Advanced Nursing Drug Dosage
Part 2 of 2 by Georgiana Cox, CAPS Online Tutor
In this post I will provide examples of intravenous flow rates and pediatric dosages. First of all, dimensional analysis is my preferred method to tackle advanced dosage problems. I think this method is easiest to use to keep track of all the units and not miss any important steps.There are two types of intravenous flow rate problems you will see. Depending on the wording of the problem you may have to calculate for drops per minute or milliliters per hour. For problems asking you to calculate drops per minute a drop factor will always be provided. The drop factor is the number of drops in one milliliter used in intravenous medication administration. Usually the drop factor can be found on the packaging for the tubing you use to set up an IV administration. If you see “gtt” in a problem, that just means drops. For the problems asking you to calculate the infusion rate for an IV pump, you need to solve for milliliters per hour. In the hospital we use IV pumps most of the time to administer IV medications.
There are also rounding rules you must use when you are doing these problems to keep in mind for nursing school dosage exams. They will be provided when you take dosage exams so don’t worry about memorizing them. However, here they are for your consideration:
NMNE rounding rules
- Dosage less than 1, round answers to nearest hundreth
- Dosage between 1-10, round answers to nearest tenth
- Dosage greater than 10, round answers to the nearest whole number
- For all weights, the final answer is rounded to the nearest tenth
- Pediatrics round dosage answers to nearest hundredth
- All IV hourly rates round to the nearest tenth
- All IV drops per minute rates round to the nearest whole number
Intravenous flow rates
1. Hespan 500 ml is ordered to be infused over 3 hours. The drop factor is 15 gtt/ml. How many drops per minute should be given to infuse the total amount of Hespan over 3 hours?
2. The physician orders cefuroxime 1 g in 50 ml of normal saline solution to be infused over 30 minutes. The tubing drop factor is 60 gtt/ml. How many drops per minute should be given to infuse the total amount of cefuroxime over 30 minutes?
3. Infuse 1000 ml of lactated Ringer’s solution over 12 hours. How many ml/hr should the IV pump be programmed for?
4. The physician orders morphine sulfate 15 mg/hr IV. Given a bag with a concentration of 100 mg of morphine sulfate in 200 ml of D5W, how many milliliters per hour should the IV pump be programmed for?
Pediatric dosages
1. The physician orders Keflex 250 mg po four times a day for a child weighing 50 pounds. You have Keflex 250-mg capsules. The recommended daily po dosage for a child is 25 to 50 mg/kg/day in divided doses every 6 hours.
a. What is the safe recommended dosage range for this child?
b. Is the order safe?
c. If yes, how many capsules will you administer?
2. The physician orders Benadryl 25 mg IV every 6 hours for a child weighing 50 pounds. You have available Benadryl 12.5 mg/ml. The recommended daily dosage for a child weighing more than 12 kg is 5 mg/kg/24 hrs in four divided doses.
a. What is the safe recommended single dosage for this child?
b. Is the order safe?
c. If yes, how many milliliters will you prepare?
3. A child is to receive vancomycin 750 mg IV piggy back every 6 hours. The child weighs 68 pounds. The recommended dosage of vancomycin is 40 to 60 mg/kg/24 hr.
a. What dose per kilogram per 24 hours is the child receiving?
b. Is the order safe?
If you are looking at some of these problems and saying to yourself, “What the heck?”— don’t worry. It will all make sense when they start teaching you this stuff in nursing school 😊. In nursing school you have to take dosage exams every semester and get a 90% or higher to proceed in the program. If you aren’t familiar with dosage problems already I hope this two part blog post helps you get your “feet wet” with these kinds of problems.
For more practice, visit the following resources. Some of these practice questions and answers are resources created by other nursing schools so feel free to skip over school specific information and look at the practice questions and answers: Mighty Nurse UKY Bridge Nursing Program Nurseslabs Good luck!
Georgiana Cox is a level 4 nursing student attending the University of New Mexico.
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