Test Bank for Brown and Mulholland’s Drug Calculations, 12th Edition by Ann Tritak-Elmiger, and Marg

Brown and Mulholland’s Drug Calculations: Ratio and Proportion Problems for Clinical Practice 12th Edition, Ann Tritak-Elmiger Contents: Chapter 1. General Mathematics Chapter 2. Ratio & Proportion Chapter 3. Safe Medication Administration Chapter 4. Medication Measurements and Oral Dose Calculations Chapter 5. Injectable Medication Calculations Chapter 6. Reconstitution of Medications form Powders and Crystals: Oral and Intramuscular Chapter 7. Basic Intravenous Therapy Calculations Chapter 8. Advanced Intravenous Calculations Chapter 9. Insulin Administration and Type 2 Diabetes Medications Chapter 10. Parenteral Nutrition Chapter 11. Anticoagulants Chapter 12. Children’s Dosages

Chapter 01: General Mathematics Brown and Mulholland’s Drug Calculations: Ratio and Proportion Problems for Clinical Practice, 12th Edition Tritak-Elmiger Test Bank

Directions: Solve the following problems.

1. Add and reduce to lowest terms: ANS:

2. Add: ANS:

3. Multiply and reduce to lowest terms: ANS:

4. Multiply and reduce to lowest terms: ANS:

5. Divide and reduce to lowest terms: ANS:

6. Divide and reduce to lowest terms: ANS:

7. Which is greater,

?

ANS:

8. Which is smaller, ANS:

9. Change to a decimal: ANS:

0.125 10. Change to a fraction: 0.008 ANS:

11. Which is smaller, 0.125 or 0.25?

ANS:

0.125 12. Which is greater, 0.25 or 0.05?

ANS:

0.25 13. Round to the nearest tenth: 3.124 ANS:

3.1 14. Round to the nearest hundredth: 0.42877 ANS:

0.43 15. Round to the nearest whole number: 5.742 ANS:

6

16. Round to the nearest ten thousandth: 0.576391 ANS:

0.5764 17. Divide 7.35 by 0.25.

ANS:

29.4 18. Multiply 4.25 by 0.2.

ANS:

0.85 19. Find 5% of 75.

ANS:

0.05  75 = 3.75 (10% of 75 is 7.5; 5% would be one half of that) 20. Find 55% of 120.

ANS:

0.55  120 = 66 (a little more than one half of 120) 21. Write

as a percentage and as a decimal.

ANS:

10%, 0.1 22. Write 0.05 as a fraction and as a percentage.

ANS:

23. Write 85% as a fraction and as a decimal.

ANS:

24. Change 1 ANS:

to an improper fraction.

25. Change

to a whole or mixed number.

ANS:

26. Which is larger, tens or tenths?

ANS:

Tens 27. Write three hundred seventy seven thousandths as a decimal.

ANS:

0.377 28. Make 150 mL of a 50% strength solution. How many mL of the solute will be needed?

ANS:

75 mL Know Want to Know 1 mL : 2 mL = x mL : 150 mL 2x = 1  150 = 150 x = 75 mL Proof: 1  150 = 150 2  75 = 150 29. You need to make a 75% Betadine solution for a total of 250 mL. How much Betadine will

you need?

ANS:

187.5 mL Know Want to Know 75 mL : 100 mL = x mL : 250 mL 3 : 4 = x : 250 4x = 3  250 = 750 4x = 750 mL x = 187.5 mL of Betadine. Add 62.50 mL of solution for a total of 250 mL. Proof: 3  250 = 750 4  187.5 = 750 30. You need to make a 10% solution of hydrogen peroxide for a total of 500 mL. You are using

normal saline (NS) as the solvent. How many mL of hydrogen peroxide will you need?

ANS:

50 mL Know Want to Know 10 mL : 100 mL = x mL : 500 mL 1 : 10 = x mL : 500 mL 10x = 1  500 = 500 x = 50 mL of hydrogen peroxide. Add 450 mL of NS to make 500 mL of a 10% solution.

Proof: 50  10 = 500 1  500 = 500 Directions: CALCULATING SOLUTIONS Health care professionals need to know how to prepare solutions from stock solutions. A solution consists of a solute (concentrate) plus a solvent (liquid). A solute can be either liquid or a powder, and a solvent can be either water or NS. The resulting reconstituted solution will be a weaker strength than the original. The strength of the solution is represented by a ratio of solute to solvent. Many times health care workers have to prepare solutions for irrigations, tube feedings, infant formulas, or perhaps cleaning solutions. This worksheet will give the student practice making up different types and strengths of solutions.

Prepare a 100 mL of a

strength solution of hydrogen peroxide (solute) using NS (solvent).

This means one part hydrogen peroxide (solute) to three parts of NS (solvent).

EXAMPLE: Know Want to Know 1 : 3 = x : 100 3x = 1  100 = 100 3x = 33.33 mL of the solute hydrogen peroxide needed Proof: 1  100 = 100 3  33.33 = 99.9 100 mL solution wanted 33.33 mL hydrogen peroxide 66.67 mL of NS 66.67 mL of NS added to the 33.33 mL of hydrogen peroxide yields 100 mL of a

strength

hydrogen peroxide solution for irrigation.

31. Prepare a 70% Betadine solution for traction pin care. Cleanse area twice daily with 10 mL of

a 70% Betadine solution with NS. a. How many mL of total solution will you prepare? b. How many mL of Betadine will be needed? c. How many mL of NS will you add?

ANS:

a. 10  2 times per day = 20 mL of 70% Betadine solution should be prepared.

b.

Know Want to Know 0.70 : 1 = x : 20 mL x = 0.70  20 = 140 x = 14 mL of Betadine needed Proof: 0.70  20 = 14.00 1  14 = 14 c.

20 mL needed 14 mL Betadine 6 mL NS added to make 20 mL of a 70% Betadine solution 32. Prepare 100 mL of a 10% strength solution of bleach for cleaning.

a. How many mL of bleach will be needed? b. How many mL of water will be needed?

ANS:

a.

Know Want to Know 1 : 10 = x : 100 10x = 100 x = 10 mL of bleach need Proof: 1  100 = 100 10  10 = 100 b.

100 mL total needed 10 mL bleach needed 90 mL of water added to make 100 mL of bleach solution 33. Make a

strength solution of hydrogen peroxide. Irrigate the wound with 100 mL of solution

4 times a day. a. How many total mL will be needed? b. How many mL of hydrogen peroxide will be needed? c. How many mL of sterile NS will be needed?

ANS:

a. 100 mL  4 times per day = 400 mL of solution needed b.

Know Want to Know 1 : 4 = x : 400 4x = 400 x = 100 mL of hydrogen per oxide needed

Proof: 1  400 = 400 4  100 = 400 c.

400 mL total needed 100 mL hydrogen peroxide 300 mL of sterile NS added to make 400 mL of

strength solution

34. Make 4 cups of a 20% vinegar solution for household cleaning.

a. How many total mL will you prepare? b. How many mL of vinegar will be needed? c. How many mL of water will be needed?

ANS:

a.

Know Want to Know 1 cup : 240 mL = 4 cups : x mL x = 240  4 = 960 x = 960 mL total solution needed Proof: 240  4 = 960 1  960 = 960 b.

Know Want to Know 20 : 100 = x : 960 5x = 960 x = 192 mL of vinegar needed Proof: 5  192 = 960 1  960 = 960 c.

960 mL total solution needed 192 mL hydrogen peroxide 768 mL of water added a make a 20% solution 35. Make a 60% strength baking soda solution to clean your stainless steel sink. The directions

read: 200 mL of a 60% solution will clean five stainless steel appliances. a. How many mL of baking soda will you need? b. How many mL of water will you need?

ANS:

a.

Know Want to Know 0.60 : 1 = x : 200

x = 0.60  200 = 120 x = 120 mL of baking soda needed Proof: 0.60  200 = 120 120  1 = 120 b.

200 mL total solution needed 120 mL baking soda 80 mL of water added a make a 60% solution 36. Make a

strength drink of Ensure from a 12 oz. can.

a. How many mL are in 12 oz? b. How many mL of Ensure will be needed? c. How many mL of water will be needed?

ANS:

a.

Know Want to Know 1 oz : 30 mL = 12 oz : x mL x = 30  12 = 360 mL in 12 oz.

Proof: 30  12 = 360 1  360 = 360 b.

Know Want to Know 1 : 3 = x : 360 3x = 360 x = 120 mL of Ensure needed Proof: 1  360 = 360 3  120 = 360 c.

360 mL total needed 120 mL Ensure 240 mL of water needed to make a 37. Make a

strength drink

strength drink of Sustacal from a 10 oz can.

a. How many mL are in 10 oz? b. How many mL of Sustacal will be needed? c. How many mL of water will be needed?

ANS:

a.

Know Want to Know 10 oz : 30 mL = 10 oz : x mL x = 30  10 = 300 x = 300 mL in 10 oz Proof: 30  10 = 300 1  300 = 300 b.

Know Want to Know 3 : 4 = x : 300 4x = 3  300 = 900 x = 225 mL of Sustacal needed Proof: 3  300 = 900 4  225 = 900 c.

300 mL total needed 225 mL Sustacal 75 mL of water needed to make a 38. Make a

strength drink

strength drink of 360 mL of Isomil.

a. How many mL of Isomil will be needed? b. How many mL of water will be added?

ANS:

a.

Know Want to Know 1 : 2 = x : 360 2x = 360 x = 180 mL of Isomil needed Proof: 1  360 = 360 2  180 = 360 b.

360 mL total needed 180 mL of Isomil 180 mL of water added to Isomil to make a 39. Make a

strength drink

strength drink from a 12 oz. can of Ensure.

a. How many total mL of Ensure is 12 oz? b. How many mL of Ensure will be needed?

c. How many mL of water will be added?

ANS:

a.

Know Want to Know 1 oz : 30 mL = 12 oz : x mL x = 30  12 = 360 mL x = 360 mL in 12 oz Proof: 30  12 = 360 1  360 = 360 b.

Know Want to Know 2 : 3 = x : 360 3x = 2  360 = 720 x = 240 mL of Ensure needed Proof: 2  360 = 720 3  240 = 720 c.

360 mL total needed 240 mL of Ensure 120 mL of water added to make a 40. Prepare 400 mL of a

strength drink

strength drink of Sustacal for each nasogastric feeding 3 times daily.

a. How many total mL will be needed? b. How many total mL of Sustacal will be needed for the three feedings? c. How many mL of water will be needed?

ANS:

a. 400 mL  3 times daily = 1200 mL b.

Know Want to Know 3 : 4 = x : 1200 4x = 3  1200 = 3600 x = 900 mL of Sustacal needed Proof: 2  1200 = 3600 4  900 = 3600 c.

1200 mL total need for three feedings 900 mL of Sustacal needed

300 mL of water added to make a

strength drink

Directions: Change the following fractions to ratios in lowest terms.

41.

ANS:

3:4 42.

ANS:

1:2 43.

ANS:

2:3 44.

ANS:

1:4 45.45.

ANS:

1:2 Directions: Change the following ratios to fractions and reduce to the lowest terms.

46. 5 : 25 ANS:

47. 5 : 100 ANS:

48. 3 : 9 ANS:

49. 4 : 12 ANS:

50. 50 : 200 ANS:

Directions: Change the following percentages to fractions and reduce to the lowest terms.

51. 5% ANS:

52. 10% ANS:

53. 4.5% ANS:

54. 7.6% ANS:

55. 20% ANS:

Directions: Change the following percentages to ratios and reduce to lowest terms.

56. 8% ANS:

8 : 100 = 2:25 57. 10% ANS:

10 : 100 = 1 : 10 58. 0.9% ANS:

9 : 1000 59. 0.45% ANS:

45 : 10,000 = 9 : 2000 60. 50% ANS:

50 : 100 = 1 : 2 Directions: Change the following ratios to lowest term fractions and cross multiply.

61. 1 : 4 = 16 : x ANS:

62. 1 : 3 = 80 : x ANS:

63. 1 : 3 = 60 : x ANS:

64. 25 : 75 = 10 : x ANS:

65. 80 : 20 = 120 : x ANS:

Chapter 02: Ratio and Proportion Brown and Mulholland’s Drug Calculations: Ratio and Proportion Problems for Clinical Practice 12th Edition, Ann Tritak-Elmiger ESSAY

Directions: Solve the following problems.

1. Solve for x, and prove your answer: 2 : 5 = 10 : x ANS:

x = 25 Know Want to Know 2 : 5 = 10 : x

x = 25 Proof: 2  25 = 50 5  10 = 50 2. Solve for x, and prove your answer: 3 : 10 = 6 : x ANS:

x = 20 Know Want to Know 3 : 10 = 6 : x

x = 25 Proof: 3  20 = 60 10  6 = 60 Directions: Set up a ratio and proportion in each of the following problems. Label and prove your answers.

3. There are 20 patient beds contained in each hospital unit. How many units would there be for

a hospital with a 300-bed capacity?

ANS:

15 units Know Want to Know 20 beds : 1 unit = 300 beds : x units

x = 15 units Proof: 20  15 = 300 1  300 = 300 4. Each nurse is assigned five patients for a shift. How many nurses will be needed for 250

patients?

ANS:

50 nurses Know Want to Know 1 nurse : 5 patients = x nurses : 250 patients x = 50 nurses Proof: 1  250 = 250 5  50 = 250 5. If a patient needs to have three pills 4 times a day, how many pills will be needed for a 1-week

supply?

ANS:

84 pills Know Want to Know 12 pills : 1 day = x pills : 7 days x = 1  27 x = 84 pills Proof: 12  7 = 84 1  84 = 84 6. A hospital hires one CNA for every 10 patients. How many CNAs will be needed for 200

patients?

ANS:

20 CNAs Know Want to Know 1 CNA : 10 patients = x CNAs : 200 patients

x = 20 CNAs

Proof: 1  200 = 200 10  20 = 200 7. A patient has a bottle of liquid medicine that contains 60 doses of medicine. How many days

will the bottle last if the patient takes 4 doses a day?

ANS:

15 days Know Want to Know 4 doses : 1 day = 60 doses : x days x = 15 days Proof: 4  15 = 60 1  60 = 60 8. A hospital averages 22 admissions per day. How many admissions does it average in a 30-day

month?

ANS:

600 admissions Know Want to Know 22 admissions : 1 day = x admissions : 30 days x = 22  30 x = 600 admissions Proof: 22  30 = 660 1  660 = 660 9. The x-ray department schedules a chest x-ray every 15 min. How many chest x-rays can be

taken in 7 hr?

ANS:

28 x-rays Know Want to Know 4 x-rays : 1 hr = x x-rays : 7 hr x=47 x = 28 x-rays Proof: 4  7 = 28 1  28 = 28 10. There are 50 syringes in each package. The hospital uses 50 packages a week. How many

syringes does the hospital use in a week?

ANS:

2500 syringes Know Want to Know 50 syringes : 1 package = x syringes : 50 packages x = 50  50 x = 2500 syringes Proof : 50  50 = 2500 1  2500 = 2500 11. The emergency room budgets for 100 L of intravenous D5W per day. How many liters are

needed for 4 weeks?

ANS:

2800 L Know Want to Know 100 L : 1 day = x L : 28 days x = 100  28 x = 2800 L Proof: 100  28 = 2800 1  2800 = 2800 12. The hospital schedules 150 nurses per week to cover two 12-hr shifts. How many nurses are

employed each shift?

ANS:

75 nurses Know Want to Know 150 nurses : 2 shifts = x nurses : 1 shift x = 75 nurses per shift Proof: 150  1 = 150 2  75 = 150 13. The hospital offers up to $3000 in tuition reimbursement. If each course costs $500, how

many courses can you take?

ANS:

6 courses Know Want to Know $500 : 1 course = $3000 : x courses

x = 6 courses Proof: 500  6 = 3000 1  3000 = 3000 14. There are 3 unit coordinators for each unit. How many unit coordinators will be employed for

12 units?

ANS:

36 coordinators Know Want to Know 3 coordinators : 1 unit = x coordinators : 12 units x = 3  12 x = 36 coordinators Proof: 3  12 = 36 1  36 = 36 15. If you are paid $25 per hr for overtime, how many hr do you need to work to receive $600 in

overtime earnings?

ANS:

24 hr Know Want to Know $25 : 1 hr = $600 : x hr x = 24 hr Proof: 25  24 = 600 1  600 = 600 16. The patient must drink 8 oz of water every hr. How many oz will be consumed in 12 hr?

ANS:

96 oz Know Want to Know 8 oz : 1 hr = x oz : 12 hr x = 8  12 x = 96 oz Proof: 8  12 = 96 1  96 = 96

17. You have to mix formula at 2 Tbsp per 8-oz bottle. How many Tbsp will you need to use for 6

bottles?

ANS:

12 Tbsp Know Want to Know 2 Tbsp : 1 bottle = x Tbsp : 6 bottles x=26 x = 12 Tbsp Proof: 2  6 = 12 1  12 = 1 18. The top sheets from the laundry are 12 to a package. How many packages will you need to

cover 60 beds?

ANS:

5 packages Know Want to Know 12 beds : 1 package = 60 beds : x packages

x = 5 packages Proof: 12  5 = 60 1  60 = 60 19. The patient has a bottle of 100 cap. How many days will the bottle last if the patient takes 4

cap per day?

ANS:

25 days Know Want to Know 4 cap : 1 day = 100 cap : x days

x = 25 days Proof: 4  25 = 100 1  100 = 100 20. Your patient is being discharged and has to take 2 pills 3 times a day. How many pills will be

needed for a 14-day supply?

ANS:

84 pills Know Want to Know 6 pills : 1 day = x pills : 14 days x = 6  14 x = 84 pills Proof: 6  14 = 84 1  84 = 84 21. How many syringes are there in a package of 10 dozen? Conversion factor: 1 dozen = 12

syringes.

ANS:

120 syringes Know Want to Know 12 syringes : 1 dozen = x syringes : 10 dozen x = 12  10 x = 120 syringes Proof: 12  10 = 120 1  120 = 120 22. How many hr are there in 10 days? Conversion factor: 24 hr = 1 day.

ANS:

240 hr Know Want to Know 24 hr : 1 day = x hr : 10 days x = 24  10 x = 240 hr Proof: 24  10 = 240 1  240 = 240 23. How many min are in 4.5 hr? Conversion factor: 1 hr = 60 min.

ANS:

270 min Know Want to Know 1 hr : 60 min = 4.5 hr : x min x = 60  4.5 x = 270 min Proof: 1  270 = 270 60  4.5 = 270

24. A bottle of 40 tablets costs the pharmacy $100. How much does each tablet cost?

ANS:

$2.50 per tablet Know Want to Know 40 tablets : 100 dollars = 1 tablet : x dollars

x = $2.50 per tablet Proof: 40  2.50 = 100 100  1 = 100 25. The hospital assigns 4 interns to every resident. There are 7 residents. How many interns will

the hospital need?

ANS:

28 interns Know Want to Know 4 interns : 1 resident = x interns : 7 residents x=47 x = 28 interns Proof: 4  7 = 28 1  28 = 28 26. The container holds 1.5 quarts. How many oz does it hold? Conversion factor: 32 oz = 1

quart.

ANS:

48 oz Know Want to Know 32 oz : 1 quart = x oz : 1.5 quarts x = 32  1.5 x = 48 oz Proof: 32  1.5 = 48 1  48 = 48 27. The accounting office prints 400 pages per day. How many reams of paper should be bought

to last 30 days? Conversion factor: 500 pages = 1 ream.

ANS:

24 reams

Step 1: Know Want to Know 400 pages : 1 day = x pages : 30 days x = 400  30 x = 12,000 pages in 30 days Proof: 400  30 1  12,000 =12,000 Step 2: Know Want to Know 500 pages : 1 ream = 12,000 pages : x reams x = 24 reams Proof: 500  24 = 12,000 1  12,000 = 12,000 28. The patient takes 5 medications 4 times a day. How many medications does the patient take in

1 week? Conversion factor: 7 days = 1 week.

ANS:

140 medications per week Know Want to Know 20 medications : 1 day = x medications : 7 days x = 20  7 x = 140 medications per week Proof: 20  7 = 140 1  140 = 140 29. There are 10 RNs on each unit per 24-hr shift. How many RN salaries are needed for a week

on a unit? Conversion factor: 7 days = 1 week.

ANS:

70 RN salaries Know Want to Know 10 RNs : 1 day = x RNs : 7 days x = 10  7 x = 70 RN salaries Proof: 10  7 = 70 1  70 = 70 30. The computer has 4 gigabytes (GB) of memory. How many megabytes (MB) of memory does

this equal? Conversion factor: 1024 MB = 1 GB.

ANS:

4096 MB Know Want to Know 1024 MB : 1 GM = x MB : 4 GB x = 1024  4 x = 4096 MB Proof: 1024  4 = 4096 1  4096 = 4096 31. The cardiac rehabilitation track is

mile. The patient is now completing 12 laps on the track

every morning. How many miles is the patient completing? Conversion factor: 4 laps (each lap is

mile) = 1 mile. (Create a one-step ratio and proportion.)

ANS:

3 miles Know Want to Know 4 laps : 1 mile = 12 laps : x miles x = 3 miles Proof: 4  3 = 12 1  12 = 12 32. The surgeon makes an incision that is 7

cm long. What is the equivalent in inches?

Conversion factor: 2.5 cm = approximately 1 inch.

ANS:

3 inches Know Want to Know 2.5 cm : 1 inch = 7.5 cm : x inch x = 3 inches Proof: 2.5  3 = 7.5 1  7.5 = 7.5 33. The field is 300 yards long. How many meters is it? Conversion factor: 1 yard =

approximately 0.9 m.

ANS:

270 m Know Want to Know 1 yard : 0.9 m = 300 yards : x m x = 0.9  300 x = 270 m Proof: 1  270 = 270 0.9  300 = 270 34. The medication prescription is for 60 tablets. If the patient takes 4 tablets a day, how many

days will the prescription last?

ANS:

15 days Know Want to Know 4 tablets : 1 day = 60 tablets : x days x = 15 days Proof: 4  15 = 60 1  60 = 60 35. The patient needs to drink 8 oz of water every hr while awake (16 hr). How many mL of

water will the patient drink? Conversion factor: 8 oz = 24 mL. ANS:

3840 mL Know Want to Know 240 mL : 1 hr = x mL : 16 hr x = 240  16 x = 3840 mL Proof: 240  16 = 3840 1  3840 = 3840 36. The patient is supposed to drink 8 oz of fluid every waking hr. How many quarts should be

consumed in 12 hr? Conversion factor: 16 oz = 1 pint, 2 pints = 1 quart. (Create a two-step ratio and proportion.)

ANS:

3 quarts Step 1: Know Want to Know 32 oz : 1 quart = 8 oz : x quarts

x = 0.25 quarts Proof: 32  0.25 = 8 18=8 Step 2: Know Want to Know 0.25 quarts : 1 hr = x quarts : 12hr x = 0.25  12 x =3 quarts Proof: 0.25  12 =3 13=3 37. The patient takes 7 oral medications per day. How many medications does the patient take in

2 weeks? Conversion factor: 7 days = 1 week.

ANS:

98 medications Know Want to Know 7 medications : 1 day = x medications : 14 days x = 14  7 x = 98 medications Proof: 7  14 = 98 1  98 = 98 38. A newborn weighs 3500 g. How many kg does the infant weigh? Conversion factor: 1 kg =

1000 g.

ANS:

3.5 kg Know 1 kg : 1000 g = x kg : 3500 g

Want to Know

x = 3.5 kg Proof: 1  3500 = 3000 3.5  1000 = 3500 39. How many km are in 75 miles? Conversion factor: 0.6 miles = 1 km.

ANS:

125 km Know Want to Know 0.6 miles : 1 km = 75 miles : x km x = 125 km Proof: 0.6  125 = 75 1  75 = 75 40. A child weighs 66 lb. How many kg does the child weigh? Conversion factor: 1 kg = 2.2 lb.

ANS:

30 kg Know 1 kg : 2.2 lb = x kg : 66 lb

Want to Know

x = 30 kg Proof: 1  66 = 66 2.2  30 = 66 Directions: Fill in the quantity for x in the following ratio and proportion table.

41. 1 : 2 = 4 : x ANS:

8 42. 2 : 6 = 3 : x ANS:

9 43. 5 : 10 = 10 : x ANS:

20 44. 12 : 4 = 15 : x ANS:

5 45. x : 5 = 5 : 25 ANS:

1 46. 50 : 10 = 100 : x ANS:

20 47. 10 : 60 = 5 : x ANS:

30 48. 4 : 1 = x : 2 ANS:

8 49. 25 : 75 = x : 30 ANS:

10 50. 250 : x = 2 : 1 ANS:

125 51. If you exercise 3 miles per day 5 days per week on a treadmill, how many miles do you

exercise in 20 days?

ANS:

60 miles Know Want to Know 15 miles : 5 days = x miles : 20 days x = 60 miles in 20 days Proof: 15  20 = 300 5  60 = 300 52. The nurse receives 1.5 vacation/sick days per month after 5 years of service. How many

vacation/sick days will the nurse receive per year?

ANS:

18 days Know Want to Know 1.5 days : 1 month = x days : 12 months x = 1.5  12

x = 18 vacation/sick days per year Proof: 1.5  12 = 18 1  18 = 18 53. The physician’s order states the patient must consume 1500 mL of water every 24 hr. If the

patient is awake 12 hr per day, how many mL of water should the patient consume each waking hr?

ANS:

125 mL per hr Know Want to Know 1500 mL : 12 hr = x mL : 1 hr x = 125 mL per hr Proof: 1500  1 = 1500 12  125 = 1500 54. The ambulance averages 15 miles per gallon. If gasoline costs 3 dollars per gallon, then what

is the cost for driving 450 miles per week? (Is this a one-step or two-step ratio and proportion?)

ANS:

90 dollars per week Two-step ratio and proportion Step 1: Know Want to Know 15 miles : 1 gallon = 450 miles : x gallons

x = 30 gallons per week Step 2: Know Want to Know $3:1 gallon = $x : 30 gallons x = $90 per week 55. The patient is taking medicine to increase urinary output. The physician requested to be

notified if the patient’s urinary output fell below 1500 mL per 24 hr. The patient averages an output of 50 mL per hr. Should the physician be notified?

ANS:

Know Want to Know 50 mL : 1 hr = x mL : 24 hr

x = 1200 mL per 24 hr Yes. The physician should be notified.

Chapter 03: Safe Medication Administration Brown and Mulholland’s Drug Calculations: Ratio and Proportion Problems for Clinical Practice 12th Edition, Ann Tritak-Elmiger ESSAY

Directions: Spell out the listed abbreviation in the space provided.

1. NPO ANS:

nothing by mouth 2. pc ANS:

after meals 3. ad lib ANS:

as desired 4. prn ANS:

as needed 5. bid ANS:

twice a day 6. stat ANS:

immediately 7. IM ANS:

intramuscular route 8. q4h ANS:

every four hr 9.

ANS:

with 10.

ANS:

without Directions: Write the approved metric abbreviation in the space provided.

11. liter ANS:

L 12. milligram ANS:

mg 13. gram ANS:

g 14. milliliter ANS:

mL 15. microgram ANS:

mcg 16. kilogram ANS:

kg Directions: State the comparable times in the space provided (traditional time versus 24-hr clock).

17. 1:20 AM ANS:

0120 hr 18. 12:30 PM ANS:

1230 hr 19. 10 AM ANS:

1000 hr 20. 6 PM ANS:

1800 hr 21. 1730 hr ANS:

5:30 PM 22. 1410 hr ANS:

2:10 PM 23. 0045 hr ANS:

12:45 AM 24. 0930 hr ANS:

9:30 AM Directions: For each of the following medication-related errors, select the patient “right” that was violated (select a, b, c, d, or e for each). Use pharmacology text references if needed.

After your selection, discuss the clinical implications and preventive measures you will take in your practice to avoid such errors. a. Right patient b. Right drug c. Right time d. Right dose e. Right route 25. Ordered: Fast-acting regular insulin 10 units for a patient with high blood glucose level.

Given: Intermediate-acting insulin 10 units.

ANS:

b

When comparing the order with the label, it is very important to read the label 3 times during preparation. Knowing the action of the medications you are preparing and avoiding distractions as you prepare them are also important steps to avoid this type of potentially grave error.

26. Ordered: Amoxicillin 125 mg.

Label: Amoxicillin 125 mg per 5 mL, 100 mL vial.

Given: Amoxicillin 100 mL. ANS:

d Understand the label differences between unit dose and total dose in any container. The amount was massive overdose.

27. Ordered: Percocet 1 tablet q4h prn pain for a patient allergic to aspirin.

Given: Percodan 1 tablet.

ANS:

b Be aware that many drugs have similar names. Percodan contains aspirin. Aspirin is contraindicated not only for patients allergic to it but may also be contraindicated for preoperative and postoperative patients because of increased bleeding times. Aspirin is contained in many products. Percocet contains acetaminophen.

28. Ordered: Large amount of narcotic prescribed for Mr. Smith, room 403, bed A, who is a

patient of Dr. Davis, whose name was noted on the chart and in the narcotic record. Mr. Smith is a patient with a terminal illness and has been receiving increasingly large amounts of pain medication for the past 2 months.

Given: Large amount of narcotics to Mr. Davis, an underweight patient of another physician, room 403, bed B. Mr. Davis had never received a narcotic medication before.

ANS:

a Two approved methods of patient identification must be used before administering medications. Check The Joint Commission (TJC) policies and agency policies. One method would be a scan of the patient identification bracelet with the patient medication label, whereas another might be asking patients to state their full names. Avoiding distractions when preparing and administering medications is critical to safe administration.

29. Ordered: Hydralazine 50 mg po 4 times daily.

Label: Hydroxyzine 50 mg.

Given: Hydroxyzine 50 mg.

ANS:

b

Many drugs have similar sounding names, and thousands of drugs are on the market.

Attention must be paid to spelling of all orders and medication labels. A pharmacy-delivered unit dose will often help prevent this type of error; however, pharmacies may also make errors.

30. Ordered: Insulin subcutaneous injection daily for an older patient who is newly diagnosed

with diabetes. Under supervision, the patient practiced injecting an orange for a few days, followed by self-injections under supervision until discharge shortly thereafter.

Given: At home, the patient injected an orange with insulin and ate the orange each day. The patient complained of the taste to the home-care nurse during the first post-hospital visit.

ANS:

e Patient teaching and discharge planning were inadequate in this example. The family must be included. Hospital stays are short, and often the patient’s condition renders him or her incapable of absorbing a lot of information in a short time period.

31. Ordered: 5 mL, 1 tsp Benadryl syrup q8h to be administered by a caregiver at home after

discharge for patient allergies. Benadryl, an antihistamine, has a side effect of drowsiness.

Given: 1 soup spoonful Benadryl, 1 household tsp Benadryl 8 hr later,

household Tbsp

Benadryl 8 hr later, and so forth until the physician was notified about a change in the patient’s condition (extreme drowsiness).

ANS:

d Discharge planning should anticipate how the patient might take or measure medications when at home. A soup spoon is not equal to a household tsp, and a household tsp is not equal to

of a household Tbsp. Calibrated medication tsp and small calibrated cups are needed for

discharge medications.

32. Ordered: Propranolol LA (long-acting tablet) po for a patient with a nasogastric (NG) tube

(through nose to stomach).

Given: Crushed propranolol LA via the NG tube.

ANS:

e po, by mouth, was the route ordered. The nurse cannot legally change the route without an order. If the route ordered needs to be clarified, the prescriber of the order must be consulted.

33. Ordered: By phone: Ceftizoxime 1 g.

Given: Cefotaxime 1 g.

ANS:

b

Telephone orders present special risks. Check TJC and agency policies. The name of the drug should be spelled back to the person who is ordering by telephone. Telephone orders should be taken only in an emergency. Labels should be read carefully. Special attention must be paid to drugs with long names and to those that have a letter after the name, which may indicate a modified drug, a different drug than one with the same name but without a letter, such as LA (long-acting). Multigenerational antibiotics with long names often have similar names.

34. Ordered: Potassium chloride (KCl) 20 mEq verbal order during a bedside emergency to be

added to intravenous (IV) infusion solution, and atropine 0.5 mg to be given by direct IV (directly into the vein). Both medications were prepared by Nurse A. Given: (KCl) 20 mEq in syringe directly into the vein by nurse B, who was handed two unmarked syringes by nurse A, who verbally identified them.

ANS:

e Emergency situations and unmarked, unidentified medications, as well as a preparer who is not the giver, present special risks. The medication wrapper or label should be kept with the emergency drug for a side-by-side comparison with the medication. The name and dose should be restated to the person giving the drug.

Directions: Write out the following orders and abbreviations.

35. Tylenol 500 mg tab 1 q6h po prn for fever over 100° F headache ANS:

Tylenol 500 milligrams 1 tablet every 6 hr by mouth as needed for fever over 100° F and for headache.

36. Ampicillin oral susp 125 mg po tid ANS:

Ampicillin oral suspension 125 milligrams by mouth 3 times a day.

37. Cytotec tab 100 mcg qid po pc and HS ANS:

Cytotec tablet 100 micrograms 4 times a day by mouth, after meals and at bedtime.

38. Penicillin G 500,000 units IM daily ANS:

Penicillin G 500,000 units intramuscular route daily.

39. Potassium chloride sol. 10 mEq po daily AM

juice

ANS:

Potassium chloride solution 10 milliequivalents by mouth daily in the morning with juice.

40. Maalox 30 mL q4h prn upset stomach or heartburn

ANS:

Maalox 30 milliliters every 4 hr as necessary for upset stomach or heartburn.

Directions: Identify briefly why the following orders would need to be clarified.

41. Potassium chloride sol 10 mEq daily in morning ANS:

The route is omitted.

42. Codeine tab 5 mg po for pain ANS:

The frequency schedule is omitted.

43. Benadryl 1 tsp po every 12 hr for allergies ANS:

The metric dose is omitted.

Many drugs are supplied in several strengths. The order must specify the dose, not the volume, for example, 25 mg, 50 mg, and so on.

44. Digoxin 10 mg daily in AM ANS:

The route and form are omitted.

45. Aspirin 2 tablets po for headache q4h prn ANS:

The dosage strength is omitted.

Aspirin is supplied in various strengths.

Directions: Provide answers for the following statements.

46. State two safety requirements for identifying patients.

ANS:

Use two methods such as the wristband, scanner, or asking the patient to state his or her full name. (Do not use the bed or room number as an identifier.)

47. State the appropriate action to take for unclear orders.

ANS:

Clarify with the prescriber. Do not guess. If you are a student, consult your instructor.

48. State the appropriate action to take for incomplete labels on medicines.

ANS:

Discard the medication.

49. State the appropriate safeguard to take for transfer and postoperative patients before giving a

medication.

ANS:

Check the records to see when and which medications were last given in the prior setting.

50. State the reason why delays in documenting medications promptly after administration may

cause a medication error.

ANS:

If the medication is not promptly documented, the medication may be given twice. For example, the patient may complain of pain to two different staff members. If the second nurse does not see that a medication was given by the first nurse, it may be given again, resulting in potential ADE (adverse drug event) overdose injury to the patient.

COMPLETION

Directions: Determine the appropriate interpretation of the abbreviations.

A patient was admitted to the hospital for severe abdominal pain. Pain medication, morphine sulfate, was ordered A _ (IV) B (stat) and C (q3h) D (prn).

The medications were ordered IV because the patient had E (N&V) and was F (NPO). The tests revealed that the patient had appendicitis. After surgery, the patient still had difficulty with G (po) feedings so an H (NG) tube was ordered with feedings to be given I (q2h).

Sips of water were allowed J (ad lib), but an K (I&O) record had to be maintained. When the patient was able to tolerate fluids, soft foods were gradually introduced, and the NG tube and IV were removed. Rectal L (supp) were ordered for the occasional complaints of nausea, to be given before meals.

Medications were given in the form of oral M (susp) and elixirs because they were easy to swallow. The patient had a history of angina and occasional chest pain and now was able to take nitroglycerin pills N (subl). The patient made a very good recovery, did not have any chest pain episodes in the hospital or suffer any O (ADEs) during hospitalization, and was discharged to home.

1. A ANS: IV route 2. B ANS: immediately 3. C ANS: every 3 hr

4. D ANS: as needed 5. E ANS: nausea and vomiting 6. F ANS: nothing by mouth 7. G ANS: by mouth, oral 8. H ANS: nasogastric 9. I ANS: every 2 hr 10. J ANS: as desired 11. K ANS: intake and output 12. L ANS: suppositories 13. M ANS: suspensions 14. N ANS: sublingual 15. O ANS: adverse drug events

Chapter 04: Medication Measurements and Oral Dose Calculations Brown and Mulholland’s Drug Calculations: Ratio and Proportion Problems for Clinical Practice 12th Edition, Ann Tritak-Elmiger ESSAY

Directions: Read the ordered and available amounts. Decide if you are going to give the same, more, or less than the unit dose available.

1. Ordered: Phenobarbital 30 mg po stat for a patient needing sedation.

Available: Phenobarbital: 60 mg tablets scored.

Give: same, more, or less than unit dose. (Circle one) ANS:

Less. 30 mg is 1/2 of the unit dose, 60 mg 2. Ordered: Clarithromycin, 0.25 g po q12h for a patient with a sinus infection.

Available: Clarithromycin, 250 mg tablets.

Give: same, more, or less than unit dose. (Circle one) ANS:

Same. 0.25 g = 250 mg 3. Ordered: Decadron 0.5 mg po daily for a patient with an acute allergic reaction.

Available: Decadron 0.25 mg tablets.

Give: same, more, or less than unit dose. (Circle one) ANS:

More. 0.5 mg is twice the unit dose, 0.25 mg 4. Ordered: Cipro, 0.75 g po daily for a patient with a urinary tract infection.

Available: Cipro 750 mg tablets.

Give: same, more, or less than unit dose. (Circle one) ANS:

Same. 0.75 g = 750 mg unit dose 5. Ordered: Glucophage 0.5 g po daily for a patient with diabetes.

Available: Glucophage 500 mg tablets.

Give: same, more, or less than unit dose. (Circle one) ANS:

Same. 0.5 g = 500 mg unit dose 6. Ordered: Synthroid 100 mcg po daily for a patient with hypothyroidism.

Available: Synthroid 0.05 mg tablets.

Give: same, more, or less than unit dose. (Circle one) ANS:

More. 100 mcg = 0.1 mg, twice the amount of the unit dose

7. Ordered: Aspirin 650 mg po q4h prn for joint pain.

Available: Aspirin 325 mg tablets.

Give: same, more, or less than unit dose. (Circle one) ANS:

More. 650 mg is twice the amount of 325 mg unit dose 8. Ordered: Dilantin 0.1 g po daily for a patient with seizures.

Available: Dilantin 100 mg tablets.

Give: same, more, or less than unit dose. (Circle one) ANS:

Same 0.1 g = 100 mg 9. Ordered: Coumadin 7.5 mg po daily for a patient with a clotting risk.

Available: Coumadin 2.5 mg tablets.

Give: same, more, or less than unit dose. (Circle one) ANS:

More. 7.5 mg is 3 times the amount of the 2.5 mg unit dose 10. Ordered: Children’s acetaminophen oral suspension 160 mg.

Available: Children’s acetaminophen oral suspension 80 mg per 2.5 mL. Give: same, more, or less than unit dose. (Circle one) ANS:

More. 160 mg is twice the amount of the 80 mg unit dose 11. Ordered: Phenobarb elix 15 mg po daily for a child with seizures.

Available: Phenobarb elix 20 mg per 5 mL. Give: same, more, or less than unit dose. (Circle one) ANS:

Less. 15 mg is less than the 20 mg unit dose 12. Ordered: Cephalexin oral suspension 0.25 g po q6h for a child with an infection.

Available: Cephalexin oral suspension 0.125 mg per 5 mL. Give: same, more, or less than unit dose. (Circle one) ANS:

More. 0.25 g is twice the amount of the 0.125 mg unit dose 13. Ordered: Potassium chloride solution 20 mEq po daily for a patient with a potassium deficit.

Available: Potassium chloride solution. 40 mEq per 15 mL. Give: same, more, or less than unit dose. (Circle one) ANS:

Less. 20 mEq is half the 40 mEq unit dose 14. Ordered: Lorabid oral suspension 0.3 g po bid for a patient with an infection.

Available: Lorabid oral suspension, 200 mg per 5 mL. Give: same, more, or less than unit dose. (Circle one) ANS:

More. 0.3 g = 300 mg, more than the unit dose supplied Directions: Read the ordered and available amounts. Estimate the approximate dose.

15. Ordered amount: po 0.5 g.

Supplied: 0.25 g tablets.

Estimated dose: ANS:

2 tablets 16. Ordered amount: po 0.1 g.

Supplied: 100 mg cap.

Estimated dose: ANS:

1 cap 17. Ordered amount: po 20 mg.

Supplied: 10 mg tablets.

Estimated dose: ANS:

2 tablets 18. Ordered amount: po 10 mg.

Supplied: 20 mg scored tablets.

Estimated dose: ANS:

1/2 tablet 19. Ordered amount: po 250 mg.

Supplied: 125 mg cap.

Estimated dose: ANS:

2 cap 20. Ordered amount: po 0.5 g.

Supplied: 250 mg per 5 mL. Estimated dose: ANS:

10 mL 21. Ordered amount: po 50 mg.

Supplied: 10 mg per mL. Estimated dose: ANS:

5 mL 22. Ordered amount: po 0.2 mg.

Supplied: 100 mcg per mL. Estimated dose: ANS:

2 mL 23. Ordered amount: po 50 mcg.

Supplied: 0.05 mg per mL. Estimated dose: ANS:

1 mL 24. Ordered amount: po 2000 mcg.

Supplied: 1 mg per tablet.

Estimated dose: ANS:

2 tablets Directions: Read the ordered and available amounts. Decide if you are going to give the same, more, or less than the unit dose available. Calculate the amount of medication to give and label your answers.

Equivalents: 1000 mcg = 1 mg; 1000 mg = 1 g 25. Ordered: Hydantoin 0.2 g cap po tid for a patient with seizures.

Available: Hydantoin 100 mg cap.

Give: same, more, or less.

ANS:

More. 0.2 g = 200 mg Give 2 cap 100 mg : 1 cap = 200 mg : x cap 26. Ordered: Dynabac 0.25 g po bid enteric-coated tablet for a patient with tonsillitis.

Available: Dynabac 250 mg e-c tablets.

Give: same, more, or less.

ANS:

Same. 0.25 g = 250 mg Give 1 enteric-coated tablet

27. Ordered: Dexamethasone 1.5 mg tablet po daily for a patient with asthma.

Available: Dexamethasone 0.75 mg tablet for asthma.

Give: same, more, or less.

ANS:

More. 1.5 mg = 2  0.75 mg Give 2 tablets 0.75 mg : 1 tablet = 1.5 mg : x tablet 28. Ordered: Spectracef 0.4 g po with meals tid for 10 days for a patient with a skin infection.

Available: Spectracef 200 mg tablets.

Give: same, more, or less.

ANS:

More. 0.4 g = 400 mg Give 2 tablets 200 mg : 1 tablet = 400 mg : x tablet 29. Ordered: Synthroid tablets 150 mcg po daily in AM for a patient with hypothyroidism.

Available: Synthroid 0.15 mg scored tablets.

Give: same, more, or less.

ANS:

Same. 150 mcg = 0.15 mg Give 1 tablet 150 mcg : 1 tablet : 150 mcg : x tablet Directions: Read the ordered and available amounts. Decide if you are going to give the same, more, or less of the unit dose available. Calculate the amount of medication in mL to give and label your answers.

30. Ordered: Benadryl elix 25 mg po stat for allergic pruritus.

Available: Benadryl elix 12.5 mg/5 mL. Give: same, more, or less.

ANS:

More. 25 mg is 2  12.5 mg Give 10 mL 12.5 mg : 5 mL = 25 mg : x mL 31. Ordered: Ceclor oral suspension 0.5 g po stat for a patient with an infection.

Available: Ceclor 250 mg/5 mL. Give: same, more, or less.

ANS:

More. 0.5 g = 500 mg is twice 0.25 g/5 mL, 2  5 = 10 mL Give 10 mL 250 mg : 5 mL = 500 mg : x mL 32. Ordered: Potassium chloride solution 20 mEq po daily.

Available: Potassium chloride solution 40 mEq/15 mL. Give: same, more, or less.

ANS:

Less. 20 mEq is 1/2 of 40 mEq Give 7.5 mL 40 mEq : 15 mL = 20 mEq : x mL 33. Ordered: Riomet 0.5 g solution po bid for a patient with type 2 diabetes.

Available: Riomet 500 mg/5 mL. Give: same, more, or less.

ANS:

Same. 0.5 g = 400 mg Give 5 mL 500 mg : 5 mL = 500 mg : x mL 34. Ordered: Prozac oral solution 10 mg for a patient with depression.

Available: Prozac oral solution 20 mg per 5 mL. Give: same, more, or less.

ANS:

Less. 10 mg is 1/2 of 20 mg Give 2.5 mL 20 mg : 5 mL = 10 mg : x mL Directions: Solve the following problems. Determine whether they are one-step or two-step problems. Move decimals for metric conversions. Estimate your answers. Will you give more or less of what is on hand? Prove your work.

35. Ordered: Dilantin (phenytoin sodium) extended-release 60-mg cap for a patient who had a

seizure. How many capsules will you give?

ANS:

2 tablets

36. Ordered: Levaquin (levofloxin) 0.5 g po daily for a patient with an infection. How many

tablets will you give?

ANS:

2 tablets 0.5 g = 500 mg Have Want to Have 250 mg : 1 tablet = 500 mg: x tablets =

x = 2 tablets Proof: 250

2 = 500 1 500 = 500

37. Ordered: Depakene syrup (valproic acid) 400 mg po bid for a patient with seizures.

How many mL will you give per dose?

ANS:

8 mL Have Want to Have 250 mg: 5 mL = 400 mg: x mL = = 8 mL Proof: 250

8 = 2000 5 400 = 2000

38. Ordered: Retrovir (zidovudine) 0.3 g po for a patient who is HIV positive.

How many cap will you give?

ANS:

3 cap 0.3 g = 300 mg

Have Want to Have 100 mg : 1 cap = 300 mg : x cap = x = 3 cap (NOTE: When more than 1 or 2 unit doses are ordered, recheck the order and the math. Consult a current drug reference for the usual dose. Consult with the prescriber if questions remain.)

Proof: 100  3 = 300 1  300 = 300 39. Ordered: L-Dopa (levodopa) 1.5 g po for a patient with Parkinson’s disease.

Available: 500 mg tablets.

How many tablets will you give?

ANS:

3 tablets 1.5 g = 1500 mg Have Want to Have 500 mg : 1 tablet = 1500 mg : x tablets = x = 3 tablets Proof: 500 3 = 1500 1 1500 = 1500 40. Ordered: Ativan 1 mg tablet po HS prn anxiety.

Available: Ativan 0.5 mg tablets.

How many tablets will you give?

ANS:

2 tablets 1 mg is two times 0.5 mg.

Have Want to Have 0.5 mg : 1 tablet = 1 mg : x tablets 0.5x = 1 = x = 2 tablets Proof: 0.5

2=1 1 1=1

41. Ordered: Prochlorperazine syrup 8 mg po stat for a patient with preoperative anxiety.

Available: Prochlorperazine syrup 5 mg per mL. How many mL will you give to nearest tenth of an mL?

ANS:

1.6 mL Have Want to Have 5 mg: 1 mL = 8 mg: x mL 5x = 8 = x = 1.6 mL Proof: 5

1.6 = 8 1 8=8

42. Ordered: Zithromax oral suspension 0.4 g once daily for a patient with an infection.

How many mL will you prepare?

ANS:

10 mL Step 1: Have Want to Have 1000 mg : 1g = x mg : 0.4 g = x = 1000 0.4 g x = 400 mg Proof: 1000

0.4 = 400 1 400 = 400

Step 2: Have Want to Have 200 mg : 5 mL = 400 mg : x mL 200x = 2000 = x = 10 mL Proof: 200

10 = 2000 5 400 = 2000

43. Ordered: Alprazolam solution 0.75 mg tid po for a patient with an anxiety disorder.

How many mL to the nearest hundredth will you prepare per dose?

ANS:

0.75 mL Have Want to Have 1 mg : 1 mL = 0.75 mg : x mL x = 1 0.75 = 0.75 mL Proof: 1

0.75 = 0.75

44. Ordered: Lithium citrate syrup 10 mEq tid po for a patient with bipolar disorder.

How many mL will you prepare to the nearest tenth of a mL?

ANS:

1.3 mL Have Want to Have 8 mEq : 5 mL = 10 mEq : x mL = x = 6.25 mL rounded to 6.3 mL

Proof: 8

6.25 = 50 5 10 = 50

45. Ordered: Lanoxin Elixir Pediatric 62.5 mcg po for a child with heart failure.

How many mL to the nearest hundredth of an mL will you prepare?

ANS:

1.25 mL Have Want to Have 50 mcg : 1 mL = 62.5 mcg : x mL = x = 1.25 mL Proof: 50

1.25 = 62.5 1 62.5 = 62.5

46. Ordered: Lufyllin Elixir 50 mg po stat for a child with asthma.

How many mL will you prepare to the nearest tenth of an mL?

ANS:

7.5 mL Have

Want to Have

100 mg : 15 mL = 50 mg : x mL 100x = 50 15 = x = 7.5 mL Proof: 100

7.5 = 750 15 50 = 750

47. Ordered: KAON-CL 20% (potassium chloride) solution 10 mEq po daily for a patient taking

a diuretic.

How many mL will you prepare to the nearest tenth of an mL? ANS:

3.8 mL Have Want to Have 40 mEq : 15 mL = 10 mEq: x mL =

x = 3.75 rounded to 3.8 mL Proof: 40

3.75 = 150 15 10 = 150

48. Ordered: Acetaminophen Elixir 500 mg po q4h prn for a patient with a fever.

How many mL will you prepare to the nearest tenth of an mL?

ANS:

15.6 mL Have

Want to Have

325 mg : 10.15 mL = 500 mg : x mL 325x = 10.15 500 = x = 15.61 mL Proof: 325

15.61 = 5073 10.15 500 = 5073

Rounding affects the answers. Perform calculations prior to rounding.

49. Ordered: Valproic acid solution 350 mg po daily for patient with a seizure disorder.

How many mL will you prepare?

ANS:

7 mL Have

Want to Have

250 mg : 5 mL = 350 mg : x mL 250x = 5 350 mg = x = 7 mL Proof: 250 5

7 = 1750 350 = 1750

50. Ordered: Zofran oral solution 10 mg preoperatively stat to prevent postoperative nausea and

vomiting.

How many mL will you prepare to the nearest tenth of an mL? ANS:

12.5 mL Have Want to Have 4 mg : 5 mL = 10 mg : x mL 4x = 5  10 = x = 12.5 mL Proof: 4  12.5 = 50 5  10 = 50 51. Ordered: Loperamide hydrochloride oral solution 1.5 mg po stat for a patient with diarrhea.

How many mL will you prepare to the nearest tenth of an mL? ANS:

7.5 mL Have Want to Have 1 mg : 5 mL = 1.5 mg : x mL x = 5  1.5 x = 7.5 mL Proof: 1  7.5 = 7.5 5  1.5 = 7.5 52. Ordered: Cytoxan 0.2 g po daily for a patient with cancer.

Available: Cytoxan 50 mg tablets, Cytoxin 100 mg tablets, and Cytoxan 200 mg tablets.

Which unit dose would you select? State the reason briefly.

ANS:

Cytoxan 200 mg (0.2 g) tablets. The patient would only have to take 1 tablet.

53. Ordered: Amoxicillin oral cap 0.1 g po qid for a patient with an infection.

Available: Amoxicillin cap in 3 concentrations: 100 mg per cap, 250 mg per cap, and 500 mg per cap.

Which concentration would you select for this order? State the reason briefly.

ANS:

Amoxicillin 100 mg (0.1 g) per cap. A capsule cannot be divided so the other two could not be used.

54. Ordered: Saphris 10 mg SL bid for a patient with a bipolar disorder.

Available: Saphris SL in 5 and 10 mg SL tablets. a. Which concentration would you select for this order?

b. What instructions would you give before administering this medication?

1. Take the medication with a glass of water or juice and follow with a small meal immediately.

2. Allow the medication to dissolve under the tongue completely. Do not chew or swallow it.

Wait 10 min before eating or drinking.

ANS:

a. 10 mg SL tablet is best. It would allow the patient to take only 1 tablet b. Direction # 2. SL means sublingual route (under the tongue).

Chapter 05: Injectable Medication Calculations Brown and Mulholland’s Drug Calculations: Ratio and Proportion Problems for Clinical Practice 12th Edition, Ann Tritak-Elmiger ESSAY

Directions: Answer the following questions.

1. What is the usual dose in mL for a skin test?

ANS:

0.1 mL 2. A skin test is administered with which size syringe?

ANS:

1 mL syringe 3. Would the gauge number be small or large?

ANS:

The gauge number would be large. The larger the gauge number, the smaller the needle diameter.

4. What is the descriptor for medications that when combined in one syringe or solution interact

and cause undesired changes in composition or effects such as crystallization?

ANS:

Incompatibility 5. What is the name and abbreviation for the route used for skin test injections?

ANS:

Intradermal, ID 6. What is the first step a nurse must take after reading an order for a parenteral injection mix?

ANS:

The nurse must check for medication compatibility.

7. What is the name of the kind of reference a nurse must consult before mixing two or more

medications in one syringe or intravenous (IV) solution?

ANS:

The nurse must consult a current reliable compatibility drug reference. The nurse should call the pharmacy if there are questions.

8. What is the reason for mixing two or more medications in one syringe for an IM injection?

ANS:

The patient is spared the discomfort of two separate injections. One of the medications may extend the beneficial effect of the other or reduce uncomfortable side effects of the other medication, such as nausea or vomiting.

9. In general, which is absorbed faster, an oral medication or a parenteral medication?

ANS:

A parenteral medication is absorbed faster.

10. Does the nurse have to measure the dose in a prefilled syringe? If so, why? If not, why not?

ANS:

The dose must be measured. Prefilled syringes often contain a small amount of air and extra medication.

11. An error of dosage with one decimal place, such as preparing 1 mL instead of 0.1 mL results

in how much of an error?

ANS:

A 10-times dose error 12. What is the importance of writing a leading 0 in front of a decimal number less than one?

ANS:

The zero (0) alerts the reader that a decimal will follow immediately, which helps prevent erroneous medication calculations and adverse drug events.

13. What is the value of estimating medication doses before calculation and preparation?

ANS:

Estimation of a reasonable answer helps reduce major math errors.

14. Can the nurse legally administer a medication after the expiration date?

ANS:

No. The prescriber must reorder (prescribe) the medication. The nurse is not licensed to prescribe medications.

15. Name the three approved sites for IM injections.

ANS:

Deltoid, ventrogluteal muscle, and vastus lateralis 16. Which site is not recommended for IM injections? Why? ANS:

The dorsogluteal area is not recommended because of the proximity of nerves and blood vessels in the area.

17. State the approved abbreviations for four parenteral routes.

ANS:

ID, Subcut, IM, and IV 18. Why shouldn’t needles be recapped?

ANS:

The highest risk of a needlestick injury is during recapping.

19. What are the names of three diseases cited in the text that can be contracted from a needlestick

injury?

ANS:

Hepatitis B, Hepatitis C, and AIDS 20. What is the purpose of a filter needle? When is it used? Can the filter needle be used to inject

the patient?

ANS:

A filter needle is used to withdraw medication from glass ampules to prevent particles of glass from entering the syringe. The filter needle must be discarded and a new sterile nonfilter needle is used to inject the medication in the patient.

Directions: Examine the following syringes. Notice the total capacity and the 1 mL markings.

Indicate the filled-in dose measurement in the space provided.

21. Total capacity:

mL Smallest measurable dose: Indicated dose: mL

mL

ANS:

3 mL capacity; 0.1 mL calibrations; 1.7 mL dose 22. Total capacity:

mL Smallest measurable dose: Indicated dose: mL

mL

ANS:

5 mL capacity; 0.2 mL calibrations; 3.2 mL dose 23. Total capacity:

mL

Smallest measurable dose: Indicated dose: mL

mL

ANS:

10 mL capacity; 0.2 mL calibrations; 4.8 mL dose 24. Total capacity:

mL Smallest measurable dose: Indicated dose: mL

mL

ANS:

1 mL capacity; 0.01 mL calibrations; 0.35 mL dose 25. Total capacity:

mL Smallest measurable dose: Indicated dose: mL

mL

ANS:

3 mL capacity; 0.1 mL calibrations; 2.3 mL dose Directions: Indicate the requested dose with a line through the calibration on the syringe.

26. 2.9 mL

ANS:

27. 0.84 mL

ANS:

28. 6.4 mL

ANS:

29. 3.6 mL

ANS:

30. 0.8 mL

ANS:

31. 0.75 mL

ANS:

32. 2.3 mL

ANS:

33. 4.4 mL

ANS:

34. 8.6 mL

ANS:

35. 4.8 mL

ANS:

Directions: Calculate the amount to be given using the labels and orders provided. Prove the answers.

36. Ordered: Atropine 0.5 mg IM for a patient with bradycardia.

How many mL will you prepare (to the nearest tenth)?

ANS:

1.3 mL Have Want to Have 0.4 mg : 1 mL = 0.5 mg : x mL x = 1.25, rounded to 1.3 mL

37. Ordered: Neupogen (Filgrastim) 0.2 mg subcut once a week for a patient who is

immunosuppressed.

a. Estimated dose: b. How many mL will you prepare (to the nearest hundredth of an mL)? c. How many mg are the equivalents of 200 mcg?

ANS:

a. Estimate dose: Less than 1 mL b. Prepare 0.67 mL Step 1: Have Want to Have 1000 mcg : 1 mg = x mcg : 0.2 mg x = 1000  0.2 = 200 mcg Proof: 1000  0.2 = 200 1  200 = 200 Step 2: Have Want to Have 300 mcg : 1 mL = 200 mcg : x mL x = 0.666 mL rounded to 0.67 mL Proof: 300  0.67 = 201 1  200 = 200 c. 0.2 mg = 200 mcg (1 mg = 1000 mcg) 38. Ordered: Promethazine 30 mg IM stat for a patient with nausea.

a. Estimated dose: b. How many mL will you prepare?

ANS:

a. Estimated dose: slightly more than a half an mL, less than 1 mL b. 0.6 mL Have Want to Have 50 mg : 1 mL = 30 mg : x mL x = 0.6 mL Proof: 50  0.6 = 30 1  30 = 30 39. Ordered: Solu-Cortef 0.2 g IM stat, an anti-inflammatory steroid, for a patient with severe

inflammatory response. May also be given to support blood pressure in sepsis.

a. Estimated dose: b. How many mL will you prepare?

ANS:

a. Estimate dose: more than 1 mL, less than 2 mL b. 1.6 mL Step 1: Have Want to Have 1000 mg : 1 g = x mg : 0.2 g x = 1000  0.2 x = 200 mg Proof: 1000  0.2 = 200 1  200 = 200 Step 2: Have Want to Have 250 mg : 2 mL = 200 mg : x mL x = 1.6 mL Proof: 250  1.6 = 400

2  200 = 400 40. Ordered: Dilaudid 3 mg IM stat for a patient in pain.

a. Estimated dose: b. How many mL will you prepare to the nearest hundredth of an mL? ANS:

a. Estimate dose: Less than 1 mL b. 0.75 mL Have Want to Have 4 mg : 1 mL = 3 mg : x mL x = 0.75 mL Proof: 4  0.75 = 3 13=3 41. Ordered: Stadol 0.75 mg IM stat for a frail patient with a migraine headache.

a. Estimated dose: b. How many mL will you prepare to the nearest hundredth of an mL? ANS:

a. Estimate dose: Less than 1 mL b. 0.38 mL Have

Want to Have

2 mg : 1 mL = 0.75 mg : x mL

x = 0.375 rounded to 0.38 mL Proof: 2  0.375 = 0.75 1  0.75 = 0.75 42. Ordered: Phenobarbital sodium 0.06 g IM stat for a patient who needs sedation.

Available: Phenobarbital sodium 120 mg per 2 mL. a. Estimated dose: b. How many mL will you prepare?

ANS:

a. Estimate dose: 1 mL (0.06 g = 60 mg; 120 mg = 0.12 g) b. 1 mL Step 1: Have Want to Have 1000 mg : 1 g = x mg : 0.06 g x = 1000  0.06 = 60 mg Proof: 1000  0.06 = 60 1  60 = 60 Step 2: Have Want to Have 120 mg : 2 mL = 60 mg : x mL 120x = 120 x = 1 mL Proof: 120  1 = 120 1  120 = 120 43. Ordered: Ativan 3 mg IM stat for a patient with anxiety.

a. Estimated dose: b. How many mL will you prepare?

ANS:

a. Estimate dose:

of an mL

b. 0.75 mL Have Want to Have 4 mg : 1 mL = 3 mg : x mL 4x = 3 x = 0.75 mL Proof: 4  0.75 = 3 13=3 Directions: Give deep IM and follow with massage. IM route painful and only used if other routes unavailable.

44. Ordered: Lanoxin 0.3 mg deep IM stat loading dose for a patient with heart failure.

a. Estimated dose: b. How many mL will you prepare to the nearest hundredth of an mL? ANS:

a. Estimate dose: More than 1 mL, less than 2 mL because 0.3 mg = 300 mcg b. 1.2 mL Step 1: Have Want to Have 1000 mcg : 1 mg = x mcg : 0.3 mg x = 1000  0.3 = 300 mcg Proof: 1000  0.3 = 300 1  300 = 300 Step 2: Have Want to Have 500 mcg : 2 mL = 300 mcg : x mL x = 1.2 mL deep IM

45. Ordered: Epoetin alfa 13,000 units subcut twice weekly for a cancer patient with severe

anemia.

a. Estimated dose: b. How many mL will you prepare to the nearest tenth (after reading the label and label insert)?

ANS:

a. Estimate dose: More than 1 mL, less than 2 mL b. 1.3 mL Have Want to Have 10,000 units : 1 mL = 13, 000 units : x mL

x = 1.3 mL per dose Proof: 10,000  1.3 = 13,000 1  13,000 = 13,000 46. Ordered: Haldol 4 mg IM HS prn for a patient with agitation.

a. Estimated dose: b. How many mL will you prepare?

ANS:

a. Estimate dose: More than

mL, less than 1 mL

b. 0.8 mL Have Want to Have 5 mg : 1 mL = 4 mg : x mL x = 0.8 mL Proof: 5  0.8 = 4 14=4 47. Ordered: Tobramycin 70 mg IM q8h for a patient with an infection.

a. Estimated dose: b. How many mL will you prepare to the nearest tenth of an mL? ANS:

a. Estimate dose: More than 1 mL, less than 2 mL b. 1.8 mL Have Want to Have 40 mg : 1 mL = 70 mg : x mL x = 1.75 mL rounded to 1.8 mL Proof: 40  1.75 = 70 1  70 = 70 48. Ordered: Zantac (ranitidine hydrochloride) 30 mg IM q6h for a patient with an ulcer.

a. Estimated dose: b. How many mL will you prepare? c. Indicate the dose on the syringe.

ANS:

a. Estimate dose: Slightly more than 1 mL b. 1.2 mL Have Want to Have 25 mg : 1 mL = 30 mg : x mL

x = 1.2 mL Proof: 25  1.2 = 30 1  30 = 30 c.

49. Ordered: Tigan 75 mg IM stat for a patient with nausea.

a. Estimated dose: b. How many mL will you prepare to the nearest hundredth of an mL? c. Indicate the dose on the syringe provided.

ANS:

a. Estimate dose:

of 1 mL

b. 0.75 mL Have Want to Have 100 mg : 1 mL = 75 mg : x mL x = 0.75 mL Proof: 100  0.75 = 75 1  75 = 75 c.

50. Ordered: Morphine sulfate 15 mg and promethazine 20 mg both IM stat for a patient with

postoperative pain.

Round each dose to the nearest tenth of an mL.

a. Estimated dose: b. How many mL of morphine will you prepare? c. How many mL of promethazine will you prepare? d. What will be the total dose to nearest tenth of an mL? e. Indicate the total combined dose on the syringe.

ANS:

a. Estimate dose: More than 1 mL, less than 2 mL b. 1.5 mL Have Want to Have 10 mg : 1 mL = 15 mg : x mL 10x = 15 x = 1.5 mL morphine Proof: 10  1.5 = 15 1  15 = 15 c. 0.4 mL Have Want to Have 50 mg : 1 mL = 2 mg : x mL x = 0.4 mL promethazine d. 1.5 + 0.4 = 1.9 mL total combined volume e.

Chapter 06: Reconstitution of Medications from Powders and Crystals: Oral and Intramuscular Brown and Mulholland’s Drug Calculations: Ratio and Proportion Problems for Clinical Practice 12th Edition, Ann Tritak-Elmiger ESSAY

Directions: Answer the questions below.

1. Ordered: 500,000 units Pfizerpen IM q6h.

Available: Pfizerpen 1 million units for reconstitution.

Directions for mixing: Add 18.2 mL diluent to yield 250,000 units per mL or add 3 mL diluent to yield 1,000,000 units per mL. How many mL will you give if you use 18.2 mL of diluent?

ANS:

2 mL Have Want to Have 250,000 units : 1 mL = 500,000 units : x mL 25 x = 1  50 = 50 x = 2 mL Proof: 1  50 = 50 25  2 = 50 2. Ordered: Principen 200 mg po q6h.

Available: Principen (ampicillin) for oral suspension.

Directions: Add 72 mL of water. Shake well to make 100 mL. Each 5 mL yields 125 mg of ampicillin.

How many mL will you give?

ANS:

8 mL Have Want to Have 5 mL : 125 mg = x mL : 200 mg 125 x = 5  200 = 1000 x = 8 mL Proof: 5  200 = 1000 125  8 = 1000 3. Ordered: Measles, mumps, and rubella virus vaccine 0.5 mL subcutaneous.

Available: 10 mL multidose vial.

Directions: Use only the special diluent supplied for reconstitution. Withdraw the entire content (7 mL) of diluent and inject into the sterile vial of vaccine. Agitate to ensure thorough mixing. Each dose is 0.5 mL.

How many doses are in the vial?

ANS:

20 doses Have Want to Have 0.5 mL : 1 dose = 10 mL : x dose 0.5 x = 1  10 = 10 x = 20 doses Proof: 0.5  20 = 10 1  10 = 10 4. Ordered: Methicillin 750 mg IM q6h.

Available: Methicillin sodium 1 g.

Directions: Add 5.7 mL sterile water for injection. Each 2 mL equals 1 g methicillin sodium.

Discard after storing 24 hr at room temperature or after 4 days of refrigeration.

How many mL will you inject?

ANS:

1.5 mL Have Want to Have 2 mL : 1000 mg = x mL : 750 mg 1000x = 2  750 = 1500 x = 1.5 mL Proof: 2  750 = 1500 1.5  1000 = 1500 5. Ordered: Penicillin G potassium 250,000 units IM q8h.

Available: Penicillin G potassium 1 million units.

Directions: Add 9.6 mL diluent for 100,000 units/mL. Add 4.6 mL diluent for 200,000 units/mL. Add 1.6 mL diluent for 500,000 units/mL. How many mL will you give if you add 4.6 mL diluent to the powder?

ANS:

1.3 mL Have Want to Have 200,000 units : 1 mL = 250,000 units : x mL 20x = 25 x = 1.25 = 1.3 mL Proof: 1  25 = 25 20  1.25 = 25 6. Ordered: Ampicillin 350 mg IM q6h.

Available: Ampicillin 1 g.

Directions: Add 3.5 mL diluent. Each mL equals 250 mg.

How many mL will you give?

ANS:

1.4 mL Have Want to Have 250 mg : 1 mL = 350 mg : x mL 25x = 1  35 = 35 x = 1.4 mL Proof: 1  35 = 35 25  1.4 = 35 7. Ordered: Cefadyl 400 mg IM q6h.

Available: Cefadyl 1g.

Directions: Add 2 mL Bacteriostatic Water for injection. Each 1.2 mL contains 500 mg of cephapirin.

How many mL will you inject?

ANS:

1 mL Have Want to Have 500 mg : 1.2 mL = 400 mg : x mL 5x = 1.2  4 = 4.8 x = 0.96 = 1 mL Proof: 5  0.96 = 4.8 1.2  4 = 4.8 8. Ordered: Pfizerpen 600,000 units IM q12h.

Available: Pfizerpen 5 million units.

Directions: Add 8.2 mL diluent to yield 500,000 units/mL. Add 3.2 mL diluent to yield 1,000,000 units/mL. If you add 8.2 mL of diluent, how many mL of Pfizerpen will you give?

ANS:

1.2 mL Have Want to Have 500,000 units : 1 mL = 600,000 units : x mL 5x = 6 x = 1.2 mL Proof: 1  6 = 6 5  1.2 = 6 9. Ordered: Ticar 0.5 g.

Available: Ticar 1g.

Directions: Add 2 mL sterile water for injection or 1% lidocaine HCl (without epinephrine).

Each 2.6 mL equals 1000 mg of Ticar.

How many mL will you give?

ANS:

1.3 mL Have Want to Have 2.6 mL : 1000 mg = x mL : 500 mg 10x = 2.6  5 = 13 x = 1.3 mL Proof: 2.6  5 = 13 10  1.3 = 13 10. Ordered: Rocephin 500 mg IM bid.

Available: Rocephin 0.5 g vial.

Directions: Add 1.8 mL of diluent to yield 250 mg/mL. Add 1 mL of diluent to yield 350 mg/mL. How many mL will you give if you add 1 mL of diluent?

ANS:

1.4 mL Have Want to Have 350 mg : 1 mL = 500 mg : x mL 350x = 500 x = 1.428 = 1.4 mL Proof: 1  500 = 500 350  1.428 = 499.8 = 50 Directions: Mark the amount to be given on each syringe.

11. Ordered: 100 mg Solu-Medrol IM every 6 hr times 5 doses for inflammatory allergic

reaction.

Available: 500 mg Solu-Medrol/8 mL.

After reconstituting, how many mL will you give?

ANS:

1.6 mL Know Want to Know 62.5 mg : 1 mL = 100 mg : x mL 62.5x = 1  100 x = 1.6 mL Proof: 62.5  1.6 = 100 1  100 = 100

12. Ordered: Penicillin G 250,000 units IM every 12 hr for pneumonia.

Available: Penicillin G sodium 5,000,000 units per vial.

a. How much diluent will you add? b. How many mL will you give?

ANS:

a. 18 mL b. 1 mL Know

Want to Know

250x = 1250 = 250 x = 1 mL Proof: 1  250 = 250 250  1 = 250 The 1 mL concentration is recommended as penicillin can be irritating in a concentrated form.

13. Ordered: Tazidime 150 mg IM 4 times a day for chronic bronchitis.

Available: Tazidime 500 mg.

How many mL will you give?

ANS:

1 mL Know Want to Know 280 mg : 1.8 mL = 150 mg : x mL 280x = 1.8  150 = 270 280x = 270 x = 0.964 = 1 mL Proof: 280  0.964 = 269.9 1.8  150 = 270

14. Ordered: Penicillin G potassium 400,000 units IM every 12 hr for an open wound.

Available: Pfizerpen 5 million units.

a. How much diluent will you add? b. How many mL will you give?

ANS:

a. Add 8.2 mL of diluent to make 500,000 units/mL b. 0.8 mL Know

Want to Know

5x = 4 x = 0.8 mL Proof: 5  0.8 = 4 14=4

15. Ordered: Pipracil 400 mg IM 2 times a day for a wound infection.

Available: Pipracil sodium 2 g.

Directions: Add 4 mL of sterile water for injection to yield 1 g per 2.5 mL. How many mL will you give?

ANS:

1 mL Know 10x = 2.5  4 = 10 x = 1 mL Proof: 10  1 = 10 2.5  4 = 10

Want to Know

16. Ordered: Solu-Medrol 30 mg IM daily times 3 days for an autoimmune inflammation.

Available: Solu-Medrol 40 mg Directions: Press down on activator to force 1 mL of diluent into the vial.

How many mL will you give?

ANS:

0.75 mL Know

Want to Know

4x = 3 x = 0.75 mL Proof: 1  3 = 3 4  0.75 = 3

17. Ordered: Rocephin 500 mg IM every 4 hr for otitis media.

Available: Rocephin (ceftriaxone sodium) 2 g.

a. How much diluent will you add? b. How many mL will you give?

ANS:

a. Add 7.2 mL of diluent b. 2 mL Know Want to Know 250 mg : 1 mL = 500 mg : x mL 250x = 500 x = 2 mL Proof: 250  2 = 500 1  500 = 500

18. Ordered: Kefzol 75 mg IM daily for 3 days for a burn infection.

Available: Kefzol 500 mg for reconstitution.

a. How many mL of diluent will you add? b. How many mL will you give?

ANS:

a. Add 2 mL of diluent b. 0.9 mL Know Want to Know 225 mg : 1 mL = 200 mg : x mL 225x = 200 x = 0.888 = 0.9 mL Proof: 225  0.88 = 198 1  200 = 200

19. Ordered: Librium 75 mg IM one time only for anxiety.

Available: Librium 100 mg with 2 mL of diluent to yield 100 mg per 2 mL How many mL will you give?

ANS:

1.5 mL Know Want to Know 100 mg : 2 mL = 75 mg : x mL 100x = 2  75 = 150 x = 1.5 mL Proof: 2  75 = 150 100  1.5 = 150

20. Ordered: Velosef 200 mg IM 4 times a day for a urinary tract infection.

Available: Velosef 250 mg per vial.

a. How many mL of diluent will you add? b. How many mL will you give?

ANS:

a. Add 1.2 mL of sterile diluent b. 1 mL Know Want to Know 250 mg : 1.2 mL = 200 mg : x mL 250x = 240 x = 0.96 mL round to 1 mL Proof: 1.2  200 = 240

0.96  250 = 240

21. Ordered: Methicillin (Staphcillin) 1 g every 8 hr IV for a respiratory infection.

Available: Staphcillin 4 g in powdered form in the vial.

Directions: Add 5.7 mL of diluent to yield 8 mL. Further dilute in 100 mL of D5W and infuse in 40 min.

How many mL per hr will you set the infusion device to infuse?

ANS:

150 mL per hr to infuse in 40 min Know Want to Know 8 mL : 4 g = x mL : 1 g 4x = 8  1 = 8 x = 2 mL Withdraw 2 mL from the vial.

Proof: 1  8 = 8 42=8 Know

Want to Know

4x = 10  60 = 600 x = 150 mL per hr to infuse in 40 min Proof: 10  60 = 600 4  150 = 600 22. Ordered: Piperacillin sodium 2 g IV every 8 hr for a pelvic infection.

Available: Piperacillin 4 g vial in powdered form.

Directions: Add 7.8 mL of diluents to yield 10 mL of drug solution. Dilute the dose in 200 mL of D5W to infuse in 90 min.

How many mL per hr will you set the infusion device to infuse?

ANS:

133 mL per hr Know Want to Know 10 mL : 4 g = x mL : 2 g 4x = 10  2 = 20 x = 5 mL Withdraw 5 mL from the vial and inject into 200 mL D5W. Proof: 10  2 = 20 4  5 = 20

Know

Want to Know

9x = 20  60 = 1200 x = 133.3 = 133 mL per hr to set the infusion device Proof: 20  60 = 1200 9  133.3 = 1199.9 23. Ordered: Doxycycline (Vibramycin) 100 mg IV every 12 hr for gonorrhea.

Available: Vibramycin vial with powder to make 100 mg of medication.

Directions: Add 8 mL of diluent to make 100 mg of Vibramycin. Further dilute in 150 mL of D5W to infuse in 50 min.

How many mL per hr will you set the IV infusion device to infuse?

ANS:

180 mL per hr Know

Want to Know

x = 3  60 = 180 x = 180 mL per hr Proof: 1  180 = 180 3  60 = 180 24. Ordered: Maxipime 500 mg IV every 8 hr for otitis media.

Available: Maxipime 1 g.

Directions: Add 8.7 mL of diluents to yield 10 mL of drug solution. Further dilute dose in 100 mL of D5W to infuse in 40 min.

How many mL per hr will you set the IV infusion device to infuse?

ANS:

150 mL per hr Know

Want to Know

100 x = 500 x = 5 mL Add 5 mL of Maxipime to 100 mL of D5W. Proof: 1  500 = 500 100  5 = 500 Know 2 x = 5  60 = 300

Want to Know

x = 150 mL per hr Proof: 5  60 = 300 2  150 = 300 25. Ordered: Ranitidine (Zantac) 50 mg IV every 8 hr for gastric ulcers.

Available: Zantac injection (ranitidine hydrochloride) 50 mg in 50 mL 0.45% sodium chloride.

Directions: Infuse in 20 min.

How many mL per hr will you set the IV infusion device to infuse?

ANS:

150 mL per hr Know

Want to Know

2 x = 5  60 = 300 2 x = 300 x = 150 mL per hr Proof: 5  60 = 300 2  150 = 300 26. Ordered: Cipro 400 mg IV for a urinary tract infection. Infuse in 90 min.

Available: Cipro (ciprofloxacin) 400 mg in 40 mL of sterile 1% solution.

Directions: Further dilute in 200 mL of D5W. a. How many drops per min will you set the IV device to infuse using a gravity tubing at 20 drops per mL? b. How many mL per hr will you set the electronic infusion device?

ANS:

a. Use the drop rate formula: drop/time  volume = drops per min b. 160 mL Know Want to Know 240 mL : 90 min = x mL : 60 min 3x = 8  60 = 480 3x = 480 x = 160 mL per hr Proof: 80  60 = 480 3  160 = 480 27. Ordered: Ticar (ticarcillin) 500 mg IM daily for 4 days for a skin infection.

Available: Ticar for IM or IV use.

Directions: For IM use, add 2 mL of sterile water for Injection. Each 2.6 mL of solution will contain 1 g of ticarcillin.

How many mL will you inject?

ANS:

1.3 mL Know Want to Know 2.6 mg : 1000 mg = x mL : 500 mg 10x = 2.6  5 = 13 10x = 13 x = 1.3 mL Proof: 2.6  5 = 13 10  1.3 = 13 28. Ordered: Oxacillin 250 mg IV every 8 hr for 4 doses for a respiratory tract infection. Infuse

in 150 mL of D5W in 50 min.

Available: Oxacillin sodium 1 g.

Directions: Add 5.7 mL sterile water for Injection. Each 1.5 mL contains 250 mg of oxacillin. a. How many mL per hr will you set the gravity infusion set with 15 drops per min? b. How many mL per hr will you set the electronic infusion device to infuse?

ANS:

a. b. 180 mL Know

Want to Know

x = 3  60 = 180 x = 180 mL Proof: 3  60 = 180 1  180 = 180 29. Ordered: Tagamet 200 mg IV every 12 hr for a duodenal ulcer.

Available: Tagamet multidose vial with 300 mg per 2 mL. Directions: Dilute each dose with 50 mL of D5W to infuse in 30 min. a. How many mL of Tagamet will you need? b. How many mL per hr will you set the electronic infusion device to infuse?

ANS:

a. 1.33 mL Know 150x = 1  200 = 200

Want to Know

150x = 200 x = 1.33 mL Proof: 2  200 = 400 300  1.33 = 399 b. 100 mL Know

Want to Know

3x = 5  60 = 300 x = 100 mL per hr Proof: 5  60 = 300 3  100 = 300 30. Ordered: 40 mEq potassium chloride in 200 mL of D5W to infuse in 90 min for potassium

depletion.

Available: 20 mL single-dose vial for IV use. Each mL contains 2 mEq of potassium chloride. a. How many mL of medication will you need to inject into 200 mL of D5W for infusion? b. How many mL per hr will you set the electronic infusion device to infuse?

ANS:

a. 20 mL Know Want to Know 2 mEq : 1 mL = 40 mEq : x mL 2x = 40 x = 20 mL Proof: 2  20 = 40 1  40 = 40 b. 133 mL Know 9x = 20  60 = 1200 9x = 1200 x = 133.33 = 133 mL per hr Proof: 20  60 = 300 9  133.33 = 1199.9

Want to Know

Chapter 07: Basic Intravenous Calculations Brown and Mulholland’s Drug Calculations: Ratio and Proportion Problems for Clinical Practice 12th Edition, Ann Tritak-Elmiger ESSAY

Directions: Answer the questions below.

1. Step 1:

Step 2:

Ordered: 1500 mL of D5W to be infused in 12 hr.

How many mL per hr will you infuse?

ANS:

125 mL per hr

2. Ordered: Intravenous piggyback (IVPB) with 100 mL of solution to be infused in 40 min.

The drop factor is 20.

At how many gtt per min will you regulate the IV? ANS:

50 gtt per min

3. Ordered: 1000 mL of 0.45% sodium chloride to be infused in 8 hr. The drop factor is 15.

At how many gtt per min will you regulate the IV? ANS:

Step 1:

Step 2:

4. Ordered: 200 mL IVPB is to be infused in 40-60 min. The drop factor is microdrip.

a. How many gtt per min will be infused using the 60-min rate? b. If the IVPB is delivered via an infusion device, at what rate will you set it?

ANS:

a.

Step 1:

b.

Step 2: 200 mL per hr (microdrip has the same rate as the electronic infusion device, which is 60 mL per hr).

5. Ordered: 250 mL IVPB to be infused in 90 min. The drop factor is 15.

How many gtt per min will be infused?

ANS:

42 gtt per min

6. Ordered: 200 mL to be infused in 30–40 min. The drop factor is 20.

How many gtt per min will deliver the fastest rate?

ANS:

133 gtt per min

7. Ordered: 200 mL of lactated Ringer’s solution is being delivered at 33 mL per hr.

How long will the IV take to infuse?

ANS:

6 hr and 4 min 200 mL : x hr = 33 mL : 1 hr 33x = 200 x = 6.06 = 6 hr, 4 min Proof: 6.06  33 = 200 1  200 = 200 8. A unit of blood (500 mL) is hung at 0800 hr. The flow rate is 40 gtt per min. The IV tubing

drop factor is 10.

When will the infusion be completed?

ANS:

1005 hr Step 1: 40 gtt : x mL = 10 gtt : 1 mL 10x = 40

x = 40 mL per min Proof: 40  1 = 40 4  10 = 40 Step 2: 4 mL : 1 min = 500 mL : x min 4x = 500

Proof: 1  500 = 500 4  125 = 500 9. Calculate the infusion time for an IV of 1000 mL of normal saline (NS) at 30 gtt per min with

a drop factor of 15.

How many hr will it take to infuse?

ANS:

8 hr and 18 min Step 1: 30 gtt : x mL = 15 gtt : 1 mL 15x = 30 x = 2 mL per min Proof: 30  1 = 30 2  15 = 30 Step 2: 2 mL : 1 min = 1000 mL : x min 2x = 1000

Proof: 1  1000 = 1000 2  500 = 1000 10. An IV of 1000 mL is infusing at 83 mL per hr, and 420 mL remains to be infused.

How much time is left for the IV to infuse?

ANS:

5 hr and 4 min 83 mL : 1 hr = 420 mL : x hr 83x = 420 x = 5.06 = 5 hr, 4 min Proof: 1  420 = 420

83  5.06 = 420 11. Calculate the infusion time for an IV of 750 mL of D5W at 60 mL per hr.

How many hr will it take to infuse?

ANS:

12.5 hr 60 mL : 1 hr = 750 mL : x hr 60x = 750 x = 12.5 hr to infuse 750 mL Proof: 1  750 = 750 60  12.5 = 750 12. Ordered: 500 mL to be infused in 90 min. The drop factor on the gravity tubing is 20 gtt/mL.

a. How many drops per min will you set the gravity device? b. How many mL per hr will infuse if an electronic device is used?

ANS:

a.

b.

500 mL : 90 min = x mL : 60 min 90x = 500  60 = 30,000 90x = 30,000 x = 333.33 = 333 mL per hr for 500 mL to infuse in 90 min using an electronic device Proof: 500  60 = 30,000 90  333.3 = 29,997 13. Ordered: 2000 mL of normal saline (NS) to infuse in 24 hr.

At how many mL per hr will you set the electronic device?

ANS:

83.3 mL per hr

14. Ordered: IVPB with 250 mL of solution to be infused in 20–40 min. The drop factor is 15 gtt

per mL. a. At how many gtt per min will you set the IV tubing to infuse 250 mL in the fastest time? b. At how many mL per hr will the electronic IV device have to be set to infuse 250 mL in the fastest time?

ANS:

a.

b.

250 mL : 20 min = x mL : 60 min 20x = 250  60 = 15,000 20x = 15,000 x = 750 mL per hr Proof: 250  60 = 15,000 20  750 = 15,000 15. Ordered: 1000 mL 0.9% NS to infuse in 12 hr. The drop factor on the gravity tubing is 20.

At how many gtt per min will you regulate the IV? ANS:

28 gtt per min Step 1:

Step 2:

16. Ordered: 1000 mL D5W to infuse at 60 mL per hr.

How long will it take to infuse?

ANS:

16 hr and 40 min 60 mL : 1hr = 1000 mL : x hr 60x = 1000 x = 16.66 = 16 hr, 40 min to infuse Proof: 1000  1 = 1000 16.66  60 = 999.6 17. Ordered: IVPB with 150 mL of solution is to be infused in 50 min.

At how many mL per hr will you set the electronic device?

ANS:

180 mL per hr

18. Ordered: 500 mL lactated Ringer’s solution to infuse at 40 mL per hr. The IV was started at

1500 hr.

When will the IV be completed?

ANS:

0330 hr 40 mL : 1 hr = 500 mL : x hr 40x = 500 x = 12.5 hr Proof: 40  12.5 = 500 1  500 = 500 1500 hr + 12.5 hr = 0330 hr the next day 19. Calculate the infusion time for an IV of 1000 mL of D5W to infuse at 40 gtt per min with a

drop factor of 15 gtt per mL. How many hr will it take to infuse?

ANS:

5 hr and 33 min Step 1: 40 gtt : x mL = 15 gtt : 1 mL 15x = 40  1 = 40 x = 2.66 = 3 mL per min Proof: 40  1 = 40 2.66  15 = 39.9 Step 2: 3 mL : 1 min = 1000 mL : x min 3x = 1  1000 = 1000 x = 333.3 min  60 = 5.55 hr Proof: 1  1000 = 1000 3  333.3 = 999.9 0.55  60 = 33 min = 5 hr, 33 min to infuse 1000 mL 20. Ordered: 150 mL IVPB is to be infused in 90 min.

a. If the IVPB is delivered via an electronic infusion device, at what rate will you set the device? b. If the IVPB is delivered via a gravity device with a drop factor of 15, at what rate will you set the gravity pump?

ANS:

a.

150 mL : 90 min = x mL : 60 min 90x = 150  60 = 9000 x = 100 mL per hr

Proof: 60  150 = 9000 90  100 = 9000 b.

Directions: For the following questions, calculate mL per hr for an electronic infusion device.

21. Ordered: 1500 mL D5W in 24 hr.

ANS:

22. Ordered: 1000 mL NS in 12 hr.

ANS:

23. Ordered: 500 mL 0.9% NS in 8 hr.

ANS:

24. Ordered: 500 mL lactated Ringer’s solution in 12 hr.

ANS:

25. Ordered: 2000 mL NS in 24 hr.

ANS:

26. Ordered: 1200 mL TPN in 12 hr.

ANS:

27. Ordered: 1000 mL 0.45% sodium chloride in 8 hr.

ANS:

28. Ordered: D5LR 750 mL in 10 hr.

ANS:

29. Ordered: Lactated Ringer’s solution 500 mL in 6 hr.

ANS:

30. Ordered: D5W 1500 mL in 15 hr.

ANS:

Directions: Calculate infusion completion time.

31. 1000 mL infusing at 125 mL per hr was started at 1800 hr.

Completion time: ANS:

0200 hr

32. 500 mL infusing at 75 mL per hr was started at 0800 hr.

Completion time: ANS:

1442 hr

33. 750 mL infusing at 83 mL per hr was started at 1100 hr.

Completion time:

ANS:

2000 hr Know Want to Know 83 mL : 1 hr = 750 mL : x hr 83x = 750 hr x = 9 hr 1100 hr + 9 hr = 2000 hr completion time 34. 1000 mL infusing at 100 mL per hr was started at 1400 hr.

Completion time: ANS:

2400

35. 480 mL is remaining in the IV. The current time is 1300 hr and the IV is infusing at 83 mL

per hr.

Completion time: ANS:

1848 hr Know Want to Know 83 mL : 1 hr = 480 mL : x hr 83x = 480 hr x = 5.78 = 5.8 hr (0.8 hr  60 min = 48 min) = 5 hr and 48 min 1300 hr + 5 hr 48 min = 1848 hr completion time 36. 500 mL is remaining in the IV. It is infusing at 42 mL per hr. The infusion was started at 1630

hr.

Completion time: ANS:

0354 hr Know Want to Know 42 mL : 1 hr = 500 mL : x hr 42x = 500 hr x = 11.9 hr (0.9 hr  60 min = 54 min) = 11 hr and 54 min 1630 hr + 11 hr 54 min = 0354 hr completion time 37. 1200 mL is infusing at 125 mL per hr. The infusion was started at 1700 hr.

Completion time:

ANS:

0236 hr

38. 800 mL is remaining in the IV. It is infusing at 100 mL per hr. The IV was started at 0900 hr.

Completion time: ANS:

1700 hr

39. 1500 mL is infusing at 150 mL per hr. The IV was started at 2030 hr.

Completion time: ANS:

0630 hr

40. 1000 mL is infusing at 83 mL per hr. The IV was started at 0600 hr.

Completion time: ANS:

1800 hr Know Want to Know 83 mL : 1 hr = 1000 mL : x hr 83x = 1000 x = 12.04 = 12 hr 0600 hr + 12 hr = 1800 hr completion time

41. Ordered: 200 mL in 45 min.

ANS:

267 mL per hr

Proof: 9  266.66 = 2399.9 40  60 = 2400 42. Ordered: 250 mL in 2 hr.

ANS:

250 mL per 2 hr = 125 mL per hr Proof: 2  125 = 250 43. Ordered: 50 mL in 30 min.

ANS:

100 mL per hr

Proof: 3  100 = 300 5  60 = 300 44. Ordered: 150 mL in 50 min.

ANS:

180 mL per hr

Proof: 3  60 = 180 1  180 = 180 45. Ordered: 300 mL in

hr.

ANS:

200 mL per hr

Proof: 3  200 = 600 10  60 = 600 46. Ordered: 500 mL in 3 hr.

ANS:

167 mL per hr Know Want to Know 500 mL : 3 hr = x mL : 1 hr 3x = 500  1 = 500 x = 166.6 = 167 mL per hr Proof: 500  1 = 500 3  166.6 = 499.9 47. Ordered: 300 mL in 45 min.

ANS:

400 mL per hr

Proof: 9  400 = 3600 60  60 = 3600 48. Ordered: 50 mL in 45 min.

ANS:

67 mL per hr

Proof: 10  60 = 600 9  66.6 = 599.4 49. Ordered: 150 mL in 30 min.

ANS:

300 mL per hr

Proof: 5  60 = 300 1  300 = 300 50. Ordered: 200 mL in 50 min.

ANS:

240 mL per hr

Proof: 4  60 = 240 1  240 = 240

Chapter 08: Advanced Intravenous Calculations Brown and Mulholland’s Drug Calculations: Ratio and Proportion Problems for Clinical Practice 12th Edition, Ann Tritak-Elmiger ESSAY

Directions: Change the dose ordered per min to dose per hr in the metric terms requested. Use a calculator for long division and multiplication. Verify your entries and answers by entering the data twice.

1. Drug per kg per min: 2 mcg kg per min.

Weight: 5.4 kg. a. mcg per hr: b. mg per hr (to nearest tenth of an mg): ANS:

a. 648 b. 0.7 2. Drug per kg per min: 5 mcg per kg per min.

Weight: 30 kg. a. mcg per hr: b. mg per hr (to nearest tenth of an mg): ANS:

a. 9000 b. 9 3. Drug per kg per min: 6 mcg per kg per min.

Weight: 55 kg. a. mcg per hr: b. mg per hr (to nearest tenth of an mg): ANS:

a. 19,800 b. 19.8 4. Drug per kg per min: 10 mcg per kg per min.

Weight: 75 kg. a. mcg per hr: b. mg per hr (to nearest tenth of an mg): ANS:

a. 45,000 b. 45 5. Drug per kg per min: 15 mcg per kg per min.

Weight: 100 kg. a. mcg per hr:

b. mg per hr (to nearest tenth of an mg): ANS:

a. 90,000 b. 90 Directions: Calculate the hourly intravenous (IV) flow rates.

6. Total drug: 100 mg.

Total volume: 10 mL. Hourly drug ordered: 4 mg.

What is the hourly volume (mL per hr to nearest tenth of an mL)?

ANS:

4 mL per hr 1:1=4:x 7. Total drug: 250 mg.

Total volume: 1000 mL. Hourly drug ordered: 6 mg.

What is the hourly volume (mL per hr to nearest tenth of an mL)?

ANS:

24 mL per hr 1:4=6:x 8. Total drug: 1 g.

Total volume: 500 mL. Hourly drug ordered: 15 mg.

What is the hourly volume (mL per hr to nearest tenth of an mL)?

ANS:

7.5 mL per hr 2 : 1 = 15 : x 9. Total drug: 400 mg.

Total volume: 250 mL. Hourly drug ordered: 5 mg.

What is the hourly volume (mL per hr to nearest tenth of an mL)?

ANS:

3.1 mL per hr 8:5=5:x 10. Total drug: 500 mg.

Total volume: 250 mL. Hourly drug ordered: 10 mg.

What is the hourly volume (mL per hr to nearest tenth of an mL)?

ANS:

5 mL per hr

2 : 1 = 10 : x 11. The IV for a patient in critical care is flowing at 12 mL per hr.

Ordered: 0.2 mg per min.

IV: 0.2 mg per min. a. How many mg per hr are ordered? b. What is the total drug : total mL ratio? c. Is the flow rate correct? If not, what should it be? d. What is the appropriate nursing action, if any?

ANS:

a. 12 mg per hr (0.2 mg  60 min) b. 1 : 2 ratio (500 mg : 1000 mL) c. Flow rate is incorrect. It should be 24 mL per hr. (1 mg : 2 mL = 12 mg : x mL) d. Assess patient condition. Obtain an order to adjust the flow rate. Report and document the finding and the changed order.

12. You check your patient’s IV flow rate in ICU on a pump. It is 7.2 mL per hr.

Ordered: 30 mcg per min.

IV: 250 mg in 1000 mL of solution. a. How many mg per hr are ordered? b. What is the total drug : total mL ratio? c. Is the flow rate correct? If not, what should it be? d. What is the appropriate nursing action, if any?

ANS:

a. 1.8 mg per hr (30  60  1000) b. 1 : 4 ratio (250 : 1000) c. Yes, the flow rate is correct. (1 mg : 4 mL = 1.8 mg : x mL) d. N/A 13. The patient’s IV is flowing at 10 mL per hr.

Ordered: 2 mg per hr.

IV: 100 mg in 500 mL of solution. a. What is the total drug : total mL ratio? b. How many mg per hr is the patient receiving? c. Is the patient receiving the correct amount of medication? d. What is the appropriate nursing action, if any?

ANS:

a. 1 : 5 ratio (100 mg : 500 mL) b. 2 mg per hr (1 mg : 5 mL = x mg : 10 mL) c. Yes, the patient is receiving the correct amount of medication. d. N/A 14. The patient’s IV is ordered for 150 mcg per min

Available: 400 mg in 250 mL. a. What is the total drug : total mL ratio? b. How many mcg per hr should the patient receive? c. How many mg per hr should the patient receive?

d. How many mL per hr should the patient receive to the nearest tenth of an mL? ANS:

a. 8 : 5 ratio (400 : 250 = 8 : 5) b. 9000 mcg per hr (150 mcg  60 min) c. 9 mg per hr (9000 mcg  1000) d. 5.6 mL per hr (8 mg : 5 mL = 9 mg : x mL) 15. Ordered: An IV of 2 mcg per kg per min.

Available: The pharmacy-prepared IV contains 100 mg in 250 mL. Patient weight: 50 kg. a. What is the total drug : total mL ratio? b. How many mcg per hr are ordered? c. How many mg per hr are ordered? d. How many mL per hr are needed to the nearest tenth of an mL? ANS:

a. 1 : 2.5 (100 mg : 250 mL) b. 6000 mcg per hr (2 mcg  50 kg  60 min) c. 6 mg per hr (6000 mcg  1000) (conversion : 1000 mcg = 1 mg) d. 15 mL per hr (1 mg : 2.5 mL = 6 mg : x mL) 16. Ordered: Sodium nitroprusside IV 0.5 mcg per kg per min to maintain blood pressure.

Patient weight: 80 kg.

Available: Sodium nitroprusside 25 mg in 250 mL D5W. a. What is the total drug : total mL ratio? b. How many mcg per hr are ordered? c. How many mg per hr are ordered? d. How many mL per hr are needed to the nearest tenth of an mL? ANS:

a. 1:10 (25 mg : 250 mL) b. 2400 mcg per hr (0.5 mcg  80 kg  60 min) c. 2.4 mg per hr (2400  1000) (conversion : 1000 mcg = 1 mg) d. 24 mL per hr (1 mg : 10 mL = 2.4 mg : x mL) 17. Ordered: Nicardipine hydrochloride IV 1.2 mg per hr for a patient with hypertension.

IV solution at bedside: 25 mg nicardipine in 500 mL of normal saline (NS) infusing at 24 mL per hr. a. What is the total drug : total mL ratio? b. What is the mL per hr ordered flow rate for this solution? c. Is the solution infusing at the correct flow rate? d. If not, what action should the nurse take?

ANS:

a. 1 : 20 (25 mg : 500 mL) b. 24 mL per hr ordered (1 mg : 20 mL = 1.2 mg : x mL) c. The infusion rate is correct. d. N/A

18. Ordered: Isoproterenol (Isuprel) IV infusion 120 mcg per hr for a patient with coronary

artery disease.

IV solution at bedside: Isuprel 1 mg in 500 mL of D5W infusing at 50 mL per hr. a. What is the total drug : total mL ratio? b. How many mg per hr are ordered? c. How many mL per hr are ordered? d. Is the solution infusing at the correct flow rate? e. If not, what action should the nurse take?

ANS:

a. 1 : 500 (1 mg : 500 mL) b. 0.12 mg per hr (120 mcg  1000) (conversion : 1000 mcg = 1 mg) c. 60 mL per hr (1 mg : 500 mL = 0.12 mg : x mL) d. No, the flow rate is incorrect. e. Assess the blood pressure and heart rhythm are rate, and contact the prescriber for flow rate adjustment instructions.

19. Ordered: Granisetron hydrochloride injection (Kytril) 10 mcg per kg IV injection 30 min

before chemotherapy to reduce nausea and vomiting.

Available: Kytril vial IV 0.1 mg per mL. Patient weight: 60 kg.

Dilution: May be given undiluted as an injection into a port over 30 seconds.

The nurse adds 2.4 mL of sterile NS for injection to the medication for ease of timing the injection rate into the injection port. a. What is the total dose of drug in mg to be given? b. What is the total volume of drug for injection? c. How many total seconds per calibration?

ANS:

a. 0.6 mg (10 mcg  60 kg = 600 mcg  1000) (conversion factor 1000 mcg = 1 mg) b. 6 mL (0.1 mg : 1 mL = 0.6 mg : x mL) c. 1 second per calibration (30 calibrations : 30 seconds = 1 calibration : 1 second) 20. Ordered: Diltiazem hydrochloride 5 mg per hr IV infusion for a patient with an arrhythmia.

Available from pharmacy: Diltiazem 200 mg in 250 mL NS. a. What is the total drug : total volume ratio in solution? b. What is the flow rate for this order to nearest tenth of an mL? c. How many mg per mL are in the final concentration?

ANS:

a. 4 : 5 (200 mg : 250 mL) b. 6.25 (rounded to 6.3 mL per hr) (4 mg : 5 mL = 5 mg : x mL) 4x = 25 x = 6.25 (rounded to 6.3 mL per hr) c. 0.8 mg per mL in solution final concentration

(4 mg : 5 mL :: x mg : 1 mL) Directions: Solve the following problems using a calculator, moving decimals, reducing drug : total volume ratios, and labeling your answers.

21. Ordered: Morphine sulfate 10 mg direct IV for severe pain.

Literature recommendation: Dilute to 5 mL with sterile water for injection or sterile saline for injection and infuse over 4 min.

a. How many mL of the drug will be withdrawn from the vial (to the nearest tenth)? b. How many mL will be in the syringe after dilution? Indicate the dose on the syringe. c. How many mL per min will be injected? d. How many total seconds will the injection take? e. How many seconds per calibration?

ANS:

a. 0.7 mL b. 5 mL (0.7 mL plus 4.3 mL of diluent)

c. 5 mL : 4 min = x mL : 1 min 4x = 5 x = 1.25 mL, or 1.3 mL Proof: 4  1.25 = 5 51=5 d. 4 min  60 = 240 seconds e.

, or approximately 10 seconds per calibration

22. Ordered: Cardizem 20 mg IV for a rapid ventricular rate.

Available: Cardizem 5 mg per mL after reconstitution.

Literature recommendation: Give each single dose over 2 min.

a. What is the total mL to be injected? b. What is the total mL per min to be injected?

ANS:

a. 5 mg : 1 mL = 20 mg : x mL 5x = 20 x = 4 mL Proof: 5  4 = 20 1  20 = 20 b. 4 mL : 2 min = x mL : 1 min 2x = 4 x = 2 mL per min Proof: 4  1 = 4 22=4 23. If a patient is receiving 1.5 mg per hr of a drug in an IV, how many mcg per min are being

infused?

ANS:

Conversion factors: 1000 mcg = 1 mg 60 min = 1 hr 24. For an IV solution of Drug Y, 250 mg in 1000 mL, the hourly ordered drug is 10 mg. How

many mL per hr will the rate be on the infusion pump?

ANS:

TD TV HD HV 250 mg : 1000 mL = 10 mg : x mL 1 : 4 = 10 : x x = 4  10 = 40 mL per hr ordered (can be seen at a glance once the correct reduced ratio and proportion are set up) Proof: 1  40 = 40 4  10 = 40 25. How many mg per mL are contained in this bag of IV solution?

ANS:

TD TV HD HV 500 mg : 1000 mL = x mg : 1 mL 1:2=x:1 2x = 1 x = 0.5 mg per mL (can be seen at a glance once the correct reduced TD : TV ratio is set up) 26. Ordered: Aminophylline 10 mg per hr for a patient with asthma.

Available: Aminophylline 250 mg in 1000 mL D5W infusing at 30 mL per hr on an infusion pump. a. What is the ordered mL per hr flow rate? b. Is the current flow rate correct? If not, what action should the nurse take?

ANS:

a. 40 mL per hr ordered TD TV HD HV 250 mg : 1000 mL = 10 mg : x mL 1 : 4 = 10 : x x = 4  10 = 40 (can be seen at a glance once the correct reduced ratio of total drug : total volume) Proof: 1  40 = 40 4  10 = 40 b. The Current flow rate is incorrect. Assess patient and contact physician for orders to adjust IV document.

27. Ordered: Magnesium sulfate 1 g per hr for maintenance IV for a patient with preeclampsia.

Available: Magnesium sulfate 40 g per 250 mL D5W. What flow rate you will set (in mL per hr rounded to nearest tenth of an mL) on the infusion pump?

ANS:

TD

TV

HD

HV

40 mg : 250 mL = 1 g : x mL 4 : 25 = 1 : x 4x = 25 x = 6.25 mL (rounded to 6.3 mL per hr) Proof: 40  6.25 = 250 1  250 = 250 28. Ordered: Nitroprusside sodium at 0.4 mcg per kg per min for a patient with severe

hypertension. Patient weight is 198 lb.

Available: Nitroprusside sodium 50 mg in 250 mL D5W. a. What is the patient’s weight in kg? b. What is the hourly drug ordered in mg (to the nearest tenth of an mg)? c. What is the flow rate to be set on the infusion pump?

ANS:

a. 198  2.2 = 90 kg b. 0.4  90  60 = 2160 mcg per hr, or 2.16 mg per hr, rounded to 2.2 mg per hr c. 50 mg : 250 mL = TD/TV ratio of 1 : 5 TD TV HD HV 1 mg : 5 mL = 2.2 g : x mL x = 11 mL per hr Proof: 1  11 = 11 5  2.2 = 11 29. Ordered: Dobutamine (Dobutrex) at 1 mcg per kg per min to be infused. Patient weight is 70

kg. The Dobutrex has been placed in 1 L of D5W. What flow rate will you set (to nearest whole number)?

ANS:

1 mcg  70 kg  60 min = 4200 mcg per hr, or 4.2 mg per hr TD TV HD 250 mg : 1000 mL = 4.2 mg : x mL

HV

1 mg : 4 mL = 4.2 mg : x mL x = 4  4.2 = 16.8 rounded to 17 mL per hr Proof: 1  16.8 = 16.8 4  4.2 = 16.8 30. Ordered: Dopamine IV at 4 mcg per kg per min.

Safe dose range (SDR): 2–10 mcg per kg per min. IV is flowing at 10 mL per hr.

Patient weight: 60 kg. a. Is the order within SDR? b. What is the total mg per min ordered? c. What is the total mg per hr ordered (to the nearest tenth of an mg)? d. How many total mL per hr are ordered? e. Is the current IV flow rate correct? If not, what nursing actions are necessary?

ANS:

a. Order of 4 mcg per kg per min is within SDR of 2–10 mcg per kg per min b. 4 mcg  60 kg = 240 mcg per min, or 0.24 mg per min c. 0.24 mg per min  60 min = 14.4 mg per hr d. 18 mL per hr TD TV HD HV 200 mg : 250 mL = 14.4 mg : x mL/hr 4 : 5 = 14.4 : x 4x = 5  14.4, or 18 mL per hr (4 mg for every 5 mL) Proof: 4  18 = 72 5  14.4 = 72

e. No. Rate is too low. Assess patient. Contact the physician for the protocol for increasing the flow rate. This is a very powerful medication, and abrupt changes of flow rate and drug delivery can produce undesirable side effects.

Chapter 09: Insulin Administration and Type 2 Diabetes Medications Brown and Mulholland’s Drug Calculations: Ratio and Proportion Problems for Clinical Practice 12th Edition, Ann Tritak-Elmiger COMPLETION 1. Units measured:

ANS: 32 2. Units measured:

ANS: 18 3. Units measured:

ANS: 23 4. Units measured:

ANS: 16 5. Units measured:

ANS: 27 ESSAY

Directions: Answer the following questions.

1. The patient’s blood sugar is 210 mg per dL. According to the sliding scale below, how many

units of insulin will the patient receive?

ANS:

Give 17 units of insulin based on the sliding scale 2. Ordered: 1000 mL of 0.9% sodium chloride with 100 units Humulin regular (R) insulin to

infuse at 12 units per hr until the blood sugar level is stabilized at 150 mg per dL. At how many mL per hr will you set the infusion device?

ANS:

120 mL per hr Have Want to Have 100 units : 1000 mL = 12 units : x mL 100x = 1000  12 = 12,000 x = 120 mL per hr Proof: 12  1000 = 12,000 100  120 = 12,000 3. Ordered: 50 units Humulin R insulin in 250 mL of 0.45% sodium chloride to infuse at 5 units

per hr. a. How many hr will it take to infuse? b. How many mL per hr will be infused?

ANS:

a. 10 mL per hr

Have Want to Have 5 units : 1 hr = 50 units : x hr 5x = 50 x = 10 hr Proof: 1  50 = 50 5  10 = 50 b. 25 mL per hr Have Want to Have 250 mL : 10 hr = x mL : 1 hr 10x = 250 x = 25 mL per hr Proof: 250  1 = 250 10  25 = 250 4. Ordered: 40 units Humulin R insulin in 500 mL of 0.9% sodium chloride to infuse at 8 units

per hr. a. How many hr will the IV infuse? b. How many mL per hr will be infused?

ANS:

a. 5 mL per hr Have Want to Have 8 units : 1 hr = 40 units : x hr 8x = 40 x = 5 hr Proof: 1  40 = 40 8  5 = 40 b. 100 mL per hr Have Want to Have 500 mL : 5 hr = x mL : 1 hr 5x = 500 x = 100 mL per hr Proof: 1  500 = 500 5  100 = 500 5. Ordered: 500 mL of 0.9% sodium chloride with 75 units of Humulin R insulin to infuse at 6

units per hr. a. How many hr will the IV infuse? b. How many mL per hr will be infused?

ANS:

a. 12.5 mL per hr Have Want to Have 6 units : 1 hr = 75 units : x hr 6x = 75 x = 12.5 hr, or 12 hr and 30 min Proof: 1  75 = 75 6  12.5 = 75 b. 40 mL per hr Have Want to Have 500 mL : 12.5 hr = x mL : 1 hr 12.5x = 500 x = 40 mL per hr Proof: 1  500 = 500 12.5  40 = 500 6. Ordered: 40 units Humulin R insulin in 250 mL of normal saline (NS) to infuse for 12 hr.

a. How many units per hr will be infused? b. How many mL per hr will be infused?

ANS:

a. 3.3 mL per hr Have Want to Have 40 units : 12 hr = x units : 1 hr 12x = 40 x = 3.3 units per hr Proof: 1  40 = 40 12  3.3 = 39.6 = 40 b. 21 mL per hr Have Want to Have 40 units : 250 mL = 3.3 units : x mL 40x = 250  3.3 = 825 40x = 825 x = 20.6 = 21 mL per hr Proof: 40  20.6 = 824 250  3.3 = 825 OR

7. Ordered: 55 units Humulin R insulin in 500 mL of NS to infuse for 24 hr.

a. How many units per hr will be infused? b. How many mL per hr will be infused?

ANS:

a. 2.29 mL per hr Have Want to Have 55 units : 24 hr = x units : 1 hr 24x = 55 x = 2.29 units per hr Proof: 55  1 = 55 24  2.29 = 55 b. 21 mL per hr Have Want to Have 55 units : 500 mL = 2.29 units : x mL 55x = 1145 x = 20.8 = 21 mL per hr Proof: 55  20.8 = 1145 500  2.29 = 1145 8. Ordered: 45 units Humulin R insulin in 500 mL of NS to infuse in 24 hr.

How many units per hr will infuse?

ANS:

1.88 units per hr Have Want to Have 45 units : 24 hr = x units : 1 hr 24x = 45 x = 1.875, rounded to 1.88 units per hr Proof: 1  45 = 45 24  1.87 = 45 9. Ordered: 80 units Humulin R insulin in 1000 mL of 0.9% sodium chloride to infuse at 7 units

per hr.

At how many mL per hr will you set the electronic infusion device?

ANS:

88 mL per hr

Have Want to Have 1000 mL : 80 units = x mL : 7 units 80x = 7000 x = 87.5 = 88 mL per hr Proof: 7  1000 = 7000 80  87.5 = 7000 10. Ordered: 35 units Humulin R insulin in 250 mL of 0.45% of sodium chloride to infuse in 12

hr. a. How many units per hr will the patient receive? b. How many mL per hr will infuse via the electronic infusion device?

ANS:

a. 2.91 mL per hr Have Want to Have 35 units : 12 hr = x units : 1 hr 12x = 35 x = 2.91 units per hr Proof: 1  35 = 35 12  2.91 = 34.9 = 35 b. 21 mL per hr Have Want to Have 35 units : 250 mL = 2.91 units : x mL 35x = 250  2.91 = 727.5 35x = 727.5 x = 20.78 = 21 mL per hr Proof: 250  2.91 = 727.5 35  20.78 = 727.3 11. A blood glucose level (BGL) of 120 mg per dL is desired. The standing order for this patient

is: Give 1 unit of insulin for every 10 mg above 120 mg per dL. Give 1 unit of insulin for every 10 g carbohydrates (CHO) consumed.

Calculate the total number of units of insulin that will be required for a BGL reading of 140 mg per dL and 21 g CHO consumed. Round answers to the nearest whole number.

ANS:

4 units Step 1: The desired BGL is 120 mg per dL. The BGL is 140 mg per dL. The difference between 120 and 140 is 20. The order states to give 1 unit of insulin for every 10 mg above 120 mg.

R & P Method 10 mg : 1 unit = 20 mg : x units 10x = 20 x = 2 units of insulin needed

Easy Method 20  10 = 2 units

Step 2: The total CHO consumed is 21 g. The order is to give 1 unit of insulin for every 10 g of CHO consumed.

R & P Method 1 unit : 10 g = x unit : 21 g 10x = 21 x = 2.1 = 2 units of insulin needed

Easy Method 20  10 = 2.1 = 2 units

The total number of insulin needed is 4 units.

12. Ordered: 1 unit of insulin for every 10 mg above 125 mg per dL. The BGL level is 160 mg

per dL. How many units of insulin are required?

ANS:

4 units The difference between 125 mg and 160 mg is 35 mg.

R & P Method 1 unit : 10 mg = x units : 35 mg 10x = 35 x = 3.5 = 4 units required

Easy Method 35  10 = 3.5 = 4 units

Directions: For the following problems, refer to Table 10-2.

Table 10-2 Insulin Units Required Based on CHO Intake and Weight Weight in lb Weight in Kg Unit: grams of CHO 100–109 45.5–49.5 1:16 110–129 50–58.6 1:15 130–139 59–63.2 1:14 140–149 63.6–67.7 1:13 150–159 68.2–72.3 1:12 160–169 72.7–76.8 1:11 170–179 77.3–81.4 1:10 180–189 81.8–85.9 1:9 190–198 86.4–90 1:8 200–239 90.9–108.6 1:7 240+ 109.1+ 1:6 13. The patient weighs 194 lb and has consumed 35 g CHO. How many units of insulin will be

required?

ANS:

4 units R & P Method 1 unit : 8 g CHO = x units : 35 g CHO 8x = 35 x = 4.37 = 4 units or insulin required

Easy Method 35  8 = 4.37 = 4 units

14. The patient weighs 215 lb. She ate 32 g CHO for breakfast, 20 g CHO for lunch, 42 g CHO

for dinner, and 10 g CHO for a bedtime snack.

How many total units of insulin did she require for the entire day?

ANS:

15 units Total CHO = 32 + 20 + 42 + 10 = 104 g CHO R & P Method Easy Method 1 unit : 7 g CHO = x units : 104 g CHO 104  7 = 14.85 = 15 units 7x = 104 x = 14.85 = 15 units or insulin required for the day 15. The patient weighs 75 kg and has consumed 20 g CHO for breakfast, 10 g CHO for lunch, and

20 g CHO for dinner. Based on this, how many total units of insulin were required for the day?

ANS:

15 units Total CHO = 20 + 10 + 20 = 50 g CHO total for the day R & P Method 1 unit : 11 g CHO = x units : 50 g CHO 11x = 50 x = 4.5 = 5 units or insulin required for the day

Easy Method 50  11 = 4.5 = 5 units

16. Hypoglycemia is characterized by a glucose blood level below what level?

ANS:

70 mg per dL 17. When hypoglycemia is identified on a conscious person, what can be given to increase the

blood sugar level?

ANS:

Orange juice or apple juice; the liquids will enter the bloodstream faster than a piece of candy.

18. What other medication in a multiple dose vial is commonly confused with insulin?

ANS:

Heparin 19. Insulin is a high-alert drug; therefore, what measures should be taken by the nurse to prevent

an incorrect dosage?

ANS:

Another nurse should check the amount in the syringe with the order before administering.

The verification of IV drips rates with insulin should also be performed with another nurse.

20. What is the only type of insulin that can be given intravenously?

ANS:

Regular insulin 21. Name some fast-acting insulins.

ANS:

Humalog (insulin lispro), Novolog (insulin aspart), Apidra (insulin glulisine).

22. Glucagon injection is used to treat what condition?

ANS:

Hypoglycemia, which occurs when a person is unconscious and has a blood sugar level below 70 mg per dL. 23. Insulin is manufactured by what body organ?

ANS:

The islets of Langerhans located in the pancreas.

24. Can Lantus (insulin glargine) be mixed with other insulins?

ANS:

No. It may result in a delayed onset of action.

25. Name an incretin mimetic.

ANS:

Byetta 26. When mixing regular and intermediate insulins, which one should be drawn up first?

ANS:

Regular insulin 27. When mixing regular and intermediate insulin, which one should have the measured amount

of air injected into the vial first?

ANS:

Intermediate acting without letting the needle touch the insulin.

Directions: Calculate insulin requirements based on the following orders: Order: Give 1 unit of insulin for every 15 mg the BGL is above 170 mg per dL. Give 1 unit of insulin for every 10 g of CHO consumed.

28. The BGL is 200 mg per dL, and 110 g CHO have been consumed.

How many total units of insulin are required?

ANS:

29. The BGL is 200 mg per dL, and 150 g CHO has been consumed.

ANS:

18 units Step 1: 220 mg  170 mg = 50 mg above 170 mg per dL Know Want to know 1 unit : 15 mg = x units : 50 mg 15x = 50 x = 3.33 = 3 units of insulin for a BGL 50 mg per dL above 170 mg per dL

Proof: 1          

Easy Method: 50  15 = 3.3 = 3 units Step 2: Know Want to know 1 unit : 10 g CHO  x units : 15 g CHO 1x = 15 units Proof: 1    



Easy Method: 150  10 = 15 units Give 3 units + 15 units = 18 units total 30. The BGL is 160 mg per dL, and 40 g CHO has been consumed.

ANS:

4 units Step 1: The BGL of 160 mg per dL is below the ordered amount, so no insulin is required Step 2: Know Want to Know 1 unit : 10 mg CHO = x units : 40 mg CHO x = 4 units Proof: 1          

asy Method: 40  10 units = 4 units 31. The BGL is 280 mg per dL, and 210 g CHO has been consumed.

ANS:

28 units Step 1: 280 mg 170 mg = 110 mg per dL above the desired BGL Know

Want to Know

1 unit : mg = x units : 3x = 22 x = 7.33 = 7 units Proof: 1         

mg

Easy Method: 110  15 = 7.3 units Step 2: Know Want to Know 1 unit : 1 g CHO = x unit : 21 x = 21 units

g CHO

Proof: 1     Easy Method: 210  10 = 21 units Give 7 units + 21 units = 28 units total insulin 32. The BGL is 180 mg per dL, and 160 g CHO has been consumed.

ANS:

17 units Step 1: 180 mg  170 = 10 mg per dL above the desired BGL Know

Want to Know

1 Unit : mg = x units : 3x = 2 x = 0.667 = 1 unit Proof: 1         

mg

 Step 2: Know Want to Know 1 unit : g CHO = x units : 16 x = 16 units

g CHO

Proof: 1  16 = 16 Easy Method:

  units

Give 1 unit + 16 units = 17 units total Directions: Mark the syringe with the amount of insulin ordered.

33. Ordered: 68 units.

ANS:

34. Ordered: 44 units.

ANS:

35. Ordered: 39 units.

ANS:

36. Ordered: 42 units.

ANS:

37. Ordered: 78 units.

ANS:

Directions: Mark the syringe with the ordered amount of regular and intermediate-acting insulin.

38. Ordered: 7 units of Humalog R and 25 units of Humulin N.

ANS:

39. Ordered: 6 units of Humalog R and 16 units of Humulin N.

ANS:

40. Ordered: 10 units of Humalog R and 12 units of Humulin N.

ANS:

41. Ordered: 8 units of Humalog and 16 units of Humulin N.

ANS:

42. Ordered: 4 units of Humalog R and 8 units of Humulin N.

ANS:

43. Ordered: 12 units of Novolog and 22 units of Novolin N.

ANS:

44. Ordered: 6 units of Novolog and 18 units of Novolin N.

ANS:

45. Ordered: 14 units of Novolog 22 units and of Novolin N.

ANS:

Chapter 10: Parenteral Nutrition Brown and Mulholland’s Drug Calculations: Ratio and Proportion Problems for Clinical Practice 12th Edition, Ann Tritak-Elmiger TRUE/FALSE 1. TPN formulas are determined by energy, fluid, and calorie needs.

ANS: T

The activity level will determine the caloric requirements, and the renal and cardiac status will determine the fluid level to be delivered.

2. Patients with renal impairment cannot receive TPN. ANS: F

Special formulas can be prepared for patients with diabetes and renal and hepatic impairments.

3. PPN concentrations are limited to 8.5-1.5% amino acids, 20–70% dextrose, and 20% lipids.

ANS: F

The values listed are for central parenteral nutrition (CPN). The veins are larger in the central system and can tolerate increased concentrations.

4. Lipids administered with parenteral nutrition improve venous tolerance.

ANS: T

The lipids increase the osmolarity of the solution, which makes the solution less of an irritant to the vein.

5. Medications can be given using the port on the TPN tubing during the TPN administration.

ANS: F

Always consult a pharmacist if asked to deliver a medication along with the TPN solution to determine compatibility.

6. PPN is used for therapy longer than 2 weeks ANS: F

PPN is only used for nutritional support that has less than a 2-week duration.

7. TPN solutions can be run for 24–30 hr.

ANS: F

TPN solutions should only be run for 12–15 hr as the solution may begin to deteriorate. Also a shorter period of administration in the home setting will allow more free time.

8. A three-in-one solution consists of amino acids, insulin, and lipids.

ANS: F

A three-in-one solution has amino acids, dextrose, and lipids.

9. The administration of insulin with a TPN solution helps to control hyperglycemia.

ANS: T

Hyperglycemia is a complication of high concentrations of dextrose in the TPN solution.

10. Lipids can be administered via both PPN and CPN. ANS: T

Lipids are isotonic and can be administered peripherally or centrally.

ESSAY

Directions: Calculate and solve the following problems.

1. Ordered: Central peripheral nutrition (CPN) formula with:

Amino acids 8.5% in 400 mL Dextrose 50% in 355 mL Lipids 20% in 120 mL The total volume (TV) is 1250 mL. a. Calculate the g per L for amino acids. b. Calculate the g per bag for amino acids.

ANS:

a. 0.085  400 = 34 g per L b. 34 g  1.25 TV per L = 42.5 g per bag of amino acids 2. Ordered: CPN formula with:

Amino acids 8.5% in 400 mL Dextrose 50% in 355 mL Lipids 20% in 120 mL The TV is 1250 mL. a. Calculate the g per L for dextrose. b. Calculate the g per bag for dextrose.

ANS:

a. 0.50  355 = 177.5 g per L b. 177.5 g  1.25 TV per L = 221.9 g per bag of dextrose 3. Ordered: CPN formula with:

Amino acids 8.5% in 400 mL Dextrose 50% in 355 mL Lipids 20% in 120 mL The TV is 1250 mL. a. Calculate the g per L for lipids. b. Calculate the g per bag for lipids.

ANS:

a. 0.20  120 = 25 g per L of lipids

b. 24 g  1.25 TV per L = 30 g per bag of lipids Directions: Calculate and solve the following problems.

4. The total parenteral nutrition (TPN) order has calcium gluconate 10 mEq per L as an additive.

The TV is 1400 mL. How many mEq per bag of calcium gluconate will the patient receive?

ANS:

10 mEq per L  1.4 L = 14 mEq per bag 5. The TPN order has magnesium sulfate 8 mEq per L. The TV is 1235 mL. How many mEq per

bag of magnesium sulfate will the patient receive?

ANS:

8 mEq per L  1.235 L = 9.88 mEq per bag 6. The peripheral parenteral nutrition (PPN) order is for sodium chloride 25 mEq per L. The TV

is 1330 mL. How many mEq per bag of sodium chloride will the patient receive?

ANS:

25 mEq per L  1.33 L = 33.25 mEq per bag 7. There are 280.4 g of carbohydrates (CHO) in the parenteral nutrition bag. How many

kilocalories of CHO will the patient receive?

ANS:

280.4 g  4 kcal = 1121.6 kcal of CHO 8. There are 60 g of protein (PRO) in the parenteral nutrition bag. How many kilocalories of

PRO will the patient receive?

ANS:

60 g  4 kcal = 240 kcal PRO 9. The parenteral nutrition bag holds 1410 mL to infuse in 12 hr. At how many mL per hr will

you set the infusion device?

ANS:

118 mL per hr 1410 mL : 12 hr :: x mL : 1hr 12x = 1410 x = 117.5 = 118 mL per hr Proof: 1  1410 = 1410 12  117.5 = 1410 10. The PPN is infusing at 110 mL per hr. The TV is 1250 mL. The bag was hung at 2000 hr. At

what time is it scheduled to be completed?

ANS:

0722 hr 1250 mL : x hr :: 110 mL : 1 hr 110x = 1250 x = 11.36 = 11 hr, 22 min The PPN will be completed at 0722 hr.

Proof: 1  1250 = 1250 11.36  110 = 1250

Chapter 11: Anticoagulants Brown and Mulholland’s Drug Calculations: Ratio and Proportion Problems for Clinical Practice 12th Edition, Ann Tritak-Elmiger ESSAY

Directions: Answer the following questions.

1. Ordered: 8500 units heparin subcutaneous q8h.

Available: 10,000 units per mL in a multidose vial.

How many mL will you give?

ANS:

0.85 mL Have

Want to Have

100x = 85 x = 0.85 mL Proof: 1  8500 = 8500 10,000  0.85 = 8500 2. Ordered: Lovenox 30 mg subcutaneous q12h.

Available: Lovenox 40 mg per 0.4 mL. How many mL will you give?

ANS:

0.3 mL Have Want to Have 40 mg : 0.4 mL = 30 mg : x mL 40x = 0.4  30 = 12 40x = 12 x = 0.3 mL Proof: 0.4  30 = 12 40  0.3 = 12 3. Ordered: Fragmin 120 international units per kg subcutaneous q12h. The patient weighs 151

lb According to the protocol, patients who weigh between 60 and 69 kg should receive 9000 international units of Fragmin q12h.

Available: 10,000 international units per mL. a. How many kg does the patient weigh? b. How many mL will you give?

ANS:

a. 69 kg

Have Want to Have 1 kg : 2.2 lb = x kg : 151 lb 2.2x = 151 x = 68.63 = 69 kg Proof: 1  151 = 151 68.63  2.2 = 151 b. 0.9 mL Have

Want to Have

10x = 9 x = 0.9 mL Proof: 1  9000 = 9000 10,000  0.9 = 9000 4. Ordered: Heparin 2000 units per hr intravenous (IV).

Available: 500 mL with 20,000 units heparin. a. How many hr will it take to infuse? b. How many mL per hr will infuse?

ANS:

a. 10 hr Have Want to Have 2000 units : 1 hr = 20,000 units : x hr 2x = 20 x = 10 hr Proof: 10  2000 = 20,000 1  20,000 = 20,000 b. 50 mL per hr Have Want to Have 500 mL : 10 hr = x mL : 1 hr x = 50 mL per hr Proof: 1  500 = 500 10  50 = 500 5. Ordered: Heparin 800 units per hr IV.

Available: 1000 mL with 5000 units of heparin. a. How many hr will it take to infuse? b. How many mL per hr will infuse?

ANS:

a. 6 hr 15 min Have Want to Have 800 units : 1 hr = 5000 units : x hr 8x = 50 x = 6.25 = 6 hr 15 min Proof: 1  5000 = 5000 800  6.25 = 5000 b. 160 mL per hr Have Want to Have 1000 mL : 6.25 hr = x mL : 1 hr 6.25x = 1000 x = 160 mL per hr Proof: 1  1000 = 1000 6.25  160 = 1000 6. Ordered: 30,000 units heparin IV in 250 mL to infuse at 20 units per kg per hr. The patient

weighs 185 lb. a. How many kg does the patient weigh? b. How many units per hr will the patient receive? c. How many mL per hr will infuse? d. How many hr will it take to infuse?

ANS:

a. 84 kg Have Want to Have 1 kg : 2.2 lb = x kg : 185 lb 2.2x = 185 x = 84 kg Proof: 1  185 = 185 2.2  84 = 185 b. 1680 units per hr Have Want to Have 20 units : 1 kg = x units : 84 kg x = 20  84 = 1680 x = 1680 units per hr Proof: 1  1680 = 1680 20  84 = 1680

c. 14 mL per hr Have Want to Have 30,000 units : 250 mL = 1680 : x mL 30,000x = 250  1680 = 420,000 3x = 42 x = 14 mL per hr Proof: 30,000  14 = 420,000 250  1680 = 420,000 d. 17 hr 51 min Have Want to Have 14 mL : 1 hr = 250 mL : x hr 14x = 250 x = 17.85 = 17 hr 51 min Proof: 1  250 = 250 14  17.85 = 250 7. Ordered: 40 units per kg heparin IV. The patient weighs 210 lb.

a. How many kg does the patient weigh? b. How many total units of heparin will the patient receive?

ANS:

a. 95 kg Have Want to Have 1 kg : 2.2 lb = x kg : 210 lb 2.2x = 210 x = 95.45 = 95 kg Proof: 1  210 = 210 2.2  95.45 = 210 b. 3800 total units Have Want to Have 40 units : 1 kg = x units : 95 kg x = 40  95 = 3800 x = 3800 total units Proof: 1  3800 = 3800 40  95 = 3800 8. Ordered: 2000 units per hr heparin.

Available: 1000 mL with 30,000 units heparin.

a. How many hr will it take the IV to infuse? b. At how many mL per hr will you set the electronic infusion device?

ANS:

a. 15 hr Have Want to Have 2000 units : 1 hr = 30,000 units : x hr 2x = 30 x = 15 hr Proof: 1  30,000 = 30,000 2000  15 = 30,000 b. 67 mL per hr Have Want to Have 30,000 units : 1000 mL = 2000 units : x mL 3x = 200 x = 66.6 = 67 mL per hr Proof: 66.6  30,000 = 2,000,000 1000  2000 = 2,000,000 9. Ordered: Heparin 8000 units subcutaneous q8h.

Available: Multidose vials of 5000, 10,000, and 20,000 units per mL. a. Which vial should you choose? b. How many mL should you give?

ANS:

a. 10,000 units per mL vial b. 0.8 mL Have Want to Have 10,000 units : 1 mL = 8000 units : x mL 10x = 8 x = 0.8 mL Proof: 1  8000 = 8000 0.8  10,000 = 8000 10. Ordered: 50 units per kg per hr heparin IV. The patient weighs 75 kg.

How many units per hr should the patient receive?

ANS:

3750 units per hr

Have Want to Have 50 units : 1 kg = x units : 75 kg x = 50  75 = 3750 x = 3750 units per hr Proof: 1  3750 = 3750 50  75 = 3750 11. How are low molecular anticoagulants (Lovenox and Fragmin) different from heparin?

ANS:

They have a longer half-life, which means they stay in the body longer than does heparin.

12. Anticoagulants would be prescribed for what conditions?

ANS:

Deep vein thrombosis, pulmonary embolism, after knee and hip surgery.

13. In what area of the body should Lovenox and Fragmin be given?

ANS:

They should be given in the “love handles.” Bilateral overhangs of antero-lateral flanks.

14. Why should the subcutaneous injection site of heparin, Lovenox, or Fragmin not be rubbed

after injection?

ANS:

Rubbing the injection site will increase bleeding and may result in the development of a hematoma.

15. Why are anticoagulants and insulin sometimes confused?

ANS:

They both are measured in units and have the same size multidose vials.

16. The subcutaneous dosage of heparin should not exceed how many mL? ANS:

1 mL 17. What medication should be available for patients who are on heparin therapy?

ANS:

Protamine sulfate, which is used to counteract the effects of heparin.

Directions: Answer the question and fill in the correct amount of heparin on the syringe.

18. Ordered: 12,000 units of heparin subcutaneous every 6 hr.

Available: Heparin 20,000 units per mL vial.

How many mL will you give?

ANS:

a. 0.6 mL Know

Want to Know

20x = 12 x = 0.6 mL Proof: 1  12 = 12 20  0.6 = 12

19. Ordered: 6000 units of heparin subcutaneous every 4 hr.

Available: Heparin sodium 5000 units per mL and 10,000 units per mL.

a. Which vial should you choose? b. How much heparin should you give?

ANS:

a. Use the 10,000 unit vial. If you use the 5000 unit vial, the dose would be more than the allowed 1 mL. b. 0.6 mL Know

Want to Know

10x = 6 x = 0.6 mL Proof: 1  6 = 6 10  0.6 = 6

20. Ordered: 15,000 units of heparin subcutaneous every 6 hr.

Available: Heparin sodium 20,000 units per mL.

How many mL will you give?

ANS:

0.75 mL Know

Want to Know

20x = 15 x = 0.75 mL Proof: 1  15 = 15 20  0.75 = 15

Directions: Calculate the hr needed to infuse the IV. 21. Ordered: 5000 units per hr.

Available: 500 mL D5W with 25,000 units heparin.

ANS:

5 hr

Know

Want to Know

5x = 1 25 = 25 x = 5 hr Proof: 5  15 = 25 1  25 = 25 22. Ordered: 4000 units per hr.

Available: 250 mL D5W with 25,000 units heparin.

ANS:

6 hr and 15 min Know

Want to Know

4x = 25 x = 6.25 hr (0.25  60 = 15) = 6 hr 15 min to infuse Proof: 1  25 = 25 4  6.25 = 25 23. Ordered: 1000 units heparin per hr.

Available: 1000 mL with 25,000 units of heparin.

ANS:

25 hr Know

Want to Know

x = 25 hr to infuse Proof: 1  25 = 25 25  1 = 25 24. Ordered: Heparin 800 units per hr.

Available: 1000 mL D5W with 10,000 units of heparin.

ANS:

12 hr and 30 min Know

Want to Know

8x = 1  10 = 10 8x = 10 x = 12.5 hr (0.5  60 = 30) = 12 hr 30 min to infuse Proof: 1  100 = 100 8  12.5 = 100

25. Ordered: Heparin 1500 units per hr.

Available: 500 mL in D5W with 25,000 units of heparin.

ANS:

16 hr and 36 min Know

Want to Know

15x = 1  250 = 250 x = 16.6 hr (0.6  60 = 36) = 16 hr 36 min to infuse Proof: 1  250 = 250 15  16.6 = 249 26. Ordered: Heparin 800 units per hr.

Available: 250 mL D5W with 15,000 units of heparin.

ANS:

18 hr and 45 min Know

Want to Know

8x = 150 x = 18.75 hr (0.75  60 = 45) = 18 hr 45 min to infuse Proof: 1  150 = 150 8  18.75 = 150 27. Ordered: Heparin 1200 units per hr.

Available: 1000 mL of D5W with 25,000 units of heparin.

ANS:

20 hr and 48 min Know

Want to Know

12x = 250 x = 20.8 hr (0.8  60 = 48) = 20 hr 48 min to infuse Proof: 1  250 = 250 12  20.8 = 249.6 28. Ordered: 3000 units of heparin per hr.

Available: 1000 mL D5W with 25,000 units of heparin.

ANS:

8 hr and 20 min

Know

Want to Know

3x = 25 x = 8.33 hr (0.33  60 = 19.8 = 20) = 8 hr 20 min to infuse Proof: 1  25 = 25 3  8.33 = 24.99 29. Ordered: 2500 units of heparin per hr.

Available: 500 mL D5W with 20,000 units of heparin.

ANS:

8 hr Know

Want to Know

25x = 200 x = 8 hr to infuse Proof: 1  200 = 200 25  8 = 200 30. Ordered: Infuse 6000 units of heparin per hr.

Available: 25,000 units of heparin in 1000 mL D5W. ANS:

4 hr and 12 min Know

Want to Know

6x = 25 x = 4.167 = 4.2 hr (0.2  60 = 12) = 4 hr 12 min Proof: 1  25 = 25 4.16  6 = 24.96 Directions: Calculate units per hr.

31. Ordered: Infuse 250 mL with 25,000 units of heparin at 25 mL per hr.

ANS:

2500 units per hr Know x = 25  100 = 2500 x = 2500 units per hr

Want to Know

Proof: 1  2500 = 2500 25  100 = 2500

32. Ordered: 500 mL with 10,000 units of heparin to infuse at 100 mL per hr.

ANS:

2000 units per hr Know

Want to Know

x = 20  100 = 2000 x = 2000 units per hr Proof: 1  2000 = 2000 20  100 = 2000

33. Ordered: 1000 mL with 25,000 units of heparin to run at 120 mL per hr.

ANS:

3000 units per hr Know

Want to Know

x = 25  120 = 3000 x = 3000 units per hr Proof: 1  3000 = 3000 25  120 = 3000

34. Ordered: 250 mL with 15,000 units of heparin to infuse at 50 mL per hr.

ANS:

3000 units per hr Know x = 60  50 = 3000 x = 3000 units per hr

Want to Know

Proof: 1  3000 = 3000 60  50 = 3000

35. Ordered: 500 mL with 25,000 units of heparin to infuse at 50 mL per hr.

ANS:

2500 units per hr Know

Want to Know

x = 50  50 = 2500 x = 2500 units per hr Proof: 1  2500 = 2500 50  50 = 2500

36. Ordered: 250 mL with 10,000 units of heparin to infuse at 100 mL per hr.

ANS:

4000 units per hr Know

Want to Know

x = 40  100 = 4000 x = 4000 units per hr Proof: 1  4000 = 4000 40  100 = 4000

37. Ordered: 500 mL with 15,000 units to infuse at 120 mL per hr.

ANS:

3600 units per hr Know x = 30  120 = 3600

Want to Know

x = 3600 units per hr Proof: 1  3600 = 3600 30  120 = 3600

38. Ordered: 1000 mL with 25,000 units to infuse at 100 mL per hr.

ANS:

2500 units per hr Know

Want to Know

x = 25  100 = 2500 x = 2500 units per hr Proof: 1  2500 = 2500 25  100 = 2500

39. Ordered: 500 mL with 20,000 units to infuse at 100 mL per hr.

ANS:

4000 units per hr Know

Want to Know

x = 40  100 = 4000 x = 4000 units per hr Proof: 1  4000 = 4000 40  100 = 4000

40. Ordered: 250 mL with 10,000 units to infuse at 60 mL per hr.

ANS:

2400 units per hr Know

Want to Know

x = 40  60 = 2400 x = 2400 units per hr Proof: 1  2400 = 2400 40  60 = 2400

Directions: Calculate units of heparin per kg of body weight.

41. Ordered: 20 units per kg. Patient weight is 90 kg.

How many units will the patient receive?

ANS:

1800 units Know Want to Know 20 units : 1 kg = x units : 90 kg x = 20  90 = 1800 x = 1800 units Proof: 1  1800 = 1800 20  90 = 1800 42. Ordered: 25 units per kg. Patient weight is 105 kg.

How many units will the patient receive?

ANS:

2625 units Know Want to Know 25 units : 1 kg = x units : 105 kg x = 25  105 = 2625 x = 2625 units Proof: 1  2625 = 2625 25  105 = 2625 43. Ordered: 40 units per kg. Patient weight is 250 lb.

How many units will the patient receive?

ANS:

4560 units 1 kg = 2.2 lb; therefore, 250  2.2 = 113.6 = 114 kg Know Want to Know 40 units : 1 kg = x units : 114 kg

x = 40  114 = 4560 units Proof: 1  4560 = 4560 40  114 = 4560 44. Ordered: 100 units per kg of heparin. Patient weight is 130 kg.

a. How many units of heparin will the patient receive?

ANS:

a. 13,000 units Know Want to Know 100 units : 1 kg = x units : 130 kg x = 100  130 = 13,000 x = 13,000 units Proof: 1  13,000 = 13,000 100  130 = 13,000 45. Ordered: 80 units per kg of heparin. Patient weight is 185 lb.

Available: 500 mL with 25,000 units of heparin. a. How many units of heparin will the patient receive? b. What rate will you set the electronic infusion device?

ANS:

a. 6720 units 185  2.2 = 84.09 = 84 kg Know Want to Know 80 units : 1 kg = x units : 84 kg x = 80  84 = 6720 x = 6720 units Proof: 1  6720 = 6720 80  84 = 6720 b. 134 mL per hr Know Want to Know 500 mL : 25,000 units = x mL : 6720 units 25000x = 6720  500 x = 134.4 = 134 mL per hr Proof: 1  6720 = 6720 50  134.4 = 6720 46.

Ordered: A loading dose of heparin to infuse at 75 units per kg. The patient weighs 120 kg.

Available: 500 mL D5W with 15,000 units of heparin. Titrate to infuse at 1000 units per hr.

a. Calculate the units needed for the loading dose. b. Calculate the mL per hr to set the electronic infusion device.

ANS:

a. 9000 units Know Want to Know 75 units : 1 kg = x units : 120 kg x = 75  120 = 9000 x = 9000 units for the loading dose Proof: 1  9000 = 9000 75  120 = 9000 b. 33 mL per hr Know

Want to Know

x = 33.3 = 33 mL per hr Proof: 33  30 = 999 47. The bolus dose of heparin is 60 units per kg. Patient weight is 185 lb.

What is the bolus dose?

ANS:

5040 units 185  2.2 = 84 kg Know Want to Know 60 units : 1 kg = x units : 84 kg x = 60  84 = 5040 x = 5040 units for the bolus dose Proof: 1  5040 = 5040 60  84 = 5040 48. Order: The loading dose of heparin is 80 units per kg. Patient weight is 120 kg. Follow the

loading dose with 500 mL D5W with 25,000 units of heparin. Titrate to infuse at 1200 units per hr. a. How many units is the loading dose? b. How many mL per hr will you set the electronic infusion device?

ANS:

a. 9600 units Know

Want to Know

80 units : 1 kg = x units : 120 kg x = 80  120 = 9600 x = 9600 units for the loading dose Proof: 1  9600 = 9600 80  120 = 9600 b. 24 mL per hr Know

Want to Know

50x = 1200 x = 24 mL per hr Proof: 1  1200 = 1200 50  24 = 1200 49. Ordered: Heparin 800 units per hr.

Available: 500 mL D5W with 25,000 units of heparin.

What rate will you set the electronic infusion device?

ANS:

16 mL per hr Know

Want to Know

50x = 1  800 = 800 x = 16 mL per hr Proof: 1  800 = 800 50  16 = 800 50. Ordered: 25,000 units of heparin in 250 mL D5W to infuse at 2000 units per hr.

What rate will you set the electronic infusion device?

ANS:

20 mL per hr Know Want to Know 250 mL : 25,000 units = x mL : 2000 units 25x = 250  2 = 500 x = 20 mL per hr Proof: 25  20 = 500 250  2 = 500

Chapter 12: Children’s Dosages Brown and Mulholland’s Drug Calculations: Ratio and Proportion Problems for Clinical Practice 12th Edition, Ann Tritak-Elmiger ESSAY

Directions: Fill in the desired dose to the nearest tenth of a unit. Use a calculator to solve these problems.

1. Order: 10 mg per kg.

Weight (BSA): 35 kg.

What is the dose in mg?

ANS:

350 mg 2. Order: 500 mg per m2.

Weight or BSA: 0.45 m2.

What is the dose in mg?

ANS:

225 mg 3. Order: 500 mcg per kg.

Weight or BSA: 11 lb.

What is the dose in mg?

ANS:

2.5 mg 4. Order: 0.25 g per kg.

Weight or BSA: 13.2 lb.

What is the dose in mg?

ANS:

1500 mg 5. Order: 20 mg per m2.

Weight or BSA: BSA 0.55 m2.

What is the dose in mg?

ANS:

11 mg Directions: Calculate the 24-hr dose in mg. Use a calculator to solve these problems.

6. Order: 0.25 g q8h.

What is the 24-hr dose in mg?

ANS:

750 mg 7. Order: 0.5 g q12h.

What is the 24-hr dose in mg?

ANS:

1000 mg 8. Order: 50 mcg q4h.

What is the 24-hr dose in mg?

ANS:

0.3 mg 9. Order: 0.1 g qid.

What is the 24-hr dose in mg?

ANS:

400 mg 10. Order: 400 mcg q6h.

What is the 24-hr dose in mg?

ANS:

1.6 mg Directions: Calculate the safe dosage ranges (SDR) and drug dose and indicate if it is safe to administer or if it should be held. (Hold = Recheck order, recalculate dose, and contact prescriber promptly if it is an underdose or overdose.) Use a calculator to solve these problems.

11. Order: 5 mg per kg stat.

Child’s weight: 10 kg.

SDR for this child’s weight: 60 mg maximum per dose.

Safe or hold?

ANS:

60 mg maximum per dose Safe 12. Order: 200 mg po daily.

Child’s weight: 15 kg.

SDR for this child’s weight: 5–10 mg per kg per dose.

Safe or hold?

ANS:

75–150 mg per dose Hold (overdose) 13. Order: 100 mg po daily.

Child’s weight: 20 kg.

SDR for this child’s weight: 2–5 mg per kg per day.

Safe or hold?

ANS:

40–100 mg per day Safe 14. Order: 50 mg po daily.

Child’s weight: 22 lb.

SDR for this child’s weight: 10–20 mg per kg per day.

Safe or hold?

ANS:

100–200 mg per day Hold (underdose) 15. Order: 15 mg po bid.

Child’s weight: 10 kg.

SDR for this child’s weight: 3 mg per kg per day in three divided doses.

Safe or hold?

ANS:

30 mg in three divided doses (10 mg per dose) Hold (insufficient frequency schedule; single dose overdoses) 16. Order: 1 mg po daily.

Child’s weight: 5 kg.

SDR for this child’s weight: 100–200 mcg per kg per day.

Safe or hold?

ANS:

0.5–1 mg per day (500–1000 mcg per day) Safe 17. Order: 0.25 g po qid.

Child’s weight: 20 kg.

SDR for this child’s weight: 25–50 mg per kg day in four divided doses.

Safe or hold?

ANS:

500–1000 mg per day in four divided doses (0.125–0.25 g 4 times per day) Safe 18. Order: 0.1 mg intravenously (IV) bid.

Child’s weight: 8 kg.

SDR for this child’s weight: 25 mcg per kg per day in two divided doses.

Safe or hold?

ANS:

0.1 mg (100 mcg) 2 times per day (200 mcg per day in two divided doses)

Safe 19. Order: 1 g po daily.

Child’s weight: 40 kg.

SDR for this child’s weight: 25–50 mg per kg per day.

Safe or hold?

ANS:

1–2 g per day (1000–2000 mg per day) Safe 20. Order: 2 mg IV daily in AM.

Child’s weight: 15 kg.

SDR for this child’s weight: 50–100 mcg per kg per dose per day.

Safe or hold?

ANS:

0.75–1 mg per dose (750–1000 mcg per dose) Hold (overdose) 21. A medicated IV of 100 mL of D5W q5h is ordered for a child. Pediatric policy states that a

buretrol must be used and that it may only contain a maximum of 1 hr’s worth of the ordered flow rate. a. How many mL will the nurse place in the buretrol? b. What is the purpose of the buretrol?

ANS:

a.

b. The purpose of the volume-control device is to prevent IV medication and fluid overloads by limiting the maximum amount that could potentially be erroneously delivered. Typically a drop factor of 60 is used.

22. An IV of 250 mL of lactated Ringer’s solution is ordered q24h for a child.

Pediatric policy states that a buretrol must be used and that it may only contain a maximum of 2 hr’s worth of the ordered flow rate.

How many mL will the nurse place in the buretrol to the nearest mL?

ANS:

23. Which of the following conversion formulas is correct for lb and kg?

a. 2.2 kg = 1 lb OR b. 2.2 lb = 1 kg ANS:

b 24. An infant weighs 5 lb 8 oz.

a. How many total lb does the child weigh to the nearest tenth of a lb? b. What is the infant’s estimated weight in kg? c. How many kg does the infant weigh to the nearest tenth of a kg?

ANS:

a.

b. Estimated weight in kg: approximately 2.5 kg (5.5  2) c.

2.5 kg 2.2 lb : 1 kg = 5.5 lb : x kg x = 2.5 kg 25. A child weighs 30 lb 4 oz.

a. How many total lb does the child weigh to the nearest tenth of a lb? b. What is the child’s estimated weight in kg? c. What is the child’s actual weight in kg?

ANS:

a.

b. Estimated weight in kg: 30  2 = 15 kg c. 13.6 kg 2.2 lb : 1 kg = 30.3 lb : x kg 2.2x = 30 x = 13.6 kg Directions: The approximate average U.S. normal newborn weight range is 2500-4000 g (5.5–8.8 lb). Weight below 2500 g is a low birth weight. Convert the following newborn g weights to kg and indicate the relationship to the average normal newborn weight (average, above average, or below average). Conversion formula: 1000 k = 1 kg. Use a calculator, and enter the data twice for verification.

26. 2630 g

.

ANS:

2.63 kg, average 27. 2500 g

.

ANS:

2.5 kg, average 28. 3730 g

.

ANS:

3.73 kg, average 29. 2250 g

.

ANS:

2.25 kg, below average (low birth weight) 30. 4500 g

.

ANS:

4.5 kg, above average (high birth weight) Note: Both low- and high-birth-weight infants have increased risk for complications.

31. Ordered: Dilantin 30 mg q12h po daily for a child with a seizure disorder who weighs 12 kg.

SDR: 5 mg per kg per day in two to three equally divided dosages.

Available: Dilantin 30 mg per cap. a. What is the SDR?

b. Is the dose safe to give, or should you hold it and contact the prescriber promptly after rechecking the order and recalculating the dose?

ANS:

a. 5 mg  12 kg = 60 mg per day in two to three equally divided doses 60  2 = 30 mg q12h; 60  3 = 20 mg q8h b. Safe to give (30 mg q12h) 32. Ordered: Morphine sulfate 5 mg subcutaneous stat for a child in pain who weighs 20 kg.

SDR: 0.1–0.2 mg per kg per dose.

Use a calculator to determine the SDR.

a. What is the SDR? b. Is the dose safe to give, or should you hold it and contact the prescriber promptly after rechecking the order and recalculating dose? c. If it is safe to give, then how many mL will you prepare?

ANS:

a. SDR is 2–4 mg per dose (0.1  20 = 2 mg; 0.2  20 = 4 mg) b. Hold. Recheck order and calculations. This order is overdose; contact prescriber promptly and document. c. N/A 33. Ordered: Lanoxin 62.5 mcg po stat for a child with heart failure.

How many tablet(s) will you give?

ANS:

0.5 tablet; of a scored tablet 125 mcg : 1 tablet = x mL : 1 hr

x = 0.5 tablet;

of a scored tablet

Proof: 125  0.5 = 62.5 1  62.5 = 62.5 34. Ordered: Children’s acetaminophen suspension 160 mg po stat for a 3-year-old child with a

fever who weighs 30 lb.

a. What is the recommended dose in mg and mL for this child? b. If safe, how many mg will you be administering? c. How many mL equivalents will you give using the calibrated equipment supplied with the medicine?

ANS:

a. 160 mg (5 mL) is recommended manufacturer dose for a 3-year-old child b. Safe to give 160 mg. c. 5 mL in the dosing cup (1 metric tsp) 35. Ordered: Infant’s acetaminophen suspension concentrated drops 160 mg for a 3-year-old

child with a fever who weighs 30 lb.

a. What is the recommended dose in mg and mL for this medicine for this child? b. If safe, how many mL will you be administering? c. Which is more concentrated, the children’s acetaminophen (problem 34) or the infant’s acetaminophen?

ANS:

a. 160 mg contained in 1.6 mL b. Hold; this is an overdose. c. The infant’s acetaminophen is much more concentrated (80 mg per 0.8 mL versus 160 mg per 5 mL for children’s preparation).

Note: Parents have sometimes used children’s and infant’s over-the-counter medications interchangeably thinking that they are equal strength. Be sure to warn them during discharge planning, not to make substitutions if a child is on these medications.

36. Ordered: Mycostatin (nystatin) oral syrup 200,000 units bid for a 4-month-old infant with

thrush (oral candidiasis).

SDR for children and infants over 3 months: 250,000–500,000 units per day.

Directions: Place half the dose in either side of the mouth.

a. Is the order within the SDR? b. How many mL will you prepare? c. How many mL will you administer on each side of the mouth?

ANS:

a. The order of 400,000 units per day is within the daily SDR. b. 2 mL (100,000 units : 1 mL = 200,000 units : 2 mL) c. 1 mL each side of the mouth with an oral (needleless) syringe 37. Ordered: Furosemide 15 mg IV, initial dose for a child with edema.

The nurse plans to deliver the medication in a volume-control device, filling the container up to 20 mL with lactated Ringer’s solution from an existing infusion. It will be infused at the recommended rate of 1 min per mL. a. How long will it take to deliver the infusion? b. What will the flow rate be in mL per hr?

ANS:

a. 20 min 1 mL : 1 min = 20 mL : x min x = 20 min b. 60 mL per hr 20 mL : 20 min = x mL : 60 min 20 x = 1200 x = 60 mL per hr 38. Ordered: Digoxin 50 mg IV for a child with congestive heart failure.

SDR: 0.015–0.35 mg per kg.

Child’s weight: 10 kg. a. What is the SDR for this child? b. Decision: Is the ordered dose safe to give or should the nurse hold it, recalculate it, and contact the prescriber promptly? c. If safe to give, how many mL will you prepare?

ANS:

a. SDR: 0.15–3.5 mg 10  0.015 = 0.15 mg low safe dose 10  0.35 = 3.5 mg high safe dose b. Hold. Recheck order and calculations. This order is overdose; contact prescriber promptly and document. c. N/A 39. Ordered: Morphine sulfate 3.5 mg IV for an adolescent undergoing a procedure.

SDR: Adolescents: 3–4 mg IV. May be repeated in 5 min if necessary.

a. Is the order safe for this child? b. If safe, how many mL will you prepare?

ANS:

a. The order is safe. b. 0.4 mL (10 mg: 1 mL = 0.4 mg : 0.4 mL) 40. Ordered: Cleocin (clindamycin) pediatric solution 100 mg po q6h for a child with a severe

respiratory infection who weighs 40 lb.

SDR: 8–25 mg per kg per 24 hr in four divided doses.

Use a calculator. Enter data twice for verification. a. Estimated weight in kg b. Exact weight in kg to the nearest tenth c. SDR for this child to nearest tenth of an mg d. Total daily dose ordered e. Evaluation and decision f. Amount to be given (if applicable), rounded to nearest tenth of an mL ANS:

a. 40  2 = 20 kg estimated kg weight b. 40  2.2 = 18.2 kg exact kg weight c. 8  18.2 = 145.6 mg, 145.6 mg low safe dose 25  18.2 = 455 mg, 455 mg maximum safe dose 145.6 to 455 mg in 4 divided doses daily d. 400 mg e. Order is within daily SDR f. 75 mg : 5 mL = 100 mg : x mL x = 6.66 rounded to 6.7 mL Proof: 75  6.66 = 499.95 5  100 = 500 41. Ordered: Furosemide 30 mg q12h for a child with congestive heart failure weighing 35 lb.

SDR: 0.5–2 mg per kg per dose q6-12h.

Use a calculator. Enter the data twice for verification. a. Estimated weight in kg b. Exact weight in kg to the nearest tenth c. SDR for this child to nearest tenth of an mg d. Ordered dose e. Evaluation and decision f. Volume to be administered (if applicable) ANS:

a. 35  2 = 18 kg estimated kg weight b. 35  2.2 = 15.9 kg exact kg weight c. 8–31.8 mg q6-12h d. 30 mg q12h e. Safe to give f. 40 mg : 4 mL = 30 mg : x mL x = 3 mL Proof: 40  3 = 120 4  30 = 120 42. Ordered: Aminophylline IV in D5W at 0.7 mg per kg per hr for a 1-year-old child with

asthma. Child’s weight is 12 kg. The IV 250 mg aminophylline per 250 mL started just a short time earlier is flowing at 5 mL per hr when you enter the room to care for the child.

SDR: 0.6–0.7 mg per kg per hr. a. SDR of mL per hr for this child b. Ordered flow rate in mg per hr c. Ordered flow rate in mL per hr d. Current flow rate in mL per hr e. Evaluation and decision ANS:

a. 7.2–8.4 mg per hr b. 0.7  12 = 8.4 mg per hr c. 250 mg : 250 mL = 8.4 mg : x mL

1 : 1 = 8.4 : x x = 8.4 mL per hr Proof: 250  8.4 = 2100 250  8.4 = 2100 d. 5 mL per hr e. Flowing more slowly than ordered; recheck calculations. Assess patient’s cardio/respiratory status and urinary output and contact prescriber for adjustments to flow rate document.

43. Ordered: 800 mg Cefotaxime sodium (Claforan) IV q6h per volume-control device to be

administered over 30 min for a 57-lb child.

SDR: 25–50 mg per kg q6h.

Available: 1 g vial diluted to a total of 20 mL with sterile water for injection. a. Estimated weight in kg b. Exact weight in kg to the nearest tenth c. SDR for this child d. Ordered dose for this child and total for day e. Amount of drug in mL to be administered ANS:

a. 57  2 = 28 kg estimated kg weight b. 57  2.2 = 25.9 kg exact kg weight c. 647.5 mg low safe dose to 1295 mg high safe dose daily d. 800 mg; 3200 mg e. 16 mL 1000 mg : 20 mL = 800 mg : x mL 1000x = 16,000 x = 16 mL Proof: 1000  16 = 16,000 20  800 = 16,000 44. Ordered: Doxorubicin HCl 18 mg daily for 3 days for a child with a neoplasm.

SDR: 30 mg per m2 once each day for 3 days.

Child’s BSA: 0.6 m2. a. SDR for this child b. Ordered dose c. Evaluation and decision ANS:

a. 30  0.6 = 18 mg b. 18 mg c. Safe to give 45. Ordered: Methotrexate sodium 0.25 g for child with lymphoma who weighs 80 lb and is

125-cm tall.

SDR: 200–500 mg per m2 every 2-4 weeks for lymphoma.

BSA formula for m2:

a. BSA for this child (calculate formula) b. SDR for this child c. Ordered dose d. Evaluation and decision ANS:

a. 1.12 m2

b. 1–2 mg daily (200  1.12 = 224 mg low safe dose; 500  1.12 = 560 mg high safe dose) c. 0.25 g = 250 mg d. Safe dose ordered 46. Ordered: Midazolam 1 mg IV injection stat for a child in status epilepticus who weighs 44 lb.

SDR: 0.05–0.1 mg per kg. Up to 0.6 mg per kg may be needed. a. Estimated weight in kg b. Exact weight in kg to the nearest tenth c. SDR for this child d. Ordered dose e. Evaluation and decision ANS:

a. 44  2 = 22 kg estimated kg weight b. 44  2.2 = 20 kg exact kg weight c. 1–2 mg daily (0.05  20 = 1 mg; 0.1  20 = 2 mg) d. 1 mg e. Safe order, administer medication 47. Ordered: Synthroid (levothyroxine sodium) 0.15 mg po every morning for a child with

hypothyroidism who weighs 40 lb.

SDR: 4–5 mcg per kg per day po.

a. Estimated weight in kg b. Exact weight in kg to the nearest tenth c. SDR for this child (to the nearest tenth of an mg) d. Dose ordered e. Evaluation and decision f. Amount to be administered (if applicable) ANS:

a. 40  2 = 20 kg estimated kg weight b. 40  2.2 = 18.2 kg exact kg weight c. 72.8 mcg low safe dose to 91 mcg high safe dose po per day d. 0.15 mg (150 mcg) e. Overdose ordered. Recalculate. Hold the medication. Contact prescriber promptly for clarification and document response. f. Do not administer.

48. Ordered: Potassium chloride 10 mEq to be added to an IV of D5W to make a total of 100 mL

to be administered in a volume-control device over 1.25 hr for a child with hypokalemia who weighs 30 lb.

SDR: 0.5–1 mEq per kg per hr. Do not exceed 10 mEq per hr. a. Estimated weight in kg b. Exact weight in kg to the nearest tenth c. SDR for this child d. Dose ordered per hr e. Evaluation and decision f. Flow rate in mL per hr (if applicable) ANS:

a. 30  2 = 15 kg estimated kg weight b. 30  2.2 = 13.6 kg exact kg weight

c. 6.8 mEq low safe hourly dose to 13.6 mEq per hr high safe hourly dose d. 10 mEq  1.25 hr = 8 mEq per hr e. Safe to administer f. 100 mL : 1.25 hr = x mL : 1 hr 1.25x = 100 x = 80 mL per hr Proof: 100  1 = 100 1.25  80 = 100 49. Ordered: Lidocaine HCL IV infusion 20 mcg per kg per min for a child with ventricular

tachycardia who weighs 15 kg.

SDR: 20–50 mcg per kg per min.

Directions for dilution: Add 6 mg per kg of Lidocaine to a compatible solution to make a total of 100 mL. Infusing when you arrive on duty: Lidocaine HCl IV at 20 mL per hr. a. SDR in mcg per min, mcg per hr, and mg per hr b. Ordered flow rate in mg per hr c. Evaluation and decision: Is the order safe? d. Ordered flow rate in mL per hr (to the nearest whole number) using the concentration of 6 mg per kg in 100 mL of solution e. Evaluation and decision regarding existing flow rate ANS:

a. 300–750 mcg per min; 18,000–45,000 mcg per hr; 18–45 mg per hr b. 20 mcg  15 kg  60 = 18,000 mcg per hr = 18 mg per hr c. Order of 18 mg per hr within the SDR d. 20 mL per hr 90 mg : 100 mL = 18 mg : x mL 90x = 1800 x = 20 mL per hr e. Existing flow rate is correct.

Proof: 90  20 = 1800 100  18 = 1800 50. Ordered: Augmentin oral suspension 0.1 g qid po, for a 5-year-old child with tonsillitis who

weighs 20 kg.

SDR: 20–40 mg per kg per day in four divided doses.

a. SDR for this child b. Evaluation and decision (state reason[s]) c. Estimate and calculate the dose if safe ANS:

a. 20 mg  20 kg = 400 mg low safe daily dose; 40 mg  20 kg = 800 mg high safe daily dose b. Safe to give. Order of 0.1 g qid (100 mg 4 times daily = 400 mg daily) is within SDR c. Estimate: Will give slightly less than 5 mL 125 mg : 5 mL = 100 mL : x mL

x = 4 mL dose Proof: 125  4 = 500 5  100 = 500