Math Test Preparation Module
Rules to consider: For pediatric med calculations, carry your answer to the
thousandths place and round to the 100ths place. For adult med calculations, carry
your answer to the 100ths place and round to the 10ths.
For adolescents that weigh 50 kg or greater, the standard adult dosage is frequently
prescribed instead of a calculated dosage by weight. It is the responsibility of the
nurse to verify that the order for a child’s dosage does not exceed the maximum
adult dosage recommended by the manufacturer.
Section I: Calculating Flow Rates for Electronic Pumps in ml/hr
Rule # 1: To regulate an IV volume by electronic infusion pump calibrated in ml/hr
calculate:
Total ml ordered/Total hours ordered = ml/hr (round to nearest whole number)
Rule # 2: Total ml ordered/Total min ordered x 60 min/hr = ml/hr (round to nearest
whole number). This rule is used if the IV is ordered to run at less than 1 hour or
more than 1 hour, i.e., 90 minutes)
Example: Order is for D5W 250 ml IV over the next 2 hours by infusion pump.
Using the above formula, you will have 250 ml/2hr = 125 ml/hr.
You will sometimes have a med that is piggy backed and will be ordered to infuse in
less than one hour.
Example: Order is for Ampicillin 500 mg in 50 ml D5W to infuse in 30 minutes via
pump.
Using Rule # 2 you will have 50 ml/30 min x 60 min/hr = 50 ml x 60 min =
___ml/hr
30 min 1 hr
The minutes cancel out leaving the answer in ml/hr. So, the answer is 50 x 60
divided by 30 = 3000/30= 100 ml/hr
Example: If the same problem is in 50 ml to infuse over 90 minutes you would use
Rule # 2 and set it up as 50 ml/90 min x 60 min/hr = 33.33 ml/hr = 33 ml/hr
50 ml x 60 min = 33 ml/hr
90 min 1 hr
Remember to look at your answers to be certain that they make sense. If 50 ml is
to infuse in 90 minutes, you know it must be less than the 50 ml/hr. If your answer
pg. 1
is more than the 50 ml/hr you KNOW you have done something incorrect. OR, if you
are calculating 50 ml in 30 minutes, you KNOW your answer MUST be more than the
50 ml/hr and if it is less than that you KNOW you have done something wrong.
Practice Problems:
1. Order reads D5W 250 ml IV over the next 2 hours by infusion pump.
Calculate the flow rate.
2. Order is for NS 250 ml IV to infuse as a bolus in 30 minutes. Calculate the
flow rate.
Section II: Calculating Flow rates for manually regulated IV’s in gtt/min
Now, if it is not an IV pump, you need to consider the drop factor of the tubing. For
a pump it is usually 60 gtts/ml. But you have 10, 15, 20, 30, and 60 gtt factor
tubing. The gtt factor is how many gtts = 1 ml.
Rule # 1: The formula method to calculate IV flow rate for manually regulated IVs
ordered in ml/hr or for a prescribed number of minutes is:
Volume/ Time in minutes x drop factor (gtt/ml) = rate (gtt/min)
D5W is to infuse at 125 ml/hr. The infusion set has a drop factor of 10 gtt/ml.
Calculate the IV flow rate in gtt/min.
Using the formula in Rule # 1:
125 ml X 10 gtt = 1250 gtt = 20.833 gtt/min (ml cancel out) = 21 gtt/min
60 min 1 ml 60 min
Practice Problems:
1. Order is for Ampicillin 500 mg IV in 100 ml of NS to infuse over 45 minutes.
The drop factor is 20 gtt/ml. What is the flow rate?
2. Order is for Theophylline 0.5 g IV in 250 ml D5W to infuse over 2 hours by
infusion pump. Drop factor of the tubing is 60 gtt/ml
pg. 2
Section III: Intake and Output:
In order to calculate the I&O problems correctly, you need to calculate the volume
over time of an IV infusion. Formula is total hours x ml/hr = total volume
Example: You have an order to infuse an IV at 50 ml/hr over 5 hours. The total
volume infused is: 5 hrs x 50 ml/hr = 250 ml is total volume infused.
Other things to remember with I & O: Conversions (oz to ml, tsp to ml, etc.). Ice
chips are counted as one half of the amount given. If your patient takes in 1 cup of
ice chips during your shift you will count the one cup as 240 ml and take one half of
that. 240/2 = 120 ml of ice chips
If a catheter or NG or other tube is irrigated, you have to subtract the amount of the
irrigant from the shift total output. In other words, you irrigate a catheter during
your shift with 500 cc of NS. When you empty the catheter bag at the end of the
shift, you have 2500 cc. Your output is the 2500 cc less the 500 cc you used to
irrigate the catheter (200 cc). You DO NOT count the 500 cc as intake, just subtract
from the catheter output.
Practice Problems:
1. At 0700 the MD orders 1 L of D5 NS to infuse at 75 ml/hr for the first 3 hours
and then at 125 ml continuously. For breakfast, the patient took 1 cup of
coffee, 8 ounces of milk, and 2 ounces of orange juice. The patient voided 50
ml at 0900 and 75 ml at 1000. At 11:00 the nurse inserted a foley catheter
and obtained 425 ml of urine. For lunch the patient only took 5 ounces of
broth. The foley was emptied at 1500 and measured 250 ml. Calculate the
patient’s total I & O starting at 0700 and ending at 1500.
a. Intake is _______
b. Output is _______
2. A patient who had prostate surgery yesterday has an indwelling urinary
catheter with a continuous bladder irrigation. He is NPO for breakfast and is
started on a clear liquid diet for lunch. He took 6 ounces of broth and 4
ounces of cranberry juice. His IV is infusing at 125 cc/hr since 0700. By the
end of the shift, you calculate that 2000 ml of bladder irrigant has infused.
The total amount emptied from the urinary bag was 2270 ml. Calculate the
total I and O for the shift (0700-1500).
a. Intake ________
b. Output ________
Section IV: Reconstitution of Meds:
The label will usually provide a concentration after the diluent is added. If it is not
given, you will use the volume of the diluent. In other words, if the label states to
add 5 ml of sterile water to the 500 mg of powdered Ancef and no concentration is
listed then the concentration will be 500 mg per 5 ml.
pg. 3
Usually, the concentration is listed. For example: Add 1.8 ml sterile water to 500
mg of powdered Ancef to provide a concentration of 280 mg/ml. (The volume of the
liquid mixed with the powder is greater than the volume added which is why the
concentration is not 500 mg = 1.8 ml).
Sometimes the package will have multiple diluents to add. That way you can use it
IV or IM. Remember if it is IM you want the largest concentration per ml so you
don’t need to give large volumes IM.
Example: For IV or IM use: Add NS or sterile water for injection and shake:
Diluent Strength of Mixed Medication
5 ml 500 mg/ml
7.5 ml 250 mg/ml
Your order is for 700 mg of Ampicillin IV q6h. The above instructions are for the vial
you are given. How many ml will you give?
If 5 ml is used: 700 mg/500 mg/ml = 1.4 ml (Desired/Have X Quantity)
If 7.5 ml is used: 700 mg/250 mg/ml = 2.8 ml
Practice Problems:
1. Order is for Tazidime 250 mg IM q12h. On hand is a 500 mg vial of
powdered Tazidime with IM reconstitution directions that state: “For IM
solution, Add 1.5 ml of an approved diluent. Provides an approximate volume
of 1.8 ml (280 mg/ml)”
2. Order is for SoluMedrol 200 mg IV 6h. On hand is: 500 mg vial of powdered
SoluMedrol for IM or IV injection with directions that state: “Reconstitute with
8 ml Water for injection. When reconstituted as directed each 8 ml contains:
SoluMedrol 500 mg (62.5 mg/ml)
Section V: Safe Dose
Rule # 1: To verify safe dosage: Convert the weight to kilograms if needed. Look
at the range given or the mg/kg for the safe dose and multiply the weight in
kilograms times the mg or mcg given. Compare the recommended dose or dose
pg. 4
range to the prescribed dose. If it is in that range, it is safe. Then calculate the ml,
tabs, etc. for that dose.
Example: Order is for Morphine 1.8 mg IM stat. On hand is Morphine 5 mg/ml. The
child weighs 79 lbs. Your reference states that the usual IM/SC dosage is 0.05
mg/kg/dose.
Is this a safe dose? 79 lbs/2.2 lbs/kg. Pounds will cancel and your answer is 35.9
kg. Then multiple 35.9 x 0.05 mg/dose (kg cancel out) = 1.795 mg/dose or 1.8
mg/dose. The ordered dose is 1.8 mg so yes, it is safe.
Then you will use Desired/Have x quantity to calculate the amount you will give to
the patient. 1.8 mg/5 mg/ml = 1.8 mg x 1 ml = 0.36 x 1 ml = 0.36 ml
5 ml
To calculate if a range is given:
Order is Vistaril 20 mg IM q 4-6h PRN, nausea. The child weighs 44 lb. The drug
reference states recommended dosage is 0.5-1 mg/kg/dose. The vial you have on
hand is Vistaril 50 mg/ml
What is the safe dose for this child?
Convert pounds to kg 44 lb /2.2 lb/kg = 44 lb / 2.2 = 20 kg
Minimum dose = 0.5 mg/kg/dose x 20 kg = 10 mg/dose
Maximum dose = 1 mg/kg/dose x 20 kg = 20 mg/dose
The dose is 20 mg so is in the min-max range and is therefore safe.
To calculate the amount to be given use D/H x Q
20 mg/50 mg x 1 ml = 2.5 ml is the amount to give per dose.
You may have a problem with a range and the answer is less than the minimum for
the range. That dose would be safe but not therapeutic.
Practice Problems:
1. Order is for Keflex 125 mg PO q6h for a child who weighs 44 lb. The
recommended pediatric dosage of Keflex is 25-50 mg/kg/day in 4 equally
divided doses. On hand is Keflex 125 mg/5 ml.
Is the ordered dose safe? If it is safe, how many ml will you give?
pg. 5
2. Order is for Amoxicillin 200 mg PO q8h for a child who weighs 22 lbs. On
hand is Amoxicillin 50 mg/ml. The drug reference states recommended
dosage is 20 to 40 mg/kg/day in divided doses every 8 hours. Is the dose
safe? If it is safe, how much will you give to the child?
PREVENTION OF MEDICATION ERRORS
Medication errors can occur for a number of reasons: administering the wrong
drug, the wrong amount, at the wrong time, by the wrong route, or to the wrong
patient. We will consider here errors that can occur when the drug order is
misinterpreted.
Never leave the decimal point naked. Writing .2 instead of 0.2 could cause
the decimal point to be missed and could result in an overdose. Always place
a zero before a decimal point; for example, 0.2, 0.5.
Never place a decimal point and zero after a whole number. The decimal
point could be missed and the zero could be misinterpreted, for example, 5.0
mg could be read as 50 mg. The correct way is to write 5 mg.
Avoid using decimals whenever whole numbers can be used as alternatives;
for example, 0.5 g can be expressed as 500 mg.
Have a second qualified person double-check any calculations for accuracy.
If you have difficulty interpreting the spelling of a drug name or the number
used for the dosage, or the dosage seems inappropriate, always question the
order. This is not only your duty, but you have an ethical and legal
responsibility to be sure that the drugs you administer are safe. If a
medication error results in legal action, you could be held accountable, even
though the order was written incorrectly. You are expected to recognize
inappropriate dosage, to check reference books with unfamiliar drugs, and to
ask the physician or pharmacist about any questionable dosage. 1
1
(Woodrow, Colbert, & Smith, 2002)
(Morris, 2010)
pg. 6