Gray Morris's Calculate with Confidence (Canadian Edition),

2nd Edition

Visit the link below to download the full version of this book:

https://medipdf.com/product/gray-morriss-calculate-with-confidence-canadian-edit
ion-2nd-edition/

Click Download Now

GRAY MORRIS’S CALCULATE WITH CONFIDENCE, SECOND EDITION ISBN: 978-0-323-69571-8
Copyright © 2022 Elsevier, Inc. All rights reserved.

Adapted from Calculate With Confidence, Seventh Edition, by Deborah Gray Morris. Copyright © 2018 by
Elsevier Inc. 978-0-323-39683-7 (softcover)

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopy, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Reproducing passages from this book without such written
permission is an infringement of copyright law.

Requests for permission to make copies of any part of the work should be mailed to: College Licensing
Officer, access ©, 1 Yonge Street, Suite 1900, Toronto, ON M5E 1E5. Fax: (416) 868-1621. All other inquiries
should be directed to the publisher www.elsevier.com/permissions.

Every reasonable effort has been made to acquire permission for copyrighted material used in this text
and to acknowledge all such indebtedness accurately. Any errors and omissions called to the publisher’s
attention will be corrected in future printings.

This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Notice

Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds or experiments described herein. Because of
rapid advances in the medical sciences, in particular, independent verification of diagnoses and
drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by
Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a
matter of products liability, negligence or otherwise, or from any use or operation of any methods,
products, instructions, or ideas contained in the material herein.

Library of Congress Control Number: 2020943609

VP Education Content: Kevonne Holloway

Content Strategist (Acquisitions, Canada): Roberta A. Spinosa-Millman
Director, Content Development: Laurie Gower
Content Development Specialist : Theresa Fitzgerald
Publishing Services Manager: Julie Eddy
Senior Project Manager: Rachel E. McMullen
Design Direction: Patrick Ferguson

Last digit is the print number: 9 8 7 6 5 4 3 2 1

To my students, past, present and future—
I wish you well in your nursing careers.
—Tania Killian
About the Authors

Tania Killian
Tania Killian, BScN, BEd, MEd, CCN, CHSE, began her nursing career at Lakehead Uni-
versity in Thunder Bay, Ontario. Graduating in 1998, she continued her educational pur-
suits at Lakehead University, subsequently completing a Bachelor and then a Masters of
Education. Tania supplemented her studies with practical field experience, spending her
summers working Search and Rescue for the Canadian Coast Guard. It was the combina-
tion of academics and experiential learning that served to solidify her love for prehospital
and emergency care. Tania parlayed this passion into a profession providing essential
service as an emergency/trauma nurse throughout the evolution of her career. The student
turned teacher in 2002 when Tania became a full-time professor at Seneca College. Now,
almost 20 years later, Tania continues to be a valued and respected faculty member of
Seneca’s School of Health Sciences. Her college portfolio includes a variety of course cur-
riculum development and delivery. In addition to her classroom leadership, Tania also
manages simulation and virtual reality programs for numerous faculties within Seneca
College. Within her roles, she has secured several funding initiatives and established and
continues to maintain partnerships within the international community to grow numerous
projects that enhance student learning.
An advocate of innovation, Tania has advanced cross-disciplinary experiential learning
in the various responsibilities she holds at the college. She has served as a Seneca Ambas-
sador internationally and has hosted international delegations at the college to share best
practices in nursing studies. Combining her medical training with her love of sports, Tania
has added new capacities and ‘personal bests’ to her career. She is proud to have served
professionally at several Olympic, Paralympic, Pan Am, and national games. Closer to
home, Tania is a member of several Team Ontario sport teams where she has the privilege
of working with sector allies to provide high-quality health care to elite athletes.
Tania’s other love is animals, and she is often seen with her loyal dog, Lucy, by her side.

Deborah C. Gray Morris

Deborah C. Gray Morris, RN, BSN, MA, LNC, began her nursing education at Bronx
Community College, graduating in 1971. In 1973, Deborah earned a bachelor of science
in nursing (BSN) from the City College of the City University of New York, followed by a
master (MA) in nursing from New York University in 1978. In 1998, Deborah pursued her
interest in the legal aspects of nursing and graduated with certification as a legal nurse
consultant from Long Island University’s Legal Nurse Consultant Program in 1999. Deborah
has also earned 12 credits from John Jay College of the City University of New York, includ-
ing credits in criminal justice and forensic science.
Deborah is currently a full professor and the chairperson of the Department of Nursing
and Allied Health Sciences at Bronx Community College, where she teaches dosage cal-
culations in the Registered Nursing and Licensed Practical Nursing Programs. Deborah
has held the position of chairperson since 2010; first as acting, then elected to the position
in 2011. Prior to becoming chairperson, Deborah served as deputy chairperson for
13 years and as course coordinator for Pharmacology Computations. Her second term as

iv
 About the Authors v

chairperson began in July 2015. Deborah is also a program evaluator for the Accreditation
Commission for Education in Nursing (ACEN). Upon request, Deborah provides consult-
ant services to nursing programs in the area of dosage calculation.
Deborah’s interest in dosage calculation started with her career at Bronx Community
College of the City University of New York in 1978. Her original position at the college
was in the capacity of providing nursing students with tutoring in the area of dosage cal-
culation, which had been identified as an area of difficulty for students. She began with the
development of a manual to assist students with the subject matter and later developed a
course titled Pharmacology Computations, which was approved through the college gov-
ernance bodies and is currently a required course for students in the Associate Degree
Nursing Program. Deborah’s very first edition of Calculate with Confidence was published
in 1994. Calculate with Confidence is currently in its 7th U.S. edition and ranks among the
top books published by Elsevier in this area.
Deborah is married.
Reviewers
Jennifer Black, RN, BScN, MN Pammla Petrucka, RN, PhD
Professor & Coordinator Professor
Practical Nursing Program College of Nursing
Fanshawe College—Woodstock/Oxford Regional Campus University of Saskatchewan
Woodstock, Ontario Saskatoon, Saskatchewan
Julie Duff Cloutier, RN, BScN, MSc, PhD(c) Crystal Schauerte, BscN, MscN
Assistant Professor Nursing Professor
School of Nursing Department of Nursing
Laurentian University Algonquin College
Sudbury, Ontario Ottawa, Ontario
Michelle Earl, BSN, PID Ruth Swart, EdD, MHS, RN, BN, BSc
Team Leader and Placement Coordinator Senior Instructor
Practical Nursing Faculty of Nursing
Sprott Shaw College—Kelowna Campus; University of Calgary
Clinical Nursing Instructor Calgary, Alberta
University of British Columbia—Okanagan Campus
Kelowna, British Columbia Selena Talbot, RN, MAEd
Instructor III
Andrea Gretchev, RN, BScN, MN, CCNE
Faculty of Nursing
BSN Curriculum Coordinator
University of Regina
Douglas College, Health Sciences
Regina, Saskatchewan
Coquitlam, British Columbia
(Amy) Phuong Thi Dieu Hoang, BSc Andrea Tannahill, RN, MSN
Mathematics, BEd Nursing Instructor
Professor School of Health Sciences
Department of Mathematics University of Alberta BScN Collaborative Program at Red
Niagara College Deer College
Welland, Ontario Red Deer, Alberta
Kelly Kidd, RN, BScN, MN Barbara Thompson, RN, BScN, MScN
Professor Nursing Studies Professor of Nursing, Coordinator Practical Nursing
Coordinator Year 1 Practical Nursing Program Program
Coordinator Clinical Education Health Programs
Health and Community Studies Sault College
Algonquin College Sault Ste. Marie, Ontario
Pembroke, Ontario Lorna Walsh, BN, MEd, RN
Allison McFadden-Squire, BScN, RN, MEd(c) Nurse Educator/Year 1 and 2 Coordinator
Curriculum Lead Centre for Nursing Studies
Practical Nurse Program Memorial University of Newfoundland
NorQuest College St. John’s, Newfoundland
Edmonton, Alberta
With special thanks to
Dennise Morgan, RN, BScN, MN, CON(c) Terri Burrell RN, BScN, MSN
Clinical Supervisor Faculty
Seneca-York Collaborative BScN Program Saskatchewan Collaborative Bachelor of Science in
Practical Nursing Program Nursing (SCBScN)
Seneca College of Applied Arts and Technology Saskatchewan Polytechnic—Regina Campus
Department of Health Sciences Regina, Saskatchewan
Toronto, Ontario
vi
 Preface to the Instructor
The culture of safety continues to be a priority in the delivery of health care. To advance
patient safety and its importance in health care delivery worldwide, several organizations
continue to promote patient safety, which includes an emphasis on improving safety in
medication administration. Canadian organizations include Health Canada, the Canadian
Institute for Health Information (CIHI), the Institute for Safe Medication Practices Canada
(ISMP Canada), and the Canadian Patient Safety Institute (CPSI). These organizations also
collaborate on the Canadian Medication Incident Reporting and Prevention System
(CMIRPS). This pan-Canadian program encourages reporting, sharing, and learning about
medication incidents in order to help reduce their reoccurrence and create a safer health
care system.
The second Canadian edition of Gray Morris’s Calculate with Confidence continues to
emphasize safety in medication administration and is written to meet the needs of current
and future practitioners of health care at any level. This book can be used as a resource for
any education program or practice setting that involves dosage calculation and medication
administration by health care providers.
Gray Morris’s Calculate with Confidence, Second Canadian Edition, primarily uses the
metric system in calculating dosages, but it presents examples that incorporate imperial
system (household, apothecary) measurements where applicable. Specifically, you will see
the conversion of pounds to kilograms in some examples because weight is still sometimes
measured in pounds in the community at large. Therefore it is prudent to include imperial
units of measurement in this book.
The second Canadian edition of Gray Morris’s Calculate with Confidence illustrates the
standard methods of dosage calculation: the ratio and proportion method, the formula
method, and the dimensional analysis method. With the inclusion of all three, instructors
have the freedom to decide which method(s) best suit their program, and students have
the same freedom to choose the method that facilitates correct dosage calculations.
This second Canadian edition responds to evidence-informed practices as they relate to
safe medication practices at all levels. Highlights include best practices for the labelling,
dispensing, preparing, and administering of medications. With the nursing student in
mind, emphasis is placed on critical thinking and clinical reasoning in the prevention of
medication errors. Principles of competence and safety are integrated throughout.
Answers to the Practice Problems include rationales to enhance the understanding of
principles. In response to the increased need for competency in basic math as an essential
prerequisite for dosage calculation, many Practice Problems are included in the basic math
section.
The once controversial use of calculators is now a more accepted practise, and they are used
in many nursing exams, including when writing licensure exams such as the NCLEX. Critical
care areas in some health care institutions have policies that require the use of calculators to
verify calculations to avoid medication errors. A basic calculator is usually sufficient for dosage
calculations. Calculator use is not encouraged in the basic math section of this book due to the
expectation that students should be able to perform calculations proficiently and independently
without their use.
Despite decreased errors in calculating medication dosages due to the availability of
better technology, health care providers must continue to use sound clinical reasoning in
problem solving to minimize the risk to patient safety.

vii
viii Preface to the Instructor

The second Canadian edition of Gray Morris’s Calculate with Confidence embodies all
the standards of nursing practice. It clearly delineates the nurse’s responsibility in medica-
tion practices, including accurate dosage calculation to optimize safe patient outcomes.

Organization of Content
The second Canadian edition is organized in a progression from simple topics to more
complex ones, making content relevant to the needs of students and using realistic Practice
Problems and Clinical Reasoning Questions to enhance learning and make material clini-
cally applicable.
The 23 chapters are arranged into 5 units.
Unit One includes Chapters 1 through 4. This unit provides a review of basic math skills,
including fractions, decimals, ratio and proportion, and percentages. A pre-test and post-
test are included. This unit allows students to determine their weaknesses and strengths in
math and provides a review. Academic institutions using this book may use these units as
independent study for students to review basic math concepts before venturing on to actual
dosage calculations.
Unit Two includes Chapters 5 through 7. Chapter 5 introduces students to the metric
and imperial (household, apothecary) systems of measurement. Canada’s health care pro-
viders use the metric system. However, some units of household measurement are dis-
cussed because of their continued use, albeit limited. These measurements are pound,
ounce, teaspoon, tablespoon, and cup. In Chapter 6, students learn to convert measure-
ments. Chapter 7 presents conversions relating to temperature, length, weight, and inter-
national time.
Unit Three includes Chapters 8 through 14. This unit provides essential information
that is needed as a foundation for dosage calculation and safe medication administration.
Chapter 8 includes an expanded discussion of medication errors, routes of medication
administration, equipment used in medication administration, the rights of medication
administration, and the nursing role in preventing medication errors. Chapter 9 presents
the abbreviations used in medication administration and discusses how to interpret medi-
cation orders. Chapter 10 introduces students to medication administration records and
the various medication distribution systems. Chapter 11 provides students with the skills
necessary to read medication labels to calculate dosages. Chapters 12 through 14 introduce
students to the various methods used for dosage calculation followed by Practice Problems
illustrating each method.
Unit Four includes Chapters 15 through 18. In Chapter 15, students learn the principles
and calculations related to oral medications (solid and liquids). In Chapter 16, students
learn about the various types of syringes and skills needed for calculating injectable medi-
cations. Chapter 17 introduces students to the calculations associated with reconstituting
solutions for injectable and noninjectable medications. Calculations associated with the
preparation of noninjectable solutions such as nutritional feedings include determining the
strength of a solution and determining the amount of the desired solution. Chapter 18
introduces students to insulin types, insulin equipment, and Canadian Diabetes Associa-
tion 2018 Clinical Practice Guidelines for the prevention and management of diabetes in
Canada.
Unit Five includes Chapters 19 through 23. Chapters 19 and 20 provide students with
a discussion of intravenous (IV) fluids and associated calculations related to IV therapy.
The recalculation of IV flow rate includes an alternative method to determining the per-
centage of variation. IV labels have been added throughout the chapter, with a discussion
of additives to IV solutions. Chapter 21 focuses on heparin and uses the new heparin
labelling. Sample heparin weight-based protocols are used to adjust IV heparin based on
activated partial thromboplastin time (aPTT). Chapter 22 discusses the principles of cal-
culating pediatric and adult dosages, with emphasis on calculating dosages based on body
weight and body surface area as well as verifying the safety of dosages. Chapter 23 provides
students with the skills necessary to calculate critical care IV medications. Determining
the titration of IV flow rates for titrated medications includes developing a titration table.
 Preface to the Instructor ix

Safety Alerts, Practice Problems, Clinical Reasoning scenarios, and Points to Remember
are included throughout the book. A Comprehensive Post-Test is included at the end of
the book and covers all 23 chapters.

Features of the Second Canadian Edition

• Objectives at the beginning of each chapter to emphasize content to be mastered.
• Canadian medication labels.
• Integration of ISMP Canada recommendations in the book to alert students to the
importance of patient safety and reducing medication errors.
• Content related to preventing medication errors, such as the use of Tall Man Lettering,
verification of the rights of medication administration, and an examination of the
nursing role in preventing medication errors.
• Discussions on preventing medication errors in chapters dealing with high-alert medi-
cations (heparin and insulin).
• An up-to-date insulin chapter that reflects the Canadian Diabetes Association 2018
Clinical Practice Guidelines on insulin therapy, which features basal + bolus + correction
insulin dosing as well as IV insulin therapy.
• An IV chapter, including IV labels and a discussion of IV additives. Recalculation of IV
therapy includes an alternative approach to determining the variation of change using
percentages.
• Safety Alert boxes that direct students to common errors and how to avoid them.
• Clinical Reasoning questions in Chapters 15 to 22 to allow students to critically think
through more complex questions.
• Inclusion of heparin weight-based protocol and problems on adjusting the flow rate
based on PTT.
• Critical care discussion on IV flow rates for titrated medications, including how to
develop a titration table.
• Calculation of fluid resuscitation for patients with burns as well as daily pediatric fluid
maintenance.
• Practice Problems and Chapter Review problems in each chapter.
• An Answer Key at the end of each chapter to provide immediate feedback on solutions
to problems.
• NEW! A-Z medication index referencing page numbers where the drug labels can be found.

Ancillaries
Evolve Resources for Gray Morris’s Calculate with Confidence, Second Canadian Edition,
are available to enhance student instruction. This online resource can be found at http://
evolve.elsevier.com/Canada/GrayMorris/. It corresponds with the chapters of the main
book and includes the following:
• TEACH for Nurses
• Test Bank
• PowerPoint Slides
• Image Collection of Drug Labels
• Answer Key from Textbook
• Student Review Questions
• NEW! Tips for Clinical Practice easy reference
• NEW! Next Generation NCLEX Case Studies (both generic and book-specific)
• NEW! Elsevier’s Interactive Drug Calculation Application, version 1: This interactive
drug calculation application provides hands-on, interactive practice for the user to
master drug calculations. Users can select the mode (Study, Exam, or Comprehensive
Exam) and then the category for study and exam modes. There are eight categories that
cover the main drug calculation topics. Users are also able to select the number of
problems they want to complete and their preferred drug calculation method. A calcula-
tor is available for easy access within any mode, and the application also provides history
of the work done by the user. There are 750 practice problems in this application.
x Preface to the Instructor

We hope that this book provides clear concept review, practice questions, detailed
explanations and clinical reasoning questions to help you master the dosage calculations
you need to correctly administer medications safely.
This book is not only for the beginner health care provider but is meant to also benefit
the experienced health care provider as a useful reference.
Tania Killian
 Acknowledgements
First and foremost, I must thank Theresa Fitzgerald for guiding me throughout this process.
Without her patience and continued encouragement, I would not have completed this
book.
Thank you to Roberta A. Spinosa-Millman and Rachel McMullen of Elsevier for giving
me the opportunity to write this book and their support throughout the process.
I wish to acknowledge the valuable contributions of my reviewers. Thank you for your
notes regarding the improvement of quality, coherence, and presentation of the content of
the book. I am grateful for the combined insight they provided. I would also like to thank
Marcia Brown for her work on the first edition.
And most importantly, to my family, friends, colleagues, and the “Coffee Club” who
inspired me to take a chance at writing.
—Tania Killian

xi
Contents

UNIT ONE Math Review 1

PRE-TEST 2
1 Fractions, 6
Types of Fractions, 7
Converting Fractions, 8
Comparing Fractions, 8
Reducing Fractions, 10
Adding Fractions, 11
Subtracting Fractions, 12
Multiplying Fractions, 14
Dividing Fractions, 15

2 Decimals, 23
Reading and Writing Decimals, 24
Comparing the Value of Decimals, 26
Adding and Subtracting Decimals, 27
Multiplying Decimals, 29
Dividing Decimals, 31
Rounding Off Decimals, 32
Changing Fractions to Decimals, 34
Changing Decimals to Fractions, 34

3 Ratio and Proportion, 40

Ratios, 40
Proportions, 41
Solving for x in Ratio and Proportion, 42
Applying Ratio and Proportion to Dosage Calculation, 44

4 Percentages, 51
Percentage Measures, 51
Converting Percentages to Fractions,
Decimals, and Ratios, 52
Converting Fractions, Decimals,
and Ratios to Percentages, 54
Comparing Percentages and Ratios, 56
Determining the Percentage of a Quantity, 57
Determining What Percentage
One Number Is of Another, 57
Calculating the Percentage of Change, 59

xii
 Contents xiii

POST-TEST 64

UNIT TWO Systems of Measurement 69

5 Standardizing Measurement Systems, 70
Metric System, 71
Rules of the Metric System, 73
Units of Measurement, 74
Conversions Between Metric Units, 75
Apothecary System (Imperial), 77
Roman Numeral System (Imperial), 78
Household System (Imperial), 78
Other Measurements Used in Dosage Calculation, 79

6 Converting Within and Between Systems, 85

Equivalents Among Metric and Household Systems, 85
Converting, 85
Methods of Converting, 86
Converting Within the Same System, 89
Converting Between Systems, 91
Calculating Intake and Output, 93

7 Additional Conversions Useful in the Health

Care Setting, 103
Converting Between Celsius and Fahrenheit, 103
Converting Measures of Length, 106
Converting Between Units of Weight, 107
Converting Between Traditional and Military (International)
Time, 109
Calculating Completion Times, 111

UNIT THREE Methods of Administration and

Calculation 117
8 Medication Administration, 118
Medication Errors, 118
Critical Thinking and Medication Administration, 120
Factors That Influence Medication Dosages and Action, 121
Special Considerations for Older Adults, 121
The Rights of Medication Administration, 122
Medication Reconciliation, 127
Routes of Medication Administration, 129
Equipment Used for Medication Administration, 130

9 Understanding and Interpreting Medication

Orders, 136
Verbal Orders, 136
Transcription of Medication Orders, 137
Writing a Medication Order, 139
Components of a Medication Order, 139
Interpreting a Medication Order, 143
xiv Contents

10 Medication Administration Records and Drug

Distribution Systems, 151
Medication Orders, 151
Medication Administration Record, 151
Essential Components of a Medication
Administration Record, 153
Documentation of Medication Administration, 154
Computers and Medication Administration, 156
Medication Distribution Systems, 156
Advantages and Disadvantages of Technology, 159

11 Reading Medication Labels, 163

Reading Medication Labels, 163

12 Dosage Calculation Using the Ratio and

Proportion Method, 203
Using Ratio and Proportion to Calculate Dosages, 203

13 Dosage Calculation Using the Formula Method, 237

Formula for Calculating Dosages, 237
Applying the Formula, 238

14 Dosage Calculation Using the Dimensional

Analysis Method, 263
Understanding the Basics of Dimensional Analysis, 263
Dosage Calculation Using Dimensional Analysis, 266

UNIT FOUR Oral and Parenteral Dosage Forms

and Insulin 287
15 Oral Medications, 288
Forms of Solid Medication, 288
Calculating Dosages of Tablets and Capsules, 292
Calculating Dosages of Oral Liquids, 306
Measuring Oral Liquids, 307

16 Parenteral Medications, 348

Packaging of Parenteral Medications, 348
Syringes, 351
Reading Parenteral Labels, 360
Calculating Parenteral Dosages, 370
Calculating Injectable Medications According
to the Syringe, 371
Calculating Dosages for Medications in Units, 376
Mixing Medications in the Same Syringe, 378
 Contents xv

17 Reconstitution of Solutions, 420

Basic Principles of Reconstitution, 421
Reconstituting Medications With More Than One Direction for
Mixing (Multiple Strength), 430
Reconstituting Medications From Package Insert Directions for
Different Routes of Administration, 433
Medication Labels With Instructions to “See Accompanying
Literature” (Package Insert) for Reconstitution and
Administration, 433
Calculating Dosages of Reconstituted Medications, 435
Reconstituting Noninjectable Solutions, 438

18 Insulin, 473
Labels, 474
Types of Insulin and Their Action, 475
Appearance of Insulin, 479
Insulin Administration Methods, 479
Insulin Orders, 485
Preparing a Single Dose of Insulin in an Insulin Syringe, 488
Measuring Two Types of Insulin in the Same Syringe, 489
Intravenous Insulin, 492
Calculating an Intravenous Insulin Infusion, 492
Hypoglycemia, 493

UNIT FIVE Intravenous and Heparin Calculations,

Pediatric Dosage Calculations, and
Critical Care Calculations 509
19 Intravenous Solutions and Equipment, 510
Intravenous Delivery Methods, 510
Intravenous Solutions, 511
Administration of Intravenous Solutions, 516

20 Intravenous Calculations, 528

Intravenous Flow Rate Calculation, 528
Calculating Flow Rates for Infusion Pumps
in Millilitres per Hour, 528
Calculating Flow Rates in Drops per Minute, 532
Intravenous Tubing, 532
Calculating Flow Rates in Drops per Minute
Using a Formula, 535
Determining Infusion Time and Volume, 545
Recalculating an Intravenous Flow Rate, 547
Charting Intravenous Therapy, 550
Labelling Solution Bags, 550
Administration of Medications by Intravenous Push, 550
xvi Contents

21 Heparin Calculations, 562

Heparin, 562
Heparin Errors, 562
Heparin Dosage Strengths, 563
Reading Heparin Labels, 564
Calculating Subcutaneous Heparin Dosages, 565
Calculating Intravenous Heparin Dosages, 566
Calculating Heparin Dosages Based on Weight, 568

22 Pediatric and Adult Dosage Calculations Based

on Weight, 590
Principles of Pediatric Dosage Calculation, 591
Calculating Dosages Based on Body Weight, 592
Calculating Adult Dosages Based on Body Weight, 599
Calculating Pediatric Dosages Using Body Surface Area, 604
Calculating Body Surface Area Using a Formula, 607
Calculating Dosages Based on Body Surface Area, 609
Fluid Resuscitation After a Burn Injury, 612
Intravenous Therapy and Children, 616
Calculating Pediatric Intravenous Fluid Maintenance, 618
Calculating Intravenous Medications by Burette, 619
Determining Whether a Pediatric Intravenous
Dosage Is Safe, 622
Pediatric Oral and Parenteral Medications, 624

23 Critical Care Calculations, 653

Calculating the Intravenous Flow Rate
in Millilitres per Hour, 654
Calculating Critical Care Dosages per Hour
or per Minute, 655
Medications Ordered in Milligrams per Minute, 656
Calculating Dosages Based on Micrograms
per Kilogram per Minute, 657
Intravenous Flow Rates for Titrated Medications, 658
Developing a Titration Table, 660

COMPREHENSIVE POST-TEST 682

Appendix A: Arabic Equivalents for Roman Numerals, 705

Appendix B: Diabetes Management Record:
Subcutaneous Insulin, 706

References, 709
Drug Label Credits, 711
Drug Index, 712
Index, 717
 UNIT ONE
Math Review
A n essential role of the nurse is providing safe medication administration to all patients.
To accurately perform dosage calculations, the nurse must have knowledge of basic math,
regardless of the problem-solving method used in calculation. Knowledge of basic math is a
necessary component of dosage calculation that nurses need to know to prevent medication
errors and ensure the safe administration of medications to all patients, regardless of the
setting. Serious harm to patients can result from a mathematical error during calculation and
administration of a medication dosage. The nurse must practise and be proficient in the basic
math used in dosage calculations. Knowledge of basic math is a prerequisite for the preven-
tion of medication errors and ensures the safe administration of medications.
Although calculators are accessible for basic math operations, the nurse needs to be able
to perform the processes involved in basic math. Controversy still exists among educators
regarding the use of calculators in dosage calculation. Calculators may indeed be recom-
mended for complex calculations to ensure accuracy and save time; the types of calculations
requiring their use are presented later in this text. However, because the basic math required
for less complex calculations is often simple and can be done without the use of a calculator,
it is a realistic expectation that each practitioner should be competent in the performance of
basic math operations without its use. Performing basic math operations enables the nurse
to think logically and critically about the dosage ordered and the dosage calculated.

Pre-Test
Chapter 1 Fractions
Chapter 2 Decimals
Chapter 3 Ratio and Proportion
Chapter 4 Percentages
Post-Test

Copyright © 2022, Elsevier Inc. All rights reserved. 1