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
024681010 mL

A child weighing 8 kg is prescribed 15 mg/kg of a drug. The stock solution contains 20 mg/mL. Draw up the dose: what volume V do you give?

8 kg15 mg/kg20 mg/mL
V = mL
2.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 2320 micrograms. The ampoule contains 4 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

2320 mcg4 mg/mL
V = mL
3.IV infusion ratesMedium
V = ?15 gtt/mL20 gtt/min6 h

A drip runs at 20 gtt/min through a set of 15 gtt/mL. How many millilitres V does the patient receive in 6 hours?

20 gtt/min15 gtt/mL6 h
V = mL
4.IV infusion ratesHard
450 mL15 gtt/mL28 gtt/mint = ? h

A drip runs at 28 gtt/min through a set of 15 gtt/mL. There are 450 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

28 gtt/min15 gtt/mL450 mL
t = h
5.Pediatric & critical-care dosingMedium
heparin 1 000 units/mL60 units/kg · 70 kg → V = ? mL

Practice exercise (made-up values, not clinical guidance). A practice protocol calls for a heparin bolus of 60 units/kg for a patient who weighs 70 kg. The vial contains 1 000 units/mL. What volume V do you draw up? Round to one decimal place.

60 units/kg70 kg1 000 units/mL
V = mL
6.Pediatric & critical-care dosingHard
500 mg250 mLdobutamine? mL/h83 kg7.5 mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A bag contains dobutamine 500 mg in 250 mL. The order is 7.5 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.

500 mg/250 mL7.5 mcg/kg/min83 kg
R = mL/h
7.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftwater120 mLmilk240 mLIV infusion100 mL/h × 8 hIV antibiotic2 × 100 mLurine225 mLurine425 mLurine500 mLwound drain110 mLvomit150 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL.

water: 120 mLmilk: 240 mLIV infusion: 100 mL/h × 8 hIV antibiotic: 2 × 100 mL
I = mL
8.IV fluids & fluid balanceHard
500 mL150 mL infused100 mL/h12:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 100 mL/h. At 12:00, 150 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL150 mL infused100 mL/h
t = h
9.Nursing math & unit conversionsMedium
94969810010210410635363738394041°F°C100 °F? °C

Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 100 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.

100 °F
T = °C
10.Nursing math & unit conversionsHard
3 mcg/min? mg/h1 h = 60 min1 mg = 1000 mcg

Practice exercise (made-up values, not clinical guidance). An infusion delivers 3 mcg/min. Express this dose rate D in mg/h.

3 mcg/min1 h = 60 min1 mg = 1000 mcg
D = mg/h

3Solutions

1.Dosage calculations

Answer: V = 6 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.

Dose from body weight

D = 15·8 = 120 mg

Volume

V = 120/20 = 6 mL

On the syringe

On this 10 mL syringe every small line is 0.2 mL.

Answer

V = 6 mL
2.Dosage calculations

Answer: V = 0.58 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

4 mg/mL = 4000 mcg/mL

Volume

V = 2320/4000 = 0.58 mL

Answer

V = 0.58 mL
3.IV infusion rates

Answer: V = 480 mL

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.

Rate in mL/h

20·60/15 = 80 mL/h

Volume

V = 80·6 = 480 mL

Answer

V = 480 mL
4.IV infusion rates

Answer: t = 4 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.

Rate in mL/h

28·60/15 = 112 mL/h

Time left

t = 450/112 = 4.018 ≈ 4 h

Answer

t = 4 h
5.Pediatric & critical-care dosing

Answer: V = 4.2 mL

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.

Units needed

60·70 = 4 200 units

Volume

V = 4200/1000 = 4.2 mL

Answer

V = 4.2 mL
6.Pediatric & critical-care dosing

Answer: R = 18.7 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

500 mg = 500 000 mcg
500 000/250 = 2000 mcg/mL

Dose per minute and per hour

7.5·83 = 622.5 mcg/min
622.5·60 = 37350 mcg/h

Pump rate

R = 37350/2000 = 18.68 ≈ 18.7 mL/h

Answer

R = 18.7 mL/h
7.IV fluids & fluid balance

Answer: I = 1360 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: 120 + 240 = 360 mL
IV infusion: 100·8 = 800 mL
IV antibiotic: 2·100 = 200 mL
I = 1360 mL

Answer

I = 1360 mL
8.IV fluids & fluid balance

Answer: t = 3.5 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.

Volume left

500 − 150 = 350 mL

Time

t = 350/100 = 3.5 h

Answer

t = 3.5 h

That is about 3 h 30 min, so the bag runs out at about 15:30.

9.Nursing math & unit conversions

Answer: T = 37.8 °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

100 − 32 = 68

Multiply by 5/9

T = 68·5/9 = 37.78 ≈ 37.8 °C

Answer

T = 37.8 °C
10.Nursing math & unit conversions

Answer: D = 0.18 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 = 3 mcg/min × (60 min/1 h) × (1 mg/1000 mcg)

Calculate

D = 3·60/1000 = 0.18 mg/h

Answer

D = 0.18 mg/h

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