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Clinical Calculations: Module 5: Parenteral Medications

Calculating Doses of Parenteral Medications

Module 5 – Calculating Doses of Parenteral Medications

What’s in this module?

Parenteral medications are administered by injection, not through the gastrointestinal tract.  The medication may be injected by the following routes:

  1. Intramuscular (into a muscle, abbreviated as IM)
  2. Subcutaneous (below the dermis and epidermis, abbreviated as subcut or SC)
  3. Intradermal (a shallow injection under the dermis, abbreviated as ID)
  4. Intravenous (into a vein, abbreviated as IV)
  5. Intrathecal (into the cerebrospinal fluid)
  6. Intracardiac (into the heart muscles or ventricles)
  7. Intra-articular (into a joint)

We will focus primarily on IM, SC, and IV injections in this module.  You will learn more about the other parenteral routes in your more advanced nursing courses.

In this module, you will learn how to read information on manufacturer’s medication labels for parenteral medications.  You will learn to calculate the correct amount of injectable medications to give a client.  

Summary of problem types in this module

Problems will involve reading medication labels and healthcare providers' orders.  You will calculate the correct amount of injectable medications to give a client.  Assume all questions ask for the amount per dose unless instructed otherwise.

Equivalents to know

You should now know all your commonly used equivalents.

Rounding rules to know

You will continue to use the rounding rules for numbers >1 and <1.

There are no new rounding rules for this module, but if there are specific instructions in a problem please follow those instructions.

Starting factors and answer units

The SF in most of the problems is the amount of medication the healthcare provider has ordered.  The dose is usually stated in mg, mcg, or g.  Insulin and heparin doses will be stated in units.

Weight-based medications will use the client’s weight as the SF.  This will be illustrated for you later in this module.

Types of Injections

Image showing a cross section of skin. Visible of the epidermis, dermis, subcutaneous area and muscle. The angle of injection for an intradermal, subcutaneous, and intramuscular injections are illustrated. The angle for an intradermal injection is 15 degrees. The angle for a subcutaneous injection is 45 degrees. The angle for an intramuscular injection is 90 degrees.

slideplayer.com/slide/2422396/8/images/2/Types+of+Injections+Intramuscular+Subcutaneous+Intradermal.jpg   Retrieved 1/5/19

 

This illustration shows the administration of injections by the IM, SC, and ID routes.  The blue area is a cross-section of skin with the layers of skin and the muscle labeled.  The angles of administration are also shown.  Needles and syringes are very small for the ID route, a bit larger for the SC route, and still larger for the IM route.

The ID route is most often used for TB tests.  SC injections include insulin and heparin.  IM and IV injections are used for other medications.

Syringes and Needles

Images of 4 syringes with needles. The syringes are 2 milliliters, 5 milliliters, 10 milliliters, and 20 milliliters in size.

https://is.alicdn.com/img/pb/628/425/367/367425628_793.JPG   Retrieved 1/5/19

 

Syringes vary considerably in size.  The nurse will select the correct syringe depending on the amount of fluid to be injected.  The smallest syringe shown measures up to 2 ml.  The largest syringe measures up to 20 ml, and would not be used for IM, SC, and ID injections.  Syringes used for TB tests, insulin, and heparin are even smaller than the smallest syringe shown.

Needle sizes are smallest for ID injections, a bit larger for SC injections, and larger for IM injections. 

 

Image describing the gauges of needles and providing the needle gauge and needle length for intradermal, subcutaneous, and intramuscular injections. "The larger the gauge number, the smaller the diameter of the lumen. The smaller the gauge number, the larger the diameter of the lumen." For intradermal injections, use a 25 to 28 gauge needle that is one half to five eighths inch long. For subcutaneous injections, use a 26 to 30 gauge needle that is three eighths to one half inch long. For intramuscular injections, use a needle that has a gauge of 18, 20, 21, 22, 23, or 25 and has a length of 1 inch, one and a half inch, or 2 inches.

https://slideplayer.com/slide/10867983/39/images/11/Syringes+The+larger+the+gauge+number%2C+the+smaller+the+diameter+of+the+lumen.+The+smaller+the+gauge+number%2C+the+larger+the+diameter+of+the+lumen..jpg   Retrieved 1/5/19

 

The sizes of syringes and needles are included here just so you will have a better understanding of giving parenteral medications.  In this module, the focus will be on calculating the amount of medication to give.  You will learn more about giving parenteral medications later in your nursing program.

IV injections may not use a needle at all.  IV access is established first with tubing and a port for syringe access.  There will be a further discussion of IV access in a later module.

 

Image titled "Reading a Syringe". There is an image of a syringe with the plunger pulled back to the 4 milliliter mark. The two bullet points in the image state, "Always use the plunger ring closest to the tip to read the volume contained in a syringe" and "This syringe contains 4 milliliters of liquid".

slideplayer.com/slide/12221989/72/images/8/Reading+a+Syringe+1.+2.+3.+Always+use+the+plunger+ring+closest+to+the+tip+to+read+the+volume+contained+in+a+syringe..jpg   Retrieved 1/5/19

Vials and Ampules

An image of vials of medication

s3.amazonaws.com/static.hivequal.org/files/posts/747/facebook_images/large.jpg?1453904827  Retrieved 1/5/19

 

Parenteral medications are packaged in vials and ampules.  Vials are glass containers with a rubber stopper in the top of the container.  The vial may contain more than one dose of medication and any excess is saved for later use.  The medication is accessed by pushing a needle attached to a syringe through the rubber stopper. 

 

Image of medication being withdrawn from a vial. A gloved hand is holding the vial upside down. Another gloved hand is holding a needle and syringe with the needle pushed through the rubber stopper of the vial.

www.groundreport.com/wp-content/uploads/archived/01359189955_ARTICLE_IMAGE_syringeandvialjpg.jpg  Retrieved 1/5/19

 

Ampules are glass containers with a top designed to be snapped or broken off.  The correct dose of medication is removed from the ampule and any excess is discarded.  Special filtered needles are used to withdraw the medication to prevent glass from being withdrawn into the medication.  A different needle (not filtered) is used to give the medication. 

 

An image of 5 different ampules

https://skillsmodules.atitesting.com/SkillsModulesContent/v2/medication-administration-3/images/Meds3_ampule4.jpg 

Retrieved 1/5/19

 

Problem Type 1 – Reading Medication Labels

Image of a medication label. Starting at the top and reading down, the label says "Bentyl", dicyclomine HCl U.S.P injection, 20 milligrams per 2 milliliters, prescription only, for intramuscular use only, one 2 milliliter ampule, and manufactured for Aptalis Pharma U.S. Inc.

https://www.drugs.com/pro/images/c56598d5-9cd1-4cce-b172-ac338775aec7/bentyl-ampule.jpg    Retrieved 1/5/19

 

If the medication is generic, it will have no trade name.  The generic name is always required.  The generic name may be in lower-case type, but sometimes may be printed in upper-case type.

A trade name is always marked with the symbol Image is the registered trademark symbol of a capital letter R with a circle around it. for trademark.  This symbol may be small and difficult to read, but it always follows the trade name.  The trade name usually begins with a capital letter, but this feature depends on the manufacturer.

 
The medication label shown above contains the following information:

  1. Trade name of the medication:  Bentyl (note trademark symbol, capitalized name)
  2. Generic name of the medication:  dicyclomine HCl (in lower case letters here but may sometimes be capitalized)
  3. Route:  IM only
  4. Strength:  20 mg per 2 ml (or 10 mg per ml)
  5. Total in the container:  2 ml
  6. Manufacturer:  Aptalis Pharma US, Inc.
  7. Lot number: not shown in this illustration
  8. Expiration date: not shown in this illustration

Make certain that you can identify all this information from a label.  Note that the strength of the medication must be stated per ml.  On an actual label, the lot number and expiration date would be shown.

 

Here’s another sample label:

Image of a medication label: Information on the label includes "Ondansetron Injection, U.S.P", 40 milligram per 20 milliliters (2 milligrams per milliliter), for IV or IM injection, 20 milliliter multidose vial, and "Novaplus". There are details about the formulation of the medication and storage instructions.

drugline.org/img/drug/ondansetron-injection-17054_3.jpg   Retrieved 1/5/19

 

The medication label shown above contains the following information:

  1. Trade name of the medication:  none
  2. Generic name of the medication:  ondansetron
  3. Route:  IV or IM
  4. Strength:  40 mg per 20 ml (or 2 mg per ml)
  5. Total in the container:  20 ml
  6. Manufacturer:  Novaplus
  7. Lot number: not shown in this illustration
  8. Expiration date: not shown in this illustration
  9. Storage instructions
  10. Details about the formulation of the medication

Make certain that you can identify all this information from a label. 

 

Problem Type 2 – Injections

Example 1:

Image of an unopened vial of furosemide. Label indicates that the vial contains 2 milliliters of furosemide. The vial contains a total of 20 milligrams. The strength of the medication is 10 milligrams per milliliter.

https://d2ch1jyy91788s.cloudfront.net/buyemp/images/product/Hospira-Furosemide-Injection-USP-33773522-1200_1200.png  Retrieved 1/5/19

 

A healthcare provider has prescribed furosemide 30 mg IV every 2 hours for your client.  How many ml will you give?

Here’s the problem set up in the dimensional analysis format:

SF = 30 mg

AU = ml

Equivalents:

10 mg = 1 ml

Equation for the dose in ml:

The equation is 30 milligrams over 1 times 1 milliliter over 10 milligrams. Cross out milligrams. Solve the equation to get 30 milliliters over 10 which reduces to a final answer of 3 milliliters.

You will need more than one vial to give this dose.  This vial only contains 2 ml.

 

Example 2:

Image of an unopened vial of ketorolac tromethamine. The label says it is a 2 milliliter single-dose vial that contains 60 milligrams.

www.clintpharmaceuticals.com/mm5/graphics/00000001/Chronic%20Pain%20Treatment%20Agents%20-01-0379601%20-%20Ketorolac%2060mg%20-%202ml%20vial%20-%20Box-25_03.jpg      Retrieved 1/5/19

 

A healthcare provider has prescribed ketorolac tromethamine 50 mg IM now for your client.  How many ml will you give?

SF = 50 mg

AU = ml

Equivalents:

60 mg = 2 ml

Equation for the dose in ml:

The equation is 50 milligrams over 1 times 2 milliliters over 60 milligrams. Cancel milligrams. That leaves milliliters which is your answer unit. Solve the equation to get 1.66 milliliters which rounds to a final answer of 1.7 milliliters.

 

Problem Type 3 – Medication with Doses in Units

Doses in units are always stated in whole numbers.  When the dose is converted to ml, use the rounding rules for numbers <1 and >1.

Image of an unopened vial of heparin. The vial is a 10 milliliter multi-dose vial. The vial contains 50,000 units of heparin (5,000 units per milliliter).

https://images.mooremedical.com/450x450/87992.jpg   Retrieved 1/5/19

 

Heparin is an anticoagulant used to prevent blood clots after surgery, for an immobile client, or for a cardiac client.  Doses are stated in units.

 

Example 1:

A healthcare provider has prescribed 6,000 units of heparin SC every 12 hours for your client.  Please refer to the vial above.  How many ml will you give?

SF = 6,000 units

AU = ml

Equivalents:

5,000 units = 1 ml

Equation for the dose in ml:  

The equation is 6000 units over 1 times 1 milliliter over 5000 units. Cancel units. That leaves milliliter which is your answer unit. Solve the equation to get a final answer of 1.2 milliliters.

 

Example 2:

Insulin is used to lower blood glucose in diabetic clients.  The standard strength of insulin is U 100, meaning 100 units per ml. Always check your label because there are other strengths of insulin.  Special syringes are used for insulin with the dose marked in units.  The syringes in the illustration are a typical size for insulin syringes and hold only 1 ml (100 units).  The measurements on the side of the syringes are units.  Insulin injections are given SC.

Image of an unopened vial of Humalog insulin along with two insulin syringes.

c-hit.org/wp-content/uploads/2016/04/Insulin-2-1170x780.jpg   Retrieved 1/5/19

 

A healthcare provider has prescribed 85 units of Humalog insulin lispro SC every morning.  How many ml of insulin would equal the dose in units?

SF = 85 units

AU = ml

Equivalents:

100 units = 1 ml

Equation for the dose in ml:

The equation is 85 units over 1 times 1 milliliter over 100 units. Cancel units. That leaves milliliters which is your answer unit. Solve the equation to get a final answer of 0.85 milliliters.   

Most insulin injections are less than 1 ml (100 units).  Doses more than 100 units should be verified with the healthcare provider before the first dose is given. 

A second nurse always checks the syringe and verifies the healthcare provider’s prescription before any dose of insulin is given.

 

Problem Type 4 –Doses Based on Body Weight

New SF: the client’s weight.  Most weight based medication prescriptions are stated in kilograms, so if your client’s weight is in pounds a conversion factor must be included in your equation.

 

Example 1: Let’s use the Humalog insulin lispro from the example above  

The healthcare provider has set a total daily insulin requirement at 0.75 units per kg per day SC.  What is the total daily requirement in units if your client weighs 215 pounds?  (Round your answer to a whole number.)

Here’s the problem set up in the dimensional analysis format:

SF = 215 lb

AU = units

Equivalents:

0.75 units = 1 kg

1 kg = 2.2 lb

Equation for the dose in units:

The equation is 215 pounds over 1 times 1 kilogram over 2.2 pounds times 0.75 units over 1 kilogram. Pounds is in both the numerator and denominator, so cancel pounds. Kilograms is in both the numerator and denominator, so cancel kilograms. That leaves unit which is the answer unit. Solve the equation to get 161.25 units over 2.2, which reduces to 73.29 and rounds to the final answer of 73 units.

 

Example 2:

Your client has a bacterial infection. The healthcare provider has prescribed gentamicin 1.5 mg per kg IV every 8 hours.  Your client weighs 81.8 kg. You have on hand gentamicin solution 40 mg/ml.  How many ml will you give?

SF = 81.8 kg

AU = ml

Equivalents:

1.5 mg = 1 kg

40 mg = 1 ml

Equation for the dose in ml:

The equation is 81.8 kilograms over 1 times 15 milligrams over 1 kilogram times 1 milliliter over 40 milligrams. Cancel kilograms. Cancel milligrams. That leaves milliliters which is your answer unit. Solve the equation to get 3.06 milliliters which rounds to 3.1 milliliters.

Note that you have the client’s weight in kg, so you do not need to do a weight conversion in this problem.

 

Example 3:

Your client, who weighs 175 lb, has pneumonia.  The healthcare provider has prescribed amikacin 20mg/kg IV every 24 hours for 7 days.  You have on hand amikacin 250mg/ml.  How many ml will you give?

SF = 175 lb

AU = ml

Equivalents:

20 mg = 1 kg

1 kg = 2.2 lb

250 mg = 1 ml

Equation for the dose in ml:

The equation is 175 pounds over 1 times 1 kilogram over 2.2 pounds times 20 milligrams over 1 kilogram times 1 milliliter over 250 milligrams. Cross out pounds. Cross out kilograms. Cross out milligrams. That leaves milliliter which is your answer unit. Solve the equation to get 6.36 which rounds to 6.4 milliliters.

Note that even a complicated problem like this one can easily be set up with dimensional analysis.  Just make certain that all your units of measurement except the AU cancel out in the equation. The other units of measurement must appear in both the numerator of a fraction and the denominator of a fraction in the equation to cancel out.

 

Problem Type 5 – Prefilled Syringes

Image of four examples of pre-filled syringes.

www.innovationessence.com/wp-content/uploads/2016/11/syringes2.jpg   Retrieved 1/5/19

 

Some medications or solutions come in a prefilled syringe like those pictured above.  In this case you need to calculate both the dose you will give and the amount you need to waste (or discharge) from the syringe before delivering the dose to the client.

 

Example 1:

Image of an Embrel pre-filled syringe box and the pre-filled syringe. The syringe holds 1 milliliter of medication that contains 50 milligrams of Enbrel.

https://4.imimg.com/data4/KL/QW/MY-10335408/etanercept-injection-250x250.jpg   Retrieved 2//19

 

Your client needs 35 mg of Enbrel (etanercept) SC for arthritis.  You have on hand a prefilled syringe containing 1 ml with a strength of 50 mg per ml.  How much must you discard from the prefilled syringe to give the client the correct dose?

SF = 35 mg

AU = ml

Equivalents:

50 mg = 1 ml

Equation for the dose in ml:

The equation is 35 milligrams over 1 times 1 milliliter over 50 milligrams. Cancel milligrams. Solve the equation to get an answer of 0.7 milliliters. 

Next you need to determine the amount of medication to discard. To do so, subtract the amount to give to the client from the 1 ml total in the syringe.

The equation is 1 milliliter minus 0.7 milliliters. Solve the equation to get the answer of 0.3 milliliter to discard (waste).

Make certain that you notice the requirements of the problem.  Does the problem ask for the amount to give or the amount to discard?

 

Practice Problems

Module 5 Practice Problems

Use the Heparin label for problems 1-8:

Image is of a label from a vial of heparin. The label states "Heparin Sodium Injection, U.S.P", "30,000 U.S.P units per 30 milliliters (1,000 U.S.P units per milliliter)", multi-dose vial, "for subcutaneous or intravenous use", "prescription only", "NOT for Lock Flush", "derived from porcine intestinal tissue", "Distributed by Pfizer Labs"

https://dailymed.nlm.nih.gov/dailymed/image.cfm?type=img&amp;name=heparin-11.jpg&amp;setid=56dc3074-f1c5-45a3-b923-f1d14858e06d    Retrieved 2/1/2019

 

  1. By what routes can the medication be administered?
  2. What is the medication strength?
  3. Is heparin a generic or trade name?
  4. Who is the manufacturer?
  5. Can this medication be used to flush an IV lock?
  6. A healthcare provider has prescribed 500 units of heparin SC twice daily for your client.  How many ml will you give? 
  7. The prescription in question 6 has changed to 300 units twice daily.  How many ml will you give?
  8. The prescription in question 6 has changed to 250 units twice daily.  How many ml will you give?

 

Use the Vitamin K label for problems 9-16:

Image is of a label from an ampule of Vitamin K. The label includes the following information: "1 milliliter single-dose ampule", "Vitamin K one injection", "prescription only", "phytonadione injectable emulsion, U.S.P.", 10 milligrams per milliliter, "For I.M., S.C., or I.V. (with caution)", "Protect from light. Keep ampules in tray until time of use.", details about the formulation of the medication, and manufactured by Novaplus.

https://dailymed.nlm.nih.gov/dailymed/image.cfm?type=img&amp;name=vitamin-06.jpg&amp;setid=469bd195-1fa6-41e8-a0a9-fa772490eebf      Retrieved 2/2/2019

 

  1. Is there a trade name for this medication?
  2. By which routes can the medication be given?
  3. How many ml total are in each ampule?
  4. What is the dosage strength?
  5. Who is the manufacturer?
  6. A healthcare provider has prescribed 8 mg of Vitamin K SC two times today for your client.  How many ml will you give? 
  7. The prescription has changed to 7 mg per dose.  How many ml will you give?
  8. The prescription has changed to 7.5 mg per dose.  How many ml will you give?

 

Use the vial of lincomycin for problems 17-19:

Image of an unopened vial of Lincocin. The label indicates that it is a one to two milliliter vial of Lincocin. The label further indicates "prescription only", "lincomycin injection", and "300 milligrams per milliliter".

www.acesurgical.com/media/catalog/product/cache/1/image/800x800/9df78eab33525d08d6e5fb8d27136e95/9/2/9254145_01.jpg   Retrieved 2/1/2019

 

  1. Your client has a prescription for lincomycin 400 mg IM twice daily.  How many ml will you give?
  2. Your client’s prescription changes to lincomycin 550 mg IM twice daily.  How many ml will you give?
  3. Your client’s prescription changes to lincomycin 650 mg IM twice daily.  How many ml will you give?

 

Use the illustration of Novolin R for problems 20-22:

Image is of the box for the Novolin R vial and the vial. Information provided includes: "Novolin R", "Regular Human Insulin Injection (recombinant DNA origin)", "100 units per milliliter", and 10 milliliters total volume.

https://www.cvs.com/webcontent/images/drug/DrugItem_7809.JPG  Retrieved 2/1/2019

 

  1. Your client has a prescription for regular insulin 25 units SC before every meal and at bedtime.  How many ml would each dose measure?
  2. Your client has a prescription for regular insulin 35 units SC before every meal and at bedtime.  How many ml would each dose measure?
  3. Your client has a prescription for regular insulin 20 units SC before every meal and at bedtime.  How many ml would each dose measure?

 

Use the vial of heparin sodium for problems 23-26:

Image of a vial of heparin sodium. The label indicates that there is a total of 10 milliliters and 50,000 units in the vial. The concentration of the medication is 5000 units per milliliter.

https://images.mooremedical.com/450x450/87992.jpg    Retrieved 2/1/2019

  1. A healthcare provider has prescribed heparin 4500 units SC every 12 hours for your client.  You have a vial of heparin 5,000 units per ml.  How many ml will you give?
  2. The healthcare provider changes the prescription to heparin 5500 units SC every 12 hours for your client.  How many ml will you give?
  3. The healthcare provider changes the prescription to heparin 3500 units SC every 8 hours for your client.  How many ml will you give?
  4. The healthcare provider changes the prescription to heparin 6500 units SC every 12 hours for your client.  How many ml will you give?

 

Use the morphine sulfate label for problems 27-29:

Image of a morphine sulfate label. The label is from a box of 1 milliliter single dose vials. Each vial contains morphine sulfate injection, "for intravenous use only", and "4 milligrams per 1 milliliter".

https://medlibrary.org/lib/images-rx/morphine-sulfate-11/morphine-sulfate-injection-anda-4.jpg  Retrieved 2/4/2019

 

  1. A healthcare provider has prescribed morphine sulfate 0.1 mg/kg IV once then every 4 hours as needed for your client’s pain.  Your client weighs 185 lb.  How many ml will you give?
  2. A healthcare provider has prescribed morphine sulfate 0.05 mg/kg IV once then every 3 hours as needed for your client’s pain.  Your client weighs 125 lb.  How many ml will you give?
  3. A healthcare provider has prescribed morphine sulfate 0.15 mg/kg IV once then every 2 hours as needed for your client’s pain.  Your client weighs 155 lb.  How many ml will you give?

 

Use the vial of heparin sodium for problems 30-32:

Image of a 10 milliliter vial of heparin sodium with a concentration of 5000 units per milliliter.

 

  1. A healthcare provider has prescribed heparin 80 units/kg IV once for your client.  Your client weighs 79.5 kg.  You have a vial of heparin containing 5,000 units per ml.  How many ml will you give?
  2. A healthcare provider has prescribed heparin 70 units/kg IV once for your client.  Your client weighs 185 lb.  You have a vial of heparin containing 5,000 units per ml.  How many ml will you give?
  3. A healthcare provider has prescribed heparin 50 units/kg IV once for your client.  Your client weighs 93.2 kg.  You have a vial of heparin containing 5,000 units per ml.  How many ml will you give?

Answers to Practice Problems

Answers to Module 5 Practice Problems

The Heparin problems (1-8):

  1. By what routes can the medication be administered? 

SC or IV only

  1. What is the medication strength?  

30,000 units/30 ml or 1,000 units/ml

  1. Is heparin a generic or trade name? 

generic (there is no trade name)

  1. Who is the manufacturer? 

Pfizer

  1. Can this medication be used to flush an IV lock? 

No

 

  1. A healthcare provider has prescribed 500 units of heparin SC twice daily for your client. How many ml will you give?

SF = 500 units

AU = ml

Equivalents:

1000 units = 1 ml

Equation for the dose in ml:

The equation is 500 units over 1 times 1 milliliter over 1000 units. Cancel units. Solve the equation to get the final answer of 0.5 milliliters.

 

  1. The prescription in question 6 has changed to 300 units twice daily. How many ml will you give?

SF = 300 units

AU = ml

Equivalents:

1000 units = 1 ml

Equation for the dose in ml:

The equation is 300 units over 1 times 1 milliliter over 1000 units. Cancel units. That leaves milliliter which is your answer unit. Solve the equation to get a final answer of 0.3 milliliters.

 

  1. The prescription in question 6 has changed to 250 units twice daily. How many ml will you give?

SF = 250 units

AU = ml

Equivalents:

1000 units = 1 ml

Equation for the dose in ml:

The equation is 250 units over 1 times 1 milliliter over 1000 units. Cancel units. That leaves milliliters which is your answer unit. Solve the equation to get a final answer of 0.25 milliliters.

 

The Vitamin K problems (9-16):

  1. Is there a trade name for this medication? 

No – phytonadione is another name for Vitamin K1. There is no trademark symbol in either name.

  1. By which routes can the medication be given? 

IM, SC, IV (with caution)

  1. How many ml total are in each ampule? 

1 ml

  1. What is the dosage strength?  

10mg/ml

  1. Who is the manufacturer?  

Novaplus

 

  1. A healthcare provider has prescribed 8 mg of Vitamin K SC two times today for your client. How many ml will you give?

SF = 8 mg

AU = ml

Equivalents:

10 mg = 1 ml

Equation for the dose in ml:

The equation is 8 milligrams over 1 times 1 milliliter over 10 milligrams. Cross out milligrams. That leaves milliliters which is your answer unit. Solve the equation to get a final answer of 0.8 milliliters.

         

  1. The prescription has changed to 7 mg per dose. How many ml will you give?

SF = 7 mg

AU = ml

Equivalents:

10 mg = 1 ml

Equation for the dose in ml:

The equation is 7 milligrams over 1 times 1 milliliter over 10 milligrams. Cross out milligrams. That leaves milliliter which is your answer unit. Solve the equation to get a final answer of 0.7 milliliters.

          

  1. The prescription has changed to 7.5 mg per dose. How many ml will you give?

SF = 7.5 mg

AU = ml

Equivalents:

10 mg = 1 ml

Equation for the dose in ml:

The equation is 7.5 milligrams over 1 times 1 milliliter over 10 milligrams. Cross out milligrams. That leaves milliliter which is the answer unit. Solve the equation to get a final answer of 0.75 milliliter.

 

The lincomycin problems (17-19)          

  1. Your client has a prescription for lincomycin 400 mg IM twice daily. How many ml will you give?

SF = 400 mg

AU = ml

Equivalents:

300 mg = 1 ml

Equation for the dose in ml:

The equation is 400 milligrams over 1 times 1 milliliter over 300 milligrams. Cross out milligrams. That leaves milliliter which is your answer unit. Solve the equation to get 1.33 milliliters which rounds to the final answer of 1.3 milliliters.

           

  1. Your client's prescription changes to lincomycin 550 mg IM twice daily. How many ml will you give?

SF =550 mg

AU = ml

Equivalents:

300 mg = 1 ml

Equation for the dose in ml:

The equation is 550 milligrams over 1 times 1 milliliter over 300 milligrams. Cancel milligrams. That leaves milliliter which is your answer unit. Solve the equation to get an answer of 1.83 milliliters which rounds to the final answer of 1.8 milliliters.

         

  1. Your client's prescription changes to lincomycin 650 mg IM twice daily. How many ml will you give?

SF = 650 mg

AU = ml

Equivalents:

300 mg = 1 ml

Equation for the dose in ml:

The equation is 650 milligrams over 1 times 1 milliliter over 300 milligrams. Cancel milligrams. That leaves milliliter which is your answer unit. Solve the equation to get 2.16 milliliters which rounds to the final answer of 2.2 milliliters.

 

The Novolin R problems (20-22):     

  1. Your client has a prescription for regular insulin 25 units SC before every meal and at bedtime. How many ml would each dose measure?

SF = 25 units

AU = ml

Equivalents:

100 units = 1 ml

Equation for the dose in ml:

The equation is 25 units over 1 times 1 milliliter over 100 units. Cancel units. That leaves milliliter which is your answer unit. Solve the equation to get a final answer of 0.25 milliliter.

        

  1. Your client has a prescription for regular insulin 35 units SC before every meal and at bedtime. How many ml would each dose measure?

SF = 35 units

AU = ml

Equivalents:

100 units = 1 ml

Equation for the dose in ml:

The equation is 35 units over 1 times 1 milliliter over 100 units. Cancel units. That leaves milliliter which is your answer unit. Solve the equation to get a final answer of 0.35 milliliter.

 

  1. Your client has a prescription for a regular insulin 20 units SC before every meal and at bedtime. How many ml would each dose measure?

SF = 20 units

AU = ml

Equivalents:

100 units = 1 ml

Equation for the dose in ml:

The equation is 20 units over 1 times 1 milliliter over 100 units. Cancel units. That leaves milliliter which is your answer unit. Solve the equation to get a final answer of 0.2 milliliter.

 

The heparin sodium problems (23-26)         

  1. A healthcare provider has prescribed heparin 4500 units SC every 12 hours for your client. You have a vial of heparin 5,000 units per ml. How many ml will you give?

SF = 4500 units

AU = ml

Equivalents:

5,000 units = 1 ml

Equation for the dose in ml:

The equation is 4500 units over 1 times 1 milliliter over 5000 units. Cancel units. That leaves milliliter which is your answer unit. Solve the equation to get the final answer of 0.9 milliliter.

 

  1. The healthcare provider changes the prescription to heparin 5500 units SC every 12 hours for your client. How many ml will you give?

SF = 5500 units

AU = ml

Equivalents:

5,000 units = 1 ml

Equation for the dose in ml:

The equation is 5500 units over 1 times 1 milliliter over 5000 units. Cross out units. That leaves milliliter which is your answer unit. Solve the equation to get the final answer of 1.1 milliliters.

 

  1. The healthcare provider changes the prescription to heparin 3500 units SC every 8 hours for your client. How many ml will you give?

SF = 3500 units

AU = ml

Equivalents:

5,000 units = 1 ml

Equation for the dose in ml:

The equation is 3500 units over 1 times 1 milliliter over 5000 units. Cross out units. That leaves milliliter which is your answer unit. Solve the equation to get the final answer of 0.7 milliliter.

 

  1. The healthcare provider changes the prescription to heparin 6500 units SC every 12 hours for your client. How many ml will you give?

SF = 6500 units

AU = ml

Equivalents:

5,000 units = 1 ml

Equation for the dose in ml:

The equation is 6500 units over 1 times 1 milliliter over 5000 units. Cancel units. That leaves milliliter which is your answer unit. Solve the equation to get the final answer of 1.3 milliliters.

 

The morphine sulfate problems (27-29):

  1. A healthcare provider has prescribed morphine sulfate 0.1 mg/kg IV once then every 4 hours as needed for your client's pain. Your client weights 185 lbs. How many ml will you give?

SF = 185 lb

AU = ml

Equivalents:

0.1 mg = 1 kg

1 kg = 2.2 lb

4 mg = 1 ml

Equation for the dose in ml:

Since the prescription is weight based, the equation starts with the client's weight. There are multiple equivalents to be used. Use them so that you can cancel your previous unit until you are left with the answer unit. The equation is 185 pounds over 1 times 1 kilogram over 2.2. pounds times 0.1 milligram over 1 kilogram times 1 milliliter over 4 milligrams. Cancel pounds. Cancel kilograms. Cancel milligrams. That leaves milliliter which is your answer unit. Solve the equation to get 18.5 milliliters over 8.8, which further reduces to 2.1 milliliters.

 

  1. A healthcare provider has prescribed morphine sulfate 0.05 mg/kg IV once then every 3 hours as needed for your client's pain. Your client weighs 125 lbs. How many ml will you give?

SF = 125 lb

AU = ml

Equivalents:

0.05 mg = 1 kg

1 kg = 2.2 lb

4 mg = 1 ml

Equation for the dose in ml:

The equation is 125 pounds over 1 times 1 kilogram over 2.2. pounds times 0.05 milligrams over 1 kilogram times 1 milliliter over 4 milligrams. Cancel pounds. Cancel kilograms. Cancel milligrams. That leaves milliliters which is your answer unit. Solve the equation to get 6.25 milliliters over 8.8 which further reduces to 0.71 milliliter.

 

  1. A healthcare provider has prescribed morphine sulfate 0.15 mg/kg IV once then every 2 hours as needed for your client's pain. Your client weighs 155 lbs. How many ml will you give?

SF = 155 lbs

AU = ml

Equivalents:

0.15 mg = 1 kg

1 kg = 2.2 lb

4 mg = 1 ml

Equation for the dose in ml:

The equation is 155 pounds over 1 times 1 kilogram over 2.2 pounds times 0.15 milligram over 1 kilogram times 1 milliliter over 4 milligrams. Cross out pounds, kilograms, and milligrams. That leaves milliliter which is your answer unit. Solve the equation to get 23.25 milliliters over 8.8 which reduces to 2.64 milliliters and rounds to 2.6 milliliters.

 

The heparin weight based problems (30-32)                                                  

  1. A healthcare provider has prescribed heparin 80 units/kg IV once for your client. Your client weighs 79.5 kg. You have a vial of heparin containing 5,000 units per ml. How many ml will you give?

SF = 79.5 kg

AU = ml

Equivalents:

5,000 units = 1 ml

80 units = 1 kg

Equation for the dose in ml:

The equation is 79.5 kilograms over 1 times 80 units over 1 kilogram times 1 milliliter over 5000 units. Cancel kilograms. Cancel units. That leaves you with milliliter which is your answer unit. Solve the equation to get 6360 milliliters over 5000 which reduces to 1.27 milliliters and rounds to the final answer of 1.3 milliliters.

Note that you have the client’s weight in kg, so you do not need to do a weight conversion in this problem.

 

  1. A healthcare provider has prescribed heparin 70 units/kg IV once for your client. Your client weighs 185 lbs. You have a vial of heparin containing 5,000 units per ml. How many ml will you give?

SF = 185 lb

AU = ml

Equivalents:

70 units = 1 kg

1 kg = 2.2 lb

5,000 units = 1 ml

Equation for the dose in ml:

The equation is 185 pounds over 1 times 1 kilogram over 2.2 pounds times 70 units over 1 kilogram times 1 milliliter over 5000 units. Cancel pounds, kilograms and units. That leaves milliliters which is your answer unit. Solve the equation to get 12950 over 1100 which reduces to 1.17 milliliters and rounds to the final answer of 1.2 milliliters.

 

  1. A healthcare provider has prescribed heparin 50 units/kg IV once for your client. Your client weighs 93.2 kg. You have a vial of heparin containing 5,000 units per ml. How many ml will you give?

SF = 93.2 kg

AU = ml

Equivalents:

5,000 units = 1 ml

50 units = 1 kg

Equation for the dose in ml:

The equation is 93.2 kilograms over 1 times 50 units over 1 kilogram times 1 milliliter over 5000 units. Cancel kilograms and units. That leaves milliliter which is your answer unit. Solve the equation to get get 4660 milliliters over 5000 which reduces to 0.932 and rounds to 0.93 milliliter.

Note that you have the client’s weight in kg, so you do not need to do a weight conversion in this problem.

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