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
12345678910111208:00?8:00 AM7:00 AM10:00 AM8:00 PM

Practice exercise (made-up values, not clinical guidance). A dose is charted at 08:00 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.

08:00
  1. 18:00 AM
  2. 27:00 AM
  3. 310:00 AM
  4. 48:00 PM
2.Nursing math & unit conversionsHard
00:0019:2007:50t = ?

Practice exercise (made-up values, not clinical guidance). An infusion starts at 19:20 and finishes at 07:50 the next morning (24-hour clock). How many minutes t did it run?

19:2007:50
t = min
3.Dosage calculationsMedium
0.5%20 mLm = ? mg

How many milligrams of drug m are in 20 mL of a 0.5% (w/v) solution?

0.5% w/v20 mL
m = mg
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 3200 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

3200 units5000 units/mL
V = mL
5.IV infusion ratesMedium
500 mL60 gtt/mL8 h? gtt/min

Infuse 500 mL over 8 hours with a giving set of 60 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

500 mL8 h60 gtt/mL
R = gtt/min
6.IV infusion ratesHard
350 mLleft? mL/h2 h left

1000 mL was ordered over 6 hours. After 4 hours you find that 350 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?

1000 mL / 6 hafter 4 h: 350 mL
Δ = %
7.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftjuice150 mLsoup250 mLice chips120 mLIV infusion100 mL/h × 12 hIV antibiotic2 × 50 mLurine475 mLurine150 mLurine150 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 95 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

95 kg12 hurine: 475 mLurine: 150 mLurine: 150 mL
U = mL/kg/h
8.IV fluids & fluid balanceHard
1000 mL250 mL infused150 mL/h13:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 150 mL/h. At 13:00, 250 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

1000 mL250 mL infused150 mL/h
t = h
9.Pediatric & critical-care dosingMedium
12 500 units250 mLheparin? mL/h75 kg16 units/kg/h

Practice exercise (made-up values, not clinical guidance). A bag contains 12 500 units of heparin in 250 mL. The order is 16 units/kg/h for a patient who weighs 75 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

12 500 units/250 mL16 units/kg/h75 kg
R = mL/h
10.Pediatric & critical-care dosingHard
400 mg250 mLdopamine? mL/h73 kg2 mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A bag contains dopamine 400 mg in 250 mL. The order is 2 mcg/kg/min for a patient who weighs 73 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

400 mg/250 mL2 mcg/kg/min73 kg
R = mL/h
11.Pharmacy calculationsMedium
00.10.20.30.40.50.60.70.80.911 mL

A solution has a ratio strength of 1:1000. You need 0.81 mg. Draw up the volume in the 1 mL syringe: what volume V is that?

1:10000.81 mg
V = mL
12.Pharmacy calculationsHard
10%60 g+2%salicylic acid? g5%salicylic acid

Practice exercise (made-up values, not clinical guidance). You have 60 g of 10% salicylic acid ointment. How many grams m of 2% salicylic acid ointment must you add to make a 5% ointment? Round to the nearest whole gram.

60 g · 10%2%5%
m = g

3Solutions

1.Nursing math & unit conversions

Answer: 8:00 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

08 → 8 AM

Answer

8:00 AM

Answer

8:00 AM
2.Nursing math & unit conversions

Answer: t = 750 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

19:20 → 24:00 = 280 min

After midnight

00:00 → 07:50 = 470 min

Total

t = 280 + 470 = 750 min

Answer

t = 750 min
3.Dosage calculations

Answer: m = 100 mg

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% = 0.5 g/100 mL = 5 mg/mL

Mass of drug

m = 5·20 = 100 mg

Answer

m = 100 mg
4.Dosage calculations

Answer: V = 0.64 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.

Volume

V = 3200/5000 = 0.64 mL

On the syringe

On this 1 mL syringe every small line is 0.01 mL.

Answer

V = 0.64 mL
5.IV infusion rates

Answer: R = 63 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

8·60 = 480 min

Drip rate

R = 500·60/480 = 62.5 ≈ 63 gtt/min

Answer

R = 63 gtt/min

At the bedside you round to the nearest whole drop: 63 gtt/min.

6.IV infusion rates

Answer: Δ = 5 %

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

1000/6 = 166.7 mL/h

New rate

R = 350/2 = 175 mL/h

Percentage change

Δ = (175 − 166.7)/166.7·100% = 5%

Answer

Δ = 5%

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

7.IV fluids & fluid balance

Answer: U = 0.68 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

475 + 150 + 150 = 775 mL

Per kilogram per hour

U = 775/(95·12) = 0.6798 ≈ 0.68 mL/kg/h

Answer

U = 0.68 mL/kg/h
8.IV fluids & fluid balance

Answer: t = 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

1000 − 250 = 750 mL

Time

t = 750/150 = 5 h

Answer

t = 5 h

That is about 5 h 00 min, so the bag runs out at about 18:00.

9.Pediatric & critical-care dosing

Answer: R = 24 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.

Units per hour

16·75 = 1 200 units/h

Concentration

12 500/250 = 50 units/mL

Pump rate

R = 1200/50 = 24 mL/h

Answer

R = 24 mL/h
10.Pediatric & critical-care dosing

Answer: R = 5.5 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

400 mg = 400 000 mcg
400 000/250 = 1600 mcg/mL

Dose per minute and per hour

2·73 = 146 mcg/min
146·60 = 8760 mcg/h

Pump rate

R = 8760/1600 = 5.475 ≈ 5.5 mL/h

Answer

R = 5.5 mL/h
11.Pharmacy calculations

Answer: V = 0.81 mL

Strength to volume: turn the strength into mg per mL first. A w/v percentage is grams per 100 mL, so x% = 10x mg/mL. A ratio strength 1:n is 1 g in n mL. After reconstitution the concentration is the powder's dose over the final volume (diluent + powder volume). Then volume = dose/concentration.

Strength in mg/mL

1000 mg/1000 mL = 1 mg/mL

Volume

V = 0.81/1 = 0.81 mL

Answer

V = 0.81 mL
12.Pharmacy calculations

Answer: m = 100 g

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

10%: 5 − 2 = 3 parts
2%: 10 − 5 = 5 parts

Scale to the amount you have

m = 60·5/3 = 100 g

Answer

m = 100 g

Check: 60 g + 100 g = 160 g of 5% ointment.

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