Rochester Regional Health System
Nursing Education/Staff Development
Medication Review Packet
2014
The Medication Administration Examination for all new hire nurses consists of fifty multiplechoice questions. The test questions consist of twenty dosage calculations for oral and parenteral
medications and thirty questions on principles of medication administration and therapeutic
effects/side effects of medications.
On the day of your exam please bring a calculator. You may also bring a current dug
reference book.
Part I of this study guide provides information on dosage calculations and IV flow rate
calculations. The answers for the sample practice questions have been provided to assist in your
review. A calculator may be used for the calculation portion of the exam.
Part II of this packet provides the name of the drugs that you will need to know for the drug
portion of the exam. Please use a current nursing drug reference book to review the drug’s
action, side effects and important nursing administration implications for each of the drugs listed.
The Joint Commission and Unity Health System’s prohibited abbreviations are to be reviewed as
part of the medication exam expectation. See attached page to this guide.
If you have any questions in regards to the test or the review packet please contact Clinical
Education at 723-7115.
Part I: Dosage and IV drip rate Calculations
To calculate the correct oral and parenteral medication dosage ordered follow 3 steps:
1)
Be sure all measures are in the same system of measurement and all units are in
the same size. Do not forget to convert whenever necessary.
Remember: Always convert unit measures to be the same.
gram= g = 1 gram
microgram =mcg (ug) = 0.001 milligram
milligram = mg = 0.001 gram
1000 mcg = 1 milligram
1000 mg =1 gram
liter = L = 1
millilitre = ml = 0.001L
1000 ml =1L
1kg = 2.2 lbs
When converting grams to milligrams: move the decimal point to the right 3 places (larger
to smaller)
1
When converting milligrams to grams: move the decimal point 3 places to the left (smaller
to larger).
3)
Calculate the drug dosage using one of the suggested formula:
Formula Example One:
Amount to be Given = Desired Dose
Dose Available X Quantity Available
Example 1:
Ordered: Lasix 60 mg IV
Available: Lasix 10 mg/ml
Amount to be Given= Desired Dose
Dose Available X Quantity Available
60 mg X 1 ml = 6 ml
Dose to be given = 6 ml
10 mg
Example 2: A patient who weighs 60 kgs is to receive 5mg/kg/day of a medication
intravenously in divided doses q 8 hrs. How many mg should the patient receive of the
medication with each dose:
Dose= 5 mg X 60 kg/day= 300 mg/day  3 doses
Dose to be given: 100 mg
Formula Example Two: Ratio proportion (fraction method)
Dose on hand
Vehicle
=
Dose desired
Amount desired
The know quantities are on the left side of the equation. A “vehicle” is the quantity available.
The one known and one unknown (x) is on the right side.
Example One: The order reads 200mg and you have on hand a bag of 400mg in 500cc.
Theophylline 400 mg = 200 mg
500cc
x cc
400 x = 500 X 200
400 x = 100000
x = 100000
400
x = 250 cc
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Practice Problems for Oral and Parenteral Medications
1.
Ordered: Hydrochlorothiazide 50 mg PO
Give: ______tab(s)
Available in 25mg tablets
2.
Ordered: Lasix 20 mg IV
Give: ______ml(s)
Available: Lasix 100mg in 10 ml
3.
Ordered: Lanoxin 0.125 mg PO daily
Give: ______tab(s)
Available: Lanoxin 0.25mg tablets
4.
Ordered: Inderal 15 mg PO
Give: ______tab(s)
Available: Inderal 10 mg tablets
5.
Ordered: Penicillin 250,000 units IM
Give: ______ml(s)
Available: Penicillin 500,000 units per
10 ml
6.
Ordered: Ampicillin 250 mg IV q 6 hrs
Give: ______
Available: Ampicillin 1 Gm in 500 ml
7.
Ordered: Demerol 50 mg IM q 4 hrs prn
Give: ______ml(s)
Available: Demerol 100 mg in 2 ml
8.
Ordered: Amoxicillin 100 mg PO qid
Give: ______ml(s)
Available: 80 ml suspension 125mg
per 5 ml
9.
Ordered; Duricef 1 Gm PO qid ac
Give ______tab(s)
Available: Duricef 250 mg tablets
10.
How many milligrams are equal to 0.50 grams? __________
11.
Ordered: Dopamine 4 mcg/kg/min. The patient weights 50 kg.
Available: Dopamine 400 mg mixed in 500 ml of IV solution.
The infusion pump should be set at how many ml per hour?
Remember: Always convert unit measures to be the same.
gram= g = 1 gram
milligram = mg = 0.001 gram
microgram =mcg (ug) = 0.001 milligram
1000 mcg = 1 milligram
1000 mg =1 gram
liter = L = 1
millilitre = ml = 0.001L
1000 ml =1L
1kg = 2.2 lbs
When converting grams to milligrams: move the decimal point to the right 3 places (larger to
3
smaller)
When converting milligrams to grams: move the decimal point 3 places to the left (small to
large)
Answer Key
Oral and Parenteral Medications: Amount to be Given =
1.
50 mg
25 mg X 1 tablet = 2 tablets
2.
20 mg X 10 ml = 2 ml
100 mg
3.
0.125 mg
0.25 mg X 1 tablet = 0.5 tablet
4.
15 mg
10 mg X 1 tablet = 1.5 tablets
5.
250,000 units
500,000 units X 10 ml = 5 ml
Desired Dose X Quantity Available
Dose Available
6.
Ordered dose is in mg. Available dose is in gm. You first need to convert grams to
milligrams to ensure the dosage units your are comparing are the same.1 gram = 1000mg.
Next: 250 mg
1000mg X 500 ml = 125 ml
7.
50 mg
100mg X 2ml = 1 ml
8.
100 mg
125 mg X 5 ml = 0.8 X 5 ml = 4 ml
9.
Convert grams to milligrams to have like units.
1000 mg
250 mg X 1 tablet = 4 tablets
10.
0.5. gram = how many mg? 1 gm = 1000 mg
0.50 gram X 1000mg = 500 mg
11.
Calculate Dose: Desired Dose
Dose= 4 mcg X 50 kg
Dose= 200 mcg per min. Convert 200 mcg to mg (1mcg =.001 mg)
200 mcg = 0.2 mg then
Dose on hand
4
Dopamine 400 mg in 500 ml or 400 mg = 4 mg
500 ml 5 ml
Desired Dose = 0.2 mg/min X 5 ml = 1 mg/min = 0.25ml/min X 60 min = 15 ml
Dose on hand
4 mg
1
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I.V. flow rate calculations
To calculate the correct and accurate flow rate ordered, be sure to follow three simple steps:
Step 1: Be sure all measures are in the same system, and all units are in the same size.
Convert when necessary.
Step 2: Carefully consider what is a reasonable amount of the drug that should be
administered.
Step 3: Calculate the intravenous drip rate using the formula:
Drip Rate = Volume to be infused X drip factor (gtt/ml)
Total time in minutes
Example: Ordered: Infuse 1200 ml of normal saline over 6 hrs
Drip rate factor of the infusion is 15 gtt/ml
What will be the drip rate in gtts/minute:
Step 1: Calculate total time in minutes:
6 hours X 60 minutes = 360 minutes
Step 3: Calculate drip rate
Drip rate = Volume to be infused X drip factor
Total time in minutes
Drip Rate = 1200 ml X 15 gtts/ml = 50 gtts/min
360 min
When rounding numbers: round to the nearest whole number. If tenths > 5, round up; if the
tenths is < 5, round down. If the tenths is = 5, then look at the hundredths and utilize the >, <
principle.
Example: Round 24.82 to the nearest whole number = 25
Round 36.6 to the nearest number = 37
Round 35.8 to the nearest number = 36
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Practice Problems for Intravenous Drug Calculations:
1.
Ordered: Ampicillin 500 mg dissolved in 200 ml D5W
to infuse within 2 hours
Drip rate: ________gtts/min
Drip factor: 10 gtts/ml
2.
Ordered; Normal Saline 1200 ml to infuse over 10 hrs
Drip rate: ________gtts/min
Drip factor: 15gtts/ml
3.
Ordered: 1000 ml Lactated Ringers IV in 24 hrs
Drip rate: ________gtts/min
Drip factor: 60 gtts/ml
4.
Ordered: 1500 ml D5NS IV to run for 12 hrs
Drip rate: ______gtts/min
Drip factor: 20gtts/ml
5.
Ordered: 1 L D5W to run from 0900 to 1800
Drip rate: ________gtts/min
Drip factor: 10gtts/ml
6.
Ordered: 2.5 L NS IV to infuse at 125ml/hr
Drip rate: ______gtts/min
Drip factor: 20 gtts/ml
7.
Ordered: 1000 ml D5W IV for 6 hrs
Drip rate: ________gtts/min
Drip factor: 15gtts/ml
8.
Ordered: Ancef 1Gm in 100cc D5W IVPB to infuse > 45 min.
Drip rate: _________gtts/min
Drip factor: 60gtts/ml
9.
Ordered: Ampicillin 500 mg in 50 ml of NS to infuse > 30 min.
Drip rate: ______gtts/min.
Drip factor: 15gtts/ml
Ordered: 500 ml D5LR to infuse >3 hrs
Drip factor: 60gtts/ml
10.
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Answers to IV drug calculations
1.
200 ml X 10 gtts/ml
120 min
= 16.66 or 17 gtts/min
2.
1200 ml X 15 gtts/ml
600 min
= 30 gtts/min
3.
1000 ml X 60 gtts/ml
1440 min
= 41.66 or 42 gtts/min
4.
1500 X 20 gtt/ml
720
= 41.66 or 42 gtt/min
5.
1000 ml X 10 gtt/ml
540 min
= 18.52 or 19 gtts/min
6.
125 ml X 20 gtts/ml
60 min
= 41.66 or 42 gtts/min
7.
1000 X 15 gtts/ml
360 min
= 41.66 or 42 gtts/min
8.
100 X 60 gtts/ml
45 min
= 133.33 or 133gtts/min
9.
50 X 15 gtts/ml
30 min
10.
= 25 gtts/min
500 X 60 gtts/ml
180 min
= 166.6 or 167 gtts/min
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Part II: Drug List
It is important for the nurse administering medications to know how the drug he/she is
administering will affect the patient. The nurse must be aware of the drug’s actions,
contraindications, side effects and nursing implications to facilitate the delivery of safe
quality patient care. Please refer to a current nursing drug reference book to review the following
medications for the exam.
Activated charcoal
Ativan
Atropine
Adrenalin
Beta-blockers- i.e. Metoprolol
Cardizem XL
Corticosteriods
Cafergot
Demerol
Digoxin
Dilantin
Dimercaprol
Dopamine
Epinephrine
Estrogen Preperations
Flu Vaccine
Flumazenil
Heparin
Insulin-NPH, Lantus, Regular, Humalog
Lasix
Lithium
Lovenox
Morphine Sulfate
Narcan
Nitroglycerin
NSAIDS
Opioids
Protamine Sulfate
Premarin
Tricyclic antidepressants- i.e. Elavil
Unasyn
Vancomycin
Ventolin
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Attachment A
Prohibited
Acceptable
ug
Use mcg for microgram
T.I.W.
Write out three times weekly, 3 X weekly
qd or q.d.
Use q day, q 24 hours, every day or daily
q hs
Write out q hour of sleep or at bedtime
q.o.d. or qod
Write out every other day, q other day
u or U
Write out units
X 3 d, X 2 d
Write out 3 days, 2 days
IU
Write out international unit
MS or MSO4
Write out Morphine Sulfate
MgSO4
Write out Magnesium Sulfate
Never use a zero by itself after a decimal point.
Correct: 1 mg Incorrect: 1.0 mg
Always use a zero before a decimal point.
Correct: 0.5 mg Incorrect: .5 mg
Trailing zeros after decimal point
A decimal point without a zero
Caution: Always use a space between drug name,
dose and units of measure
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Clinical Education revised 1/11
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