Nursing Math: cram pack

Formula sheets, the key method steps for every topic and 12 practice problems, with full solutions at the back.

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1Formulas and methods

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.

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.

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

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

Pharmacy calculations

Percentage strength
% w/v = g per 100 mL
Amount in a solution
g = % × mL / 100
Ratio strength
1:X = 1 g in X mL; % = 100 / X
Reconstitution
final volume = diluent + powder volume
Concentration
mg/mL = drug in vial / final volume
Alligation
parts of H = T − L, parts of L = H − T
Water or base
0%

2Practice problems

1.Nursing math & unit conversionsMedium
1.1718 mL? mLround to 0.1 mL

Practice exercise (made-up values, not clinical guidance). A dose calculation for an injection gives 1.1718 mL. The rule in this exercise is that volumes of 1 mL or more are rounded to the nearest tenth of a mL. What value x do you record?

1.1718 mL
x = mL
2.Nursing math & unit conversionsHard
00:0023:0005:45t = ?

Practice exercise (made-up values, not clinical guidance). An infusion starts at 23:00 and finishes at 05:45 the next morning (24-hour clock). How many minutes t did it run?

23:0005:45
t = min
3.Dosage calculationsMedium
0.5%w/vV = ? mL

A dose of 10 mg is needed from a 0.5% (w/v) solution. What volume V contains this dose?

10 mg0.5% w/v
V = mL
4.Dosage calculationsHard
10%stockV₁ = ? mL

You must prepare 200 mL of a 2.5% (w/v) solution from a 10% (w/v) stock solution. What volume of stock V₁ do you need?

C₁ = 10%C₂ = 2.5%V₂ = 200 mL
V₁ = mL
5.IV infusion ratesMedium
60 gtt/mL150 mL/h? gtt/min

An infusion is ordered at 150 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.

150 mL/h60 gtt/mL
R = gtt/min
6.IV infusion ratesHard
600 mL60 gtt/mL32 gtt/mint = ? h

A drip runs at 32 gtt/min through a set of 60 gtt/mL. There are 600 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

32 gtt/min60 gtt/mL600 mL
t = h
7.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftsoup180 mLjelly120 mLice chips200 mLIV infusion50 mL/h × 12 hIV antibiotic2 × 100 mLurine200 mLurine225 mLurine325 mLwound drain120 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 fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.

soup: 180 mLjelly: 120 mLice chips: 200 mLIV infusion: 50 mL/h × 12 hIV antibiotic: 2 × 100 mLurine: 200 mLurine: 225 mLurine: 325 mLwound drain: 120 mL
B = mL
8.IV fluids & fluid balanceHard
1000 mL350 mL infused75 mL/h09:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 75 mL/h. At 09:00, 350 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

1000 mL350 mL infused75 mL/h
t = h
9.Pediatric & critical-care dosingMedium
heparin 1 000 units/mL60 units/kg · 91 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 91 kg. The vial contains 1 000 units/mL. What volume V do you draw up? Round to one decimal place.

60 units/kg91 kg1 000 units/mL
V = mL
10.Pediatric & critical-care dosingHard
50 mg250 mLnitroglycerin? mL/h62 kg30 mcg/min

Practice exercise (made-up values, not clinical guidance). A patient who weighs 62 kg has an order for nitroglycerin at 30 mcg/min. The bag contains 50 mg in 250 mL. Find the pump rate R in mL/h. Round to one decimal place.

50 mg/250 mL30 mcg/min62 kg
R = mL/h
11.Pharmacy calculationsMedium
ampicillin 500 mgAdd 1.8 mL sterile water.Powder volume: 0.2 mL.? mg/mL

Practice exercise (made-up values, not clinical guidance). A vial contains ampicillin 500 mg as a powder. The practice label says to add 1.8 mL of sterile water; the powder adds 0.2 mL to the volume. What is the concentration C in mg/mL after reconstitution?

500 mg1.8 mL+0.2 mL
C = mg/mL
12.Pharmacy calculationsHard
23%sodium chloride+3%sodium chloride? mL13%300 mL

Practice exercise (made-up values, not clinical guidance). You must prepare 300 mL of 13% sodium chloride by mixing 23% and 3% sodium chloride. How many mL V of the 3% solution do you need? Round to the nearest whole mL.

23%3%13%300 mL
V = mL

3Solutions

1.Nursing math & unit conversions

Answer: x = 1.2 mL

Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.

Digit in the tenths place

1.1718 → 1

Only the next digit decides

1.1718 → 7
7 is 5 or more, so round 1 up.
The digits after it (18) are ignored: round once, never step by step.

Round

x = 1.2 mL

Answer

x = 1.2 mL
2.Nursing math & unit conversions

Answer: t = 405 min

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.

Before midnight

23:00 → 24:00 = 60 min

After midnight

00:00 → 05:45 = 345 min

Total

t = 60 + 345 = 405 min

Answer

t = 405 min
3.Dosage calculations

Answer: V = 2 mL

Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.

Concentration

0.5% = 5 mg/mL

Volume

V = 10/5 = 2 mL

Answer

V = 2 mL
4.Dosage calculations

Answer: V₁ = 50 mL

Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.

Volume of stock

V₁ = 2.5·200/10 = 50 mL

Answer

V₁ = 50 mL
5.IV infusion rates

Answer: R = 150 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

150/60 = 2.5 mL/min

Drip rate

R = 2.5·60 = 150 gtt/min

Answer

R = 150 gtt/min

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

6.IV infusion rates

Answer: t = 18.8 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

32·60/60 = 32 mL/h

Time left

t = 600/32 = 18.75 ≈ 18.8 h

Answer

t = 18.8 h
7.IV fluids & fluid balance

Answer: B = 330 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.

Total intake

oral: 180 + 120 = 300 mL
ice chips: 200/2 = 100 mL
IV infusion: 50·12 = 600 mL
IV antibiotic: 2·100 = 200 mL
total intake = 1200 mL

Total output

200 + 225 + 325 + 120 = 870 mL

Balance

B = 1200 − 870 = 330 mL

Answer

B = 330 mL

Positive: more fluid went in than came out.

8.IV fluids & fluid balance

Answer: t = 8.7 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

1000 − 350 = 650 mL

Time

t = 650/75 = 8.667 ≈ 8.7 h

Answer

t = 8.7 h

That is about 8 h 40 min, so the bag runs out at about 17:40.

9.Pediatric & critical-care dosing

Answer: V = 5.5 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

60·91 = 5 460 units

Volume

V = 5460/1000 = 5.46 ≈ 5.5 mL

Answer

V = 5.5 mL
10.Pediatric & critical-care dosing

Answer: R = 9 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

50 000/250 = 200 mcg/mL

Dose per hour

The order is per minute for the whole patient, so the weight is not needed.

30·60 = 1800 mcg/h

Pump rate

R = 1800/200 = 9 mL/h

Answer

R = 9 mL/h
11.Pharmacy calculations

Answer: C = 250 mg/mL

Reconstitution: the powder takes up space, so the final volume is the diluent plus the powder volume. Concentration = drug in the vial/final volume, and the volume to give = dose/concentration. On a multi-strength label, use the concentration that belongs to the amount of diluent you actually added. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Final volume

1.8 + 0.2 = 2 mL

Concentration

C = 500/2 = 250 mg/mL

Answer

C = 250 mg/mL
12.Pharmacy calculations

Answer: V = 150 mL

Alligation: to mix a higher strength H and a lower strength L into a target strength T, take (T − L) parts of H and (H − T) parts of L. The parts are crossed: each stock gets the distance from the target to the other stock. Water or a plain base counts as 0%. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Alligation parts

23%: 13 − 3 = 10 parts
3%: 23 − 13 = 10 parts
total: 20 parts

Share the volume

V = 300·10/20 = 150 mL

Answer

V = 150 mL

Check: 150 mL of 23% + 150 mL of 3% = 300 mL.

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