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 Fourth Edition
DRUG
CALCULATIONS
FOR NURSES

K23674_Book.indb 1 4/22/15 10:11 PM

K23674_Book.indb 2 4/22/15 10:11 PM
 Fourth Edition
DRUG
CALCULATIONS
FOR NURSES

ROBERT LAPHAM

K23674_Book.indb 3 4/22/15 10:11 PM

CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742

© 2016 by Taylor & Francis Group, LLC

CRC Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government works

Version Date: 20150505

International Standard Book Number-13: 978-1-4822-4846-3 (eBook - PDF)

This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have
been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibil-
ity or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions
expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect
the views/opinions of the publishers. The information or guidance contained in this book is intended for use by medical,
scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own
judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best
practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or
diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and
the drug companies’ and device or material manufacturers’ printed instructions, and their websites, before administering
or utilizing any of the drugs, devices or materials mentioned in this book. This book does not indicate whether a particular
treatment is appropriate or suitable for a particular individual. Ultimately it is the sole responsibility of the medical profes-
sional to make his or her own professional judgements, so as to advise and treat patients appropriately. The authors and
publishers have also attempted to trace the copyright holders of all material reproduced in this publication and apologize
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 Do not worry about your difficulties in Mathematics. I can assure you
mine are still greater.
Albert Einstein (1879–1955)
German-American physicist who developed the special and general
theories of relativity

K23674_Book.indb 5 4/22/15 10:11 PM

K23674_Book.indb 6 4/22/15 10:11 PM
 Contents

Preface xi
How to use this book xiii
Before we start xv
Pre-test xix

Part I: Mathematics 1
1 Basics 3
Introduction 5
Arithmetic symbols 6
Basic maths 6
Rules of arithmetic 15
Fractions and decimals 17
Roman numerals 30
Powers or exponentials 31

2 First principles 33
Sense of number and the use of calculators or formulae 33
Estimation of answers 34
The ‘one unit’ rule 35
Checking your answer – does it seem reasonable? 37
Putting it all together 38
Minimizing errors 39

3 Per cent and percentages 41

Introduction 42
Per cent and percentages 42
Converting fractions to percentages and vice versa 43
Converting decimals to percentages and vice versa 43
Calculations involving percentages 44
Drug calculations involving percentages 48
How to use the per cent key on your calculator 51

4 Units and equivalences 55

Introduction 56
SI units 56
Prefixes used in clinical practice 57
Equivalences 58
Conversion from one unit to another 59
Guide to writing units 62

K23674_Book.indb 7 4/22/15 10:11 PM

 viii Contents

5 Moles and millimoles 65

Introduction 66
What are moles and millimoles? 66
Millimoles and micromoles 67

6 Drug strengths or concentrations 73

Introduction 74
Percentage concentration 75
mg/mL concentrations 77
‘1 in …’ concentrations or ratio strengths 80
Parts per million (ppm) 81
Drugs expressed in units 83

Part II: Performing calculations 87

7 Dosage calculations 89
Introduction 90
Calculating the number of tablets or capsules required 90
Drug dosages based on patient parameters 93
Ways of expressing doses 96
Calculating drug dosages 97
Displacement values or volumes 101
Prescriber calculations 103

8 Infusion rate calculations 107

Introduction 108
Drip rate calculations (drops/min) 109
Conversion of dosages to mL/hour 112
Conversion of mL/hour back to a dose 121
Calculating the length of time for IV infusions 124

Part III: Administering medicines 129

9 Intravenous therapy and infusion devices 131
IV infusion therapy 133
Answers 140
Infusion devices 144
Infusion device classification 148

10 Action and administration of medicines 151

Action and administration of medicines 152
Introduction 153
Pharmacokinetics and pharmacodynamics 154

K23674_Book.indb 8 4/22/15 10:11 PM

 Contents ix

Administration of medicines 167

Promoting the safer use of injectable medicines 175

11 Children and medicines 179

Introduction 180
Drug handling in children 181
Pharmacodynamics 183
Routes of administration of drugs 183
Practical implications 185
Useful reference books 190
Approximate values useful in the calculation of
doses in children 190

12 The elderly and medicines 193

Introduction 194
Drug handling in the elderly 194
Specific problems in the elderly 197
General principles 198

13 Sources and interpretation of drug information 201

Introduction 201
Sources of drug information 202
The internet 203
Summary of product characteristics (SPC) 204

Revision test 211

Section one: basics 211
Per cent and percentages 212
Units and equivalences 212
Drug strengths or concentrations 213
Dosage calculations 213
Infusion rate calculations 214
Compare your scores 215
Answers to problems 216

Answers to problems set in chapters 219

3. Per cent and percentages 220
4. Units and equivalences 222
5. Moles and millimoles 223
6. Drug strengths or concentrations 227
7. Dosage calculations 228
8. Infusion rate calculations 250
10. Action and administration of medicine 278

K23674_Book.indb 9 4/22/15 10:11 PM

 x Contents

Appendices 279
1 Body surface area (BSA) estimates 281
2 Weight conversion tables 283
3 Height conversion tables 285
4 Calculation of body mass index (bmi) 287
5 Estimation of renal function 295
6 Abbreviations used in prescriptions 297

Index 299

K23674_Book.indb 10 4/22/15 10:11 PM

 Preface

Drug treatments given to patients in hospital are becoming increasingly

more complex. Sometimes, these treatment regimes involve potent and,
at times, new and novel drugs. Many of these drugs are toxic or pos-
sibly fatal if administered incorrectly or in overdose. It is therefore very
important to be able to carry out drug calculations correctly so as not to
put the patient at risk.
In current nursing practice, the need to calculate drug dosages is not
uncommon. These calculations have to be performed competently and
accurately to ensure that the nurse – and more importantly the patient –
is not put at risk. This book provides an aid to the basics of mathematics
and drug calculations. It is intended to be of use to all nurses of all grades
and specialities, and to be a handy reference for use on the ward.
The concept of this book arose from nurses themselves; a fre-
quently asked question was: ‘Can you help me with drug calculations?’
Consequently, a small booklet was written to help nurses with their
drug calculations, particularly those studying for their IV certificate.
This was very well received, and copies were being reproduced from
the originals, indicating the need for such help, and for a book like this.
The book’s content was determined by means of a questionnaire sent
to nurses, asking them what they would like to see featured in a drug
calculations book. As a result, this book was written with the aim to
cover the topics that nurses would like to see.
Although the book was primarily written with nurses in mind, it can
also be used by anyone who uses drug calculations in their work. Some
topics have been dealt with in greater detail for this reason (e.g. moles
and millimoles). Therefore this book can be used by anyone who wishes
to improve their skills in drug calculations, and it can also be used as a
refresher course.

K23674_Book.indb 11 4/22/15 10:11 PM

K23674_Book.indb 12 4/22/15 10:11 PM
 How to use this book

This book is designed to be used for self-study. Before you start, you
should attempt the pre-test to assess your current ability in carrying out
drug calculations. After completing the book, repeat the test and com-
pare the two scores to see if you have made any improvement.
To attain maximum benefit from the book, start at the beginning
and work through one chapter at a time, as subsequent chapters increase
in difficulty. You should understand each chapter fully and be able to
answer the problems confidently before moving on to the next chapter.
Alternatively, if you wish to quickly skip through any chapter, you
can refer to the Key Points found at the beginning of each chapter.

Case reports
During the period 1991 to 2002, the journal Pharmacy in Practice high-
lighted various medication errors. These have been used throughout the
book to illustrate various learning points.

Estimations
It is good practice to estimate answers to drug calculations. Throughout
the book, for all worked examples and answers to problems, estima-
tions will be given before calculating the answers. Estimations are usu-
ally manipulations of numbers, and for simple calculations, most of the
answers can be obtained by number manipulation. There are various
means to estimate answers and by following those given in the book,
readers will be able to see some of the techniques used, and hopefully
develop their own.

Online practice questions

New to this edition is an online test bank featuring hundreds of practice
questions. Test yourself, track your progress and refer back to the book to
address your areas of weakness. Please go to www.drugcalcsnurses.co.uk
to register.

K23674_Book.indb 13 4/22/15 10:11 PM

K23674_Book.indb 14 4/22/15 10:11 PM
 Before we start

Drug calculation questions are a major concern for most healthcare

professionals, including nurses and those teaching them. There are
numerous articles highlighting the poor performance of various health-
care professionals.
The vast majority of calculations are likely to be relatively straight-
forward, and you will probably need to perform complex calculations
only infrequently. But it is obvious that people are struggling with basic
calculations.
It is difficult to explain why people find maths difficult, but the best
way to overcome this is to try and make maths easy to understand by
going back to first principles. The aim is not to demean or offend any-
one, but to remind and explain the basics. Maths is just another lan-
guage that tells us how we measure and estimate, and these are the two
key words. It is vital, however, that any person performing calculations
using any method, formula or calculator can understand and explain
how the final dose is actually arrived at through the calculation.

Numeracy
Numeracy is used for a range of healthcare activities, such as measuring
height and body weight, drug administration and for managerial tasks
such as budgeting (Hutton 2009). Poor numeracy among healthcare
staff is not new. It has always been a concern and is regularly raised in
the media. Recently (May 2014) a trust chief executive quoted a failure
rate of 50 to 80 per cent when testing nursing job applicants’ literacy
and numeracy skills (Lintern 2014).
In nursing and midwifery, the Nursing and Midwifery Council (NMC)
has introduced several measures to improve the numeracy skills of nurses
and midwives by introducing the concept of Essential Skills Clusters –
ESCs (NMC 07/2007). Since 2008, applicants for pre-registration
­programmes must be able to manipulate numbers as applied to volume,
weight and length (including addition, subtraction, division, multiplica-
tion and use of decimals, fractions and percentages) and be able to use a
calculator (Axe 2011, NMC 03/2008).
Why do nurses regularly perform badly in numeracy tests? McMullan,
Jones and Lea (2010) provided some suggestions: individuals who are
anxious about performing numeracy may be drawn to people-oriented
and caring careers such as those in healthcare. They also suggested an
over-reliance on calculators and no practice in mental arithmetic in sec-
ondary schools as contributing factors.

K23674_Book.indb 15 4/22/15 10:11 PM

 xvi Before we start

The ESCs (NMC 07/2007) require the standard of a 100% pass

mark for numerical assessment for nursing students graduating to regis-
tration. Young, Weeks and Hutton (2013) produced a list of numeracy
skills (linked to the NMC ESCs) and where they are needed in nursing
practice:

Numeracy Skill Example

Estimation • All medication dosages

• IV infusion rate calculations
Addition • Fluid balance
• Addition of doses of varying strengths (tablets,
capsules, suspensions)
Subtraction • Fluid balance
Multiplication • Conversion of units
• IV infusion rate calculations
Division • Conversion of units
• IV infusion rate calculations
Fractions • Drip rate calculations
• Enteral feeding
• Conversion to SI units
Decimals • Conversion of units
• IV infusion rate calculations
SI Units • Prescriptions
• Haematology and biochemistry blood results
• Patients’ weight measurement and conversion
Conversion of units • Paediatric dosages
• Translation to imperial measures for patients/
relatives (e.g. birth weight)
Understanding • Distinguish between percentage expressions
percentages (e.g. 5% dextrose, grams/100 mL, 98% oxygen
saturation, 2% management cuts)
Ratio • Preparation of solutions
• Medications dosage calculation
Use of formulae • Dosage calculations
• IV infusion rate calculations
• Body surface area (BSA) estimation
• Body mass index (BMI) calculation
Use of tables • Conversion tables (Imperial/SI units)
• BMI tables
Use of charts/graphs • Temperature charts
• Growth charts
• Prescription charts
Appreciation of statistics • Evidence-based practice
Continued

K23674_Book.indb 16 4/22/15 10:11 PM

 Before we start xvii

Numeracy Skill Example

Budgeting • Stock control

Basic bookkeeping • Helping clients with managing their money
Measurement • Fluid balance
• Vital signs
• Preparing/drawing-up and dispensing medicines
Negative numbers • Fluid balance
• Ophthalmics
Recognition of indices • Blood results (e.g. WBC 4.0 × 109/L)

References
Axe S. Numeracy and nurse prescribing: do the standards achieve their
aim? Nurse Education in Practice 2011; 11(5): 285–287.
Hutton M. Numeracy and drug calculations in practice. Primary Health
Care 2009; 19(5): 40–45.
Lintern S. Concern as nurses fail drug numeracy testing. Health Service
Journal 2014; May 23: 13.
McMullan M, Jones R, Lea S. Patient safety: numerical skills and drug cal-
culation abilities of nursing students and Registered Nurses. Journal
of Advanced Nursing 2010; 66(4): 891–899.
NMC Circular 07/2007: Introduction of Essential Skills Clusters for Pre-
Registration Nursing Programmes. Nursing and Midwifery Council,
London.
NMC Circular 03/2008: The Evidence of Literacy and Numeracy Required
for Entry to Pre-Registration Nursing Programmes. Nursing and
Midwifery Council, London.
Young S, Weeks KW and Hutton BM. Safety in numbers 1: essential
numerical and scientific principles underpinning medication dose
calculation. Nurse Education in Practice 2012; 13(2): e11–e22.

K23674_Book.indb 17 4/22/15 10:11 PM

K23674_Book.indb 18 4/22/15 10:11 PM
 Pre-test

To obtain the maximum benefit from this book, it is a good idea to

attempt the pre-test before you start working through the chapters. The
aim of this pre-test is to assess your ability at various calculations.
The pre-test is divided into several chapters that correspond to each
chapter in the book, and the questions reflect the topics covered by each
chapter. You don’t have to attempt every chapter, only the ones that you
feel are relevant to you. Answering the questions will help you identify
particular calculations you have difficulty with.
You can use calculators or anything else you find useful to answer
the questions, but it is best to complete the pre-test on your own, as it is
your ability that is being assessed and not someone else’s.
Don’t worry if you can’t answer all of the questions. The aim of the
pre-test is to help you to identify areas of weakness. Again, you don’t have
to complete every section, just the ones you want to test your ability on.
Once you have completed the pre-test and checked your answers,
you can the start using the book. Concentrate particularly on the areas
you were weak on, and if necessary, miss out the chapters you were
confident with.
It is up to you as to how you use this book, but the pre-test should
help you to identify areas you need to concentrate on.
The pre-test consists of 50 questions and covers all the topics and
types of questions in the book. Mark your score out of 50 and then
double it to find the percentage.

BASICS
This section tests your ability on basic principles such as multiplication,
division, fractions, decimals, powers and using calculators before you
start any drug calculations.

Long multiplication
Solve the following:

1 678 × 465
2 308 × 1.28

Long division
Solve the following:

3 3143 ÷ 28
4 37.5 ÷ 1.25

K23674_Book.indb 19 4/22/15 10:11 PM

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