NLE Fundamentals of Nursing & the Nursing Process — Medication Administration & Dosage CalculationCheat Sheet
Medication Administration & Dosage Calculation cheat sheet — the reference card you wish you had on exam day. Condensed from the full study notes, this is the high-yield core of Medication Administration & Dosage Calculation for NLE Fundamentals of Nursing & the Nursing Process. Download, print, revise.
Exam context
For the Philippine Nurse Licensure Examination (PNLE), Professional Regulation Commission (PRC) — Board of Nursing tests Fundamentals of Nursing & the Nursing Process under a "Core" label, with Medication Administration & Dosage Calculation in the 6th slot across 8 chapters. NLE candidates must clear the 75% weighted average with no sub-test below 60% cut on the 2026 paper, which draws about 50 Fundamentals of Nursing & the Nursing Process questions. Date to watch: Bi-annual.
Medication Administration & Dosage Calculation - Cheat Sheet
Your last-minute exam companion covering every formula, right, route, and critical safety principle for NLE success. Review in 30 minutes before the exam.
Sections
Formulas
Formula
Dose to Give = (Desired ÷ Have) × Quantity = D/H × Q
Meaning
Desired = ordered dose; Have = strength on hand; Quantity = volume/amount of one dose unit
Watch Out
Do NOT skip unit conversion—if desired is in mg and have is in g, convert first or you will give 1000× the dose
When To Use
Every time you calculate a medication dose from stock strength (tablets, capsules, liquids)
Formula
Weight-Based Dose = mg/kg × patient weight in kg
Meaning
mg/kg = prescribed dose per kilogram; always convert pounds to kg first (1 kg = 2.2 lb)
Watch Out
Forgetting to convert lb to kg is the #1 error; you will underdose or overdose significantly—always divide lb by 2.2
When To Use
Pediatrics, chemotherapy, antibiotic dosing, and any order that specifies mg/kg
Formula
IV Flow Rate (mL/hr) = Total Volume (mL) ÷ Total Time (hr)
Meaning
Used for electronic infusion pumps; gives steady rate in milliliters per hour
Watch Out
Make sure time is in HOURS, not minutes; if given 480 minutes, divide by 60 first to get 8 hours
When To Use
Setting up any IV on an electronic pump or calculating pump settings
Formula
IV Drip Rate (gtt/min) = [Total Volume (mL) × Drop Factor (gtt/mL)] ÷ Total Time (min)
Meaning
gtt/min = drops per minute for gravity infusion; drop factor varies by IV set (10, 15, 20, or 60 gtt/mL)
Watch Out
Confusing drop factor units—always check your IV set package; microdrip = 60 gtt/mL = 1 mL/drop, NOT 1 gtt/mL
When To Use
Gravity infusions without a pump; must round to nearest whole number (cannot deliver partial drop)
Formula
Pediatric Clark's Rule (if weight not given) = Child Wt (lb) ÷ 150 lb × Adult Dose
Meaning
Estimates child dose when only adult dose is available and weight is missing
Watch Out
This is an estimate only—always verify with safe dose range and never substitute for actual weight-based calculation
When To Use
Rare in modern practice but still tested on NLE; always prefer weight-based dosing
Formula
IV Concentration = Drug Amount (mg) ÷ Total Volume (mL)
Meaning
Tells you how many mg are in each mL of solution (e.g., 100 mg/mL)
Watch Out
Always know the concentration on hand before drawing up; insulin vials vary (100 units/mL or 50 units/mL)
When To Use
When calculating how many mL to draw up of a concentrated drug (e.g., insulin, heparin, concentrated KCl)
Common Values
Value
60 gtt/mL
Symbol
gtt/mL
Quantity
Microdrip drop factor
Value
10, 15, or 20 gtt/mL
Symbol
gtt/mL
Quantity
Macrodrip drop factor (common)
Value
5 mL
Symbol
mL
Quantity
Standard teaspoon
Value
15 mL
Symbol
mL
Quantity
Standard tablespoon
Value
30 mL (approx)
Symbol
mL
Quantity
Standard ounce
Value
1,000 mg
Symbol
mg
Quantity
1 gram
Value
1,000 mcg (µg)
Symbol
mcg
Quantity
1 milligram
Value
2.2 pounds
Symbol
lb
Quantity
1 kilogram
Value
1,000 mL
Symbol
mL
Quantity
1 liter
Section Title
Core Dosage Calculation Formulas
Important Facts
- Conversions: 1 g = 1,000 mg; 1 mg = 1,000 mcg (µg); 1 kg = 2.2 lb; 1 L = 1,000 mL; 1 tsp = 5 mL; 1 tbsp = 15 mL; 1 oz ≈ 30 mL
- Always convert to the SAME unit before calculating; mixing units = wrong answer
- Use LEADING ZERO for decimals <1 (write 0.5 mg, NOT .5 mg); NEVER use trailing zero (NOT 5.0 mg—safety risk in prescriptions)
- The formula D/H × Q works for ANY unit as long as D and H are in the SAME unit
- Microdrip = 60 gtt/mL; 1 gtt = 1 mL; often used for pediatrics, medications needing precision, or older patients with fragile veins
- Macrodrip = 10, 15, or 20 gtt/mL; used for large volumes needing faster infusion in stable adults
- IV pumps are NOT 100% accurate—always check line and site visually every hour; gravity sets depend on gravity and may slow over time
- Always ROUND gtt/min to nearest whole number (you cannot give 31.5 drops)
- For weight-based dosing in pediatrics, verify the calculated dose is within the SAFE DOSE RANGE in drug references before giving
Key Definitions
Term
Desired Dose
Example
Order reads 'metformin 500 mg PO BID' — desired dose = 500 mg
Definition
The amount of medication ordered by the physician for this patient at this time.
Term
Dose on Hand (Stock Strength)
Example
Metformin tablet labeled '250 mg per tablet' — have = 250 mg
Definition
The concentration or strength of the medication available in the medication storage (bottle, vial, or unit dose).
Term
Bioavailability
Example
IV has 100% bioavailability (all drug enters bloodstream); oral may be 50–80% (some absorbed in GI tract)
Definition
Percentage of an administered dose that reaches systemic circulation and is available to produce a therapeutic effect.
Term
Half-Life (t½)
Example
Warfarin t½ ≈ 40 hours; dosing once daily is sufficient; tobramycin t½ ≈ 2 hours; needs multiple daily doses
Definition
Time required for plasma drug concentration to fall by half; determines dosing intervals.
Term
Therapeutic Range
Example
Digoxin therapeutic range: 0.5–2.0 ng/mL; below = ineffective, above = toxicity risk
Definition
The plasma concentration range at which a drug is safe and effective without toxicity.
Term
Onset, Peak, and Duration
Example
IV morphine: onset 5 min, peak 15–20 min, duration 3–6 hrs; assess pain before and after peak time
Definition
Onset = time from administration to first effect; peak = maximum drug concentration/effect; duration = total time drug is active.
Diagrams To Know
- The D/H × Q formula and how each component changes the answer
- IV flow rate calculation pathway (is it a pump? gravity? what is the drop factor?)
- Pound-to-kilogram conversion (always ÷ 2.2, never × 2.2)
Common Values
Value
10–15 degrees
Symbol
°
Quantity
Intradermal angle
Value
45–90 degrees
Symbol
°
Quantity
Subcutaneous angle
Value
90 degrees (perpendicular)
Symbol
°
Quantity
Intramuscular angle
Value
0.1 mL
Symbol
mL
Quantity
Intradermal max volume
Value
1 mL
Symbol
mL
Quantity
Subcutaneous max volume
Value
3 mL (deltoid: ≤1 mL)
Symbol
mL
Quantity
Intramuscular max volume (adult)
Section Title
Routes of Administration & Injection Angles
Important Facts
- ORAL (PO): safest, most convenient; slower onset; do NOT crush enteric-coated or sustained-release tablets
- SUBLINGUAL (SL): under tongue; bypasses first-pass metabolism (absorbed directly into bloodstream); e.g., nitroglycerin
- BUCCAL: against cheek; slower absorption than SL; do not chew or swallow
- TOPICAL/TRANSDERMAL: skin application; rotate patch sites; remove old patch before applying new; slow onset, long duration
- INHALATION: via lungs; rapid onset; used for bronchodilators and anesthetics; teach patient proper MDI/nebulizer technique
- INSTILLATION: eye, ear, nose drops; do NOT share applicators to prevent cross-infection
- RECTAL: suppository; slower than PO; useful if patient NPO or vomiting
- INTRAMUSCULAR SITES (in order of safety): 1) Ventrogluteal (safest—away from major nerves/vessels; even for infants), 2) Vastus lateralis (preferred for infants <7 months), 3) Deltoid, 4) Dorsogluteal (AVOID—risk of sciatic nerve damage)
- Do NOT aspirate after SC heparin or enoxaparin injection—causes bruising/hematoma; gentle massage also not recommended
- SC insulin injection: rotate sites in a pattern (e.g., abdomen, then arms, then legs, then back to abdomen next week); avoid ~5 cm radius around umbilicus
Key Definitions
Term
Intradermal (ID)
Example
Mantoux (TB) test, allergy testing—read result at 48–72 hours
Definition
Injection into the dermis for allergy testing or TB screening; 10–15° angle; forms a bleb/wheal; volume ≤0.1 mL.
Term
Subcutaneous (SC/SQ)
Example
Insulin, heparin, enoxaparin, vaccines; rotate sites to avoid lipodystrophy
Definition
Injection into fatty tissue under skin; 45–90° angle; volume ≤1 mL (usually 0.5 mL); absorbs slowly.
Term
Intramuscular (IM)
Example
Vaccines, antibiotics, hormones; use Z-track for irritating drugs
Definition
Injection into muscle; 90° angle; adult volume up to 3 mL (deltoid ≤1 mL); faster absorption than SC.
Term
Intravenous (IV)
Example
Fluids, antibiotics, chemotherapy, emergency medications
Definition
Injection directly into a vein; immediate onset, 100% bioavailability; highest risk; requires strict asepsis and monitoring.
Term
Z-Track Technique
Example
Iron dextran, magnesium sulfate, certain antibiotics—prevents tissue staining and irritation
Definition
For IM injections: displace skin 1–1.5 inches laterally, inject, then release skin to seal puncture and prevent drug leakage into SC tissue.
Diagrams To Know
- Injection angles: ID 10–15°, SC 45–90°, IM 90°
- IM injection sites: ventrogluteal, vastus lateralis, deltoid, dorsogluteal (with risk)
- Z-track injection sequence: displace → insert → inject → release
Section Title
The Ten Rights of Medication Administration
Important Facts
- THREE CHECKS of the label: (1) when removing from storage, (2) when preparing/pouring, (3) at bedside before administering
- If patient questions a medication, STOP and re-verify the order before giving—patient insight is valuable
- NEVER leave oral medications at bedside; stay with patient until swallowed to confirm administration
- Use PATIENT'S NAME when speaking to them, not room number, to ensure you have the right person
- Check for ALLERGIES before EVERY dose; ask about environmental allergies too (e.g., penicillin if allergic to shellfish—cross-reaction possible)
- HIGH-ALERT drugs (insulin, heparin, anticoagulants, opioids, KCl, chemotherapy, neuromuscular blockers) require independent double-checks by two nurses
- If you make a medication error: (1) assess patient immediately, (2) notify prescriber and unit manager, (3) complete incident report, (4) document honestly in chart; never hide or document falsely
- Medication reconciliation at hospital admission and discharge is a patient safety requirement under PRC and RA 9173
- For patients in ICU or on multiple medications, verify orders in the medical record match the MAR before administering
- Safe abbreviations only: use 'units' (not U), 'mcg' (not µ), leading zeros (0.5 mg), NO trailing zeros (not 5.0 mg)
Key Definitions
Term
Right Patient
Example
Ask patient to state name and compare to wristband; check hospital ID and birthdate against MAR
Definition
Verify identity using TWO identifiers (name + hospital ID or birthdate); NEVER use room number alone.
Term
Right Drug
Example
Order says 'amoxicillin' but label reads 'ampicillin'—STOP, do NOT give; notify prescriber
Definition
Verify ordered drug name against the label; check for look-alike/sound-alike names (e.g., cefazolin vs cephalexin).
Term
Right Dose
Example
Order: 500 mg; on hand 250 mg tablets. Calculate: 500/250 × 1 = 2 tablets. Do not give 1 tablet.
Definition
Calculate dose and verify it matches the order; double-check high-alert drugs (insulin, heparin, KCl, opioids).
Term
Right Route
Example
If order is 'metformin 500 mg PO' but patient is NPO, clarify with prescriber before giving IV
Definition
Confirm the route ordered (PO, IV, IM, SC, etc.) matches the drug form available and patient's ability to take it.
Term
Right Time/Frequency
Example
Order 'ampicillin 500 mg q6h' = give at 0600, 1200, 1800, 2400; NOT all at once
Definition
Administer at the correct time and interval; respect q6h (every 6 hours), BID (twice daily), AC (before meals), etc.
Term
Right Documentation
Example
In MAR: 'Acetaminophen 500 mg PO at 1000; patient tolerated well; pain decreased to 3/10 at 1030'
Definition
Chart AFTER giving the medication, NEVER before; record drug name, dose, route, time, site (if injection), and patient response.
Term
Right Reason/Indication
Example
Patient with no fever does not need acetaminophen; patient with normal BP may not need antihypertensive—question the order
Definition
Verify the therapeutic purpose—why is this patient getting this drug? (e.g., for fever, hypertension, infection).
Term
Right Assessment
Example
Before giving metoprolol, check heart rate; if HR <60, hold and notify. Before morphine, check respiratory rate; if RR <12, hold.
Definition
Check relevant vital signs and parameters BEFORE administering (e.g., apical pulse before digoxin, BP before ACE inhibitor, RR before opioid).
Term
Right Response/Evaluation
Example
After IV morphine (peak 15–20 min), reassess pain and respiratory status; document patient response
Definition
Monitor the patient AFTER administration to assess therapeutic effect and adverse effects; reassess at peak time.
Term
Right to Refuse
Example
Patient refuses antihypertensive due to side effects—do not give; chart reason; inform MD for alternative
Definition
Patient may decline any medication; STOP, do NOT force; document reason, notify prescriber, and continue monitoring.
Diagrams To Know
- The Ten Rights checklist pathway
- Three checks of the label timeline
- Two-identifier verification process
Common Values
Value
280–310 mOsm/L
Symbol
mOsm/L
Quantity
Normal plasma osmolality
Value
72–96 hours
Symbol
hours
Quantity
Peripheral IV catheter change interval
Value
60 gtt/mL
Symbol
gtt/mL
Quantity
Microdrip used for IV medications
Section Title
IV Therapy: Fluids, Tonicity, and Complications
Important Facts
- ISOTONIC fluids (0.9% NaCl, LR) are FIRST-LINE for fluid replacement in most dehydrated patients; expand extracellular fluid
- D5W = 5% dextrose in water; isotonic in the bag but becomes HYPOTONIC after dextrose is metabolized—useful as maintenance fluid and for glucose delivery
- HYPOTONIC solutions shift fluid into cells; used for hypernatremia and cellular dehydration; CONTRAINDICATED in increased ICP (brain swells further)
- HYPERTONIC solutions used for severe hypervolemia, cerebral edema, and hypernatremia; give SLOWLY via pump or central line; monitor for vein irritation
- Assess IV site EVERY HOUR minimum; check color, warmth, swelling, pain, flow rate, presence of blood in catheter
- Change peripheral IV catheter per facility policy (typically every 72–96 hours); central lines per protocol (usually 10–14 days)
- Maintain strict asepsis during dressing changes and IV site care to prevent CLABSI (catheter-related bloodstream infection)
- Always verify IV fluid compatibility before mixing or co-infusing medications; some combos precipitate and block the line
- KCl NEVER given as IV push—FATAL; must be diluted and infused slowly (20 mEq/L in saline over 1–4 hours depending on serum K level)
- For patients on diuretics or with renal disease, monitor for electrolyte abnormalities; check Na, K, Cl, BUN, Cr regularly
- If infiltration or extravasation suspected: STOP infusion immediately, remove catheter, assess limb, notify MD, may require topical treatments or compartment assessment
Key Definitions
Term
Isotonic Solution
Example
0.9% NaCl (normal saline), lactated Ringer's (LR), D5W (isotonic in bag, becomes hypotonic after dextrose metabolized)
Definition
Same osmolality as plasma (~280 mOsm/L); does NOT shift fluid between compartments; expands ECF volume.
Term
Hypotonic Solution
Example
0.45% NaCl (half-normal saline), 0.33% NaCl; risk of cerebral edema and hyponatremia; NEVER use in increased ICP
Definition
<280 mOsm/L; shifts fluid INTO cells (causes cells to swell); used for cellular dehydration.
Term
Hypertonic Solution
Example
3% NaCl, 5–10% dextrose solutions; given slowly via central line when possible; monitor for vein irritation and hyperglycemia
Definition
>280 mOsm/L; pulls fluid OUT of cells into vascular space; used for fluid overload and cerebral edema.
Term
Infiltration
Example
Peripheral line in arm swells; skin around site pale and cool; fluid flows slowly. Action: stop, remove catheter, elevate limb, apply warm/cool compress per solution
Definition
IV fluid leaks into surrounding tissue instead of entering the vein; causes swelling, coolness, pallor, no blood return.
Term
Phlebitis
Example
Peripheral IV site becomes red and warm; patient reports pain along vein. Action: discontinue IV, restart in another site, warm compress, monitor
Definition
Vein inflammation from mechanical irritation or chemical injury; presents with redness, warmth, pain, palpable cord.
Term
Extravasation
Example
Chemotherapy (doxorubicin), potassium, calcium, some antibiotics if infiltrated can cause permanent tissue damage—stop infusion immediately, notify MD
Definition
Leakage of a vesicant (tissue-damaging) drug into surrounding tissue; medical emergency causing tissue necrosis.
Term
Fluid Overload (Circulatory Overload)
Example
Patient receiving 1 L/hr × 6 hours; now short of breath, crackles bilaterally, BP 160/100. Action: slow to KVO rate, raise HOB, notify MD, give O2, monitor I&O
Definition
Excessive IV fluid infusion causing pulmonary edema, hypertension, and cardiovascular stress; signs: dyspnea, crackles, distended neck veins.
Term
Air Embolism
Example
IV tubing disconnects and air enters during infusion; patient suddenly dyspneic, chest pain, hypotension—emergency
Definition
Air bubble enters vein and travels to lungs/heart; potentially fatal; prevention: prime all tubing, secure connections, regulate pressure.
Term
Speed Shock
Example
IV antibiotic infused too fast (over 5 min instead of 30 min); patient develops fever, chills, shock—always check infusion times
Definition
Rapid IV drug infusion causing systemic toxicity; signs: flushed face, headache, tightness in chest, tachycardia, hypotension.
Diagrams To Know
- IV fluid tonicity spectrum: hypotonic vs isotonic vs hypertonic and where they work
- IV complication assessment tree: is it infiltration, phlebitis, extravasation, or fluid overload?
- IV site inspection checklist
Common Values
Value
Units only (U100 = 100 units/mL)
Symbol
units
Quantity
Insulin syringe marking
Value
3.5–5.0 mEq/L
Symbol
mEq/L
Quantity
Normal serum potassium
Value
25–35 seconds
Symbol
sec
Quantity
Normal aPTT (baseline)
Value
1.5–2.5× control
Symbol
fold
Quantity
Therapeutic aPTT on heparin
Value
0.8–1.1
Symbol
ratio
Quantity
Normal INR
Value
2–3 (most indications)
Symbol
ratio
Quantity
Therapeutic INR on warfarin
Value
70–100 mg/dL
Symbol
mg/dL
Quantity
Normal serum glucose (fasting)
Value
10 mEq/hr
Symbol
mEq/hr
Quantity
Max IV KCl infusion rate
Section Title
High-Alert Medications & Antidotes
Important Facts
- INSULIN: Always use INSULIN SYRINGES (do NOT use TB or regular syringes); units ≠ mg; when mixing two types: CLEAR BEFORE CLOUDY (regular/short-acting, then NPH); rotate injection sites daily
- HEPARIN: Monitor aPTT (active partial thromboplastin time); therapeutic range 1.5–2.5× control; check aPTT 4–6 hr after initiation/dose change; half-life ~90 min IV, ~2 hrs SC
- ENOXAPARIN: SC only; do NOT give IV; weight-based dosing (prophylaxis vs treatment); do NOT aspirate—inject 45–90° angle into abdomen away from umbilicus; no massage
- WARFARIN: onset 3–5 days; monitor PT/INR; interaction with many drugs (NSAIDs, antibiotics, phenytoin); food with vitamin K (spinach, broccoli) decreases effect; patient education critical
- OPIOIDS: Assess pain level (0–10 scale) and respiratory rate BEFORE giving; hold if RR <12 or patient sedated; peak times: IV 15–20 min, IM 30–60 min, PO 1–2 hrs; watch for addiction risk
- POTASSIUM: Normal serum K = 3.5–5.0 mEq/L; IV KCl ALWAYS diluted and ALWAYS via pump; max infusion rate 10 mEq/hr; watch for peaked T waves (hyperkalemia) on ECG; risk of cardiac arrhythmia if too fast
- CONCENTRATED ELECTROLYTES (KCl >20 mEq/L): restricted item in medication storage; double-check before each draw; verify on pharmacy label
- CHEMOTHERAPY: calculated by BSA (body surface area in m²); high risk of error; second RN verification required; monitor for extravasation; hold if counts too low
- NEUROMUSCULAR BLOCKERS (succinylcholine, rocuronium): paralytic agents used during anesthesia; RN monitors paralysis depth; antidote for non-depolarizing = neostigmine + glycopyrrolate
- Always check for DRUG INTERACTIONS before giving high-alert drugs; verify renal/hepatic function is adequate for elimination (especially in older adults, pediatrics, renal disease)
Key Definitions
Term
High-Alert Drug
Example
Insulin, heparin, anticoagulants, opioids, concentrated KCl, chemotherapy, neuromuscular blockers
Definition
Medication with high risk of significant harm if given in error; requires independent double-check by two nurses before administration.
Term
Insulin
Example
When mixing NPH and regular: 'clear before cloudy' (draw regular/short-acting first, then NPH); rotate SC sites
Definition
Hormone for glucose control; ALWAYS use INSULIN SYRINGES (U100 = 100 units/mL); monitor blood glucose.
Term
Heparin & Enoxaparin
Example
Monitor aPTT for unfractionated heparin (goal 1.5–2.5× control); enoxaparin dosed by weight; antidote = protamine sulfate
Definition
Anticoagulants; heparin IV, SC; enoxaparin SC only; monitor for bleeding; do NOT aspirate or massage SC injection site.
Term
Warfarin
Example
Vitamin K is the antidote; used for atrial fibrillation, mechanical heart valves, DVT/PE prophylaxis
Definition
Oral anticoagulant; takes 3–5 days for effect; monitor PT/INR (goal usually 2–3 for most indications).
Term
Opioids
Example
Morphine 5–10 mg IV/IM; onset varies by route (IV 5 min, IM 15–30 min); peak 15–20 min IV; monitor pain and respiratory depression
Definition
Potent analgesics; assess respiratory rate BEFORE giving; hold if RR <12; naloxone is the antidote.
Term
Potassium Chloride (KCl)
Example
Dilute 20 mEq KCl in 100–250 mL NS; infuse at ≤10 mEq/hr; never faster; monitor for infiltration (tissue damage)
Definition
Electrolyte replacement; NEVER given as IV push (causes fatal cardiac arrhythmias); must be diluted in IV fluid and infused slowly via pump.
Term
Protamine Sulfate
Example
Dose: 1 mg per 100 units of heparin; given IV over 10 min; monitor aPTT to confirm reversal
Definition
Antidote for unfractionated heparin; reverses anticoagulant effect; give IV slowly to avoid hypotension.
Term
Vitamin K
Example
Used for warfarin overdose with bleeding; dose 2.5–10 mg PO or IV; monitor PT/INR for reversal
Definition
Antidote for warfarin; restores vitamin K-dependent clotting factors; onset 12–24 hours.
Term
Naloxone
Example
Patient with RR 8 after morphine: naloxone 0.4–0.8 mg IV; patient wakes and respiratory rate increases; assess for pain re-emergence
Definition
Antidote for opioid overdose; reverses respiratory depression; IV/IM/IN; onset 2–3 min IV; short duration, may need repeat doses.
Term
N-Acetylcysteine
Example
Used within 24 hours of OD; loading dose IV, then tapering doses over 16 hours; monitor liver function
Definition
Antidote for acetaminophen overdose; protects liver by replenishing glutathione; given IV or PO.
Diagrams To Know
- High-alert drug list and their antidotes
- Insulin injection site rotation pattern
- Heparin and warfarin monitoring parameters
Formulas
Formula
Pediatric Clark's Rule = (Child Weight in lbs ÷ 150) × Adult Dose
Meaning
Estimates child dose when weight not given; older formula, less commonly used now
Watch Out
This is a crude estimate—verify result against safe pediatric dose range in drug reference; never administer without verification
When To Use
Rare; ALWAYS prefer weight-based dosing (mg/kg) when available; use Clark's Rule only if weight truly unavailable
Formula
Pediatric Dose = mg/kg ordered × child weight in kg
Meaning
Standard weight-based dosing for children; ensures safe, proportional dosing
Watch Out
Forgetting to convert lb to kg is the #1 error in pediatric dosing; always divide lb by 2.2 first; double-check calculation with another nurse
When To Use
ALL pediatric dosing—this is the gold standard; always check dose is within safe range BEFORE administering
Common Values
Value
6–8 kg
Symbol
kg
Quantity
Typical pediatric weight (6 months)
Value
10–12 kg
Symbol
kg
Quantity
Typical pediatric weight (1 year)
Value
15–20 kg
Symbol
kg
Quantity
Typical pediatric weight (5 years)
Value
≥65 years
Symbol
years
Quantity
Older adult age threshold
Section Title
Special Populations: Pediatrics & Older Adults
Important Facts
- PEDIATRIC DOSING: Always weight-based (mg/kg); volume is SMALL (often mL, not tablets); use oral syringes (not household spoons) for liquids; verify safe dose range in pediatric drug reference BEFORE giving
- PEDIATRIC CALCULATIONS: Convert lb to kg first (÷ 2.2); double-check D/H × Q calculation; round mL to nearest 0.1 mL; use appropriate measuring device
- Ventrogluteal IM site is safe even for INFANTS; vastus lateralis preferred for babies <7 months; deltoid used only in older children (arm muscle smaller)
- Pediatric drug orders: if calculated dose seems very small or very large, VERIFY immediately—medication error in pediatrics can be fatal
- OLDER ADULT DOSING: 'Start low, go slow'—lower initial dose, slower titration; assess renal function (eGFR, Cr, BUN) before dosing renally eliminated drugs
- Older adults on diuretics: monitor electrolytes (K, Na), renal function (Cr, BUN), BP, weight for fluid loss; teach signs of dehydration and orthostatic hypotension
- Polypharmacy assessment: review ALL medications (Rx, OTC, supplements) at each visit; check for duplicates, interactions, and appropriateness for age
- Common drug interactions in older adults: NSAIDs + ACE inhibitor + diuretic (hyperkalemia, AKI); warfarin + NSAIDs (bleeding risk); multiple CNS depressants (falls, confusion)
- Older adults at HIGH RISK for falls on medications like opioids, sedatives, antihypertensives; assess gait, balance, cognitive status; implement fall precautions
- Beers Criteria: list of medications to AVOID or use with caution in older adults (e.g., benzodiazepines, long-acting NSAIDs, certain anticholinergics); check before prescribing or administering
Key Definitions
Term
Pediatric Patient
Example
6-month-old weighs 8 kg; amoxicillin order 30 mg/kg = 30 × 8 = 240 mg; on hand suspension 125 mg/5 mL; give 240÷125 × 5 = 9.6 mL
Definition
Infant to adolescent; requires weight-based dosing (mg/kg) and careful monitoring due to immature organ systems and rapid physiologic changes.
Term
Older Adult
Example
80-year-old on digoxin, metoprolol, lisinopril, aspirin; kidney function declining (Cr 1.8); digoxin t½ extended—risk of toxicity; start low, go slow
Definition
Age ≥65 years; altered pharmacokinetics (reduced hepatic metabolism, renal clearance); drugs accumulate; polypharmacy common.
Term
Pharmacokinetic Changes in Older Adults
Example
Warfarin metabolism slowed; INR rises higher and stays elevated longer; requires closer monitoring and lower doses than younger patients
Definition
Decreased absorption, altered distribution, reduced hepatic metabolism, impaired renal excretion; result: slower onset, longer duration, drug accumulation.
Term
Polypharmacy
Example
Patient on 10+ medications; diuretic + ACE inhibitor + NSAID → increased hyperkalemia risk; must check interactions carefully
Definition
Use of multiple medications; increases risk of drug interactions, adverse effects, and medication errors; common in older adults.
Diagrams To Know
- Pediatric safe dose range verification checklist
- Older adult medication review framework
- Weight-based dosing calculation pathway for pediatrics
Section Title
Safe Medication Administration Practices
Important Facts
- NEVER leave oral medications at bedside unattended; patient must swallow in front of you to confirm administration
- If patient questions a medication ('I don't usually take this'), STOP and verify order—patient insight is valuable; do not give until verified
- ALWAYS check for ALLERGIES: ask directly, check allergy alert on chart, verify vs MAR; include food allergies (shellfish + penicillin cross-reaction possible)
- ASSESS BEFORE GIVING: check vital signs, relevant labs, patient status—e.g., apical pulse before digoxin, BP before antihypertensive, RR before opioid, glucose before insulin
- MEDICATION RECONCILIATION: at hospital admission, review ALL medications patient was taking at home; at discharge, provide updated list; at transfers between units, reconcile
- DOCUMENTATION: chart AFTER giving, not before; include: drug name, dose, route, time, site (if injection), patient response, patient education given, patient questions answered
- MEDICATION ERROR management: (1) STOP, (2) assess patient immediately, (3) notify prescriber and unit manager, (4) complete incident report, (5) continue monitoring, (6) do NOT hide or falsely document
- USE SAFE ABBREVIATIONS ONLY: write 'units' in full (not U); 'mcg' (not µ); use LEADING ZERO (0.5 mg not .5 mg); NEVER trailing zero (not 5.0 mg—dangerous in prescriptions)
- HIGH-ALERT DRUGS require TWO independent nurse checks before administration; both nurses verify patient, dose, calculation, expiration date
- LOOK-ALIKE/SOUND-ALIKE drug names: cefazolin vs cephalexin, atenolol vs albuterol, digoxin vs digitoxin—triple-check spelling and verify indication
Key Definitions
Term
Three Checks of the Label
Example
Acetaminophen order: check at drawer (is this acetaminophen?), at preparation (250 mg/5 mL?), at bedside (right patient, right amount?)
Definition
Safety protocol: check label (1) when removing from storage, (2) when preparing/measuring, (3) at bedside before administering; compares to physician's order each time.
Term
Two-Identifier Verification
Example
Ask 'What is your full name and date of birth?' Compare answer to wristband and MAR; document verification in chart
Definition
Confirm patient identity using TWO independent identifiers (name + ID number or birthdate); not room number or bed assignment.
Term
Medication Error
Example
Gave 2 tablets when order said 1 tablet; gave warfarin at 0800 instead of 1800; gave gentamicin to wrong patient
Definition
Any deviation from a correct medication dose, route, time, or patient; includes giving wrong drug or giving correct drug to wrong patient.
Term
Incident Report (Adverse Event Report)
Example
After medication error, complete incident report with facts (time, drug, dose, what happened, patient response); notify supervisor; ensure patient safety first
Definition
Documentation of a medication error or adverse event; used for quality improvement, never for punishment; protected legal document.
Term
Contraindication
Example
Patient allergic to penicillin = contraindication to amoxicillin; eGFR <30 = contraindication to many drugs without dose adjustment
Definition
Reason NOT to give a medication to a patient (e.g., allergy, low BP, liver disease, drug interaction).
Term
Drug Interaction
Example
Warfarin + aspirin = increased bleeding risk; metformin + alcohol = risk of lactic acidosis; digoxin + loop diuretic = hypokalemia + digoxin toxicity
Definition
Effect of one drug on another when given together; may increase/decrease effect, or cause new adverse effect.
Diagrams To Know
- The Three Checks pathway and timing
- Medication error response flowchart: assess → notify → report → document
- Pre-administration assessment checklist by drug class
Must Remember
- D/H × Q formula: Dose = (Desired ÷ Have) × Quantity; ALWAYS convert to same unit first or you will give wrong dose
- Weight-based dosing: Always convert pounds to kg (÷ 2.2, never × 2.2); verify calculated dose is within SAFE DOSE RANGE before giving
- IV gtt/min = (Volume mL × Drop Factor gtt/mL) ÷ Time in minutes; round to whole number; microdrip = 60 gtt/mL
- THE TEN RIGHTS: Right patient (two identifiers, NOT room number), drug, dose, route, time, documentation (AFTER giving), reason, assessment, response, and refusal—all non-negotiable
- Three checks of the label: Remove from storage, during preparation, and at bedside before giving; compare to physician order EACH time
- NEVER give IV potassium (KCl) as IV push undiluted—FATAL; always dilute and infuse slowly via pump at ≤10 mEq/hr
- High-alert drugs (insulin, heparin, warfarin, opioids, KCl, chemotherapy) require independent DOUBLE-CHECK by two nurses; verify dose, calculation, patient, and expiration
- Safe abbreviations: Write 'units' in full (NOT U), 'mcg' (NOT µ), use LEADING ZERO (0.5 mg NOT .5 mg), NEVER trailing zero (NOT 5.0 mg)
- IV fluid tonicity: Isotonic (0.9% NaCl, LR) stays in ECF; hypotonic (0.45% NaCl) shifts INTO cells; hypertonic (3% NaCl) pulls fluid OUT—know which to use when
- Medication error management: Stop → assess patient → notify prescriber and manager → complete incident report → document honestly; PATIENT SAFETY is priority #1, never hide errors
Last Minute Tips
- Before EVERY exam, memorize the four unit conversions cold: 1 g = 1,000 mg; 1 mg = 1,000 mcg; 1 kg = 2.2 lb; 1 tsp = 5 mL. If you mix these up, you will fail the calculation questions.
- If an exam question says 'the nurse should...' for medication administration, the answer is almost ALWAYS one of the Rights (verify patient ID, check for allergy, assess before giving, chart after giving). When in doubt, choose the safest option and the most detailed verification step.
- For any IV infusion question, first IDENTIFY the formula: Is it mL/hr (pump) or gtt/min (gravity)? Then check if drop factor is given. If not given and it is gravity, assume 15 gtt/mL. Round gtt/min to whole number.
- Pediatric dosing questions: Always check if the answer matches the SAFE DOSE RANGE in a pediatric reference. If your calculated dose is 1,000 mg but the safe range is 100–300 mg, you made an error—recheck your math before answering.
- On the NLE, if you see 'the patient questions this medication,' the correct action is ALWAYS 'stop and verify the order,' NOT 'reassure the patient and give it.' Patient safety and verification come before reassurance.
Comparison Tables
Rows
Values
- 10–15°
- ≤0.1 mL
- 5–15 min
- Forearm, inner arm
- Forms bleb; for testing only
Property
Intradermal (ID)
Values
- 45–90°
- ≤1 mL
- 15–30 min
- Abdomen, arms, thighs
- No aspiration/massage for heparin; rotate sites
Property
Subcutaneous (SC/SQ)
Values
- 90°
- ≤3 mL (deltoid ≤1 mL)
- 10–30 min
- Ventrogluteal (safest), vastus lateralis, deltoid
- Use Z-track for irritants; avoid dorsogluteal
Property
Intramuscular (IM)
Values
- 15–20° into vein
- Unlimited
- Immediate (seconds–5 min)
- Veins: hand, forearm, upper arm, central line
- Highest risk; strict asepsis; monitor for complications
Property
Intravenous (IV)
Columns
- Route
- Injection Angle
- Max Volume
- Onset Time
- Best Sites
- Key Precautions
Table Title
Routes of Administration: Comparison
Rows
Values
- ~280 mOsm/L
- No shift; expands ECF
- 0.9% NaCl, LR, D5W (in bag)
- Fluid replacement, dehydration, maintenance
- None (safest); use first-line in most situations
Property
Isotonic
Values
- <280 mOsm/L
- Pulls fluid INTO cells (cell swelling)
- 0.45% NaCl, 0.33% NaCl
- Cellular dehydration, hypernatremia
- NEVER in increased ICP, head trauma, or post-neurosurgery
Property
Hypotonic
Values
- >280 mOsm/L
- Pulls fluid OUT of cells (cell shrinking)
- 3% NaCl, D10W, D20W
- Severe hypervolemia, cerebral edema, hyponatremia
- Give SLOWLY via pump; risk of vein irritation; not with PO fluids
Property
Hypertonic
Columns
- Fluid Type
- Osmolality
- Effect on Cells
- Common Examples
- When to Use
- Contraindications
Table Title
IV Fluid Tonicity: Osmolality and Clinical Use
Rows
Values
- Blood glucose
- 80–120 mg/dL (varies by protocol)
- Glucagon (if hypoglycemia)
- Use ONLY insulin syringes; 'clear before cloudy' when mixing
Property
Insulin
Values
- aPTT
- 1.5–2.5× control
- Protamine sulfate (1 mg per 100 units heparin)
- Do NOT give IM; monitor for bleeding; check aPTT 4–6 hr after dose change
Property
Heparin (unfractionated)
Values
- PT/INR
- 2–3 (most indications; varies by condition)
- Vitamin K (phytonadione) 2.5–10 mg
- Onset 3–5 days; food/drugs affect INR; monitor for bleeding
Property
Warfarin
Values
- Respiratory rate, pain, sedation level
- RR ≥12, pain controlled, alert/appropriate
- Naloxone 0.4–0.8 mg IV/IM/IN
- Hold if RR <12; assess before EVERY dose; watch for respiratory depression
Property
Opioids
Values
- Serum potassium
- 3.5–5.0 mEq/L
- None (NEVER give undiluted; cardiotoxic)
- ALWAYS dilute; max infusion 10 mEq/hr; NEVER give IV push
Property
Potassium chloride (IV)
Values
- Serum digoxin level, apical pulse, ECG
- 0.5–2.0 ng/mL
- Digoxin-specific Fab fragments (Digibind)
- Check apical pulse ≥60 before giving; risk of toxicity in renal disease
Property
Digoxin
Columns
- Drug Class
- Monitoring Parameter
- Target Range/Goal
- Antidote
- Critical Precaution
Table Title
High-Alert Medications: Monitoring and Antidotes
Rows
Values
- Unclear handwriting, abbreviations, dose ambiguity
- Verify order is legible and complete; clarify with prescriber if unsure; use only safe abbreviations
- Assess patient immediately; notify prescriber and manager; no 'near miss' passes
Property
Ordering Phase
Values
- Misreading order, transposition of digits, copying errors
- Compare MAR to original order; double-check high-alert drugs; one nurse reads, other verifies
- Document error with facts; complete incident report; monitor patient closely
Property
Transcription Phase
Values
- Wrong drug selected, wrong dose calculated, expiration missed
- Three checks; quiet environment; use computer/pump prompts; verify calculations twice
- Do NOT give if error detected during prep; inform supervisor; reconcile with order
Property
Preparation Phase
Values
- Wrong patient, wrong time, wrong route, patient questions medicine
- Two-identifier verification; three checks at bedside; listen to patient concerns; do not skip steps when busy
- STOP immediately; assess patient; notify prescriber and manager right away; incident report required
Property
Administration Phase
Columns
- Error Stage
- High-Risk Situations
- Prevention Strategies
- If Error Occurs
Table Title
Medication Error: Prevention and Response
Rows
Values
- Weight-based (mg/kg); verify safe dose range BEFORE giving
- Start low, go slow; reduce doses for reduced renal/hepatic clearance
Property
Dosing Approach
Values
- Immature liver/kidneys; faster metabolism of some drugs; shorter half-lives
- Reduced hepatic metabolism; reduced renal clearance; drugs accumulate; longer half-lives
Property
Pharmacokinetics
Values
- SMALL (oral syringe mL, not household spoons); IM volume tiny; SC usually <0.5 mL
- Standard volumes usually appropriate; assess ability to swallow/absorb
Property
Volume of Injection
Values
- Ventrogluteal safe even for infants; vastus lateralis for <7 months; avoid deltoid in small children
- Ventrogluteal safest; assess muscle mass and fragility; use smaller volume if needed
Property
IM Site Selection
Values
- Drug effects, growth/development, fluid intake/output, electrolytes
- Drug interactions, renal/hepatic function, fall risk, polypharmacy complications, orthostatic hypotension
Property
Monitoring Focus
Values
- CRITICAL: calculation errors, wrong dose, wrong concentration; often FATAL
- HIGH: drug interactions, underdosing/overdosing, adverse effects from accumulation
Property
Error Risk
Columns
- Aspect
- Pediatrics
- Older Adults
Table Title
Pediatric vs Older Adult Medication Administration
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