Math Calculations for last semester of Nursing Program

0 Hello to all. My instructor sent out 2 pgs of practice problems and I am having a hard time figuring out the flow rates. I feel as if key items are missing (i.e. gtt/min or ml/hr and time to be infused)
If someone could help anyone please do!!!! I am going crazy because we have the exam on thursday and she sent it with no answer key.
I answered the first 2 of each section then stopped because honestly it does not make sense for me to answer them the way it is presented
Drug Calculation Practice Questions
Compute the flow rate for each of these medications administered by infusion pump.
 The patient has an order to receive Lidocaine (xylocaine) for PVC's. The pharmacy has sent you Lidocaine 2 grams IV in 1000 ml D5W at 4mg/min. What is the pump setting to deliver the desired dosage?
 A patient weighing 154 pounds is ordered to have Dopamine at 15 mcg/kg/min. The pharmacy has sent you Dopamine 800 mg in 500 ml NS. What is the rate of infusion?
 Your patient is ordered to have Tridil (nitroglycerine) for chest pain. The patient is to have 5 mcg/min. The pharmacy has sent 50mg in 500 ml of D5W. What is the rate of infusion?
 Your patient admitted with an exacerbation of asthma has an Aminophylline (theophylline) drip running at 6 ml/hr. The bag that is up is 500ml D5W with 2 grams of aminophylline. How much is the patient receiving?
 Your 220 pound patient has a dopamine drip running at 25 ml /hour. The bag that is hanging is 500 ml D5W with 900mg of dopamine. How much is the patient receiving?
Your patient is to start a dopamine drip due to severe hyptotension. The pharmacy has sent you a 250ml bag of NS with 400mg dopamine. What is the rate of infusion if the physician has ordered the following: 8mcg/kg for your client that weighs 186 pounds?
0.4227/hr???
How much would the patient be receiving if his pump was running at 11ml/hr?
I got 17.6/hr???
You have a client that is in atrial fibrillation. The doctor has ordered procainamide (Procaine, Pronestyl) IV. The order reads to give the patient 2 mg/min. The pharmacy has sent you a 500ml bag of D5W with 3gm of procainamide. What is the rate of infusion?
Hint: Milligrams/minute
6.6mg/hr???
If this patient's IV was running at 22ml/hr, how much medicine is he receiving?
No more hints...you can do it. To use the calculation sheet do the following. Look at the way the medications is ordered (mcg/kg/min; mcg/min; ml/hr) Look at how much medication you are adding to the bag (is it ordered in mg or grams). Fill in the blanks based on your orders.
Your patient has an Aminophylline drip of 500mg aminophylline in 250ml NS. How much if the patient receiving if his pump is running at 12ml/hr?
Your patient is complaining of chest pain. The doctor has ordered Tridil (NTG) at 5mcg/min. You have a 500ml bottle of D5W with 50mg of Tridil added. What is the rate of infusion? 
0Jan 8, '12 by jmdRNThe patient has an order to receive Lidocaine (xylocaine) for PVC's. The pharmacy has sent you Lidocaine 2 grams IV in 1000 ml D5W at 4mg/min. What is the pump setting to deliver the desired dosage?

0Jan 8, '12 by WantingtheBestSo 2mg/ml.
1000/2=500
2ml/min
2x60min= 120ml/hr
So the answers is 120ml/hr?? 
2Jan 8, '12 by NCRNMDMI am only going to answer (or attempt to answer) some of these. If my answers are wrong, I hope that someone will correct me.
Okay, let's start with the first one. Here's how I understand it: 2 grams of Lidocaine in 1000 ml of fluid. 2 grams is 2000 mg, and you have it in 1000 ml of IV fluid. 2000 mg/1000 ml= 2 mg/1 ml. Since the patient needs 4 mg/min, you would set the pump to deliver 2 ml/minute because 2 times 2 equals four.
To do micrograms, you need two formulas. The first is micrograms x kilograms/1000 x 60. Let's take the second problem, for example, and apply the formula to it. A patient weighing 154 pounds is ordered to have Dopamine at 15 mcg/kg/min. The pharmacy has sent you Dopamine 800 mg in 500 ml NS. What is the rate of infusion?
Let's get the kilogram weight first. Divide 154 by 2.2 and you get 70 kilograms. Now, let's multiply 15 micrograms by the 70 kilograms. When we do that, we get 1050. Now, let's divide that by 1000. When we do that, we get 1.05. Now, let's multiply that by 60. When we do that, we get 63. 63 is the dose in milligrams per hour that we want to give the patient. Now we must use a second formula in order to figure out milliliters per hour. To figure this out, we will use the formula: desired/what you have on hand x the volume. In this situation, we would say 63/800 x 500. This gives us an answer of 39.375, or 39.4 ml/hr. This dose will deliver the proper dose of medication to the patient.
Let's move on to the micrograms per minute Nitroglycerine problem. This is another two step problem. First, we are going to convert mcg/min to mg/hr. To do this, we are going to take the 5 micrograms, divide by 1000, and multiply by 60. 5 mcg/1000 x 60= 0.3 mg/hr. Next we are going to use the desired/have x volume equation again. This time we are going to say 0.3/50 x 500. This gives us an answer of 3 ml per hour.
I hope that these are correct, and I hope that someone will set me straight if they aren't. I also hope that this helps you out a little bit. nursing calculators
Try that link, it has a ton of calculators on it, and it describes how to go about the calculations directly underneath the calculator. Good luck! 
0Jan 8, '12 by momtojoshquestion......do nurses have to figure this out for real?....
nurses that i talk to say it comes all set...the dosage....all you have to do is plug in the numbers in the machine?..is this true?
i am so very afraid of this math....i passed it in LPN school.....i dont even come close to doing this....or knowing how...and i am trying to get into a RN program.....maybe i should rethink? as this scares the poop out of me......i am haivng some sort of panic attack now just thinking about it.....
please let me know... 
0Jan 8, '12 by NCRNMDMIn most hospitals, the IV pumps are very sophisticated, and you can just input your information into the machine. However, when you are an ICU RN and your patient is receiving three pressors, two sedatives, a paralytic, an insulin drip, an antibiotic, lidocaine, potassium, and IV fluids are you going to be content to simply trust everything the machine says? When your patient is on the verge of death, and in such critical condition that you are afraid to turn them, are you going to be satisfied that the numbers the IV pump produced are totally accurate? I know I'm not, and I want to work the math out before I input my information into the IV pump as a double check. In some facilities, like smaller community hospitals, the technology isn't as advanced, and, yes, nurses do this type of math everyday.
However, don't let it scare you away from nursing school. You are there to learn, and you will be taught all about this kind of math. 
2Jan 8, '12 by Esme12, ASN, BSN, RN Senior ModeratorQuote from momtojoshyou may find these site very helpful. they are simple effective tools to iv/med calculations. don't be afraid you will learn.question......do nurses have to figure this out for real?....
nurses that i talk to say it comes all set...the dosage....all you have to do is plug in the numbers in the machine?..is this true?
i am so very afraid of this math....i passed it in lpn school.....i don't even come close to doing this....or knowing how...and i am trying to get into a rn program.....maybe i should rethink? as this scares the poop out of me......i am having some sort of panic attack now just thinking about it.....
please let me know...
dosagehelp.com  helping nursing students learn dosage calculations
http://www.davesems.com/files/drug_d...lculations.pdf
but....yes you do. you are responsible for all the meds you give.
you are the final safety check before the meds are administered to the patient. you should always double check the administration rates when using dose mode pumps for safety's sake......maybe you input the wrong concentration when programming the pump and need to correct it before hitting start. nurses who truly believe that all you need to do is plug in the information and everything's good are deluding themselves that they are practicing safe. machines have made mistakes with fatal outcomes.
http://allnurses.com/nursingnews/ba...ts584283.html
http://allnurses.com/nursingnews/nu...ws556477.html
case in point. supervising in a small community hospital i went to start an iv on a seven year old girl that was receiving a antibiotic that can be toxic to the liver. i saw the iv bag and noticed the bag was 10 times the amount that a child of 70 lbs should receive. when i left the room the nurse caring for her came up to me and asked if i had started the antibiotic and i said no.....she was relieved because she was checking the dose and realized it was too much for a child. this dosage had been given every eight hours for 3 days because it was checked by pharmacy, in the pyxis, and matched the order.
when i called the pharmacy at home he remembered the name and was shocked it was a child of 70 pounds not an adult of 70 kilos. the information was correct in the computer and clearly stated 70 pounds. had that nurse not checked that massive dosage would have continued for who knows how long. the md was po'd because he had spoken to the pharmacy himself and wrote for the dosage he was told to give. the liver enzymes were only slightly elevated and disaster was averted.
always check your math.GrnTea and JustBeachyNurse like this. 
0Jan 9, '12 by KelRN215, BSN, RNQuote from momtojoshYES, nurses do have to figure this out for real. Our pumps are quite sophisticated and for drips (for example a heparin drip), it will ask for the concentration of heparin, the patient's weight in kilograms and the intended rate in units/kg/hr and convert that to mL/hr. HOWEVER, it is still ultimately your responsibility to ensure that the right dose is delivered to the patient. So yes, you should calculate the math beforehand to ensure that the rate the pump is delivering is correct.question......do nurses have to figure this out for real?....
nurses that i talk to say it comes all set...the dosage....all you have to do is plug in the numbers in the machine?..is this true?
i am so very afraid of this math....i passed it in LPN school.....i dont even come close to doing this....or knowing how...and i am trying to get into a RN program.....maybe i should rethink? as this scares the poop out of me......i am haivng some sort of panic attack now just thinking about it.....
please let me know... 
0Jan 10, '12 by SCSTxRN, ADN, BSN, MSNI was taught  and I teach  to do this by "dimensional analysis"
Assuming you know that 1kg = 2.2 lbs, 60 minutes = 1 hour, and 1000mcg = 1mg and 1g = 1000 mg
To use 'dimensional analysis' you have to have everything equal to something else in the problem, so for #1, the order is 4mg / minute and the concentration is 2 grams in 1000mL
1. 4mg 1g 1000mL 60 min
min 1000 mg 2g 1 hour
2.
154lbs 1kg 15mcg 1mg 500mL =
pt. 2.2 lbs kg min 1000mcg 800 mg
gives answer in ml/ hour (which is a pump rate)
lbs on top cancels lbs on bottom, etc  all thats left is ml/hour, multiply across the top and bottom, divide,
3.
5mcg 1mg 500mL 60 minutes
minute 1000mcg 50 mg 1 hour
again leaves answers in mL/ hour
4.
6mL 2g 1000 mg
hour 500 mL 1g
This will give you mg/hour if you want mg/min, multiply by 1 hour
60 min
5. Weight is thrown in there to make you NUTS  it doesn't matter in this problem.
25mL 900 mg
hour 500 ML
again, this gives you mg / hour  if you want it per minute, see above.
6. Your patient is to start a dopamine drip due to severe hyptotension. The pharmacy has sent you a 250ml bag of NS with 400mg dopamine. What is the rate of infusion if the physician has ordered the following: 8mcg/kg for your client that weighs 186 pounds?
186 lbs 1kg 8mcg 1mg 250mL
patient 2.2lb kg (per hour?) 1000mcg 400mg
=0.42 mL/(hour?)
7. How much would the patient be receiving if his pump was running at 11ml/hr?
I got 17.6/hr???
11mL 400mg
hour 250 mL = 17.6 mg/hour if you want to take that all the way to weight dosage, though
11mL 400mg 1000mcg patient 2.2lb
hour 250 mL 1 mg 186lbs 1kg
then the patient is receiving 208 mcg/kg, so it kind of depends on exactly what the teacher is asking.
My head hurts, and all this formatting is making it worse. If you would like me to check your answers, send me a message so I get an email. It seems like you're on the right track, though.
And YES  nurses really do have to do this kind of math. You do get to use a calculator, usually, but the set up is all you. 
1Jan 10, '12 by LadyinScrubsQuote from momtojoshMomtoJosh  I had the same attitude as you until I got a rude awakeningwe ran out of pumps. I had to do the IV calculation the old fashioned way and apply it to a drip. That was a teaching moment.question......do nurses have to figure this out for real?....
nurses that i talk to say it comes all set...the dosage....all you have to do is plug in the numbers in the machine?..is this true?
i am so very afraid of this math....i passed it in LPN school.....i dont even come close to doing this....or knowing how...and i am trying to get into a RN program.....maybe i should rethink? as this scares the poop out of me......i am haivng some sort of panic attack now just thinking about it.....
please let me know...
Don't count on technology doing your job. What happens if there is a problem. What did those nurses who stayed on the job during Katrina do? They had no power, but they had patients, and the patients needed meds. You need to learn the basics. You never know when you will need them.
As far as the math that we do, it is simple math. I would say what we are doing is probably elementary or middle school mathratios/porportions; adding, subtracting, and multiplying; and solving for a missing number. Math is a tool just like every thing else we learn in nursing school.
If math frightens you, it is because you do not understand math's rules and have not done enough problems. There are only so many ways questions can be asked. Once you undersand this and understand how to solve these questions, you won't be afraid. I was in your shoes and was an adult before I took my first algebra class. Now I love the challenge math presents.Last edit by LadyinScrubs on Jan 10, '12GrnTea likes this. 
1Jan 10, '12 by GrnTea, BSN, MSN, RNthis isn't math, it's basic algebra, multiplication, and division. you learned how to solve for x in sophomore (high school) algebra. this is why high school math is a prerequisite to nursing school....and it's also illustrative of why you should remember stuff you learned in your firstyear pharmacy calculations class. because, well, you need it to be a nurse.KelRN215 likes this.

0Jan 11, '12 by LadyinScrubsGreenTea, solme time ago, the kiddles started to learn "new math". They were being introduced to algebra, although it called "new math" in elementary school. Those of us who are "seasoned" had to be introduced to the concepts of algebra in jr. high school (now known as middle school). By the time the kids of today are in middle school, they are doing simple algebra. This is why so many parents started having difficulty when "new math" was introduced many years ago...and I was one of those parents.