Drug Calculations

C H A P T E R
1 6
MEASUREMENT AND DRUG

CALCULATIONS
I.
SYSTEMS OF MEASUREMENT
A. METRIC SYSTEM
1. THE METRIC SYSTEM IS THE
INTERNATIONAL SYSTEM OF UNITS.
ITUSES DECIMALS MULTIPLIED
ORDIVIDED BY MULTIPLES OF 10.
2. COMMON MEASUREMENTS USED IN
HEALTH CARE FIELDS:
a. Weight:
1 mg (milligram) 5 1000 mcg
(micrograms)
alsog
1 g (gram)
5 1000 mg
(milligrams)
1 kg (kilogram) 5 1000 g (grams)
alsoGM
b. Volume:
1 L (liter) 5 1000 ml (milliliters) or
cc(cubic centimeters)
3. SOME METRIC CONVERSION
EXAMPLES:
a. To convert from a larger unit to a
smaller one, move x decimal places to
the right.
b. To convert from a smaller unit to a
larger one, move x decimal places to
theleft.
c. Conversion examples:
200 mg 5 0.2 g
5.8 L
5 5800 ml
0.78 g
5 780 mg
750 ml 5 0.75 L
6 mcg
5 0.006 mg
72 mg
5 7200 mcg
B. APOTHECARIES SYSTEM
1. THE APOTHECARIES SYSTEM USES
BOTH ARABIC AND ROMAN NUMERALS
AND FRACTIONS RATHER THAN
DECIMALS.
2. THE SYMBOL OR ABBREVIATION IS
WRITTEN FIRST, FOLLOWED BY THE
QUANTITY.
3. CONVERSIONS ARE NOT EQUAL AS

MEASUREMENTS IN THIS SYSTEM
BUT ARE APPROXIMATIONS.
THEREFORE, DISCREPANCIES WILL
EXIST.
4. COMMON USEFUL MEASUREMENTS:
a. Weight measurements are in grains (gr),
drams (dr) or ( ), ounces (oz) or (),
and pounds (lb).
b. When Roman numerals are used to
write doses, symbols such as ss 5
and iiiss 5 3 are used.
c. Volume measurements are in minims
(m) or (min), drams (dr) or ( ), ounces
(oz) or (), pints (pt), and quarts (qt).
5. WEIGHT CONVERSION FOR
MEDICATION ADMINISTRATION
ONLY UTILIZES THE GRAIN
MEASUREMENT: 60 GRAINS (GR 60) 5
1 DRAM.
6. COMMON VOLUME CONVERSIONS:
60 minims 5 1 fluid dram
4 drams 5 ounce
8 drams 5 1 ounce
16 ounces 5 1 pint
32 ounces 5 1 quart
2 pints
5 1 quart
4 quarts 5 1 gallon
C. HOUSEHOLD SYSTEM
1. THE HOUSEHOLD SYSTEM IS THE
LEAST ACCURATE OF THE SYSTEMS
AND IS WHAT IS USED BY MOST
PEOPLE AT HOME. IT IS THE
STANDARD COOKBOOK
MEASUREMENT SYSTEM.
2. THE HOUSEHOLD SYSTEM USES
ARABIC NUMBERS AND FRACTIONS.
3. THE NURSE SHOULD UTILIZE
ANOTHER SYSTEM OF MEASURE
WHENEVER POSSIBLE BUT SHOULD
BEPREPARED TO MAKE
CONVERSIONSFOR HOME USE WHEN
NECESSARY.
379
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380
II.
Unit III PHARMACOLOGY
4. COMMON USEFUL MEASUREMENTS:

60 drops (gtts) 5 1 teaspoon (tsp)
3 teaspoons (tsp) 5 1 tablespoon
(tbsp or T)
3 tsp or 1 T
5 ounce (oz)
2 tablespoons
5 1 ounce (oz)
8 ounces (oz)
5 1 cup (c)
16 ounces (oz) 5 2 cups or 1 pint (pt)
32 ounces (oz) 5 4 cups or 1 quart (qt)
2 pints (pt)
5 1 quart (qt)
5. EQUIVALENTS FROM HOUSEHOLD
TO APOTHECARIES TO METRIC
(SEE TABLE16-1)
MEASUREMENT CONVERSIONS
A. USING THE RATIO-PROPORTION METHOD
1. CARRY DECIMALS OUT TO
TWODECIMAL PLACES FOR
ACCURACY.
2. RATIOS MAY BE STATED AS
FRACTIONS AND CROSS MULTIPLIED
TO SOLVE FOR X. OR USE RATIOPROPORTIONS TO SOLVE BY
MULTIPLYING THE MEANS AND THE
EXTREMES. THE PRODUCT OF THE
MEANS EQUALS THE PRODUCT OF
THE EXTREMES.
3. WHEN USING RATIO-PROPORTIONS,
IT IS PREFERABLE TO PLACE THE
KNOWN EQUIVALENT IN THE FIRST
RATIO AND THE UNKNOWN
EQUIVALENT IN THE SECOND RATIO.
Table 16-1 Household to Apothecaries, and Metric

Equivalencies
Household
1 gtt
Metric
minim 1 (m i)
minim 15 (m xv)
Cengage Learning 2015
Apothecaries
1 ml
1 tsp
60 gtts
5 ml
1 tsp
dram i ( i)
5 ml
tsp
ounce ( ss)
1 tbsp
ounce ( ss)
15 ml
1 tbsp
dram iv ( iv)
15 ml
2 tbsp
dr viii ( viii)
30 ml
2 tbsp
1 ounce ( i)
30 ml
1 cup
8 ounces ( viii)
240 ml
1 pint
16 ounces ( xvi)
500 ml
1 quart
32 ounces ( xxxii)
1000 ml
grains 15 (gr xv)
1 gram (1000 mg)
grains 1 (gr i)
60 mg
2.2 lb
1 kg (1000 g)
III.
B. EXAMPLES OF CONVERSIONS BETWEEN

SYSTEMS USING RATIO-PROPORTION
METHOD
1. YOU MUST KNOW AT LEAST ONE
CONVERSION FACTOR BETWEEN THE
TWO SYSTEMS.
2. FOR EXAMPLE, WHEN CONVERTING
POUNDS TO KILOGRAMS, YOU
KNOWTHAT 1 KG IS EQUAL TO
2.2POUNDS.
3. EXAMPLE PROBLEM 1 : 50 LB 5 x KG
a. The known equivalent ratio 2.2 lb :
1 kg is placed first.
b. The unknown equivalent ratio 50 lb :
x is placed second.
c. In ratio format, the problem looks
likethis:
2.2 lb : 1 kg :: 50 lb : x kg
The product of the means is 50.
The product of the extremes is 2.2x.
d. Then solve for x by dividing 50 by 2.2.
1) x 5 50 4 2.2
2) x 5 22.7 kg
e. Or in fraction format, the problem
looks like this:
1) 2.2 lb/1 kg 5 50 lb/x kg
2) Cross multiplied 1 3 50 5 50 and
2.2 3 x 5 2.2x
3) 50 4 2.2 5 22.7 kg
4. EXAMPLE PROBLEM 2 : 5 5 ML 5
X MINIMS
a. Conversion factor for converting
milliliters to minims is 1 ml 5 15 m.
b. The known equivalent ratio 1 ml :
15 m is placed first.
c. The unknown equivalent ratio : 5
ml : x is placed second.
d. In ratio format, the problem looks
likethis:
1) 1 ml : 15 m :: 5 5 ml : x m
2) Multiply the means: 15 3 5 5 75
3) Multiply the extremes: 1 3 x 5 1x
e. Solve for x by dividing 75 by 1. The
answer is 75 minims.
f. In fraction format, the problem looks
like this:
1) 1 ml/15 m 5 5 ml/x m
2) Cross multiply 15 3 5 5 75
3) Cross multiply 1 3 x 5 1x
4) Solve for x: 75 4 1 5 75.
g. The answer is 75 minims.
DRUG CALCULATION METHODS
A. ANY OF THE FOLLOWING METHODS
ARE APPROPRIATE TO USE IN
CALCULATING DRUG DOSAGES;
HOWEVER, IT IS RECOMMENDED
THAT YOU USE WHAT YOU ARE MOST
FAMILIAR WITH.
B. DRUG CALCULATIONS USING THE
RATIO-PROPORTION METHOD
381
Chapter 16 MEASUREMENT AND DRUG CALCULATIONS
1. EXAMPLE1
a. One form of digoxin (Lanoxin) comes
in 0.125-mg tablets.
b. The medication order reads digoxin
(Lanoxin) 0.0625 mg p.o. every day.
c. How many tablets do you administer?
d. Calculation:
1) First, set up the problem using
the ratio or the fraction format.
2) 1 tab/0.125 5 X/0.0625 and solve
for x
3) 0.125x 5 0.0625 3 1
4) 0.125x 5 0.0625
5) x 5 0.0625/0.125
6) x 5 tab
7) Or: 1 : 0.125 :: x : 0.0625
8) 0.125x 5 1 3 0.0625
9) x 5 0.0625/0.125
10) x 5 tab
2. EXAMPLE2
a. One form of phenytoin (Dilantin)
comes in 100-mg capsules.
b. The medication order reads phenytoin
(Dilantin) 0.3 g p.o. every day.
c. How many capsules will you
administer?
d. Calculation
1) First convert grams to mg, then
you are able to set up the problem
properly.
a) 0.3 g 5 x mg
b) 1 g : 1000 mg :: 0.3 g : x mg
c) 1x 5 0.3 3 1000
d) x 5 300 mg
2) Then set up the problem knowing
that 0.3 g 5 300 mg. How many
capsules will you administer?
a) 100 mg : 1 capsule :: 300 mg :
x capsules
b) 300 mg 4 100 mg x
c) x 5 3 capsules
3) You will administer three 100-mg
capsules of phenytoin (Dilantin).
C. DRUG CALCULATIONS USING THE
FORMULA METHOD
1. FORMULAS MAY BE USED WHEN THE
DOSES CALCULATED ARE OF THE
SAME MEASUREMENT SYSTEM.
2. THEREFORE, BOTH THE DESIRED DOSE
AND THE DOSE ON HAND MUST BE
CONVERTED TO THE SAME SYSTEM
BEFORE A FORMULA CAN BE APPLIED.
3. FORMULA 1:
D
a.
3Q 5X
H
b. D 5 the desired dose
c. H 5 the strength available
d. Q 5 the quantity of measure (unit of
measure)
e. x 5 the unknown
4. FORMULA 2:
a. DW/SW 5 DV/SV
b. This formula is a proportion set up as
a fraction and is functionally the
same as the ratio-proportion method.
c. DW is the dose weight (desired dose).
d. SW is the stock weight (what is on
hand).
e. DV is the dose volume (the unknown).
f. SV is the stock volume (the quantity
or volume that contains the available
dose).
IV.
ORAL MEDICATION CALCULATION

EXAMPLES
A. RATIO-PROPORTION METHOD
1. ORDERED: WARFARIN SODIUM
(COUMADIN) 7.5 MG P.O. EVERY DAY
2. AVAILABLE: WARFARIN SODIUM
(COUMADIN) 2.5 MG TABS
3. CALCULATION:
a. 2.5 mg/1 tab 5 7.5 mg/x tabs
b. Cross multiply: 7.5 3 1 5 7.5 and
2.5 3 x
c. 7.5 mg/2.5x
d. x 5 3 tabs
4. YOU WILL ADMINISTER THREE
2.5-MG TABLETS OF WARFARIN
SODIUM (COUMADIN).
B. FORMULA 1 METHOD
1. ORDERED: AMPICILLIN (OMNIPEN)
1 G P.O. EVERY 6 HOURS
2. AVAILABLE: AMPICILLIN (OMNIPEN)
250-MG CAPSULES
3. CALCULATION:
a. First convert grams to milligrams:
1 g 5 1000 mg
D
3Q 5X
b.
H
1000 mg
c.
31 5 X
250 mg
d. 4 5 X
4. YOU WILL ADMINISTER FOUR 250-MG
CAPSULES OF AMPICILLIN (OMNIPEN).
C. FORMULA 2 METHOD
1. ORDERED: PHENOBARBITAL
(SOLFOTON) GR ISS P.O. QAM
2. AVAILABLE: PHENOBARBITAL
(SOLFOTON) 15 MG TABLETS
3. CALCULATION
a. First convert grains to milligrams.
b. gr i 5 60 mg
c. gr iss 5 90 mg
d. Then use the formula: DW/SW 5 DV/SV.
e. 90 mg 5 DV (x tabs)
f. 15 mg 1 tab
g. 15x 5 90 mg
h. x
5 90/15
i. x
5 6 tablets
4. YOU WILL ADMINISTER SIX TABLETS
OF PHENOBARBITAL (SOLFOTON).
382
V.
VI.
PARENTERAL MEDICATION CALCULATION

A. EXAMPLE1
1. ORDER: MORPHINE SULFATE
(DURAMORPH) GR IM EVERY
4HOURS P.R.N.
2. AVAILABLE: MORPHINE SULFATE
(DURAMORPH) 10 MG/ML
3. HOW MANY MILLIGRAMS AND HOW
MANY MILLILITERS WILL YOU
ADMINISTER?
4. CALCULATION:
a. First convert gr to milligrams:
gr i/60 mg 5 gr / x, x 5 15 mg.
b. If the desired dose is 15 mg, then what
is the volume to be administered IM?
c. 10 mg/1 ml 5 15 mg/x ml
d. 10x 5 15
e. x 5 15/10
f. x 5 1.5 ml
5. YOU WILL ADMINISTER 1.5 ML OF
THE MORPHINE SULFATE
(DURAMORPH) SOLUTION IM.
B. EXAMPLE2
1. ORDER: MEPERIDINE (DEMEROL HCL)
50 MG IM EVERY 4 HOURS P.R.N.
2. AVAILABLE: MEPERIDINE (DEMEROL
HCL) 75 MG/ML
3. WHAT VOLUME OF THE MEPERIDINE
(DEMEROL HCL) SOLUTION WILL
YOU ADMINISTER?
4. CALCULATION:
a. 75 mg/1 ml 5 50 mg/x ml
b. 75x 5 50
c. x 5 50/75
d. x 5 2 /3 or 0.66 ml or 0.67 ml of the
meperidine (Demerol HCl) solution.
MEPERIDINE (DEMEROL HCL)
SOLUTION.
POWDERED DRUG CALCULATION
EXAMPLES
A. RECONSTITUTED ORAL MEDICATIONS
1. THE POWDERED AMOXICILLIN
(AMOXIL) BOTTLE READS: ADD 85 ML
WATER TO MAKE 100 ML OF
AMOXICILLIN SUSPENSION.
2. WHEN RECONSTITUTED, THE
AVAILABLE SUSPENSION WILL HAVE
A CONCENTRATION OF 125 MG/5 ML.
3. THE ORDER READS: AMOXICILLIN
SUSPENSION (AMOXIL) 200 MG P.O.
EVERY 6 HOURS.
4. HOW MANY MILLILITERS PER
DOSEWILL YOU ADMINISTER? HOW
MANY DOSES ARE THERE IN THE
BOTTLE?
5. CALCULATION
a. 125 mg/5 ml 5 200 mg/x ml
b. 125x 5 1000
c. 1000/125 5 8
6. YOU WILL ADMINISTER 8 ML PER

DOSE. TO DETERMINE THE NUMBER
OF DOSES PER BOTTLE, DIVIDE 100
ML BY THE 8-ML DOSE 5 12.5 DOSES.
B. RECONSTITUTED PARENTERAL
MEDICATIONS
1. THREE (3)MILLION UNITS PENICILLIN
G POTASSIUM (PFIZERPEN) COMES IN
DRY CRYSTAL FORM IN A BOTTLE
FOR RECONSTITUTION.
2. THE BOTTLE READS: DILUTE
WITH4.2ML NORMAL SALINE TO
MAKE 5 ML.
3. THE ORDER READS: PENICILLIN
GPOTASSIUM (PFIZERPEN)
300,000UNITS IM NOW.
4. AVAILABLE: PENICILLIN G
POTASSIUM (PFIZERPEN) 3 MILLION
UNITS IN 5 ML
5. HOW MANY MILLILITERS WILL
YOUADMINISTER TO EQUAL
300,000UNITS?
6. CALCULATION:
a. First, write out millions: 3 million
5 3,000,000
b. Set up the ratio: 3,000,000/5 ml
5 300,000/x ml
c. 3,000,000 3 x 5 5 3 300,000
d. 3,000,000x 5 1,500,000
e. x 5 3,000,000/1,500,000
f. x 5 1/2 or 0.5 ml
SOLUTION.
VII. INTRAVENOUS DRUG CALCULATION
EXAMPLES
A. MANUAL REGULATION: FORMULAS FOR
DROPS PER MINUTE
1. FORMULA: V1/T1 3 V2/V2 5 GTT/MIN
a. V1 5 Volume to infuse
b. V2 5 drop factor of the tubing
(10, 15, or 20)
c. T1 5 Time in hours to infuse
d. T2 5 time in minutes (usually 60)
e. Example:
1) Run 750 ml D5 0.9 NS over
4 hours, with a tubing drop factor
of 10 gtts/ml.
2) V1 5 750, V2 5 10, T1 5 4 hours,
and T2 5 60
3) 750/4 3 10/60 5
4) 7500/240 5
5) 31.25 gtts/min or 31 gtts/min
2. FORMULA: V/T 3 C 5 R
a. This formula requires that you
already know the hourly rate.
1) V 5 volume ordered to be infused
in 1 hour.
2) C 5 drop factor (gtts ml).
3) T 5 time ordered by the
physician converted to minutes.
383
b. Example:
1) The physician has ordered D5
0.45 at 75 ml per hour.
2) The tubing drop factor is 10 gtts/ml.
3) Use the following steps to
calculate the IV flow rate in drops
per minute.
a) 75 ml/60 min 3 10 gtts/1 ml 5
b) Cancel the zeros out, leaving
75/6 3 1/1.
c) Cancel the 1s, leaving 75/6.
d) The answer is 12.5 gtts/min or
13 gtts/min.
B. THREE-STEP METHOD FOR IV DRIP
CALCULATIONS
1. TO DETERMINE ML/HR, DIVIDE
TOTAL FLUIDS BY HOURS TO RUN.
2. TO DETERMINE ML/MIN, DIVIDE
ML/HR BY 60 MINUTES.
3. TO DETERMINE DROPS/MINUTE,
MULTIPLY ML/MIN AND GTTS/ML.
4. EXAMPLE:
a. The order states: run 100 ml D5W over
30 minutes.
b. The tubing drop factor is 10 gtts/ml.
c. Figure ml/hr: 100 ml/ hr 5 100 3 2
divided by 1 5 200 ml/hr
d. Figure ml/min: 200 ml/hr divided by
60 minutes 5 3.3 ml/min
e. Figure drops/minute: 3.3 ml/min 3
10 gtt/ml 5 33 gtts/min
C. ELECTRONIC FLOW REGULATORS
1. ELECTRONIC FLOW REGULATORS OR
PUMPS MUST BE SET AT AN HOURLY
RATE IN MILLILITER PER HOUR.
2. THEREFORE, ALL VOLUME ORDERS
MUST BE CONVERTED TO ML/HR
BEFORE SETTING THE REGULATOR.
3. EXAMPLE USING THE
RATIO-PROPORTION METHOD
a. The order states: administer nafcillin
sodium (Nafcil) IVPB, 1 Gm diluted
in 50 ml. Run over 15 minutes.
b. The tubing drop factor is 15 gtts/ml.
c. For what rate will you set the
electronic regulator?
d. Using the ratio-proportion method,
set up the equation:
1) 50 ml/15 min 5 x ml/60 min
(1 hr)
2) 15x 5 3000
3) x 5 3000/15
4) x 5 200 ml/hr
e. You will set the electronic regulator
for 200 ml/hr.
4. EXAMPLE USING THE THREE-STEP
METHOD
a. The order reads: Administer 250 ml
of D5 0.45 over 6 hours per microdrip.
b. Microdrip tubing drop factor is
60 gtts/ml.
c. Figure ml/hr: 250 ml/6 hr 5 41.5 or

42ml/hr set on the electronic regulator
d. Figure ml/min: 42 ml/hr divided by
60minutes 5 0.7 ml/min
e. Figure gtts/min: 0.7 ml/min 3 60 gtts/ml
5 42 gtts/min via microdrip tubing
VIII. HEPARIN CALCULATION EXAMPLES
A. SUBCUTANEOUS HEPARIN DOSAGES
1. THE ORDER READS: HEPARIN
SODIUM (HEPARIN) 2500 UNITS S.Q.
STAT.
2. THE AVAILABLE CONCENTRATION IS
HEPARIN SODIUM (HEPARIN)
5000UNITS/ML.
3. SET UP THE RATIO:
a. 5000 units/1 ml 5 2500 units/x ml
b. 5000x 5 2500
c. x 5 2500/5000
d. x 5
THE AVAILABLE CONCENTRATION
OF HEPARIN SODIUM (HEPARIN).
B. INTRAVENOUS INFUSION HEPARIN
1. THE ORDER READS: INFUSE
1000UNITS/HOUR OF HEPARIN
SODIUM (HEPARIN) IV.
2. AVAILABLE IS 1 L NS WITH 40,000
UNITS OF HEPARIN SODIUM
(HEPARIN) ADDED.
3. THE DROP FACTOR FOR THE
ADMINISTRATION IV SET IS
15 GTTS/ML.
4. CONVERT TO UNITS/ML:
40,000UNITS/1000 ML 5 40 UNITS/1 ML
5. SET UP THE EQUATION:
a. 40 units/1 ml 5 1000 units/x ml
b. 40x 5 1000
c. x 5 1000/40
d. x 5 25 ml/hour
6. YOU WILL SET THE ELECTRONIC
REGULATOR TO 25 ML/HOUR.
IX. PEDIATRIC DOSAGE CALCULATION
METHODS AND EXAMPLES
A. CALCULATION OF PEDIATRIC DOSAGES
BASED ON THE CHILDS WEIGHT
1. ALWAYS CONVERT POUNDS TO
KILOGRAMS FIRST. REMEMBER THAT
2.2 LB 5 1 KG.
2. MULTIPLY THE WEIGHT IN
KILOGRAMS BY THE RECOMMENDED
DOSE PER KILOGRAMS.
a. An appropriate dose for a drug is
10mg/kg/24 hrs.
b. The child weighs 20 kg.
c. Therefore, 10 mg 3 20 kg 5
200 mg/24 hr.
3. DIVIDE THE 24-HOUR DOSE BY THE
NUMBER OF RECOMMENDED DOSES
PER DAY.
a. 200 mg/day divided by 4 doses 5
50 mg per dose.
384
4. FINALLY, CALCULATE THE VOLUME

OR AMOUNT TO BE ADMINISTERED
FROM WHAT IS IN STOCK.
B. CALCULATION OF PEDIATRIC DOSES
BASED ON A RECOMMENDED SAFE DOSE
RANGE
1. EXAMPLE:
a. The order states: cephalexin (Keflex)
oral suspension 150 mg p.o. every
6hours.
b. The child weighs 20 kg.
c. The medication package states that
the recommended dose is 2550 mg/
kg/day in 4 divided doses.
d. Is the ordered dose within safe
limits?
e. Calculation
1) First figure out what the safe
range is for this child.
a) 25 mg 3 20 kg 5 500 mg/day
b) 50 mg 3 20 kg 5 1000 mg/day
2) The safe range for this child is
500mg to 1000 mg per 24-hour
period.
3) The actual dose ordered is 150
mg every 6 hours
4) To determine if it falls within the
range, either multiply the actual
dose by 4 (every 6 hours is 4
doses per day) or divide the range
dosages by 4 to determine the
range for the individual dosages.
a) 150 mg 3 4 doses 5 600 mg/
day, which is within the range
of 500 mg to 1000 mg per day.
b) Thus, the dose is determined
to be safe.
5) Also, dividing the recommended
daily dosages gives a dose range
of:
a) 500 mg 4 4 doses 5 125 mg/
dose, and
b) 1000 mg 4 4 doses 5 250 mg/
dose
6) The dose of 150 mg falls within
the recommended range of
125 mg to 250 mg per dose for
this child.
C. PEDIATRIC DOSAGE CALCULATIONS
BASED ON BODY SURFACE AREA
1. THREE WAYS TO DETERMINE
DOSAGES BASED ON BODY SURFACE
AREA(BSA).
a. One is based on the height and the
weight of the child using a formula.
b. The second method calculates BSA
based on only the childs weight.
c. The third method is based on the
use of a tool called a West Nomogram
chart. The nomogram is used only
for children of normal height and

weight and is also a method that
requires some skill. It is not addressed
in this review.
2. BSA CALCULATIONS USING HEIGHT
AND WEIGHT
Either of the following formulas, one
using metric measurements and one
using English measurements, may
be used.
kg*cm/3600
5 BSA ( m2 )
3600
b. Example:
1) A child weighs 20 kg and is
70 cm tall
2) 20 kg 3 70 cm/3600 5 1400 / 3600
a.
5 0.388
5 0.62m2 BSA
3) Ib 3 in/3131 5 BSA ( m2 )
c. Using the same measurements
converted to pounds and inches:
1) The child weighs 44 lb and is
28in. tall.
2) 44 Ib 3 28 in/3131 5 BSA
3)
1231/3131 5 BSA
4) 0.39 5 BSA
5) 0.63 5 BSA (m2)
3. BODY SURFACE AREA CALCULATION
USING WEIGHT ONLY
a. Formula:
( 4 3 child's weight in kg ) 1 7
5 m2 BSA
(child's wt in kg ) 1 90
b. Example: A child weighs 45pounds.
1) Convert pounds to kg: 45 4 2.2 5
20.4 kg
a) ( 4 1 20.4) 1 7 5 81.8 1 7 5
20.4 1 90
110.4
88.8
5 0.80 m2
110.4
4. CALCULATION OF PEDIATRIC
DOSAGES USING BSA
a. The formula for calculation of dosages
using BSA is:
(BSA in m2/1.7 m2) 3 50 5 the
estimated pediatric dose
b. Example:
1) A child is 34 inches tall and
weighs 28pounds.
2) The adult dose for a medication
is 50 mg.
3) First figure the BSA for the child:
a) 34 3 28/3131
b) 0.30
c) 0.55 m2
385
4) Then use the formula to

determine the estimated pediatric
dose.
a) (0.55 m2/1.7 m2) 3 50 5 16.21
5) The estimated pediatric dose for
this child is 16 mg per dose.
c. Example:
1) A child weighs 35 kg and is 120
cm tall.
2) The adult dose for the ordered
medication is 500 mg.
3) First determine the childs BSA:

a) 120 3 35/3600 5
b) 1.16
c) 1.08 m2
4) Then utilize the dosage
formula.
a) (1.08 m2/1.7 m2) 3 500 5 318
5) The estimated dose for this child
is 320 mg per dose.
PRACTICE QUESTIONS
1. A physician has ordered acetylsalicylic acid
(aspirin) 10 gr every 4 hours p.r.n. The available
dose for aspirin is 325 mg per tablet. What will
the nurse administer?
1. 2 tabs
2. 1 tab
3. 6.6 tabs
4. 1.5 tabs
2. The physician has ordered guaifenesin
(Robitussin) expectorant syrup 1 ounces p.o.
every 4 hours. One 90-ml bottle of guaifenesin
(Robitussin) syrup is available. What will the
nurse administer?
1. 30 ml
2. 45 ml
3. 15 ml
4. 10 ml
3. The physicians order reads phenytoin sodium
(Dilantin) 0.1 g p.o. now. On hand are phenytoin
sodium (Dilantin) capsules, 100 mg per
capsule. The nurse will give
1. 1 capsule.
2. 3 capsules.
3. 2 capsules.
4. 1 capsules.
4. The order reads levodopa (Dopar) 1.5 g p.o. b.i.d.
On hand are levodopa (Dopar) tablets in a
500-mg strength. The nurse will give
1. 1.5 tablets.
2. 3 tablets.
3. tablet.
4. 2 tablets.
5. The doctors order states glipizide (Glucotrol)
5000 mcg daily. On hand the nurse has glipizide
(Glucotrol) 2.5 mg tablets. How many tablets
will the nurse administer?
1. 1 tablet
2. 2.5 tablets
3. 0.2 tablets
4. 2 tablets
6. The nurse reads a physicians order, which
states atropine sulfate 0.5 mg IM stat. The
nurse has atropine sulfate 0.3 mg/0.5 ml
for injection available. What volume of the
atropine solution should the nurse
administerIM?
1. 0.1 ml
2. 0.5 ml
3. 0.8 ml
4. 1.0 ml
7. The order reads hydromorphone HCl (Dilaudid)
1.5 mg s.q. every 4 to 6 hours p.r.n. The nurse
has injectable hydromorphone HCl (Dilaudid)
ampules gr 1/30 per ml. What volume will the
nurse administer?
1. 0.9 ml
2. 7.5 ml
3. 0.5 ml
4. 0.75 ml
8. The doctors order reads vitamin B12 injection
1000 mcg once a month. The nurse has
injectable vitamin B12 available in a
concentration of 0.5 mg/ml. What volume
should the nurse administer?
1. 2.5 ml
2. 2 ml
3. 0.5 ml
4. 1 ml
9. The doctor has ordered furosemide (Lasix)
40-mg IV push. The nurse has injectable
furosemide (Lasix) 20 mg in 2 ml available.
What should the nurse administer?
1. 4 ml
2. 0.4 ml
3. 2 ml
4. 3 ml
386
10. The doctor has ordered diazepam (Valium)

2.5-mg IV push stat. Available is injectable
diazepam (Valium) 5 mg/ml. How much
willthe nurse administer?
1. 0.75 ml
2. 1 ml
3. 0.5 ml
4. 5 ml
11. The order reads ceftriaxone (Rocephin)
1.4 g IM b.i.d. Available is a ceftriaxone
(Rocephin) 1-vial; when reconstituted with
2.1 ml, it results in a concentration of
350 mg per ml. What volume will the nurse
administer?
1. 3 ml/1 vial
2. 4 ml/2 vials
3. add more diluent to yield 4 ml in 1 vial
4. 5 ml total/2 vials
12. Amoxicillin with clavulanic acid (Augmentin)
powder reconstituted with 69 ml water
results in a 75-ml suspension with a
200-mg/5-ml concentration. The doctors
order reads Augmentin 600-mg oral
suspension p.o. every 12 hours. What
volume of the suspension will the nurse
administer?
1. 30 ml
2. 10 ml
3. 15 ml
4. 20 ml
13. Administer 800 ml IV D5W at 75 ml/hour.
Thedrop factor is 10 gtt/ml. What is the
drops-per-minute rate?
1. 13
2. 10
3. 17
4. 21
14. Infuse heparin 40,000 units in 1000 ml of
normal saline IV over 24 hours. The
administration set has a drop factor of
10 gtt/ml. The nurse will set the gtt per minute
at what rate?
1. 14 gtt
2. 42 gtt
3. 17 gtt
4. 7 gtt
15. The order reads heparin 2000 units s.q. The
nurse has on hand heparin 2500 units/ml.
Howmuch will the nurse administer?
1. 0.8 ml
2. 0.5 ml
3. 0.6 ml
4. 0.9 ml
16. Heparin 30,000 units in 1000 ml of normal
saline is to be administered IV over
24 hours via microdrip. How many
units of heparin is the client receiving

per hour?
1. 635
2. 1000
3. 1250
4. 125
17. Infuse 2000 ml of lactated Ringers over
12hours. The drop factor is 15 gtt/ml.
The nurse will regulate the IV to how many
gtt per minute?
1. 28
2. 42
3. 56
4. 14
18. Use an electronic regulator to administer 1500ml
of D5W in 6 hours. The nurse will set the
machine for
1. 150 ml/hour.
2. 200 ml/hour.
3. 250 ml/hour.
4. 275 ml/hour.
19. The physician has ordered morphine
sulfate (Duramorph) 10 mg s.q. every
4 hours p.r.n. The child weighs 80 lb.
The recommended maximum dose of
morphine sulfate (Duramorph) is 0.1 mg to
0.2 mg/kg/dose. To determine the safety
of this dose, what is the safe dose range
for this child?
1. 3.6 mg to 7.3 mg/dose
2. 5 mg to 10 mg/dose
3. 36 mg to 73 mg/dose
4. 2.8 mg to 6 mg/dose
20. The nurse determines a 23-kg child to weigh
how many pounds?
21. The recommended dosage for cefaclor
(Ceclor)suspension is 20 to 40 mg/kg/day
divided into 2or 3 doses. The child
receivingthe cefaclor (Ceclor) weighs 22 kg.
What is the recommended range for the
individual dose ordered as twice daily for
thischild?
1. 330 to 660 mg
2. 440 to 880 mg
3. 220 to 440 mg
4. 200 to 400 mg
22. The recommended dosage for furosemide
(Lasix) oral solution is a single dose of
2 mg/kg, and subsequent doses of 1 to
2 mg/kg every 6hours until suitable
response, up to a maximum of
6 mg/kg/day. What is the minimum
to maximum 24-hour dose range for a
child weighing 26 kg?
1. 52 mg to 156 mg/24 hours
387
23. Using the childs weight, determine what the
pediatric dose for digoxin (Lanoxin) would be if
the usual adult dose is 0.15 mg p.o. every day.
The child weighs 13 kg. The nurse will
administer
1. 0.15 mg.
2. 0.05 mg.
3. 0.1 mg.
4. 0.07 mg.
24. An adult dose of doxycycline (Vibramycin) is
100 mg b.i.d. The child who is to take
doxycycline (Vibramycin) is 32 inches tall and
weighs 48pounds. Determine the childs dose

based on BSA.
1. 30 mg/dose
2. 25 mg/dose
3. 50 mg/dose
4. 40 mg/dose
25. The recommended adult dose of acyclovir is
200 mg every 4 hours. What would an
appropriate dose be for a child weighing 8 kg
and standing 57 cm tall?
1. 40 mg
2. 60 mg
3. 30 mg
4. 50 mg
ANSWERS AND RATIONALES

1. 1. Find the number of tablets to be administered:
1 gr 5 60 mg and 1 tablet 5 325 mg
First convert grains to milligrams:
1 gr 5 60 mg, 10 gr 5 600 mg
660 mg is the desired dose.
Set up the ratio:
325 mg 660 mg
5
1 tab
x
660
325
x 5 2.03
x5
1500 mg
tablets
500 mg
x 5 3 tablets
The nurse will administer 3 tablets of levodopa
(Dopar).
5. 4. Find the number of tablets to be administered.
x5
The order is for 5000 mcg, and the tablets on

hand are 2.5 mg.
Convert 5000 mcg to milligrams:
Because conversions between apothecary

andmetric systems are not exact, two
325-mg tablets may be administered for the
600-mg grains. The nurse will administer
2tablets.
1000 mcg 5 1 mg, then 5000 mcg 5 5 mg

Set up the ratio to determine the number of
tablets to deliver:
2. 2. Find the amount of expectorant that should be

administered.
1 ounce 5 30 ml
Convert ounces to milliliters:
1 ounce 5 30 ml, 1 ounces 5 45 ml, x5 45 ml
The nurse will administer 45 ml.
3. 1.
500 mg 1500 mg
5
1 tablet
x
Find the number of capsules to be administered.

The order is for 0.1 g and each capsule 5 100 mg.
Convert grams to milligrams:
1 gram 5 1000 mg, 0.1 g 5 100 mg, x 5 1 capsule
The nurse will administer 1 capsule.
4. 2. Find the number of tablets to be administered.

The order is for 1.5 g, and the tablets on hand
are 500 mg.
First convert 1.5 g to milligrams:
1 gram 5 1000 mg, 1.5 g 5 1500 mg
Determine the number of tablets to be
administered:
2.5 mg 5 mg
5
1 tab
x
5 mg
x5
tablets
2.5 mg
x 5 2 tablets
The nurse will administer 2 tablets of glipizide
(Glucotrol).
6. 3. Find the volume for this injection.

Set up a ratio:
0.3 mg 5.0 mg
5
5 ml
x
x 5 5 ml 3
0.5 mg
3.0 mg
2.5
ml,
0.3
x 5 0.8 ml
x5
The nurse will administer 0.8 ml of the

injectable solution intramuscularly.
388
7. 4. Find the volume to inject.

Conversion: 1 gr 5 60 mg, and the drug has
1/30 grain per ml.
Convert 1/30 grain and 1.5 mg to the same
units.
Note: It is generally easier to convert grains to
milligrams.
60
mg
1 gr 5 60 mg, 1/30 gr 5
30
The medicine has a strength of 2 mg/ml.
Then set up the ratio:
1.5 mg
2 mg/ml 5
x
1.2 mg
ml 5 .75 ml
x5
2 mg
injectable solution.
Convert the grams to mg:

1 g 5 1000 mg, 1.4 g 5 1400 mg
Convert 1.4 g to milligrams (move the decimal
point three places) to equal 1400 mg.
Set up a ratio:
350 mg/ml 5
x5
1400 mg
,
x
1400 mg
ml,
350 mg
x 5 4 ml
The nurse will need to administer 4 ml of the
ceftriaxone (Rocephin). There is not enough
medication in 1 vial to administer 4 ml.
Therefore the nurse will need to reconstitute
2vials for the prescribed dose.
12. 3. Determine the volume to be administered.
The concentration available is 0.5 mg/ml.

Convert mcg to mg:
The order is for 600 mg; available is

200 mg/5 ml.
Set up a ratio:
1 mg 5 1000 mcg
Then set up the ratio:
200 mg
600 mg
5
5 ml
x
0.5 mg 1 mg
5
1 ml
x
x5
8. 2. Find the volume for this injection.
x5
1 mg
ml
0.5 mg
x 5 2 ml
The nurse will administer 2 ml injectable
vitamin B12.
9. 1. Find the volume to inject.

The order is for 40 mg; available is 20 mg/2 ml.
Set up the ratio:
20 mg 40 mg
5
2 ml
x
40 3 2
20 ml
x 5 4 ml
x5
The nurse will administer 4 ml of injectable

furosemide (Lasix) IV push.
10. 3. Find the volume to be injected.

The order is for 2.5 mg; the available solution
is5 mg/ml.
Set up a ratio:
5 mg 2.5 mg
5
1 ml
x
x5
2.5 mg
ml
5 mg
x 5 0.5 ml
injectable furosemide (Valium) solution.
11. 2. Find the volume to be administered.

The order is for 1.4 g; the available solution is
350 mg/ml.
5 3 600 mg
ml
200 mg
x 5 15 ml
The nurse will administer 15 ml of the
reconstituted Augmentin suspension.
13. 1. Determine the drip rate per minute in gtt.

The order is for a rate of 75 ml/hr; the drop
factor is 10 gtt/ml.
Convert the order to ml/minute:
1 hour 5 60 minutes, 1/60 3 75 ml/hr 5
1.25 ml/minute
Determine the drip rate:
x 5 order 3 drop factor
x 5 1.25 ml/min 3 10 gtt/ml
x 5 12.5 gtt/min, rounded to 13
The nurse will administer 13 gtt/minute.
14. 4. Determine the gtt/minute rate.

The order is for a rate of 1000 ml/day; the drop
factor is 10 gtt/ml.
Convert the order to ml/minute:
1 day 5 24 hours/day 3 60 minutes/hour
1000
1000 ml / day 5
5 0.69 ml / minute
24 3 60
minutes/day
Determine the drip rate:
x 5 order 3 drop factor
x 5 0.69 ml/minute 3 10 gtt/ml
x 5 6.9 gtt/minute, rounded to 7
15. 1. What volume will the nurse administer?

The order is for 2000 units and available is a
2500-units/ml solution.
389
Set up a ratio:
Upper threshold: 0.2 mg/kg 3 36.4 kg 5 7.3 mg
2500 units 2000 units

5
1 ml
x
10 mg per dose is not within the safe dose

range for this child.
2000
2500
x 5 4/5 or 0.8 ml
20. 51. A 23-kg child weighs 50.6pounds or 51.
The nurse will administer 0.8 ml.
21. 3. Determine the recommended safety range of
x5
16. 1. Determine the units to be administered

perhour.
The rate is 30,000 units over 24 hours.
Note: The mention of microdrip does not
enter into this calculation at all; you only need
to convert units per day to units per hour. The
microdrip calculation is only a factor when
determining the setting for delivery of the
order.
The order is for
30,000 units
x
5
24 hours
1 hour
Multiply the 23 kg by 2.2 to convert from

kg tolbs.
this drug.
The recommended dosage is from 20 mg/kg/
day to 40 mg/kg/day.
The childs weight is 22 kg; the drug will be
administered 2 times per day.
Calculate the recommended upper and lower
thresholds for this child.
Lower threshold: 20 mg/kg/day 3 22 kg 5
440 mg/day
2 doses per day, lower threshold per dose 5
1/2 3 440 mg 5 220 mg
x5
Upper threshold: 40 mg/kg/day 3 22 kg 5

880 mg/day
The nurse will administer 1250 units per hour.
2 doses per day, upper threshold per dose 5

1/2 3 880 mg 5 440 mg
The range for this child is 220 mg to 440 mg.
30,000 units
24 hours
x 5 1249.9 units per hour, or 1250 units per hour
17. 2. Determine the drip rate in gtt/minute.

The order is for 2000 ml/12 hours; the drop
factor is 15 gtt/minute.
Convert the prescription to a rate per minute:
2000 ml
5 167ml/hours
12 hours
167 ml
5 2.78 ml/hours
60 minutes
Now calculate the drip rate:
2.78 ml/minute 3 15 gtt/ml 5 41.7 gtt/minute
or 42 gtt/minute
18. 3. Determine the setting in ml/hour for an

electronic regulator.
The order is for 1500 ml/6 hours.
1500 ml
5 250 ml/hour
x5
6 hours
The nurse will set the machine to administer
250 ml/hour.
19. 1. Determine the safety of this order.

The recommended dose is from 0.1 mg/kg to
0.2 mg/kg; the childs weight is 80pounds.
Convert the childs weight to kilograms:
1
kilograms,
2.2
80
80 lb 5
kg 5 36.4kg
2.2
1 pound 5
Calculate the recommended upper and lower

thresholds for this child.
Lower threshold: 0.1 mg/kg 3 36.4 kg 5 3.6 mg
22. 1. Determine the range of daily safe dosages for a

26-kg child.
The safe dosage range has a minimum of
2 mg/kg as a single application, and a
maximum of 6 mg/kg/day
Determine the lower threshold for this child:
If the first 2 mg/kg shows results, there would
be no further application.
For a child of 26 kg, the lower threshold is
26 kg 3 2 mg/kg 5 52 mg.
Determine the upper threshold:
The daily upper limit is given as 6 mg/kg/day.
For a child of 26 kg, the upper threshold is
26 kg 3 6 mg/kg 5 156 mg.
The range for this child is 52 mg to 156 mg.
23. 2. Find the amount of digoxin the nurse should

administer based on BSA.
The usual adult dose is for 0.15 mg, and the
child weighs 13 kg.
S 5 log W 3 0.425 1 log H 3 0.725 1 1.8564,
where
S is in cm2; W is in kg; and H is in cm.
Determine the childs BSA using weight:
( 4 3 13) 1 7
13 1 90
52 1 7
59
5
5 0.57 m2 BSA
103
103
Determine the childs dose based on BSA:

0.57 m2
3 0.15 mg 5 0.34 3 0.15 5 0.05 mg
1.7
The nurse will administer a 0.05-mg dose.
390
24. 4. Determine a childs dose of Vibramycin
25. 1. Determine a childs dose of acyclovir using BSA.
usingBSA.
An adult dose is 100 mg; the child is 32 inches
tall and weighs 48pounds.
The adult dose is 200 mg; the child is 57 cm

tall and weighs 8 kg.
Determine the childs BSA:
S 5 log W 3 0.425 1 log H 3 0.725 1 1.8564,

S is in cm2; W is in kg; and H is in cm.
Determine the childs BSA:
8 kg 3 57 cm
456
5
5 0.12 5 0.35 m2
3600
3600
Determine the childs dose:
48 3 32
1536
5
5 0.49 5 0.70 m2
3131
3131
0.35 m2
3 200 mg 5 child's dose
1.7
0.21 3 200 5 42 mg
Determine the childs dose based on the BSA:
0.70 m2
3 100 mg 5 41 mg/dose
1.7
The nurse will administer 40 mg every 4 hours.
The nurse will administer 40 mg per dose.
REFERENCES
Broyles, B. E. (2009). Dosage calculation practice for
nurses (2nd ed.). Clifton Park, NY: Delmar Cengage
Learning.
Curren, A. M. (2009). Math for meds: Dosages and
solutions (10th ed.). Clifton Park, NY: Delmar Cengage
Learning.
Gray Morris, D. C. (2009). Calculate with confidence
(5th ed.). St. Louis, MO: Mosby.
Pickar, G. D. (2012). Dosage calculations

(10th ed.). Clifton Park, NY: Delmar Cengage
Learning.
Saxton, D. F., Ercolano-ONeill, N., & Glavinspiehs, C.
(2005). Math and meds for nurses (2nd ed.). Clifton
Park, NY: Delmar Cengage Learning.

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C H A P T E R

MEASUREMENT AND DRUG

3. CONVERSIONS ARE NOT EQUAL AS

Unit III PHARMACOLOGY

4. COMMON USEFUL MEASUREMENTS:

Table 16-1 Household to Apothecaries, and Metric

Cengage Learning 2015

grains 15 (gr xv)

1 gram (1000 mg)

B. EXAMPLES OF CONVERSIONS BETWEEN

Chapter 16 MEASUREMENT AND DRUG CALCULATIONS

ORAL MEDICATION CALCULATION

Unit III PHARMACOLOGY

PARENTERAL MEDICATION CALCULATION

6. YOU WILL ADMINISTER 8 ML PER

Chapter 16 MEASUREMENT AND DRUG CALCULATIONS

c. Figure ml/hr: 250 ml/6 hr 5 41.5 or

Unit III PHARMACOLOGY

4. FINALLY, CALCULATE THE VOLUME

for children of normal height and

Chapter 16 MEASUREMENT AND DRUG CALCULATIONS

4) Then use the formula to

3) First determine the childs BSA:

Unit III PHARMACOLOGY

10. The doctor has ordered diazepam (Valium)

units of heparin is the client receiving

Chapter 16 MEASUREMENT AND DRUG CALCULATIONS

weighs 48pounds. Determine the childs dose

ANSWERS AND RATIONALES

5. 4. Find the number of tablets to be administered.

The order is for 5000 mcg, and the tablets on

Because conversions between apothecary

1000 mcg 5 1 mg, then 5000 mcg 5 5 mg

2. 2. Find the amount of expectorant that should be

Find the number of capsules to be administered.

4. 2. Find the number of tablets to be administered.

6. 3. Find the volume for this injection.

The nurse will administer 0.8 ml of the

Unit III PHARMACOLOGY

7. 4. Find the volume to inject.

Convert the grams to mg:

12. 3. Determine the volume to be administered.

The concentration available is 0.5 mg/ml.

The order is for 600 mg; available is

8. 2. Find the volume for this injection.

9. 1. Find the volume to inject.

The nurse will administer 4 ml of injectable

10. 3. Find the volume to be injected.

11. 2. Find the volume to be administered.

13. 1. Determine the drip rate per minute in gtt.

14. 4. Determine the gtt/minute rate.

15. 1. What volume will the nurse administer?

Chapter 16 MEASUREMENT AND DRUG CALCULATIONS

Upper threshold: 0.2 mg/kg 3 36.4 kg 5 7.3 mg

2500 units 2000 units

10 mg per dose is not within the safe dose

20. 51. A 23-kg child weighs 50.6pounds or 51.

The nurse will administer 0.8 ml.

21. 3. Determine the recommended safety range of

16. 1. Determine the units to be administered

Multiply the 23 kg by 2.2 to convert from

Upper threshold: 40 mg/kg/day 3 22 kg 5

The nurse will administer 1250 units per hour.

2 doses per day, upper threshold per dose 5