Dosage Calc Question - Interpreting question

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I am a 1st year ADN student.

I just took my first dosage calc test in my nursing class. You cannot miss more than 2 or you fail. You can retake once. If you miss more than 2 again, you are kicked-out of the program.

I am having difficulty interpreting whether the calculation is to be per dose or per day if the question does not specify. For example,

Ordered: Acetaminophen 320 mg po q4h for an elderly client. Pharmacy sends 80 mg/ml. The nurse will administer how many ml?____

The question includes "q4h", but does not specify either "ml per dose" or "ml per day". The answer to this question is 4 mL, which would be per dose. Then why include the "q4h"??

How would you interpret the question?

Another one I missed pertained to insulin dosage. Put my interpretation of the the timing of dosage screwed me up again. For example,

Give 10units of Insulin at am and hs. At 0730, the patient's blood sugar was 235. According to sliding scale below, How much insulin will the nurse administer?

Blood Sugar (mg/dL) Regular Insulin

0 - 150 No insulin

151 - 200 2 units

201 - 240 4 units

241- 280 6 units

281 - 330 8 units

over 330 Call MD

I calculate 10 + 4 = 14units, plus I include the "hs". I assumed there was no reading. Hummmmm, I just realized,,,,, you would have to always check blood sugar before administering meds???? Anyway, I answered with 20units for the day. If '"hs" is not included in the calculation, then why does the question have it there?

Thanks!

jkm

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I think you are waaaay over thinking these questions. Stop and think about what is being asked. The first question asks how many mL will the nurse administer? Give how many mL. Period. They set you up to do the conversion, that's all

Question 2 is simply asking how much you would give to this patient for that blood sugar at that time of day. 0730 is the am 10+ fsbs of that value = how many more units?

You're just developing your critical thinking. It's hard because you are learning new things like calculations and fitting that in to the critical thinking. We were all there. Relax, stop stressing over having to have so many right answers, and break the question down. Once you figure out what is actually asked, it's easy peasy! You can do it! Good luck!

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Jkm , you are over analyzing the questions. Yes it's true they tried to confuse you to challenge your critical thinking. Ok so the dosage 320mg q 4 hrs meaning every dose that you give has to be 320mg, only q4. Now the bottle came as 80mg/ml so if the patient ask you for pain meds how much will you give at one time? So just calculate single dose which is 4. Now if they ask you how much in 24hrs the that is different. Take your time reading the question and then ask yourself what are they asking me to do.

For the insulin this is very critical and always double check with another nurse once u start working. They are giving you the accucheck breakfast therefore you only need to calculate for that time because you never calculate for another time. It is very important to check your patients accucheck before insulin. Hope this helps.

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Specializes in Public Health.

Not exactly related but what kind of insulin is the pt getting that is given ten units BID PLUS sliding scale dosing as well. If the BID is long acting, then it's just added in to confuse ppl.

Also the q4hr and hs are in the question because you need to recognize when an order is not complete.

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Not exactly related but what kind of insulin is the pt getting that is given ten units BID PLUS sliding scale dosing as well. If the BID is long acting, then it's just added in to confuse ppl.

Also the q4hr and hs are in the question because you need to recognize when an order is not complete.

Excellent! I didn't think of it that way... I was thinking 5 rights... So in that way it would be checking right time of day to add in that scheduled dose with the sliding scale. Good thought.

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Momanurse, I'm confused with your answer. Regardless of the insulin some patients are on standing order of regular insulin plus sliding scale, with this question is about calculating the right dose. Why do you think the second question is not complete? I hope JKM won't become more confused.

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Specializes in Acute Care, Rehab, Palliative.

Part of the challenge of dosage calculation question is sorting out which info in important and which is not. They will add many details that don't matter just to test your ability to read the question and pull out what does matter.

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Specializes in Pedi.
I am a 1st year ADN student.

I just took my first dosage calc test in my nursing class. You cannot miss more than 2 or you fail. You can retake once. If you miss more than 2 again, you are kicked-out of the program.

I am having difficulty interpreting whether the calculation is to be per dose or per day if the question does not specify. For example,

Ordered: Acetaminophen 320 mg po q4h for an elderly client. Pharmacy sends 80 mg/ml. The nurse will administer how many ml?____

The question includes "q4h", but does not specify either "ml per dose" or "ml per day". The answer to this question is 4 mL, which would be per dose. Then why include the "q4h"??

How would you interpret the question?

The q 4hr is part of the order. The question is asking you how much acetaminophen to administer and the dose is 320 mg. That's all this is asking. You will never administer a day's worth of acetaminophen to a client, what you administer is what's ordered.

Another one I missed pertained to insulin dosage. Put my interpretation of the the timing of dosage screwed me up again. For example,

Give 10units of Insulin at am and hs. At 0730, the patient's blood sugar was 235. According to sliding scale below, How much insulin will the nurse administer?

Blood Sugar (mg/dL) Regular Insulin

0 - 150 No insulin

151 - 200 2 units

201 - 240 4 units

241- 280 6 units

281 - 330 8 units

over 330 Call MD

I calculate 10 + 4 = 14units, plus I include the "hs". I assumed there was no reading. Hummmmm, I just realized,,,,, you would have to always check blood sugar before administering meds???? Anyway, I answered with 20units for the day. If '"hs" is not included in the calculation, then why does the question have it there?

Thanks!

jkm

No no no. This isn't asking you how many units of insulin the client is to receive in a day. You don't administer a full day's dose to a patient unless it is a once/day medication (like lantus). The question specifically told you this was at 0730. The patient has 10 standing units at breakfast and needs an additional 4 units per sliding scale, so you will administer 14 units. If you administer 24 units, you're nearly double dosing him and will spend your whole shift trying to get his blood sugar back to normal.

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Specializes in Public Health.
Momanurse I'm confused with your answer. Regardless of the insulin some patients are on standing order of regular insulin plus sliding scale, with this question is about calculating the right dose. Why do you think the second question is not complete? I hope JKM won't become more confused.[/quote']

She was quoting something I mentioned. What I meant was that they put the whole order in the question to distract you and also because real orders have the med, dose, frequency, time,etc.

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Thanks all. Your responses definitely help me see what I am doing wrong.

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Yes I see now. I really missed the boat on this one. This was the only question of its kind on the 25 problem test. I put this scenario in the same scenario as all the others which were similar to the 1st question I asked about.

Thanks for your explanation!

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*Tip*

Just as others have stated, think of these med dosage calc questions as general math/algebra word questions. If you recall those from school you'll remember those questions most always contained extraneous information you don't need to solve the problem. The key here as then is to understand what you are being asked to solve and disregard the other "noise".

My other tip is not just to seek the correct math answer, but understand the drug you are giving and it's relation to the problem/dosage. Once you *know* about this or that drug (normal dosage range, etc...) then it helps you think through your answers in terms of understanding what you are doing. That is if you know the standard dosage is .05 mg/ml and you come up with .5 or even 5, then something is wrong.

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