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
60 kg7.5 mg/kg/day2× per dayD = ? mg

A patient weighs 60 kg. The prescribed dose is 7.5 mg/kg per day, given in 2 equal doses. How many milligrams D are given per dose?

60 kg7.5 mg/kg/day2× per day
D = mg
2.Dosage calculationsHard
100 mg/5 mLV = ? mL

A child weighing 18 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 100 mg in 5 mL. What volume V do you give?

18 kg10 mg/kg100 mg/5 mL
V = mL
3.IV infusion ratesMedium
460 mLleft? mL/h2 h left

1500 mL was ordered over 8 hours. After 6 hours you find that 460 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?

1500 mL / 8 hafter 6 h: 460 mL
R = mL/h
4.IV infusion ratesHard
100 mg100 mL15 gtt/mL20 mg/h? gtt/min

100 mg of a drug is diluted in 100 mL and given by gravity through a set of 15 gtt/mL. The order is 20 mg per hour. Find the drip rate R in drops per minute.

100 mg/100 mL20 mg/h15 gtt/mL
R = gtt/min
5.Pediatric & critical-care dosingMedium
100 units250 mLregular insulin? mL/h2 units/h

Practice exercise (made-up values, not clinical guidance). An infusion contains 100 units of regular insulin in 250 mL. The order is 2 units/h. Find the pump rate R in mL/h. Round to one decimal place.

100 units/250 mL2 units/h
R = mL/h
6.Pediatric & critical-care dosingHard
250 mg250 mLdobutamine? mL/h83 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 83 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/min83 kg
R = mL/h
7.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftjuice150 mLsoup150 mLIV infusion125 mL/h × 12 hIV antibiotic2 × 50 mLurine175 mLurine450 mLurine500 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.

juice: 150 mLsoup: 150 mLIV infusion: 125 mL/h × 12 hIV antibiotic: 2 × 50 mL
I = mL
8.IV fluids & fluid balanceHard
500 mL100 mL/hstart 09:4510:45: ? mL

Practice exercise (made-up values, not clinical guidance). A 500 mL bag was started at 09:45 and runs by pump at 100 mL/h. How many mL V are left in the bag at 10:45?

500 mL100 mL/h09:45 → 10:45
V = mL
9.Nursing math & unit conversionsMedium
94969810010210410635363738394041°F°C95.8 °F? °C

Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 95.8 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.

95.8 °F
T = °C
10.Nursing math & unit conversionsHard
1 tsp · 2/day · 7 d? × 100 mL1 tsp = 5 mL

Practice exercise (made-up values, not clinical guidance). A prescription reads 1 tsp of an oral suspension twice a day for 7 days. The suspension comes in 100 mL bottles. Using 1 tsp = 5 mL, how many whole bottles N must be supplied so the course is complete?

1 tsptwice a day7 days100 mL1 tsp = 5 mL
N =

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.

Total per day

7.5·60 = 450 mg

Per dose

D = 450/2 = 225 mg

Answer

D = 225 mg
2.Dosage calculations

Answer: V = 9 mL

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 from weight

10·18 = 180 mg

Volume

V = (180/100)·5 = 9 mL

Answer

V = 9 mL
3.IV infusion rates

Answer: R = 230 mL/h

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.

Original rate

1500/8 = 187.5 mL/h

New rate

R = 460/2 = 230 mL/h

Answer

R = 230 mL/h

Many hospitals allow such an adjustment up to 25% without a new order; check local policy.

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

100/100 = 1 mg/mL

Volume per hour

20/1 = 20 mL/h

Drip rate

R = 20·15/60 = 5 gtt/min

Answer

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

Answer: R = 5 mL/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

100/250 = 0.4 units/mL

Pump rate

R = 2/0.4 = 5 mL/h

Answer

R = 5 mL/h
6.Pediatric & critical-care dosing

Answer: R = 12.5 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

2.5·83 = 207.5 mcg/min
207.5·60 = 12450 mcg/h

Pump rate

R = 12450/1000 = 12.45 ≈ 12.5 mL/h

Answer

R = 12.5 mL/h
7.IV fluids & fluid balance

Answer: I = 1900 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: 150 + 150 = 300 mL
IV infusion: 125·12 = 1500 mL
IV antibiotic: 2·50 = 100 mL
I = 1900 mL

Answer

I = 1900 mL
8.IV fluids & fluid balance

Answer: V = 400 mL

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.

Elapsed time

09:45 → 10:45 = 1 h

Volume infused

100·1 = 100 mL

Volume left

V = 500 − 100 = 400 mL

Answer

V = 400 mL
9.Nursing math & unit conversions

Answer: T = 35.4 °C

Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.

Subtract 32

95.8 − 32 = 63.8

Multiply by 5/9

T = 63.8·5/9 = 35.44 ≈ 35.4 °C

Answer

T = 35.4 °C
10.Nursing math & unit conversions

Answer: N = 1

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.

Total volume

5 mL × 2 × 7 = 70 mL

Bottles

70/100 = 0.7 → N = 1

Answer

N = 1

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