NURS 4431 Nursing Care of Children

and Adolescents

Math for Pediatric Nursing

A Study Guide
Pediatric Medications & Dosages
Math Test
• Your math exam will be given during your
clinical orientation/lab day, Week 2 of the
course.
• It will be a paper and pencil exam to be graded
by the Clinical Instructor.
• The test consists of 30 questions that must be
completed in 60 minutes.
Pediatric Medications & Dosages
Math Test
• You cannot give medications in Clinical until you
pass the math test with a 90% or higher.
• A score of 90% or higher is passing.
• Students have two attempts: Math Test #1 and
Math Test #2.
Pediatric Medications & Dosages
Math Test
• If you have to take Math Test #2, it will be
given the first day of the 2nd week of clinical.
• The score on Math Test #1 counts 10%
towards the N4431 course grade.
• If 90% is NOT achieved on Math Test #2,
a student must withdraw from N4431.
Key Points
DO NOT PANIC; DO STUDY!

 You will be provided a basic calculator to

use for the test.

Work practice problems in Pediatric

Medications & Dosages Math Study Guide
posted on EPIC.

Study this tutorial .

Read in Wong textbook; pp. 1120-1130 on

medication administration.
Key Points
Follow Calculation Rules:
• Round all answers to the 2nd decimal.
Place 1.2672 is rounded to 1.27
• Round at end of your calculations 
Round your final answer only.
• If the number is 5 or greater, round off to the
next highest number 1.585 = 1.59
 IV infusion rates, daily maintenance fluid
needs, and calorie amounts are rounded to
whole numbers, not decimals.
Key Points
 Joint Commission “Do Not Use” List (1/2004):
• Lead with zero “0” before a decimal point:
0.12 mg not .12
• Do not end with zero “0” after a decimal point:
1.2 mg not 1.20 mg
• Write unit or units; do not write U or u
• Write international units; do not write IU
• Write daily or every other day; Do not write QD
or QOD
• Write morphine sulfate or magnesium sulfate;
do not write MS, MSO4, or MgSO4
Key Points
 Joint Commission Recommendations (5/2005):
• Write greater than; do not write >
• Write less than; do not write <
• Write ml or milliliters; do not write cc
• Write at; do not write @
• Write mcg or micrograms; do not write µg
• Write names of drug in full: do not abbreviate
• Use metric units: do not use apothecary units
 KNOW Essential Equivalents
MOST IMPORTANT IN PEDIATRIC NURSING!
1 kg = 2.2 lbs
 You must be able to convert the weight
of your patients from kg to lbs and from lbs
to kg.

1 in = 2.54 cm
 You must be able to convert the height or
length of your patients from inches or
feet/inches to cm and from cm to inches.
 KNOW Essential Equivalents
 IMPORTANT for MEASURING FLUIDS
AND MEDICATION ADMINISTRATION
1 oz = 30 mL
1 Tbsp = 15 mL
1 tsp = 5 mL
3 tsp = 1 Tbsp
1 cup = 240 mL
1 liter = 1000 mL
**WHEN WEIGHING DIAPERS: 1 mL = 1 gm**
 KNOW Essential Equivalents
IMPORTANT when CALCULATING
MEDICATION DOSAGES
1 kg = 1000 gm
1 gm =1000 mg
1 mg = 1000 mcg
1 gm =15 gr (grain)
1 gr = 60 mg
 Conversions
1 lb = 16 oz
∗ 12 lbs 5 oz
5 oz = 5/16
5 ÷ 16 = 0.3125
12.31 lbs
∗ 9.75 lbs
0.75 lbs = ? oz
0.75 x 16 = 12 oz
9 lbs 12 oz
∗ 25 ½ lbs = 25.5 lbs
25 ¼ lbs = 25.25 lbs
25 ¾ lbs = 25.75 lbs
 Conversions
1 kg = 2.2 lbs

∗ 6 kg x 2.2 = 13.2 lbs

∗ 8.44 lbs ÷ 2.2 = 3.84 kg

∗ 25.75 lbs ÷ 2.2 = 11.7 kg

 Conversions
1 in = 2.54 cm

∗ 21 in x 2.54 = 53.34 cm

∗ 78 cm ÷ 2.54 = 30.71 in
Safe Dosage Calculations
Ordered: Ciprofloxacin 400mg IV every 12 hr
Available in vial: 500 mg in 2 mL
Safe dose range: 10-20 mg/kg/DAY (24 hrs)
Patient weight: 42.56 kg
#1. Safe dose range is 425.6 to 851.2 mg/DAY
42.56 kg x 10 mg/kg/day = 425.6
42.56 kg x 20 mg/kg/day = 851.2
#2. Actual dose = 800 mg/DAY (24 hrs)
#3. Actual dose is within safe range.
#4. YES, dose is safe.
Safe Dosage Calculations
Ordered: Tylenol 320 mg PO every 6 hrs prn
Available in bottle of oral suspension: 80mg/mL
Safe dose range: 10 – 15 mg/kg/DOSE every 6 hrs
Patient weight: 14.42 kg
#1. Safe dose range is 144.2 to 216.3 mg/DOSE
14.42 kg x 10 mg/kg/dose = 144.2
14.42 kg x 15 mg/kg/dose = 216.3
#2. Actual dose = 320 mg/DOSE
#3. Actual dose is above safe range
#4. NO, dose is NOT safe.
 Amount to Administer
Ordered: Cefuroxime 275 mg PO BID
Available in bottle of oral suspension: 125 mg/mL
#1. 1 mL__ = ? mL_
125 mg 275 mg
#2. 1 x 275 = 275
125 x ? mL = 275 (or 275 ÷ 125 = ? mL)
? = 2.2mL
#3. Administer 2.2 mL (275 mg)
 Amount to Administer
Ordered: Dilantin 35 mg IV now
Available in vial: 100 mg/2 mL
#1. 2 mL__ = ? mL_
100 mg 35 mg
#2. 2 x 35 = 70
100 x ? mL = 70 (or 70 ÷ 100 = ? mL)
? = 0.7 mL
#3. Administer 0.7 mL (35 mg)
Dilutions & Concentrations
Ordered: Ciprofloxacin 400mg IV q12 hr
Available in vial: 400 mg in 1.6 mL
Correct concentration: 10 mg/mL

How many mL of normal saline (NS) would

you add to dilute 400 mg of Ciprofloxacin
and have the correct concentration?
Dilutions & Concentrations
Ordered: Ciprofloxacin 400mg IV every 12 hr
Available in vial: 400 mg in 1.6 mL
Correct concentration: 10 mg/mL
#1. 1 mL = ? mL__
10 mg 400 mg
#2. Total volume needed for correct concentration = 40 mL
10 x ? mL = 400 (or 400 ÷ 10 = ? mL)? = 40 mL
#3. 400 mg of Ciprofloxacin = 1.6 mL
40 mL – 1.6 mL = 38.4 mL
#4. Add an additional 38.4 mL of NS
Dilutions & Concentrations
Ordered: Levaquin 300 mg IV every 24 hrs. - to be
infused over 90 minutes.
Available: Levaquin in a syringe pre-mixed with D5W
Correct concentration: 5 mg/mL

Based on the correct concentration, how many mL

of solution is in the syringe?
#1. 1 mL = ? mL_
5 mg 300 mg
#2. Total volume needed for correct concentration = 60 mL
5 x ? mL = 300 (or 300 ÷ 5 = ? mL) ? = 60 mL
#3. The total volume in the pre-mixed syringe is 60 mL.
 IV Infusion Rates/Times
What is the correct IV rate (in mL/hr) to
infuse 50 mL over 40 minutes?
#1. 50 mL X 60 min = 3000
40 min 1hr. 40
#2. 3000 ÷ 40 = 75 mL/hr
#3. IV rate = 75 mL/hr
 IV Infusion Rates/Times
What is the correct IV rate (in mL/hr) to
infuse 50 mL over 40 minutes?
#1. 50 mL = ? mL
40 min 60 min
#2. (50 X 60) ÷ 40 = 75 mL/hr
#3. IV rate = 75 mL/hr
 IV Infusion Rates/Times
Patient needs 1245 mL/day of IV
fluid intake
#1. 1245 mL = ? mL
24 hr 1 hr
#2. 1245 ÷ 24 = 51.88 mL/hr
#3. IV rate = 52 mL/hr
 Total Fluid Intake
From 1000-1900 (9 hours), patient had the following:
* IV running at 20 mL/hr
* Oral intake of 1 cup of milk & 120 mL of water
(1 cup = 8 oz)

What was the patient’s total fluid intake from

1000 to 1900 (9 hrs)?
#1. Total intake from 1000-1900:
IV: 9 hrs@20 mL/hr = 180 mL
PO: milk: 8 oz x 30 mL/oz = 240 ml
water = 120 mL
#2. 180 + 240 + 120 = 540 mL
#3. Total fluid intake was 540 mL
 Daily Maintenance Fluids Needs

Maintenance formula based on weight:

• 100 ml/kg/day for first 10 kg of body weight
• 50 ml/kg/day for second 10 kg of body weight
• 20 ml/kg/day for each additional kg of body weight

¹Hockenberry, M. (2004). Wong’s Clinical Manual of Pediatric Nursing (6th ed), p. 103.
 Daily Maintenance Fluids Needs
Child weighs 17.56 kg
#1. 100 x 10 = 1000 mL
#2. 50 x 7.56 = 378 mL
#3. 1000 + 378 mL = 1378 mL
#4. For maintenance, the child needs 1378 mL
of fluid intake per day.
 Daily Maintenance Fluids Needs
Child weighs 39.17 kg
#1. 100 x 10 = 1000 mL
#2. 50 x 10 = 500 mL
#3. 20 x 19.17 = 383.4 mL
#4. 1000 + 500 + 383 mL = 1883 mL
#5. For maintenance, the child needs 1883 mL
of fluid intake per day.
 Caloric Intake
Infant’s total intake for 24 hr: 5 bottles
Each bottle contained: 2.5 oz of formula
Formula: 24 calories/oz
Infant weight: 2.78 kg
Infant age: 3 weeks

How many calories did the infant receive in

the past 24 hours?
#1. 5 x 2.5 = 12.5 oz/day
#2. 12.5 x 24 = 300 calories/day (300 kcal/day)
 Caloric Intake
In the past 24 hours, did the infant receive
calories at or above the minimum?
Based on age and weight; infant needs a minimum of
108 cal/kg/day.²
#3. 108 x 2.78 = 300.24 or 300 calories/day
Minimum intake = 300 calories/day
Actual intake = 300 calories/day
#4. YES, caloric intake is at or above
the minimum.
2 Hockenberry, M. (2004). Wong’s Clinical Manual of Pediatric Nursing (6th ed), p. 103.
 Caloric Intake
Infant’s total intake for 24 hr: 6 bottles
Each bottle contained: 3 oz of formula
Formula: 20 calories/oz
Infant weight: 3.9 kg
Infant age: 4.5 weeks

How many calories did the infant receive in

the past 24 hours?
#1. 6 x 3 = 18 oz/day
#2. 18 x 20 = 360 calories/day (360 kcal/day)
 Caloric Intake
In the past 24 hours, did the infant receive
calories at or above the minimum?
Based on age and weight; infant needs a minimum
of 108 cal/kg/day. ²
#3. 108 x 3.9 = 421.2 or 421 calories/day
Minimum intake = 421 calories/day
Actual intake = 360 calories/day
#4. NO, caloric intake is NOT at or above the
minimum.
2 Hockenberry, M. (2004). Wong’s Clinical Manual of Pediatric Nursing (6th ed), p. 103.
That’s All for Now . . .

Thanks for your attention!

If you have questions, be sure to:
*Contact your Clinical Instructor
*Contact your Academic Coach
*Contact the Student Success Coordinator-
Ceil Flores cflores@uta.edu
*Contact your Lead Teacher, Jenny Roye
N4431 Lead Teacher: roye@uta.edu

Be prepared – keep studying!