuse erythromycin 800 mg. Erythromycin supply: 1-g vial to
be reconstituted with 20 mL sterile water and further diluted in 250 mL NS to infuse over 1 hr.
6. Calculate the PO fluids in mL/shift.
A patient is admitted to the hospital with a diagnosis of dyspnea, peripheral edema with a 10-lb weight
gain, and a history of congestive heart failure. The orders from the physician include:
 Bed rest in Fowler‘s position
 Chest x-ray, complete blood count, electrolyte panel, BUN, serum creatinine levels, and a digoxin
level
 IV of D5W/1–2 NS at 50 mL/hr
 Daily AM weight
 Antiembolism stockings
 Furosemide 40 mg IV daily
 Digoxin 0.125 mg PO daily
 KCl 20 mEq PO tid
 Low-Na diet
 Restrict PO fluids to 1500 mL/day
 Vitals every 4h
1. Calculate gtt/min using microtubing (60 gtt/mL).
2. Calculate the weight gain in kilograms.
3. Calculate how many mL of Lasix the patient will receive IV from a multidose vial labeled 10 mg/mL.
4. Calculate how many tablets of digoxin the patient will receive from a unit dose of 0.25 mg/tablet.
5. Calculate how many tablets of K-Dur the patient will receive from a unit dose of 10 mEq/tablet.
Surgery
A 58-year-old male is admitted to the medical/surgical unit following surgery for transurethral resection
of prostate. The physician‘s post-operative orders include:
 Admit to the medical/surgical unit
 Monitor urinary output hourly
 Vitals every 2 hr
 Monitor for symptoms of TURP Syndrome
 Adjust rate of continuous bladder irrigation 3 Liter bags of sterile normal saline to maintain a
patent catheter, adjust rate to maintain pink to clear urine, and maintain urinary catheter traction
 IV D5W/0.45% normal saline 1000 mL/8 hr
 Ciprofloxacin (Cipro) 400 mg IV every 12 hr
 Docusate sodium (Colace) 100 mg PO bid
 Dimenhydrinate 25 mg IV every 4 hr prn
 Acetaminophen (Tylenol) 300 mg with 30 mg of codeine PO 1 to 2 tablets every 4 to 6 hr prn
 Discontinue IV when drinking well
 Complete blood count, electrolytes, creatinine in am
1. Calculate how many mL/hr to set the IV pump. Supply: D5W/0.45% NS 1000 mL bag.
2. Calculate how many gtt/min using 20 gtt/mL IV tubing.
3. Calculate how many mL/hr to set the IV pump to deliver the Cipro. Supply: Ciprofloxasin 400 mg/200
mL D5W to infuse over 60 minutes.
4. Calculate how many capsules to give of Colace. Supply: docusate sodium 100 mg/capsule.
6. Calculate how many mL will be given of dimenhydrinate.
A 40-year-old male returns to his nurse practitioner‘s office after 3 months for a cholesterol level of 240
mg/dl. The nurse practitioner‘s orders include:
 Continue low-fat, high fiber diet
 Continue to briskly walk 3 to 4 times weekly for 30 minutes
 Stop smoking and begin Chantix 0.5 mg PO once daily for days 1–3 then 0.5 mg PO bid for Day
4–7, then 1 mg PO for day 8
 Atorvastatin (Lipitor) 20 mg PO daily
 Cholestyramine resin 4 g/dose PO bid to be taken 1 hr before Lipitor
 Niacin 1.5 g/day PO
 Return appointment in 4 weeks for lipid levels.
1. Calculate how many tablets of Chantix the patient will be taking on days 1–3. Supply: Chantix 0.5 mg
tablets.
2. Calculate how many tablets of Chantix the patient will be taking on day 8. Supply: Chantix 0.5 mg
tablets.
3. Calculate how many tablets of Lipitor the patient will be taking. Supply: Lipitor 10 mg tablets.
4. Calculate how many g/day of cholestyramine resin the patient will be taking. Supply: Cholestyramine
resin 4 g/dose powder to be mixed with 4 to 6 oz of fluid.
5. Calculate how many tablets/day of niacin the patient is taking. Supply: Niacin 500 mg tablets.
A patient is admitted to the hospital for a left total knee replacement. The orders from the physician
include:
 Admit to Orthopedic Unit
 IV D5/LR with 20 mEq KCl 1000 mL every 8 hours
 CBC with differential, chemistry panel, and blood gases
 Cefazolin 1 g IV 1 hour prior to surgery and 500 mg every 8 hours postoperation
 Enoxaparin (Lovenox) 30 mg SQ daily
 Ferrous sulfate 0.3 g PO daily
 Docusate sodium 100 mg PO bid
2. Calculate mL/hr to set the IV pump to infuse cefazolin 1 g IV. Supply: Cefazolin (Ancef) 1 g/100 mL
D5W to be administered over 30 minutes.
3. Calculate mL/hr to set the IV pump to infuse cefazolin 500 mg IV. Supply: Cefazolin (Ancef) 500
4. Calculate how many mL of Lovenox the patient will receive SQ from a vial labeled enoxaparin 40
mg/0.4 mL.
5. Calculate how many tablets of ferrous sulfate the patient will receive from a unit dose of 300 mg/tablet.
A patient is admitted to the hospital for a colon resection. The orders from the physician include:
 Admit to Medical/Surgical Unit
 IV NS with KCl 20 mEq/L 1000 mL/12 hr
 CBC, electrolytes, urea, glucose, creatinine
 Enoxaparin (Lovenox) 40 mg SQ daily
 Cefoxitin 1 g IV every 8 hours
 Ranitidine 50 mg IV every 8 hours
 Tamsulosin (Flomax) 0.8 mg PO daily PC
 Calcium carbonate (Os-Cal) 1.25 g PO daily (1250 mg/tablet)
2. Calculate mL/hr to set the IV pump to infuse cefoxitin (Mefoxin) 1 g IV. Supply: Cefoxitin 1 g in 50
mL 0.9% NS to infuse over 30 minutes.
3. Calculate mL/hr to set the IV pump to infuse ranitidine 50 mg IV. Supply: Ranitidine (Zantac) 50
4. Calculate how many capsules of Flomax the patient will receive from a unit dose of 0.4 mg/capsule.
5. Calculate how many tablets of Os-Cal the patient will receive from a unit dose of 1250 mg/tablet.
A patient is admitted to the hospital for a right total hip replacement. The orders from the physician
include:
 Admit to Orthopedic Unit
 IV D5W/NS at 100 mL/hr
 CBC with differential, chemistry panel, BUN, creatinine, and urinalysis
 Monitor intake/output
 Atenolol 50 mg PO daily
 Lisinopril 5 mg PO daily
 Enoxaparin (Lovenox) 40 mg SQ every 12 hours
 Dimenhydrinate 50 mg IV every 4 hours for nausea and vomiting
 Morphine 10 mg IV every 4 hours prn for pain
1. Calculate how many tablets of atenolol will the patient receive from a unit dose of 25 mg/tablet.
2. Calculate how many tablets of lisinopril will the patient receive from a unit dose of 2.5 mg/tablet.
3. Calculate how many mL of Lovenox the patient will receive SQ from a vial labeled enoxaparin 80
mg/0.8 mL.
4. Calculate the mL of dimenhydrinate to be given IV. Supply: Dimenhydrinate 50 mg/mL to be further
diluted in 10 mL NS and administered slowly over 2 minutes.
5. Calculate the mL of morphine sulfate to be given IV. Supply: Morphine sulfate 8 mg/mL to be further
diluted in 5 mL sterile water or NS and administered over 4 to 5 minutes.
A patient is admitted to the hospital with nausea, shortness of breath, and fatigue 10 days after receiving
chemotherapy for breast cancer. The orders from the physician include:
 Admit to Oncology Unit
 Complete blood cell count (CBC) with differential, chest x-ray, urinalysis, chemistry panel, and
sputum culture
 Vitals every 4 hours (call if temperature above 102_F)
 Bedrest with BRP
 Monitor intake/output
 Type and cross-match for 1 unit of PRBC for Hg 8 g/dL or below
 Filgrastim (Neupogen) 5 mcg/kg/day IV until the ANC reaches 10,000/mm3
 6 pack of platelets if count under 20,000
 Premedicate prior to blood transfusion with acetaminophen (Tylenol) 650 mg PO and
diphenhydramine (Benadryl) 25 mg IV
 Metoclopramide (Reglan) 2 mg/kg IV every 2 hours for two doses
 IV D5W at 100 mL/hr
Calculate gtt/min using macrotubing (15 gtt/mL).
2. Calculate how many mL per day of filgrastim (Neupogen) will be given for a patient weighing 150 lb.
Supply: Neupogen 300 mcg/mL.
3. Calculate how many mg of metoclopramide (Reglan) the patient will receive IV. Patient weighs 150 lb.
Supply: Metoclopramide 5 mg/mL.
4. Calculate mL/hr to set the IV pump to infuse 1 unit of PRBC over 3 hours. Supply:
PRBC 1 unit = 450 mL
*Preventing Medication Errors: Before administration of the PRBC, the nurse must change the IV to
0.9% NS and strictly follow the protocol for administration of blood or blood components. Use of other
IV solutions will damage the blood components: D5W solutions will cause red blood cells to aggregate
and lyse and Lactated Ringers will cause blood to clot.
5. Calculate how many mL of diphenhydramine (Benadryl) the patient will receive from a vial labeled
diphenhydramine 50 mg/mL to be administrated over1 minute IV push.
A patient is admitted to the hospital with intractable bone pain secondary to prostate cancer. The orders
 IV D5W/1–2 NS with 20 mEq KCl/L at 60 mL/hr
 IV 500 mL NS with 25 mg Dilaudid and 50 mg Thorazine at 21 mL/hr
 Heparin 25,000 units/250 mL D5W at 11 mL/hr
 Bed rest
 Do not resuscitate
 Bumex 2 mg IV every AM after albumin infusion
 Albumin 12.5 g IV every AM
1. Calculate how many mEq/hr of KCl the patient is receiving.
2. Calculate how many mg/hr of Dilaudid the patient is receiving.
3. Calculate how many mg/hr of Thorazine the patient is receiving.
4. Calculate how many units/hr of heparin the patient is receiving.
5. Calculate how many mL of Bumex the patient will receive from a stock dose of 0.25 mg/mL.

Mathematics For Medical Practitioners Drug Calculation

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MATHEMATICS FOR MEDICAL PRACTITIONERS

KINDS OF IV DRIP FACTORS

The Dial-a-Flow device (sometimes referred to as Dial-a-Flo) is an extension IV tubing that

SIX RIGHTS BEFORE ADMINISTERING MEDICATIONS

1: DIMENSIONAL ANALYSIS/DEDUCTION METHOD

The Mathematical Foundation for Dimensional Analysis

Going one step further, now consider this equivalence:

Other unit fractions can be obtained from the equivalences.

Concept 2 When a quantity is multiplied by 1, the quantity is unchanged.

UNIT EQUIVALENCIES- the value of equivalencies between two units.

CONVERSION FACTOR- it is a unit equivalency written as a fraction.

Apply this method to the problem above: Covert 50 lb to kg

To create an equation using dimensional analysis:

Step 4: Draw the magic line

STEP4b: Write an equal to sign at the end of the magic line.

Variable with ml is:

STEP6a: Multiply all the numerators.

Step6b: Multiply all the denominators

METHOD 2 (SEQUENCIAL METHOD SIMILAR DIMENSIONS)

Step 3a: Write all the conversion factors as unit equivalents

 variable with drops among unit Equivalents is:

 variable with ml among Unit Equivalents is:

Cancelling ml will be left with hr which is an unwanted dimension. We need a unit

 variable with hrs among the Unit Equivalents is:

Step4a: Multiply all the numerators

Step4b: Multiply all the denominators

Step5: Divide the final values

METHOD 3 (RANDOM METHOD)

METHOD 1(SEQUENTIAL METHOD)

Step 3: Identify conversion factors and write as unit equivalents.

 1.5% glycine= 1.5g of glycine in 100ml

Step 4: Draw the magic line

STEP4b: Write an equal to sign at the end of the magic line.

STEP6: Multiply all the numerators.

Step6b: Multiply all the denominators

METHOD 2(SEQUENTIAL- starting with variable whose

 1.5% glycine = 1.5g of glycine in 100ml of 1.5% glycine solution.

STEP5a: Multiply all the numerators.

Step5b: Multiply all the denominators

Step 3: Identify conversion factors and write as unit equivalents.

Step 4: Draw the magic line

STEP4b: Write an equal to sign at the end of the magic line.

STEP6: Multiply all the numerators.

Step6b: Multiply all the denominators

USING SEQUENTIAL METHOD (OTHER WAY)

Unit equivalences (conversion factors):

SEQUENTIAL METHOD (OTHER WAY)

Unit equivalences (conversion factors):

Time of finish will be 8pm + 4hr23min= 12:23am

Unit equivalents (Conversion Factors)

Unit equivalents (Conversion Factors)

Unit equivalents (Conversion Factors)

SEQUENTIAL METHOD (OTHER WAY)

SEQUENTIAL METHOD (OTHER WAY)

Unit equivalent (conversion factors)

Unit equivalent (conversion factors)

Unit equivalents (conversion Factors)

Unit equivalents (conversion Factors)

In proportion problem the unknown quantity (? mL) to give 75mg is identify as x

SOLVING A SIMPLE PROPORTION PROBLEM

COLLECT ALL THE DATA FOR THE QUESTION

Pitocin (oxytocin) 10 units/1,000 mL RL, start at 0.5mIU/min increases by 1 mIU/min q20

Hence 0.05ml is given in one minute i.e. flow rate is 0.05ml/min.