Nrs 201 medication review

Welcome to Maternal/Child/Psych Nursing! The purpose of the 20-point quiz is to review previous math skills and prepare
the student for math skills needed during the 201 clinical rotations. The math
questions on the quiz will be VERY similar to the following examples. Please
spend time reviewing your math before the quiz is given during the first week of
the semester.
There are 20 questions on the quiz. It is not multiple choice. You will need to
show your work on the quiz. You will need to get 90% or better on this quiz to
pass the course. If you do not pass the first quiz, you will be given one additional
chance to pass. See Math Policy in the NRS 201 syllabus.


Formulas to memorize for the quiz:

• Volume (ml) X calibration = flow rate (gtts/min) • ML left X 60 minutes = time left in minutes C0 (1.8) + 32 = Fo (F0 – 32) ÷ 1.8 = C0 Pounds to kilograms (divide by 2.2) 0 – 7 ounces = round down to nearest pound 8 – 15 ounces = round up to the nearest pound BID = twice a day TID = three times day QID = four times a day 1 TSP = 5 ml 1 TBS = 15 ml Calculations of Medications:
It is important for you to take a second and do a “guesstimate” when you do your
computations to see that you have gotten yourself “in the ballpark.” In other
words, putting 36 ml of Epinephrine into an ETT (endotracheal tube) does NOT
make sense nor does an 8 pound 5 ounce infant weigh over 16 kg. Most of the
time you should be able to plug your answer back into the equation and double
check that your answer is correct. Incorrect dosages are often lethal to patients,
especially infants and children.

Dosages are calculated using the infant’s weight (written as
mg/kg). Remember with infant weight conversions:
0-7 ounces = round down to the nearest pound
8-15 ounces = round up to the nearest pound

Example 1:

A premature infant girl is admitted to the NICU and has just coded. She weighs 3 pounds 8 ounces and needs a dose of Epinephrine 1:10,000 via her
ETT. The recommended dose of Epinephrine is 0.01mg/kg. Epinephrine is
supplied 0.1 mg/ml. How many ml of Epinephrine did she receive?
Step 1:
Divide 4 pounds by 2.2 to get kilogram weight, 4 ÷2.2 = 1.8 kg.
Step 2:
Get your desired dose by multiplying 1.8 (kg) X 0.01 (mg/kg) = 0.018 mg which
can round to 0.02 mg.
Step 3:
Find out how many ml of the medication is needed.
Medication supplied 0.1 mg/ml, need to give 0.02 mg.
Desired
(X vehicle) = volume of needed medication (1 ml) = 0.2 mls into ETT
X = 0.2 mls into ETT

Example 2:

In transitional nursery you take an axillary temperature on a 2-hour old infant and get 36.2 degrees C. What is that temperature in F? Would it be OK to
bathe the infant now?
Step 1:
Convert the temperature to F by using the following calculation:
97.1 (ax) is the infant’s temperature
No, it is not OK to bathe the infant now. This temperature is to too low (36.5-37.5 C is the acceptable range) and the bath will further cold-stress the newborn. The bath will be done when the infant is more stable. Medicating Children
Calculation of Medications:

Dosages are calculated using child’s weight (written as mg/ kg)
Example 1:

The doctor orders morphine 2 mg for a two-year-old child who weighs 12 kg. The recommended dose for morphine is 0.1-mg/ kg/dose. Did the doctor
order the appropriate dose?
Step 1:
To calculate the appropriate dose multiply 12 (kg) X 0.1 (mg) = 1.2 mg.
No, the doctor did not order the appropriate dose.
Example 2:

Five-year-old Bobby weighs 44 pounds, the doctor asks how many kilograms does this child weigh?
Step 1:
Divide 44 pounds by 2.2 to get kilogram weight, 44 ÷ 2.2 = 20 kilograms.

Example 3:

The doctor orders Phenobarbital (100 mg/ 2 ml) for a 10-year-old girl who weighs 30 kg. The recommended loading dose is 10 – 20 mg/kg/dose. The
doctor orders 500 mg to be given IV over 30 minutes. Is this an appropriate
dose? How much medication would you give?

Step 1:
Find the therapeutic range,

500 mg is within the therapeutic range; yes this is an appropriate dose.
Step 2:
Find how many ml of the medication to give.
Medication comes 100 mg / 2 ml, need to give 500 mg.
Pediatric Intravenous Fluids

Fluid Administration:

Fluid pumps are used on all pediatric patients to reduce the risk of fluid overload. Infusion volumes and IV site assessments are recorded every one or
two hours depending on hospital policy.
The amount of fluid (ml / hour) or IV rate infused is based on the child’s weight:
A TKO (to keep open) rate in Pediatrics is usually 5 – 15 ml per hour.
Please memorize fol owing calculations for the quiz!
Calculation of Daily Maintenance Fluids:

Example 1:

An eight-kilogram child would need: 8 X 100 = 800 ml in a twenty-four hour period. To find an hourly IV rate, you would need to divide 800/24 = 33.3 or 33 ml per
hour.
Example 2:

A twelve-kilogram child would need: 1000 + 50 (2) = 1100 ml in a twenty-four hour period. To find an hourly IV rate, you would need to divide 1100/24 = 45.8 or 46 ml per hour. Medicating Moms
Example 1:

A client, 32 weeks’ gestation, is admitted to the Antepartum unit with a diagnosis of PTL (preterm labor). Her doctor orders her to receive a bolus of 500
mls of LR, over 30 minutes, to be followed by a continuous infusion of 25
gtts/min. After hanging 1 liter of IV fluid, what is the hourly (ml/hr) infusion rate if
the IV tubing calibration is 10 gtts/ml? How many hours will this initial IV bag
last?
Step 1:
Utilize the formula to compute the hourly infusion rate
X

Step 2:
To find the amount of time the initial IV bag will last
500 ml infused over 30 minutes for the bolus leaves 500ml left in the IV 150 ml/hr equals approximately 200 minutes or 3.3 hours. When added to the initial 30-minute bolus, this liter of fluid will last close to 4 hours. Example 2:

A client is admitted to the postpartum floor at 20 weeks gestation with a diagnosis of pyelonephritis. She is to receive 900 mg of Clindamycin in 100 ml of
D5W and is to infuse over 30 minutes. Her primary IV line is D5W infusing at
100 ml/hr. The calibration of the tubing is 15 gtts/min. This antibiotic will be
hung as a secondary solution infused via the IV pump that must be set in ml/hr.
What rate would you set the pump to deliver the medication at the ordered rate?
Note: since it is infusing via a pump, the calibration of the tubing is not needed for
solving this problem. Also, the mgs of medication is not needed. The only value
that you work with is the volume and time.

Step 1:
Calculate as follows

Cross multiply = 6000 = 30X
6000 = X
30
X = 200ml/hr

Example 3:

The newly delivered mother is hemorrhaging. The doctor orders her to receive 3000 ml over the next 12 hours to replace lost volume. The calibration of
the tubing is 10 gtts/ml. What is the hourly rate for this IV? What are the drops
per minute for this infusion?
Step 1:
Find the hourly rate, simply divide the total ml by the hours: 3000 = 250 hr/hr.
250 that is: 42gtts/min.
Example 4:

A client is being admitted to L & D for induction of labor using Pitocin. An IV has been started with a #16 gauge catheter. The fluid is LR which is running
at 125 hr/hr. Per protocol, 10 units of Pitocin is added to a 500 ml bag of D5LR
and piggybacked into the primary IV line, which infuses by gravity. The IV pump
for the Pitocin is set at 6 ml/hr. How many milliunits/minute of Pitocin is this
patient receiving?
Step 1:
Determine how much Pitocin is per one ml of IV solution
10 Units: 500 ml = XUnit: 1 ml
500 X =10 ml
X = 10 ÷ 500, which is = 1
50
Step 2:
.02 Unit : 1 ml = XUnit : 6 ml
XUnit = .02(6)
X = .12 Unit Pit/6 ml/hr
Step 3:
.12 Unit : 60 min = XUnit: 1 min,
60 X =. 12
X = .12 which is .002 units/minute

However, the questions asks for milliUnits/min, so .002(1000) = 2
milliUnits/minute. This is the initial starting rate for Pitocin. The protocol allows
the nurse to increase this rate by 1-2 milliUnits every 15-60 minutes until
establishing a “good” contraction pattern.
Medication Problems
1. A 6-year-old child who weighs 22 kg needs how much fluid over a 24-hour 2. The physician has ordered Cefuroxime 210 mg IV q 6 hours for your patient. This child weighs 5.4 kg. When you look the recommended dosage up you find that it is 300 mg /kg/day. Is the physician’s order a “safe dose” for this child? Show your calculations. 3. The order reads “Ampicillin 270 mg q 6 hours IV”. The pharmacy has sent a 500 mg vial with instructions to add 1.7 ml of diluent, which will then give a solution containing 250mg/ ml. What volume of this solution will give you the ordered dose? 4. Order is for Cefixime (Suprax) 80 mg, PO q 12 hours. The dose parameter is 8 mg/kg/day in a single or two divided doses. The drug is available as Suprax 100 mg /5ml oral suspension. The child’s weight is 20 kg. Is the dose within safe dose parameters? Show calculations. How many ml of Suprax would you give per dose? 5. The physician has ordered Zofran 4mg in 25 ml of D 5. 2 NS via a buretrol to be infused in 20 minutes. Available is a 2ml single dose vial labeled 1ml/2mg of Zofran. How many ml of medication will you add to the buretrol? What hourly rate should be set on the IV pump? 6. A patient is receiving 2 grams of Ampicillin in 50 ml of D5W that is to infuse over 15 minutes using an IV pump that you must set at rate per hour. What rate would you set on the infusion pump? 7. A patient is admitted to 7 East with bleeding at 14 weeks gestation. She is receiving an IV of LR @ 29 gtts/min. The calibration of the tubing is 15. How many ml of IV solution does the patient receive in one hour? How long will one liter of fluid last? 8. You are working on the antepartum unit and need to add 30 mEq of KCL to 1 L of D5 ½ NS and run the IV for 24 hours for a client with hyperemesis gravidarum. Available are 20 ml ampules labeled KCL 2 mEq/ml. The infusion set has a drop factor of 15 gtts/ml. How many ml of KCL should be added? 9. The patient is a 32 weeks gestation preemie admitted with severe IUGR and prematurity to the NICU. Her admitting weight is 2# 9 ounces. She codes shortly after admission and needs Epinephrine 1:10,000 admitted via her ETT (endotracheal tube). Epinephrine is supplied as 0.1 mg/ml and is given 0.01 mg/kg. She receives 2 doses during her resuscitation and is revived successfully. How many ml of Epinephrine 10,000 did the patient receive? 10. Thirty-nine point four (39.4 C) is what temperature on the Fahrenheit scale? 11. The patient is admitted to the NICU and weighs 1 pound 4 ounces. How 12. The doctor has prescribed 3000 ml of D5LR to be infused over 24 hours. The drop factor of the infusion set is 15 gtts/ml. What is the hourly rate for the infusion? 13. How many gtts/min would you have with an IV rate of 125ml/hour if you use 14. How much time will you have left in minutes, if the IV rate is 125ml/hour and you have 100ml IV fluid left in the bag? 15. How much time will you have left in minutes, if the IV rate is 200ml/hour and 16. The physician has ordered Cefuroxime 210 mg IV q 6 hours for your patient. The medication comes as 400mg / 2ml. The medication is added to a 50ml bag of D5W to be infused over 20 minutes. What would you set the IV rate at to deliver the medication in 20 minutes? 17. The order reads “Ampicillin 270 mg q 6 hours IV.” The pharmacy has sent a 500 mg vial with instructions to add 1.7 ml of diluent, which will then give a solution containing 250mg/ ml. What volume of this solution will give you the ordered dose? 18. The doctor orders a maintenance IV rate of 55ml/hr on a 6-kg infant. Is this an appropriate IV rate for this child? Show calculations.
19. The pharmacist labels a home medication to be given TID to a three-year-old
child. The nurse instructs the parents to give the medication how many times daily? 20. A four-year-old is started on IV Rocephin 400mg Q 12 hours for suspected sepsis. The medication is placed in a 50ml bag of D5W to infuse over thirty minutes. Calculate the ml/hour flow rate to set on the infusion pump. Medication Quiz Answers 1. 1540 ml 2. 1620 mg recommended / 840 mg ordered / dose is low but safe. 3. 1.08 or 1.1ml 4. Yes, it is a safe dose. Give 4 ml 5. 2 ml of med, 75 ml/hr 6. 200 ml/hr 7. 116 ml/hr, lasts for 8.62 hours = 8 hours and 37 minutes 8. 15 ml 9. 0.27 or 0.28 total ml of Epinephrine 10. 102.9 degrees F 11. 0.45 or 0.5 kg 12. 125 ml/hr 13. 31.25 or 32 gtts/min 14. 48 minutes 15. 22.5 or 23 minutes 16. 150 ml/hr 17. 1.08 ml or 1.1 ml 18. No, 25 ml/hr is an appropriate hourly rate 19. Three times daily 20. 100 ml/hr

Source: http://wc.pima.edu/~kcorbett/NRS201MathReview%20revised%20fall%2004.pdf