Mastering Drug Calculations: Essential Skills for Nursing
School
Midlands Technical College**We aren't endorsed by this school
Course
NUR 134
Subject
Nursing
Date
Dec 12, 2024
Pages
236
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MIDLANDS TECHNICAL COLLEGE NURSING DEPARTMENT NUR 131: Introduction to Pharmacology LEARNING PACKET FALL 2024 Instructor: Ann Harmon RN MSN - Sections A70, A71, A72, I70, A90, A91, A92 Office: HSB 114 (803) 822-3328 harmona@midlandstech.edu
2 This Learning Packet is designed to assist you as you learn to apply mathematical skills in administration of drugs and solutions to provide safe patient care. This is a one-hour course, so it will be necessary for you to study and practice drug calculations outside of class time. You should do the practice exercises in your textbook as well as the Learning Packet. If you have problems in solving these, you should ask for assistance and explanation during class session. You may also go to the learning center for math tutoring. The first day of class will include a diagnostic test to help you identify areas that you need to review. Conversion tables and a list of equivalencies frequently used in drug calculations are included in this Learning Packet. You must memorize these to be able to use them in your calculations. All clinical nursing courses include a dosage competency test with the requirement that you make a 90% to pass the course. Patient safety is the primary reason for learning to calculate accurately. TABLE OF EQUIVALENTS: You must memorize the following values and conversion factors. You will need to know these calculation problems for medications, for intake and output, IV fluids, or tube feedings. Metric Equivalents: Weights: 1 kilogram (kg) = 1000 grams (g, gm, G) 1 gram (g) = 1000 milligrams (mg) 1 milligram = 1000 micrograms (mcg) Volume: 1 liter (L) = 1000 milliliters (ml) 1 cubic centimeter (cc) = 1 milliliter (ml) Household Equivalents: 3 teaspoons (t, tsp) = 1 tablespoon (T, tbsp) 2 tablespoons (T) = 1 ounce (oz) 16 fluidounces = 1 pint (pt) = 2 cups = 480 ml 2 pints (pt) = 1 quart (qt) = 960 ml ½ pint = 1 cup = 240 ml
3 SOLIDS: Metric System Household System 1 kg = 2.2 lbs LENGTH: Metric System Household System 2.5 centimeters (cm) = 1 inch (in, ”)LIQUID: Metric System Household System 5 ml = 1 teaspoon (t) 30 ml = 1 ounce = 2 T 240 ml = 1 cup 480 ml = 2 cups = 1 pint 960 ml = 4 cups = 1 quart There may be more than one abbreviation listed for a value. Generally the first listed is the preferred. Others are listed so you are able to recognize the value if other abbreviations are used.
4 SUMMARY OF ALL EQUIVALENTS: 1 g = 1000 mg 1 Kg = 1000 g 1 mg = 1000 mcg 1 Kg = 2.2 lbs 1 tsp = 5 ml 1 oz = 30 ml 1 oz = 2 Tbsp 1 Tbsp = 15 ml 1 cc = 1 ml 16 oz = 1 lb 1 in = 2.5 cm 1 Liter (L) = 1000 ml 1 cup = 240 ml 2 cups = 1 pint = 480 ml 2 pints = 1 quart = 960 ml Microdrop (pediatric drop factor) = 60 gtt/ml (gtt = drop; gtts = drops) > greater than < less than
5 Chapter I Arithmetic Review Do practice exercises. Complete and turn in Diagnostic Test of Arithmetic on the following pages to identify any areas of difficulty. Be aware that in rounding numbers you are using approximatenumbers. In preparing medications it is often necessary to use exactnumbers. In these cases it may be inappropriate to round. Objective: The student should recall basic arithmetic problems utilizing the use of fractions, decimals, and percentages when calculating. A. Fractions Changing mixed fractions to improper fractions Multiplying fractions Dividing fractions Reducing fractions B. DecimalsLeading zero Trailing zero Moving decimals Rounding to tenths, hundredths, thousandths, and whole numbers C. Percentages Changing decimal numbers to percentages Changing percentages to decimal numbers Changing percentages to fractions Changing fractions to percentages Assignments: Work problems in Chapter 1 Work problems in Learning Packet Work problems on course D2L website (Arithmetic Practice Quiz and Fraction Problems)
6 Practice Problems: Chapter 1 Solve the following problems and check your answers. Follow directions for each question. Show the work for problems 1 –8. 1. Solve the problem and reduce the answer to the lowest possible fraction. 1.56 X 2 ¾ X 14.2 X 5= 4 ½ X 3 2 6 2. Solve the following problem and round the answer to the nearest hundredth. 18.75% X 3 X 1 = 1 ¼ X 5/8 X 2 3. Change the following decimal number to a fraction and reduce to the lowest possible fraction. 3.156 = 4. Solve the following problem by rounding answer to the nearest hundredth. 42.53% =
7 5. Change the following number to million units and round answer to the nearest hundredth. 7,497,355 units = million units 6. Solve the following problem and reduce your answer to the lowest possible fraction. 14/21 = 0.35% 7. Solve the following problem and reduce answer to the lowest possible fraction. ¾ X 0.4% X 2.1 3 X 0.24% X 1 2/3 8. Change the following decimal number to a fraction and reduce answer to the lowest possible fraction. 3.156 = 9. Round the following number to the nearest tenth. 15.38745 = 10. Solve the following problem and round to the nearest hundredth. 349.89898 X 10 =
8 Work and Answers to the Practice Problems 1. Solve the problem and reduce the lowest possible fraction. Solve the following problems and check your answers. Follow directions for each question. Show the work for problems 1 –8. First: Change all decimals and mixed fractions to fractions. As you are doing this task, take the fractions that are in the denominator, bring them up on the same line and flip them. Now, instead of dividing by fractions you are multiplying all fractions. You want them all on one row. 1.56 X 2 ¾ X 14.2 X 5= 4 ½ X 3 X 2 X 6 Note: 1.56 as a fraction is 1.56/1. 2 ¾ as an improper fraction is 11/4. The 4½ as an improper fraction is 9/2 –bring that up and flip it –now you are multiplying it by 2/9. The 3 as a fraction is 3/1 –when you bring it up and flip it, you are now multiplying by 1/3. The remaining number do not need to be changed. 1.56 X 11 X 14.2 X 5 X 2 X 1 = 1 4 2 6 9 3 Note: Because your answer is a fraction, you cannot have any decimals in your fraction; so now you need to get rid of the decimals or move the decimals to the right. So the 1.56 becomes 156, but you need to also add 2 zeros to the denominator, which will make that 100. The 14.2 becomes 142 and you need to add 1 zero to the denominator to make 20. Now, you are ready to reduce your fractions as far as you can without getting a decimal in the answer. I will let you do that, because of the many ways it can be reduced. 156 X 11 X 142 X 5 X 2 X 1 = 10,153100 4 20 6 9 3 5400
9 2. Solve the following problem and round to the nearest hundredth. First: Change percentages and mixed fractions to improper fractions. You will need to get rid of the percent sign. In order to get rid of the percentage sign, you put the number over 100. Note: You will change the 1¼ to 5/4 and bring it up to the top line (numerator) and flip it. You will do the same for the 5/8 –it will become 8/5. 18.75% X 3 X 1 = 18.75 X 3 X 1 X 4 X 8 = 0.36 1 ¼ X 5/8 X 2 100 1 2 5 5 Note: you can choose at this time to now reduce your fractions in order to put less numbers on the calculator. You can reduce on your own. Then you will solve for your answer by multiplying all numbers in the numerator and dividing by each number in the denominator. This will be a new way of solving this problem. You need to learn to use the calculator and solve the problem without stopping and writing down numbers and re-introducing them to the calculator. This causes too many errors. 3. Change the following decimal number to a fraction and reduce to the lowest possible fraction. 3.156 = 3.156 = 3,156 = 7891 1,000 250Note: When reducing to the lowest possible fraction answer, you cannot have any decimals in your answer; therefore you have to move the decimal to the right 3 places and add 3 zeros to the denominator. 4. Solve the following problem by rounding answer to the nearest hundredth. 42.53% = 42.53 = 0.43100 Note: To make a percentage number a fraction, you need to put that number over 100.
10 5. Change the following number to million units and round answer to the nearest hundredth.7,497,355 units = 7.5 million unitsNote: When changing from units to million units, you move the decimal by counting 6 spaces to the left. This will give you 7.497355. Rounding to the nearest hundredth gives you 7.50, but you have to drop the trailing zero when dealing with medications. It is a rule of the course. 6. Solve the following problem and reduce your answer to the lowest possible fraction. 14/21 = 14 X 100 = 14 X 10,000 = 40000.35% 21 0.35 21 35 21Note: You must get rid of the percent sign and make the number a fraction = 0.35/100. Then you bring the fraction up and flip it = 100/0.35. Because you answer is the lowest possible fraction, you must get rid of the decimal; therefore the 0.35 becomes 35 and you must add 2 zeros to the 100 = 10,000. 7. Solve the following problem and reduce answer to the lowest possible fraction. ¾ X 0.4% X 2.1 = 3 X 0.24% X 1 2/3 3 X 0.4 X 2.1 X 1 X 100 X 3 = Make all fractions4 100 1 3 0.24 5 3 X 4 X 21 X 1 X 10000 X 3 = Move the decimals. 4 1000 10 3 24 5 = 21 Note: Reduce numbers before solving. 40
11 8. Change the following decimal number to a fraction and reduce answer to the lowest possible fraction. 3.156 = 3.156 = 3156 = 7891 1000 250 Note: You can take any number (that is not a percent) and put it over 1 in order to make a fraction. Putting it over 1 does not change the value of the numerator. Because your answer is a fraction, you have to get rid of the decimal. 9. Round the following number to the nearest tenth. 15.38745 = 15.4Note: When rounding to the nearest tenth, you look only at the hundredth spot and if that number is great than 5, you round the tenth spot up. Therefore 15.38 = 15.4. 10. Solve the following problem and round to the nearest hundredth. 349.89898 X 10 = 3,498.9898 = 3,498.99 Note: When rounding a number to the nearest hundredth, you would look at the thousandth spot and if that number is greater than 5, you round up. Therefore, 3,498.989 = 3,498.99.
12 ARITHMETIC PRACTICE QUIZ Directions: You may use a calculator. Follow directions for each question. 1. Write 0.544 as a fraction, reducing it to the lowest fraction possible. 2. Write 3915 as a decimal number and round to the nearest tenth. 100 3. Round 27.156 to the nearest tenth. 4. Round 216.1532 to the nearest hundredth. 5. Write 27 as a decimal number rounded to the nearest hundredth. 8 6. 4.8 = (Round answer to the nearest tenth) 0.55 7. 12 X 5 X 4 = (Round answer to the nearest hundredth) 26 9 8. 6 5/8 = (Round answer to the nearest hundredth) 4/9 9. Write 17.8% as a fraction, reducing answer to the lowest fraction possible. 10. Write 33.8% as a decimal number without using the % symbol and round to the nearest hundredth
13 Answers to Practice Arithmetic Quiz: 1. 68/125 2. 39.2 3. 27.2 4. 216.15 5. 3.38 6. 8.7 7. 1.03 8. 14.91 9. 89/500 10. 0.34
14 ARITHMETIC PRACTICE QUIZ Directions: You may use a calculator. Follow directions for each question. 1. Write 0.456 as a fraction, reducing it to the lowest fraction possible. 2. Write 1299 as a decimal number and round to the nearest hundredth. 1000 3. Round 127.656 to the nearest tenth. 4. Round 16.3542 to the nearest hundredth. 5. Write 17 as a decimal number rounded to the nearest hundredth. 8 6. 4.1 = (Round to the nearest tenth) 0.53 7. 10 X 3 X 3 = (Round to the nearest hundredth) 22 8 8. 5 3/8 = (Round to the nearest hundredth) 5/9 9. Write 26.8% as a fraction, reducing answer to the lowest fraction possible. 10. Write 43.5% as a decimal number without using the % symbol and round answer to the nearest hundredth.
15 Arithmetic Practice Quiz Answers 1. 57/125 2. 1.3 3. 127.7 4. 16.35 5. 2.13 6. 7.7 7. 0.51 8. 9.68 9. 67/250 10. 0.44
16 Chapter 2 Drug Administration Answer questions and do all practice exercises and additional exercises included in the chapter. Objective: The student should understand all aspects of medication administration as stated below: 1.Memorize all equivalents in Learning Packet (pages 2, 3, and 4) 2.Memorize common medical abbreviations in Appendix C of Textbook. 3.Recognize all information that must be included in a medication order. 4.Recall information that must be included on a medication administration sheet. 5.List those health professionals who can legally write a drug order. 6.Explain who is responsible for seeing that the medication administration is carried out correctly. 7.Explain the difference between the Trade Name of a drug and the generic name. 8.List the six rights of medication administration. 9. Describe the route of administration indicated by the following: a.PO f. IC k. TRANSDERMAL b. IM g. PR l. INHALATION c. IV h. IT m. OINTMENT d. SUBCUT i. SL n. SUPP e. ID J. TOPICAL 10. Give standard time for medications ordered at the following military times: a. 0300 d. 0025 b. 2000 e. 1733 c. 1500 f. 1016 11. Give military time for medications ordered at the following times: a. 4:00 pm d. 12:40 am b. 7:00 pm e. 6:45 am c. 11:00 pm f. 11:50 am 12. Describe ways to identify correct patient when administering medications. 13. Review the drug labels in the chapter.State information found on the label that is pertinent to administration of a correct dose of medication.
17 14. Define the following: Medication Administration Record (MAR) and electronic Medication Administration Record (eMAR) Enteral Parenteral Solution Sustained-release or Extended-release Buccal Elixer Syrup Suspension Scored tablets/caplets Trade or Brand name Generic name Dosage strength Cutaneous Reconstituted drug Side effect (more favorable term is Adverse Drug Reaction or ADR) Adverse Drug Event (ADE) Drug precautions Drug Strength Controlled Drug Diluent 15. Explain the “3 checks” regarding reading the drug labels when administering medications. 16. Define the following types of medication orders: Standing order Routine order STAT order PRN order 17. When writing out an order for a patient, write out everything. Do not use abbreviations. Do not change the look of the order. (Ex: do not change an order for 10 mg to 1 tablet or change grams to milligrams.) The patient may alsobe referredtoas a lay person or one not familiar with medical terms. 18. Be familiar with the JACHO’s “Do Not Use”list. Assignments: Answer any work problems and practice sets in Chapter 2 Complete Study Questions 1 –17 above in Learning Packet
18 NUR 131: INTRODUCTION TO PHARMACOLOGY PRACTICE QUIZ ON EQUIVALENTS Directions: Fill in the blanks with the correct answer. Round answer to the nearest hundredth. 1. 2 t (teaspoons) = ___________ ml (milliliters) 2. 1.5 g (gram) = ___________ mg (milligrams) 3. 3 oz (ounce) = ___________ ml 4. 1½ T (tablespoons) = ___________ ml 5. 40,000 mcg = ___________ mg 6. 1/3 g (gram) = ____________ mg 7. 12 cc = ____________ ml 8. 1.4 L (liter) = ____________ ml 9. 22.4 lbs (pounds) = ____________ kg (kilogram) 10. 0.5 mg = ____________ mcg (microgram) Answers: 1. 10 ml 6. 333.33 mg 2. 1500 mg 7. 12 ml 3. 90 ml 8. 1400 ml 4. 22.5 ml 9. 10.18 kg 5. 40 mg 10. 500 mcg
19 Solve the following practice problems: Round answer off to the nearest hundredth. See pages 90-92 in the Learning Packet for extra help on the weights. 1. 45 lbs = _________ Kg 2. 123.7 lbs = ___________lbs _________oz 3. 14 lbs 8 oz = ___________ lbs 4. 24 lbs 3 oz = ___________ Kg 5. 32 Kg = _____________ lbs 6. 6.7 Kg = _________lbs ________ oz 7. 120 cm = ____________ inches 8. 5 ft 9 in = ___________ inches 9. 3 ft 8 in = ___________ ft 10. 4 ft 3 in = ___________ cm Answers: 1.20.45 Kg 6. 14 lbs 11.84 oz 2.123 lbs 11.2 oz 7. 48 inches 3.14.5 lbs 8. 69 inches 4.10.99 Kg 9. 3.67 ft 5.70.4 lbs 10. 127.5 cm
20 Chapter 3 Dimensional AnalysisDimensional Analysis is a simple approach to drug calculations. This method allows you to calculate drugs safely and quickly. In order to use dimensional analysis, you must know your conversion (or equivalents). The objectives of Chapter 3 are the student will learn to: 1. Solve problems using dimensional analysis to calculate drug dosages. 2. Calculates drug dosages using a common sense approach. 3. Use dimensional analysis to free you from the need to memorize formula. 4. Calculates drug dosages quickly and safely. Ask yourself 2 questions: What unit of measurement am I looking for in my answer? What unit of measurement do I need to cancel out? Review the information in your text. Do the practice exercises. Be sure you have memorized equivalencies listed at the beginning of your Learning Packet. Dimensional Analysis is an approach that requires no memorization of formula. You must know your equivalents. If you need help in getting started with calculating medications using the doctor’s order and a drug label (strength of drug), you may use the example below: Ordered Dose of the drug X Drug Strength, which is the way the drug is supplied (ml, tabs, capsules) amount of the drug Be sure you set your problem up so you are able to cancel all labels except the one you are solving for. If you are solving for tablets, that should be the only label you have not cancelled. If you are solving for milliliters, that should be the only label in the equation you have not cancelled. Remember to round off your answer to the nearest hundredth. Do not round as you work the problem. Add leading zeros –no trailing zeros. For example: The physician orders 375 mg of a medication. Each tablet on hand supplies 125 mg. How many tablets would you give? Tablets = 375 mg x 1 tablet = 3 tablets 1 125 mg
21 Try these: 1. The physician orders 300 mg PO of Amoxicillin. Each 5 milliliters (ml) contains 250 mg. How many ml’s will you give?300 mg x 5 ml = ______ml 1 250 mg 2.Your patient is to receive Demerol 75 mg IM. The ampule is labeled 100 mg/ml Set up the problem to determine how many ml’s you will give?3.The doctor orders Dilaudid 1.5 mg PO. The dose on hand is 3 mg per tablet. How many tablets will you give? ANSWERS: 1.) 6 ml 2.) 0.75 ml 3.) 0.5 or ½ tab Other Assignments:Work problems in Chapter 3 Work problems in Learning Packet Work problems on Equivalency Quiz on D2L course website
22 Chapter 3 Dimensional Analysis Ask Yourself 2 Questions What unit of measurement am I looking for in my answer? What unit of measurement do I need to cancel out? Objective Learn to use dimensional analysis to calculate drug dosages Example 1 30 lbs = ? oz 30 lbs x 16 oz = 480 oz 1 1 lb Dimensional Analysis Commonsense approach to drug calculations Frees you from the need to memorize formula Calculate quickly and safely In order to use dimensional analysis, you must know the equivalents Example 2 7 oz = ? lb 7 oz x 1 lb = 0.4375 = 0.44 lb 1 16 oz
23 Example 3 68.5 in = ? ft and ? in 68.5 in x 1 ft = 5.71 ft or 5 ft 8.52 in 12 in 0.71 ft x 12 in = 8.52 11 ft It is best if you divide 68.5 in by 12 in using long division. Your answer would be exactly 5 feet 8.5 inches. Example 6 –Using 2 equivalents 24,500 mcg = ? g 24,500 mcg X 1 mg x 1 g = 1 1000 mcg 1000 mg 0.0245 g = 0.02 g Example 4 37 mcg = ? mg 37 mcg x 1 mg = 0.037 or 0.04 mg 1 1000 mcg Where is all of this work leading you? Drug Calculations Doctor’s order x Drug strength = Amount of drug Using labels to obtain the drug strength and to calculate amount of drug to administer Calculating safety of doctor’s ordersCalculating tube feedings as well as oral intake Example 5 0.6 mg = ? mcg 0.6 mg x 1000 mcg = 600 mcg 1 1 mg Example 7 Doctor’s order = Cardura 8 mg po qd.Drug strength: 1 capsule = 4 mg How many capsules will you give? 8 mg X 1 cap = 2 capsules 4 mg
24 Example 8 –Using equivalents with drug orders Doctor’s order = Tylenol elixir ½ tsp q6h prn for temp > 101.5How many mg of Tylenol elixir is patient receiving per dose? On hand is Tylenol elixir 160 mg/5 ml 1 tsp x 5 ml x 160 mg = 80 mg 2 1 tsp 5 ml
25 Chapter 3: Dimensional Analysis Quiz #1 (Work these problems for Test #1) Directions: You must use dimensional analysis to solve problems 1 - 9. You must show all work. Round off your answer to the nearest hundredth. 1. 1/5 g = ____________ mg 2. 0.46 g = _____________ mcg 3. 2 ¾ tsp = _____________ml 4. 2/3 cup = ______________ ml 5. 3¾ oz = ______________ ml 6. Doctor’s order = Lipitor 20 mg po b.i.d. Using the label below, how many tablets will you give? _________________ tablets
26 7. Doctor’s order: Azithromycin 140 mg daily for infection. Using the label below, how many ml’s will you give? _________________ ml 8. Doctor’s order = Lexapro 4.7 mg PO once daily. Using the label below, how many ml’s will you give? __________________ ml 9. Doctor ordered ½ tsp of Amoxicillin po t.i.d. Using the label below, how many mg of Amoxicillin did the physician order? __________________ mg
27 10. The patient’s po intake for breakfast is 6 oz of juice; 1 pint of milk; ½ cup of water; and 1 cup of coffee with 2 tsp of cream. What is the patient’s total po intake of fluid for breakfast in mls? (You do not need to do dimensional analysis unless you desire.) __________________ ml Answers and Work for Dimensional Analysis Quiz #1 Directions: Use dimensional analysis to solve problems 1 - 9. You must show all work. Round off your answer to the nearest hundredth. 1. 1/5 g = ____200____ mg 1 g X 1000 mg = 200 mg 5 1 g 2. 0.46 g = ____460,000_________ mcg 0.46 g X 1000 mg X 1000 mcg = 460,000 mcg 1 1 g 1 mg 3. 2 ¾ tsp = _13.75 _____ml 2.75 tsp X 5 ml = 13.75 ml or 1 1 tsp 11 tsp X 5 ml = 13.75 ml 4 1 tsp 4. 2/3 cup = _____160_________ ml 2 cup X 240 ml = 160 ml 3 1 cup
28 5. 3 ¾ oz = ____112.5__________ ml 15 oz X 30 ml = 112.5 ml 4 1 oz or 3.75 oz X 30 ml = 112.5 ml 1 1 oz 6. Doctor’s order = Lipitor 20 mg po b.i.d. Using the label below, how many tablets will you give? 20 mg X 1 tab = 2 tabs 1 10 mg_2_ tabs 7. Doctor’s order = Zithromax 140 mg daily for infection. Using the label below, how many ml’s will you give? 140 mg X 5 ml 1 200 mg ___3.5___ ml 8. Doctor’s order = Lexapro 4.7 mg PO once daily. Using the label below, how many ml’s will you give? 4.7 mg X 5 ml = 4.7 ml 1 5 mg _____4.7 ml
29 9. Doctor ordered ½ tsp of Amoxicillin po t.i.d. The drug strength for Amoxicillin is 200 mg per 5 ml. How many mg of Amoxicillin did the physician order?1 tsp X 5 ml X 200 mg = 100 mg 2 1 tsp 5 ml ______100_mg 10. The patient’s po intake for breakfast is 6 oz of juice; 1 pint of milk; ½ cup of water; and 1 cup of coffee with 2 tsp of cream. What is the patient’s total po intake of fluid for breakfast in ml’s? (You do not need to do dimensional analysis unless you desire.) 6oz juice (30 ml = 1 oz) = 180 ml 1 pint milk (480 ml = 1 pt) = 480 ml ½ cup water (240 ml = 1 cup) = 120 ml 1 cup coffee (240 ml = 1 cup) = 240 ml 2 tsp cream (5 ml = 1 tsp) = 10 ml1030_ ml
30 Practice Quiz on Equivalents Fill in the blanks with the correct answer. You may use a calculator. Round answer off to the nearest hundredth if applicable. Must use dimensional analysis method shown in Chapter 3. You will have to work your problems with dimensional analysis on Test #1. 1. 2.3 tsp (teaspoons) = __________ ml (milliliters) 2. 1.5 g (gram) = __________ mg (milligrams) 3. 6 oz (ounce) = __________ ml 4. 2 T (tablespoons) = __________ ml 5. 4/5 gram (gram) = __________ mcg 6. 435,000 mcg (microgram)= __________ g (gram) 7. 4 ft 10 in = __________ cm 8. 0.7 L (liter) = __________ ml 9. 27 lbs (pounds) = __________ kg (kilogram) 10. 3.8 mg = __________ mcg (microgram)
31 Answers to Practice Quiz on Equivalents 1. 2.3 tsp (teaspoons) = ___11.5_ ml (milliliters) 2.3 tsp X 5 ml 1 1 tsp 2. 1.5 g (gram) = __1,500_ mg (milligrams) 1.5 g X 1000 mg 1 1 g 3. 6 oz (ounce) = ___180_ ml 6 oz X 30 ml 1 1 oz 4. 2 T (tablespoons) = ___30_ ml 2 T X 15 ml 1 1 T 5. 4/5 g (gram) = __800,000_ mcg 4 gram X 1000 mg X 1000 mcg 5 1 gram 1 mg 6. 435,000 mcg (micrograms) = _0.435_ g 435,000 mcg X 1 mg X 1 gram = 0.435 1 1000 mcg 1000 mg
32 7. 4 ft 10 in = __145_ cm 58 in X 2.5 cm 1 1 in Note: 4 ft 10 in needs to change to 58 inches before you begin. 8. 0.7 L (liter) = __700_ ml 0,7 L X 1000 ml 1 1 L 9. 27 lbs (pounds) = __12.27_ kg (kilogram) 27 lbs X 1 Kg = 12.272…1 2.2 lbs 10. 3.8 mg = ___3,800_ mcg (microgram) 3.8 mg X 1000 mcg 1 1 mg
33 Equivalents/Dimensional Analysis Quiz Fill in the blanks with the correct answer. Round answer off to the nearest hundredth. You must use dimensional analysis and show your work. 1. 4.7 tsp (teaspoons) = __________ ml (milliliters) 2. 2.53 g (gram) = __________ mg (milligrams) 3. 7.3 oz (ounce) = __________ ml 4. 1/6 G (gram) = __________ mcg 5. 24.5 lbs = __________ kg (kilogram)
34 6. 15 lbs 5 oz = ___________kg (kilogram) 7. 3½ qt = ___________ tsp 8. 2.56 pt = ____________oz 9. 2 2/3 cups = ______________ tsp 10. 3 ft 7 in = ______________ cm
35 Answers to Equivalents/Dimensional Analysis Quiz 1. 23.5 ml 2. 2,530 mg 3. 219 ml 4. 166,666.67 mcg Note: Leave 1/6 as a fraction. If you change it to a decimal, it will be a repeating number and you cannot round off that number. 5. 11.14 kg 6. 6.96 kg 15 lbs 5 oz = 15.3125 lbs Take 5 oz and divide by 16 = 0.3125 lb. Add to 15 lbs to get the total number of lbs. You want to get rid of the ounces and only have lbs. Then set your problem up in dimensional analysis format: 15.3125 lbs X 1 kg = 6.96 kg 1 2.2 lbs Note: When you are changing lbs and ounces to kg, you need to change the oz to lbs first by dividing by 16. Then add that number to the remaining lbs. 7. 672 tsp 8. 40.96 oz 9. 128 tsp 8 cup X 240 ml X 1 tsp = 128 tsp 3 1 cup 5 ml Note: You need to make 2 2/3 cup an improper fraction and not a decimal. It has a repeating number and you are not allowed to round it off. 10. 107.5 cm (Change 3 ft and 7 in to 43 in first.)
36 Chapter 4 The Apothecary, Household, and Metric Systems Students are expected to have learned the equivalents on pp: 2 –4 in the Learning Packet and to utilize the equivalents when changing from one unit of measurement to another. The student is also expected to utilize dimensional analysis when performing this function. There will not be a separate lecture on this chapter, but will be incorporated into Chapter 3 content. The objectives of Chapter 4 are: 1. Recall the units that are contained in each system of measurement: Metric and Household. 2. Recognize the abbreviations for each unit of measurement. 3. Convert from one system of measurement to another. 4. State the units of measurements for liquids and solids. For the next problem you must use your equivalencies to convert from one value (label) to another. You must know how to go from grams (g) to milligrams (mg). You remember that 1 g = 1000 mg You can move from gto mgby moving the decimal three places to the right. 1.000g = 1000 mg To go from mgto g you would move the decimal 3 places to the left 1 mg = 0.001 g 1000 mg = 1.000 gm = 1 gm Or you can use the conversion equation: You place the known value on the left, the equivalency on the right, so that the values cancel except the one needed for your answer: 0.75 g X 1000 mg = 750 mg 1 1 g The grams cancel. Your answer is in mg’s.This does basically the same as moving your decimal as previously discussed.
37 Practice for Conversions: 1.10 oz = _________ teaspoons (t or tsp) 2.3 tsp = __________oz 3.2 ½ qt. = _________pt. 4.7 kg = __________ lb Answers 1.) 60 tsp 2.) ½ ounce 3.) 5 pts 4.) 15.4 lbs Assignment:Work problems in Chapter 4 Work problems in Learning Packet
38 Chapter 5 : Converting from One System of Measurement to Another Students are expected to know and utilize this information when working with Chapter 3. There will not be a separate lecture for Chapter 5. The objective for Chapter 5 is: Convert a quantity from one system of measurement to its equivalent in another system of measurement utilizing dimensional analysis. You can include your conversion equation in your dimensional analysis formula . See the problem below. 1. The patient has an order for Novobiocin 0.75 g PO. The dose on hand is capsules of 250 mg. How many capsules will you give? Set up the problem as follows: 0.75 g x 1 cap x 1000 mg = ______ caps 1 250 mg 1 g The gand mgcancel out and the answer is in capsules. This can be used with conversion of any equivalents. Try it with this problem. 2.The doctor orders Phenobarbital 30 mg PO. The dose on hand is tablets of 15 mg. How many tablets will you give? 3. Ordered is Digitoxin 0.1 mg PO. On hand is 0.3 mg per ml. How many ml’s will you give?4. The doctor orders Phenobarbital 15 mg PO. The dose on hand is 20 mg per 5 ml. How many ml’s will you give?5.Ordered: Sodium Bicarbonate 300 mg PO. On hand is 0.3 g/ml. What is the correct number of ml’s to give?
39 6. Ordered: Morphine Sulfate 4.75 mg IM. Supplied is Morphine Sulfate 10 mg per ml. How many ml’s will you give?7. The prescribed dose of Atropine Sulfate is 0.3 mg PO. The dosage available is tablets of 0.6 mg each. How many tablets will you give? 8. Ordered is Phenobarbital Elixir 15 mg PO . On hand is Phenobarbital Elixir 20 mg per tsp. How many ml’s will you give?ANSWERS: 1.)3 cap 2.) 2 tabs 3.) 0.33 ml 4.) 3.75 ml 5.) 1 ml 6.) 0.48 ml 7.) ½ tab 8.) 3.75 ml Assignments: Work problems in Chapter 5 Work problems in Learning Packet
40 Chapters 4, 5, and pp: 132 –148 (in Chapter 6) NURSING 131: INTRODUCTION TO PHARMACOLOGY CHAPTER 3: PRACTICE DIMENSIONAL ANALYSIS QUIZ #2 (Work problems for Tests 1 and 2) Directions: Use dimensional analysis to solve the following problems. Round off answer to the nearest hundredth. You must show all work. 1. 13 ml = __________ oz 2. 1.435 mg = __________ mcg 3. 105 mg = ___________ g 4. 14 lbs 5 oz = ___________ Kg 5. 21 in = ____________ cm 6. 24.5 Kg = ______ lbs _______ oz 7. 0.65 L = ___________ ml 8. 2456 ml = ___________ L 9. 2 oz = ____________ ml 10. 1.7 tsp = ___________ ml 11. 1.23 Kg = ____________ g 12. 4 Tbsp = ____________ oz
41 13. 10 tsp = _____________ Tbsp 14. 3.5 pt = _____________ ml 15. 1 32cup = ____________ ml Directions: Solve the following problems using dimensional analysis. Round off to the nearest hundredth. You must show all work. 16. How many tablets will you give if the order is for ½ g and each tablet contains ¼ g? ____________ tab(s) 17. The doctor orders 0.3 mg of a drug to be given. Available are tablets that are 0.1 mg per tablet. How many tablets will you give? ____________ tab(s) 18. Order: Morphine Sulfate 7 mg IM. On hand is Morphine Sulfate 10 mg per ml. How many ml’s will you give?____________ ml(s) 19. Order: Aspirin 210 mg po q6h prn for pain. On hand is Aspirin Elixir 100 mg/1 tsp. How many ml’s will you give?____________ ml(s) 20. Order: Digoxin 0.125 mg po daily. On hand is 50 mcg / ml. How many ml’s will you give?____________ ml(s)
42 21. Order: Codiene 10 mg po q6h prn for pain. Using the label below, how many ml’s will you administer? _______________ ml(s) 22. Erythromycin 170 mg po q8h. Using the label below, how many ml’s will you give? ___________mls 25 ml CODIENE Phosphate Oral Solution Sample 15 mg per 5 ml
43 23. Patient is receiving 7.5 mls of Naproxen Suspension po b.i.d. Using the label below, how many mg’s of this drug is the patient receiving? ____________ mgs 24. Patient states that she had 1/3 cup coffee; 1¼ cup of water; 3 oz of orange juice; and ½ pt of chocolate milk. What is the patient’s total intake of fluid in ml’s?____________ ml(s) 25. The physician orders 2 Tbsp of Maalox po STAT for your patient. You do not have tablespoons on your unit. (1) What is the most accurate and best measurement you can use to measure the Maalox and (2) how much will you give? Answer:1:_____________________________________ Answer 2:_____________________________________
44 Answers: 1. 0.43 oz 23. 187.5 mg 2. 1435 mcg 24. 710 ml 3. 0.11 g 25. Use a measuring cup with oz or ml’s1 oz or 30 ml 4. 6.51 Kg 5. 52.5 cm 6. 53 lbs 14.4 oz 7. 650 ml 8. 2.46 L 9. 60 ml 10. 8.5 ml 11. 1230 g 12. 2 oz 13. 3.33 T 14. 1680 ml 15. 400 ml 16. 2 tabs 17. 3 tabs 18. 0.7 ml 19. 10.5 ml 20. 2.5 ml 21. 3.33 ml 22. 4.25 ml
45 (Chapters 4, 5, and pp: 132 –148 in Chapter 6) Dimensional Analysis Practice Problems #3 (Work problems for Test #1 and the remaining problems for Test #2) Directions: Use dimensional analysis to solve problems. You must show all work. Round off your answer to the nearest hundredth. Work problems prior to class and we will go over these in class.. 1. 27 mg = ____________ mcg 2. ¾ tsp = ____________ ml 3. 0.38 g = _____________ mg 4. ¾ cup = ______________ ml 5. 2 ¼ oz = ______________ ml 6. 25 lbs = ______________ Kg 7. 45 lbs 11 oz = _______________Kg (See pp: 69 - 71 of LP for assistance) 8. 2.5 Liters = ______________ ml 9. 4 ft 8 in = _____________ cm
46 10. 2.9 tsp = ______________ ml 11. 54.2 mg = ______________ mcg 12. 2.57 g = _________________ mcg 13. 1.25 qt = ________ tsp 14. 2.56 pt = ___________ oz 15. 16.57 kg = ________ lbs ________ oz 16. Order: Aspirin 90 mg suppository every 6 hours for a temp >101.5. On hand is a 120 mg Aspirin suppository. How many suppositories (or what part of a suppository) will you give? 17. Order: Naprosyn 1375 mg/day in divided doses po. Each tablet contains 0.275 g. How many tablets equal this daily dose? 18. Order: Penicillin G Potassium 1.4 million units IV every 6 hours. On hand is 20,000,000 units per 20 mls. How many ml’s will you give? 19. Order: Tylenol ¾ tsp (120 mg/5 ml) is ordered every 6 hours prn for pain. On hand is Tylenol 200 mg/5 ml. How many ml’s will you administer?
47 20. Order: Prochlorperazine 2.8 mg IM qd. Using the label below, how many ml’s will you give?21. Order: Indomethacin ¼ tsp po t.i.d. Using the label below, how many mgs of Indomethacin is the patient receiving per dose? 22. Order: Acetaminophen and codeine 3.7 ml q 4-6 hrs prn for pain. Using the label below, how many mg’s of Acetaminophen and how many mg’s of Codeine is the patient receiving per dose?
48 23. Order: Unasyn 0.85 g IV q 12 hrs. Using the label below, how many ml’s will you administer? Ampicillin and Sulbactam Vial SizeVolume of Diluent to be AddedWithdrawal VolumeThere is sufficient excess present to allow withdrawal and administration of the stated volumes.1.5 g3.2 mL4 mL3 g6.4 mL8 mL24. Order: Cymbalta 0.03 g PO daily. Using the label below, how many capsules will you give? 25. Order: K-Tab 1000 mg po qd with Lasix. Using the label below, how many mEq of KCL will you be giving?
49 26. Order: Zithromax 110 mg po qd. Using the label below, how many ml’s of water will you add to the bottle to mix? How many ml’s will you give? 27. Order: Colchicine 0.3 mg po q1h X 8 and b.i.d. for 5 days. On hand is Colchicine 0.6 mg per tablet. How many tablets of Colchicine will the patient receive in 6 days? 28. 125 cm tall = _____ft _____in 29. Order is for 135 mg of Biaxin po q12 hrs. How many tablets will you give? 30. Order is for 325 mg of Motrin elixir PO q4h - q6h PRN for pain. On hand is 200 mg/1 tsp. How many mls will you give?
50 31. Order is for 2 tablets on Benicar HCT 20 mg/12.5 mg po daily. Using the label below, how many mg’s ofOlmesartan Medoxomil and how many mg’sof Hydrochorothiazide is the patient receiving? 32. Order is for Morphine 1/200 g subcut STAT. On hand is Morphine 1/100 g per ml. How many mls will you give? 33. Order: Penicillin G Potassium 3.2 million units IV every 6 hours. On hand is a 20,000,000 units vial. The directions are to reconstitute the vial with 11.5 mls of diluent. Using the label below, how many ml’s will you give?
51 34. Order is for Rocephin (Ceftriaxone) 435 mg IM daily. Using the drug label and package insert instructions below, you add 1.8 ml of diluent for mixing. What is the drug strength? How many mls will you give? 35. The physician orders Vancomycin 375 mg to be added to 100mL D5W IVPB q8h to infuse over 50 minutes. Read the label below to determine how many milliliters of Vancomycin you must withdraw from the vial and add to the 100 mL of D5W.
52 Answers and Work:Dimensional Analysis Practice Problems #3Directions: Use dimensional analysis to solve problems. You must show all work. Round off your answer to the nearest hundredth. Work problems prior to class and we will go over these in class.. 1. 27 mg = _____27,000 mcg 27 mg X 1000 mcg = 27,000 mcg 1 1 mg 2. ¾ tsp = ___3.75_ ml 3 tsp x 5 ml = 3.75 ml 4 1 tsp 3. 0.38 g = ____380_ mg 0.38 g (gram) X 1000 mg = 380 mg 1 1 gram 4. ¾ cup = ___180_ ml 3 cup X 240 ml = 180 ml 4 1 cup 5. 2 ¼ oz = ____67.5_ ml 2.25 oz X 30 ml = 67.5 ml 1 1 oz 6. 25 lbs = ____11.36_ Kg 25 lbs X 1 kg = 11.363…1 2.2 lbs
53 7. 45 lbs 11 oz = __20.77_Kg (11 oz ÷ 16 = 0.6875 lb) 45.6875 lbs X 1 kg = 20.767… Kg1 2.2 lbs 8. 2.5 Liters = ____2500_ ml 2.5 L X 1000 ml = 2500 ml 1 1 L 9. 4 ft 8 in = ____140_ cm 4 ft 8 in = 4 X 12 + 8 = 56 in 56 in X 2.5 cm = 140 cm 1 1 in 10. 2.9 tsp = ___14.5_ ml 2.9 tsp x 5 ml = 14.5 ml 1 1 tsp 11. 54.2 mg = ____54,200_ mcg 54.2 mg X 1000 mcg = 54,200 mcg 1 1 mg 12. 2.57 g = _________________ mcg 2.57 g X 1000 mg X 1000 mcg = 2,570,000 mcg (or 2.57 million mcg) 1 1 g 1 mg 13. 1.25 qt = ________ tsp 1.25 qt X 960 ml X 1 tsp = 240 tsp 1 1 qt 5 ml
54 14. 2.56 pt = ___________ oz 2.56 pt X 480 ml X 1 oz = 40.96 oz 1 1 pt 30 ml 15. 16.57 kg = ________ lbs ________ oz (Needs to be worked in 2 steps) 16.57 kg X 2.2 lb = 36.454 lbs (First change kg to lbs) 1 1 kg 0.454 lb X 16 oz = 7.26 oz (Second, change the portion of a lb to oz.) 1 1 kg Final Answer is 36 lbs 7.26 oz 16. Order: Aspirin 90 mg suppository every 6 hours for a temp >101.5. On hand is a 120 mg Aspirin suppository. How many suppositories (or what part of a suppository) will you give? 90 mg X 1 supp = 0.75 supp 1 120 mg 17. Order: Naprosyn 1375 mg/day in divided doses po. Each tablet contains 0.275 g. How many tablets equal this daily dose? 1375 mg X 1 tab X 1 g = 5 tabs 1 0.275 g 1000 mg 18. Order: Penicillin G Potassium 1.4 million units IV every 6 hours. On hand is 20,000,000 units per 20 mls. How many ml’swill you give? 1.4 million units X 20 mls = 1.4 mls 1 20 million units* (see below) *Note: 20,000,000 units is read as 20 million units. Alternate way: 1,400,000 units* X 20 mls = 1.4 mls 1 20,000,000 units (see below) *Note: 1.4 million units is read as 1,400,000 units. 1 million has 6 zeros or 6 spaces. So, you move the decimal to the right 6 spaces.
55 19. Order: Tylenol ¾ tsp (120 mg/5 ml) is ordered every 6 hours prn for pain. On hand is Tylenol 200 mg/5 ml. How many ml’swill you administer? 3 tsp X 120 mg X 5 ml X 5 ml = 2.25 mls 4 5 ml 1 tsp 200 mg Note: The order is ¾ tsp (120 mg/5 ml). The drug strength is 200 mg/5 ml. You have to use the entire order. The drug strength that you have on hand is the one that the mls goes on top (not the drug strength that’s part of the order). 20. Order: Compazine 2.8 mg po qd. Using the label, how many ml’swill you give? (Drug strength is 5 mg/ml) 2.8 mg X 1 ml = 0.56 ml 1 5 mg 21. Order: Indocin ¼ tsp po t.i.d. Using the label, how many mgs of Indocin is the patient receiving per dose? 1 tsp X 25 mg X 5 ml = 6.25 mg 4 5 ml 1 tsp 22. Order: Acetaminophen and codeine 3.7 ml q 4-6 hrs prn for pain. Using the label, how many mg’s of Acetaminophen and how many mg’s of Codeine is patient receiving per dose? A = 3.7 ml X 120 mg = 88.8 mg 1 5 ml C = 3.7 ml X 12 mg = 8.88 mg 1 5 ml 23. Order: Unasyn 0.85 g IV q 12 hrs. Using the label, how many ml’swill you administer? 0.85 g X 8 ml = 2.2666.. = 2.27 mls 1 3 g Note: You are using the 3 gram vial. You will add 6.4 ml of diluent to the vial to make a total of 8 ml. This will give you the drug strength of 8 ml/3 grams.
56 24. Order: Cymbalta 0.03 g PO daily. Using the label, how many capsules will you give? 0.03 g X 1 cap X 1000 mg = 1 cap 1 30 mg 1 g 25. Order: K-Tab 1000 mg po qd with Lasix. Using the label, how many mEq of KCL will you be giving? 1000 mg X 10 mEq = 13.333… = 13.33 mEq1 750 mg 26. Order: Zithromax 110 mg po qd. Using the label, how many ml’s of water will you add to the bottle to mix? How many ml’swill you give? Label says to add 15 mls of water to add. 110 mg X 5 ml = 2.75 ml 1 200 mg 27. Order: Colchicine 0.3 mg po q1h X 8 and b.i.d. for 5 days. On hand is Colchicine 0.6 mg per tablet. How many tabs of Colchicine will the patient receive in 6 days? 0.3 mg X 1 tab X = ½ tab 1 0.6 mg Therefore, 0.3 mg = ½ tab. ½ tab q1h X 8 (hrs) = 4 tabs (1stday) ½ tab bid X 5 days = 5 tabs (next 5 days) Total # of tabs in 6 days = 9 tabs
57 28. 125 cm tall = _____ft _____in 125 cm X 1 in = 50 in 1 2.5 cm 50 in X 1 ft = 4 ft 2 in(Do not use the calculator - use long division) 1 12 in 29. Order is for 135 mg of Biaxin po q12 hrs. Using the label, how many tablets will you give? 135 mg X 1 tab = 0.27 tab or 0.25 tab 1 500 mg Note: In reality, I would give 0.25 or ¼ of a tab, because you cannot give 0.27 tab. For this course, you can leave your answer as is: 0.27 tab. 30. Order is for 325 mg of Motrin elixir PO q4h - q6h PRN for pain. On hand is 200 mg/1 tsp. How many mls will you give? 325 mg X 1 tsp X 5 ml = 8.125 = 8.13 mls 1 200 mg 1 tsp Note:When using dimensional analysis, it does not matter which order (or sequence) you put the fractions. What matters is that you have the fractions turned the correct way. 31. Order is for 2 tablets on Benicar HCT 20 mg/12.5 mg po daily. Using the label, how many mg’s ofOlmesartan Medoxomil and how many mg’sof Hydrochorothiazide is the patient receiving? OM = 2 tabs X 20 mg = 40 mg 1 1 tab H = 2 tabs X 12.5 mg = 25 mg 1 1 tab
58 32. Order is for Morphine 1/200 g subcut STAT. On hand is Morphine 1/100 g per ml. How many mls will you give? 1 g X 1 ml X 100 = 0.5 ml 200 1 g 1 g 100 1 Note:The fraction below the 1 ml needs to be brought up and multiplied by the reciprocal of the fraction. The 1 ml will then be over 1. 33. Order: Penicillin G Potassium 3.2 million units IV every 6 hours. On hand is a 20,000,000 units vial. The directions are to reconstitute the vial with 11.5 mls of diluent. Using the label below, how many ml’s will you give? 3.2 million units X 1 ml = 3.2 mL 1 1 million units
59 34. Order is for Rocephin (Ceftriaxone) 435 mg IM daily. Using the drug label and package insert instructions below, you add 1.8 ml of diluent for mixing. What is the drug strength? How many mls will you give? Answer 1. If you add 1.8 ml of diluent to a 500 mg vial, you will get a drug strength of 250 mg/ml. Answer 2. 435 mg X 1 ml = 1.74 mL 1 250 mg 35. The physician orders Vancomycin 375 mg in 100mL D5W IVPB q8h to infuse over 50 minutes. Read the label below to determine how many milliliters of Vancomycin you must withdraw from the vial and add to the 100 mL of D5W. 375 mg X 10 ml = 7.5 ml will be withdrawn from the vial 1 500 mg
60 (Chapters 4, 5, and pp: 132 –148 in Chapter 6) NURSING 131: DIMENSIONAL ANALYSIS PRACTICE PROBLEMS #4 (Work problems for Tests 1 and 2) Directions: Use dimensional analysis to solve the following problems. Round the answer off to the nearest hundredth. You must show all work.1. 123 ml = __________ oz 2. 0.623 mg = __________ mcg 3. 1125 mg = ___________ g 4. 24 lbs 6 oz = ___________ Kg (See pp: 69-71 of LP for assistance) 5. 74 in = ____________ cm 6. 27.2 Kg = ______ lbs _______ oz (See pp: 69-71 of LP for assistance) 7. 6.75 L = ___________ ml 8. 4 ft 3 in = ___________ cm 9. 2.46 Kg = ____________ g 10. 13 tsp = _____________ Tbsp 11. 2.75 pt = _____________ ml 12. 1 ¾ cup = ____________ ml
61 13. The prescriber ordered 0.4 mL tid of the expectorant potassium iodide (Iostat) po. The label reads 325 mg/5 mL. How many milligrams are contained in 0.4 mL? 14. The prescriber’s order reads: Add 800 units Humulin regular insulin to 1000 mL bag of 0.45% NS; and infuse at rate of 8 units/hr IV. Using the label below, calculate the amount of insulin in mls that must be added to the IV fluid bag. Note: The infusion rate of 8 units/hr is for information only and is not part of working this problem. 15. The patient is to receive a total amount of 0.001 g of Xanax (alprazolam) in 24 hrs po. (a) How many tablets would you give if each tablet contains 0.25 mg. (b) How many 0.25 mg tablets would be required for 7 days? 16. Order: 100 mg of the antihistamine diphenhydramine hydrochloride, (Benadryl) hs po. The label reads 0.125 g/5 mL. How many milliliters equal the prescribed dose?
62 17. The prescriber ordered 4 mg/kg of Dilantin po q8h. The patient weighs 49 lbs. Using the label below, how many milliliters will you administer to this patient? 18. Order: 120 mg of propranolol SR (Inderal SR) po per day. If each capsule contains 60 mg how many milligrams of propranolol will the patient receive in 30 days? 19. The prescriber ordered Morphine S04 0.2 mg subcut STAT. How many mcg in this dose? 20. The physician prescribes methylprednisolone 40 mg IM. The vial of powder states: add 8 mL of bacteriostatic water for injection to the 500 mg vial to make a concentration of 125 mg per 2 mL. How many milliliters equal the ordered dose?
63 Answers: 1. 4.1 oz 2. 623 mcg 3. 1.13 g 4. 11.08 Kg 5. 185 cm 6. 59 lbs 13.44 oz 7. 6750 ml 8. 127.5 cm 9. 2,460 g 10. 4.33 Tbsp 11. 1320 ml 12. 420 ml 13. 26 mg 14. 1.6 ml 15. 28 tabs 16. 4 ml 17. 3.56 ml 18. 3600 mg 19. 200 mcg 20. 0.64 ml
64 Chapter 6 Calculating Oral Drug Doses (Practice Set #1) Do single step conversions and body weight calculations. Do BSA calculations using the square root metric formula. Do multi-step conversions. Do exercises and practice sets. Practice reading drug labels. Do the additional exercises in the textbook. 1.The doctor orders Codeine Sulfate 30 mg. PO. The dose on hand is 0.015 gm/ml. How many ml’s will you give?2. The doctor orders Atropine Sulfate 1.2 mg PO. The dose on hand is 0.6 mg tablets. How many tablets will you give? 3. The doctor orders Codeine 60 mg PO. The dose on hand is 30 mg tablets. How many tablets will you give? 4. The doctor orders elixir of Phenobarbital 30 mg PO. The dose on hand is in a bottle labeled 1 ml = 15 mg. How many ml’s will you give?5. The doctor orders Thiamine Chloride 200 mg PO. The dose on hand is 80 mg per tablet (scored). How many tablets will you give? 6. The doctor orders Calcium Lactate 65 mg PO. The dose on hand is 60 mg per tab. How many tablets will you administer?
65 7. The doctor orders Atropine 0.0006 gm PO. The dose on hand is 0.3 mg per tab. How many tablets will you give? 8. The label on the stock bottle reads Penicillin V Potassium 250 mg per 5 ml., and the doctor’s order reads Penicillin V Potassium 125 mg PO. How many ml’s will you administer? 9. Penicillin V Potassium 120,000 units po q8h was ordered. Using the label below, how many ml’s will deliver 120,000 units? 10. The doctor’s order reads Penicillin G Potassium 0.2 million units IV q6h Using the label below, how many ml’s will you administerif you added 75 mls of diluent to the vial to reconstitute.
66 11. The label on the ampule reads Quinine Hydrochloride 100 mg per 1 ml and the doctor’s order reads Quinine Hydrochloride 125 mg PO. How many ml’s will you administer?12. The label on the vial reads Methoxamine Hydrochloride 10 mg per 1 ml, and the doctor’s order reads Methoxamine Hydrochloride 0.015 gm. How many ml’s will you administer?Answers1.2 ml’s2.2 tablets 3.2 tablets 4.2 ml 5.2.5 tablets 6.1.08 tablets or 1 tablet 7.2 tabs 8.2.5 ml 9.1.5 ml 10.0.8 ml. 11.1.25 ml. 12.1.5 ml.
67 PRACTICE SET # 2 I. Solve the following problems: 1. Label on stock bottle reads 1 million units in 10 ml. of solution. Order reads to give 50,000 units. How many ml’s will you give?________________________ 2. Order reads give 560,000 units. Label on stock bottle reads 1 million units in 10 ml. How many ml’s will you give?________________________ 3. Label on stock bottle reads 100 mg in 2 ml. Order reads to give 25 mg. How many ml’s will you give?________________________ 4.Label on stock bottle reads 0.5 mg in 1 ml. Order reads: give 0.25 mg. How many ml’s will you give? ________________________ 5.Label on stock bottle reads 0.5 mg in 1 ml. Order reads give 0.4 mg. How many ml’s will you give? ________________________
68 II. Convert the following: 6.1 pint = _________ ml 7.17 lbs 5 oz = _________ kg 8.0.5 gm =_________ mcg 9.45 ml = _________ T 10.89 mcg = _________ mg 11.0.2 gm = _________ mg 12.3 pints = _________ L. 13.20.15 mg = _________ gm 14.6.5 L = _________ ml 15.3.5 ml = _________ tsp
69 III. Solve the following 16.How many 0.2 mg tablets(s) should be used to give 0.6 mg? 17.How many 600 mg tablets should be used to give a dose of 3 gm? 18.Doctor’s order reads, give 0.1 million units. Label on bottle reads 5,000,000 units in 20 ml. How many ml’s do you give? 19.Prepare 350,000 units of Penicillin from a vial labeled 1 million units in 5 ml. 20.Digoxin 0.05 mg. PO has been ordered. Using the label below, how many ml’s do you give?
70 ANSWERS 1.0.5 ml 2.5.6 mls 3.0.5 ml 4.0.5 ml 5.0.8 ml 6.480 ml 7.7.87 kg 8.500,000 mcg 9.3 T 10.0.09 mg 11.200 mg 12.1.44 L 13.0.02 gm 14.6500 ml 15.0.7 tsp 16.3 tablets 17.5 tablets 18.0.4 ml 19.1.75 ml 20.1 ml
71 Chapter 8 Preparation of Solutions and Enteral or Tube Feedings The objectives are: 1. Calculate the dilution of nutritional solutions –amount of full strength solution and water for prepared diluted solution2. Understand the relationships among the amount of nutritional solution, the strength of solution, and the amount of water to add to the solution. NUR 131 Chapter 8: Solutions Dilution of Liquid Feedings and Tube Feeding Strength of Solutions The strength of a solution can be stated as a ratio, percentage, but mostly as a fraction.The ratio 1:2 (read “1 to 2”) means that there is 1 part of the drug in 2 parts of the solution. This solution is also referred to as ½ strength solution or a 50% solution. The ratio 1:10 (read “1 to 10”) means that there is 1 part of the drug in 10 parts of solution. This solution is also referred to as a 10% solution. A 5% solution means that there are 5 parts of the drug in 100 parts of solution. A 2½% solution means that there are 2 ½ parts of the drug in 100 parts of solution. Strengths: Always write as a fraction for calculations
72 Dilution of Tube and Oral Feedings Dilution of Liquid Feedings and Tube Feedings Oral feedings such as formula. Oral feedings such as liquid supplements Tube feedings for naso-gastric tubes, gastric tubes, and other feeding tubes Examples include Ensure, Pediasure Dilution of Feedings Using the Entire Stock or Amount Stock amount (in ml’s) prescribed strength = total amount of diluted feeding Example: Make a ¾ strength feeding from a 240 ml can of Ensure 240 ml ÷ ¾ = 240 ml x 4/3 = 320 ml total 320 ml –240 ml = 80 ml water Mix 240 ml can of Ensure plus 80 ml water Dilution of Feedings Using a Portion of Stock for a Specific Total Amount Prescribed total amount x prescribed strength = amount of tube feeding/formula to use Example: Make a 2/3 strength feeding of Similac formula to equal a total 120 ml 120 ml x 2/3 = 80 ml of Similac 120 ml –80 ml = 40 ml water Mix 80 ml of Similac with 40 ml of water to make a total of 120 ml Other Examples 1. Make a 1/3 strength feeding from a 270 ml can of Protein shake. 2. Make a total of 300 ml from a can of Liquid Meal using ¾ strength. Helpful Hint: _______mls of stock (If using the entire stock –divide by the prescribed strength) +_______ mls of water (always unknown in any question) =______mls total (If starting from the total amount –multiply by the prescribed strength)
73 3. Order: Ensure ¾ strength q6h. On hand is Ensure 240 ml per can. Using the entire can of Ensure, what is the total amount of fluid in ml’s that will be given q6h? 4. An infant is ordered 90 ml of ¾ strength Good Start every 4 hours via the GT. How many milliliters of Good Start and how many milliliters of water will you mix together? 5. The physician has ordered 2/3 strength Ensure. Using the entire can of 240 milliliters, how many milliliters of water will you add? What will the total volume be? 6. The child is to receive ½ strength Gatorade 120 milliliters every 2 hours for dehydration. How many milliliters of Gatorade and how many milliliters of water will you mix? 7. The patient is receiving a continuous feeding at 45 ml/hr of 2/3 strength Ensure. Dietary brings 8 oz cans of Ensure to the bedside. How many milliliters of water will the nurse add to make this feeding? What will be the total volume made? 8. 240 milliliter bolus of ¼ Pediasure is ordered every 4 hours. How many milliliters of formula and water will the nurse use to mix this feeding? 9. Pulmocare 2/3 strength at 65 ml/hr is ordered. 480 ml cans of Pulmocare are sitting at the bedside. How many milliliters of water will the nurse add to dilute this feeding? What is the total volume made? 10. After surgery, an infant is started on ¼ strength Pedialyte at 45 ml every 3 hours. Pedialyte 90 ml bottles are brought into the room. How many milliliters of Pedialyte and water will be used to prepare each feeding?
74 11. A patient has a bolus (single) feeding of 180 ml’s of 2/3 strength Ensure. Cases of 8-ounce cans of Ensure are available in the supply room. How many ml’s of Ensure and how many ml’s of water will the nurse correctly administer in a single feeding? 12. A patient has a continuous feeding running at 80 ml/hr of 4/5 strength Nutren via pump. Available are 1 liter of containers Nutren. How many ml’s of water will the nurse correctly add to make 4/5 strength Nutren when preparing 4/5 strength Nutren from 1 liter of Nutren? 13. The physician has ordered a continuous feeding at 60 ml/hr of 3/4 strength ProBalance. The nurse is supplied with 240ml cans ProBalance. How many ml’s of water will the nurse correctly add to make 3/4 strength ProBalance when preparing 3/4 strength ProBalance from 240 ml ProBalance? 14. A bolus (single) feeding of 360 ml’s of 2/5 strength Glucerna is due at 10 am. At 10 am the nurse is preparing the feeding opening one 12-ounce can of Glucerna. How many ml’s of Glucerna and how many ml’s of water will the nurse correctly administer at 10 am to provide a single feeding? 15. Bolus (single) feedings of 300ml’s of 3/5 strength Pulmocare are ordered every 4 hours. To prepare a single feeding the nurse has 8-ounce cans of Pulmocare available. How many ml’s of Pulmocare and how many ml’s of water will the nurse correctly administer? 16. The patient has continuous feeding ordered at 72 ml/hr of 5/8 strength Gatorade. To prepare the feeding the nurse has 8 ounce containers of Gatorade supplied. Using an entire 8 ounce container of Gatorade to make 5/8 strength feeding how many ml’s of water will the nurse correctly add to the Gatorade ?
75 Answers and Work for Dilution of Tube and Oral Feedings 1. Make a 1/3 strength feeding from a 270 cc can of Protein shake. 270 ml (Can) ÷ 1/3 = 270 ml X 3/1 = 810 ml (Total) 810 ml - 270 ml = 540 ml (Water) 2. Make a total of 300 ml from a can of Liquid Meal using ¾ strength. 300 ml (Total) X ¾ = 225 ml (Can) 300 ml –225 ml = 75 ml (Water) 3. Order: Ensure ¾ strength q6h. On hand is Ensure 240 cc per can. Using the entire can of Ensure, what is the total amount of fluid in ml’s that will be given q6h? Note: There are 2 hints in this problem which tell you to start with the can. 240 ml (Can) X 4/3 = 320 ml (total) 320 ml –240 ml = 80 ml (Water) 4. An infant is ordered 90 ml of ¾ strength Good Start every 4 hours via the GT. How many milliliters of Good Start and how many milliliters of water will you mix together? Note: The main hint for starting with a total amount is when the question asks you to calculate how many ml out of the can (Good Start)? 90 ml (Total) X ¾ = 67.5 ml (Can) 90 ml –67.5 ml = 22.5 ml (Water) 5. The physician has ordered 2/3 strength Ensure. Using the entire can of 240 milliliters, how many milliliters of water will you add? What will the total volume be? 240 ml (Can) X 3/2 = 360 ml (Total) 360 ml –240 ml = 120 ml (Water) 6. The child is to receive ½ strength Gatorade 120 milliliters every 2 hours for dehydration. How many milliliters of Gatorade and how many milliliters of water will you mix? 120 ml (Total) X ½ = 60 ml (Can) 120 ml –60 ml = 60 ml (Water)
76 7. The patient is receiving a continuous feeding at 45 ml/hr of 2/3 strength Ensure. Dietary brings 8 oz cans of Ensure to the bedside. How many milliliters of water will the nurse add to make this feeding? What will be the total volume made? There are 2 more hints in this problem that’s telling you to start with the can. If you see the word continuous in the problem, you start with the can. If you see a flow rate (45 ml/hr or it can be any number), you will start with the can. Change 8 oz to ml first = 240 ml 240 ml (Can) X 3/2 = 360 ml (Total) 360 ml –240 ml = 120 ml (Water) 8. 240 milliliter bolus of ¼ Pediasure is ordered every 4 hours. How many milliliters of formula and ater will the nurse use to mix this feeding? 240 ml (Total) X ¼ = 60 ml (Can) 240 ml –60 ml = 180 ml (Water) 9. Pulmocare 2/3 strength at 65 ml/hr is ordered. 480 ml cans of Pulmocare are sitting at the bedside. How many milliliters of water will the nurse add to dilute this feeding? What is the total volume made? 480 ml (Can) X 3/2 = 720 ml (Total) 720 ml –480 ml = 240 ml (Water) 10. After surgery, an infant is started on ¼ strength Pedialyte at 45 ml every 3 hours. Pedialyte 90 ml bottles are brought into the room. How many milliliters of Pedialyte and water will be used to prepare each feeding? 45 ml (Total) X ¼ = 11.25 ml (Can) 45 ml –11.25 ml = 33.75 ml (Water) 11. A patient has a bolus (single) feeding of 180 ml’s of 2/3 strength Ensure. Cases of 8-ounce cans of Ensure are available in the supply room. How many ml’s of Ensure and how many ml’s of water will the nurse correctly administer in a single feeding? 180 ml (Total) X 2/3 = 120 ml (Can) 180 ml –120 ml = 60 ml (Water)
77 12. A patient has a continuous feeding running at 80 ml/hr of 4/5 strength Nutren via pump. Available are 1 liter of containers Nutren. How many ml’s of water will the nurse correctly add to make 4/5 strength Nutren when preparing 4/5 strength Nutren from 1 liter of Nutren? 1 Liter = 1000 ml 1000 ml (Can) X 5/4 = 1250 ml (Total) 1250 ml –1000 ml = 250 ml (Water) 13. The physician has ordered a continuous feeding at 60 ml/hr of 3/4 strength ProBalance. The nurse is supplied with 240ml cans ProBalance. How many ml’s of water will the nurse correctly add to make 3/4 strength ProBalance when preparing 3/4 strength ProBalance from 240 ml ProBalance? 240 ml (Can) X 4/3 = 320 ml (Total) 320 ml –240 ml = 80 ml (Water) 14. A bolus (single) feeding of 360 ml’s of 2/5 strength Glucerna is due at 10 am. At 10 am the nurse is preparing the feeding opening one 12-ounce can of Glucerna. How many ml’s of Glucerna and how many ml’s of water will the nurse correctly administer at 10 am to provide a single feeding? 360 ml (Total) X 2/5 = 144 ml (Can) 360 ml –144 ml = 216 ml (Water) 15. Bolus (single) feedings of 300ml’s of 3/5 strength Pulmocare are ordered every 4 hours. To prepare a single feeding the nurse has 8-ounce cans of Pulmocare available. How many ml’s of Pulmocare and how many ml’s of water will the nurse correctly administer? 300 ml (Total) X 3/5 = 180 ml (Can) 300 ml –180 ml = 120 ml (Water) 16. The patient has continuous feeding ordered at 72 ml/hr of 5/8 strength Gatorade. To prepare the feeding the nurse has 8 ounce containers of Gatorade supplied. Using an entire 8 ounce container of Gatorade to make 5/8 strength feeding how many ml’s of water will the nurse correctly add to the Gatorade ? 8 oz = 240 ml 240 ml (Can) X 8/5 = 384 ml (Total) 384 ml –240 ml = 144 ml (Water)
78
79 NUR 131: INTRODUCTION TO PHARMACOLOGY CHAPTER 8: PRACTICE QUIZ –ENTERAL/TUBE FEEDINGS Directions: You must show all work. Round to the nearest hundredth (if applicable). Label all answers. You may use a calculator. 1. ¼ strength feeding to make a total of 200 ml __________ ml water __________ ml feeding 2. ½ strength feeding to make a total of 120 ml __________ ml water __________ ml feeding 3. 1/3 strength feeding to make a total of 120 ml __________ ml water __________ ml feeding 4. ¾ strength feeding to make a total of 120 ml __________ ml water __________ ml feeding 5. 2/3 strength feeding to make a total of 120 ml __________ ml water __________ ml feeding 6. ½ strength feeding using the entire can of 120 ml __________ ml water __________ ml feeding 7. 1/3 strength feeding using the entire can of 120 ml __________ ml water __________ ml feeding 8. ¾ strength feeding using the entire can of 120 ml __________ ml water __________ ml feeding 9. 2/3 strength feeding using the entire can of 120 ml __________ ml water __________ ml feeding 10. ¼ strength feeding using the entire can of 120 ml __________ ml water __________ ml feeding
80 Answers: 1. 150 ml water 50 ml feeding 2. 60 ml water 60 ml feeding 3. 80 ml water 40 ml feeding 4. 30 ml water 90 ml feeding 5. 40 ml water 80 ml feeding 6. 120 ml water 120 ml feeding 240 ml total 7. 240 ml water 120 ml feeding 360 ml total 8. 40 ml water 120 ml feeding 160 ml total 9. 60 ml water 120 ml feeding 180 ml total 10. 360 ml water 120 ml feeding 480 ml total
81 NURSING 131 –INTRODUCTION TO PHARMACOLOGY CHAPTER 8: PRACTICE PROBLEMS FOR SOLUTIONS/FEEDINGS DIRECTIONS: Label all answers. Round off answer to the nearest hundredth. Must show work! 1. Describe how you will prepare a 3/5 strength of Ensure, using the entire can of 240 ml of Ensure. How many mls of water will you add? 2. The patient is receiving 260 ml of ¾ strength Jevity to be given q6h via gastrostomy tube. How many ml’s of water should be added to the can of Jevity to dilute the entire can to the ordered strength? Jevity comes as 210 ml cans. 3. Order: Pulmocare 2/3 strength at 50 ml/hour via feeding tube. Using the entire 300 ml can of Pulmocare, how many ml’s of water will you add?4. An infant is placed on tube feedings q4h. Order is to give 84 ml of ¾ strength Similac. How many ml’s of Similac and how many ml’s of water willyou mix together? 5. A child is to receive 2/3 strength Gatorade 90 ml every 2 hours po for dehydration. How many ml’s of Gatorade and how many ml’s of water will you mix together?Answers: 1. 240 ml Ensure 160 ml water 2. 210 ml Jevity 70 ml water 3. 300 ml Pulmocare 150 ml water 4. 63 ml Similac 21 ml water 5. 60 ml Gatorade 30 ml water
82 Tube Feeding Practice Problems Directions: Solve all problems. Round answer to the nearest hundredth. After completing these problems, check your answers. 1.A patient has a bolus (single) feeding of 180 ml’s of 2/5 strength Ensure.Cases of 7-ounce cans of Ensure are available in the supply room. How many ml’s of Ensure and how many ml’s of water will the nurse correctly administer in a single feeding? 2. A patient has a continuous feeding running at 80 ml/hr of 3/5 strength Nutren via pump. Available are 1 liter of containers Nutren. How many ml’s of water will the nurse correctly add to make 3/5 strength Nutren when preparing 3/5 strength Nutren from 1 liter of Nutren? 3. The physician has ordered a continuous feeding at 60 ml/hr of 1/4 strength ProBalance. The nurse is supplied with 200 ml cans ProBalance. How many ml’s of water will the nurse correctly add to make 1/4 strength ProBalance when preparing 1/4 strength ProBalance from 200 ml ProBalance? 4. A bolus (single) feeding of 280 ml’s of 3/5 strength Glucerna is due at 10 am.At 10 am the nurse is preparing the feeding opening one 10-ounce can of Glucerna. How many ml’s of Glucerna and how many ml’s of water will the nurse correctly administer at 10 am to provide a single feeding? 5. Bolus (single) feedings of 300 ml’s of 4/5 strength Pulmocare are ordered every 4 hours.To prepare a single feeding the nurse has 8-ounce cans of Pulmocare available. How many ml’s of Pulmocare and how many ml’s of water will the nurse correctly administer?6. The patient has continuous feeding ordered at 72 ml/hr of 7/8 strength Gatorade. To prepare the feeding the nurse has 8 ounce containers of Gatorade supplied. Using an entire 8 ounce container of Gatorade to make 7/8 strength feeding how many ml’s of water will the nurse correctly add the Gatorade? 7. An infant is ordered 90 ml of 2/3 strength Good Start every 4 hours via the GT. How many milliliters of Good Start and how many milliliters of water will you mix together? 8. The physician has ordered 3/4 strength Ensure. Using the entire can of 240 milliliters, how many milliliters of water will you add? What will the total volume be? 9. The child is to receive ½ strength Gatorade 185 milliliters every 2 hours for dehydration. How many milliliters of Gatorade and how many milliliters of water will you mix?
83 10. The patient is receiving a continuous feeding at 45 ml/hr of 2/3 strength Ensure. Dietary brings 6 oz cans of Ensure to the bedside. How many milliliters of water will the nurse add to make this feeding? What will be the total volume made? 11. 210 milliliter bolus of ¼ Pediasure is ordered every 4 hours. How many milliliters of formula and water will the nurse use to mix this feeding? 12. Pulmocare 2/3 strength at 65 ml/hr is ordered. 360 ml cans of Pulmocare are sitting at the bedside. How many milliliters of water will the nurse add to dilute this feeding? What is the total volume made? 13. After surgery, an infant is started on 3/4 strength Pedialyte at 45 ml every 3 hours. Pedialyte 70 ml bottles are brought into the room. How many milliliters of Pedialyte and water will be used to prepare each feeding? . Answers to the Tube Feeding Practice Problems: 1. 72 ml Ensure 108 ml water 2. 666.67 ml water 3. 600 ml water 4. 168 ml Glucerna 112 ml water 5. 240 ml Pulmocare 60 ml water
84 6. 34.29 ml water 7. 60 ml of Good Start 30 ml water 8. 80 ml water 320 ml total 9. 92.5 ml Gaterade 92.5 ml water 10. 90 ml water 270 ml total 11. 52.5 ml Pediasure 157.5 ml water 12. 180 ml water 540 ml total 13. 33.75 ml Pedialyte 11.25 ml water
85 Chapter 6: Calculating Oral Medication Dosages1. Chapter Six: Calculating Oral Medication Dosages Objectives: The student should carry out the following: Calculate doses by body weight. Calculate doses by body surface area (BSA). Utilize adult nomogram and square root metric formula to determine BSA. Calculate multi-step conversion problems. Calculate doses for oral medications in liquid form. Calculate doses for oral medications in tablet form. Calculate doses for oral medications from information on drug labels. Assignments:Work problems in Chapter 6 (pp:149 –174) Work problems in Learning Packet
86 These slides refer to pp: 149 –174 in Chapter 6 for Test #3. Chapter 6Calculating OralMedication DosagesThe order is 12 milligrams per kilogram of the antituberculosisdrug, rifampin (Rifadin). How many mg’s would you administer to a patient who weighs 75 kilograms?Sometimes the amount of medication prescribed depends on the patient’s body weight. A patient who weighs more will receive more of the drug, and a patient who weighs less will receive less of the drug. (Example is 50 mg/Kg/day)You write this as a fraction: (include the time frame)50 mgKg/dayDosage by Body Weight12 mg X 75 kg = 900 mgkg 1Chapter Six: Calculating Oral Medication DosagesObjectives:Calculate doses by body weight.Calculate doses by body surface area (BSA).Utilize the square root metric formula to determine the BSA,Do multi-step conversion problems.Calculate doses for oral medications in liquid form.Calculate doses for oral medications in tablet form.Calculate doses for oral medications frominformation on drug labels.
87 Example 1: The order is 0.4 mg per kg t.i.d. of Prednisone for a patient who weighs 50 kg. Read the drug label in the next slide and determine the number of tablets you would give to the patient. (Drug label reads 20 mg/tab) Order: 50 mg/Kg of RocephinIM STAT. Child weighs 35 lbs. Label reads 500 mg/1 ml. How many ml’s will you give?50 mg X 1 kg X 35 lbs X 1 ml = 1.59 mL Kg 2.2 lbs 1 500 mg Multistep Conversions0.4 mg X 50 kg X 1 tab =kg/tid 1 20 mg= 1 tab tid20 MG Prednisone Tablets Each tablet contains Prednisone 20 mg 100 mgX35 lbsX1 KgX5 mlKg/Stat1 2.2 lbs 500 mg= 15.90909 = 15.91 ml Stat
88 Calculate the BSA for the following: Adult: 5 ft 9 in and 189 lbs Child: 42 in and 65 lbs Infant: 28.5 in and 22 lbs 7 ozAnswers: Adult: 2.03 m2Child: 0.93 m2Infant: 0.45 m2Calculating Dosage by Body Surface Area√175 cm X 82.72727272 Kg= 2.01 m23600Or√70 in X 2.5 X 182 lbs ÷ 2.2 = 2.01 m23600Example using the metric system square root formula:What is the BSA of a male who is 5 feet 10 inches tall and weighs 182 pounds?First you convert 5 feet 10 inches to 70 in. Convert inches to cm (X 2.5)Convert lbs to Kg (÷ 2.2 Do not round)Multiply cm X kgDivide by 3600 –hit then equal (=) sign first, then hit the square root button on the calculatorSee next slide for workIn many cases body surface area (BSA) is a more important factor than weight in determin-ingappropriate drug dosages. This is particularly true of pediatric drugs and drugs that are used for cancer therapy.A patient’s BSA, which is measured in square meters (m2), can be determined by using the square root metric formula.
89 Practice Problems for pp: 149 –174 in Chapter 6 Directions: Round all answers to the nearest hundredth. Show all work. 1.The physician orders Biaxin (clarithromycin) 7.5 milligrams per kilogram PO q12h. If the strength is 250 milligrams per 5 mL, how many mL of this antibiotic drug should be administered to a patient who weighs 154 lbs?2.A drug is ordered at 6.6 mg/m2 PO q12h for three doses. How many 5 mg tablets of this drug would you administer to a patient with a BSA of 2.29 m2?3. Unasyn 1,400 mgs/m2IV is ordered q12h. BSA is 1.7 m2. On hand is a 3 gram vial / 8 ml. How many mls will you administer? 4. Vinblastine 3.7 mg/m2is ordered as a single IV dose for a child weighing 75 lbs and 4 ft 2 in tall. Instructionsstate to prepare a solution containing 1 mg/ml of vinblastine sulfate (vinblastine sulfate injection) , add 10 mL of Sodium Chloride Injection (unpreserved) to the 10 mg of Vinblastine Sulfate (vinblastine sulfate injection) for Injection in the sterile vial. How many mls will you administer? Answers: 1. 10.5 mls 2. 3.02 tabs 3. 6.35 mls 4. 4.03 mls (BSA = 1.09 m2)
90 Chapter 12: Calculating Pediatric Dosages Chapter 12 will be taught with Chapter 6 because much of the content is the same. The new content is determining the safety of a prescribed dose of medication. Objectives for Chapter 12 –The student should carry out the following: 1. Calculate pediatric dosages based on body weight. 2. Calculate pediatric dosages based on body surface area. 3. Compare the drug order to the recommended safe dose to determine the safety of the medication order. 4. Calculate body surface area of a child the using square root metric formula. Assignments:Work problems in Chapter 12, except for the IV and flow rate problems. Work problems in the Learning Packet Work problems on D2L course website INSTRUCTIONS FOR EACH PEDIATRIC DOSAGE CALCULATIONS In pediatric drug problems - always round answer to hundredths. Do not round while you are working the problem. Only round your answer. CONVERTING WEIGHTS FOR DOSAGE CALCULATIONS: In doing calculations to check pediatric drug doses you may need to convert from one measure of body weight to another. You must know how to convert from pounds to kilograms and from kilograms to pounds. Kilogram (Kg) is the larger measure and is equal to 2.2 pounds (lb). To convert from kilograms to pounds you will multiply by 2.2. To convert from pounds to kilograms you will divide by 2.2. You may also use the conversion equation to convert from one measure to another. This may help prevent confusion. * Note: Use 1 Kg = 2.2 lbs. Do not use 1 lb = 0.45 Kg. Note: The textbook states to round down for pediatric medications. Since we are rounding to the nearest hundredth in this course, it is not necessary to round down. Continue to round as you were taught.
91 CONVERSION EQUATIONS*Note: Always use 2.2 lb / Kg in your calculations to convert from lb to Kg and vice versa. A. TO CONVERT FROM lb TO Kg 1. State known factors: Child weighs 15 lbs 2. State equivalency with value you are solving for in the upper level of the fraction. Ex. 1 Kg 2.2 lbs 3. Then multiply. 15 lbs X 1 Kg = 6.8181818 Kg 2.2 lbs B. Convert lbs and ounces (oz) to Kg. 14 lbs 8 oz = 14 8 lbs = 14.5 lbs X 1 kg = 6.590909 Kg 162.2 lbs C. TO CONVERT FROM Kg TO lb 1. 15 Kg. State known factors: Child weighs 15 Kg. 2. State equivalency with desired value in upper level of fraction. Ex:. 2.2 lb 1 Kg 3. And multiply. 15 kg x 2.2 lb = 33 lb 1 kg D. Convert Kg to lbs and ounces 8 Kg X 2.2 lbs = 17.6 lbs Now change 0.6 of a lb to ounces. 1 Kg (0.6 lb X 16 oz = 9.6 oz) = 17 lbs 9.6 oz 1 lb
92 CONVERT THE FOLLOWING AND DO NOT ROUND YOUR ANSWER: 1. 12 lb = ______Kg 2. 12 Kg = ______lb 3. 25 lb 4 oz = ______Kg 4. 6 Kg = _______lbs _______ oz 5. 15 lb 10 oz = ______Kg 6. 30 Kg =_______lb 7. 46 Kg = ______lb 8. 53 lb = ______Kg Answers: 1.) 5.4545454 Kg 2.) 26.4 lbs 3.) 11.477272 Kg 4.) 13 lbs 3.2 oz 5.) 7.1022727 Kg 6.) 66 lbs, 7.)101.2 lbs 8.) 24.090909 kg. CALCULATING SAFE DOSE BASED ON BODY WEIGHT Most drugs that children receive are calculated based on dosages recommended by the manufacturer. These recommendations are published in drug handbooks, The PDR, and The National Formulary. In some instances age may be a consideration in the dosage recommendation as well as the severity of the disease, or the reason the drug is being given. For example the dosage may vary when a drug is ordered for restlessness as opposed to sedation, or to control seizures. Read your resource carefully to be sure you are using the correct dosage based on the desired application of the drug. The recommended dosage may state: mg/kg/day, mg/lb/day. It may state: given in equally divided doses at recommended (q4h, q6h, q8h) intervals. Example 1:The recommended dose for Amoxicillin oral suspension for a child is 20 to 40 mg/kg/day in equally divided doses every eight hours. For a child weighing 20 kg, what is the number of mg/every 8 hours the child can safely have (use the highest of the range)? You will set up the problem as follows: 40 mg X 20 Kg X 1 day = 266.67 mg q8hrs recommended safe dose Kg/day 1 3 (represents an every 8 hr dose))
93 Example 2: The order is for Erythromycin 250 mg po every 8 hours. Recommended safe dose is 30 –50 mg/kg/day. Child weighs 22 lbs 5 oz. What is the maximum safe dose per day for this child? Is the order safe to give? First, you need to change 22 lbs 5 oz to lbs. Take 5 oz, divide by 16 oz and add to 22 lbs. This would = 22.3125 lbs. (Do not round) 50 mg X 1 kg X 22.3125 lbs = 507.102 = 507.1 mg/day RSDKg/day 2.2 lbs 1 Order = 250 mg q8hr (X3) = 750 mg/day. Order is not safe to give. Or: 250 mg X 3 (represents every 8 hours) = 750 mg/day Q8h day Ans: 507.1 mg/day Ans: Unsafe RSD: 507.1 mg/day Order: 750 mg/day Note: Unless the question is asking for the safe dose range, you can use the highest safe dose factor in the range (ex: 50 mg/Kg/day) to calculate the maximum safe dose. If the order does not exceed the highest safe dose, then the order is considered safe. Example 3:Atropine may be given to children for organophosphate poisoning. The recommended dose is 0.05 mg/kg IM or IV for a child weighing 10.91 kg. Is 0.5 mg a safe dose for a child weighing 10.91 kg? 0.05 mg X 10.91 Kg = 0.5455 = 0.55 mg/dose RSDOrder is 0.5 mg/doseYes, it is safe.Kg/dose 1 Ans: 0.55 mg/dose Ans: Safe RSD: 0.55 mg/dose Order: 0.5 mg/dose In order to know if an order is safe or unsafe to give, you have to compare the recommended safe dose (RSD) to the drug order –needs to be the same measurement and the same time frame.
94 CALCULATIONS FOR SAFE DOSE USING BODY WEIGHT ( Kg) 1. The recommended dose of Chloral Hydrate is 50 - 75 mg/kg/dose. Prior to a diagnostic test your patient is to receive 250 mg/dose po. Is this a safe dose for a child who weighs 4.46 kg? (Note: Use the highest recommended safe dose) Ans: ____________ RSD: ___________ Order: ___________ 2. Your patient is ordered Amoxicillin 500 mg po q6h. He weighs 25 lbs. The recommended dose is 20 to 40 mg/Kg/day in equally divided doses q6h? What is the maximum safe dose per day? Is the order safe to give? Ans: ____________ Ans:_____________ RSD: ___________ Order: ___________ 3. A child admitted with meningitis weighs 5.6 Kg. He is to receive Penicillin G Potassium 0.2 million units q12h. The recommended safe dose is 75,000 units/Kg/day equally divided q12h? What is the maximum safe daily dose? Is the order safe to give? Ans: ____________ Ans:_____________ RSD: ___________ Order: ___________
95 4. Your assigned patient is an infant who weighs 12 lbs. He is to receive Ampicillin oral suspension 125 mg q6h. The label indicates that children weighing less than 20 lbs should receive 100 mg/Kg/day in equally divided doses at 6-hour intervals. What is the maximum safe dose to be given every 6 hours? Is the ordered dose a safe dose? Ans: ____________ Ans:_____________ RSD: ___________ Order: ___________ Answers: 1. Ans: 334.5 mg/dose Ans: _Safe__RSD: 334.5 mg/dose Order: 250 mg/dose 2.Kg = 11.363636; 454..55 mg/day (Order is 500 mg q6hr (X4) = 2000 mg/day - is not safe. 454.55 mg/day max safe daily dose) Ans: 454.55 mg/day Ans: Unsafe RSD: 454.55 mg/day Order: 2000 mg/day Note: Keep all answers per day. 3.Yes, Order is 200,000 units q12hr = 400,000 units/day - is safe because the maximum safe dose is 420,000 units per day Ans: 420,000 units/day Ans:_Safe RSD: 420,000 units/day Order: 400,000 units/day 4.Yes, Order is for 125 mg q6hr is safe because the recommended safe dose is 136.36 mg every 6 hours. Ans: 136.36 mg q6h Ans:_Safe RSD: 136.36 mg q6h Order: 125 mg q6h
96 USING BODY SURFACE AREA (BSA) TO CALCULATE SAFE DOSE BSA MAY BE THE MOST ACCURATE WAY TO CALCULATE SAFE DOSE. IT MAY ALSO BE USED IN DETERMINING SAFE DOSE FOR GERIATRIC, PEDIATRIC, AND CHEMOTHERAPY PATIENTS. In some cases a drug may be recommended based on mg/m2. In this calculation you will use the square root metric formulato find the child's or adult’s BSA. Calculation of the BSA (m2) using square root metric formula. Square root of: the weight in kg times the height in cm or 3600 the weight in lbs ÷ 2.2 times height in inches X 2.5 (Preferred method) 3600 An example of using mg/m2: Find BSA in m2for a child with a height of 24 in and 16 lb. If po Atropine is not to exceed 0.3 mg/m2/dose, is 0.1 mg a safe dose? 0.3 mg X 0.35 m2 X = 0.105 or 0.11 mg/dose (max RSD)Yes, 0.1 mg is safe.m2/dose 1 Ans:_Safe RSD: 0.11 mg/dose Order: 0.1 mg/dose FIND BSA IN m2 FOR THE FOLLOWING (Use the square root metric formula): 1. 5.36 Kg and 56 cm = _______m25. 32 lbs and 31 in = _______m22. 45 lbs and 40 in = ________m26. 21 lbs 5 oz and 26 in = _____m23. 7.2 Kg and 71 cm = ________m27. 16 lbs 3 oz and 22 in = ______m24. 28 lbs and 30 in = ________m28. 7 lbs 11 oz and 20 in = ______m2Answers: 1) 0.29 m2 2.) 0.75 m2 3.) 0.38 m24.) 0.51 m25.) 0.56 m26.) 0.42 m2 7.) 0.34 m28.) 0.22m2
97 HOW TO CALCULATE A CHILD’S RSD WHEN THERE IS NOT A RECOMMENDATION FOR A CHILD'S DOSAGE: In order to determine safe dose for a child when no child's recommended dose is given, use the following formula: CHILD'S BSA IN m2 X USUAL ADULT DOSE = RECOMMENDED CHILD'S DOSE ADULT BSA 1.7 m21.7 m2IS THE NUMBER ALWAYS USED FOR THE ADULT BSA. For example:The usual adult dose of an antibiotic is 1 gram every 6 hours. Your pediatric patient is 23 inches tall and weighs14 lbs. Order is 175 mg every 6 hours. Is the ordered dose safe to give? Calculate the child's BSA in m2. You will need to show your work on the test. The BSA in m2 is 0.32 m2. Use it in your formula and remember to convert from grams to mgs. 0.32 m2X 1 gram X 1000 mg = 188.235 = 188.24 mg q6h child’s recommended1.7 m2 q6h1 g safe dose Yes, Order for 175 mg q6h is a safe dose, because it is less than the recommended safe dose of 188.24 mg q6h. Ans: 188.24 mg q6h Ans:_Safe RSD: 188.24 mg/q6h Order: 175 mg/q6h CALCULATIONS USING BSA IN m21. The recommended adult dose of Zantac is 150 mg t.i.d. po. Your patient weighs 5.36 kg and is 56 cm in length. What is the maximum safe t.i.d. dose? Is the ordered dose of 25 mg t.i.d. a safe dose for this child? Ans: ______________ Ans:______________ RSD: _____________ Order: _____________ You are using this formula, because there is not a recommended safe dose for a child, so you have to rely on the safe dose for the adult.
98 2. Your patient weighs 28 lbs and is 30 in. tall. If the usual adult dose of a medication is 60 mg, is the ordered dose of 15 mg a safe dose?. Ans:______________ RSD: _____________ Order: _____________ 3. Your patient has an order for Demerol 15 mg IM q4h prn for pain. The patient weighs 24 lbs and is 32 in tall. Is this a safe dose if the average adult dose is 50 mg q4h? Ans:______________ RSD: _____________ Order: _____________ 4. Your patient weighs 75 lbs and is 4 ft 10 in inches tall. He is to receive a medication with a recommended adult dose of 250 mg/day in equally divided doses every 4 - 6 hours. Is an order of 50 mg q6h a safe dose? Ans:______________ RSD: _____________ Order: _____________
99 Answers: 1.) 0.29 m2;25.59 mg t.i.d. is the RSD; order of 25 mg t.i.d is safe Ans: 25.59 mg t.i.d. Ans:_Safe RSD: 25.59 mg t.i.d. Order: 25 mg t.i.d. 2.) 0.51 m2, 18 mg/dose is the RSD. Yes, 15 mg/dose for the order is safe. Ans: 18 mg/dose Ans:_Safe RSD: 18 mg/dose Order: 15 mg/dose3.) 0.49 m2, 14.41 mg q4hr is the RSD. No, 15 mg q4h is the order and it is not safe. Ans: 14.41 mg q4h Ans:_Unsafe RSD: 14.41 mg q4h Order: 15 mg q4h 4.) 1.17 m2, 172.06 mg /day is the RSD. No, 50 mg q6h (X4) = 200 mg/day, so the order is unsafe to give Ans: 172.06 mg/day Ans:_Unsafe RSD: 172.06 mg/day Order: 200 mg/day
100 PowerPoint Slides (Lecture) The medication order reads: EES Suspension 30 mg/kg po q6h. Read the label on the next slide. The child weighs 38 kgs. How many mls of the drug will you administer to this child? (Label reads 200 mg/5 ml or see p. 72 in your text.) Chapter Twelve: Calculating Pediatric DosagesObjectives:Calculate pediatric dosages based on body weight.Calculate pediatric dosages based on body surface area.Determine the safety of the medication order.Determine body surface area using square root metric formula.100 ml for Oral suspension ERTHYROMYCIN ETHYSUCCINATE FOR ORAL SUSPENSION, USP 200 MG/5 ML (when reconstituted) Chapter 12Calculating Pediatric DosagesCalculating Drug Dosages by Body Weight30 mg X 5 ml X 38 kg =kg / q6h200 mg1= 28.5 ml q6hEryPed 200
101 Read the information on the label in next slide. The prescriber ordered:Cefaclor 20 mg/kg po bid.The child weighs 14 lbs 5 oz. How many milliliters of this antibiotic will you prepare?20 mg X 1 kg X 14.3125 lbs X 5 ml = = 5.204 = 5.2 mls bid kg / bid 2.2 lbs 1 125 mg
102 The physician ordered:0.04 mg IM stat of a drug.The child weighs 40 kilograms, and the recommended dose is 0.001 milligram per kilogram. Is this a safe dose for this child?Compare order to RSD for safetyIf the order is = to or <the RSD - safeIf the order is > RSD - unsafeThere are 2 questions. Let’s answer the safe daily dose first.Take the highest RSD, which is:40 mcgX 75 lbsX 1 kg= 1363.636kg/day12.2 lbs= 1363.64 mcg/day is RSDIn order to find the safe dose, look for the recommended safe dose.RSD = 0.001 mgX 40 kg = 0.04 mgkg1RSD: 0.04 mgOrder: 0.04 mg order is same as RSD, therefore it is safe to give.Now we will answer if the ordered dose is safe.Compare Order to RSD -have to be the same measurement and the same time frameExample 5:Order: Digoxin 4.5 ml po bid. On hand is Digoxin 0.05 mg/ml. The recommended safe dose is 20 mcg –40 mcg/Kg/day. Patient weighs 75 lbs. What is the safe daily dosage inmcg’s? Is the ordered dose safe to give?Order is 4.5 ml bid –we need to change this to mcg/day4.5 mlX 0.05 mgX 1000 mcgbid1 ml1 mg= 225 mcg bid (X 2) = 450 mcg/day is the order1363.64 mcg/day is the RSDOrder < RSD = safe to giveTo determine if the order is safe to give, compare Order to the RSD. They have to be the same measurement and the same time frame. VERY IMPORTANT SLIDE Ans: 1363.64 mcg/day Ans: Safe RSD: 1363 mg/day Order: 450 mcg/day
103 1.25 mgs X 0.5 m2m2/week 1 = 0.625 = 0.63 mg week Calculating Drug Dosages by Body Surface Area (Example is 35 mg/m2/day)Example 1:If a child has a BSA of 0.5 square meter, and the medication order is for 1.25 milligrams per square meter of Vinblastine Sulfate (Velban) IV weekly, then how many milligrams of this antineoplastic drug should the child receive?√90 cm X 40 lbs ÷2.2 3600= 0.674 = 0.67 m2Example 3: The prescriber has ordered 30 milligrams per square meter of Cortef. The child weighs 40 kilograms and is 45 inches tall. Read the label on the next slide and determine how many milliliters this child should receive.Example 2:Estimate the BSA of a child who weighs 40 pounds and is 90 centimeters tall. Calculate the BSA .
104 √45 in X 2.5 X 40 kg3600= 1.118 = 1.12 m230 mg X 1.12 m2X 1 ml= 16.8 mlm21 2 mgUsing the BSA Formula when there is nota Recommended Safe Dose for the ChildChild’s m2X Recommended Adult Dose=1.7 m2Recommended Safe Dose (RSD) for the ChildThe prescriber ordered Keflex 150 mg q8h po. The recommended adult dosage of Keflex is 500 mg q8h. The child weighs 15 kilograms and is 77 centimeters tall? What is the recommended safe dosage (RSD) for the child? Is the ordered dose safe to give? Calculating Child’s Dosage Based on the Adult Dosage and the Child’s BSA (m2)RSD =0.57 m2X500 mg 1.7 m2q8h= 167.647 =167.65 mg q8h RSD?77 cm X 15 kg3600= 0.566= 0.57 m2Cortef 4 fl oz Hydrocortisone cypionate Oral suspension 10 mg/5 ml
105 P. 81 #17. Azulfidine oral suspension 190 mg PO q.i.d. is ordered for a child weighing 35 lbs and 34 in tall. The recommended safe dosage for Azulfidine is 30 mg/kg/day. What is the recommended safe daily dosage in mgs? Is the ordered dose safe to give? Extra Problems (Will be worked in class)P. 81 #19. Vancomycin 214 mg PO every 6 hours is ordered for a child weighing 24 lbs 5 oz. The recommended safe dose (RSD) for Vancomycin is 44 mg/kg/day divided every 6 hours. What is the RSD in mgs for this child for 24 hours? Is the ordered dose safe to give? Now for the safety of the orderCompare order to RSDOrder = 150 mg q8hRSD = 167.65 mg q8hIs the order safe? Yes or NoAns: 167.65 mg/q8h Ans: Safe RSD: 167.65 mg/q8h Order: 150 mg/q8h Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________
106 P. 79 #10. Order: Gentamycin 8.2 mg IV t.i.d. Recommended pediatric dosage is 30 mg/ m2/ day in 3 - 4 divided doses. Infant weighs 15 lbs and is 23" in height. What is the safe daily dose in mgs? Is the order safe to give? P 83 #10. A child weighing 32.4 lbs is receiving Digoxin 0.28 mg b.i.d PO. Recommended safe dose for Digoxin is 20 mcg/kg/day. What is the RSD in mgs of Digoxin that this child can receive b.i.d? Is the order safe to give? Order: Benadryl 8.8 ml IM every 6 hours. The recommended safe dose of Benadryl is 5 mg/kg/day given in 4 –6 equally divided doses. The medication is supplied 12.5 mg per 5 ml. How many mgs will you give per dose? Is the ordered dose safe to give for a child weighing 14 lbs 6 oz? p. 135 #40. Digoxin 64 mcg/m2PO STAT is ordered for a child weighing 24 lbs 8 oz and is 24½ in length. How many ml’s willyou give this child if the label on the Digoxin bottle reads 0.67ml per 0.008 mg? Ans:________________ Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________
107 Chapters 6 and 12 Practice Problems Directions: Round the answer off to the nearest hundredth (if applicable). Label all answers. 1. 26.8 lbs = _______ lbs ______ oz 2. 12.4 lbs = _______ Kg 3. 15 lbs 12 oz = ________ lbs 4. 8 lbs 10 oz = ________ Kg 5. 7.4 Kg = _______ lbs _______ oz 6. 24 in tall and 28 lbs = _________ m2 7. 135 cm tall and 55 Kg = _________ m2 8. 125 cm tall and 75 lbs = _________ m2 9. Child weighs 5.8 Kg. Recommended dosage for Unasyn is 200 mg/Kg/day. What is the recommended safe dose in mgs/per day for this child? Ans:______________
108 10. Infant weighs 9 lbs 4 oz. Recommended dosage for Tylenol is 15 mg/Kg/dose. What is the recommended safe dose in mgs for this infant? Ans:______________ 11. Child weighs 25.6 lbs. Recommended dosage for Benedryl is 5 mg/Kg/day. What is the recommended safe dose in mgs/per day for this child? Ans:______________ 12. Infant is 27 inches in length and weighs 12 lbs. Recommended dosage for Zantac is 80 mg/m2/day. What is the recommended safe daily dose in mgs for this infant? Ans: ____________ 13. Child weighs 10 Kg and is 39 in tall. There is not a recommended safe dose for a child. The adult dosage of Feldene is 20 mg/day. What is the recommended safe dosage per day of Feldene for this child, based on the adult dose and the child’s BSA (m2)? Ans: ____________
109 14. Child weighs 22 lbs 5 oz. Recommended dosage for Morphine 0.09 mg/lb/dose. What is the recommended safe dose in mgs for this child? Ans: ____________ 15. Tylenol is ordered for a child who weighs 47 lbs. The label on the bottle of Tylenol states for a child weighing 7 –15 kg, give 40 mg PO every 4 –6 hours PRN. For children weighing 16 –23 kg, give 60 mg PO every 4 –6 hours PRN. What is the maximum daily dose in mg’s of Tylenol that the child can receive per 24 hours? Ans: ____________
110 Chapters 6 and 12 Answers and Work Shown Directions: Round answer off to the nearest hundredth. 1. 26.8 lbs = 26 lbs 12.8 oz 0.8 lbs X 16 oz = 12.8 oz 1 lb 2. 12.4 lbs = 5.64 Kg 12.4 lbs X 1 kg = 5.636 kg 2.2 lbs 3. 15 lbs 12 oz = 15.75 lbs 12 oz X 1 lb = 0.75 lbs 16 oz 4. 8 lbs 10 oz = 3.92 Kg 10 oz X 1 lb = 0.625 lb 16 oz 8.625 lbs X I kg = 3.920 kg 2.2 lbs 5. 7.4 Kg = 16 lbs 4.48 oz 7.4 kg X 2.2 lbs = 16.28 lbs 1 kg 0.28 lbs X 16 oz = 4.48 oz 1 lb
111 6. 24 in tall and 28 lbs = ____0.46 m2 24 X 2.5 X 28 / 2.2 3600 7. 135 cm tall and 55 Kg = ____1.44 m2 135 X 55 3600 8. 125 cm tall and 75 lbs = ____1.09 m2125 X 75/2.2 3600 9. Child weighs 5.8 Kg. Recommended dosage for Unasyn is 200 mg/Kg/day. What is the recommended safe dose in mgs/per day for this child? 200 mg X 5.8 kg = Ans: 1160 mg/day kg/day 1 10. Infant weighs 9 lbs 4 oz. Recommended dosage for Tylenol is 15 mg/Kg/dose. What is the recommended safe dose in mgs for this infant?4 oz X 1 lb = 0.25 = 0.25 lb = 9.25 lbs 16 oz 15 mg X 1 kg X 9.25 lbs = 63.068 mg/dose kg/dose 2.2 lbs 1 = Ans: 63.07mg/dose 11. Child weighs 25.6 lbs. Recommended dosage for Benedryl is 5 mg/Kg/day. What is the recommended safe dose in mgs/per day for this child? 5 mg X 1 kg X 25.6 lbs = 58.181 mg/day kg/day 2.2 lbs 1 = Ans: 58.18 mg/day
112 12. Infant is 27 inches in length and weighs 12 lbs. Recommended dosage for Zantac is 80 mg/m2/day. What is the recommended safe daily dose in mgs for this infant? 27 X 2.5 X 12 / 2.2 3600 Child’s BSA is 0.32 m280 mg X 0.32 m2= Ans: 25.6 mg/day m2/day 1 13. Child weighs 10 Kg and is 39 in tall. There is not a recommended safe dose for a child. The adult dosage of Feldene is 20 mg/day. What is the recommended safe dosage per day of Feldene for this child, based on the adult dose and the child’s BSA (m2)? 10 X 39 X 2.5 3600 Child’s BSA is 0.52 m20.52 m2X 20 mg = 6.117 mg/day = 1.7 m2day Ans: 6.12 mg/day 14. Child weighs 22 lbs 5 oz. Recommended dosage for Morphine 0.09mg/lb/dose. What is the recommended safe dose in mgs for this child? 5 oz X 1 lb = 0.3125 lb = 22.3125 lbs 16 oz 0.09 mg X 22.3125 lbs = 2.008 lb/dose = Ans: 2.01 mg/dose lb/dose 1
113 15. Tylenol is ordered for a child who weighs 47 lbs. The label on the bottle of Tylenol states for a child weighing 7 –15 kg, give 40 mg PO every 4 –6 hours PRN. For children weighing 16 –23 kg, give 60 mg PO every 4 –6 hours PRN. What is the maximum daily dose in mg’sof Tylenol that the child can receive per 24 hours? 47 lbs X 1 kg = 21.363 = 21.36 kg 1 2.2 lbs 60 mg every 4 –6 hours = 60 mg every 4 hours is the maximum amount 60 mg every 4 hours (x6) = Ans: 360 mg/day 60 mg every 6 hours (x4) = 240 mg/day
114 Practice Safe Dose Questions (Adult Type) 1. Atorvastatin has been prescribed as 0.02 grams once daily. Using the label below, how many tablet(s) will you administer to the patient in a single dose? The recommended safe dose of Atorvastatin is 10-20 mg a day. Is the ordered dose safe? Answer (1)_____________________ Answer (2) Safe (YES or NO)_____________ RSD: ___________________ Order:________________________ 2. Erythromycin Ethylsuccinate 500 mg has been ordered q8h for an upper respiratory infection for an adult with a G-tube. Using the label below many mL is this order? The recommended safe dose for this patient is 400 mg Erythromycin Ethylsuccinate every 6 hours. Is this dose safe to give? Answer (1)_______ ________ Answer (2) Safe (YES or NO)_____________ RSD: ___________________ Order:________________________ 3. Eliquis 1 tab b.i.d is ordered. Using the label below how many mg will you give the patient in a single dose? The recommended safe dose of this medication is 2.5 - 5 mg daily. Is this dose safe?Answer (1)_____________________ Answer (2) Safe (YES or NO)_____________ RSD: ___________________ Order:________________________
115 4. Ibuprofen 2 tsp (200 mg/ 5 ml) PO is prescribed q4-6 hr PRN for arthritis pain. Using the label on the bottle below, how many mls will the nurse give in a single dose? For adults, the maximum dosage of ibuprofen is 800 milligrams per dose or 3,200 milligrams per day. Is this dose safe to give? Answer (1)_____________________ Answer (2) Safe (YES or NO)_____________ RSD: ___________________ Order:________________________ 5. Digoxin PO 125 mcg daily is ordered for a patient. Using the label below, how many tablet(s) will the nurse give in a single dose? The recommended safe dose for maintenance of this medication is 0.125 - 0.375 mg daily. Is this dose safe to give? Answer (1)_____________________ Answer (2) Safe (YES or NO)_____________ RSD: ___________________ Order:________________________ 6. Metoprolol Succinate 50 mg t.i.d. PO is ordered for high blood pressure. Using the label below, how many tab(s) would the nurse give in a single dose? The recommended safe dose of this mediation is 100 - 400 mg per day. Is this dose safe to give? Answer (1)_____________________ Answer (2) Safe (YES or NO)_____________ RSD: ___________________ Order:______________________
116 7. Cefaclor 1.5 tsp (250 mg/ 5 ml) PO every 12 hours is prescribed a respiratory infection. Using the label below, how many mls will the nurse give in a single dose? Recommended safe dose for Cefaclor for this patient is 250 to 500 mg orally every 8 hours. Is this dose safe to give? Answer (1)_____________________ Answer (2) Safe (YES or NO)_____________ RSD: ___________________ Order:________________________
117 Answers: 1. Ans 1: 2 tabs Ans 2: Safe RSD: 20 mg/day Order: 20 mg/day 2. Ans 1: 12.5 mL Ans 2: Safe RSD: 1600 mg/day Order: 1500 mg/day (Note: The order and the RSD have different time frames; therefore you need to take both ORDER and RSD to per day.) 3. Ans 1: 2.5 mg Ans 2: Safe RSD: 5 mg/day Order: 5 mg/day 4. Ans 1: 20 mL Ans 2: Safe RSD: 3200 mg/day Order: 2400 mg/day (Note: The order and the RSD have different time frames; therefore you need to take both ORDER and RSD to per day. Since the order is q4-6h, you use the time frame that of q4h, which is 6 times a day) 5. Ans 1: ½ or 0.5 tab Ans 2: Safe RSD: 0.375 mg/day Order: 0.125 mg/day (Note: Needed to change 125 mcg to mg to match the RSD.) 6. Ans 1: 2 tabs Ans 2: Safe RSD: 400 mg/day Order: 150 mg/day 7. Ans 1: 5 ml Ans 2: Safe RSD: 1500 mg/day Order: 750 mg/day
118 NURSING 131 –INTRODUCTION TO PHARMACOLOGY Chapter 12: PEDIATRIC DRUG CALCULATION PRACTICE QUIZ #1 DIRECTIONS: Round off answer to the nearest hundredth. Must show work! Label all answers. 1. Order: Morphine 2.7 mg IV. Using the label below, how many ml's will you give? Ans: _________________ 2. Order: Ampicillin 230 mg PO every 6 hours. Using the label below, how many ml's will you give? Ans:_________________ 3. Order: Gentamycin 12.7 mg IV every 8 hours. Using the label below, how many ml's will you give? Ans:. _________________
119 4. Order: ASA 115 mg every 4 hours prn for temperature. You have on hand baby ASA 75 mg tablets. How many tablets will you give? Ans: _________________ 5. You are to give Susphrine 0.04 mg SQ. The vial is labeled 0.5 mg/ 1 ml. You would give ________ ml's. Ans: _________________ 6. You are to give Cephalexin suspension 0.43 g PO q8h. Using the label below, you would give ________ ml's. Ans:_________________ 7. Order: Penicillin 1.2 million units IV stat. Using the label below, you add 11.5 mls of diluent to the vial to reconstitute. How many ml's will you give? Ans:_________________
120 8. A child weighs 10.5 kg. The recommended dose for Digoxin is 0.006 mg/ kg PO. The bottle label reads 1 ml = 0.05 mg. How many ml's will you give? Ans:_________________ 9. Give Rocephin IM every 24 hours to a child weighing 10 lbs 12 oz. Recommended dosage for Rocephin is 75 mg/ kg every 12 hours. What is the safe daily dose in mgs? 9._________________ 10. Order: Gentamycin 8.2 mg IV t.i.d. Recommended pediatric dosage is 30 mg/ m2/ day in 3 - 4 divided doses. Infant weighs 15 lbs and is 23" in height. What is the safe daily dose in mgs? Is the order safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 11. Order: Motrin 300 mg PO t.i.d. Child weighs 84 lbs and is 48" tall. There is not a recommended safe dosage for pediatrics. Recommended adult dose is 200 - 600 mg t.i.d. What is the maximum safe dosage in mg's that the child should receive t.i.d.? Is the order safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________
121 12. Order: Tempra ½ tsp (160 mg/ 5 ml) PO every 4 - 6 hours. Using the label below, how many ml's will you give? Ans:_________________ 13. Order: Septra suspension 2.5 ml B.I.D. po. Septra contains 2 drugs. Recommended dosage is 8 mg/kg/day of trimethroprim and 40 mg/kg/day of sulfamethoxazole. Child weighs 10.4 lbs. What is the safe daily dose in mg for each drug? Is the order safe to give? See label below. Ans: T (RSD)= ______________ Ans: S (RSD)=______________ Ans (Safe or Unsafe) : _____________ RSD (T): ___________ Order (T): ___________ RSD (S): ___________ Order (S): ___________
122 14. Order: Tetracycline 100 mg PO every 6 hours. Child weighs 70 lbs and 50” tall. There is not a recommended safe dose of Tetracycline for children. The usual adult dose is 250 mg qid. What is the child’s safe dosagein mg every 6 hours? Is the order safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 15. Order: Amoxicillin 75 mg PO q.i.d. The recommended safe dose is 40 mg/kg/day. Child weighs 22 lbs 10 oz. What is the recommended safe dosage in mg per day? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 16. A child weighing 70 lbs has orders for Ibuprofen Elixir PO for increased temperature. The directions for recommended safe dosage appear on the label as follows: Children (20-27 kg)..........................180 mg every 6 hours Children (28-35 kg)..........................240 mg every 6 hours What is the recommended safe daily dosage in mgs of Ibuprofen for this child? Ans:_________________
123 17. Azulfidine oral suspension 190 mg PO q.i.d. is ordered for a child weighing 35 lbs and 34 in tall. The recommended safe dosage for Azulfidine is 30 mg/kg/day. What is the recommended safe daily dosage in mgs? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 18. Atarax Elixer is ordered for a child weighing 9 kg and 80 cm tall. There is not a recommended pediatric dose. The recommended adult dose is 50 mg every 6 hours. Calculate the safe dosage in mg to give this child every 6 hours? Ans:._________________ 19. Vancomycin 214 mg PO every 6 hours is ordered for a child weighing 24 lbs 5 oz. The recommended safe dose (RSD) for Vancomycin is 44 mg/kg/day divided every 6 hours. What is the RSD in mgs for this child for 24 hours? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 20. Order is for Keflex 125 mg q6h. The recommended safe dose of Keflex is 100 mg/Kg/day. Child weighs 18 lbs. What is the recommended safe daily dosage in mgs of Keflex? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________
124 ANSWERS:1. 0.27 ml 2. 4.6 ml 3. 0.32 ml 4. 1.53 tabs or 1½ tabs 5. 0.08 ml 6. 8.6 ml 7. 1.2 ml 8. 1.26 ml 9. Ans: 732.95 mg/day is the safe daily dose 10. 0.33 m2Ans: 9.9 mg/day is the safe daily dose Ans: Unsafe RSD: 9.9 mg/day Order: 24.6 mg/day 11. 1.13 m2Ans: 398.82 mg t.i.d.is the safe dose Ans: Safe RSD: 398.82 mg t.i.d. Order: 300 mg t.i.d. 12. 0.8 ml 13. Ans: T (RSD) = 37.82 mg/day Ans: S (RSD) = 189.09 mg/day Ans: Unsafe RSD (T) = 37.82 mg/day Order (T): 40 mg/day RSD (S) = 189.09 mg/day Order (S): 200 mg/day 14. 1.05 m2Ans: 154.41 mg every 6 hrs is the safe dose Ans: Safe RSD: 154.41 mg q6h Order: 100 mg q6h
125 15. Ans: 411.36 mg/day Ans: Safe RSD: 411.36 mg/day Order: 300 mg/day 16. 960 mg/day is the safe daily dosage 17. Ans: 477.27 mg/day Ans: Unsafe RSD: 477.27 mg/day Order: 760 mg/day 18. 0.45 m2Ans: 13.24 mg q6h 19. Ans: 486.25 mg/day Ans: Unsafe RSD: 486.25 mg/day Order: 856 mg/day 20. Ans: 818.18 mg/day Ans: Safe RSD: 818.18 mg/day Order: 500 mg/day
126 NURSING 131 PEDIATRIC PRACTICE PROBLEMS #2 ROUND ALL ANSWERS OFF TO THE NEAREST HUNDRETH! MUST SHOW ALL WORK. 1. Order is for Acetaminophen 7.5 ml every 6 hours PO PRN for pain. On hand is Acetaminophen 80 mg / ½ tsp. How many mgs of Tylenol will the child receive with each dose? Ans:_________________ 2. The recommended pediatric dose for Adriamycin IV is 15 - 30 mg/m2/day. Calculate the dosage in mg a child 180 cm tall and weighing 55 kg should receive each day. Ans:_________________ 3. Order is Azulfidine 80 mg PO q.i.d. The recommended safe dose is 30 mg/kg/day. Child weighs 25 lbs 10 oz. Calculate the recommended safe dosage in mg per day? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 4. The maintenance dose of Gantrisin suspension is 150 mg/kg/day. Calculate the initial dosage in mg of Gantrisin for a 44 lb 4 oz child if the intial daily dose is ½ of the 24 hour maintenance dose. Ans:_________________
127 5. Order is for EryPed ½ tsp (400 mg/5 ml) PO every 6 hours. Using the label below, how many ml's will you give? Ans:_________________ 6. Order is for Solganol 7 mg IM daily. The recommended pediatric safe dosage for Solganol is 10 mg/m2/day. The child is 150 cm tall and 70 lbs. What is the safe dosage in mg this child can receive per day? Is the order safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 7. Order is for Codiene elixer 1 tsp (12 mg/5 ml) PO every 4 - 6 hours PRN for pain. The child weighs 45.6 lbs. The recommended safe dose for Codiene is 0.5 mg/kg every 4 hours. What is the recommended safe dose in mg of Codiene to be given every 4 hours? Is 1 tsp safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________
128 8. Gentamycin 12.5 mg IV every 8 hours is ordered. Recommended safe dose is 60 mg/m2/day. Child weighs 20 lbs and is 28" tall. What is the recommended safe dose in mg per day? Is the 12.5 mg every 8 hours safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 9. Tetracyline 150 mg t.i.d. PO is ordered for a child weighing 14 kg and 86 cm tall. The recommended adult dose of Tetracyline is 250 - 500 mg every 6 hours. What is the recommended safe dosage in mg per day for this child? Is the 150 mg t.i.d safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 10. A child weighing 32.4 lbs is receiving Digoxin 0.28 mg b.i.d PO. Recommended safe dose for Digoxin is 20 mcg/kg/day. What is the recommended safe dose in mgs of Digoxin that this child can receive b.i.d? Is the order safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________
129 ANSWERS: 1. Ans: 240 mg 2. BSA = 1.66 m2Ans: 49.8 mg/day 3. Ans: 349.43 mg/day Ans: Safe RSD = 349.43 mg/day Order: 320 mg/day) 4. 1508.52 mg/day = initial dose 5. 5 ml 6. Ans: 11.5 mg/day (based on BSA = 1.15 m2) Ans: Safe RSD: 11.5 mg/day Order: 7 mg/day 7. Ans: 10.36 mg q4h Ans: Unsafe RSD = 10.36 mg q4h Order = 12 mg q4h 8. Ans: 25.2 mg/day (based on a BSA of 0.42 m2) Ans: Unsafe RSD = 25.2 mg/day Order = 37.5 mg/day 9. Ans: 682.35 mg/day (Based on a BSA of 0.58 m2) Ans: Safe RSD = 682.35 mg/day Order = 450 mg/day 10. Ans: 0.15 mg b.i.d. Ans: Unsafe RSD: 0.15 mg/b.i.d. Order: 0.28 mg/b.i.d.
130 Drug Calculation Practice Test - Pediatrics Directions: Use dimensional analysis to solve the following problems. You must show all work. Round off answer to the nearest hundredth. Label all answers. 1. Order: Demerol (Merperidine HCL) 4.5 mg IM STAT. The child weighs 12 lbs 5 oz. The recommended safe dose for Demerol is 1.1 –2.2 mg/kg every 4 hours PRN. Using the label below, how many ml's will you give? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 2. Order: Amoxicillin 75 mg PO q.i.d. The recommended safe dose is 40 mg/kg/day. Child weighs 22 lbs 10 oz. Calculate the recommended safe dosage per day? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 3. Order: Solumedrol 4.2 mg IM every 8 hours. The recommended safe dose for Solumedrol is 0.5 - 1.7 mg/kg/day. The child weighs 17 lbs 12 oz. What is the maximum safe dosage in mg per day? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________
131 4. On hand is Tylenol 80 mg/0.8ml. Order is for 15 mg/kg/dose. The child weighs 10 lbs 2 oz. How many mls would you give this infant per dose? Ans: ____________ 5. Order: Bicillin L-A 0.416 million units IM. Using the label below, how many ml's will you give? Ans: ____________ 6. Order: Atarax is labeled 25 mg per 5 ml. Order reads 1.2 mg/Kg every 6 hours. How many mls will you prepare for a child who weighs 35 lbs 5 oz? Ans: ____________ 7. The recommended pediatric safe dosage for Rocephin is 100 mg/Kg/day. The doctor has ordered the medication to be given twice a day. What is the safe dose in mgs to be given b.i.d. for a child who weighs 31.5 lbs? Ans: ____________
132 8. Order: Tylenol ½ tsp (160mg/5ml) PO every 6 hours. On hand is Tylenol 120 mg/5ml. How many ml’s will you administer?Ans: ____________ 9. Order is for Erythromycin Drops 153 mg PO every 6 hrs. Using the label below, how many ml’s will you administer? The RSD is 30 –50 mg/Kg/day. Is the ordered dose safe to give if the child weighs 27 lbs 8 oz? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 10. Order: Codeine elixir 1 tsp (12 mg/5ml) PO every 4 - 6 hours PRN for pain. The child weighs 45.4 lbs. The recommended safe dose for Codeine is 0.5 mg/kg every 4 hours. What is the recommended safe dose in mg to be given every 4 hours? Is 1 tsp safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________
133 11. Order: Digoxin 1.5 ml po bid. The recommended safe dose is 20 –40 mcg/Kg/day. Child weighs 4.6 Kg. What is the safe daily dosage in mcg’sfor this child? Using the label below, is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 12. Order: Benedryl 22 mg PO every 6 hours. The recommended safe dose of Benadryl is 4 - 6 mg/kg/day given in 4 equally divided doses. The medication is supplied 50 mg/ml. Determine the maximum every 6 hour dose in mg for a child weighing 37.6 lbs? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________
134 13. Recommended dosage for Septra is 8 mg/kg/day of Trimethroprim and 40 mg/kg/day of Sulfamethoxazole. Septra contains 2 drugs. Child weighs 20 lbs 10 oz. What is the safe daily dose in mg for each drug? Ans (T) RSD: ____________ Ans (S) RSD: ____________ 14. Order: Tetracycline 100 mg PO every 6 hours. Child weighs 70 lbs and 50” tall. There is not a recommended safe dose of Tetracylcine for children. The usual adult dose is 250 mg Q.I.D. What is the child’s safe dosage in mg every 6 hours? Is the order safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 15. Order: Ibuprofen ¼ tsp (120 mg/ 5ml) PO every 6 hours PRN for pain. On hand is Ibuprofen 40 mg/ 0.4ml. The recommended safe dose of Ibuprofen is 4 - 6 mg/kg/day given every 6 hours. Child weighs 29.8 lbs. Determine the maximum dose in mg to be given every 6 hrs. Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________
135 16. A child weighing 70 lbs has orders for Ibuprofenl Elixer PO for increased temperature. The directions for recommended safe dosage appear on the label as follows: Children (20-27 kg)..........................180 mg every 6 hours Children (28-35 kg)..........................240 mg every 6 hours What is the recommended safe daily dosage in mg of Ibuprofen for this child? Ans: ____________ 17. Order is for Gentamycin 7.8 mg IM every 8 hours. The recommended safe dosage for Gentamycin is 60 mg/m2/day. Child weighs 25 lbs and is 32 inches tall. What is the recommended safe daily dose in mg? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 18. Phenergan Elixer is ordered for a child weighing 19 kg and 125 cm tall. There is not a recommended pediatric dose. The recommended adult dose is 50 mg every 6 hours. Calculate the safe dosage in mg to give this child every 6 hours? Ans: ____________
136 19. A child weighing 32.4 lbs is receiving Digoxin 0.28 mg b.i.d. PO. Recommended safe dosage for Digoxin is 0.02 mg/Kg/day. What is the recommended safe dose in mcg of Digoxin that this child can receive b.i.d? Is this safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 20. The physician ordered:0.05 mg IM stat of a drug. The child weighs 26 lbs 2 oz. The recommended dose is 0.001 milligram per kilogram. What is the RSD in mg/dose? Is the order safe for this child? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________
137 Answers to the Practice Test Questions –Pediatrics 1. Ans: 0.18 ml Ans: Safe RSD: 12.31 mg q4h Order: 4.5 mg STAT (One dose) 2. Ans: 411.36 mg/day Ans: Safe RSD: 411.36 mg/day Order: 300 mg/day 3. Ans: 13.72 mg/day Ans: Safe RSD: 13.72 mg/day Order: 12.6 mg/day 4. Ans: 0.69 ml 5. Ans: 0.69 ml 6. Ans: 3.85 ml 7. Ans: 715.91 mg bid 8. Ans: 3.33 ml 9. Ans: 3.83 ml Ans: Safe RSD: 625 mg/day Order: 612 mg/day 10. Ans: 10.32 mg q4h Ans: Unsafe RSD: 10.32 mg q4h Order: 12 mg q4h 11. Ans: 184 mcg/day Ans: Safe RSD: 184 mcg/day Order: 150 mcg/day 12. Ans: 25.64 mg q6h Ans: Safe RSD: 25.64 mg q6h Order: 22 mg q6h
138 13. Ans: Trimethroprin: 75 mg/day RSD Ans: Sulfamethoxazole: 375 mg/day RSD 14. Ans: 154.41 mg q6h (same amount as qid) (Based on a BSA of 1.05 m2) Ans: Safe RSD: 154.41 mg q6h Order: 100 mg q6h 15. Ans: 20.32 mg q6h Ans: Unsafe RSD: 20.32 mg q6h Order: 30 mg q6h 16. Ans: 960 mg/day RSD 17. Ans: 30 mg/day (based on a BSA of 0.5 m2) Ans: Safe RSD: 30 mg/day Order: 23.4 mg/day 18. Ans: 23.82 mg q6h RSD (based on a BSA of 0.81 m2) 19. Ans: 147.27 mcg bid RSD Ans: Unsafe RSD: 147.27 mcg b.i.d. Order: 280 mcg bid 20. Ans: 0.01 mg Ans: Unsafe RSD: 0.01 mg/dose Order: 0.05 mg Stat (dose)
139 EXTRA PEDIATRIC PROBLEMS: 1. Order: Morphine 2.6 mg IM every 4 hrs PRN for pain. On hand is Morphine 8 mg/1 ml. The child weighs 14 lbs 7 oz. The recommended safe dose for Morphine is 0.5 mg –1.2 mg/kg every 4 hours. How many mls will you give? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 2. Order: Tylenol drops ¾ tsp (120 mg/5 ml) PO every 4-6 hours PRN for pain. On hand is a bottle of Tylenol Elixir with a drug strength of 160mg/1 tsp. How many mls will you give? The recommended safe dose for Acetaminophen is 10-15 mg/kg/dose every 4 –6 hours. This child weighs 16 lbs 5 oz. Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 3. Order is for Penicillin 0.35 million units IV every 8 hours. On hand is Penicilllin 750,000 units per 10 mls. How many mls will you give? Is the order safe if the RSD is 300,000 units/kg/day and the child weighs 26 lbs 9 oz? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________
140 4. Your patient has an order for Demerol 45 mg IM every 4 hours prn for pain. The patient weighs 51 pounds and is 53 inches tall. What is the safe pediatric dose in mg q4h if the average adult dose is 100 mg every 4 –6 hours prn? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 5. Order: Lopressor 30 mg/m2daily. The patient is 127 cm tall and weighs 136 lbs. On hand is 20 mg tablets of Lopressor. How many tablets will you give? Ans: ____________ 6. Order: Diphenhydramine HCL is ordered for child who is itching. How many mls will you prepare for a child who weighs 34 lbs 12 oz and 36 inches tall when the order reads Diphenhydramine HCL 30 mg/m2po every 6 hours? Ans: ____________
141 ANSWERS: 1. Order: Morphine 2.6 mg IM every 4 hrs PRN for pain. On hand is Morphine 8 mg/1 ml. The child weighs 14 lbs 7 oz. The recommended safe dose for Morphine is 0.5 mg –1.2 mg/kg every 4 hours. How many mls will you give? Is the ordered dose safe to give? 2.6 mg/1 X 1 ml/8 mg = 0.33 mls 1.2 mg/kg q4hrs X 14.4375 lbs/1 X 1 kg/2.2 lbs = 7.88 mg q4hrs RSD Ans: 0.33 ml Ans: Safe RSD: 7.88 mg q4h Order: 2.6 mg q4h 2. Order: Tylenol drops ¾ tsp (120 mg/5 ml) PO every 4-6 hours PRN for pain. On hand is a bottle of Tylenol Elixir with a drug strength of 160mg/1 tsp. How many mls will you give? The recommended safe dose for Acetaminophen is 10-15 mg/kg/dose every 4 –6 hours. This child weighs 16 lbs 5 oz. Is the ordered dose safe to give? 3 tsp/4 X 120 mg/5 ml X 5 ml/1 tsp X 1 tsp/160 mg X 5 ml/1 tsp = 2.81 mls 15 mg/kg dose q 4-6 hrs X 16.3125 lbs/1 X 1 kg/2.2 lbs = 111.22 mg q 4-6 hrs RSD Order: 3 tsp/4 q 4-6 hrs X 120 mg/5 ml X 5 ml/1 tsp = 90 mg q 4-6 hrs Ans: 2.81 mls Ans: Safe RSD: 111.22 mg q 4 –6 hrs Order: 90 mg q 4 –6 hrs
142 3. Order is for Penicillin 0.35 million units IV every 8 hours. On hand is Penicilllin 750,000 units per 10 mls. How many mls will you give? Is the order safe if the RSD is 300,000 units/kg/day and the child weighs 26 lbs 9 oz? 0.35 million units/1 X 10 mls/0.75 million units = 4.67 mls OR: 350,000 u/1 X 10 mls/750,000 u = 4.67 mls 0.3 million units/kg day X 26.5625 lbs/1 X 1 kg/2.2 lbs = 3.62 million units/day RSD Order: 0.35 million units q8h X 3 = 1.05 million units/day OR: 300,000 u/kg day X 26.5625 lbs X 1 kg/2.2 lbs = 3,620,000 u/day RSD Order: 350,000 u q8h X 3 = 1,050,000 u/day Ans: 4.67 mls Ans: Safe RSD: 3.62 million units/day Order: 1.05 million units/day OR: RSD: 3,620,000 units/day Order: 1,050,000 units/day 4. Your patient has an order for Demerol 45 mg IM every 4 hours prn for pain. The patient weighs 51 pounds and is 53 inches tall. What is the safe pediatric dose if the average adult dose is 100 mg every 4 –6 hours prn? Is the ordered dose safe to give? √51 ÷ 2.2 X 53 X 2.5 = 0.92 m23600 0.92 m2/1.7 m2X 100 mg/q 4-6 hrs = 54.12 mg q4hrs RSD Ans: 54.12 mg q4hrs Ans: Safe RSD: 54.12 mg q4hrs Order: 45 mg q4hrs
143 5. Order: Lopressor 30 mg/m2daily. The patient is 127 cm tall and weighs 136 lbs. On hand is 20 mg tablets of Lopressor. How many tablets will you give? √136 ÷ 2.2 X 127 = 1.48 m23600 30 mg/m2day X 1.48 m2/1 X 1 tab/20 mg = 2.22 tabs Ans: 2.22 tabs 6. Order: Diphenhydramine HCL is ordered for child who is itching. How many mls will you prepare for a child who weighs 34 lbs 12 oz and 36 inches tall when the order reads Diphenhydramine HCL 30 mg/m2po every 6 hours? √34.75 ÷ 2.2 X 36 X 2.5 = 0.63 m23600 30 mg/m2q6h X 0.63 m2/1 X 5 ml/12.5 mg = 3.78 mls Ans: 7.56 mls
144 Chapter 12: Pediatric Practice Problems Directions: Must show all work. Must work all problems using dimensional analysis. Round all answers to the nearest hundredth! 1. Order: Tylenol Elixir 3/4 tsp. (160 mg/5ml) PO every 4-6 hours PRN for pain. On hand is a bottle of Tylenol drops with a drug strength of 80 mg/0.8 ml. How many mls will you give? Answer: ______________ 2. Vancomycin 180 mg PO q6h is ordered for a child weighing 36 lbs 4 oz. The recommended safe dose (RSD) for Vancomycin is 44 mg/kg/day divided every 6 hours. What is the RSD for this child for 24 hours? Is the ordered dose safe to give? Answer: _______________ Safe: __________________ RSD:______________ Order:______________ 3. Rocephin 350 mg IV daily is ordered for a child weighing 8 lbs 5 oz. The recommended safe dose (RSD) for Rocephin is 75 mg/kg per day. What is the safe daily dose for this child? Is the ordered dose safe to give? Answer:________________ Safe: __________________ RSD:______________ Order:______________
145 4. Order: Ceclor 200 mg PO every 8 hours. How many milliliters of Ceclor will you give? The recommended safe dose for Ceclor is 20 mg/kg/day. This child weighs 26.7 kgs. Is the ordered dose safe to give? Answer: _______________ Safe:________________ RSD:______________ Order:______________ 5. Order: Acetaminophen drops 0.6 ml (80 mg/0.8 ml) PO every 4-6 hours PRN for pain. On hand is a bottle of Acetaminophen Elixir with a drug strength of 160mg/1 tsp. How many ml will you give? The recommended safe does for Acetaminophen is 10-15 mg/kg/dose. This child weighs 10.6 pounds. Is the ordered dose safe to give? Answer: _______________ Safe: _______________ RSD:______________ Order:______________ 6. Zinacef 600 mg PO every 6 hours is ordered for a child weighing 21 lbs 9 oz. The recommended safe dose (RSD) for Zinacef is 200-240 mg/kg/day divided every 6 hours. What is the RSD for this child for 24 hours? Is the ordered dose safe to give? Answer: _______________ Safe: __________________ RSD:______________ Order:______________ Ceclor Cefaclor For oral suspension 187 mg/5 ml Total volume 20 ml
146 7. Fortaz 275 mg IV every 8 hours is ordered for a child weighing 12 lbs 8 oz. The recommended safe dose (RSD) for Fortaz is 50 mg/kg every 8 hours. What is the safe dosage to be given every 8 hours for this child? Is the ordered dose safe to give? Answer: _______________ Safe: __________________ RSD:______________ Order:______________ 8. Order: Amoxicillin 975 mg PO every 8 hours. On hand is Amoxicillin suspension 250mg/5 milliliters. How many milliliters of Amoxicillin will you give? The recommended safe dose for Amoxicillin is 80 mg/kg/day divided every 8 hours. The child weighs 36 kg. Is the ordered dose safe to give? Answer ________________ Safe ________________ RSD:______________ Order:______________ 9. Order is for Morphine 1.5 mg IV. You have on hand a 10 mg/1ml tubex syringe. How many ml’s would you give? The recommended safe dose for Morphine is 0.05-0.2 milligrams per kilogram per dose every 4 hours. The patient is 14 pounds 8 ounces. Is the ordered dose safe to give? Answer _______________ Safe _______________ RSD:______________ Order:______________
147 10. Order reads to give Digoxin 2.75 ml PO BID. How many mgs of Digoxin will youadminister per dose? The recommended safe dose for Digoxin is 0.02-0.04 mg/kg/day in two divided doses. The patient weighs 17 lb 5 oz. Is the ordered dose safe to give? Answer________________ Safe _______________ RSD:______________ Order:______________ 11. Order: Ampicillin 750 mg IV every 6 hours for an infant weighing 15.47 lbs and 6 months old. The recommended safe dosage (RSD) for Ampicillin is 200-400 mg/kg/day divided every 6 hours. What is the RSD for this child for 24 hours? Is the ordered dose safe to give? Answer _____________________ Safe ______________________ RSD:______________ Order:______________ 12. A 3 year old is ordered 4.5 milliliters of Lortab Elixir po q6h prn for post-op pain. The recommended safe dose for Lortab is 0.6mg/kg/day of hydrocodone or no more than 5 milligrams per single dose of hydrocodone for children 2-12 years old. The child weighs 35.5 pounds. How many milligrams of hydrocodone is the child receiving per dose? Is the ordered dose safe to give? Answer ___________ Safe ___________ RSD:______________ Order:______________ LANOXIN (digoxin) Pediatric Elixer 50 mcg (0.05 mg) per ml 7.5 ml LORTAB ELIXIR Hydrodone bitratrate 2.5 mg and Acetaminophen 167 mg/5 ml
148 13. The doctor orders Carbenicillin 375 milligrams IM every 6 hours. Using the label below, you add 9.5 milliliters of sterile water to the vial to reconstitute the powder. The recommended safe dose is 30-50 mg/kg/day divided every 6 hours. The patient weighs 64.7 pounds. How many milliliters will you give? Is the dose ordered dose safe to give? Answer: _________________ Safe: _________________ RSD:______________ Order:______________ 14. Tylenol with Codeine elixir 6 ml every 6 hours prn for pain is ordered after surgery. The medication contains 2 drugs. Recommended dosage is 1.2 mg/kg/dose for Codeine and 15 mg/kg/dose for Tylenol. The child weighs 12.4 kg. The supply of Tylenol with Codeine on hand reads: each 5 ml contains 12 mg of Codeine and 120 mg of Tylenol. What is the safe dose for each drug? Is the ordered dose safe to give? RSD Codeine ___________ RSD Tylenol ___________ Safe? _________________ Codiene: RSD:______________ Order:______________ Tylenol: RSD:______________ Order:______________
149 15. Gentamycin 12 mg IV every 8 hours is ordered. Recommended safe dose is 60 mg/m2/day. Child weighs 23.4 lbs and is 42.5 inches tall. What is the recommended safe dose per day? Is the dose safe to give? Answer _____________ Safe _____________ RSD:______________ Order:______________ 16. Order: Adriamycin 20 mg IV daily. Recommended pediatric dosage is 30 mg/m2as a single injection each day. Child weighs 42 lbs and is 41 inches tall. What is the RSD per day? Is the dose safe to give? Answer _____________ Safe ______________ RSD:______________ Order:______________ 17. Order: Cytoxan 185 mg PO once for initial dose and then 125 mg PO twice weekly as a maintenance dose. RSD is 60-250 mg/m2for the initial dose and 50 mg - 150 mg/m2twice weekly as a maintenance dose. Child weighs 19.5 kg and is 110 cm tall. What is the RSD for this child for both the initial dose and the maintenance doses? Are these doses safe to give? Initial Dose ____________ Maintenance Dose _______ Initial Safe? ________________ RSD:______________ Order:______________ Maintenance Safe? ___________ RSD:______________ Order:______________
150 18. The recommended adult dose of Zantac is 150 mg po. Your patient weighs 11.6 kg and is 78 cm in length. What is the maximum safe pediatric dose? Is the ordered dose of 43 mg a safe dose? Answer _________________ Safe _________________ RSD:______________ Order:______________ 19. Your patient has an order for Demerol 50 mg IM every 4 hours prn for pain. The patient weighs 54 pounds and is 52 inches tall. What is the safe pediatric dose? Is this a safe dose if the average adult dose is 100 mg? Answer________________ Safe ___________ RSD:______________ Order:______________ 20. Amoxicillin 87.5 mg po tid is ordered for a child weighing 15 lbs 7 oz. RSD is 20 –40 mg/kg/day. What is the RSD to be given every 8 hours? Is the ordered dose safe to give? Answer________________ Safe ________________ RSD:______________ Order:______________
151 Answers to Pediatric Problems: 1. 1.2 ml 2. RSD: 725 mg/day Safe because ORDER is 720 mg/day 3. RSD: 283.38 mg/day Not safe, because ORDER is 350 mg/day 4. 5.35 ml Not safe, because ORDER is 600 mg/day and the RSD is 534 mg/day 5. 1.88 ml Safe, because ORDER is 60 mg/dose and RSD is 72.27 mg/dose 6. RSD: 2352.27 mg/day Not safe, because the ORDER is 2400 mg/day 7. RSD: 284.09 mg q8h Safe, because the ORDER is 275 mg q8h 8. 19.5 ml Not safe, the RSD is 2,880 mg/day and the ORDER is 2,925 mg/day 9. 0.15 ml Not safe, because the RSD is 1.32 mg q4h and the ORDER is 1.5 mg/dose (order does not have a time frame, so we compare dose to dose) 10. 0.14 mg/dose to be administered Safe, because RSD is 0.31 mg/day and the ORDER is 0.28 mg/day 11. RSD: 2812.73 mg/day Not safe, because the ORDER is 3000 mg/day 12. 2.25 mg/dose child is receiving Safe, because the RSD is 2.42 mg q6h (not to exceed 5 mg/dose) and the ORDER is 2.25 mg q6h 13. 0.94 ml Not safe, because the RSD is 1,470.45 mg/day and the ORDER is 1500 mg/day
152 14. C = RSD: 14.88 mg/dose T = RSD: 186 mg/dose Safe, because the ORDER for codeine is 14.4 mg/dose and the ORDER for Tylenol is 144 mg/dose (You are comparing dose to dose, because the recommendation is based on per dose) 15. RSD: 33.6 mg/day Not safe, because the ORDER is 36 mg/day 16. RSD: 21.9 mg/day Safe, because the ORDER is 20 mg/day 17. Initial dose = 192.5 mg/day Maintenance dose = 115.5 twice weekly INITIAL DOSE IS SAFE because the ORDER is for 185 mg/dose MAINTENANCE DOSE IS NOT SAFE because the ORDER is for 125 mg twice weekly 18. RSD: 44.12 mg/dose Safe, because the ORDER is 43 mg/dose (You are comparing dose to dose, because the adult recommendation is per dose.) 19. RSD: 55.29 mg/dose Safe, because the order is for 50 mg/dose (You are comparing dose to dose, because the adult recommendation is per dose.) 20. RSD: 93.56 mg q8h Safe, because the RSD is 93.56 mg q8h and the ORDER is for 87.5 mg tid. (Note: q8h and t.i.d. are the same number of times per day. The only difference between them is the time of day that the med is given)
153 Chapter 7 Syringes The objectives for chapter 7 –The student should: 1. Identify parts of the syringe. 2. Identify various types of syringes. 3. Read and measure dosages on the syringe. 4. Select the appropriate syringe to administer prescribed dosages. 5. Read the calibrations on the various types of syringes: hypodermic, insulin, and pre-filled cartridges. Note: The student is not responsible for learning the various types of needles; how to administer an injection; or the administration of insulin. Assignments: Work problems in chapter 7. Work problems in Learning Packet NEVER RECAP A NEEDLE USED TO GIVE AN INJECTION
154 NURSING 131 –INTRODUCTION TO PHARMACOLOGY CHAPTERS 6, 7, AND 12: PRACTICE PROBLEMS DIRECTIONS: Round off answer to the nearest hundreth. Must show work! Label all answers. 1. Order: Keflex 250 mg po q6h. On hand is Keflex 0.5 grams per 1 tab. How many tablets will you give? Ans: ____________ 2. Order: Ampicillin 540 mg PO every 6 hours. On hand is Ampicillin 250 mg 2 ml. How many ml’s will you give?Ans: ____________ 3. Order: Aminophylline 510 mg po bid. On hand is Aminophylline 250 mg per tablet. How many tablets will you give? Ans: ____________ 4. Order: Benadryl is labeled 25 mg per 5 ml. How many ml’s will you prepare for a child who weighs 35 lbs when the order reads 1.2 mg/Kg every 6 hours? Ans: ____________ 5. Order: Cephalexin 250 mg/m2/day. Each capsule contains 500 mg. The patient’s BSA is 2.1 m2. How many capsules will you give? Ans: ____________
155 6. Order: Thyroxin 16.25 mg/m2qd. The patient is 164 cm tall and weighs 95 Kg. On hand is 62.5 mg/tablet. How many tablets will you give? Ans: ____________ 7. Order: Penicillin 230,000 units IM. On hand is Penicillin 2.4 million units/ 2 ml. How many ml's will you give? Ans: ____________ 8. Order: Codiene 5.8 mg po q12h. There is not a recommended safe dose for this child. If the usual adult dose is 60 mg per day, what would be the child’s safe dose per day? The child weighs 28 lbs and is 30 in tall. Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 9. Order: Humulin insulin 0.11 units/Kg subcut qd. The child weighs 45.5 Kg. How many units of insulin will you administer to this child? Ans: ____________
156 10. Order: Dilantin 120 mg/m2po qd. How many mls will you administer if the child has a BSA of 1.3 m2? Ans: ____________ 11. Order: Procainamide 60 mg/m2po q12h. Using the square root metric formula, calculate the correct dosage per day for a child who weighs 40 lbs and is 42 in tall. Ans: ____________ 12. Order: Erythromycin 1/2 tsp (200 mg/ 5 ml) PO every 6 hours. Label on bottle reads 150 mg/ 5 ml. How many ml's will you give? Ans: ____________ 13. Order: Digoxin 1.25 ml po bid. On hand is Digoxin 0.05 mg/1 ml. The recommended safe dose is 0.02 mg –0.04 mg/Kg/day. Child weighs 14 lbs. What is the safe daily dosage for this child? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________
157 14. Tetracycline 325 mg po b.i.d. is ordered for a child weighing 22.2 Kg and 114 cm tall. The recommended adult dose of Tetracyline 250 –500 mg every 6 hours. What is the recommended safe dosage per day for this child? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 15. Order: Adriamycin 18.2 mg IV daily. Recommended pediatric dose is 30 mg/m2as a single injection each day. Child weighs 31 lbs and is 38 in tall. What is the recommended safe dosage per day? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 16. Order: Tylenol with Codiene elixir 1.8 ml every 6 hours. Medication contains 2 drugs. Recommended dosage is 1.2 mg/kg/dose for Codiene and 10 mg/kg/dose for Tylenol. Child weighs 12.5 lbs. What is the safe dose for each drug? The drug strength of Tylenol with Codiene is: Each 5 ml contains 12 mg of Codiene and 120 mg of Tylenol. Is the ordered dose safe to give? (Remember to keep each drug separate.) Ans: RSD for Codiene: ________________ Ans: RSD for Tylenol________________ Ans: Safe/Unsafe: ___________________ Codiene: RSD: ___________ Order: ___________ Tylenol: RSD: ___________ Order: ___________
158 17. Draw an arrow to 3.6 ml. 18. Draw an arrow to 0.44 ml. 19. Draw an arrow to 26 units. 20. Draw an arrow to 0.8 ml.
159 Answers: 1. 0.5 or ½ tab 2. 4.32 ml 3. 2.04 tabs 4. 3.82 ml 5. 1. 05 capsule 6. 0.54 tablet (based on a BSA of 2.08 m2) 7. 0.19 ml 8. RSD: 18 mg/day (based on a BSA of 0.51 m2) Safe RSD: 18 mg/day Order: 11.6 mg/day 9. 5.01 units 10. 6.24 mls 11. 87.6 mg/day (based on a BSA of 0.73 m2) 12. 3.33 ml 13. RSD: 0.25 mg/day Safe RSD: 0.25 mg/day Order = 0.13 mg/day 14. RSD: 988.24 mg/day (based on a BSA of 0.84 m2) Safe RSD: 988.24 mg/day Order = 650 mg/day 15. RSD: 18.3 mg/day (based on a BSA of 0.61 m2) Safe RSD: 18.3 mg/day Order = 18.2 mg/day 16. Codiene: RSD: 6.82 mg/dose Tylenol: RSD: 56.82 mg/dose Safe Codiene: RSD: 6.82 mg/dose Order = 4.32 mg/dose Tylenol: RSD: 56.82 mg/dose Order = 43.2 mg/dose
160 17. Draw an arrow to 3.6 ml. 18. Draw an arrow to 0.44 ml.19. Draw an arrow to 26 units. 20. Draw an arrow to 0.8 ml.
161 Chapter 9 Parenteral MedicationsThe objectives for Chapter 9: The student should be able to: 1. Define parenteral medications. 2. Solves calculation problems necessary to prepare medications for injections from drugs supplied in liquid form from vials or ampules. 3. Solves calculation problems necessary to prepare medications for injections from drugs supplied in powder form from vials. 4. Calculates the amount of drugs ordered in units. 5. Read and follow instructions on medication labels for reconstitution of the medication. Assignments:Work problems in Chapter 9 Work problems in Learning Packet 1.The order is for 0.5 g Streptomycin IM. According to the drug label below, how many ml’s will you give if you added 3,2 mls of diluent to the vial to reconstitute? Ans: ____________ 2.Your patient is to receive a dose of a drug with a recommended dose or 0.05 mg/kg/day. The patient weighs 55 kg. It is supplied as 5 mg/5 ml. How many ml’s will you give?Ans: ____________
162 3.You are to give Heparin 4000 units. The label states there are 10,000 units in 1 ml. How many ml’s will you give?Ans: ____________ 4.A vial of Ampicillin contains 1 g. The directions on the label state: Add 3.5 ml sterile water to make a solution in which 2.2 ml equals 660 mg. Your patient is ordered to receive 500 mg. How many ml’s will you give?Ans: ____________ Answers: 1.) 2 ml 2.) 2.75 ml 3.) 0.4 ml 4.) 1.67 ml
163 Parenteral Medications Chapter 9 The prescriber ordered 3 milligrams of methodone hydrochloride (Dolophine) subcut. Study the label below. How many milliliters would you administer to the patient? Objectives Do calculations necessary to prepare medications for injections from drugs supplied in liquid form from vials or ampules Do calculations necessary to prepare medications for injections from drugs supplied in powdered form from vials Do calculations involving units 3 mg x 1 ml = 0.3 ml 10 mg Ampules and Vials The prescriber ordered 0.002 grams of Naloxone HCL (Narcan) IM. Read the label below and calculate how many milliliters of this narcotic antagonist you would administer? 20 ml vial Dolophine Hydrochloride Methadone HydrochlorideInjection 10 mg / ml Multiple Dose Narcan 1 mg/ml (naloxone HCL) 10 ml vial For IM, SC, or IV use
164 0.002 g x 1 ml x 1000 mg 1 1 mg 1 g = 2 ml The prescriber order Fragmin 3500 units subcut q12h. Reading the label below, how many milliliters will you administer to the patient? Determine the quantity of solution to be withdrawn from the vial if the medication order reads 250 milligrams of 10% calcium chloride. (See page 188 in text for actual label)3500 u x 1 ml = 0.35 ml 10,000 u 250 mg x 1 ml = 2.5 ml 100 mg The prescriber has ordered 0.25 gram of the Kefzol. Reading the label below, how many milliliters of the solution would contain the prescribed dose? Fragman dalteparin hydrochloride injection 10,000 IU per ml For subcutaneous injection 9.5 ml multiple dose vial 10%10 ml single dose vial Calcium ChlorideInjection 1 gram (100 mg/ml) For IV use only KEFZOL sterile cefazolin sodium Equivalent to 500 mg Directions:Add 2 ml of sterile water or 0.9%NS for injection. Provides an approximate volume of 2.2 ml (225 mg/ml). Shake well.
165 0.25 g x 1 ml x 1000 1 225 mg 1 g = 1.11 ml 4. (Label p. 268) Order: Streptomycin 600 mg IM. How many ml will you give? 5. (Label p. 274) Order: Pfizerpen 650,000 units IV. How many mls will you give if you added 33 ml of diluent to the vial? 6. (Label p. 184) Order: Humulin Rinsulin 230 units to mix in 1 Liter of 0.45% NS. How many mls of Insulin will you prepare? Examples For the following questions, use the designated drug label in your textbook. Answers are on final page 7. (Label p. 250) Order: Penicillin G Potassium 2.4 million units IV. How many mls of diluent will you add to the powder to obtain a drug strength of 1,000,000 units/ml? How many mls will you give? 8. (Label p. 246) Order: Ceftriaxone 0.48 g IV. If you add 1.8 mls of diluent to the vial, what is the drug strength? How many mls will you give? 9. (Label p. 257) Order Fragmin 3700 units SubQ. How many ml will you give? 10. (Label p.256 ) Order: Heparin Sodium 6200 units SQ. How many ml will you give? 1. (Label p. 243) Order: Tobramycin 110 mg IM. How many ml will you give? 2. (Label p. 253) Order: Solu-Cortef 125 mg IM. How many ml will you give? 3. (Label p. 346) Order: Doxycyline 75 mg IV. How many ml will you give? Answers: 1.2.75 ml 2.1 ml 3.7.5 ml 4.1.5 ml 5.1.3 ml 6.0.46 ml 7.3.2 ml 2.4 mls to give 8.250 mg/ml 1.92 ml to give 9.0.15 ml 10.0.62 ml
166 Chapter 10: Calculating Flow Rates for Enteral Solutions and Intravenous Solutions The objectives of Chapter 10: the student should be able to: 1. Recall the definitions of enteral and intravenous. 2. Describe the basic concepts and standard equipment involved in the delivery of intravenous (IV) and enteral infusions. 3. Calculate the flow rate of IV solutions for a gravity set and an infusion pump. 4. Calculate the flow rate of enteral solutions for a gravity set and an infusion pump. 5. Calculate the durations (time factors) of enteral and intravenous infusions. Assignments: Work problems in Chapter 10 Work problems in Learning Packet HELPFUL HINTS FOR I.V. PROBLEMS When calculating intravenous flow rates, the nurse must be aware of the type of I.V. set being used. Sets that contain a needle in the drip chamber are called microdrip or minidrip. The microdrip set delivers 1 ml in 60 gtts. The 60 gtts in 1 ml is called the drop factor when calculating the flow rate. Infusion sets without a needle in the drip chamber are called macrodrip. These sets are not standard. The package label will state the drops per milliliter. You need to know this information to calculate the IV drip rates. Some common macrodrip sets deliver 10 gtts in 1 milliliter, 15 gtts in 1 ml, and 20 drops in 1 ml. Be sure to check your package for the correct drop factor. Problems in IV calculations are solved in two steps. Step 1 is used to solve problems requiring an infusion pump. Step 2 will solve problems related to the # of gtts per minute if not using a pump. There are formulas in your textbook that will assist you with the following problems. Remember: With dimensional analysis, there is not a need to memorize formulas. The formula in your textbook for calculating IV flow rates is: # of ml to infuse x 1 hour x (drop factor) drops = drops (gtts) # of hours to run 60 minutes per ml min
167 Example 1: If the order is to infuse 600 ml q8h and you are using an IV set with a drop factor of 15 gtts per ml, you would set up the problem as follows: 600 ml x 1hr x 15 gtts = _____ gtts 8 hr 60 min 1 ml min Cancel across the line. The ml’s cancel, hr’s cancel. That leaves gtts per minute. Do the calculation. The answer is: 18.75 gtts/min = 19 gtts/min (Round to the nearest whole number) To calculate milliliters per hour to set an IV infusion device you may use the following formula. Step 1. Total number of milliliters ordered = number of Number of hours to run ml/hr Another way to write it is: # ml ordered = ml/hr # hr to run This formula is used to determine the number of milliliters per hour. The pump can be set then at the number of milliliters per hour. The pump will automatically deliver the correct number of milliliters per hour. When calculating number of milliliters per hour, round to the nearest hundredth. The pump can then be set at this number. Ex: 1000 ml of D5 ½ NS in 12 hours. 1000 ml. = 83.333 = 83.33 ml/hr is the correct infusion rate for the pump. 12 hr Step 2. number of milliliters per hour x drop factor = drops per minute number of minutes In other words, ml/hr x drop factor = gtt/min # of minutes This formula is used when you have been given the number of milliliters per hour or after you have used Step 1 to determine the number of milliliters per hour. Remember you must know the drop factor of the set being used in order to determine the number of drops per minute. In practice calculation or on a test, you will be given the drop factor. In the clinical setting, you must get the drop factor from the label on the package.
168 Example 2: 500 ml of D5 NS to run from 9 a.m. –1 p.m.Available IV set: microdrip at 60 gtt/ml (drop factor), no pump is available. How many gtts per minute? 500 ml X 1 hr X 60 gtts = 125 gtts 4 hrs 60 min 1 ml min Note: When using the microdrip set with a drop factor of 60, the number of drops per minute are the same as the number of ml per hour. Because the drop factor is always 60 and the minutes are always 60, they cancel each other out. Therefore the number of ml per hour is the same number as the drops per minute to infuse. Example 2: Now, let’s do the same problem using another IV set. The drop factor is 10 gtts/ml. 500 ml X 1 hr X 10 gtts = 5000 gtts = 20.83 = 21 gtts/min 4 hrs 60 min 1 ml 240 min Since we have an answer of 20.83, you need to round to the nearest whole number = 21 gtt/min. Try this same problem using a drop factor of 15 gtts per ml.
169 Calculating Flow Rates for IV and Enteral Fluids Chapter 10 Using a calibrated plastic bag to administer a tube feeding. Objectives: Describe the basic concepts and standard equipment involved in the delivery of intravenous (IV) and enteral infusions. Calculate the flow rate of IV solutions using a gravity set and an infusion pump. Calculate the flow rate of enteral solutions using a gravity set and an infusion pump Types of IV Fluids D5W 0.9% NS (Normal Saline) 0.45% NS D5½ NS (D50.45% NS) D5¼ NS (D50.225% NS, or D50.25% NS) LR (Lactated Ringers) D5LR Fluids can be given to a patient slowly over a period of time through a vein (intravenous) or through a tube inserted into the alimentary tract (enteral). Primary intravenous line
170 Box of IV tubing calibrated at 10 drops approximately 1 mL. Calculating the Flow Rate of Infusions (No need to memorize these formulas) Amount (# of ml’s) x dropfactor (gtts/ml) = gttstime in minutes min OR Amount (# of ml’s)x gtts (drop factor) x 1 hour # of hours 1ml 60 min = ? gtts/min Tubing labeled with date, time of attachment and nurse’s initialsIn order to use dimensional analysis to solve these problems, you need to know what set- up you have and what information to pull in order to work the problem. Gravity Set Pump Seeking drops/min Seeking mls/hr Volume Volume Time Time Drop Factor The order is 840 ml per 10 hours of D5W. The drop factor is 20 gtts per ml. Calculate the number of drops per minute that you would administer. 840 ml x 20 gtts x 1 hr = 28 gtts/min 10 hrs 1 ml 60 mins Continuous Flow Solution Set 3 injection sites10 drops approx 1 ml 10Common Drop Factors 10 gtts = 1 ml 15 gtts = 1 ml 20 gtts = 1 ml 60 microgtts = 1 ml* *Note:60 micro-drops = 1ml is universal. Also called minidrop set or pediatric set.
171 The order is 240 ml per 10 hours of D5W. The drop factor is 10 gtts per ml. Calculate the number of drops per minute that you would administer. 240 ml x 10 gtts x 1 hr = 4 gtts/min 10 hr 1 ml 60 mins Note: In reality, a gravity flow rate under 15 –20 drops/min will not be possible to deliver via a gravity set. This would need to be recalculated to determine a flow rate for a pump. 240 ml = 24 ml for a pump 10 hr hr The prescriber ordered: 750 mL 0.9% NS IV to infuse over 8 hrs. Drop factor is 10 gtts/ml. How many gtts/min will you deliver? 750 ml x 10 gtts x 1 hr 8 hrs 1 ml 60 min =15.625 (16 gtts/min) Note: When the answer to a gravity set has a decimal (or a portion of a drop); always round your answer off to the nearest whole number. The order is 775 mL of 5% D/W in 6 hours. The flow rate was set at 26 drops per minute. You assess the infusion flow 3 hours later, and the patient has received 500 mL IV with 275 mL remaining to be infused. Recalculate the flow rate with a drop factor of 10 drops per milliliter. 275 ml x 10 gtts x 1 hr 3 hrs 1 ml 60 min = 15.2777….(15 gtts/min) Note: If you see the words recalculate, redo, reset, or calculate the new flow rate, you are to assess the volume of fluid that is remaining and the time remaining to use in your work to solve the problem. Also there are some of these problems that you are starting over with a brand new order and you use the volume and time of the new order.
172 The prescriber ordered 850 mL of D50.45% NS to infuse at 17 drops per minute. If the drop factor is 15 drops per milliliter, how many milliliters per hour will the patient receive? 17 gtts x 1 ml x 60 min = 68 ml/hr 1 min 15 gtts 1 hr A patient has an order for Sustacal 240 milliliters in 2 hours via feeding tube. The calibration of the tubing is 18 drops per milliliter. Calculate the rate of flow in drops per minute. 240 ml x 18 gtts = 36 gtts/min 120 min 1 ml
173 NOW FOR PRACTICE: Worksheet –IV Calculations 1.Your patient is to receive 1000 ml of D5 NS in the next 6 hours. The drop factor is 15 gtts/ml How fast will you run the IV? Ans: ____________ 2. The doctor orders 1000 ml D5NS to run in over the next 12 hours. The drop factor is 10 gtts/ml. How fast will you run the IV? Ans: ____________ 3. You are to give your patient 1500 ml of Ringers Lactate over the next 8 hours. If the drop factor is 15 gtts/ml, how fast will you run the IV? Ans: ____________ 4. The order is for your patient to receive 1000 ml of D5 NS over the next four hours. With a drop factor of 15 gtts/ml, how fast will you run the IV? Ans: ____________
174 5. The doctor orders that your patient receive 500 ml of D5W over the next 8 hours. You are using an IV administration set that delivers 15 gtts/ml. How fast would you run the IV? Ans: ____________ If you started the IV at 1030 hours, and you noticed that there was 200 ml left in the bag at 1430, what would you do? Ans: ____________ If you changed the rate, what would your adjusted rate of administration be in gtts/min? Ans: ____________ 6.The doctor has left the order to give your patient 3000 ml of D5W over the next 16 hours. The IV administration set you are using delivers 10 gtts/ml. How many gtts/min will you run in the IV? Ans: ____________ If you started the above IV at 1000 hours, at what time could you expect that 1500 ml of the fluid should be infused, if it is running adequately and there are no problems with infiltration or anything that would delay the rate of infusion? Ans: ____________
175 IV Calculation –Worksheet Answers: 1.Ans: 42 gtt/min. (41.67) 2.Ans: 14 gtt/min (13.88) 3.Ans: 47 gtt/min (46.875) 4.Ans: 63 gtt/min (62.5) 5.Ans: 16 gtt/min (15.62) Ans: Recalculate the flow rate Ans: 13 gtt/min (12.5) 6. Ans: 31 gtt/min (31.25) Ans: 1800 hrs
176 CALCULATING IV FLUIDS FOR ADMINISTRATION TO CHILDREN: The calculation of IV fluids for children is basically the same as for the adult. The exception is that in young children the drop factor for the IV administration sets is 60 drops (gtts) per cc or ml. These IV sets may be referred to as mini-drop or microdrop sets. In pediatric IV problems the drop factor is always considered to be 60 gtts/ml unless otherwise stated. When setting up IV fluids the drop factor is printed on the label of the package, so it should be easy to identify the correct IV set. An IV is ordered for your patient of 1200 ml to be administered over 16 hours. Using the pediatric drop factor calculate the number of drops per minute the fluids should infuse. 1200 ml X 60 gtts X 1 hr = 75 gtts/min 16 hr 1 ml 60 min Look at the above equation and note that all values cancel except gtts/min. Also note that all numbers cancel except the number of mls to be given and the number of hours for the infusion, therefore the only calculation necessary is: 1200 ml = 75 ml/hr 16 hr * Note: ml/hr and gtts/min are the same when using the 60 gtt/ml drop factor. When you are using this drop factor, you need only calculate the ml/hr, and you will have the gtts/min. If you are given any other drop factor must use the equation to calculate the gtts/min: For example when using a set with a 10 drop factor: 1200 ml X 10 gtts X 1 hr = 12.5 = 13 gtts/min 16 hr 1 ml 60 min (When calculating gtts per minute using a 10 drop factor you may always divide ml per hour by 6 to get gtts/min) When using a set with a 15 drop factor: 1200 ml X 15 gtts X 1 hr = 18.75 = 19 gtts/min 16 hr 1 ml 60 min Again cancel ml and hr in the equation. (When calculating gtts per minute using a 15 drop factor you may always divide ml per hour by 4 to get gtts/min)
177 Calculate the following IV problems: 1. Give 250 ml over 6 hours using a pediatric IV set. The fluids should infuse at ____________gtts/minute. Ans: ____________ 2. Give a piggyback med using a pediatric drop factor. Give 30 ml over 30 minutes. The med should infuse at a rate of ___________gtts/min. Ans: ____________ 3. Your patient has received 150 ml of D50.2 NS at 50 ml/hr. The order is changed to complete the remainder of the 500 ml of fluid in 14 hours. How many gtts/min must the fluid infuse to accomplish this? The drop factor is 60 gtt/ml. Ans: ____________ 4. Infuse 420 ml of D50.45 NS over 24 hours. Infuse at _________gtts/min. (microdrop) Ans: ____________ 5. Give 400 ml D50.2 NS with 10 mEq KCl every 6 hours using the minidrop set. This equals ___________gtts/min. Ans: ____________
178 6. Your 15-year-old patient is to receive a 1000 ml IV of D50.45 NS every 12 hours. The drop factor for the IV set is 15 gtts/ml. What is the drop rate? ___________gtts/min Ans: ____________ 7. Give 150 ml IV q1h using a 10 drop factor. __________gtts/min. Ans: ____________ 8. Your patient is to receive IV fluids at a rate of 300 ml over 8 hours. Calculate the rate using a pediatric IV set. _________gtts/min. Ans: ____________
179 Answers: 1.) Ans: 42 gtt/min (41.67) 2) Ans: 60 gtt/min 3.) Ans: 25 gtt/min 4.) Ans: 18 gtt/min (17.5) 5.) Ans: 67 gtt/min (66.7) 6.) Ans: 21 gtts/min (20.8) 7.) Ans: 25 gtts/min 8.) Ans: 38 gtt/min (37.5)
180 NUR 131: Nursing Across the Lifespan IV IV Medication Rate Practice 1. 20 ml of med over 30 minutes = ___________ml/hr 2. 28 ml of med over 30 minutes = ___________ml/hr 3. 48 ml of med over 60 minutes = ___________ml/hr 4. 116 ml of med over 60 minutes = __________ml/hr 5. 18 ml of med over 15 minutes = ___________ml/hr 6. 15 ml of med over 20 minutes = ___________ml/hr 7. 80 ml of med over 40 minutes = ___________ml/hr 8. 15 ml of med over 45 minutes = ___________ml/hr 9. IV rate is 120 ml/hr = ____________ ml of med over 30 minutes. 10. IV rate is 84 ml/hr = ____________ ml of med over 15 minutes. Answers: 1. 40 ml 2. 56 ml 3. 48 ml 4. 116 ml 5. 72 ml 6. 45 ml 7. 120 ml 8. 20 ml 9. 60 ml 10. 21 ml
181 Chapter 11: CALCULATING FLOW RATES FOR INTRAVENOUS MEDICATIONS AND DURATION OF FLOW. This chapter utilizes everything that you have learned in this course. The objectives for Chapter 11 include: 1. Describe intravenous piggyback medication administration. 2. Calculate the rate of flow of intravenous piggyback medications using gravity sets or and infusion pump. 3. Calculate the flow rate of intravenous solutions based on the amount of drug per minute or per hour, using a gravity set and infusion pump. 4. Determine the amount of drug a patient will receive IV per minute or per hour. 5. Calculate IV flow rates based on an individual’s weight. 6. Calculate IV flow rates based on an individual’s body surface area. 7. Calculate the infusion time of an IV solution. Assignments:Work problems in Chapter 11 Work problems in Learning Packet
182 Calculating Flow Rates for Intravenous Medications and Duration of Flow Chapter 11 The prescriber ordered: Kefzol 500 mg IVPB q8h. Read the information for this antibiotic medication on the next slide. Follow the directions on the label, and infuse in 1 hour. The tubing is labeled 60 microdrops per milliliter. Calculate the flow rate. Objectives: •Describe intravenous piggyback medication administration. •Calculate the rate of flow of intravenous piggyback medications. •Calculate the flow rate of intravenous solutions based on the amount of drug per minute or per hour. •Determine the amount of drug a patient will receive IV per minute or per hour •Calculate IV flow rates based on weight. •Calculate IV flow rates based on body surface area. •Calculate the infusion time of an IV solution. 100 ml x 60 gtts = 60 min 1 ml 100 gtts/min Intravenous Piggyback Infusions Primary and secondary (IVPB) infusion setup. The medication order reads: 1000 mL 5% D/W with 500 mg lidocaine at 1 mg/min. Calculate the flow rate if the drop factor is 15 drops per milliliter. In this example, the prescriber has specified the solution (1000 milliliters of 5% D/W containing 500 milligrams of the drug lidocaine) and also the amount of lidocaine per minute (1 milligram per minute) that the patient is to receive. 1 mg x 15 gtts x 1000 ml = 30 gtts/min 1 min 1 ml 500 mgKEFZOL 100 ml sterile cefazolin sodium Equivalent to 500 mg 50 ml Directions:Add 100 ml of isotonic diluent and shake well.
183 The prescriber writes an order for 50 units of Insulin in 500 ml milliliters of 0.9% NS at the rate of 2 units/hr. Calculate the flow rate using a pump. 2 units x 500 ml 1 hr 50 units = 20 ml/hrSome IV and enteral medications are prescribed based on your patient’s weight. For example, the medication order might read:0.001 mg/Kg/min This means that each minute your patient is to receive 0.001 milligram of the drug for every kilogram of body weight. This can also be written as 0.001 mg Kg/min The prescriber ordered: 250 ml 5% D/W with 90 mg Aredia, 0.001 mg/kg/min IV. The patient weighs 80 kilograms, and the drop factor is 20 drops per milliliter. Calculate the flow rate. 250 ml x 0.001 mg x 80 Kg x 20 gtts 90 mg Kg/min 1 1 ml = 4.4 = 4 gtts/min Note: Because the flow rate for this gravity set is too low, this would need to be put on a pump. 250 ml x 0.001 mg x 80 Kg x 60 min 90 mg Kg/min 1 1 hr = 13.33 ml/hr The prescriber writes an order for 400 mg of Daptomycin in 100 ml of 5% D/W to infuse at 10 mg/min. Calculate the flow rate for an IV pump. 10 mg x 100 ml x 60 mins 1 min 400 mg 1 hr = 150 ml / hr Your patient is receiving an IV of 1000 milliliters of 0.9% NS with 1000 milligrams of the bronchodilator aminophylline (somophyllin). The flow rate is 35 milliliters per hour. How many milligrams per hour is your patient receiving? 1000 mg x 35 ml = 35 mg/hour 1000 ml 1 hr The prescriber ordered 1.7 grams of oxacillin (Prostaphlin), an antibiotic drug, in 1000 milliliters 0.9% NS, to be infused at a rate of 200 milligrams per square meter per hour.Your patient’s BSA is 1.5 square meters. How many milliliters per hour should your patient receive? Note: 1.7 g = 1700 mg 1000 ml x 200 mg x 1.5 m2x 1g 1.7 g m2/hour 1 1000 mg = 176.47 ml/hour
184 An infusion of 5% D/W has solution remaining in the bag below. It is infusing at a rate of 20 drops per minute. If the drop factor is 15 drops per milliliter, how many hours will it take for the remaining solution in the bag to infuse? 5% D/W intravenous solution 300 ml(300 ml remaining in bag). 300 ml x 15 gtts x 1 min x 1 hr 1 1 ml 20 gtts 60 min = 3.75 hours Order: 250 ml of Ampicillin to infuse over 45 minutes. Drop factor is 15 gtts/ml. Calculate the flow rate. 250 ml x 15 gtts 45 min 1 ml = 83.33 = 83 gtts/min Order: 50 ml of Zantac to infuse over 15 minutes. How many ml’s/hour will you set the IV pump? 50 ml x 60 min = 200 ml/hr 15 min 1 hour An IV of 1500 milliliters of 10% D/W is to infuse at a rate of 40 drops per minute. The drop factor is 15 drops per milliliter. If this IV solution begins to infuse at 10:15 a.m., at what time will it finish? 1500 ml x 15 gtts x 1 min x 1 hour 1 1 ml 40 gtts 60 min = 9.38 hrs = 9 hrs 22.8 or 23 min (you are encouraged to round the minutes to the nearest whole number) 10:15 am + 9 hrs 23 min = 1938 or 7:38 pm Order:Dopamine to infuse at 24 ml/hr. On hand is Dopamine 250 mg/250 ml. Patient weighs 176 lbs. How many mcg/kg/min is the patient receiving? 24 ml X 250 mg X 2.2 lbs X 1 X 1000 mcg X 1 hr 1 hr 250 ml 1 kg 176 lbs 1 mg 60 min = 5 mcg/kg/min Remember: mcg Kg/min 500 ml D5W
185 Order: Ampicillin 240 mg IV q6h IV to infuse over 30 minutes. On hand is a 250 mg vial and instructions state to add 3.4 mls of diluent to the vial to get a concentration of 62.5 mg/1 ml. How many mls of Ampicillin will you add to a 50 ml bag of D5W? What is the flow rate using an IV pump? 240 mg x 1 ml = 3.84 mls added to 1 62.5 mg to D5W 53.84 mls x 60 min = 107.68 ml 30 min 1 hrOrder: Rocephin 350 mg IV daily. Instructions are to add350 mg (1.4 ml) to a 25 ml IV bag of D5 0.2NS to infuse over 45 minutes. Using a pediatric IV set, what is the flow rate? 26.4 ml x 60 drops = 35.2 45 min 1 ml = 35 drops/minOrder:Patient is receiving a continuous Heparin dripat 20 ml/hr. The latest PTT is 55. Using the Standard dose Heparin adjustment protocol on the next page, determine the number of units of Heparin the patient will receive as a bolus; and calculate the new rate of the Heparin drip. Patient weighs 180 lbs. Heparin bag states there are 15,000 units in 500 ml of NS. Low Dose Standard Heparin Adjustment Repeat PTT PTT < 30 PTT < 40 70 units/kg IVP bolusand increase drip rate by 4 units/Kg/hr In 8 hrs PTT 31 –44 PTT 41 –60 35 units/kg IVP bolus and increase drip rate by 2 units/Kg/hr In 8 hrs PTT 45 –70 PTT 61 –80 No change –Therapeutic range In 8 hrs PTT 71 –80 PTT 81 –100 Decrease drip rate by 2 units/Kg/hr In 8 hrs PTT > 80 PTT > 100 Hold Heparin drip for one hour then decrease by 3 units/kg/hr 8 hrs from when drip restarted 180 lbs X 1 Kg X 35 units = 2863.64 units Heparin bolus 1 2.2 lbs Kg 2 units X 1 Kg X 180 lbs X 500 ml = 5.45 ml/hr Kg/hr 2.2 lbs 1 15,000 units 20 ml/hr + 5.45 ml/hr = 25.45 ml/hr (new rate)
186 The physician orders Intropin at 2.5 mcg/kg/min. Patient weighs 152 lbs. The directions are as follows: Add 200 mg (1.2 ml) to 500 ml of D5W. Calculate ml’s/hourfor this infusion. Versed drip is ordered at 2.7 mg per hour continuous to keep the patient sedated while on the ventilator. Read the label below and calculate the flow rate knowing that an infusion pump has to be used for this drug. The order is 1850 mL of 5% D/W in 7.2 hours. The flow rate was set at 43 drops per minute. You assess the infusion flow 3 hours later, and the patient has received 900 mL of IV fluid. Recalculate the flow rate with a drop factor of 10 drops per milliliter. Streptomycin 500 mg/m2/day IV for 5 days. Instructions are to withdraw the medication from the vial and add it to a 250 ml bag of D5W and infuse over 50 min. On hand is a 1 gm vial of Streptomycin with a concentration of 100 mg/ml. Calculate the flow rate using a tubing drop factor of 15 drops/ml for a patient who weighs 140 lbs and is 5 ft 7 in tall. The prescriber ordered 700 mL of D50.45% NS to infuse at 22 drops per minute. If the drop factor is 15 drops per milliliter, how many milliliters per hour will the patient receive? Versed 100 mg100 mL in 0.9% NS Infuse as directed.
187 NURSING 131 –INTRODUCTION TO PHARMACOLOGY Practice Problems for Chapters 9, 10, and 11 DIRECTIONS: Label all answers. Round off answer to the nearest hundredth. Must show work! 1. Order: Streptomycin 0.35 g IM daily. On hand is 400 mg/1 ml. How many mls will you give? Ans: ____________ 2. Order: Nafcillin 850 mg IV q8h. Using the label below, how many ml’s will you administer? Ans: ____________ 3. Order: Morphine Sulfate 0.8 mg IV q 4-6 h prn for pain. On hand is 4 mg/1 ml. How many ml’s will you give?Ans: ____________ 4. Order: Pfizerpen 2.4 million units IV q6h. On hand is a 20,000,000 unit vial which states to add 11.5 ml of sterile water to make a concentration of 1,000,000 units/ml. How many ml’s will you give? Ans: ____________
188 5. Order: Ticarcillin 1.6 g IM STAT. On hand is a 6 g vial which states to “add 12 ml of sterile water. Shake well until clear. Each 2.5 ml of solution will contain 1 g of Ticarcillin.” How many ml’swill you give? Ans: ____________ 6. Order: D5 ½ NS to infuse 870 ml over 5 hours. On hand is an IV Infusion pump. How many ml/hr will you set the pump? Ans: ____________ 7. Order: One liter of D5 0.45% NS to infuse over 10 hours. On hand is IV tubing with a drop factor of 10 gtts/ml. Calculate the flow rate in gtts/min. Ans: ____________ 8. Order: Oscal 450 ml to infuse over 8 hours via feeding tube and pump. How many ml/hr will you set the pump? Ans: ____________ 9. Order: D5¼ NS at 47 ml/hour. An IV pump is not available. Using the pediatric microdrip IV tubing, Calculate the flow rate in gtts/min. Ans: ____________ 10. Order: D5 ½ NS with 20 mEq KCL/L to infuse at 125 ml/hr. On hand is IV tubing with a 20 gtts/ml drop factor. There is not a pump available. Calculate the flow rate in gtts/min. Ans: ____________
189 11. Order: Mefoxin 2 g in 250 ml of 0.9% NS to infuse over 2 hours. On hand is IV tubing with a drop factor of 15 gtts/ml. Calculate the flow rate in gtts/min. Ans: ____________ 12. Order: Heparin Infusion IV at 8 ml/hr. On hand is Heparin 10,000 units/200 ml. How many units of Heparin will the patient receive per hour? Ans: ____________ 13. Order: Ampicillin 1 g in 50 ml of D5W to infuse over 30 minutes. IV tubing has a drop factor of 20 gtts/ml. How many gtts/min will you administer? Ans: ____________ 14. Order: Unasyn 2.3 g in 100 ml of D5W to infuse over 45 minutes. On hand is an IV pump. How many ml/hr will you set the IV pump? Ans: ____________ 15. Order: Decadron 10 mg in 50 ml of 0.9% NS to infuse over 15 minutes. On hand is an IV pump. How many ml/hr will you set the IV pump? Ans: ____________ 16. Order: Diflucan 400 mg over 90 minutes. On hand is an IV bag labeled Diflucan 400 mg in 250 ml of 0.9% NS. Using the IV pump, how many ml/hr will you set the pump? Ans: ____________
190 17. Order is Cefoxitin 1.2 gram IVPB q8h. The manufacturer recommends reconstituting the 2gram vial with 10 ml of sterile water and adding it to 200 ml of D5W to infuse over 90 minutes. Calculate the flow rate if the drop factor is 15 gtts/ml. Ans: ____________ 18. A patient is receiving Dobutamine IV at 10 ml/hr. You are supplied with Dobutamine 250 mg in 250 ml of 0.9% NS. How many mcg/kg/min is the patient receiving? Patient weighs 80 Kg. Ans: ____________ 19. The physician ordered Intropin to infuse at 17 ml/hr. Patient weighs 132 lbs. Intropin comes as 160 mg/250 ml. How many mcg/kg/min is the patient receiving? Ans: ____________
191 20. Order: Heparin 400 units/hr. On hand is Heparin 10,000 units/100 ml of D5W. How many ml’s/hr should the prescribed dose of Heparin infuse into the patient?Ans: ____________ 21. Order: Lidocaine 2 mg/min IV. You are supplied with Lidocaine 2000 mg/250 ml. How many ml/hr should Lidocaine be given? Ans: ____________ 22. Order: Aminophylline 0.5 mg/Kg/hr. On hand is Aminophylline 500 mg in 500 ml of D5W. How many ml’s/hr will you give the patient if he weighs 100 Kgs?Ans: ____________ 23. Order: Dopamine 4 mcg/Kg/min. On hand is Dopamine 500 mg/250 ml of 0.9% NS. The patient’s weight is 80 Kg. How many ml’s/hr should the patient receive the prescribed dosage? Ans: ____________
192 Refer to the Heparin adjustment protocol below for questions 24 –25.Low Dose Standard Heparin Adjustment Repeat PTT PTT < 30 PTT < 40 70 units/kg IVP bolusand increase drip rate by 4 units/Kg/hr In 8 hrs PTT 31 –44 PTT 41 –60 35 units/kg IVP bolus and increase drip rate by 2 units/Kg/hr In 8 hrs PTT 45 –70 PTT 61 –80 No change –Therapeutic range In 8 hrs PTT 71 –80 PTT 81 –100 Decrease drip rate by 2 units/Kg/hr In 8 hrs PTT > 80 PTT > 100 Hold Heparin drip for one hour then decrease by 3 units/kg/hr 8 hrs from when drip restarted 24. A patient with a deep vein thrombosis is receiving continuous Heparin drip at 26 ml/hr. The last PTT was 24 seconds. Using the low dose Heparin adjustment protocol, calculate the amount of Heparin bolus in units and the new drip rate after the adjustment. The patient weighs 200 lbs and the label on the Heparin bag reads 10,000 units of Heparin in 250 ml of NS solution. Ans: ____________ Ans: ____________ 25. In the previous question, 8 hours after the adjustment, the PTT recheck was 73 seconds. Calculate the necessary adjustment in Heparin infusion. Ans: ____________ TRY THESE BRAIN TEASERS. 26. The nurse hangs a 250 ml IV bag of D5½ NS at 0100. Order is to begin the infusion at 30 ml/hr and increase the rate by 10 ml/hr every hour. What time of day will the IV fluids finish? Ans: ____________ 27. A patient’s bag of enteral feeding is hung at 0800 containing 500 ml. Orders are to begin feedings at 20 ml/hr. Two hours later increase to 40 ml/hr and every 2 hours increase the feeding by 10 ml/hr. What time of day will the enteral feeding be finished? Ans: ____________
193 Answers: 1. Ans: 0.88 ml 2. Ans: 3.4 ml 3. Ans: 0.2 ml 4. Ans: 2.4 ml 5. Ans: 4 ml 6. Ans: 174 ml/hr 7. Ans: 17 gtts/min (16.67) 8. Ans: 56.25 ml/hr 9. Ans: 47 gtts/min 10. Ans: 42 gtts/min (41.67) 11. Ans: 31 gtts/min (31.25) 12. Ans: 400 units/hr 13. Ans: 33 gtts/min (33.33) 14. Ans: 133.33 ml/hr 15. Ans: 200 ml/hr 16. Ans: 166.67 ml/hr 17. Ans: 34 drops/min (34.45) (Note: You first have to calculate the number of mls of Cefoxitin that will be given, which is 6.67 mls, then add it to the 200 ml for a total volume of 206.67 mls) 18. Ans: 2.08 mcg/Kg/min 19. Ans: 3.02 mcg/kg/min 20. Ans: 4 ml/hr 21. Ans: 15 ml/hr 22. Ans: 50 ml/hr
194 23. Ans: 9.6 ml/hr 24. Ans: 6363.64 units bolus Ans: 35.09 ml/hr (new drip rate is 26 ml/hr + 9.09 ml/hr) 25. Ans: 30.54 ml/hr (35.09 ml/hr –4.55 ml/hr) 26. Ans: 0600 27. Ans: 1815
195 NURSING 131: INTRODUCTION TO PHARMACOLOGY Parenteral Meds and Flow Rates –Practice Problems DIRECTIONS: Must label all answers. Round off answer to the nearest hundredth, unless otherwise directed. Must show work! 1. Order: Diphenhydramine HCL 8.8 ml IM every 6 hours. The recommended safe dose of Diphenhydramine HCL is 5 mg/kg/day given in 4 - 6 equally divided doses. Using the label below, determine the maximum recommended daily dosage for a child weighing 14 lbs 6 oz? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 2. Order: Morphine 1.7 mg IM every 4 hrs PRN for pain. The child weighs 14 lbs 7 oz. The recommended safe dose for Morphine is 0.5 mg –1.2 mg/kg every 4 hours. Using the label below, how many ml's will you give? Is the ordered dose safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________
196 3. Order: Bicillin 652,000 units IM. On hand is Bicillin 0.7 million units/ 2.5 ml. How many ml's will you give? ANS: _________________ 4. The order for Penicillin G Potassium is 30,000 units/Kg IM every 12 hours. Child weighs 17 lbs 6 ozs. Using the label below, you add 33 mls of diluent to the vial. What is the dosage in ml’sthat this child may receive every 12 hours? ANS: _________________ 5. The prescriber ordered 0.0006 grams of Naloxone HCL (Narcan) IM. Read the label below and calculate how many milliliters of this narcotic antagonist you would administer. ANS:________________
197 6. Order: Ampicillin 0.37 ml (250 mg/1 ml) IM STAT. Using the label below, how many ml's will you give? ANS:_________________ 7. Order: Ceftriaxone 870 mg IM q8h. Using the label below, how many ml’swill you administer? Answer:______________
198 8. Order: Mefoxin 245 mg IV every 6 hours. Directions on the label state to add 1.8 ml of sterile water to a 500 mg vial, which will make a concentration of approximately 225 mg/ml. How many ml’s will you administer? Answer:_________________ 9. Order: D5 ¼ NS to infuse 625 ml over 13 hours. On hand is an IV Infusion pump. How many ml’s/hrwill you set the pump? Answer:______________ 10. Order: 1½ liters of NS to infuse over 10 hours. On hand is IV tubing with a drop factor of 20 gtts/ml. Calculate the flow rate in gtts/min. Answer:______________ 11. Order: Boost 380 ml to infuse over 6.5 hours via feeding tube and pump. How many ml’s/hrwill you set the pump? Answer:______________
199 12. Order: D5LR at 84 ml/hour. An IV pump is not available. Using the pediatric microdrip IV tubing, calculate the flow rate in gtts/min. Answer:______________ 13. Order: D5½ NS with 30 mEq KCL/L to infuse at 75 ml/hr. On hand is IV tubing with a 15 gtts/ml drop factor. Calculate the flow rate in gtts/min. Answer:______________ 14. Rocephin 1.5 g IVPB every 12 hours is ordered. A 100 ml IV minibag containing the ordered Rocephin is sent to the floor and the label states to infuse over 45 minutes. The drop factor is 20 gtts/1ml. How many gtts/min will you administer? Answer:______________
200 15. A volume of 750 ml of LR is infusing at a rate of 37 gtts/min. If the drop factor is 15 gtts/1 ml, how many hours will it take for the IV solution to infuse? Answer:______________ 16. Order: Dobutamine 3.7 mcg/kg/min. On hand is Dobutamine 350 mg in 500 ml of 0.9%NS. The patient weighs 143 lbs. How many ml’s per hourwill you set the IV pump? Answer:______________ 17. Order: Dopamine to infuse at 18.5 ml/hr. On hand is Dopamine 400 mg/220 ml. Patient weighs 210 lbs. How many mcg/kg/minis the patient receiving? Answer:______________
201 18. Order: Patient is receiving a continuous Heparin drip at 14.6 ml/hr. The latest PTT is 45. Using the Standard dose Heparin adjustment protocol below, calculate the Heparin bolus and calculate the new rate of the Heparin drip. Patient weighs 153 lbs. Heparin bag states there are 10,000 units in 500 ml of NS. Low Dose Standard Heparin Adjustment Repeat PTT PTT < 30 PTT < 40 70 units/kg IVP bolusand increase drip rate by 4 units/Kg/hr In 8 hrs PTT 31 –44 PTT 41 –60 35 units/kg IVP bolus and increase drip rate by 2 units/Kg/hr In 8 hrs PTT 45 –70 PTT 61 –80 No change –Therapeutic range In 8 hrs PTT 71 –80 PTT 81 –100 Decrease drip rate by 2 units/Kg/hr In 8 hrs PTT > 80 PTT > 100 Hold Heparin drip for one hour then decrease by 3 units/kg/hr 8 hrs from when drip restarted Answer:______________ Answer:______________ 19. Refer to the previous question, the next PTT result is 73. Explain the needed adjustment in Heparin dosing for bolus and the new drip rate, if applicable. Answer:______________ 20. Refer to the previous question. Eight hours later, the nurse receives another PTT result of 83. Explain any needed Heparin adjustment for bolus and the new drip rate, if applicable. Answer:______________
202 21. The prescriber ordered 0.75 grams of Cefaclor, an antibiotic drug, in 500 milliliters of 0.9% NS, to be infused at a rate of 130 mg/m2/hr. Your patient’s BSA is 1.16 m2. How many milliliters per hour should your patient receive? Answer:______________ 22. Order: 450 ml of D5½ NS is to infuse at a rate of 47 drops per minute. The drop factor is 10 gtts/ml. If the IV solution begins at 9:30 am, at what time will the IV fluid finish (hours and minutes)? Answer:______________ 23. A patient has an order for Liquid Meal 360 ml to infuse over 3 hours via feeding tube. Drop factor is 20 gtts/ml. One hour later, you notice that there are 120 ml remaining in the bag. Recalculate the drip rate. Answer:______________ 24. The physician orders Intropin at 0.0025 mg/kg/min. Patient weighs 127 lbs. The directions are as follows: Add 100 mg (1 ml) to 500 ml of D5W. Calculate ml’s/hourfor this infusion. Answer:______________
203 25. Versed drip is ordered at 2.8 mg per hour continuous to keep the patient sedated while on the ventilator. Read the label below and calculate the flow rate knowing that an infusion pump has to be used for this drug. Answer: _________________ Versed 75 mg50 mL 0.9% NS Infuse as directed.
204 ANSWERS: 1. Ans: 32.67 mg/day RSD Ans: Unsafe RSD: 32.67 mg/day Order: 88 mg/day (Change the order to mg using the drug strength and multiply X4) 2. Ans: 0.43 ml Ans: Safe RSD: 7.88 mg q4h Order: 1.7 mg q4h 3. Ans: 2.33 ml 4. Ans: 0.47 ml q12h 5. Ans: 0.6 ml 6. Ans: 0.74 ml 7. Ans: 2.49 ml 8. Ans: 1.09 ml 9. Ans: 48.08 ml/hr 10. Ans: 50 gtts/min 11. Ans: 58.46 ml/hr 12. Ans: 84 gtts/min 13. Ans: 19 gtts/min (18.75) 14. Ans: 44 gtts/min (44.44) 15. Ans: 5.07 hours 16. Ans: 20.61 ml/hr 17. Ans: 5.87 mcg/kg/min 18. Ans: 2434.09 units Ans: 21.55 ml/hr
205 19. Ans: PTT is within normal range. No changes. Order another PTT in 8 hours. 20. Ans: 14.6 ml/hr 21. Ans: 100.53 ml/hr 22. Ans: 1106 or 11:06 am (1.6 hours = 1 hour 36 min) 23. Ans: 20 gtts/min 24. Ans: 43.38 ml/hr 25. Ans: 1.87 ml/hr
206 Practice Problems for Chapter 10 and Chapter 11___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________1.D5 0.45% is infusing at 75 ml/hr. How many hours will it take for 560 ml to infuse?___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________2. An order for 750 mls of D5 0.9%NS is to infuse at 28 drops/min. What time will the fluids finish if the start time is 7:15 am? Drop factor is 15 drops/ml. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
207 3. What is the flow rate in microdrops/min if the pump flow rate is 39 ml/hr? ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________4. D5 LR is infusing at 115 ml/hr. The pump begins to malfunction and you have to change to a gravity set up with a drop factor of 20 drops/ml. What is the flow rate?___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________5. Order is for 650 ml of LR to infuse over 5½ hours using an IV pump. Two hours later you notice that 300 mls have infused. Calculate the new flow rate. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
208 6. Mefoxin 2.2 gms in 100 mls of NS to infuse over 1 hour and 15 min. After 30 mins, 70 mls remain in the bag. Reset the flow rate if the drop factor factor is 20 drops/ml.___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________7. Order is for 1.5 gms of Ampicillin to infuse over 30 min using an IV pump. Available is a 2 gm vial of Ampicillin with instructions to add 9.4 mls of sterile NS to make a approximate concentration of 200 mg/ml. How many mls of Ampicillin will you add to a 100 ml bag of NS? Calculate the flow rate.___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________8. Order is for 20 mEq KCL in 100 mls of NS at a rate of 10 mEq/hr. Calculate the flow rate using a pediatric tubing set. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
209 9. Order is for Morphine 200 mg in 1000 mls of NS to be infused at a rate of 20 mcg/kg/hr. Patient weighs 270 lbs. Calculate the flow rate using an IV pump. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________10. Order is for Invanz 0.9 g IVPB over 45 min. The directions on the 1 g vial states to add 8.6 mlsof sterile NS to the vial for a concentration of 100 mg/ml. How many mls of Invanz will you add to a 250 ml bag of D5 NS? Calculate the flow rate if the drop factor is 10 drops/ml. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________11. A continuous Dopamine drip is infusing at 13 ml/hr. The patient weighs 174 lbs. Calculate the dose of the drug in mcg/Kg/min if the label on the bag reads 750 mg in 250 ml.___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
210 12. Order: Rocephin 345 mg IV to infuse over 30 minutes every 12 hours. Directions on the label state to add 1.8 ml of sterile water to a 500 mg vial, which will make a concentration of approximately 225 mg/ml. How many ml’s of Rocephinwill you add to a 25 ml bag of D5 ¼ NS. Calculate the flow rate using an IV pump. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________13. Order: Ampicillin 2.75 ml (500 mg/5 ml) IV to infuse over 40 minutes STAT. On hand is Ampicillin 1 gm/7.5 ml. How many ml's will you add to a 50 ml bag of D5 ¼ NS? Calculate the flow rate using an IV pump?___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________14. Ceftriaxone 1.25 g IVPB every 12 hours is ordered. A 100 ml IV minibag containing the ordered Ceftriaxone is sent to the floor and the label states to infuse over 45 minutes. The drop factor is 20 gtts/1ml. How many gtts/minwill you administer? ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
211 15. Order: Patient is receiving a continuous Heparin drip at 24.6 ml/hr. The latest PTT is 45. Using the Standard dose Heparin adjustment protocol in the next slide, calculate the Heparin bolus and calculate the new rate of the Heparin drip. Patient weighs 183 lbs. Heparin bag states there are 10,000 units in 500 ml of NS.___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________Low DoseStandardHeparin AdjustmentRepeat PTTPTT < 30PTT < 4070 units/kg IVP bolusand increase drip rate by 4 units/Kg/hrIn 8 hrsPTT 31 –44PTT 41 –6035 units/kg IVP bolus and increase drip rate by 2 units/Kg/hrIn 8 hrsPTT 45 –70PTT 61 –80No change –Therapeutic rangeIn 8 hrsPTT 71 –80PTT 81 –100Decrease drip rate by 2 units/Kg/hrIn 8 hrsPTT > 80PTT > 100Hold Heparin drip for one hour then decrease by 3 units/kg/hr8 hrs from when drip restarted___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________16. The physician orders Intropin at 25 mcg/kg/min. Patient weighs 152 lbs. The directions are as follows: Add 200 mg (1.2 ml) to 500 ml of D5W. Calculate ml’s/hourfor this infusion. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
212 17. The order is 1850 mL of 5% D/W in 7.2 hours. The flow rate was set at 43 drops per minute. You assess the infusion flow 3 hours later, and the patient has received 900 mL of IV fluid. Recalculate the flow rate with a drop factor of 10 drops per milliliter.___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________18. The prescriber ordered 700 mL of D50.45% NS to infuse at 22 drops per minute. If the drop factor is 15 drops per milliliter, how many milliliters per hour will the patient receive?___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________19. Versed drip is ordered at 2.7 mg per hour continuous to keep the patient sedated while on the ventilator. Read the label below and calculate the flow rate knowing that an infusion pump has to be used for this drug.Versed 100 mg100 mL in 0.9% NS Infuse as directed. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
213 20. Streptomycin 500 mg/m2/day IV for 5 days. Instructions are to withdraw the medication from the vial and add it to a 250 ml bag of D5W and infuse over 50 min. On hand is a 1 gm vial of Streptomycin with a concentration of 100 mg/ml. Calculate the flow rate using a tubing drop factor of 15 drops/ml for a patient who weighs 140 lbs and is 5 ft 7 in tall. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
214 Answers to Practice Problems for Chapters 10 and 11 1. Ans: 7.47 hours 2. Ans: 1:57 pm or 1357 hours (Solve for # of hours = 6.7 hours = 6 hours 42 mins –add to 7:15 am) 3. Ans: 39 drops/min 4. Ans: 38 drops/min (38.33) 5. Ans: 100 ml/hr 6. Ans: 31 drops/min (31.11) 7. Ans: Add 7.5 mls of Ampicillin to the 100 ml bag of fluid Ans: 215 ml/hr 8. Ans: 50 drops/min 9. Ans: 12.27 ml/hr 10. Ans: 9 mls is added to the 250 ml bag Ans: 58 drops/min (57.56) 11. Ans: 8.22 mcg/kg/min 12. Ans: Add 1.53 mls of Rocephin to the 25 ml bag of fluid Ans: 53.06 ml/hr 13. Ans: Add 2.06 mls of Ampicillin to a 50 ml bag of fluid Ans: 78.09 ml/hr
215 14. Ans: 44 drops/min (44.44) 15. Ans: 2,911.36 units bolus Ans: 32.92 ml/hr (Add 8.32 ml/hr to 24.6 ml/hr) 16. Ans: 259.71 ml/hr 17. Ans: 38 drops/min (37.7) 18. Ans: 88 ml/hr 19. Ans: 2.7 ml/hr 20. Ans: 78 drops/min (77.58) (Note: The BSA is calculated as 1.72 m2. You first have to calculate the number of mls you will withdraw from the vial which is 8.6 mls and add it to the bag of fluid to get your total volume of 258.6 mls)
216 Midlands Technical College Nur 131: Introduction to Pharmacology Sample Questions –Comprehensive Exam Directions: Round all answers off to the nearest hundredth unless otherwise directed. Show all work. 1, Reduce the following numbers to the lowest possible fractions 0.36 4.58% 2. Reduce the following fraction to the lowest possible fraction 2/5 X 10.4 X 0.4% 1.2% X 7/9 X 3 3. 8.6 Kg = _______ lbs _______ oz 4. Bid = ________ PICC = _________ Parenteral = _________ Reconstitute = _________ Standing order = ___________ Elixir = ________ Enteric coated tablet = _________ NKA = _________ Dx = ___________ Review pages 8 –9 in your Learning Packet regarding Chapter 2.
217 5. Penicillin G Potassium 0.25 million units IV every 6 hours. Using the label below and adding 11.5 mls to the vial, how many ml’s will you give? Ans: ____________ 6. The prescriber ordered Biaxin 1000 mg PO b.i.d. Read the label below and calculate how many tablets you will administer per dose. Ans: ____________ 7. The physician ordered 400 mg of Symmetrel PO b.i.d. How many ml’s will you administer to the patient if the label reads 1 ml per 500 mg? Ans: ____________
218 8. The prescriber ordered Digoxin 0.032 mg PO STAT. The bottle is labeled 0.6 ml per 0.008 mg. How many ml’s will you administer to the patient?Ans: ____________ 9. Using the label below, how many tablets of Theophylline ER will you prepare if the order is for 204 mg? Ans: ____________ 10. The prescriber ordered 0.5 g of Cloxacillin PO b.i.d. Using the label below, how many capsules will you administer? Ans: ____________
219 11. The order is to give 2.5 mg Dilaudid-HP. Using the label below, how many ml’s will you administer? Ans: ____________ 12. Read the label below and calculate how many ml’s you will administer of the drug if the physician’s order is to give 4000 units SubQ every day? Ans: ____________ 13. Corticotropin has been ordered for 80 units IM stat. The label reads 40 units per ml. How many ml’s will you prepare?Ans: ____________
220 14. Order: Paracetamol ¼ tsp (200 mg/5 ml) is ordered every 6 hours prn for pain. Using the label below, how many ml’s will you administer?Ans: ____________ 15. Tobramycin has been ordered 0.75 mg/Kg IM q 12 hours. Calculate how many ml’s you will prepare for a patient who weighs 110 lbs, if the vial is labeled 40 mg/ml. Ans: ____________ 16. The prescriber has written an order for 32 units of Humalin NPH insulin SC STAT. Identify the type of syringe and place and draw a line through the appropriate level of measurement on the syringe below. 17. How much liquid is in the tuberculin syringe shown as shown by the arrow below?
221 18. The prescriber has written an order for 5.6 milliliters of a drug IV. Identify the type of syringe and draw a line through the appropriate level on the syringe below. 19. A physician requested 0.63 milliliters of a drug. Identify the type of syringe and draw a line through the appropriate level of measurement on the syringe below. Directions: Use a drop factor of 10 gtts/ml for questions as needed. All IV infusion pumps can only be programmed to deliver ml per hour. 20. The nurse is to administer 1800 ml of TPN over 24 hours. How many ml’s per hour would the nurse program the infusion pump to deliver TPN as ordered? Ans: ____________ 21. Read the label on the minibag below and indicate how you would program the infusion pump to deliver the ordered amount. Ans: ____________ Vancomycin 1 g250 mL of D5W Infuse at 9:00 am over 90 minutes
222 22. The order is to administer Zantac 50 mg IV B.I.D. See the label below and calculate the flow rate to infuse Zantac as ordered is there is no infusion pump available. Drop factor is 10 drops/ml. Ans: ____________ 23. Versed drip is ordered at 3 mg per hour continuous to keep the patient sedated while on the ventilator. Read the label below and calculate the flow rate knowing that an infusion pump has to be used for this drug. Ans: ____________ 24. Calculate the amount of water you need to add to 1 can of Ensure to make ¾ strength solution if each can contains 240 ml. Ans: ____________ 25. An order to give 8 oz of 53Choice DM bolus feedings via G-tube q 6 hours was received. How many ml’s ofwater will you need to add to the entire can of Choice DM if each can contains 11 oz? Ans: ____________ Zantac 50 mg 50 mL in 0.9% NS Infuse at 9:00 am over 20 minutes Versed 100 mg100 mL in 0.9% NS Infuse as directed.
223 26. Continuous tube feeding with ¼ strength Jevity is infusing at 60 ml/hr. It is time to pour a new can in the feeding bag. How much water will you need to add if each can contains 120 ml? Ans: ____________ 27. Nipride is to be infused at 0.7 mcg/Kg/minute. On hand is 50 mg in 250 ml of 5% Dextrose. The patient weighs 75 Kg. Calculate the flow rate in ml/hr. Ans: ____________ 28. The order is to start Dopamine drip at 3 mcg/Kg/minute for renal perfusion. The label on the Dopamine bag reads 800 mg in 250 ml of 5% Dextrose. Calculate the flow rate in mls per hour if the patient weighs 100 Kg. Ans: ____________ 29. Dobutamine 1 mcg/Kg/minute titrate to effect has been ordered to improve cardiac output. Dobutamine comes in prepared minibags of 2 g in 500 ml. Calculate the flow rate using the IV pump for a patient weighing 198 lbs. Ans: ____________ 30. Epinephrine maintenance drip at 0.1 mcg/Kg/minute is ordered to maintain a B/P after a successful ACLS. Calculate the flow rate in ml/hr for a patient weighing 154 lbs. The pharmacy prepared a 100 ml bag minibag that contains 40 mg of Epinephrine. Ans: ____________
224 31. Amrinone 7 mcg/Kg/minute is ordered as a continuous drip for a patient who weighs 75 Kg. Calculate the flow rate using the IV pump if the label reads 1000 mg in 200 ml. Ans: ____________ 32. A 70 Kg patient is receiving 8 ml/hr Diprivan drip. The label on the bottle reads 500 mg/50 ml. How many mcg/Kg/minute is the patient receiving? Ans: ____________ 33. A continuous Dopamine drip is infusing at 12 ml/hr. The patient weighs 154 lbs. Calculate the dose of the drug in mcg/Kg/min if the label on the bag reads 800 mg in 250 ml, equivalent to 3200 mcg/ml. Ans: ____________ 34. A 90 Kg patient is receiving Levophed at 60 ml/hr. The label on the Levophed bag reads 8 mg in 1000 ml of 5% Dextrose. How many mcg/Kg/min is the patient receiving? Ans: ____________ 35. A 176 lb patient is receiving Nitropress drip at 68 ml/hr. Calculate the dose in mcg/Kg/min, if the pharmacy prepared 50 mg in 250 ml of 0.9% NS solution. Ans: ____________
225 36. Inocor is going at 15 ml/hr. The concentration of the solution as indicated on the label is: each mL contains 3 mg. How many mcg/Kg/min is the patient receiving if he weighs 165 lbs. Ans: ____________ Refer to the Heparin adjustment protocol below for questions 37 –39.Low Dose Standard Heparin Adjustment Repeat PTT PTT < 30 PTT < 40 70 units/kg IVP bolusand increase drip rate by 4 units/Kg/hr In 8 hrs PTT 31 –44 PTT 41 –60 35 units/kg IVP bolus and increase drip rate by 2 units/Kg/hr In 8 hrs PTT 45 –70 PTT 61 –80 No change –Therapeutic range In 8 hrs PTT 71 –80 PTT 81 –100 Decrease drip rate by 2 units/Kg/hr In 8 hrs PTT > 80 PTT > 100 Hold Heparin drip for one hour then decrease by 3 units/kg/hr 8 hrs from when drip restarted 37. A patient with acute myocardial infarction is receiving continuous Heparin drip at 24 ml/hr. The last PTT was 28 seconds. Using the low dose Heparin adjustment protocol, calculate the amount of Heparin bolus in units and the new drip rate after the adjustment. The patient weighs 240 lbs and the label on the Heparin bag reads 30,000 units of Heparin in 1000 ml of NS solution. Ans: ____________ Ans: ____________ 38. In the previous question, 8 hours after the adjustment, the PTT recheck was 82 seconds. Calculate the necessary adjustment in Heparin infusion. Ans: ____________
226 39. (In reference to the above question). The next day the PTT recheck was 73 seconds. Calculate the necessary adjustments. Ans: ____________ 40. A patient with Deep Vein Thrombosis (DVT) is on continuous Heparin drip at 10 ml/hr. The label on the bag reads 25,000 units of Heparin in 250 ml NS solution. The patient weighs 70 Kg. Using the standard protocol above, indicate what adjustments are necessary if the PTT result was 45 seconds. Ans: ____________ Ans: ____________ 41. (In reference to question #40 Indicate the necessary adjustment in Heparin infusion if the 8 hour PTT recheck was 102 seconds. Ans: ____________ 42. Thyroid 16.25 mg/m2is ordered for a child who weighs 60 lbs and is 4 ft 2 in tall. How many tablets will you administer if each tablet contains 30 mg? Ans: ____________
227 43. Dosage of 0.25 mg Digoxin QD PO is ordered for a child who weighs 40 lbs and 34 inches tall. Is this a safe dose if the adult recommended dose is not to exceed 0.5 mg/day? Ans: ____________ RSD: ___________ Order: ___________ 44. Demerol 15 mg IM STAT is ordered for a child who weighs 8 kg. Is this a safe dose for a child if the recommended safe dose is 8 –15 mg/kg/day in 6 equally divided doses? Ans: ____________ RSD: ___________ Order: ___________ 45. Ceclor 150 mg PO q 12 hours is ordered for a child who weighs 22 lbs. Calculate how many ml’s you will administer if Ceclor is available as shown in the label below. Is this a safe dose if the recommended dose is 30 mg/kg/day in 2 divided doses? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 75 ml (when mixed) CECLOR Cefaclor for oral suspension 125 mg / 5 ml Directions for mixing:Add 45 ml of water to the dry mixture in the bottle and shake well. Each 5 ml (approximately 1 teaspoon) will contain 125 mg of cefaclor.
228 46. Digoxin 64 mcg/m2PO STAT is ordered for a child who weighs 24 lbs 8 oz and is 24½ in length. How many ml’s will you give this child if the label on the Digoxin bottle reads 0.67ml per 0.008 mg? Ans: ____________ 47. Infant is 28 inches in length and weighs 10.5 lbs. Recommended dosage for Zantac is 60 mg/m2/day. What is the recommended safe daily dose in mgs for this infant? Ans: ____________ 48. Questran 160 mg PO tid is ordered for a child who weighs 7.8 Kg and is 36 in tall. There is not a recommended safe dose for a child. The adult dosage of Questran is 300 mg PO qid. What is the recommended safe dosage per day? Is the order safe to give? Ans: ____________ Ans: ____________ RSD: ___________ Order: ___________ 49. Order: 200 ml of D5 ½ NS is to infuse at a rate of 30 drops per minute. The drop factor is 10 drops/ml. If the IV solution begins at 4:30 pm, at what time will the IV fluid finish (hours and minutes)? Ans: ____________
229 50. Order is for D5 0.45% NACL at 115 ml/hr to infuse for 6 hours. How many grams of NACL will the patient receive for a total of 6 hours if there are 0.45 grams in 100 mls? Ans: ____________ 51. The physician orders Rocephin at 75 mg/kg to infuse over 45 minutes STAT. Patient weighs 57 lbs. The directions are as follows: Add 1943.18 mg (8.7 ml) to 50 ml of D5W. Calculate ml’s/hourfor this infusion. Ans: ____________ 52. Order: Morphine 5.8 mg IM every 4 hrs PRN for pain. On hand is Morphine 10 mg/1 ml. The child weighs 24 lbs 7 oz. The RSD for Morphine is 0.2 mg –0.8 mg/kg every 6 hours. Howmany ml's will you give? Is the ordered dose safe to give? Ans: ____________ Ans:_____________ RSD: ___________ Order: ___________ 53. Order: Ibuprofen Elixir ¾ tsp (45 mg/ 5 ml) PO every 6 hours PRN for pain. On hand is Ibuprofen drops 100 mg/ 0.5 tsp. The recommended safe dose of Ibuprofen is 15 mg/kg/day given every 4 –6 hours as needed. Determine the maximum recommended dose in mgs every 6 hours for a child weighing 18 lbs 4 oz? Is the ordered dose safe to give? Ans: ____________ Ans_____________ RSD: ___________ Order: ___________
230 54. The prescriber ordered 700 ml of D5W to infuse at 25 drops/min. Drop factor is 25 drops/ml. How many ml/hr will the patient receive? Ans: ____________ 55. Order is Mefoxin 1.2 gram IVPB q8h. The manufacturer recommends to reconstitute the 5 gram vial with 15 ml of sterile water and adding it to 200 ml of D5W and infusing it over 90 minutes. Calculate the flow rate if the drop factor is 15 gtts/ml. Ans: ____________ 56. The physician orders Intropin at 0.0025 mg/kg/min. Patient weighs 127 lbs. The directions are as follows: Add 100 mg (1 ml) to 500 ml of D5W. Calculate ml’s/hourfor this infusion. Ans: ____________
231 ANSWERS: 1, 9 /25 229 / 5000 2. 104 / 175 3. 18 lbs 14.72 oz 4. See textbook for answers. 5. Ans: 0.25 mls 6. Ans: 2 caps 7. Ans: 0.8 ml 8. Ans: 2.4 ml 9. Ans: 2.04 tabs 10. Ans: 1 cap 11. Ans: 0.25 ml 12. Ans: 0.16 ml 13. Ans: 2 mls 14. Ans: 2.08 mls 15. Ans: 0.94 ml
232 16. 50 unit per ½ ml insulin syringe 17. 0.02 ml 18. 10 ml syringe 19. Tuberculin syringe (1 ml) 20. Ans: 75 ml/hr 21. Ans: 166.67 ml/hr 22. Ans: 25 gtts/min 23. Ans: 3 ml/hr 24. Ans: 80 ml 25. Ans: 220 ml 26. Ans: 360 ml
233 27. Ans: 15.75 ml/hr 28. Ans: 5.63 ml/hr 29. Ans: 1.35 ml/hr 30. Ans: 1.05 ml/hr 31. Ans: 6.3 ml/hr 32. Ans: 19.05 mcg/kg/min 33. Ans: 9.14 mcg/kg/min 34. Ans: 0.09 mcg/kg/min 35. Ans: 2.83 mcg/kg/min 36. Ans: 10 mcg/kg/min 37. Ans: 7636.36 units bolus Ans: 38.55 ml/hr (increase the drip rate by 14.55 ml/hr - 24 ml/hr + 14.55 ml/hr) 38. Ans: Hold drip for an hour (no bolus needed), then decrease the drip rate by 10.91 ml/hr Ans: 27.64 ml/hr (38.55 ml/hr –10.91 ml/hr) 39. Ans: No bolus is needed Ans: 20.37 ml/hr (27.64 ml/hr –7.27 ml/hr) 40. Ans: 2450 units bolus Ans: 11.4 ml/hr (10 ml/hr + 1.4 ml/hr)
234 41. Ans: Hold Heparin drip for an hour Ans: 9.3 ml/hr (11.4 ml/hr –2.1 ml/hr) 42. m2= 0.97 Ans: 0.53 tab or 0.5 tab 43. m2= 0.66 Ans: Unsafe RSD: 0.19 mg/day Order: 0.25 mg/day 44. Ans: Safe RSD: 20 mg/dose Order: 15 mg/dose 45. Ans: 6 ml Ans: Safe RSD: 150 mg q12h Order: 150 mg q12h 46. m2= 0.44 Ans: 2.36 ml 47. Ans: 18 mg / day (based on 0.3 m2) 48. Ans: 310.59 mg/day Ans: UnsafeRSD: 310.59 mg/day Order: 480 mg/day 49. Ans: 5:37 pm or 1737 hrs (1.11 hrs = 1 hr 7 min - 4:30 pm + 1 hr 7 min) 50. Ans: 3.11 gms 51. Ans: 78.27 ml/hr (Add the 8.7 mls to 50 mls = 58.7 mls total volume)
235 52. Ans: 0.58 mls Ans: Safe RSD: 35.55 mg/day Ord: 34.8 mg/day 53. Ans: 31.11 mg q6h (124.43181 mg/day divided by 4) Ans: Unsafe RSD: 31.11 mg q6h Order: 33.75 mg q6h 54. Ans: 60 ml/hr 55. Ans: 34 drops/min(33.93)56. Ans: 43.38 ml/hr
236 MIDLANDS TECHNICAL COLLEGE NURSING DEPARTMENT DO NOT USE LIST PROHIBITED ABBREVIATION Appropriate Abbreviation or Alternative U or u Write "unit (s)" IU Write "International Units" Trailing Zero: Decimal followed by a zero following a whole number (ie 1.0 mg) Never write a zero by itself after a decimal point (ie 1 mg) Lack of a leading zero and decimal prior to a fraction (ie .3 mg) Always use a zero before a decimal point (ie 0.3 mg) MSO and MS Always write out the word morphine MgSO4 Always write out the word magnesium sulfate Letter abbreviations for drug names or drug protocols Write out all drug names or drug protocols μg (microgram)Write "mcg" or "microgram" as ad au AS, AD, AU Write" Right ear" and etc os od ou OS, OD, OU Write "Right eye" and etc S C or S Q sq or sub q Write "Sub Q" "subQ" or subcutaneously τ ττ τττWrite the words "one" "two" or "three" X 3 d Write out "Days" or "Doses" Qd or qd QID or qid QOD or qod Write "Daily" four times daily, every other day > (greater than) < (less than) Write “greater than” and “less than” Apothecary Units Write out @ cc D/C Write out “discharge”IN OJ q.n. q HS ss T/d (the T has a period above as a Roman-numeral/Apothecary “one”)TIW Chemical symbols Write out chemical names Uncommon Latin words or phrases such as “per os” or “ss”/ (a slash mark) Roman numerals Drug name and dosage not separated by a space