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 12 kg is prescribed 10 mg/kg of a drug. The stock solution contains 20 mg/mL. Draw up the dose: what volume V do you give?

12 kg10 mg/kg20 mg/mL
V = mL
2.Dosage calculationsHard
120 mg/5 mLV = ? mL

A child weighing 20 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 120 mg in 5 mL. What volume V do you give? Round to one decimal place.

20 kg10 mg/kg120 mg/5 mL
V = mL
3.IV infusion ratesMedium
60 gtt/mL75 mL/h? gtt/min

An infusion is ordered at 75 mL/h, but no pump is available. It runs by gravity through a giving set of 60 gtt/mL. Find the drip rate R in drops per minute.

75 mL/h60 gtt/mL
R = gtt/min
4.IV infusion ratesHard
310 mLleft? mL/h5 h left

500 mL was ordered over 10 hours. After 5 hours you find that 310 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?

500 mL / 10 hafter 5 h: 310 mL
Δ = %
5.Pediatric & critical-care dosingMedium
50 units50 mLregular insulin7.5 mL/h? units/h

Practice exercise (made-up values, not clinical guidance). An infusion of 50 units of regular insulin in 50 mL runs at 7.5 mL/h. How many units per hour D does the patient receive?

50 units/50 mL7.5 mL/h
D = units/h
6.Pediatric & critical-care dosingHard
250 mg250 mLdobutamine? mL/h55 kg5 mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A bag contains dobutamine 250 mg in 250 mL. The order is 5 mcg/kg/min for a patient who weighs 55 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

250 mg/250 mL5 mcg/kg/min55 kg
R = mL/h
7.IV fluids & fluid balanceMedium
IntakeOutput12-hour shifttea240 mLjelly120 mLsoup180 mLIV infusion50 mL/h × 12 hIV antibiotic1 × 50 mLurine350 mLurine325 mLurine500 mLwound drain50 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The patient weighs 87 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

87 kg12 hurine: 350 mLurine: 325 mLurine: 500 mLwound drain: 50 mL
U = mL/kg/h
8.IV fluids & fluid balanceHard
500 mL250 mL infused120 mL/h14:30t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 120 mL/h. At 14:30, 250 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL250 mL infused120 mL/h
t = h
9.Nursing math & unit conversionsMedium
12345678910111211:25 PM?00:2511:2522:2523:25

Practice exercise (made-up values, not clinical guidance). A dose is charted at 11:25 PM. Which entry is the same time on the 24-hour clock? Click it.

11:25 PM
  1. 100:25
  2. 211:25
  3. 322:25
  4. 423:25
10.Nursing math & unit conversionsHard
1 mcg/kg/min? mg/h64 kg1 h = 60 min1 mg = 1000 mcg

Practice exercise (made-up values, not clinical guidance). An order reads 1 mcg/kg/min for a patient who weighs 64 kg. Express the dose rate D in mg/h. Round to two decimal places.

1 mcg/kg/min64 kg
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 = 10·12 = 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 = 8.3 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

10·20 = 200 mg

Volume

V = (200/120)·5 = 8.333 ≈ 8.3 mL

Answer

V = 8.3 mL
3.IV infusion rates

Answer: R = 75 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.

Millilitres per minute

75/60 = 1.25 mL/min

Drip rate

R = 1.25·60 = 75 gtt/min

Answer

R = 75 gtt/min

With a microdrip set (60 gtt/mL), gtt/min equals mL/h.

4.IV infusion rates

Answer: Δ = 24 %

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

500/10 = 50 mL/h

New rate

R = 310/5 = 62 mL/h

Percentage change

Δ = (62 − 50)/50·100% = 24%

Answer

Δ = 24%

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

5.Pediatric & critical-care dosing

Answer: D = 7.5 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

50/50 = 1 units/mL

Units per hour

D = 7.5·1 = 7.5 units/h

Answer

D = 7.5 units/h
6.Pediatric & critical-care dosing

Answer: R = 16.5 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

5·55 = 275 mcg/min
275·60 = 16500 mcg/h

Pump rate

R = 16500/1000 = 16.5 mL/h

Answer

R = 16.5 mL/h
7.IV fluids & fluid balance

Answer: U = 1.13 mL/kg/h

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.

Total urine

350 + 325 + 500 = 1175 mL

Per kilogram per hour

U = 1175/(87·12) = 1.125 ≈ 1.13 mL/kg/h

Answer

U = 1.13 mL/kg/h
8.IV fluids & fluid balance

Answer: t = 2.1 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.

Volume left

500 − 250 = 250 mL

Time

t = 250/120 = 2.083 ≈ 2.1 h

Answer

t = 2.1 h

That is about 2 h 05 min, so the bag runs out at about 16:35.

9.Nursing math & unit conversions

Answer: 23:25

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

11 PM → 11 + 12 = 23

Answer

23:25

Answer

23:25
10.Nursing math & unit conversions

Answer: D = 3.84 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 = 1 mcg/kg/min × 64 kg × (60 min/1 h) × (1 mg/1000 mcg)

Calculate

D = 1·64·60/1000 = 3.84 mg/h

Answer

D = 3.84 mg/h

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