Medication Administration
Proficiency Exam (MAPE)
Guide
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Carrington College Nursing Manual
Section 5
Medication Administration Proficiency Exam (MAPE) Policy
MAPE exams are administered by campus program and as follows:
➢ EACH MAPE exam contains four categories of questions:
• Simple Conversions/Ratios
• Calculation of Dosages
• Safe Medication Administration
• Label Reading and Reconstitution of Medications
5.1
MAPE Passing score is 100%
MAPE exams are administered prior to progression into the next course with a
clinical component. The MAPE exam must be passed with a score of 100%.
Three (3) attempts at passing the MAPE will be provided. If a student is
unsuccessful at passing the MAPE after three (3) attempts, the student will not
progress into next level course(s) with a clinical component. In this instance, the
student must retake and pass the MAPE when the exams are administered again
for that specific program. In addition, if a student does not successfully pass a
course with a clinical component in their current level, the student will be required
to retake and pass the MAPE again regardless of their prior MAPE score.
Students will receive advance notice of the specific exam dates and times. In the
event unexpected circumstances require modification of the exam dates, times or
venues, students will be notified as soon as possible.
Students are required to complete the entire MAPE, which includes all four
categories of questions. Students are not permitted to complete only a portion of
the MAPE.
Each MAPE exam is scheduled for a maximum test time of one hour unless the
student has been approved for extended testing time through the Office of
Disability Accommodations in Academic Programs (ADA@carrington.edu). Refer
to the Student Handbook for comprehensive information. Extended testing time
accommodations are not retroactive and as such must be approved prior to testtaking.
5.2
Preparation & Remediation
The MAPE Guide and a sample MAPE Exam will be provided to students prior to
the live MAPE exam. After each MAPE exam, students will be informed of
opportunities for remediation by their course faculty.
5.3
Testing Rules
Testing rules will be provided at the exam site. Refer to the MAPE Guide for
more specific testing rules.
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TESTING RULES:
The exam is proctored and all testing procedures as outlined in the Student Handbook
apply. The role of the proctor is to ensure the academic integrity of the exam and to
assist in troubleshooting computer problems. The proctor WILL NOT discuss exam item
interpretation. The proctor cannot discuss how to approach calculating a math problem
or whether a student should submit their exam for final grading.
Students will attend the exam on the date associated with their specific course as
published in the exam schedule. Students may not drop in to other MAPE exam dates.
As the MAPE is a timed exam, it will begin and end as scheduled. Students should
arrive early and be prepared (i.e. proper dress code, badge, etc.) to begin the exam at
the scheduled start time. If the student arrives after the designated start time, the
instructor may choose to bar their entry to prevent disruption of the testing environment.
Students presenting more than 15 minutes late will not be seated. Time provided for the
exam is 60 minutes.
Students who do not present for their scheduled MAPE Exams will forfeit the exam
attempt for that scheduled exam. Extenuating circumstances will be taken into
consideration.
Students are required to show all calculations on the exam, or the provided worksheet
however, only submitted computer answers are the final answers that are graded.
The final answer will have the units of measurement pre-written in the question. For Fill
in the Blank questions, DO NOT write in the units of measurement in the answer box.
Write in a numerical value only. Answers with anything other than numerals are
incorrect.
Follow the rounding instructions provided in each question.
A leading zero must be used before a decimal for answers with less than 1 (one) (i.e.,
0.7 mg or 0.1 mL).
Pencils, worksheets, and calculators will be provided to the students. These materials
must be returned at the end of the exam; worksheets must include the student’s name.
Students may not use their own devices or writing implements. Any other technology,
such as a smart phone/watch/glasses, is prohibited and must be stored with the
students’ personal belongings during the exam.
Backpacks, purses and other personal belongings are to be stored in a designated area
as instructed by Faculty. Jackets and hoodies are prohibited. Students must be clothed
in approved dress code. Students will not wear caps, hats or sunglasses.
Students may use their preferred method of calculation (basic formula, ratio and
proportion or dimensional analysis).
After completion of the exam, direct all questions about specific exam items to your
course faculty first.
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MAPE GUIDE PURPOSE:
Disclaimer: The MAPE Guide is meant to help students start studying for the exam.
The Guide is not a complete list of everything students need to know. Students should
refer to the resources that are presented to them during the nursing courses of their
curriculum, especially as it pertains to conversions. Students are responsible for
knowing medication administration concepts and calculations as it is presented
throughout the curriculum, including but not limited to National Patient Safety Goals,
The Joint Commission “Do Not Use” list and the Institute of Safe Medication Practices
(ISMP). Review of Fundamentals and Pharmacology textbook medication administration
concepts is highly encouraged.
MAPE ADMINISTRATION:
Progression into a course with a clinical component requires successful passing of the
MAPE Exam. MAPEs will be administered per campus-specific schedules. Exam dates
and times will be communicated to students by Week Two (2) of the semester.
Students will have three (3) opportunities to pass the test. Students must successfully
pass at 100%.
After each MAPE exam, students will be informed of opportunities for remediation.
If a student is unsuccessful on the third MAPE attempt, the student will not be able to
progress into a course with a clinical component the next semester. Students will then
need to meet with the Nursing Dean or Assistant Dean in order to determine the
appropriate pathway to progression.
The student will be able to re-attempt a new series of MAPEs in the following semester
when the exams are again administered for that specific program (i.e. day versus
evening programs).
CATEGORY REQUIREMENTS FOR EACH MAPE EXAM:
The exam consists of four (4) categories:
• Simple Conversions/Ratios
• Calculation of Dosages
• Safe Medication Administration
• Label Reading and Reconstitution of Medications
There will be four (4) questions per category for a total of 16 questions. The time
provided for exam completion is 60 minutes.
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SAFE MEDICATION ADMINISTRATION
A. The Rights and Checks of Medication Administration
To ensure proper medication administration, the nurse must adhere to the ten rights
of medication administration utilized during three medication checks.
The Ten (10) Rights – Include during each check:
1. The right Client– the nurse must identify the client by checking the medication order
and the client’s identification bracelet to ensure that the right client is receiving the right
medication. Use 2 unique identifiers, such as Name and DOB or Name and MRN (This
is a NPSG).
2. The right Dose– to ensure that the right dose or amount is given, the nurse must triple
check any calculations or have another team member check the calculation. The nurse
must verify the healthcare provider’s order and whether the amount is in a safe dose
range.
3. The right Medication (Drug)– comparison of the actual medication to the medication
order on the MAR is imperative. The nurse must only give medication that they
themselves have prepared and be present when it is administered. The nurse must
verify the correct indication for use.
4. The right Route– the nurse must give the medication via the right route by comparing
the order to the MAR.
5. The right Time– the nurse will check the medication order to the MAR to ensure that
the medication is given at the right time. Either the healthcare prescriber or hospital
protocol will identify the times that the medication is to be given.
6. The right Documentation– the nurse will record the client’s status prior to the
medication administration as well as the medication given, the time it was given, the
dose given, and the route it was given in. This occurs immediately and after
administering the medication. Then the nurse will follow up and record the client’s
response to the medication given.
7. The right Assessment– the nurse will assess the client’s lab results, heart rate, blood
pressure, blood glucose, pain, and agitation/anxiety for specific needs prior to
administration of medications.
8. The right to Education– the nurse will provide client education concerning actions,
therapeutic effects and potential side effects of medications to be given.
9. The right Evaluation– the nurse will evaluate the therapeutic effectiveness of the
medication, as well as presence of any side or adverse effects, both objectively and per
client report.
10. The right of Refusal – the nurse will listen to client concerns regarding receiving any
medications. Education as to the importance of prescribed medications should be
provided, and physician notification must be made to alert him/her to client request of
refusal. Documentation of refusal must also be made.
The Three Checks – Include the ten rights when:
Check 1: Gathering/Collecting medications. Verify against order/MAR.
Check 2: Preparing medications.
Check 3: Administration at the client’s bedside.
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Medication errors are frequently the result of failure to ensure these
“Rights” and “Checks”!
Giving medications is an act that needs to be done carefully and taken seriously!
B. The Joint Commission “Do Not Use” List
•
•
The Joint Commission’s “Do Not Use” List is part of Information Management
standards.
In 2001, The Joint Commission issued a Sentinel Event Alert about medical
abbreviations. A year later, its Board of Commissioners approved a National
Patient Safety Goal requiring accredited organizations to develop and implement
a list of abbreviations not to use. In 2004, The Joint Commission created its “Do
Not Use” List to meet that goal. In 2010, NPSG.02.02.01 was integrated into the
Information Management standards as elements of performance 2 and 3 under
IM.02.02.01.
(The Joint Commission, 2019)
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C. Sharps Safety
Do not recap used needles.
Beware of needles projecting from overfilled containers. Beware of human traffic
when crossing a room or exiting a curtained area with an exposed contaminated
needle. The needle needs to be pointed away from the carrier and toward the floor
(not angled toward the ceiling).
Sharps containers need to be replaced when they are ⅔ full.
Do not attempt to push a syringe into a filled sharps container. Your hand may be
stuck by an upright needle in the container.
Be very careful if a bedside treatment that included an injection (i.e., spinal tap,
paracentesis, chest tube insertion) has been performed. A used needle inadvertently
dropped in the bedding poses a needle stick risk.
During orientation to any new clinical agency, nurses need to familiarize themselves
with the types and uses of syringes and needles, the needleless equipment
available, and the location of sharps disposal containers. Agency policies pertaining
to handling of the equipment must also be checked.
Source: Mulholland’s The Nurse, The Math, The Meds: Drug Calculations Using
Dimensional Analysis, 2019.
D. Charting and Documentation
A client record is a legal document that records all aspects of the client’s care. This
record is a means of communication between members of the healthcare team. All
aspects of the client’s care are recorded such as: subjective data; client’s behavior;
objective data; treatments; medication administration; client teaching; and discharge
planning. In addition, in the event of a medication error, the client assessment
should be documented as well as any urgent or emergent safety issues and
interventions performed.
As this record is a legal document all entries must follow legal guidelines. They are
as follows:
1. Do not erase, apply correction fluid or scratch out errors while charting – Draw
a single line through error, write error and initial above it.
2. Do not be critical or express personal opinions about the client or other care
providers – only objective data should be recorded; client’s comments should
be quoted.
3. Correct all errors promptly – be sure information is accurate.
4. Record all facts – do not speculate or guess, be specific with your
information.
5. Use nonerasable ink and make entries legible.
6. Do not leave any blank spaces – draw a line to the end of the line.
7. Do not chart for anyone else – only chart what activities you have performed.
8. If an order is questioned, record that you sought clarification – you are
responsible for your actions.
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9. Begin each entry with the date, time, and end each entry with your signature
and title.
10. Late Entry – Document as soon as possible and identify new entry as a “late
entry.”
a) Enter current date/time – do not attempt to give the appearance that the
entry was made on a previous date or an earlier time. The entry must be
signed.
The conversion of a handwritten to an electronic method of documentation takes
these guidelines into consideration.
If a medication error does occur, responding to and reporting medication errors is
the primary responsibility of the registered nurse, regardless of whether a nursing
student or another professional nurse commits the error. The highest priority is the
client’s physical well-being and physiologic status.
Once the client’s stability has been ensured, reporting of the occurrence should be
completed. The nurse manager or charge nurse as well as the primary healthcare
provider should be informed. Thorough, but objective and factual, documentation of
the event using the clinical agency’s appropriate forms per policy and procedure
should then be completed.
The 24-Hour Clock/Military Time
(Eliminate “AM/PM,” and no colon with 24-hour clock)
Documentation in the medical record uses a 24-hour (or military) time convention.
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E. ABBREVIATIONS
1. Abbreviations for Times of Medications
Abbreviation
Meaning
Abbreviation
Meaning
Stat, STAT
Immediately
q2hr
Every 2 hours
daily
Every day
q4hr
Every 4 hours
bid, BID
Twice a day
q6hr
Every 6 hours
tid, TID
Three times a day
q8hr
Every 8 hours
qid, QID
Four times a day
ac
Before meals
prn, PRN
As Needed
pc
After meals
2. Abbreviations for Routes of Medications
Abbreviation
Meaning
Abbreviation
Meaning
MDI
Metered Dose
Inhaler
ID
Intradermally
IM
Intramuscularly
po, PO
By mouth, orally
IV
Intravenously
pr, PR
Per rectum
IVP
Intravenous Push
Subcut
Subcutaneously
IVPB
Intravenous
Piggyback
SL
Sublingual
3. Metric Abbreviations
Abbreviation
Meaning
Abbreviation
Meaning
g (gm, GM)
Gram
mEq
Milliequivalent
kg, Kg
Kilogram
mg
Milligram
L
Liter
mL
Milliliter
mcg
Microgram
cm
Centimeter
m
Meter
mm
Millimeter
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4. Household Abbreviations
Abbreviation
Meaning
Abbreviation
Meaning
pt
Pint
Tbsp (T)
Tablespoon
qt
Quart
tsp (t)
Teaspoon
oz
Ounce
gal
Gallon
fl oz
Fluid ounce
lb
Pound
5. Abbreviations for Drug Preparation
Abbreviation
Meaning
Abbreviation
Meaning
cap, caps
Capsules(s)
SR
Sustained release
tab, tabs
Tablet(s)
EC
Enteric coated
elix
Elixir
susp
Suspension
supp
Suppository
syr
syrup
F. STANDARD CONVERSION FACTORS:
TEMPERATURE, METRIC, APOTHECARY & HOUSEHOLD
1. Temperature Conversions:
Celsius to Fahrenheit: T (°F) = T (°C) × 9/5 + 32 OR T (°F) = T (°C) × 1.8 + 32
Fahrenheit to Celsius: T (°C) = (T (°F) - 32) × 5/9 OR T (°C) = (T (°F) - 32)/1.8
2. Metric, Apothecary & Household Conversions
Metric Conversions
Apothecary/Household Conversions
1 mg = 1000 mcg
1 L = 1000 mL
1 fl oz = 30 mL
1 tsp = 5 mL
1 g = 1,000,000 mcg
1 cm = 10 mm
1 lb = 16 oz
1 Tbsp = 15 mL
1 g = 1000 mg
1 meter (m) = 100 cm
1 cup = 8 oz
1 Tbsp = 3 tsp
1 quart = 4 cups
1 pint = 2 cups
1 inch = 2.54 cm
1 kg = 2.2 lb
1 kg = 1000 g
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3. Conversion Calculations within the Metric System
The metric system is based on the decimal system and units of 1000. There are two
methods (rules) you can use to convert between units in the metric system. Once
you know the method that is easiest for you, use it consistently to solve your
problems.
Practice Questions below:
The first method (rule) is:
Going from large to small – multiply by 1000.
Going from small to large – divide by 1000.
a. Example: 1.5 g =
mg
A gram (g) is larger than a milligram (mg). Therefore, you multiply by 1000
to convert the 1.5 g to mg. 1.5 g x 1000 = 1500 mg
b. Example: 750 mg =
g
A milligram (mg) is smaller than a gram (g). Therefore, you divide by 1000 to
convert the 750 mg to g. 750 mg ÷ 1000 = 0.75 g
The second method (rule) is:
Going from large to small – move decimal three (3) places to the right.
Going from small to large – move decimal three (3) places to the left.
a. Example: 0.5 mg =
mcg
A mg is larger than a mcg. Therefore, you move the decimal 3 places to the
right. 0.5 mg = 500 mcg
b. Example: 200 mcg =
mg
A mcg is smaller than a milligram (mg). Therefore, you move the
decimal 3 places to the left. 200 mcg = 0.2 mg
KEY POINT: Always place a zero in front of the decimal point when the
quantity is less than a whole number. Do not place a zero after the decimal
point (called a trailing zero). Refer to the Joint Commission’s “Do Not Use” List.
Your knowledge of conversions will be tested in a variety of ways. Some require
multiple conversions.
a. Example: Health care provider’s order: Digoxin 250 mcg po daily.
Available: Digoxin 0.125 mg tab (scored). How many tablets
will you give?
To answer this question, you must first convert to the same units of
measurement. This means that you need to convert mcg to mg.
Step 1: Convert to the same units of measurement.
mcg is smaller than mg, so move the decimal 3 places to the left (250 mcg = 0.25
mg).
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Step 2: Solve the problem with your method of choice.
0.25 mg x 1 = 2 tabs
0.125
Or using the math formula:
D (desired) x Q (quantity) = X (amount)
H (have)
Step 1: Convert to the same units of measurement.
mcg is smaller than mg, so move the decimal 3 places to the left (250 mcg = 0.25
mg)
Step 2:
0.25 mg (desired) x 1 tab (quantity) = 2 tabs (amount to give)
0.125 mg (Have)
a. Example: Health care provider’s order: Ceclor oral suspension 1 g PO
QID. Available: Ceclor oral suspension 250 mg per tsp. How
many mL will you give?
To answer this question, you must first convert g to mg, then tsp to mL.
Step 1: Convert to the same units of measurement.
g is greater than mg, so multiply by 1000 (1 g = 1000 mg)
Step 2: Convert tsp to mL (1 tsp = 5 mL)
Step 3: Solve the problem with your method of choice.
5 mL: 250 mg = X mL: 1000 mg
250 X = 5000
X = 20 mL
Or using the math formula:
D (desired) x Q (quantity) = X (amount)
H (have)
Step 1: Convert to the same units of measurement.
g is greater than mg, so multiply by 1000 (1 g = 1000 mg)
Step 2: Convert tsp to mL (1 tsp = 5 mL)
Step 3:
1000 mg (desired) x 5 mL (quantity) = 20 mL (amount to give)
250 mg (Have)
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Another conversion calculation that you will need to learn to do is weight
conversion.
To convert pounds (lb) to kilograms (kg), divide by 2.2
Example:
120 lb = __?__kg. Round to nearest tenth or first decimal place.
120 lb. = 54.5454 = 54.5 lb
2.2
To convert kilograms (kg) to pounds (lb), multiply by 2.2
Example:
45.6 kg = __?__ lb. Round to nearest tenth or first decimal place.
45.6 kg x 2.2 = 100.32 = 100.3 lb
To convert ounces to grams; first convert weight to pounds then to kilograms then to
grams.
Example:
5 lb 10 oz infant weighs __?__ grams. Round to nearest tenth or first decimal place.
5 + (10 divided by 16) = 5.625 lbs.
5.625 divided by 2.2 = 2.5568 x 1000 = 2,556.8 g
MEDICATION ADMINISTRATION-COMMON ROUTES USED
Enteral administration consists of oral, NG Tube, PEG Tube, rectal suppositories
and enemas.
Parenteral administration consists of intradermal, subcutaneous, intramuscular
and intravenous routes.
Percutaneous/topical medication administration consists of creams, lotions,
ointments, transdermal drug delivery systems, topical powders and via the mucous
membranes.
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Enteral Drug Preparations (Forms)
Nursing Implications
Tablet
May be crushed if client cannot swallow.
Scored Tablets
Only tablets that are scored can be broken (split).
Coated Tablets (thin, filmy covering)
Check with Pharmacist before crushing.
Enteric Coated Tablets
Do not crush.
Sustained/Extended Release Tabs
Do not crush.
Sublingual Tabs
Dissolves under tongue. Do not chew.
Capsules
Do not open. Do not crush/split.
Elixirs
May be contraindicated in persons with diabetes or
alcohol addiction or in clients taking Disulfiram
(Antabuse).
Suppositories
Molded with a firm base and pointed tip for easier
rectal insertion.
Suspensions
Always shake bottle well.
Topical Drug Preparations (Forms)
(Absorption takes place via
skin/membranes)
Nursing Implications
Aerosolized powders or liquids
Used in nebulizers and inhalers.
Powders
Applied to the affected skin areas.
Creams
Semisolid for internal and external use.
Ointments
Semisolid in a petroleum or lanolin base.
Pastes
Thick ointments.
Suppositories
Molded with a firm base and pointed tip for easier
rectal/vaginal insertion.
Transdermal
Patches placed on external skin sites.
Drops
Usually for eyes, nose or ears.
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Parenteral Preparations (Forms)
Nursing Implications
Intradermal (ID)
Usually given for given for diagnostic purposes, such as
allergy or tuberculosis testing.
Subcutaneous (subcut)
Usually given for vaccinations or heparin/insulin
injections allowing a slower absorption of the
medication.
Intramuscular (IM)
Usually given for vaccinations, antibiotics or pain
medications. Absorption is quicker.
Intravenous (IV) and Intravenous
piggyback (IVPB)
Administration of medications directly into the vein.
Used for fluid, blood, medications, electrolytes and
emergency medication administration. Can be
administered fast or slow depending on reason for
administration. Can be used for small or large volume
amounts. Can be titrated or administered at a constant
rate.
EQUIPMENT TO MEASURE DOSES
• Medicine cups may be paper or plastic. Paper cups are used to dispense oral,
nonliquid medications such as tablets or capsules. Plastic cups are used to measure
and dispense oral, liquid medications. Plastic cups can be used to measure
medications in both the apothecary and metric systems.
• Syringes are used for injections. They come in several different types and sizes.
Each serves a different purpose and is used to administer medications via different
routes.
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Example: Small capacity syringe is calibrated in tenths of mL
Ex: 1 mL syringe is calibrated in hundredths
Ex: 1 mL insulin syringe is calibrated in units.
CALCULATIONS
A. ROUNDING RULES
Rounding of decimals:
1. Decide how far the number is to be rounded, such as to the nearest tenth (first
decimal) or the hundredths (second decimal) place, or to the nearest whole
number.
2. Mark that place by putting a line under it. If the digit to the right of that place is
less than 5, drop that digit and any others to the right. If the digit to the right of
the place to be rounded to is 5 or greater, increase the number in the place by 1
and drop the digits to the right.
Example #1: Round number to the nearest tenth: 7.4239 would be rounded to
7.4
Example #2: Round number to the nearest whole: 87.8527 would be rounded
to 88
Example #3: Round number to the nearest hundredth: 9.4393 would be
rounded to 9.44
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Rules for rounding off for nursing math tests:
1. Calculate each step of a math problem before proceeding to the next step.
Optimally, you should calculate all your math to four decimal places however,
calculating to two decimal places is the minimum.
2. Once you have completed all the steps of your calculations, the final answer
should be rounded off to the nearest tenth (first decimal place), unless otherwise
instructed in the test question.
3. Remember, before rounding, complete all the steps of your calculations first, then
round the final answer.
Do NOT round until the end of your calculation problem!
B. CALCULATION OF DOSAGES
There are three methods for solving solid and liquid oral medication calculation
problems. Try each of them and determine which one is easiest for you. Once you
know the method that is easiest for you, use it consistently to solve your
problems.
NOTE: Regardless of the method you use to solve calculation problems,
always show your work and always label everything.
Method 1: Using Ratio and Proportion (Means and Extremes)
Example: A nurse is preparing to administer aspirin 600 mg PO q4h prn for
headache. The amount supplied (or available) is aspirin 300 mg/tablet. How many
tablets should the nurse administer per dose? Round the answer to the nearest
whole number. Use a leading zero if it applies. Do not use a trailing zero.
Step 1: What is the unit of measurement the nurse should calculate?
Answer: Tablet
Step 2: What is the dose the nurse should administer (desired)?
Answer: 600 mg
Step 3: What is the dose available (have)?
Answer: 300 mg
Step 4: Does the nurse have to convert the units of measurement?
Answer: No. mg desired = mg have
Step 5: Set up the proportion and solve for x by cross-multiplying and rounding, if
necessary.
300 mg
=
600 mg
1 tablet
x tablet
300x = 600
x = 2 tablets
Step 6: Does the answer make sense?
Answer: Yes, if there are 300 mg/tablet and the prescription reads 600 mg,
it makes sense to administer 2 tablets.
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Method 2: Using Dimensional Analysis
Example: A nurse is preparing to administer aspirin 600 mg PO q4h prn for
headache. The amount supplied (or available) is aspirin 300 mg/tablet. How many
tablets should the nurse administer per dose? Round the answer to the nearest
whole number. Use a leading zero if it applies. Do not use a trailing zero.
Step 1: What is the unit of measurement the nurse should calculate?
Answer: Tablet
Now place the unit of measurement being calculated on the left side of the
equation: x tablet(s) =
Step 2: Determine the ratio that contains the same unit as the unit being calculated.
Place the ratio on the right side of the equation ensuring that the unit in the
numerator matches the unit being calculated:
x tablet(s) = 1 tablet
300 mg
Step 3: Place any remaining ratios that are relevant to the item on the right side of
the equation along with any conversion factors to cancel out unwanted
units of measure.
x tablet(s) =
1 tablet x 600 mg
300 mg
1 dose
Step 4: Solve for x and round, if necessary.
x tablet(s) = 2 tablets
Step 5: Does the answer make sense?
Answer: Yes, if there are 300 mg/tablet and the prescription reads 600 mg,
it makes sense to administer 2 tablets.
Method 3: Using Desired over Have Formula
KEY POINT: “Supply” is how the drug comes. It is the same as “available”.
“Desired” refers to the dose to be administered.
Example: A nurse is preparing to administer aspirin 600 mg PO q4h prn for
headache. The amount supplied (or available) is aspirin 300 mg/tablet. How many
tablets should the nurse administer per dose? Round the answer to the nearest
whole number. Use a leading zero if it applies. Do not use a trailing zero.
Step 1: What is the unit of measurement the nurse should calculate?
Answer: Tablet
Step 2: What is the dose the nurse should administer (desired)?
Answer: 600 mg
Step 3: What is the dose available (have)?
Answer: 300 mg
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Step 4: Does the nurse have to convert the units of measurement?
Answer: No. mg desired = mg have
Step 5: What is the quantity of the dose available?
Answer: 1 tablet
Step 6: Set up the equation and solve for x rounding, if necessary:
x = Desired x Quantity
Have
x = 600 mg x 1 tablet = 2 tablets
300 mg
Step 7: Does the answer make sense?
Answer: Yes, if there are 300 mg/tablet and the prescription reads 600 mg,
it makes sense to administer 2 tablets.
1. IV Infusion Calculations take the form of either being administered via an electronic
pump or, in the absence of an electronic infusion pump, manually using a roller
clamp on IV tubing.
a. Manual IV Infusions
When setting the flow rate of a manual infusion, it is necessary to count the
drops that fall in the drip chamber in one minute. It is also necessary to know
the manufacturer’s tubing drop factor that is printed on the packaging of the
administration set. The drop factor is listed as drops per milliliter (gtt/mL) of
solution.
When calculating a manual IV infusion, use the following formula:
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Example: A nurse is to administer Lactated Ringer’s (LR) 1500 mL IV to infuse over 8
hours. The drop factor of the administration set is 15 gtt/mL. How many drops per
minute (gtt/min) will the nurse adjust the manual IV infusion to deliver the prescribed
LR? Round the answer to the nearest whole number.
Step 1: What is the unit of measurement the nurse should calculate?
Answer: gtt/min
Step 2: What volume does the nurse need to infuse?
Answer: 1500 mL
Step 3: What is the total infusion time, in minutes?
Answer: 8 hr x 60 min/hr = 480 min
Step 4: Set up the equation and solve for the rate rounding as directed:
Rate = Volume x drop factor = 1500 mL x 15 gtt/mL = 46.875 gtt/min
Time
480 minutes
Rate = 46.875 gtt/min, which rounds to 47 gtt/min
b. IV Infusions with Electronic Pumps
Electronic infusion pumps infuse an accurate rate of a specified fluid during
a specific amount of time. The rate is expressed in mL/hour.
When calculating an infusion using an electronic pump, use the following
formula:
Example: A nurse needs to administer 365 mL of packed red blood cells over 3.5 hours.
The nurse should set the IV infusion pump to deliver how many mL/hr? Round the
answer to the nearest tenth (10th) or first decimal place.
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Step 1: What is the unit of measurement the nurse should calculate?
Answer: mL/hr
Step 2: What volume does the nurse need to infuse?
Answer: 365 mL
Step 3: What is the total infusion time, in minutes?
Answer: 3.5 hr
Step 4: Does the nurse need to convert any units of measurement?
Answer: No
Step 5: Set up the equation and solve for the rate rounding as directed:
Rate = Volume = 375 mL = 107.1428 mL/hr, which rounds 107.1 mL/hr
Time
3.5 hr
For other examples of dosage calculations, refer to the following resources:
•
•
•
•
Mulholland’s The Nurse, The Math, The Meds: Drug Calculations Using
Dimensional Analysis, 2019
ATI RN Pharmacology for Nursing: Content Mastery Series Review Module eBook,
2019
ATI > MyATI > Learn > Dosage Calculation and Safe Medication Administration 3.0
Tutorial
ATI > MyATI > Test > Dosage Calculation RN Practice Assessments 3.0
LABEL READING AND RECONSTITUTION OF MEDICATIONS
In order to administer medications safely, the nurse must accurately read and interpret
the drug label. In reading a drug label, the nurse must make note of the following basic
information:
•
•
•
•
•
•
•
•
Trade (brand) name of the medication
Generic name of the medication
Strength of the medication dosage (concentration)
Form in which the medication is provided
Route(s) of administration
Total amount or volume of the medication in the vial or container
Directions for mixing or preparation (reconstitution) of the medication, if required
Date of expiration; Storage requirements
Certain medications are unstable in liquid form. Therefore, they are supplied in a dry,
powdered form to which a diluent needs to be added just before use. This process is
referred to as “reconstitution”.
Students may expect to be asked to determine any one of the parts of the drug label.
The form of the question may be a true/false, multiple choice or multiple select.
Students may also be asked to perform a calculation using the various parts of the drug
label in order to answer a question.
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1. Practice Question
•
•
•
•
•
•
•
•
•
Trade name of the medication = Kefzol®
Generic name of the medication = Cefazolin
Strength of the medication dosage (concentration) = 330 mg/mL
Form in which the medication is provided = implied dry form due to its need to
be reconstituted
Route(s) of administration = can be used for IM or IV routes
Total amount and volume of the medication in the vial or container = 1 gram of
cefazolin
Directions for mixing or preparation (reconstitution) of the medication, if required
= For IM use, add 2.5 mL of sterile water for injection; For IV use, need
additional information
Date of expiration = 6/30/2022 for the vial. After reconstitution, expires at 24
hours if stored at room temperature or at 10 days if refrigerated at 5o C (41o F)
Storage requirements = Prior to reconstitution, needs to be protected (or stored
away) from light and stored at 25o C (77o F)
2. Practice Question
•
•
Trade name of the medication = not listed
Generic name of the medication = Acyclovir Sodium
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•
•
•
•
•
•
•
Strength of the medication dosage (concentration) = 50 mg/mL
Form in which the medication is provided = implied dry form due to its need to
be reconstituted
Route(s) of administration = IV route only
Total amount and volume of the medication in the vial or container = 500 mg
Directions for mixing or preparation (reconstitution) of the medication, if required
= must be diluted to concentration of 7 mg/mL, need additional dilution
instructions
Date of expiration = 5/4/2023 for the vial; since this is a single-use vial, any
unused portion must be discarded
Storage requirement = controlled room temperature of 20o to 25o C (68 o to 77o
F)
Sample calculation problem using Label Reading
The healthcare provider prescribes 12 mg/kg Acyclovir Sodium IV x one dose. The
client weighs 115 lb. The pharmacy provides the medication as per the label illustrated
above. How many milliliters will the nurse administer for the dose? Round the answer
to the nearest tenth (or first decimal place).
Step 1: Convert 115 lb to kg = 115 lb x 1 kg/2.2 lb = 52.2727 kg
Step 2: Calculate weight-based dose = 12 mg/kg x 52.2727 kg = 627.2724 mg (desired)
Step 3: Employ your favorite calculation method; the example below uses the formula
Method.
D (desired) x Q (quantity) = X (amount)
H (have)
627.2724 mg (desired) x 1 mL (quantity) = 12.5454, which rounds to 12.5 mL
50 mg (Have)
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MAPE PRACTICE EXAM
Simple Conversions/Ratios
1. The healthcare provider advises his client to drink at least 2000 mL of fluid per day.
How many fluid ounces (fl oz) of water per day should the client drink? Round
answer to the nearest whole number.
2. The healthcare provider prescribes digoxin 250 mcg PO daily. How many milligrams
(mg) of digoxin will the nurse administer? Round answer to the nearest hundredth
(100th) or second decimal place.
3. A child needs to receive 15 mL of a medication. How many teaspoons of the
medication will the child receive? Round answer to the nearest whole number.
4. A client measures 4 feet 10.5 inches in height. What is the client's height in
centimeters (cm)? Round the answer to the nearest tenth (10th) or first decimal
place.
Calculation of Dosages
5. The healthcare provider prescribes furosemide 25 mg to be given intravenously (IV).
The pharmacy supplies the medication in a 10 mg/mL vial. How many milliliters will
the nurse administer? Round the answer to the nearest tenth (10th) or first
decimal place only.
6. The healthcare provider prescribes gentamicin 40 mg IVPB q8h for an infection. The
medication is supplied as 40 mg/100 mL to infuse over 1 hour. The tubing drop
factor is 20 drops (gtt)/mL. At how many drops per minute will the nurse infuse the
medication? Round answer to the nearest whole number.
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7. A pediatric client in atrial fibrillation has orders to receive verapamil 0.4 mg/kg via IV
push now. The client weighs 20 kg. The pharmacy sends a vial containing 15 mg/mL
of verapamil. How many mL will the nurse administer? Round the answer to the
nearest tenth (10th) or first decimal place only.
8. The healthcare provider prescribes 500 mg amoxicillin IVPB q8hr for a client with an
infection. The recommended safe and therapeutic dosage of amoxicillin is 20 - 40
mg/kg/day divided in equal doses q8h. The medication is supplied as 500 mg/100
mL normal saline and is to be infused over 1.5 hours.
a. The client’s weight is 75 pounds. What is the safe dose range, in
milligrams, of a single dose for this medication? Round the answer to the
nearest tenth (10th) or first decimal place only.
b. Is the prescribed dose safe to administer? Answer True or False and
state why.
Safe Medication Administration
9. The nurse is to administer metoprolol (Lopressor) 50 mg PO BID at 0900. The order
states: “Hold if pulse is below 60 bpm.” The client’s pulse is 56 bpm. What is the
most appropriate action for the nurse to take?
a. Hold the medication and document the reason for holding.
b. Hold the medication at 0900, then give the medication at bedtime if pulse above
60 bpm.
c. Ambulate the client until the pulse rate increases to above 60 bpm.
d. Administer the dose, the pulse rate is close enough.
10. Which of the following is an example of an unapproved abbreviation from The Joint
Commission’s “DO NOT USE” list? Select all that apply.
a. stat
b. QD
c. IM
d. MS
e. IVPB
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11. Along with the ten (10) rights of safe medication administration, there are three
checks that must be completed during the medication administration process to
enhance medication safety. When are the three checks performed? Select all that
apply.
a.
b.
c.
d.
e.
f.
Client identification
Wasting of medications
Preparing medications
Client assessment of readiness to learn
Gathering and/or collecting medications
Administering medications at the bedside
12. Which health care provider order is incomplete?
a.
b.
b.
d.
Tylenol 325 mg PO q6h prn mild pain
Aspirin PO daily
Dilaudid 0.5 mg IV push Q1H prn severe pain
Nifedipine 10 mg SL BID
Label Reading & Reconstitution
13. Refer to the label illustrated below. The medication has not expired. The healthcare
provider prescribes carbenicillin disodium (Geopen®) 0.375 g IM q6h for an
infection.
Based on the information provided on the label above, the prescription and
knowledge of safe medication administration practices, answer the following
questions.
a. What amount of diluent will the nurse use for this order?
b. What is the unit-dose concentration after reconstitution?
c. How many millimeters will the RN administer for the prescribed dose? Round
the answer to the nearest tenth (10th) or first decimal place only.
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14. Refer to the label illustrated below. The healthcare provider has prescribed
Amoxicillin 300 mg PO q12h x 7 days. The medication has not expired. Based on
the provider prescription, the label, and safe medication administration practices,
select all the statements that are true about this medication prescription. Select all
that apply.
a.
b.
c.
d.
e.
The nurse will administer 1.5 tsp for one dose of the medication.
The reconstituted medication must be refrigerated.
The total daily dose will require 15 mL of reconstituted medication.
Reconstitute the medication with a total of 11.67 mL of water.
The reconstituted bottle contains enough medication for 6 doses.
15. Refer to the label illustrated below. The health care provider has prescribed
Ampicillin 250 mg IM to be given one hour prior to a procedure.
Based on the information provided on the label, the health care provider’s order and
knowledge of safe medication administration practices, answer the following questions.
a. How many milliliters of the prescribed dose will the nurse administer?
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b. Once reconstituted, the medication should be administered within one hour.
True or False.
c. The medication from this vial was reconstituted at 0630 and the procedure is
scheduled for 0800. The medication from this vial is safe to administer at 0700.
True or False.
16. Refer to the label illustrated below. The healthcare provider prescribes a Heparin
bolus dose of 45 units/kg IV prior to initiating a continuous infusion for treatment of a
client's pulmonary embolism. The client weighs 272 pounds. The medication has not
expired.
Using the information on the label and the prescribed order, answer the following
questions.
a. What is the bolus dosage in units? Round the answer to the nearest whole
number.
b. How many milliliters (mL) will need to be administered for the prescribed
dose? Round the answer to the nearest tenth (10th) or first decimal place.
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MAPE PRACTICE EXAM ANSWER KEY
Simple Conversions/Ratios
1.
2.
3.
4.
67 fl oz
0.25 mg
3 tsp
148.6 cm
Calculation of Dosages
5. 2.5 mL
6. 33 gtt/min
7. 0.5 mL
8a. 227.3 – 454.5 mg/dose
8b. The prescribed dose is not safe to administer. The healthcare provider ordered a 500
mg dose. The maximum the client can receive is 454.5 mg/dose.
Safe Medication Administration
9. a
10. b, d
11. c, e, f
12. b
Label Reading & Reconstitution
13a. 9.5 mL
13b. 1 g per 2.5 mL
13c. 0.9 mL
14. a, c, e
15a. 1 mL
15b. True
15c. False – the medication has expired.
16a. 5564 units to be administered.
16b. 5.6 mL
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Appendix for Campus-Specific
Information
Reno Campus
MAPE SCHEDULING
In order to progress into a course with a clinical component, the student must
successfully pass a MAPE Exam. The only exception are students entering their first
Nursing course from the second semester. No MAPE is required to enter NUR 130. The
following courses will give MAPE exams according to the schedule below:
Nursing 130
Nursing 243, 209
Nursing 251, 240, 247
Weeks 6-8-10 of the Semester
Weeks 6-8-10 of the Semester
Weeks 6-8-10 of the Semester
SAFE MEDICATION ADMINISTRATION
A. National Patient Safety Goals (NPSG) 2021
National Patient Safety Goals® Effective January 1, 2021. These goals are reviewed
and updated annually.
The NPSG 2021 table listed below can also be retrieved from
https://www.jointcommission.org/-/media/tjc/documents/standards/national-patientsafety-goals/2021/simplified-2021-hap-npsg-goals-final-11420.pdf
MAPE questions in this category will ask the student to have knowledge of those
NPSGs that pertain to safe medication administration. This would include questions
about client identification, managing medications or other solutions in unlabeled
containers, safety when administering anticoagulant therapy and medication
reconciliation.
1. Use at least two client identifiers when administering medications, blood, or blood
components; when collecting blood samples and other specimens for clinical testing;
and when providing treatments or procedures. The client’s room number or physical
location is not used as an identifier.
2. Label all medications, medication containers, and other solutions on and off the
sterile field in perioperative and other procedural settings. Note: Medication
containers include syringes, medicine cups, and basins.
3. To achieve better client outcomes, client education is a vital component of an
anticoagulation therapy program. Effective anticoagulation education includes
face-to-face interaction with a trained professional who works closely with clients
to be sure that they understand the risks involved with anticoagulation therapy
and the precautions they need to take.
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4. Medication reconciliation is intended to identify and resolve discrepancies—it is a
process of comparing the medications a client is taking (or should be taking) with
newly ordered medications. The comparison addresses duplications, omissions,
and interactions, and the need to continue current medications.
The types of information that clinicians use to reconcile medications include (among
others) medication name, dose, frequency, route, and purpose. Medication
reconciliation should occur during admission, transfers to alternate levels of care and
especially at discharge.
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2021
Hospital
National Patient Safety Goals
The purpose of the National Patient Safety Goals is to improve patient safety. The goals focus on problems
in health care safety and how to solve them.
Identify patients correctly
NPSG.01.01.01
Use at least two ways to identify patients. For example, use the patient’s name and date of
birth. This is done to make sure that each patient gets the correct medicine and treatment.
Improve staff communication
Get important test results to the right staff person on time.
NPSG.02.03.01
Use medicines safely
NPSG.03.04.01
Before a procedure, label medicines that are not labeled. For example, medicines in syringes,
cups and basins. Do this in the area where medicines and supplies are set up.
NPSG.03.05.01
Take extra care with patients who take medicines to thin their blood.
NPSG.03.06.01
Record and pass along correct information about a patient’s medicines. Find out what
medicines the patient is taking. Compare those medicines to new medicines given to the patient.
Give the patient written information about the medicines they need to take. Tell the patient it is
important to bring their up-to-date list of medicines every time they visit a doctor.
Use alarms safely
NPSG.06.01.01
Prevent infection
NPSG.07.01.01
Identify patient safety risks
NPSG.15.01.01
Prevent mistakes in surgery
UP.01.01.01
Make improvements to ensure that alarms on medical equipment are heard and responded to
on time.
Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the
World Health Organization. Set goals for improving hand cleaning. Use the goals to improve
hand cleaning.
Reduce the risk for suicide.
Make sure that the correct surgery is done on the correct patient and at the correct place
on the patient’s body.
UP.01.02.01
Mark the correct place on the patient’s body where the surgery is to be done.
UP.01.03.01
Pause before the surgery to make sure that a mistake is not being made.
This is an easy-to-read document. It has been created for the public. The exact language of the goals can
be found at www.jointcommission.org.
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B. Injection Sites and Angles of Entry for Different Routes
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MAPE questions in this category will ask the student to have knowledge of
appropriate injection sites for various medications or tests, i.e. intramuscular-deltoid
muscle for vaccinations; intradermal-TB screening; umbilical region-heparin or
insulin.
Students may also expect to be asked to determine the appropriate angle of entry
for the different injection routes.
C. Injection Comparisons Guide
Needle/gauge sizing: The gauge (abbreviated as “G”) of a needle refers to the size
of the internal diameter (or hole) of the needle. The higher the gauge, the smaller the
hole, i.e., 27G is a smaller needle diameter than 18G. Needles come in
various gauges and lengths. The length of a needle is listed after the gauge number.
For example, 25G ½ refers to a 25 gauge, ½ inch-long needle. Needle length &
gauge is determined by client’s age, client’s size/weight, injection site & viscosity of
the medication to be given.
Intradermal (ID) Injection Technique: Clean intended site vigorously within 2-inch
radius in circular motion; remove needle cap; stretch skin with nondominant hand
over site using thumb & index finger to pull skin taut; insert needle slowly with bevel
up about 1/4 inch into dermis then inject medication slowly so a bleb/wheal forms;
withdraw needle and deploy safety device; do not massage over site.
Route
Site
Needle
Length
Intradermal
(ID)
Forearm
(ventral) or
upper back
3/8 - 5/8 inch
Needle
Gauge
Angle of
Insertion
Maximum
volume of
medication
25 - 29G
5 -15 degrees
0.1 mL
Subcutaneous (Subcut) Injection Technique: Clean site vigorously within 2-inch
radius in circular motion; remove needle cap; hold like a dart with palm down; position
syringe using correct angle of entry; pinch skin using index finger and thumb of
nondominant hand; insert needle quickly and smoothly; inject med slowly; withdraw
needle & deploy safety device; may apply gentle pressure over site with gauze if
blood or fluid drainage noted; do not massage over site.
Route
Site
Subcutaneous
(subcut)
Abdomen,
triceps,
anterior thigh,
posterior hip
or shoulder
blade
Needle
Length
Needle
Gauge
Angle of
Insertion
Maximum
volume of
medication
3/8 - 5/8 inch
23 - 27G
(may be even
smaller for
insulin
syringes)
45 degrees
(thin adult or
child) or
90 degrees
(adult)
1 mL
Intramuscular (IM) Injection Technique: Clean site vigorously within 2-inch radius
in circular motion; remove needle cap; hold like a dart with palm down; position
syringe using correct angle of entry; using nondominant hand pull skin laterally or
downward and hold (Z-track method); insert needle quickly and smoothly; inject med
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slowly (1mL/ 10 sec); withdraw needle then release skin and deploy safety device;
may apply gentle pressure over site with gauze if blood or fluid drainage noted; do
not massage over site.
Needle
Length
Needle
Gauge
Angle of
Insertion
Maximum
volume of
medication
1 - 1.5 inch
(adult)
5/8 - 1 inch
(child or thin
adult)
20 - 25G
90 degrees
1 mL*
Vastus
lateralis
(infants)
Same as
above
20 - 25G
90 degrees
3 mL
Ventrogluteal
(Preferred)
Same as
above
20- 25G
(18G for very
viscous
solutions)
90 degrees
3 mL
Route
Site
Deltoid
Intramuscular
(immunization
(IM)
s)
Dorsogluteal
(Not
Recommend
ed)
*Per current practice standards
D. Mixing Medications from Two Separate Vials
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If two medications are compatible, it is possible to mix them in one injection if the total
dose is within acceptable limits. This prevents a client from having to receive more than
one injection at a time. Most nursing units have charts that list common compatible
medications. If there is any uncertainty about medication compatibilities, consult a
pharmacist or a medication reference.
When mixing medication from both a vial and ampule, prepare medication from the vial
first. Using the same syringe and filter needle, next withdraw medication from the
ampule. Nurses prepare the combination in this order because it is not necessary to add
air to withdraw medication from an ampule.
Apply these principles when mixing medications from two vials:
1. Do not contaminate one medication with another.
2. Ensure that the final dose is accurate
3. Maintain aseptic technique.
4. After mixing multidose vials, remember to label the vial, to include the date and
time of mixing and the concentration of medication per milliliter. Some
multidose vials require refrigeration after the contents are reconstituted.
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Albuquerque, Boise, Mesa,
Phoenix, Sacramento Campuses
SAFE MEDICATION ADMINISTRATION
A. Institute of Safe Medication Practices (ISMP) List of Error-Prone
Abbreviations, Symbols, and Dose Designations
(From https://www.ismp.org/recommendations/error-prone-abbreviations-list,
2021, February 5))
The ISMP List of Error-Prone Abbreviations, Symbols, and Dose
Designations contains abbreviations, symbols, and dose designations which have
been reported through the ISMP National Medication Errors Reporting Program (ISMP
MERP) and have been either misinterpreted or involved in harmful or potentially
harmful medication errors.
These abbreviations, symbols, and dose designations should NEVER be used when
communicating medical information verbally, electronically, and/or in handwritten
applications. This includes internal communications; verbal, handwritten, or electronic
prescriptions; handwritten and computer-generated medication labels; drug storage
bin labels; medication administration records; and screens associated with pharmacy
and prescriber computer order entry systems, automated dispensing cabinets, smart
infusion pumps, and other medication-related technologies. However, these
abbreviations, symbols, and dose designations may or may not be adopted by a
clinical agency.
In the Table, error-prone abbreviations, symbols, and dose designations that are
included on The Joint Commission’s “Do Not Use” list (Information Management
standard IM.02.02.01) are identified with a double asterisk (**) and must be included
on an organization’s “Do Not Use” list.
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Abbreviations
Intended
Meaning
Misinterpretation
Correction
µg
Microgram
Mistaken as “mg”
Use “mcg”
AD, AS, AU
Right ear, left
ear, each ear
Mistaken as OD, OS, OU
(right eye, left eye, each
eye)
Use “right ear,”
“left ear,” or “each
ear”
OD, OS, OU
Right eye, left
eye, each eye
Mistaken as AD, AS, AU
(right ear, left ear, each
ear)
Use “right eye,”
“left eye,” or “each
eye”
BT
Bedtime
Mistaken as “BID” (twice
daily)
Use “bedtime”
cc
Cubic
centimeters
Mistaken as “u” (units)
Use “mL”
D/C
Discharge or
discontinue
Premature discontinuation
of medications if D/C
(intended to mean
“discharge”) has been
misinterpreted as
“discontinued” when
followed by a list of
discharge medications
Use “discharge”
and “discontinue”
IJ
Injection
Mistaken as “IV” or
“intrajugular”
Use “injection”
IN
Intranasal
Mistaken as “IM” or “IV”
Use “intranasal” or
“NAS”
HS
Half-strength
Mistaken as bedtime
Use “halfstrength” or
“bedtime”
hs
At bedtime,
hours of sleep
Mistaken as half-strength
Use “halfstrength” or
“bedtime”
IU**
International
unit
Mistaken as IV
(intravenous) or 10 (ten)
Use “units”
o.d. or OD
Once daily
Mistaken as “right eye”
(OD-oculus dexter),
leading to oral liquid
medications administered
in the eye
Use “daily”
OJ
Orange juice
Mistaken as OD or OS
(right or left eye); drugs
meant to be diluted in
Use "orange juice"
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Abbreviations
Intended
Meaning
Misinterpretation
Correction
orange juice may be given
in the eye
By mouth,
orally
The “os” can be mistaken
as “left eye” (OS-oculus
sinister)
Use “PO,” “by
mouth,” or “orally”
q.d. or QD**
Every day
Mistaken as q.i.d.,
especially if the period
after the “q” or the tail of
the “q” is misunderstood as
an “i”
Use “daily”
qhs
Nightly at
bedtime
Mistaken as “qhr” or every
hour
Use “nightly”
qn
Nightly or at
bedtime
Mistaken as “qh” (every
hour)
Use “nightly” or “at
bedtime”
q.o.d. or QOD**
Every other
day
Mistaken as “q.d.” (daily)
or “q.i.d. (four times daily)
if the “o” is poorly written
Use “every other
day”
q1d
Daily
Mistaken as q.i.d. (four
times daily)
Use “daily”
q6PM, etc
Every evening
at 6 PM
Mistaken as every 6 hours
Use “daily at 6
PM” or “6 PM
daily”
SC, SQ, sub q
Subcutaneous
SC mistaken as SL
(sublingual); SQ mistaken
as “5 every;” the “q” in
“sub q” has been mistaken
as “every” (i.e., a heparin
dose ordered “sub q 2
hours before surgery”
misunderstood as every 2
hours before surgery)
Use “subcut” or
“subcutaneously”
ss
Sliding scale
(insulin) or ½
(apothecary)
Mistaken as “55”
Spell out “sliding
scale;” use “onehalf” or “½”
SSRI
Sliding scale
regular insulin
Mistaken as selectiveserotonin reuptake
inhibitor
Spell out “sliding
scale (insulin)”
SSI
Sliding scale
insulin
Mistaken as Strong
Solution of Iodine (Lugol's)
Spell out “sliding
scale (insulin)”
Per os
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Abbreviations
Intended
Meaning
Misinterpretation
Correction
i/d
One daily
Mistaken as “tid”
Use “1 daily”
TIW or tiw
3 times a week
Mistaken as “3 times a
day” or “twice in a week”
Use “3 times
weekly”
Unit
Mistaken as the number 0
or 4, causing a 10-fold
overdose or greater (i.e.,
4U seen as “40” or 4u seen
as “44”); mistaken as “cc”
so dose given in volume
instead of units (i.e., 4u
seen as 4cc)
Use “unit”
UD
As directed (“ut
dictum”)
Mistaken as unit dose (i.e.,
diltiazem 125 mg IV
infusion “UD” misinterpreted as meaning to
give the entire infusion as
a unit [bolus] dose)
Use “as directed”
Dose
Designations
and Other
Information
Intended
Meaning
Misinterpretation
Correction
1 mg
Mistaken as 10 mg if the
decimal point is not seen
Do not use trailing
zeros for doses
expressed in
whole numbers
0.5 mg
Mistaken as 5 mg if the
decimal point is not seen
Use zero before a
decimal point
when the dose is
less than a whole
unit
mg mL
The period is unnecessary
and could be mistaken as
the number 1 if written
poorly
Use mg, mL, etc.
without a terminal
period
U or u**
Trailing zero
after decimal
point (i.e., 1.0
mg)**
“Naked”
decimal point
(i.e., .5 mg)**
Abbreviations
such as mg. or
mL. with a
period following
the abbreviation
40
Revision Date: 04/19/2021
All Campuses
Quick Reference Conversion Card
Volume Measurements
1 tsp = 5 mL
1 Tbsp = 15 mL
1 Tbsp = 3 tsp
2 Tbsp = 30 mL = 1 oz
1 cup = 8 oz
1 pint = 2 cups
1 quart = 2 pints = 4 cups
1 L = 1000 mL
Length Measurements
1 inch = 2.54 cm
1 cm = 10 mm
Mass Measurements
1 lb = 16 oz
1 kg = 2.2 lb
1 kg = 1000 g
1 g = 1000 mg
1 mg = 1000 mcg
41
Revision Date: 04/19/2021