C H A P T E R 1 6

MEASUREMENT AND DRUG

CALCULATIONS

I. SYSTEMS OF MEASUREMENT 3. CONVERSIONS ARE NOT EQUAL AS

A. METRIC SYSTEM MEASUREMENTS IN THIS SYSTEM
1. THE METRIC SYSTEM IS THE BUT ARE APPROXIMATIONS.
INTERNATIONAL SYSTEM OF UNITS. THEREFORE, DISCREPANCIES WILL
ITUSES DECIMALS MULTIPLIED EXIST.
ORDIVIDED BY MULTIPLES OF 10. 4. COMMON USEFUL MEASUREMENTS:
2. COMMON MEASUREMENTS USED IN a. Weight measurements are in grains (gr),
HEALTH CARE FIELDS: drams (dr) or ( ), ounces (oz) or (),
a. Weight: and pounds (lb).
1 mg (milligram) 5 1000 mcg b. When Roman numerals are used to
(micrograms) write doses, symbols such as ss 5
alsog and iiiss 5 3 are used.
1 g (gram) 5 1000 mg c. Volume measurements are in minims
(milligrams) (m) or (min), drams (dr) or ( ), ounces
1 kg (kilogram) 5 1000 g (grams) (oz) or (), pints (pt), and quarts (qt).
alsoGM 5. WEIGHT CONVERSION FOR
b. Volume: MEDICATION ADMINISTRATION
1 L (liter) 5 1000 ml (milliliters) or ONLY UTILIZES THE GRAIN
cc(cubic centimeters) MEASUREMENT: 60 GRAINS (GR 60) 5
3. SOME METRIC CONVERSION 1 DRAM.
EXAMPLES: 6. COMMON VOLUME CONVERSIONS:
a. To convert from a larger unit to a 60 minims 5 1 fluid dram
smaller one, move x decimal places to 4 drams 5 ounce
the right. 8 drams 5 1 ounce
b. To convert from a smaller unit to a 16 ounces 5 1 pint
larger one, move x decimal places to 32 ounces 5 1 quart
theleft. 2 pints 5 1 quart
c. Conversion examples: 4 quarts 5 1 gallon
200 mg 5 0.2 g C. HOUSEHOLD SYSTEM
5.8 L 5 5800 ml 1. THE HOUSEHOLD SYSTEM IS THE
0.78 g 5 780 mg LEAST ACCURATE OF THE SYSTEMS
750 ml 5 0.75 L AND IS WHAT IS USED BY MOST
6 mcg 5 0.006 mg PEOPLE AT HOME. IT IS THE
72 mg 5 7200 mcg STANDARD COOKBOOK
B. APOTHECARIES SYSTEM MEASUREMENT SYSTEM.
1. THE APOTHECARIES SYSTEM USES 2. THE HOUSEHOLD SYSTEM USES
BOTH ARABIC AND ROMAN NUMERALS ARABIC NUMBERS AND FRACTIONS.
AND FRACTIONS RATHER THAN 3. THE NURSE SHOULD UTILIZE
DECIMALS. ANOTHER SYSTEM OF MEASURE
2. THE SYMBOL OR ABBREVIATION IS WHENEVER POSSIBLE BUT SHOULD
WRITTEN FIRST, FOLLOWED BY THE BEPREPARED TO MAKE
QUANTITY. CONVERSIONSFOR HOME USE WHEN
NECESSARY.

379
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 380 Unit III PHARMACOLOGY

4. COMMON USEFUL MEASUREMENTS: B. EXAMPLES OF CONVERSIONS BETWEEN

60 drops (gtts) 5 1 teaspoon (tsp) SYSTEMS USING RATIO-PROPORTION
3 teaspoons (tsp) 5 1 tablespoon METHOD
(tbsp or T) 1. YOU MUST KNOW AT LEAST ONE
3 tsp or 1 T 5 ounce (oz) CONVERSION FACTOR BETWEEN THE
2 tablespoons 5 1 ounce (oz) TWO SYSTEMS.
8 ounces (oz) 5 1 cup (c) 2. FOR EXAMPLE, WHEN CONVERTING
16 ounces (oz) 5 2 cups or 1 pint (pt) POUNDS TO KILOGRAMS, YOU
32 ounces (oz) 5 4 cups or 1 quart (qt) KNOWTHAT 1 KG IS EQUAL TO
2 pints (pt) 5 1 quart (qt) 2.2POUNDS.
5. EQUIVALENTS FROM HOUSEHOLD 3. EXAMPLE PROBLEM 1 : 50 LB 5 x KG
TO APOTHECARIES TO METRIC a. The known equivalent ratio 2.2 lb :
(SEE TABLE16-1) 1 kg is placed first.
II. MEASUREMENT CONVERSIONS b. The unknown equivalent ratio 50 lb :
A. USING THE RATIO-PROPORTION METHOD x is placed second.
1. CARRY DECIMALS OUT TO c. In ratio format, the problem looks
TWODECIMAL PLACES FOR likethis:
ACCURACY. 2.2 lb : 1 kg :: 50 lb : x kg
2. RATIOS MAY BE STATED AS The product of the means is 50.
FRACTIONS AND CROSS MULTIPLIED The product of the extremes is 2.2x.
TO SOLVE FOR X. OR USE RATIO- d. Then solve for x by dividing 50 by 2.2.
PROPORTIONS TO SOLVE BY 1) x 5 50 4 2.2
MULTIPLYING THE MEANS AND THE 2) x 5 22.7 kg
EXTREMES. THE PRODUCT OF THE e. Or in fraction format, the problem
MEANS EQUALS THE PRODUCT OF looks like this:
THE EXTREMES. 1) 2.2 lb/1 kg 5 50 lb/x kg
3. WHEN USING RATIO-PROPORTIONS, 2) Cross multiplied 1 3 50 5 50 and
IT IS PREFERABLE TO PLACE THE 2.2 3 x 5 2.2x
KNOWN EQUIVALENT IN THE FIRST 3) 50 4 2.2 5 22.7 kg
RATIO AND THE UNKNOWN 4. EXAMPLE PROBLEM 2 : 5 5 ML 5
EQUIVALENT IN THE SECOND RATIO. X MINIMS
a. Conversion factor for converting
milliliters to minims is 1 ml 5 15 m.
b. The known equivalent ratio 1 ml :
Table 16-1 Household to Apothecaries, and Metric
15 m is placed first.
Equivalencies
c. The unknown equivalent ratio : 5
Household Apothecaries Metric ml : x is placed second.
d. In ratio format, the problem looks
1 gtt minim 1 (m i) likethis:
minim 15 (m xv) 1 ml 1) 1 ml : 15 m :: 5 5 ml : x m
2) Multiply the means: 15 3 5 5 75
1 tsp 60 gtts 5 ml 3) Multiply the extremes: 1 3 x 5 1x
1 tsp dram i ( i) 5 ml e. Solve for x by dividing 75 by 1. The
answer is 75 minims.
tsp ounce ( ss) f. In fraction format, the problem looks
1 tbsp ounce ( ss) 15 ml like this:
1) 1 ml/15 m 5 5 ml/x m
1 tbsp dram iv ( iv) 15 ml 2) Cross multiply 15 3 5 5 75
2 tbsp dr viii ( viii) 30 ml 3) Cross multiply 1 3 x 5 1x
4) Solve for x: 75 4 1 5 75.
2 tbsp 1 ounce ( i) 30 ml g. The answer is 75 minims.
1 cup 8 ounces ( viii) 240 ml III. DRUG CALCULATION METHODS
1 pint 16 ounces ( xvi) 500 ml
A. ANY OF THE FOLLOWING METHODS
ARE APPROPRIATE TO USE IN
1 quart 32 ounces ( xxxii) 1000 ml CALCULATING DRUG DOSAGES;
Cengage Learning 2015

grains 15 (gr xv) 1 gram (1000 mg)

HOWEVER, IT IS RECOMMENDED
THAT YOU USE WHAT YOU ARE MOST
grains 1 (gr i) 60 mg FAMILIAR WITH.
2.2 lb 1 kg (1000 g)
B. DRUG CALCULATIONS USING THE
RATIO-PROPORTION METHOD

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Chapter 16 MEASUREMENT AND DRUG CALCULATIONS 381

1. EXAMPLE1 4. FORMULA 2:
a. One form of digoxin (Lanoxin) comes a. DW/SW 5 DV/SV
in 0.125-mg tablets. b. This formula is a proportion set up as
b. The medication order reads digoxin a fraction and is functionally the
(Lanoxin) 0.0625 mg p.o. every day. same as the ratio-proportion method.
c. How many tablets do you administer? c. DW is the dose weight (desired dose).
d. Calculation: d. SW is the stock weight (what is on
1) First, set up the problem using hand).
the ratio or the fraction format. e. DV is the dose volume (the unknown).
2) 1 tab/0.125 5 X/0.0625 and solve f. SV is the stock volume (the quantity
for x or volume that contains the available
3) 0.125x 5 0.0625 3 1 dose).
4) 0.125x 5 0.0625
IV. ORAL MEDICATION CALCULATION
5) x 5 0.0625/0.125
EXAMPLES
6) x 5 tab
A. RATIO-PROPORTION METHOD
7) Or: 1 : 0.125 :: x : 0.0625
1. ORDERED: WARFARIN SODIUM
8) 0.125x 5 1 3 0.0625
(COUMADIN) 7.5 MG P.O. EVERY DAY
9) x 5 0.0625/0.125
2. AVAILABLE: WARFARIN SODIUM
10) x 5 tab
(COUMADIN) 2.5 MG TABS
2. EXAMPLE2
3. CALCULATION:
a. One form of phenytoin (Dilantin)
a. 2.5 mg/1 tab 5 7.5 mg/x tabs
comes in 100-mg capsules.
b. Cross multiply: 7.5 3 1 5 7.5 and
b. The medication order reads phenytoin
2.5 3 x
(Dilantin) 0.3 g p.o. every day.
c. 7.5 mg/2.5x
c. How many capsules will you
d. x 5 3 tabs
administer?
4. YOU WILL ADMINISTER THREE
d. Calculation
2.5-MG TABLETS OF WARFARIN
1) First convert grams to mg, then
SODIUM (COUMADIN).
you are able to set up the problem
B. FORMULA 1 METHOD
properly.
1. ORDERED: AMPICILLIN (OMNIPEN)
a) 0.3 g 5 x mg
1 G P.O. EVERY 6 HOURS
b) 1 g : 1000 mg :: 0.3 g : x mg
2. AVAILABLE: AMPICILLIN (OMNIPEN)
c) 1x 5 0.3 3 1000
250-MG CAPSULES
d) x 5 300 mg
3. CALCULATION:
2) Then set up the problem knowing
a. First convert grams to milligrams:
that 0.3 g 5 300 mg. How many
1 g 5 1000 mg
capsules will you administer?
D
a) 100 mg : 1 capsule :: 300 mg : b. 3Q 5X
x capsules H
b) 300 mg 4 100 mg x 1000 mg
c. 31 5 X
c) x 5 3 capsules 250 mg
3) You will administer three 100-mg d. 4 5 X
capsules of phenytoin (Dilantin). 4. YOU WILL ADMINISTER FOUR 250-MG
C. DRUG CALCULATIONS USING THE CAPSULES OF AMPICILLIN (OMNIPEN).
FORMULA METHOD C. FORMULA 2 METHOD
1. FORMULAS MAY BE USED WHEN THE 1. ORDERED: PHENOBARBITAL
DOSES CALCULATED ARE OF THE (SOLFOTON) GR ISS P.O. QAM
SAME MEASUREMENT SYSTEM. 2. AVAILABLE: PHENOBARBITAL
2. THEREFORE, BOTH THE DESIRED DOSE (SOLFOTON) 15 MG TABLETS
AND THE DOSE ON HAND MUST BE 3. CALCULATION
CONVERTED TO THE SAME SYSTEM a. First convert grains to milligrams.
BEFORE A FORMULA CAN BE APPLIED. b. gr i 5 60 mg
3. FORMULA 1: c. gr iss 5 90 mg
D d. Then use the formula: DW/SW 5 DV/SV.
a. 3Q 5X
H e. 90 mg 5 DV (x tabs)
b. D 5 the desired dose f. 15 mg 1 tab
c. H 5 the strength available g. 15x 5 90 mg
d. Q 5 the quantity of measure (unit of h. x 5 90/15
measure) i. x 5 6 tablets
e. x 5 the unknown 4. YOU WILL ADMINISTER SIX TABLETS
OF PHENOBARBITAL (SOLFOTON).

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382 Unit III PHARMACOLOGY

V. PARENTERAL MEDICATION CALCULATION 6. YOU WILL ADMINISTER 8 ML PER

A. EXAMPLE1 DOSE. TO DETERMINE THE NUMBER
1. ORDER: MORPHINE SULFATE OF DOSES PER BOTTLE, DIVIDE 100
(DURAMORPH) GR IM EVERY ML BY THE 8-ML DOSE 5 12.5 DOSES.
4HOURS P.R.N. B. RECONSTITUTED PARENTERAL
2. AVAILABLE: MORPHINE SULFATE MEDICATIONS
(DURAMORPH) 10 MG/ML 1. THREE (3)MILLION UNITS PENICILLIN
3. HOW MANY MILLIGRAMS AND HOW G POTASSIUM (PFIZERPEN) COMES IN
MANY MILLILITERS WILL YOU DRY CRYSTAL FORM IN A BOTTLE
ADMINISTER? FOR RECONSTITUTION.
4. CALCULATION: 2. THE BOTTLE READS: DILUTE
a. First convert gr to milligrams: WITH4.2ML NORMAL SALINE TO
gr i/60 mg 5 gr / x, x 5 15 mg. MAKE 5 ML.
b. If the desired dose is 15 mg, then what 3. THE ORDER READS: PENICILLIN
is the volume to be administered IM? GPOTASSIUM (PFIZERPEN)
c. 10 mg/1 ml 5 15 mg/x ml 300,000UNITS IM NOW.
d. 10x 5 15 4. AVAILABLE: PENICILLIN G
e. x 5 15/10 POTASSIUM (PFIZERPEN) 3 MILLION
f. x 5 1.5 ml UNITS IN 5 ML
5. YOU WILL ADMINISTER 1.5 ML OF 5. HOW MANY MILLILITERS WILL
THE MORPHINE SULFATE YOUADMINISTER TO EQUAL
(DURAMORPH) SOLUTION IM. 300,000UNITS?
B. EXAMPLE2 6. CALCULATION:
1. ORDER: MEPERIDINE (DEMEROL HCL) a. First, write out millions: 3 million
50 MG IM EVERY 4 HOURS P.R.N. 5 3,000,000
2. AVAILABLE: MEPERIDINE (DEMEROL b. Set up the ratio: 3,000,000/5 ml
HCL) 75 MG/ML 5 300,000/x ml
3. WHAT VOLUME OF THE MEPERIDINE c. 3,000,000 3 x 5 5 3 300,000
(DEMEROL HCL) SOLUTION WILL d. 3,000,000x 5 1,500,000
YOU ADMINISTER? e. x 5 3,000,000/1,500,000
4. CALCULATION: f. x 5 1/2 or 0.5 ml
a. 75 mg/1 ml 5 50 mg/x ml 7. YOU WILL ADMINISTER 0.5 ML OF
b. 75x 5 50 SOLUTION.
c. x 5 50/75
VII. INTRAVENOUS DRUG CALCULATION
d. x 5 2 /3 or 0.66 ml or 0.67 ml of the
EXAMPLES
meperidine (Demerol HCl) solution.
A. MANUAL REGULATION: FORMULAS FOR
5. YOU WILL ADMINISTER 0.67 ML OF
DROPS PER MINUTE
MEPERIDINE (DEMEROL HCL)
1. FORMULA: V1/T1 3 V2/V2 5 GTT/MIN
SOLUTION.
a. V1 5 Volume to infuse
VI. POWDERED DRUG CALCULATION b. V2 5 drop factor of the tubing
EXAMPLES (10, 15, or 20)
A. RECONSTITUTED ORAL MEDICATIONS c. T1 5 Time in hours to infuse
1. THE POWDERED AMOXICILLIN d. T2 5 time in minutes (usually 60)
(AMOXIL) BOTTLE READS: ADD 85 ML e. Example:
WATER TO MAKE 100 ML OF 1) Run 750 ml D5 0.9 NS over
AMOXICILLIN SUSPENSION. 4 hours, with a tubing drop factor
2. WHEN RECONSTITUTED, THE of 10 gtts/ml.
AVAILABLE SUSPENSION WILL HAVE 2) V1 5 750, V2 5 10, T1 5 4 hours,
A CONCENTRATION OF 125 MG/5 ML. and T2 5 60
3. THE ORDER READS: AMOXICILLIN 3) 750/4 3 10/60 5
SUSPENSION (AMOXIL) 200 MG P.O. 4) 7500/240 5
EVERY 6 HOURS. 5) 31.25 gtts/min or 31 gtts/min
4. HOW MANY MILLILITERS PER 2. FORMULA: V/T 3 C 5 R
DOSEWILL YOU ADMINISTER? HOW a. This formula requires that you
MANY DOSES ARE THERE IN THE already know the hourly rate.
BOTTLE? 1) V 5 volume ordered to be infused
5. CALCULATION in 1 hour.
a. 125 mg/5 ml 5 200 mg/x ml 2) C 5 drop factor (gtts ml).
b. 125x 5 1000 3) T 5 time ordered by the
c. 1000/125 5 8 physician converted to minutes.

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Chapter 16 MEASUREMENT AND DRUG CALCULATIONS 383

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

1) The physician has ordered D5 42ml/hr set on the electronic regulator
0.45 at 75 ml per hour. d. Figure ml/min: 42 ml/hr divided by
2) The tubing drop factor is 10 gtts/ml. 60minutes 5 0.7 ml/min
3) Use the following steps to e. Figure gtts/min: 0.7 ml/min 3 60 gtts/ml
calculate the IV flow rate in drops 5 42 gtts/min via microdrip tubing
per minute. VIII. HEPARIN CALCULATION EXAMPLES
a) 75 ml/60 min 3 10 gtts/1 ml 5 A. SUBCUTANEOUS HEPARIN DOSAGES
b) Cancel the zeros out, leaving 1. THE ORDER READS: HEPARIN
75/6 3 1/1. SODIUM (HEPARIN) 2500 UNITS S.Q.
c) Cancel the 1s, leaving 75/6. STAT.
d) The answer is 12.5 gtts/min or 2. THE AVAILABLE CONCENTRATION IS
13 gtts/min. HEPARIN SODIUM (HEPARIN)
B. THREE-STEP METHOD FOR IV DRIP 5000UNITS/ML.
CALCULATIONS 3. SET UP THE RATIO:
1. TO DETERMINE ML/HR, DIVIDE a. 5000 units/1 ml 5 2500 units/x ml
TOTAL FLUIDS BY HOURS TO RUN. b. 5000x 5 2500
2. TO DETERMINE ML/MIN, DIVIDE c. x 5 2500/5000
ML/HR BY 60 MINUTES. d. x 5
3. TO DETERMINE DROPS/MINUTE, 4. YOU WILL ADMINISTER 0.5 ML OF
MULTIPLY ML/MIN AND GTTS/ML. THE AVAILABLE CONCENTRATION
4. EXAMPLE: OF HEPARIN SODIUM (HEPARIN).
a. The order states: run 100 ml D5W over B. INTRAVENOUS INFUSION HEPARIN
30 minutes. 1. THE ORDER READS: INFUSE
b. The tubing drop factor is 10 gtts/ml. 1000UNITS/HOUR OF HEPARIN
c. Figure ml/hr: 100 ml/ hr 5 100 3 2 SODIUM (HEPARIN) IV.
divided by 1 5 200 ml/hr 2. AVAILABLE IS 1 L NS WITH 40,000
d. Figure ml/min: 200 ml/hr divided by UNITS OF HEPARIN SODIUM
60 minutes 5 3.3 ml/min (HEPARIN) ADDED.
e. Figure drops/minute: 3.3 ml/min 3 3. THE DROP FACTOR FOR THE
10 gtt/ml 5 33 gtts/min ADMINISTRATION IV SET IS
C. ELECTRONIC FLOW REGULATORS 15 GTTS/ML.
1. ELECTRONIC FLOW REGULATORS OR 4. CONVERT TO UNITS/ML:
PUMPS MUST BE SET AT AN HOURLY 40,000UNITS/1000 ML 5 40 UNITS/1 ML
RATE IN MILLILITER PER HOUR. 5. SET UP THE EQUATION:
2. THEREFORE, ALL VOLUME ORDERS a. 40 units/1 ml 5 1000 units/x ml
MUST BE CONVERTED TO ML/HR b. 40x 5 1000
BEFORE SETTING THE REGULATOR. c. x 5 1000/40
3. EXAMPLE USING THE d. x 5 25 ml/hour
RATIO-PROPORTION METHOD 6. YOU WILL SET THE ELECTRONIC
a. The order states: administer nafcillin REGULATOR TO 25 ML/HOUR.
sodium (Nafcil) IVPB, 1 Gm diluted
in 50 ml. Run over 15 minutes. IX. PEDIATRIC DOSAGE CALCULATION
b. The tubing drop factor is 15 gtts/ml. METHODS AND EXAMPLES
c. For what rate will you set the A. CALCULATION OF PEDIATRIC DOSAGES
electronic regulator? BASED ON THE CHILDS WEIGHT
d. Using the ratio-proportion method, 1. ALWAYS CONVERT POUNDS TO
set up the equation: KILOGRAMS FIRST. REMEMBER THAT
1) 50 ml/15 min 5 x ml/60 min 2.2 LB 5 1 KG.
(1 hr) 2. MULTIPLY THE WEIGHT IN
2) 15x 5 3000 KILOGRAMS BY THE RECOMMENDED
3) x 5 3000/15 DOSE PER KILOGRAMS.
4) x 5 200 ml/hr a. An appropriate dose for a drug is
e. You will set the electronic regulator 10mg/kg/24 hrs.
for 200 ml/hr. b. The child weighs 20 kg.
4. EXAMPLE USING THE THREE-STEP c. Therefore, 10 mg 3 20 kg 5
METHOD 200 mg/24 hr.
a. The order reads: Administer 250 ml 3. DIVIDE THE 24-HOUR DOSE BY THE
of D5 0.45 over 6 hours per microdrip. NUMBER OF RECOMMENDED DOSES
b. Microdrip tubing drop factor is PER DAY.
60 gtts/ml. a. 200 mg/day divided by 4 doses 5
50 mg per dose.

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384 Unit III PHARMACOLOGY

4. FINALLY, CALCULATE THE VOLUME for children of normal height and

OR AMOUNT TO BE ADMINISTERED weight and is also a method that
FROM WHAT IS IN STOCK. requires some skill. It is not addressed
B. CALCULATION OF PEDIATRIC DOSES in this review.
BASED ON A RECOMMENDED SAFE DOSE 2. BSA CALCULATIONS USING HEIGHT
RANGE AND WEIGHT
1. EXAMPLE: Either of the following formulas, one
a. The order states: cephalexin (Keflex) using metric measurements and one
oral suspension 150 mg p.o. every using English measurements, may
6hours. be used.
b. The child weighs 20 kg.
a. kg*cm/3600
c. The medication package states that 5 BSA ( m2 )
the recommended dose is 2550 mg/ 3600
kg/day in 4 divided doses. b. Example:
d. Is the ordered dose within safe 1) A child weighs 20 kg and is
limits? 70 cm tall
e. Calculation 2) 20 kg 3 70 cm/3600 5 1400 / 3600
1) First figure out what the safe
range is for this child. 5 0.388
a) 25 mg 3 20 kg 5 500 mg/day 5 0.62m2 BSA
b) 50 mg 3 20 kg 5 1000 mg/day 3) Ib 3 in/3131 5 BSA ( m2 )
2) The safe range for this child is
c. Using the same measurements
500mg to 1000 mg per 24-hour
converted to pounds and inches:
period.
1) The child weighs 44 lb and is
3) The actual dose ordered is 150
28in. tall.
mg every 6 hours
4) To determine if it falls within the 2) 44 Ib 3 28 in/3131 5 BSA
range, either multiply the actual 3)
1231/3131 5 BSA
dose by 4 (every 6 hours is 4
4) 0.39 5 BSA
doses per day) or divide the range
dosages by 4 to determine the 5) 0.63 5 BSA (m2)
range for the individual dosages. 3. BODY SURFACE AREA CALCULATION
a) 150 mg 3 4 doses 5 600 mg/ USING WEIGHT ONLY
day, which is within the range a. Formula:
of 500 mg to 1000 mg per day. ( 4 3 child's weight in kg ) 1 7
5 m2 BSA
b) Thus, the dose is determined (child's wt in kg ) 1 90
to be safe. b. Example: A child weighs 45pounds.
5) Also, dividing the recommended 1) Convert pounds to kg: 45 4 2.2 5
daily dosages gives a dose range 20.4 kg
of:
a) 500 mg 4 4 doses 5 125 mg/ a) ( 4 1 20.4) 1 7 5 81.8 1 7 5
dose, and 20.4 1 90 110.4
b) 1000 mg 4 4 doses 5 250 mg/ 88.8
5 0.80 m2
dose 110.4
6) The dose of 150 mg falls within 4. CALCULATION OF PEDIATRIC
the recommended range of DOSAGES USING BSA
125 mg to 250 mg per dose for a. The formula for calculation of dosages
this child. using BSA is:
C. PEDIATRIC DOSAGE CALCULATIONS (BSA in m2/1.7 m2) 3 50 5 the
BASED ON BODY SURFACE AREA estimated pediatric dose
1. THREE WAYS TO DETERMINE b. Example:
DOSAGES BASED ON BODY SURFACE 1) A child is 34 inches tall and
AREA(BSA). weighs 28pounds.
a. One is based on the height and the 2) The adult dose for a medication
weight of the child using a formula. is 50 mg.
b. The second method calculates BSA 3) First figure the BSA for the child:
based on only the childs weight. a) 34 3 28/3131
c. The third method is based on the
b) 0.30
use of a tool called a West Nomogram
chart. The nomogram is used only c) 0.55 m2

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Chapter 16 MEASUREMENT AND DRUG CALCULATIONS 385

4) Then use the formula to 3) First determine the childs BSA:

determine the estimated pediatric a) 120 3 35/3600 5
dose.
a) (0.55 m2/1.7 m2) 3 50 5 16.21 b) 1.16
5) The estimated pediatric dose for c) 1.08 m2
this child is 16 mg per dose. 4) Then utilize the dosage
c. Example: formula.
1) A child weighs 35 kg and is 120 a) (1.08 m2/1.7 m2) 3 500 5 318
cm tall. 5) The estimated dose for this child
2) The adult dose for the ordered is 320 mg per dose.
medication is 500 mg.

PRACTICE QUESTIONS

1. A physician has ordered acetylsalicylic acid 3. 0.2 tablets

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

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386 Unit III PHARMACOLOGY

10. The doctor has ordered diazepam (Valium) units of heparin is the client receiving
2.5-mg IV push stat. Available is injectable per hour?
diazepam (Valium) 5 mg/ml. How much 1. 635
willthe nurse administer? 2. 1000
1. 0.75 ml 3. 1250
2. 1 ml 4. 125
3. 0.5 ml 17. Infuse 2000 ml of lactated Ringers over
4. 5 ml 12hours. The drop factor is 15 gtt/ml.
11. The order reads ceftriaxone (Rocephin) The nurse will regulate the IV to how many
1.4 g IM b.i.d. Available is a ceftriaxone gtt per minute?
(Rocephin) 1-vial; when reconstituted with 1. 28
2.1 ml, it results in a concentration of 2. 42
350 mg per ml. What volume will the nurse 3. 56
administer? 4. 14
1. 3 ml/1 vial 18. Use an electronic regulator to administer 1500ml
2. 4 ml/2 vials of D5W in 6 hours. The nurse will set the
3. add more diluent to yield 4 ml in 1 vial machine for
4. 5 ml total/2 vials 1. 150 ml/hour.
12. Amoxicillin with clavulanic acid (Augmentin) 2. 200 ml/hour.
powder reconstituted with 69 ml water 3. 250 ml/hour.
results in a 75-ml suspension with a 4. 275 ml/hour.
200-mg/5-ml concentration. The doctors 19. The physician has ordered morphine
order reads Augmentin 600-mg oral sulfate (Duramorph) 10 mg s.q. every
suspension p.o. every 12 hours. What 4 hours p.r.n. The child weighs 80 lb.
volume of the suspension will the nurse The recommended maximum dose of
administer? morphine sulfate (Duramorph) is 0.1 mg to
1. 30 ml 0.2 mg/kg/dose. To determine the safety
2. 10 ml of this dose, what is the safe dose range
3. 15 ml for this child?
4. 20 ml 1. 3.6 mg to 7.3 mg/dose
13. Administer 800 ml IV D5W at 75 ml/hour. 2. 5 mg to 10 mg/dose
Thedrop factor is 10 gtt/ml. What is the 3. 36 mg to 73 mg/dose
drops-per-minute rate? 4. 2.8 mg to 6 mg/dose
1. 13 20. The nurse determines a 23-kg child to weigh
2. 10 how many pounds?
3. 17
21. The recommended dosage for cefaclor
4. 21
(Ceclor)suspension is 20 to 40 mg/kg/day
14. Infuse heparin 40,000 units in 1000 ml of divided into 2or 3 doses. The child
normal saline IV over 24 hours. The receivingthe cefaclor (Ceclor) weighs 22 kg.
administration set has a drop factor of What is the recommended range for the
10 gtt/ml. The nurse will set the gtt per minute individual dose ordered as twice daily for
at what rate? thischild?
1. 14 gtt 1. 330 to 660 mg
2. 42 gtt 2. 440 to 880 mg
3. 17 gtt 3. 220 to 440 mg
4. 7 gtt 4. 200 to 400 mg
15. The order reads heparin 2000 units s.q. The 22. The recommended dosage for furosemide
nurse has on hand heparin 2500 units/ml. (Lasix) oral solution is a single dose of
Howmuch will the nurse administer? 2 mg/kg, and subsequent doses of 1 to
1. 0.8 ml 2 mg/kg every 6hours until suitable
2. 0.5 ml response, up to a maximum of
3. 0.6 ml 6 mg/kg/day. What is the minimum
4. 0.9 ml to maximum 24-hour dose range for a
16. Heparin 30,000 units in 1000 ml of normal child weighing 26 kg?
saline is to be administered IV over 1. 52 mg to 156 mg/24 hours
24 hours via microdrip. How many 2. 52 mg to 104 mg/24 hours

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Chapter 16 MEASUREMENT AND DRUG CALCULATIONS 387

3. 26 mg to 52 mg/24 hours weighs 48pounds. Determine the childs dose

4. 46 mg to 100 mg/24 hours based on BSA.
23. Using the childs weight, determine what the 1. 30 mg/dose
pediatric dose for digoxin (Lanoxin) would be if 2. 25 mg/dose
the usual adult dose is 0.15 mg p.o. every day. 3. 50 mg/dose
The child weighs 13 kg. The nurse will 4. 40 mg/dose
administer 25. The recommended adult dose of acyclovir is
1. 0.15 mg. 200 mg every 4 hours. What would an
2. 0.05 mg. appropriate dose be for a child weighing 8 kg
3. 0.1 mg. and standing 57 cm tall?
4. 0.07 mg. 1. 40 mg
24. An adult dose of doxycycline (Vibramycin) is 2. 60 mg
100 mg b.i.d. The child who is to take 3. 30 mg
doxycycline (Vibramycin) is 32 inches tall and 4. 50 mg

ANSWERS AND RATIONALES

1. 1. Find the number of tablets to be administered: 500 mg 1500 mg
5
1 gr 5 60 mg and 1 tablet 5 325 mg 1 tablet x
First convert grains to milligrams: 1500 mg
1 gr 5 60 mg, 10 gr 5 600 mg x5 tablets
500 mg
660 mg is the desired dose.
x 5 3 tablets
Set up the ratio:
The nurse will administer 3 tablets of levodopa
325 mg 660 mg
5 (Dopar).
1 tab x
5. 4. Find the number of tablets to be administered.
660 The order is for 5000 mcg, and the tablets on
x5
325 hand are 2.5 mg.
x 5 2.03 Convert 5000 mcg to milligrams:
Because conversions between apothecary 1000 mcg 5 1 mg, then 5000 mcg 5 5 mg
andmetric systems are not exact, two Set up the ratio to determine the number of
325-mg tablets may be administered for the tablets to deliver:
600-mg grains. The nurse will administer 2.5 mg 5 mg
2tablets. 5
1 tab x
2. 2. Find the amount of expectorant that should be 5 mg
administered. x5 tablets
2.5 mg
1 ounce 5 30 ml
x 5 2 tablets
Convert ounces to milliliters:
1 ounce 5 30 ml, 1 ounces 5 45 ml, x5 45 ml The nurse will administer 2 tablets of glipizide
The nurse will administer 45 ml. (Glucotrol).
3. 1. Find the number of capsules to be administered. 6. 3. Find the volume for this injection.
The order is for 0.1 g and each capsule 5 100 mg. Set up a ratio:
Convert grams to milligrams:
0.3 mg 5.0 mg
1 gram 5 1000 mg, 0.1 g 5 100 mg, x 5 1 capsule 5
5 ml x
The nurse will administer 1 capsule.
0.5 mg
4. 2. Find the number of tablets to be administered. x 5 5 ml 3
The order is for 1.5 g, and the tablets on hand 3.0 mg
are 500 mg. 2.5
x5 ml,
First convert 1.5 g to milligrams: 0.3
1 gram 5 1000 mg, 1.5 g 5 1500 mg x 5 0.8 ml
Determine the number of tablets to be The nurse will administer 0.8 ml of the
administered: injectable solution intramuscularly.

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388 Unit III PHARMACOLOGY

7. 4. Find the volume to inject. Convert the grams to mg:

Conversion: 1 gr 5 60 mg, and the drug has 1 g 5 1000 mg, 1.4 g 5 1400 mg
1/30 grain per ml. Convert 1.4 g to milligrams (move the decimal
Convert 1/30 grain and 1.5 mg to the same point three places) to equal 1400 mg.
units. Set up a ratio:
Note: It is generally easier to convert grains to
1400 mg
milligrams. 350 mg/ml 5 ,
60 x
1 gr 5 60 mg, 1/30 gr 5 mg
30 1400 mg
x5 ml,
The medicine has a strength of 2 mg/ml. 350 mg
Then set up the ratio: x 5 4 ml
1.5 mg
2 mg/ml 5 The nurse will need to administer 4 ml of the
x ceftriaxone (Rocephin). There is not enough
1.2 mg medication in 1 vial to administer 4 ml.
x5 ml 5 .75 ml
2 mg Therefore the nurse will need to reconstitute
The nurse will administer 0.75 ml of the 2vials for the prescribed dose.
injectable solution. 12. 3. Determine the volume to be administered.
8. 2. Find the volume for this injection. The order is for 600 mg; available is
The concentration available is 0.5 mg/ml. 200 mg/5 ml.
Convert mcg to mg: Set up a ratio:
1 mg 5 1000 mcg 200 mg 600 mg
5
Then set up the ratio: 5 ml x
0.5 mg 1 mg 5 3 600 mg
5 x5 ml
1 ml x 200 mg
1 mg x 5 15 ml
x5 ml
0.5 mg The nurse will administer 15 ml of the
x 5 2 ml reconstituted Augmentin suspension.
The nurse will administer 2 ml injectable 13. 1. Determine the drip rate per minute in gtt.
vitamin B12. The order is for a rate of 75 ml/hr; the drop
factor is 10 gtt/ml.
9. 1. Find the volume to inject.
Convert the order to ml/minute:
The order is for 40 mg; available is 20 mg/2 ml.
Set up the ratio: 1 hour 5 60 minutes, 1/60 3 75 ml/hr 5
1.25 ml/minute
20 mg 40 mg
5 Determine the drip rate:
2 ml x
x 5 order 3 drop factor
40 3 2
x5 x 5 1.25 ml/min 3 10 gtt/ml
20 ml
x 5 4 ml x 5 12.5 gtt/min, rounded to 13
The nurse will administer 13 gtt/minute.
The nurse will administer 4 ml of injectable
furosemide (Lasix) IV push. 14. 4. Determine the gtt/minute rate.
The order is for a rate of 1000 ml/day; the drop
10. 3. Find the volume to be injected. factor is 10 gtt/ml.
The order is for 2.5 mg; the available solution Convert the order to ml/minute:
is5 mg/ml.
Set up a ratio: 1 day 5 24 hours/day 3 60 minutes/hour
1000
5 mg 2.5 mg 1000 ml / day 5 5 0.69 ml / minute
5 24 3 60
1 ml x
minutes/day
2.5 mg
x5 ml Determine the drip rate:
5 mg
x 5 order 3 drop factor
x 5 0.5 ml
x 5 0.69 ml/minute 3 10 gtt/ml
The nurse will administer 0.5 ml of the
injectable furosemide (Valium) solution. x 5 6.9 gtt/minute, rounded to 7
The nurse will administer 7 gtt/minute.
11. 2. Find the volume to be administered.
The order is for 1.4 g; the available solution is 15. 1. What volume will the nurse administer?
350 mg/ml. The order is for 2000 units and available is a
2500-units/ml solution.

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Chapter 16 MEASUREMENT AND DRUG CALCULATIONS 389

Set up a ratio: 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
5
1 ml x range for this child.
2000 20. 51. A 23-kg child weighs 50.6pounds or 51.
x5
2500 Multiply the 23 kg by 2.2 to convert from
x 5 4/5 or 0.8 ml kg tolbs.
The nurse will administer 0.8 ml. 21. 3. Determine the recommended safety range of
this drug.
16. 1. Determine the units to be administered
The recommended dosage is from 20 mg/kg/
perhour.
day to 40 mg/kg/day.
The rate is 30,000 units over 24 hours.
The childs weight is 22 kg; the drug will be
Note: The mention of microdrip does not
administered 2 times per day.
enter into this calculation at all; you only need
Calculate the recommended upper and lower
to convert units per day to units per hour. The
thresholds for this child.
microdrip calculation is only a factor when
determining the setting for delivery of the Lower threshold: 20 mg/kg/day 3 22 kg 5
order. 440 mg/day
30,000 units x 2 doses per day, lower threshold per dose 5
The order is for 5 1/2 3 440 mg 5 220 mg
24 hours 1 hour
Upper threshold: 40 mg/kg/day 3 22 kg 5
30,000 units
x5 880 mg/day
24 hours
2 doses per day, upper threshold per dose 5
x 5 1249.9 units per hour, or 1250 units per hour
1/2 3 880 mg 5 440 mg
The nurse will administer 1250 units per hour. The range for this child is 220 mg to 440 mg.
17. 2. Determine the drip rate in gtt/minute. 22. 1. Determine the range of daily safe dosages for a
The order is for 2000 ml/12 hours; the drop 26-kg child.
factor is 15 gtt/minute. The safe dosage range has a minimum of
Convert the prescription to a rate per minute: 2 mg/kg as a single application, and a
2000 ml maximum of 6 mg/kg/day
5 167ml/hours Determine the lower threshold for this child:
12 hours
167 ml If the first 2 mg/kg shows results, there would
5 2.78 ml/hours be no further application.
60 minutes
For a child of 26 kg, the lower threshold is
Now calculate the drip rate:
26 kg 3 2 mg/kg 5 52 mg.
2.78 ml/minute 3 15 gtt/ml 5 41.7 gtt/minute Determine the upper threshold:
or 42 gtt/minute The daily upper limit is given as 6 mg/kg/day.
The nurse will administer 42 gtt/minute.
For a child of 26 kg, the upper threshold is
18. 3. Determine the setting in ml/hour for an 26 kg 3 6 mg/kg 5 156 mg.
electronic regulator. The range for this child is 52 mg to 156 mg.
The order is for 1500 ml/6 hours.
23. 2. Find the amount of digoxin the nurse should
1500 ml administer based on BSA.
x5 5 250 ml/hour
6 hours The usual adult dose is for 0.15 mg, and the
The nurse will set the machine to administer child weighs 13 kg.
250 ml/hour. S 5 log W 3 0.425 1 log H 3 0.725 1 1.8564,
19. 1. Determine the safety of this order. where
The recommended dose is from 0.1 mg/kg to S is in cm2; W is in kg; and H is in cm.
0.2 mg/kg; the childs weight is 80pounds. Determine the childs BSA using weight:
Convert the childs weight to kilograms:
( 4 3 13) 1 7 52 1 7 59
1 5 5 5 0.57 m2 BSA
1 pound 5 kilograms, 13 1 90 103 103
2.2
80 Determine the childs dose based on BSA:
80 lb 5 kg 5 36.4kg
2.2
0.57 m2
Calculate the recommended upper and lower 3 0.15 mg 5 0.34 3 0.15 5 0.05 mg
1.7
thresholds for this child.
Lower threshold: 0.1 mg/kg 3 36.4 kg 5 3.6 mg The nurse will administer a 0.05-mg dose.

Copyright 2015 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
390 Unit III PHARMACOLOGY

24. 4. Determine a childs dose of Vibramycin 25. 1. Determine a childs dose of acyclovir using BSA.
usingBSA. The adult dose is 200 mg; the child is 57 cm
An adult dose is 100 mg; the child is 32 inches tall and weighs 8 kg.
tall and weighs 48pounds. Determine the childs BSA:
S 5 log W 3 0.425 1 log H 3 0.725 1 1.8564, 8 kg 3 57 cm 456
S is in cm2; W is in kg; and H is in cm. 5 5 0.12 5 0.35 m2
3600 3600
Determine the childs BSA:
Determine the childs dose:
48 3 32 1536
5 5 0.49 5 0.70 m2 0.35 m2
3131 3131 3 200 mg 5 child's dose
1.7
Determine the childs dose based on the BSA: 0.21 3 200 5 42 mg
0.70 m2 The nurse will administer 40 mg every 4 hours.
3 100 mg 5 41 mg/dose
1.7
The nurse will administer 40 mg per dose.

REFERENCES

Broyles, B. E. (2009). Dosage calculation practice for Pickar, G. D. (2012). Dosage calculations
nurses (2nd ed.). Clifton Park, NY: Delmar Cengage (10th ed.). Clifton Park, NY: Delmar Cengage
Learning. Learning.
Curren, A. M. (2009). Math for meds: Dosages and Saxton, D. F., Ercolano-ONeill, N., & Glavinspiehs, C.
solutions (10th ed.). Clifton Park, NY: Delmar Cengage (2005). Math and meds for nurses (2nd ed.). Clifton
Learning. Park, NY: Delmar Cengage Learning.
Gray Morris, D. C. (2009). Calculate with confidence
(5th ed.). St. Louis, MO: Mosby.

Copyright 2015 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.