NCLEX-style dosage calculations: cram pack

Formula sheets, the key method steps for every topic and 10 practice problems, with full solutions at the back.

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1Formulas and methods

Dosage calculations

Dose from strength
volume = dose / strength
Weight-based dose
dose = mg/kg × body weight
Tablets
number = dose / tablet strength
Units
1 g = 1000 mg, 1 mg = 1000 mcg

Method

  1. Convert the ordered dose and the stock strength to the same unit.
  2. Use desired over have times quantity: (D/H) × Q.
  3. For weight-based doses, multiply by the weight in kg first, then divide the daily dose by the number of doses.
  4. Estimate first and check that the answer is reasonable.

IV infusion rates

Pump rate
mL/h = volume (mL)/time (h)
Drip rate
drops/min = volume (mL) × drop factor / time (min)
Infusion time
time (h) = volume (mL)/rate (mL/h)

Method

  1. Pump rate in mL/h: volume divided by time in hours.
  2. Drip rate in drops/min: volume × drop factor divided by time in minutes.
  3. For time remaining: volume left divided by the rate.
  4. Round as the question or the equipment requires.

Pediatric & critical-care dosing

Daily dose
mg/day = mg/kg/day × weight (kg)
Doses per day
number = 24 h / dosing interval (h)
Pounds to kilograms
kg = lb / 2.2
Infusion concentration
units/mL = units in bag / bag volume
Pump rate
mL/h = dose per hour / concentration
Titrated drip
mL/h = mcg/kg/min × kg × 60 / (mcg/mL)
Dose from pump rate
mcg/kg/min = mL/h × (mcg/mL) / (60 × kg)
Units
1 mg = 1000 mcg

IV fluids & fluid balance

Holliday–Segar per hour
4 mL/kg (first 10 kg) + 2 mL/kg (next 10 kg) + 1 mL/kg (each kg above 20)
Holliday–Segar per day
100 / 50 / 20 mL/kg for the same bands
Fluid balance
intake − output
Ice chips
count as half their volume
Urine output
mL/kg/h = mL / (kg × h)
Infusion time
time (h) = volume left (mL) / rate (mL/h)
Volume infused
mL = rate × time

Nursing math & unit conversions

Metric steps
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
Weight and length
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
Household measures
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
Temperature
°C = (°F − 32)·5/9, °F = °C·9/5 + 32
24-hour clock
PM hours 1–11: add 12; 12 AM = 00:xx; 12 PM = 12:xx
Dose rate
mcg/min × 60/1000 = mg/h
Laboratory factors
glucose 1 mmol/L = 18 mg/dL; creatinine 1 mg/dL = 88.4 µmol/L; Hb 1 g/dL = 10 g/L

Method

  1. Write the given quantity with its unit and the unit you want.
  2. Pick the equivalent: 1000 between kg, g, mg and mcg or L and mL; 1 kg = 2.2 lb; 1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 240 mL.
  3. Write it as a fraction so that the unwanted unit cancels; for a rate, use one fraction per unit that changes.
  4. Check the direction: a smaller unit gives a bigger number.
  5. Round only the final answer, to the precision the question names.

2Practice problems

1.Dosage calculationsMedium
45 kg5 mg/kgD = ? mg

A patient weighs 45 kg and is prescribed 5 mg/kg as a single dose. Find the dose D in mg.

45 kg5 mg/kg
D = mg
2.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 880 micrograms. The ampoule contains 2 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

880 mcg2 mg/mL
V = mL
3.IV infusion ratesMedium
250 mL15 gtt/mL3 h? gtt/min

Infuse 250 mL over 3 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

250 mL3 h15 gtt/mL
R = gtt/min
4.IV infusion ratesHard
200 mg100 mL15 gtt/mL40 mg/h? gtt/min

200 mg of a drug is diluted in 100 mL and given by gravity through a set of 15 gtt/mL. The order is 40 mg per hour. Find the drip rate R in drops per minute.

200 mg/100 mL40 mg/h15 gtt/mL
R = gtt/min
5.Pediatric & critical-care dosingMedium
100 units100 mLregular insulin10 mL/h? units/h

Practice exercise (made-up values, not clinical guidance). An infusion of 100 units of regular insulin in 100 mL runs at 10 mL/h. How many units per hour D does the patient receive?

100 units/100 mL10 mL/h
D = units/h
6.Pediatric & critical-care dosingHard
250 mg250 mLdobutamine? mL/h94 kg2.5 mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A bag contains dobutamine 250 mg in 250 mL. The order is 2.5 mcg/kg/min for a patient who weighs 94 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

250 mg/250 mL2.5 mcg/kg/min94 kg
R = mL/h
7.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftwater200 mLjuice100 mLsoup180 mLIV infusion125 mL/h × 12 hIV antibiotic2 × 100 mLurine350 mLurine425 mLurine300 mLurine225 mLvomit200 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL.

water: 200 mLjuice: 100 mLsoup: 180 mLIV infusion: 125 mL/h × 12 hIV antibiotic: 2 × 100 mL
I = mL
8.IV fluids & fluid balanceHard
1000 mL→ 125 mL/hstart 14:30ttotal​ = ? h80 mL/h × 3 h

Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 14:30 at 80 mL/h. After 3 hours the rate is changed to 125 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.

1000 mL80 mL/h · 3 h125 mL/h
t = h
9.Nursing math & unit conversionsMedium
12345678910111204:55?4:55 PM6:55 AM3:55 AM4:55 AM

Practice exercise (made-up values, not clinical guidance). A dose is charted at 04:55 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.

04:55
  1. 14:55 PM
  2. 26:55 AM
  3. 33:55 AM
  4. 44:55 AM
10.Nursing math & unit conversionsHard
10 mcg/kg/min? mg/h97 kg1 h = 60 min1 mg = 1000 mcg

Practice exercise (made-up values, not clinical guidance). An order reads 10 mcg/kg/min for a patient who weighs 97 kg. Express the dose rate D in mg/h. Round to two decimal places.

10 mcg/kg/min97 kg
D = mg/h

3Solutions

1.Dosage calculations

Answer: D = 225 mg

Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.

Dose

5·45 = 225 mg

Answer

D = 225 mg
2.Dosage calculations

Answer: V = 0.44 mL

Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.

Same units

2 mg/mL = 2000 mcg/mL

Volume

V = 880/2000 = 0.44 mL

Answer

V = 0.44 mL
3.IV infusion rates

Answer: R = 21 gtt/min

Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.

Time in minutes

3·60 = 180 min

Drip rate

R = 250·15/180 = 20.83 ≈ 21 gtt/min

Answer

R = 21 gtt/min

At the bedside you round to the nearest whole drop: 21 gtt/min.

4.IV infusion rates

Answer: R = 5 gtt/min

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

Concentration

200/100 = 2 mg/mL

Volume per hour

40/2 = 20 mL/h

Drip rate

R = 20·15/60 = 5 gtt/min

Answer

R = 5 gtt/min
5.Pediatric & critical-care dosing

Answer: D = 10 units/h

Heparin and insulin infusions: concentration = units in the bag/bag volume (units/mL). Pump rate (mL/h) = units per hour/concentration, and units per hour = mL/h × concentration. For a weight-based order, units/h = units/kg/h × weight first. A bolus volume = units needed/vial strength. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Concentration

100/100 = 1 units/mL

Units per hour

D = 10·1 = 10 units/h

Answer

D = 10 units/h
6.Pediatric & critical-care dosing

Answer: R = 14.1 mL/h

Titrated drips: first find the concentration in mcg/mL (mg × 1000/mL). For a weight-based order, mcg/min = mcg/kg/min × weight. Then mL/h = mcg/min × 60/concentration. Working backwards, mcg/kg/min = mL/h × concentration/(60 × weight). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Concentration

250 mg = 250 000 mcg
250 000/250 = 1000 mcg/mL

Dose per minute and per hour

2.5·94 = 235 mcg/min
235·60 = 14100 mcg/h

Pump rate

R = 14100/1000 = 14.1 mL/h

Answer

R = 14.1 mL/h
7.IV fluids & fluid balance

Answer: I = 2180 mL

Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Add the intake

oral: 200 + 100 + 180 = 480 mL
IV infusion: 125·12 = 1500 mL
IV antibiotic: 2·100 = 200 mL
I = 2180 mL

Answer

I = 2180 mL
8.IV fluids & fluid balance

Answer: t = 9.1 h

Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

First part

80·3 = 240 mL
1000 − 240 = 760 mL left

Second part

760/125 = 6.08 h

Total time

t = 3 + 6.08 = 9.08 ≈ 9.1 h

Answer

t = 9.1 h

That is about 9 h 05 min, so the bag runs out at about 23:35.

9.Nursing math & unit conversions

Answer: 4:55 AM

24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.

Convert the hour

04 → 4 AM

Answer

4:55 AM

Answer

4:55 AM
10.Nursing math & unit conversions

Answer: D = 58.2 mg/h

Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.

Set up the chain

D = 10 mcg/kg/min × 97 kg × (60 min/1 h) × (1 mg/1000 mcg)

Calculate

D = 10·97·60/1000 = 58.2 mg/h

Answer

D = 58.2 mg/h

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