Ebook Gray Morriss Calculate With Confidence PDF Full Chapter PDF

Gray Morris's Calculate with
Confidence - eBook PDF

Visit to download the full and correct content document:
https://ebooksecure.com/download/gray-morriss-calculate-with-confidence-ebook-pdf/
YOU’VE JUST PURCHASED
MORE THAN
A TEXTBOOK!
Enhance your learning with Evolve Student Resources.
These online study tools and exercises can help deepen your
understanding of textbook content so you can be more
prepared for class, perform better on exams, and succeed
in your course.
Activate the complete learning experience that comes with each

NEW textbook purchase by registering with your scratch-off access code at
http://evolve.elsevier.com/Killian/
If your school uses its own Learning Management System, your resources may be
delivered on that platform. Consult with your instructor.
If you rented or purchased a used book and the scratch-off code at right
has already been revealed, the code may have been used and cannot
be re-used for registration. To purchase a new code to access these
Place
valuable study resources, simply follow the link above.
Sticker
Here
REGISTER TODAY!
You can now purchase Elsevier products on Evolve!
Go to evolve.elsevier.com/shop to search and browse for products.
2019v1.0
Gray Morris’s
Calculate
WITH
Confidence
Second Canadian Edition
Tania Killian, BScN, BEd, MEd, CCN, CHSE
Professor of Nursing
Seneca College of Applied Arts and Technology
Toronto, Ontario
U.S. Author
Deborah C. Gray Morris, RN, BSN, MA, LNC
Chairperson
Department of Nursing and Allied Health Sciences
Bronx Community College of the University of New York (CUNY)
Bronx, New York
GRAY MORRIS’S CALCULATE WITH CONFIDENCE, SECOND EDITION ISBN: 978-0-323-69571-8
Copyright © 2022 Elsevier, Inc. All rights reserved.
Adapted from Calculate With Confidence, Seventh Edition, by Deborah Gray Morris. Copyright © 2018 by
Elsevier Inc. 978-0-323-39683-7 (softcover)
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopy, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Reproducing passages from this book without such written
permission is an infringement of copyright law.
Requests for permission to make copies of any part of the work should be mailed to: College Licensing
Officer, access ©, 1 Yonge Street, Suite 1900, Toronto, ON M5E 1E5. Fax: (416) 868-1621. All other inquiries
should be directed to the publisher www.elsevier.com/permissions.
Every reasonable effort has been made to acquire permission for copyrighted material used in this text
and to acknowledge all such indebtedness accurately. Any errors and omissions called to the publisher’s
attention will be corrected in future printings.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notice
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds or experiments described herein. Because of
rapid advances in the medical sciences, in particular, independent verification of diagnoses and
drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by
Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a
matter of products liability, negligence or otherwise, or from any use or operation of any methods,
products, instructions, or ideas contained in the material herein.
Library of Congress Control Number: 2020943609
VP Education Content: Kevonne Holloway

Content Strategist (Acquisitions, Canada): Roberta A. Spinosa-Millman
Director, Content Development: Laurie Gower
Content Development Specialist : Theresa Fitzgerald
Publishing Services Manager: Julie Eddy
Senior Project Manager: Rachel E. McMullen
Design Direction: Patrick Ferguson
Last digit is the print number: 9 8 7 6 5 4 3 2 1

To my students, past, present and future—
I wish you well in your nursing careers.
—Tania Killian
About the Authors
Tania Killian
Tania Killian, BScN, BEd, MEd, CCN, CHSE, began her nursing career at Lakehead Uni-
versity in Thunder Bay, Ontario. Graduating in 1998, she continued her educational pur-
suits at Lakehead University, subsequently completing a Bachelor and then a Masters of
Education. Tania supplemented her studies with practical field experience, spending her
summers working Search and Rescue for the Canadian Coast Guard. It was the combina-
tion of academics and experiential learning that served to solidify her love for prehospital
and emergency care. Tania parlayed this passion into a profession providing essential
service as an emergency/trauma nurse throughout the evolution of her career. The student
turned teacher in 2002 when Tania became a full-time professor at Seneca College. Now,
almost 20 years later, Tania continues to be a valued and respected faculty member of
Seneca’s School of Health Sciences. Her college portfolio includes a variety of course cur-
riculum development and delivery. In addition to her classroom leadership, Tania also
manages simulation and virtual reality programs for numerous faculties within Seneca
College. Within her roles, she has secured several funding initiatives and established and
continues to maintain partnerships within the international community to grow numerous
projects that enhance student learning.
An advocate of innovation, Tania has advanced cross-disciplinary experiential learning
in the various responsibilities she holds at the college. She has served as a Seneca Ambas-
sador internationally and has hosted international delegations at the college to share best
practices in nursing studies. Combining her medical training with her love of sports, Tania
has added new capacities and ‘personal bests’ to her career. She is proud to have served
professionally at several Olympic, Paralympic, Pan Am, and national games. Closer to
home, Tania is a member of several Team Ontario sport teams where she has the privilege
of working with sector allies to provide high-quality health care to elite athletes.
Tania’s other love is animals, and she is often seen with her loyal dog, Lucy, by her side.
Deborah C. Gray Morris

Deborah C. Gray Morris, RN, BSN, MA, LNC, began her nursing education at Bronx
Community College, graduating in 1971. In 1973, Deborah earned a bachelor of science
in nursing (BSN) from the City College of the City University of New York, followed by a
master (MA) in nursing from New York University in 1978. In 1998, Deborah pursued her
interest in the legal aspects of nursing and graduated with certification as a legal nurse
consultant from Long Island University’s Legal Nurse Consultant Program in 1999. Deborah
has also earned 12 credits from John Jay College of the City University of New York, includ-
ing credits in criminal justice and forensic science.
Deborah is currently a full professor and the chairperson of the Department of Nursing
and Allied Health Sciences at Bronx Community College, where she teaches dosage cal-
culations in the Registered Nursing and Licensed Practical Nursing Programs. Deborah
has held the position of chairperson since 2010; first as acting, then elected to the position
in 2011. Prior to becoming chairperson, Deborah served as deputy chairperson for
13 years and as course coordinator for Pharmacology Computations. Her second term as
iv
About the Authors v
chairperson began in July 2015. Deborah is also a program evaluator for the Accreditation
Commission for Education in Nursing (ACEN). Upon request, Deborah provides consult-
ant services to nursing programs in the area of dosage calculation.
Deborah’s interest in dosage calculation started with her career at Bronx Community
College of the City University of New York in 1978. Her original position at the college
was in the capacity of providing nursing students with tutoring in the area of dosage cal-
culation, which had been identified as an area of difficulty for students. She began with the
development of a manual to assist students with the subject matter and later developed a
course titled Pharmacology Computations, which was approved through the college gov-
ernance bodies and is currently a required course for students in the Associate Degree
Nursing Program. Deborah’s very first edition of Calculate with Confidence was published
in 1994. Calculate with Confidence is currently in its 7th U.S. edition and ranks among the
top books published by Elsevier in this area.
Deborah is married.
Reviewers
Jennifer Black, RN, BScN, MN Pammla Petrucka, RN, PhD
Professor & Coordinator Professor
Practical Nursing Program College of Nursing
Fanshawe College—Woodstock/Oxford Regional Campus University of Saskatchewan
Woodstock, Ontario Saskatoon, Saskatchewan
Julie Duff Cloutier, RN, BScN, MSc, PhD(c) Crystal Schauerte, BscN, MscN
Assistant Professor Nursing Professor
School of Nursing Department of Nursing
Laurentian University Algonquin College
Sudbury, Ontario Ottawa, Ontario
Michelle Earl, BSN, PID Ruth Swart, EdD, MHS, RN, BN, BSc
Team Leader and Placement Coordinator Senior Instructor
Practical Nursing Faculty of Nursing
Sprott Shaw College—Kelowna Campus; University of Calgary
Clinical Nursing Instructor Calgary, Alberta
University of British Columbia—Okanagan Campus
Kelowna, British Columbia Selena Talbot, RN, MAEd
Instructor III
Andrea Gretchev, RN, BScN, MN, CCNE
Faculty of Nursing
BSN Curriculum Coordinator
University of Regina
Douglas College, Health Sciences
Regina, Saskatchewan
Coquitlam, British Columbia
(Amy) Phuong Thi Dieu Hoang, BSc Andrea Tannahill, RN, MSN
Mathematics, BEd Nursing Instructor
Professor School of Health Sciences
Department of Mathematics University of Alberta BScN Collaborative Program at Red
Niagara College Deer College
Welland, Ontario Red Deer, Alberta
Kelly Kidd, RN, BScN, MN Barbara Thompson, RN, BScN, MScN
Professor Nursing Studies Professor of Nursing, Coordinator Practical Nursing
Coordinator Year 1 Practical Nursing Program Program
Coordinator Clinical Education Health Programs
Health and Community Studies Sault College
Algonquin College Sault Ste. Marie, Ontario
Pembroke, Ontario Lorna Walsh, BN, MEd, RN
Allison McFadden-Squire, BScN, RN, MEd(c) Nurse Educator/Year 1 and 2 Coordinator
Curriculum Lead Centre for Nursing Studies
Practical Nurse Program Memorial University of Newfoundland
NorQuest College St. John’s, Newfoundland
Edmonton, Alberta
With special thanks to
Dennise Morgan, RN, BScN, MN, CON(c) Terri Burrell RN, BScN, MSN
Clinical Supervisor Faculty
Seneca-York Collaborative BScN Program Saskatchewan Collaborative Bachelor of Science in
Practical Nursing Program Nursing (SCBScN)
Seneca College of Applied Arts and Technology Saskatchewan Polytechnic—Regina Campus
Department of Health Sciences Regina, Saskatchewan
Toronto, Ontario
vi
Preface to the Instructor
The culture of safety continues to be a priority in the delivery of health care. To advance
patient safety and its importance in health care delivery worldwide, several organizations
continue to promote patient safety, which includes an emphasis on improving safety in
medication administration. Canadian organizations include Health Canada, the Canadian
Institute for Health Information (CIHI), the Institute for Safe Medication Practices Canada
(ISMP Canada), and the Canadian Patient Safety Institute (CPSI). These organizations also
collaborate on the Canadian Medication Incident Reporting and Prevention System
(CMIRPS). This pan-Canadian program encourages reporting, sharing, and learning about
medication incidents in order to help reduce their reoccurrence and create a safer health
care system.
The second Canadian edition of Gray Morris’s Calculate with Confidence continues to
emphasize safety in medication administration and is written to meet the needs of current
and future practitioners of health care at any level. This book can be used as a resource for
any education program or practice setting that involves dosage calculation and medication
administration by health care providers.
Gray Morris’s Calculate with Confidence, Second Canadian Edition, primarily uses the
metric system in calculating dosages, but it presents examples that incorporate imperial
system (household, apothecary) measurements where applicable. Specifically, you will see
the conversion of pounds to kilograms in some examples because weight is still sometimes
measured in pounds in the community at large. Therefore it is prudent to include imperial
units of measurement in this book.
The second Canadian edition of Gray Morris’s Calculate with Confidence illustrates the
standard methods of dosage calculation: the ratio and proportion method, the formula
method, and the dimensional analysis method. With the inclusion of all three, instructors
have the freedom to decide which method(s) best suit their program, and students have
the same freedom to choose the method that facilitates correct dosage calculations.
This second Canadian edition responds to evidence-informed practices as they relate to
safe medication practices at all levels. Highlights include best practices for the labelling,
dispensing, preparing, and administering of medications. With the nursing student in
mind, emphasis is placed on critical thinking and clinical reasoning in the prevention of
medication errors. Principles of competence and safety are integrated throughout.
Answers to the Practice Problems include rationales to enhance the understanding of
principles. In response to the increased need for competency in basic math as an essential
prerequisite for dosage calculation, many Practice Problems are included in the basic math
section.
The once controversial use of calculators is now a more accepted practise, and they are used
in many nursing exams, including when writing licensure exams such as the NCLEX. Critical
care areas in some health care institutions have policies that require the use of calculators to
verify calculations to avoid medication errors. A basic calculator is usually sufficient for dosage
calculations. Calculator use is not encouraged in the basic math section of this book due to the
expectation that students should be able to perform calculations proficiently and independently
without their use.
Despite decreased errors in calculating medication dosages due to the availability of
better technology, health care providers must continue to use sound clinical reasoning in
problem solving to minimize the risk to patient safety.
vii
viii Preface to the Instructor
The second Canadian edition of Gray Morris’s Calculate with Confidence embodies all
the standards of nursing practice. It clearly delineates the nurse’s responsibility in medica-
tion practices, including accurate dosage calculation to optimize safe patient outcomes.
Organization of Content
The second Canadian edition is organized in a progression from simple topics to more
complex ones, making content relevant to the needs of students and using realistic Practice
Problems and Clinical Reasoning Questions to enhance learning and make material clini-
cally applicable.
The 23 chapters are arranged into 5 units.
Unit One includes Chapters 1 through 4. This unit provides a review of basic math skills,
including fractions, decimals, ratio and proportion, and percentages. A pre-test and post-
test are included. This unit allows students to determine their weaknesses and strengths in
math and provides a review. Academic institutions using this book may use these units as
independent study for students to review basic math concepts before venturing on to actual
dosage calculations.
Unit Two includes Chapters 5 through 7. Chapter 5 introduces students to the metric
and imperial (household, apothecary) systems of measurement. Canada’s health care pro-
viders use the metric system. However, some units of household measurement are dis-
cussed because of their continued use, albeit limited. These measurements are pound,
ounce, teaspoon, tablespoon, and cup. In Chapter 6, students learn to convert measure-
ments. Chapter 7 presents conversions relating to temperature, length, weight, and inter-
national time.
Unit Three includes Chapters 8 through 14. This unit provides essential information
that is needed as a foundation for dosage calculation and safe medication administration.
Chapter 8 includes an expanded discussion of medication errors, routes of medication
administration, equipment used in medication administration, the rights of medication
administration, and the nursing role in preventing medication errors. Chapter 9 presents
the abbreviations used in medication administration and discusses how to interpret medi-
cation orders. Chapter 10 introduces students to medication administration records and
the various medication distribution systems. Chapter 11 provides students with the skills
necessary to read medication labels to calculate dosages. Chapters 12 through 14 introduce
students to the various methods used for dosage calculation followed by Practice Problems
illustrating each method.
Unit Four includes Chapters 15 through 18. In Chapter 15, students learn the principles
and calculations related to oral medications (solid and liquids). In Chapter 16, students
learn about the various types of syringes and skills needed for calculating injectable medi-
cations. Chapter 17 introduces students to the calculations associated with reconstituting
solutions for injectable and noninjectable medications. Calculations associated with the
preparation of noninjectable solutions such as nutritional feedings include determining the
strength of a solution and determining the amount of the desired solution. Chapter 18
introduces students to insulin types, insulin equipment, and Canadian Diabetes Associa-
tion 2018 Clinical Practice Guidelines for the prevention and management of diabetes in
Canada.
Unit Five includes Chapters 19 through 23. Chapters 19 and 20 provide students with
a discussion of intravenous (IV) fluids and associated calculations related to IV therapy.
The recalculation of IV flow rate includes an alternative method to determining the per-
centage of variation. IV labels have been added throughout the chapter, with a discussion
of additives to IV solutions. Chapter 21 focuses on heparin and uses the new heparin
labelling. Sample heparin weight-based protocols are used to adjust IV heparin based on
activated partial thromboplastin time (aPTT). Chapter 22 discusses the principles of cal-
culating pediatric and adult dosages, with emphasis on calculating dosages based on body
weight and body surface area as well as verifying the safety of dosages. Chapter 23 provides
students with the skills necessary to calculate critical care IV medications. Determining
the titration of IV flow rates for titrated medications includes developing a titration table.
Preface to the Instructor ix
Safety Alerts, Practice Problems, Clinical Reasoning scenarios, and Points to Remember
are included throughout the book. A Comprehensive Post-Test is included at the end of
the book and covers all 23 chapters.
Features of the Second Canadian Edition

• Objectives at the beginning of each chapter to emphasize content to be mastered.
• Canadian medication labels.
• Integration of ISMP Canada recommendations in the book to alert students to the
importance of patient safety and reducing medication errors.
• Content related to preventing medication errors, such as the use of Tall Man Lettering,
verification of the rights of medication administration, and an examination of the
nursing role in preventing medication errors.
• Discussions on preventing medication errors in chapters dealing with high-alert medi-
cations (heparin and insulin).
• An up-to-date insulin chapter that reflects the Canadian Diabetes Association 2018
Clinical Practice Guidelines on insulin therapy, which features basal + bolus + correction
insulin dosing as well as IV insulin therapy.
• An IV chapter, including IV labels and a discussion of IV additives. Recalculation of IV
therapy includes an alternative approach to determining the variation of change using
percentages.
• Safety Alert boxes that direct students to common errors and how to avoid them.
• Clinical Reasoning questions in Chapters 15 to 22 to allow students to critically think
through more complex questions.
• Inclusion of heparin weight-based protocol and problems on adjusting the flow rate
based on PTT.
• Critical care discussion on IV flow rates for titrated medications, including how to
develop a titration table.
• Calculation of fluid resuscitation for patients with burns as well as daily pediatric fluid
maintenance.
• Practice Problems and Chapter Review problems in each chapter.
• An Answer Key at the end of each chapter to provide immediate feedback on solutions
to problems.
• NEW! A-Z medication index referencing page numbers where the drug labels can be found.
Ancillaries
Evolve Resources for Gray Morris’s Calculate with Confidence, Second Canadian Edition,
are available to enhance student instruction. This online resource can be found at http://
evolve.elsevier.com/Canada/GrayMorris/. It corresponds with the chapters of the main
book and includes the following:
• TEACH for Nurses
• Test Bank
• PowerPoint Slides
• Image Collection of Drug Labels
• Answer Key from Textbook
• Student Review Questions
• NEW! Tips for Clinical Practice easy reference
• NEW! Next Generation NCLEX Case Studies (both generic and book-specific)
• NEW! Elsevier’s Interactive Drug Calculation Application, version 1: This interactive
drug calculation application provides hands-on, interactive practice for the user to
master drug calculations. Users can select the mode (Study, Exam, or Comprehensive
Exam) and then the category for study and exam modes. There are eight categories that
cover the main drug calculation topics. Users are also able to select the number of
problems they want to complete and their preferred drug calculation method. A calcula-
tor is available for easy access within any mode, and the application also provides history
of the work done by the user. There are 750 practice problems in this application.
x Preface to the Instructor
We hope that this book provides clear concept review, practice questions, detailed
explanations and clinical reasoning questions to help you master the dosage calculations
you need to correctly administer medications safely.
This book is not only for the beginner health care provider but is meant to also benefit
the experienced health care provider as a useful reference.
Tania Killian
Acknowledgements
First and foremost, I must thank Theresa Fitzgerald for guiding me throughout this process.
Without her patience and continued encouragement, I would not have completed this
book.
Thank you to Roberta A. Spinosa-Millman and Rachel McMullen of Elsevier for giving
me the opportunity to write this book and their support throughout the process.
I wish to acknowledge the valuable contributions of my reviewers. Thank you for your
notes regarding the improvement of quality, coherence, and presentation of the content of
the book. I am grateful for the combined insight they provided. I would also like to thank
Marcia Brown for her work on the first edition.
And most importantly, to my family, friends, colleagues, and the “Coffee Club” who
inspired me to take a chance at writing.
—Tania Killian
xi
Contents
UNIT ONE Math Review 1

PRE-TEST 2
1 Fractions, 6
Types of Fractions, 7
Converting Fractions, 8
Comparing Fractions, 8
Reducing Fractions, 10
Adding Fractions, 11
Subtracting Fractions, 12
Multiplying Fractions, 14
Dividing Fractions, 15
2 Decimals, 23
Reading and Writing Decimals, 24
Comparing the Value of Decimals, 26
Adding and Subtracting Decimals, 27
Multiplying Decimals, 29
Dividing Decimals, 31
Rounding Off Decimals, 32
Changing Fractions to Decimals, 34
Changing Decimals to Fractions, 34
3 Ratio and Proportion, 40

Ratios, 40
Proportions, 41
Solving for x in Ratio and Proportion, 42
Applying Ratio and Proportion to Dosage Calculation, 44
4 Percentages, 51
Percentage Measures, 51
Converting Percentages to Fractions,
Decimals, and Ratios, 52
Converting Fractions, Decimals,
and Ratios to Percentages, 54
Comparing Percentages and Ratios, 56
Determining the Percentage of a Quantity, 57
Determining What Percentage
One Number Is of Another, 57
Calculating the Percentage of Change, 59
xii
Contents xiii
POST-TEST 64
UNIT TWO Systems of Measurement 69

5 Standardizing Measurement Systems, 70
Metric System, 71
Rules of the Metric System, 73
Units of Measurement, 74
Conversions Between Metric Units, 75
Apothecary System (Imperial), 77
Roman Numeral System (Imperial), 78
Household System (Imperial), 78
Other Measurements Used in Dosage Calculation, 79
6 Converting Within and Between Systems, 85

Equivalents Among Metric and Household Systems, 85
Converting, 85
Methods of Converting, 86
Converting Within the Same System, 89
Converting Between Systems, 91
Calculating Intake and Output, 93
7 Additional Conversions Useful in the Health

Care Setting, 103
Converting Between Celsius and Fahrenheit, 103
Converting Measures of Length, 106
Converting Between Units of Weight, 107
Converting Between Traditional and Military (International)
Time, 109
Calculating Completion Times, 111
UNIT THREE Methods of Administration and

Calculation 117
8 Medication Administration, 118
Medication Errors, 118
Critical Thinking and Medication Administration, 120
Factors That Influence Medication Dosages and Action, 121
Special Considerations for Older Adults, 121
The Rights of Medication Administration, 122
Medication Reconciliation, 127
Routes of Medication Administration, 129
Equipment Used for Medication Administration, 130
9 Understanding and Interpreting Medication

Orders, 136
Verbal Orders, 136
Transcription of Medication Orders, 137
Writing a Medication Order, 139
Components of a Medication Order, 139
Interpreting a Medication Order, 143
xiv Contents
10 Medication Administration Records and Drug

Distribution Systems, 151
Medication Orders, 151
Medication Administration Record, 151
Essential Components of a Medication
Administration Record, 153
Documentation of Medication Administration, 154
Computers and Medication Administration, 156
Medication Distribution Systems, 156
Advantages and Disadvantages of Technology, 159
11 Reading Medication Labels, 163

Reading Medication Labels, 163
12 Dosage Calculation Using the Ratio and

Proportion Method, 203
Using Ratio and Proportion to Calculate Dosages, 203
13 Dosage Calculation Using the Formula Method, 237

Formula for Calculating Dosages, 237
Applying the Formula, 238
14 Dosage Calculation Using the Dimensional

Analysis Method, 263
Understanding the Basics of Dimensional Analysis, 263
Dosage Calculation Using Dimensional Analysis, 266
UNIT FOUR Oral and Parenteral Dosage Forms

and Insulin 287
15 Oral Medications, 288
Forms of Solid Medication, 288
Calculating Dosages of Tablets and Capsules, 292
Calculating Dosages of Oral Liquids, 306
Measuring Oral Liquids, 307
16 Parenteral Medications, 348

Packaging of Parenteral Medications, 348
Syringes, 351
Reading Parenteral Labels, 360
Calculating Parenteral Dosages, 370
Calculating Injectable Medications According
to the Syringe, 371
Calculating Dosages for Medications in Units, 376
Mixing Medications in the Same Syringe, 378
Contents xv
17 Reconstitution of Solutions, 420

Basic Principles of Reconstitution, 421
Reconstituting Medications With More Than One Direction for
Mixing (Multiple Strength), 430
Reconstituting Medications From Package Insert Directions for
Different Routes of Administration, 433
Medication Labels With Instructions to “See Accompanying
Literature” (Package Insert) for Reconstitution and
Administration, 433
Calculating Dosages of Reconstituted Medications, 435
Reconstituting Noninjectable Solutions, 438
18 Insulin, 473
Labels, 474
Types of Insulin and Their Action, 475
Appearance of Insulin, 479
Insulin Administration Methods, 479
Insulin Orders, 485
Preparing a Single Dose of Insulin in an Insulin Syringe, 488
Measuring Two Types of Insulin in the Same Syringe, 489
Intravenous Insulin, 492
Calculating an Intravenous Insulin Infusion, 492
Hypoglycemia, 493
UNIT FIVE Intravenous and Heparin Calculations,

Pediatric Dosage Calculations, and
Critical Care Calculations 509
19 Intravenous Solutions and Equipment, 510
Intravenous Delivery Methods, 510
Intravenous Solutions, 511
Administration of Intravenous Solutions, 516
20 Intravenous Calculations, 528

Intravenous Flow Rate Calculation, 528
Calculating Flow Rates for Infusion Pumps
in Millilitres per Hour, 528
Calculating Flow Rates in Drops per Minute, 532
Intravenous Tubing, 532
Calculating Flow Rates in Drops per Minute
Using a Formula, 535
Determining Infusion Time and Volume, 545
Recalculating an Intravenous Flow Rate, 547
Charting Intravenous Therapy, 550
Labelling Solution Bags, 550
Administration of Medications by Intravenous Push, 550
xvi Contents
21 Heparin Calculations, 562

Heparin, 562
Heparin Errors, 562
Heparin Dosage Strengths, 563
Reading Heparin Labels, 564
Calculating Subcutaneous Heparin Dosages, 565
Calculating Intravenous Heparin Dosages, 566
Calculating Heparin Dosages Based on Weight, 568
22 Pediatric and Adult Dosage Calculations Based

on Weight, 590
Principles of Pediatric Dosage Calculation, 591
Calculating Dosages Based on Body Weight, 592
Calculating Adult Dosages Based on Body Weight, 599
Calculating Pediatric Dosages Using Body Surface Area, 604
Calculating Body Surface Area Using a Formula, 607
Calculating Dosages Based on Body Surface Area, 609
Fluid Resuscitation After a Burn Injury, 612
Intravenous Therapy and Children, 616
Calculating Pediatric Intravenous Fluid Maintenance, 618
Calculating Intravenous Medications by Burette, 619
Determining Whether a Pediatric Intravenous
Dosage Is Safe, 622
Pediatric Oral and Parenteral Medications, 624
23 Critical Care Calculations, 653

Calculating the Intravenous Flow Rate
in Millilitres per Hour, 654
Calculating Critical Care Dosages per Hour
or per Minute, 655
Medications Ordered in Milligrams per Minute, 656
Calculating Dosages Based on Micrograms
per Kilogram per Minute, 657
Intravenous Flow Rates for Titrated Medications, 658
Developing a Titration Table, 660
COMPREHENSIVE POST-TEST 682
Appendix A: Arabic Equivalents for Roman Numerals, 705

Appendix B: Diabetes Management Record:
Subcutaneous Insulin, 706
References, 709
Drug Label Credits, 711
Drug Index, 712
Index, 717
UNIT ONE
Math Review
A n essential role of the nurse is providing safe medication administration to all patients.
To accurately perform dosage calculations, the nurse must have knowledge of basic math,
regardless of the problem-solving method used in calculation. Knowledge of basic math is a
necessary component of dosage calculation that nurses need to know to prevent medication
errors and ensure the safe administration of medications to all patients, regardless of the
setting. Serious harm to patients can result from a mathematical error during calculation and
administration of a medication dosage. The nurse must practise and be proficient in the basic
math used in dosage calculations. Knowledge of basic math is a prerequisite for the preven-
tion of medication errors and ensures the safe administration of medications.
Although calculators are accessible for basic math operations, the nurse needs to be able
to perform the processes involved in basic math. Controversy still exists among educators
regarding the use of calculators in dosage calculation. Calculators may indeed be recom-
mended for complex calculations to ensure accuracy and save time; the types of calculations
requiring their use are presented later in this text. However, because the basic math required
for less complex calculations is often simple and can be done without the use of a calculator,
it is a realistic expectation that each practitioner should be competent in the performance of
basic math operations without its use. Performing basic math operations enables the nurse
to think logically and critically about the dosage ordered and the dosage calculated.
Pre-Test
Chapter 1 Fractions
Chapter 2 Decimals
Chapter 3 Ratio and Proportion
Chapter 4 Percentages
Post-Test
Copyright © 2022, Elsevier Inc. All rights reserved. 1

2 UNIT ONE Math Review
PRE-TEST
This test is designed to evaluate your ability in the basic math areas reviewed in Unit One.
The test consists of 62 questions. If you are able to complete the pre-test with 100% accu-
racy, you may want to bypass Unit One. Any problems answered incorrectly should be used
as a basis for what you might need to review. The purposes of this test and the review that
follows are to build your confidence in basic math skills and to help you avoid careless
mistakes when you begin to perform dosage calculations.
Reduce the following fractions to lowest terms.

14 24
1. ____________________________ 4. ___________________________
21 30
25 24
2. ___________________________ 5. ___________________________
100 36
2
3. ___________________________
150
Perform the indicated operations; reduce to lowest terms where necessary.

2 3 1 1
6. ÷ = _______________________ 13. 2 − 1 = ____________________
3 9 6 4
3 3
7. 4÷ = _______________________ 14. 9 − = _______________________
4 5
2 1 1 3
8. + = _______________________ 15. 4 − 1 = ____________________
5 9 4 4
1 5 1 3
9. 7 − 2 = ____________________ 16. 7 − 1 = ____________________
7 6 5 4
2 9
10. 4 × 4 = _____________________ 17. 7 − = ______________________
3 16
5 2 3 7
11. 3 + 5 = ____________________ 18. 3 −1 = __________________
6 3 10 10
6 5
12. 5 + 3 = ____________________
7 7
Change the following fractions to decimals; express your answer to the nearest tenth.
6 2
19. ____________________________ 21. ____________________________
7 3
6 7
20. ___________________________ 22. ____________________________
20 8
Indicate the largest fraction in each group.

3 4 7 7 11 4
23. , , ______________________ 24. , , ____________________
4 5 8 12 12 12
Copyright © 2022, Elsevier Inc. All rights reserved.

Pre-Test 3
Perform the indicated operations with decimals. Provide the exact answer; do not
round off.
25. 20.1 + 67.35 = ___________________ 27. 4.6 × 8.72 = _____________________
26. 0.008 + 5 = _____________________ 28. 56.47 − 8.7 = ____________________
Divide the following decimals; express your answer to the nearest tenth.
29. 7.5 ÷ 0.004 = ____________________ 31. 84.7 ÷ 2.3 = _____________________
30. 45 ÷ 1.9 = ______________________
Indicate the largest decimal in each group.
32. 0.674, 0.659 _____________________ 34. 0.25, 0.6, 0.175 __________________
33. 0.375, 0.37, 0.38 _________________
Solve for x, the unknown value.

1 1
35. 82 = 48 : x ______________________ 37. : x = : 15 ____________________
10 2
36. x : 300 = 1 : 150 ___________________ 38. 0.4 : 1 = 0.2 : x ____________________
Round off to the nearest tenth.
39. 0.43 ___________________________ 41. 1.47 ___________________________
40. 0.66 ___________________________
Round off to the nearest hundredth.
42. 0.735 __________________________ 44. 1.227 __________________________
43. 0.834 __________________________
Complete the table below, expressing the measures in their equivalents where indicated.
Reduce to lowest terms where necessary.
Percentage Decimal Ratio Fraction
45. 6% __________ __________ __________
46. __________ __________ 7 : 20 __________
47. __________ __________ __________ 1

5
4
48. __________ 0.015 __________ __________

Find the following percentages. Express your answer to the hundredths place as indicated.
49. 5% of 95 ________________________ 52. 20 is what % of 100 _______________

1
50. % of 2 000 _____________________ 53. 30 is what % of 164 _______________
4
51. 2 is what % of 600 ________________
54. A patient is instructed to take 7.5 millilitres (mL) of a cough syrup 3 times a day. How
many mL of cough syrup will the patient take each day? _______________
55. A tablet contains 0.75 milligrams (mg) of a medication. A patient receives 3 tablets a
day for 5 days. How many mg of the medication will the patient receive in 5 days?
_______________
56. A patient took 0.44 micrograms (mcg) of a medication every morning and
1.4 mcg each evening for 5 days. What is the total amount of medication taken?
_______________
57. Write a ratio that represents that every tablet in a bottle contains 0.5 mg of a
medication. _______________
58. Write a ratio that represents 60 mg of a medication in 1 mL of a liquid.

_______________
59. A patient takes 10 mL of a medication 3 times a day. How long will 120 mL of
medication last? _______________
60. A patient weighed 125 kilograms (kg) before dieting. After dieting, the patient weighed
113.6 kg. What is the percentage of change in the patient’s weight? _______________
61. A patient was prescribed 10 mg of a medication for a week. After a week, the health
care provider reduced the medication to 7 mg. What was the percentage of decrease
in medication? _______________
62. A patient received 22.5 mg of a medication in tablet form. Each tablet contained 4.5 mg
of medication. How many tablets were given to the patient? _______________
Answers on page 5.

Pre-Test 5
ANSWERS
2
1. 2
3 10. 18 19. 0.9 28. 47.77 37. x = 3
3
1
2. 3 1 1
4 11. 9 = 9 20. 0.3 29. 1 875 38. x = 0.5 or
6 2 2
1
3. 11 4
75 12. 8 =9 21. 0.7 30. 23.7 39. 0.4
7 7
4
4. 11
5 13. 22. 0.9 31. 36.8 40. 0.7
12
4 2
5. = 2 7
6 3 14. 8 23. 32. 0.674 41. 1.5
5 8
6. 2 2 1 11
15. 2 = 2 24. 33. 0.38 42. 0.74
4 2 12
1
7. 5 9
3 16. 5 25. 87.45 34. 0.6 43. 0.83
20
23
8. 7
45 17. 6 26. 5.008 35. x = 12 44. 1.23
16
13
9. 4 6 3
42 18. 1 =1 27. 40.112 36. x = 2
10 5
Percentage Decimal Ratio Fraction

3
45. 6% 0.06 3 : 50
50
7
46. 35% 0.35 7 : 20
20
1
47. 525% 5.25 21 : 4 5
4
3
48. 1.5% 0.015 3 : 200
200
49. 4.75 52. 20% 55. 11.25 mg 58. 60 mg : 1 mL 61. 30%
50. 5 53. 18.29% 56. 9.2 mcg 59. 4 days 62. 5 tablets
51. 0.33% 54. 22.5 mL 57. 0.5 mg : 1 tablet 60. 9%

CHAPTER 1
Fractions
Objectives
After reviewing this chapter, you should be able to:
1. Compare the size of fractions
2. Add fractions
3. Subtract fractions
4. Divide fractions
5. Multiply fractions
6. Reduce fractions to lowest terms
Health care providers need to have an understanding of fractions. Fractions may be seen in medical orders,
patient records, prescriptions, documentation relating to care given to patients, and literature related to
health care. Nurses often encounter fractions in dosage calculation.
S ome methods of solving dosage calculations rely on expressing relationships in a frac-

tion format. Therefore, proficiency with fractions can be beneficial in a variety of
situations.
A fraction is used to indicate a part of a whole number (Figure 1-1). It is a division of
a whole into units or parts (Figure 1-2). A fraction is composed of two parts: an upper
number referred to as the numerator and a lower number called the denominator. The
numerator and denominator are separated by a horizontal line. A fraction may also be read
as the numerator divided by the denominator.
1
Example: is a whole divided into two equal parts.
2
how many parts of the

Numerator whole are considered
:
Denominator how many equal parts
the whole is divided into
5
Example: In the fraction , the whole is divided into 6 equal parts (denominator), and
6
five parts (numerator) are considered.
5 5
= 5 parts of 6 parts, or of the whole.
6 6
5
The fraction may also be read as 5 divided by 6.
6
6 Copyright © 2022, Elsevier Inc. All rights reserved.

CHAPTER 1 Fractions 7
Figure 1-1 Diagram representing fractions of a whole. Five parts

shaded out of the six parts represent:
1
5 Numerator 1 6
6 Denominator . 6 1
6
1
6 1
1 6
6
125 mg
250 mg
500 mg 125 mg 125 mg
250 mg
125 mg
1 3
Whole = 250 mg = 375 mg
2 4
Figure 1-2 Fraction pie charts.
Types of Fractions
Proper Fraction: Numerator is less than the denominator, and the fraction has a value of
less than 1.
1 5 7 1
Examples: , , ,
8 6 8 150
Improper Fraction: Numerator is larger than, or equal to, the denominator, and the frac-
tion has a value of 1 or greater than 1.
3 7 300 4
Examples: , , ,
2 5 150 4
Mixed Number: Whole number and a proper fraction in which the total value of the mixed
number is greater than 1.
1 1 1 7
Examples: 3 , 5 , 9 , 25
3 8 6 8
Complex Fraction: Numerator, denominator, or both are fractions. The value may be less
than, greater than, or equal to 1.
3 1
2
1
3 2 2
Examples: , , ,
2 1
2 1 1 4 1150
Whole Numbers: Have an unexpressed denominator of one (1).
1 3 6 100
Examples: 1 = , 3 = , 6 = , 100 =
1 1 1 1
Converting Fractions
An improper fraction can be changed to a mixed number or whole number by dividing
the numerator by the denominator. If there is a remainder, that number is placed over the
denominator, and the answer is reduced to lowest terms.
6 1 100 10 2 1
Examples: = 6÷5 =1 , = 100 ÷ 25 = 4, = 10 ÷ 8 = 1 = 1
5 5 25 8 8 4
A mixed number can be changed to an improper fraction by multiplying
the whole number by the denominator, adding it to the numerator, and
placing the sum over the denominator.
1 (5 × 8) + 1 41
Example: 5 = =
8 8 8
Comparing Fractions
Comparing the size of fractions is important in the administration of medications. It
helps the new practitioner learn the value of medication dosages early on. Fractions
can be compared if the numerators are the same by comparing the denominators or if
the denominators are the same by comparing the numerators. These rules are presented in
Box 1-1.
BOX 1-1 Rules for Comparing the Size of Fractions

Here are some basic rules to keep in mind when comparing fractions.
1. If the numerators are the same, the fraction with the smaller denominator has the greater value.
1 1
Example: is larger than
2 3
1 1
150 300
2. If the denominators are the same, the fraction with the larger numerator has the greater value.
3 1
4 4
3 1
100 100
Two or more fractions with different denominators can be compared by changing both
fractions to fractions with the same denominator (see Box 1-1). This is done by finding the
lowest common denominator (LCD), or the lowest number evenly divisible by the denomi-
nators of the fractions being compared.
3 4
Example: Which is larger, or ?
4 5
NOTE Solution: The LCD is 20, because it is the smallest number that can be divided by
LCD = 20 both denominators evenly. Change each fraction to the same terms by
dividing the LCD by the denominator and multiplying that answer by the
numerator. The answer obtained from this is the new numerator. The
numerators are then placed over the LCD.
3 3 15
For the fraction , 20 ÷ 4 = 5; 5 × 3 = 15; therefore becomes .
4 4 20
4 4 16
For the fraction , 20 ÷ 5 = 4; 4 × 4 = 16; therefore becomes .
5 5 20
Therefore
4 16
5 20 ( )
is larger than
3 15
4 20
. ( )
Box 1-2 presents fundamental rules of fractions.

BOX 1-2 Fundamental Rules of Fractions

When working with fractions, there are some fundamental rules that we need to remember.
1. When the numerator and denominator of a fraction are both multiplied or divided by the same number,
the value of the fraction remains unchanged.
1 1 × ( 2) 2 2 × ( 25 ) 50
Examples: = = = = , etc.
2 2 × ( 2) 4 4 × ( 25 ) 100
50 50 ÷ (10 ) 5 5 ÷ (5 ) 1
= = = = , etc.
100 100 ÷ (10 ) 10 10 ÷ (5 ) 2
As shown in the examples, common fractions can be written in various forms, provided that the
numerator, divided by the denominator, always yields the same number (quotient). The particular form of
a fraction that has the smallest possible whole number for its numerator and denominator is called the
50 5 2 1
fraction in its lowest terms. In the example, therefore, , , or is in its lowest terms.
100 10 4 2
2. To change a fraction to its lowest terms, divide its numerator and its denominator by the largest whole
number that will divide both evenly.
128
Example: Reduce to lowest terms.
288
128 128 ÷ 32 4
= =
288 288 ÷ 32 9
Note: When you do not see the largest number that can be divided evenly at once, the fraction may have
to be reduced by using repeated steps.
128 128 ÷ 4 32 32 ÷ 8 4
Example: = = = =
288 288 ÷ 4 72 72 ÷ 8 9
Note: If both the numerator and denominator cannot be divided evenly by a whole number, the fraction is
already in lowest terms. Fractions should always be expressed in their lowest terms.
3. The LCD is the smallest whole number that can be divided evenly by all of the denominators within the
problem.
1 5
Example: and : 12 is evenly divisible by 3; therefore 12 is the LCD.
3 12
3 2 2
, , and : 28 is evenly divisible by 7 and 14; therefore 28 is the LCD.
7 14 28
PRACTICE PROBLEMS
Circle the fraction with the lesser value in each of the following sets.
6 4 4 1 3
1. 6.
30 5 8 8 8
5 6 1 1 1
2. 7.
4 8 40 10 5
1 1 1 1 1 1
3. 8.
75 100 150 300 200 175
6 7 8 4 5 10
4. 9.
18 18 18 24 24 24
4 7 3 4 1 1
5. 10.
5 5 5 3 2 6
Circle the fraction with the greater value in each of the following sets.
6 5 2 6 3
11. 16.
8 9 5 5 5
7 2 1 4 1
12. 17.
6 3 8 6 4
1 6 1 7 5 8
13. 18.
72 12 24 9 9 9
1 1 1 1 1 1
14. 19.
10 6 8 10 50 150
1 1 1 2 1 6
15. 20.
75 125 225 15 15 15
Answers on page 21.
Reducing Fractions
Fractions should always be reduced to their lowest terms.
RULE
To reduce a fraction to its lowest terms, the numerator and denominator are each divided by the
largest number by which they are both evenly divisible.
6
Example: Reduce the fraction .
20
Solution: Both numerator and denominator are evenly divisible by 2.
6 2 3
÷ =
20 2 10
6 3
=
20 10
75
Example: Reduce the fraction .
100
Solution: Both numerator and denominator are evenly divisible by 25.
75 25 3
÷ =
100 25 4
75 3
=
100 4
PRACTICE PROBLEMS
Reduce the following fractions to their lowest terms.
10 7
21. = __________________________ 22. = __________________________
15 49

64 9
23. = _________________________ 30. = __________________________
128 27
100 9
24. = _________________________ 31. = ___________________________
150 9
20 15
25. = __________________________ 32. = __________________________
28 45
14 124
26. = __________________________ 33. = _________________________
98 155
10 12
27. = __________________________ 34. = __________________________
18 18
24 36
28. = __________________________ 35. = __________________________
36 64
10
29. = __________________________ Answers on page 21.
50
Adding Fractions
RULE
To add fractions with the same denominator, add the numerators, place the sum over the denominator,
and reduce to lowest terms.
1 4 5
Example: + = NOTE
6 6 6
In addition to reducing to
1 3 4 8 lowest terms in the second
Example: + + = Example, the improper fraction
6 6 6 6
was changed to a mixed number.
8 4 1
= =1
6 3 3
RULE
To add fractions with different denominators, change fractions to their equivalent fraction with the
LCD, add the numerators, write the sum over the common denominator, and reduce if necessary.
1 1
Example: +
4 3
Solution: The LCD is 12. Change to equivalent fractions.
1 3
=
4 12
1 4
+ =
3 12
7
12
1 1 2
Example: +1 +
2 3 4

1 4
Solution: Change the mixed number 1 to . Find the LCD, change fractions to
3 3
equivalent fractions, add, and reduce if necessary.
The LCD is 12.
1 6
=
2 12
4 16
=
3 12
2 6
+ =
4 12
28 4 1
= 2 = 2
12 12 3
Subtracting Fractions
RULE
To subtract fractions with the same denominator, subtract the numerators, and place this amount
over the denominator. Reduce to lowest terms if necessary.
5 3 2 1
Example: − = =
4 4 4 2
1 5
Example: 2 −
6 6
1 13
Solution: Change the mixed number 2 to
6 6
13 5 8 4 1
− = = =1
6 6 6 3 3
RULE
To subtract fractions with different denominators, find the LCD, change to equivalent fractions, subtract
the numerators, and place the sum over the common denominator. Reduce to lowest terms if necessary.
15 3
Example: −
6 5
Solution: The LCD is 30. Change to equivalent fractions, and subtract.

15 75
=
6 30
3 18
− =
5 30
57 27 9
=1 =1
30 30 10
1 4
Example: 2 −
5 3
1 11
Solution: Change the mixed number 2 to . Find the LCD, change to equivalent
5 5
fractions, subtract, and reduce if necessary.

The LCD is 15.

11 33
=
5 15
4 20
− =
3 15
13
15
Subtracting a Fraction from a Whole Number

RULE
To subtract a fraction from a whole number, follow these steps:
1. Borrow 1 from the whole number, and change it to a fraction, creating a mixed number.
2. Change the fraction so it has the same denominator as the fraction to be subtracted.
3. Subtract the fraction from the mixed number.
4. Reduce if necessary.
7
Example: Subtract from 6
12
1 12
6 = 5+ = 5
1 12
7 7
− =
12 12
5
5
12
Subtracting Fractions Using Borrowing

RULE
To subtract fractions using borrowing, use the following steps:
1. Change both fractions to the same denominator if necessary.
2. Borrow 1 from the whole number and change it to the same denominator as the fraction in the mixed
number. Add the two fractions together.
3. Subtract the fractions and the whole numbers.
1 3
Example: 5 −3
4 4
3 1
In the above example, because is larger than , subtraction of the fractions
4 4
is not possible. Both fractions have the same denominator; no changes need
to be made. Therefore, borrow 1 from the whole number part (5), and add
the 1 to the fractional part
1
4 ()
.
1 1 1 4 1 5
The result is 5 = 4+ + = 4+ + = 4
4 1 4 4 4 4
1 5
5 = 4
4 4
3 3
3 = 3
4 4
5−3 2 1
1 = 1 =1
4 4 2
3 2
Example: Subtract 4 from 9
4 3
Both fractions need to be changed to the same denominator of 12:
2 8 3 9
9 = 9 and 4 = 4
3 12 4 12
9 8
Subtraction of the fractions is not possible because is larger than .
12 12
Therefore, borrow 1 from 9.
8 1 8 12 8 20
9 = 8+ + = 8+ + = 8
12 1 12 12 12 12
Now subtract:
2 8 20
9 = 9 = 8
3 12 12
3 9 9
− 4 = 4 = 4
4 12 12
11
4
12
Multiplying Fractions
RULE
1. Cancel terms if possible.

2. Multiply the numerators, multiply the denominators.
3. Reduce the result (product) to the lowest terms, if necessary.
NOTE Notice in this example that the numerator and denominator of any of the fractions involved
If fractions are not in lowest in multiplication may be cancelled when they can be divided by the same number
terms, reduction can be done (cross-cancellation).
1
before multiplication. This can 3 2 3
make the calculation simple Example 1: × =
4 5 10
because you are working with 2
smaller numbers. 2 3
Example 2: ×
4 4
2 1
Solution: Reduce to and then multiply.
4 2
1 3 3
× =
2 4 8
5
NOTE Example 3: 6×
6
The whole number 6 is
1
expressed as a fraction here by
6 5
placing 1 as the denominator, as × = 5
shown in Example 3, then cross- 1 6
1
cancellation is done because the
or
numerator and denominator of
the fractions can be divided by 6×5 30
the same number. = = 5
6 6
1 1
Example 4: 3 ×2
3 2
Solution: Change the mixed numbers to improper fractions. Proceed with

multiplication.
1 10 1 5
3 = ; 2 =
3 3 2 2
10 5 50 2 1
× = = 8 = 8
3 2 6 6 3
or
5
10 5 25 1
× = = 8
3 2 3 3
1
Dividing Fractions
RULE
1. To divide fractions, invert (turn upside down) the second fraction (divisor); change ÷ to ×.
2. Cancel terms, if possible.
3. Multiply fractions.
3 2
Example: √
4 3
3 3 9 1
Solution: × = =1
4 2 8 8
3 1
Example: 1 √2
5 10
Solution: Change the mixed numbers to improper fractions. Proceed with the steps
of division.
3 8 1 21
1 = ; 2 =
5 5 10 10
2
8 10 16
× =
5 21 21
1
1
Example: 5√
2
2 10
Solution: 5× = = 10
1 1
or
5 2 10
× = = 10
1 1 1
When doing dosage calculations that involve division, the fractions may be written as
1 1 1
follows: 1 4. In this case, is the numerator and is the denominator. Therefore, the
2 4 2
1
1 1 1 2 1
problem is set up as √ , which becomes × = .
4 2 4 1 2
2
PRACTICE PROBLEMS
Change the following improper fractions to mixed numbers, and reduce to lowest terms.
18 35
36. = __________________________ 39. = __________________________
5 12
60 112
37. = __________________________ 40. = _________________________
14 100
13
38. = __________________________
8
Change the following mixed numbers to improper fractions.
4 3
41. 1 = _________________________ 44. 3 = __________________________
25 8
2 4
42. 4 = __________________________ 45. 15 = _________________________
8 5
1
43. 4 = __________________________
2
Add the following fractions and mixed numbers, and reduce fractions to lowest terms.
2 5 2 2
46. + = _______________________ 49. 7 + = ______________________
3 6 5 3
1 2 1 1
47. 2 + = ______________________ 50. 12 + 10 = ___________________
8 3 2 3
3 1 2
48. 2 + 4 + = ________________
10 5 3
Subtract and reduce fractions to lowest terms.
4 3 1 1
51. − = _______________________ 55. − = ______________________
3 7 8 12
3 3 5
52. 3 − 1 = _____________________ 56. 14 − = ______________________
8 5 9
15 1 3 7
53. − = ______________________ 57. 3 −1 = ___________________
16 4 10 10
5 3
54. 2 − 2 = ____________________
6 4
Multiply the following fractions and mixed numbers, and reduce to lowest terms.
2 4 6 3
58. × = _______________________ 59. × = ______________________
3 5 25 5

1 5 4
60. × 3 = ______________________ 62. × = ______________________
50 12 9
5 3
61. 2 × 2 = ____________________
8 4
Divide the following fractions and mixed numbers and reduce to lowest terms.
6 2 7 7
63. 2 ÷ 1 = ____________________ 66. ÷ = _______________________
8 3 8 8
1 1 1 7
64. ÷ = ______________________ 67. 3 ÷ 1 = ____________________
60 2 3 12
2
65. 6 ÷ = _______________________ Answers on page 21.
5
CHAPTER REVIEW
Change the following improper fractions to mixed numbers, and reduce to lowest terms.
10 67
1. = __________________________ 6. = __________________________
8 10
30 9
2. = __________________________ 7. = ___________________________
4 2
22 11
3. = __________________________ 8. = __________________________
6 5
11 64
4. = __________________________ 9. = __________________________
4 15
59 100
5. = __________________________ 10. = _________________________
14 13
Change the following mixed numbers to improper fractions.
1 3
11. 2 = __________________________ 16. 2 = __________________________
2 5
3 4
12. 7 = __________________________ 17. 8 = _________________________
8 10
3 1
13. 8 = __________________________ 18. 9 = _________________________
5 4
1 3
14. 16 = _________________________ 19. 12 = _________________________
4 4
1 5
15. 3 = __________________________ 20. 6 = __________________________
5 7

Add the following fractions and mixed numbers. Reduce to lowest terms.
2 1 7 15 15
21. + + = __________________ 26. + = _____________________
5 3 10 47 47
1 1 1 1 4
22. + + = ___________________ 27. 10 + 12 = __________________
4 6 8 6 6
1 1 5 3 1 1
23. 20 + + = _________________ 28. 101 + 33 + 5 = ____________
2 4 4 4 4 4
1 1 1 5
24. + = _______________________ 29. 55 + 51 = __________________
2 5 3 9
1 2 1 4 9 1
25. 6 + + = _________________ 30. 1 +7 + 3 = ______________
4 9 36 5 10 2
Subtract the following fractions and mixed numbers. Reduce to lowest terms.
4 3 8 1
31. − = _______________________ 39. − = _______________________
9 9 5 3
1 1 4 1
32. 2 − 1 = ____________________ 40. − = _______________________
4 2 7 3
3 1 5 7
33. 2 − = _____________________ 41. − = ______________________
4 4 6 12
4 1 5 1
34. − = _______________________ 42. 39 − 13 = ___________________
5 6 8 3
6 1 6
35. − = _______________________ 43. 48 − 24 = ___________________
4 2 11
4 1 1 3
36. − = _______________________ 44. 12 − = ____________________
5 4 2 10
4 3 11 3
37. − = _______________________ 45. 39 − 8 = __________________
6 8 18 6
1 1
38. 4 − 1 = ____________________
6 3
Multiply the following fractions and mixed numbers. Reduce to lowest terms.
1 4 2
46. × = ______________________ 49. 15 × = ______________________
3 12 3
7 1 3
47. 2 × 3 = ____________________ 50. 36 × = ______________________
8 4 4
3 5 2
48. 8 × 1 = ______________________ 51. × = _______________________
4 4 4

2 1 3 1
52. × = _______________________ 57. × 3 = ______________________
5 6 5 8
3 4 2 1
53. × = _____________________ 58. 2 × 4 = ____________________
10 12 5 6
1 7 3
54. × = _______________________ 59. 2 × 4 = ______________________
9 3 8
10 5 2 5
55. × = ______________________ 60. × = _______________________
25 3 5 4
1 3 3
56. × × = ___________________
2 4 5
Divide the following fractions and mixed numbers. Reduce to lowest terms.
1 1 15
61. 2 ÷ 4 = ____________________ 69. ÷ 10 = _____________________
3 6 30
1 1 8 8
62. ÷ = _______________________ 70. ÷ = _______________________
3 2 3 3
1 3 3
63. 25 ÷ 12 = ____________________ 71. ÷ = _______________________
2 4 8
7 1 2
64. ÷ 2 = _____________________ 72. 12 ÷ = ______________________
8 4 3
6 3 7
65. ÷ = _______________________ 73. ÷ 14 = ______________________
2 4 8
4 1 1 3
66. ÷ = _______________________ 74. 1 ÷ = ______________________
6 2 2 4
3 15
67. ÷ 5 = _____________________ 75. ÷ 5 = ______________________
10 25 8
2
68. 3 ÷ = _______________________
5
Arrange the following fractions in order from largest to smallest.
3 1 5 14 7
76. , , , , ______________________________________________________
16 16 16 16 16
5 5 5 5 5
77. , , , , _______________________________________________________
12 32 8 6 64
78. A patient is instructed to drink 600 mL of water within 1 hour. The patient has only
been able to drink 360 mL. What portion of the water remains? (Express your answer
as a fraction reduced to lowest terms.) _______________
79. A child is prescribed oral ibuprofen (Motrin) suspension with a concentration of

100 mg per 5 mL. What part of the dosage does 20 mg represent? _______________
80. A patient is receiving 240 mL of Ensure by mouth as a supplement. The patient

consumes 200 mL. What portion of the Ensure remains? (Express your answer as a
fraction reduced to lowest terms.) _______________
1
81. A patient takes 1 tablets of medication 4 times per day for 4 days. How many tablets
2
will the patient have taken at the end of the 4 days? _______________
1
82. A juice glass holds 120 mL. If a patient drinks 2 glasses, how many mL did the patient
3
consume? _______________
1
83. How many hours are there in 3 days? _______________
2
1
84. One tablet contains 200 mg of pain medication. How many mg are in 3 tablets?
2
_______________
1
85. A bottle of medicine contains 30 doses. How many doses are in 2 bottles?
2
_______________
1
86. At the beginning of a shift, 5 bottles of hand sanitizer are available. At the end of the
1 4
shift, 3 bottles are left. How much hand sanitizer was used? _______________
2
Apply the principles of borrowing, and subtract the following:
10
87. 2 − = _______________________
21
1 3
88. 9 − = ______________________
4 4
1 3
89. 5 − 3 = ____________________
2 4
Answers on page 22.
For additional practice problems, refer to the Interactive Drug Calculation v.1 on Evolve.

ANSWERS
Answers to Practice Problems
6 6
1. LCD = 30; therefore has the lesser value. 11. LCD = 72; therefore has the higher value.
30 8
6 7
2. LCD = 8; therefore has the lesser value. 12. LCD = 6; therefore has the higher value.
8 6
1 6
3. has the lesser value; the denominator (150) is larger. 13. LCD = 72; therefore has the higher value.
150 12
6 1
4. has the lesser value; the numerator (6) is smaller. 14. has the higher value; the denominator (6) is smaller.
18 6
3 1
5 75
1 6
6. has the lesser value; the numerator (1) is smaller. 16. has the higher value; the numerator (6) is larger.
8 5
1 4
7. has the lesser value; the denominator (40) is larger. 17. LCD = 24; therefore has the higher value.
40 6
1 8
8. has the lesser value; the denominator (300) is larger. 18. has the higher value; the numerator (8) is larger.
300 9
4 1
24 10
1 6
10. LCD = 6; therefore has the lesser value. 20. has the higher value; the numerator (6) is larger.
6 15
10 ÷ 5 2 9÷9 1 11 1
21. = 30. = 39. 2 49. 8 59. 18
15 ÷ 5 3 27 ÷ 9 3 12 15 125
7÷7 1 9÷9 1 3 5 3
22. = 31. = =1 40. 1 50. 22 60.
49 ÷ 7 7 9÷9 1 25 6 50
64 ÷ 2 32 1 15 ÷ 15 1 29 7
23. = = 32. = 41. 51. 19 61. 7
128 ÷ 2 64 2 45 ÷ 15 3 25 21 32
100 ÷ 2 50 2 124 ÷ 31 4 34 31 5
24. = = 33. = 42. 52. 1 62.
150 ÷ 2 75 3 155 ÷ 31 5 8 40 27
20 ÷ 4 5 12 ÷ 6 2 9 11 13
25. = 34. = 43. 53. 63. 1
28 ÷ 4 7 18 ÷ 6 3 2 16 20
14 ÷ 2 7 1 36 ÷ 4 9 27 1 1
26. = = 35. = 44. 54. 64.
98 ÷ 2 49 7 64 ÷ 4 16 8 12 30
10 ÷ 2 5 3 79 1
27. = 36. 3 45. 55. 65. 15
18 ÷ 2 9 5 5 24
24 ÷ 12 2 2 1 4
28. = 37. 4 46. 1 56. 13 66. 1
36 ÷ 12 3 7 2 9
10 ÷ 10 1 5 19 3 2
29. = 38. 1 47. 2 57. 1 67. 2
50 ÷ 10 5 8 24 5 19
1 8
48. 7 58.
6 15
Answers to Chapter Review

2 1 7 1 1
1. 1 =1 24. LCD = 10; 45. LCD = 18; 31 68. 7
8 4 10 9 2
2 1 4 1 15 1
2. 7 = 7 25. LCD = 36; 46. = 69. =
4 2 36 9 300 20
4 2 234 18 1 11
3. 3 = 3 = 6 = 6 47. 9 70. 1
6 3 36 36 2 32
3 30
4. 2 26. 48. 14 71. 2
4 47
3 5
5. 4 27. 22 49. 10 72. 18
14 6
7 1 1
6. 6 28. 140 50. 27 73.
10 4 16
1 8 10 5
7. 4 29. LCD = 9; 106 51. = 74. 2
2 9 16 8
1 2 1 3
8. 2 30. LCD = 10; 52. = 75.
5 2 1 30 15 8
4 13 = 13 12 1 14 7 5 3 1
9. 4 10 5 53. = 76. , , , ,
15 1 120 10 16 16 16 16 16
31.
9 7 5 5 5 5 5
9 54. 77. , , , ,
10. 7 3 27 6 8 12 32 64
13 32. LCD = 4;
4 50 2 2
5 55. = 78. of water remains
11. 2 1 75 3 5
2 33. 2 = 2
4 2 9 1
59 56. 79. of the dosage
12. 19 40 5
8 34. LCD = 30;
30 7 1
43 57. 1 80. of Ensure remains
13. 8 6
5 35. LCD = 4; 1
65 58. 10 81. 24 tablets
14. 11
4 36. LCD = 20;
20 3
16 59. 8 82. 280 mL
15. 7 4
5 37. LCD = 24;
24 1
13 60. 83. 84 hours
16. 17 5 2
5 38. LCD = 6; = 2
6 6 42 14
84 61. = 84. 700 mg
17. 19 4 75 25
10 39. LCD = 15; =1
15 15 2
37 62. 85. 75 doses
18. 5 3
4 40. LCD = 21;
21 3
51 63. 2 86. 1 bottles
19. 3 1 4
4 41. LCD = 12; =
12 4 7 11
47 64. 87. 1
20. 7 18 21
7 42. LCD = 24; 26
24 2 1
13 65. 4 88. 8 = 8
21. LCD = 30; 1 6 4 2
30 43. 24
11 1 3
13 66. 1 89. 1
22. LCD = 24; 1 3 4
24 44. LCD = 10; 12
5 25 1
88 67. 1 =1
23. LCD = 4; = 22 50 2
4

CHAPTER 2 Decimals 23
CHAPTER 2
Decimals
Objectives
After reviewing this chapter, you should be able to:
1. Read decimals
2. Write decimals
3. Compare the size of decimals
4. Convert fractions to decimals
5. Convert decimals to fractions
6. Add decimals
7. Subtract decimals
8. Multiply decimals
9. Divide decimals
10. Round decimals to the nearest tenth
11. Round decimals to the nearest hundredth
Medication dosages and other measurements in the health care system use metric measures, which are
based on the decimal system. An understanding of decimals is crucial to the calculation of dosages. In
the administration of medications, nurses calculate dosages that contain decimals (e.g., levothyroxine
0.075 mg).
Decimal points in dosages have been cited as a major source of medication errors. A misunderstanding
of the value of a dosage expressed as a decimal or the omission of a decimal point can result in a serious
medication error. Decimals should be written with great care to prevent misinterpretation. A clear
understanding of the importance of decimal points and their value will assist the nurse in the prevention
of medication errors.
Example: Digoxin 0.125 mg
Example: Carvedilol 3.125 mg
A decimal is a fraction that has a denominator that is a multiple of 10. A decimal frac-
tion is written as a decimal by using a decimal point (.). The decimal point is used to
indicate place value. Some examples are as follows:
Fraction Decimal Number

3
0.3
10
18
0.18
100
175
0.175
1000
Copyright © 2022, Elsevier Inc. All rights reserved. 23

The decimal point represents the centre. Notice that the numbers written to the right
of the decimal point are decimal fractions with a denominator of 10 or a multiple of 10
and represent a value that is less than 1 or part of 1. Numbers written to the left of the
decimal point are whole numbers, or have a value of 1 or greater.
The easiest way to understand decimals is to memorize the place values (Box 2-1).
BOX 2-1 Decimal Place Values

The decimal value is determined by its position to the right of the decimal point.
Decimal point
(100 000)
Hundred-thousandths (0.00001)
(10 000)
(0.0001)
(1 000)
(0.001)
(0.01)
(100)
(0.1)
(10)
(1)
Hundred-thousands
Ten-thousandths
Ten-thousands
Thousandths
Ones (Units)
Hundredths
Thousands
Hundreds
Tenths
Tens
6 5 4 3 2 1 . 1 2 3 4 5
Whole Numbers to the Left Decimal Numbers to the Right
The first place to the right of the decimal is tenths.

The second place to the right of the decimal is hundredths.
The third place to the right of the decimal is thousandths.
The fourth place to the right of the decimal is ten-thousandths.
In the calculation of medication dosages, it is necessary to consider only three figures
after the decimal point (thousandths) (e.g., 0.375 mg).
SAFETY ALERT!
When there is no whole number before a decimal point, it is important to place a zero (0) to the left
of the decimal point to emphasize that the number is a decimal fraction and has a value less than 1. This
will emphasize its value and prevent errors in interpretation and avoid errors in dosage calculation. This
zero does not change the value of the number. This point has been emphasized by the Institute for Safe
Medication Practices Canada (ISMP Canada). The ISMP Canada (2018) official “Do Not Use” list prohibits
NOTE the writing of a decimal fraction that is less than 1 without a zero before a decimal point.
ISMP Canada is an independ-
ent national nonprofit organization
dedicated to promoting safe medi- The source of many medication errors is misplacement of a decimal point or incor-
cation practices in Canada. rect interpretation of a decimal value.
Reading and Writing Decimals

Once you understand the place value of decimals, reading and writing them are simple.
RULE
To read a decimal number:
1. Read the whole number;
2. Read the decimal point as “and”; and
3. Read the decimal fraction.
Notice that the words for all decimal fractions end in th(s).

Example 1: The number 0.001 is read as “one thousandth.”
Example 2: The number 4.06 is read as “four and six hundredths.”
Example 3: The number 0.4 is read as “four tenths.”
RULE
When there is only a zero (0) to the left of the decimal, as in Examples 1 and 3, the zero is not read
aloud.
TIPS FOR CLINICAL PRACTICE

An exception to this rule is in an emergency situation when a nurse must take a verbal order over
the phone from a prescriber. When repeating back an order for a medication involving a decimal, the zero
should be read aloud to prevent a medication error.
Example: “Zero point 4” would be the verbal interpretation of Example 3. In addition to repeating the
order back, the receiver of the order should write down the complete order or enter it into a computer,
then read it back, and receive confirmation of the order from the individual giving the order.
RULE
To write a decimal number:
1. Write the whole number (if there is no whole number, write zero [0]);
2. Write the decimal point to indicate the place value of the rightmost number; and
3. Write the decimal portion of the number.
Example: Written, seven and five tenths = 7.5
Example: Written, one hundred twenty-five thousandths = 0.125
Example: Written, five tenths = 0.5
RULE
When writing decimals, placing a zero after the last digit of a decimal fraction does not change
its value.
Example: 0.37 mg = 0.370 mg
SAFETY ALERT!
When writing decimals, unnecessary zeros should not be placed at the end of the number to avoid
misinterpretation of a value and the overlooking of a decimal point. ISMP Canada (2015) also makes this
recommendation. ISMP Canada discourages the use of trailing zeros for medication orders or other
medication-related documentation. Exception: A trailing zero may be used only when required to demon-
strate the level of precision of the value being reported, such as for laboratory results, imaging studies
that report the size of lesions, or catheter/tube sizes.
Because the last zero does not change the value of the decimal, it is not necessary. The
preferred notation, as in the example shown here, is 0.37 mg, not 0.370 mg.

PRACTICE PROBLEMS
Write each of the following numbers in word form.
1. 8.35 ___________________________ 4. 5.0007 _________________________
2. 11.001 _________________________ 5. 10.5 ___________________________
3. 4.57 ___________________________ 6. 0.163 __________________________
Write each of the following in decimal form.
7. four tenths ______________________ 10. two and twenty-three

hundredths _____________________
8. eighty-four and seven
hundredths _____________________ 11. five hundredths __________________
9. seven hundredths ________________ 12. nine thousandths ________________
Answers on page 38.
Comparing the Value of Decimals
RULE
Zeros added before or after the decimal point of a decimal number change its value.
Example: 0.375 mg ≠ (is not equal to) 0.0375 mg
Example: 2.025 mg ≠ 20.025 mg
Example: However, .7 = 0.7 and 12.625 = 12.6250;

but you should write 0.7 (with a leading zero) and 12.625 (without a
trailing zero).
SAFETY ALERT!
Understanding which decimal is of greater or lesser value is important in the calculation of dosage
problems. This knowledge helps to prevent errors in dosage and gives the nurse an understanding of the
size of a dosage (e.g., 0.5 mg, 0.05 mg). Understanding the value of decimals prevents errors of misin-
terpretation. There is an appreciable difference between 0.5 mg and 0.05 mg. In fact, 0.5 mg is 10 times
larger than 0.05 mg. A misinterpretation of the value of decimals can result in serious consequences in
dosage calculations.
RULE
When decimal numbers contain whole numbers, the whole numbers are compared to determine which
is greater.
Example: 4.8 is greater than 2.9

RULE
If the whole numbers being compared are the same (e.g., 5.6 and 5.2) or if there is no whole
number (e.g., 0.45 and 0.37), then the number in the tenths place determines which decimal is greater.
RULE
If the whole numbers are the same or zero and the numbers in the tenths place are the same,
then the decimal with the higher number in the hundredths place has the greater value, and so forth.
Example: 0.2 is the same as 0.2000, 0.20
Example: 4.4 is the same as 4.40, 4.400
PRACTICE PROBLEMS
Circle the decimal with the largest value in the following:
13. 0.5 0.15 0.05 16. 0.175 0.1 0.05
14. 2.66 2.36 2.87 17. 7.02 7.15 7.35
15. 0.125 0.375 0.25 18. 0.067 0.087 0.077
Answers on page 38.
Adding and Subtracting Decimals
RULE
To add or subtract decimals, place the numbers in columns so the decimal points are lined up directly
under one another and add or subtract from right to left. Zeros may be added at the end of the decimal
fraction, making all decimals of equal length, but unnecessary zeros should be eliminated in the final
answer.
SAFETY ALERT!
Eliminate unnecessary zeros in the final answer to avoid confusion and prevent errors of
misinterpretation.
Example: Add 16.4 + 21.8 + 13.2

16.4
21.8
+ 13.2
51.4 = 51.4

Another random document with
no related content on Scribd:
veen, uivat hau'it hangotellen, ve'en koirat vengotellen, tulee
tarha Tapion, tulee väki Vellamon. Laskee päivä radaltaan
soiton kieltä kuulemaan, kultaa maat ja mantereet,
kalevaisten tantereet. Kuulee taivahalla kuu, katsoo tuores
tuomipuu kuinka nuoret karkeloi, kalevaisten soitto soi.
Soikaa siis, te soitot, soikaa, Kalevala kaunis on, kapo kaunis,
kultakutri kukkana on karkelon!
Kevätmietteissä.
Päivä jo laskee rannan taa tähtiä taivaalle kohoaa,

valkohohdossa kuuhut valvoo, kirkasna välkkyy virran kalvo,
välkkyy hopeahohdossaan, välkkyy keskellä usviaan.
Utuharsossa unten maan merenneitoset keinuu vaan,

keinuu unina aallon pinnan, aavistuksina ihmisrinnan,
keskeltä usvia harmaita herättää toivoja armaita.
Öinen kulkija katselen leikkiä Vellamon neitosten, keskellä

usvia kuljen yksin, kevättoivoin ja epäilyksin; keväthenkeä
huokuu maa, kevättoivoja kasvattaa.
Rinta kulkijan rauhaton unten lehtoon uupunut on, tähdet

tuikkivat lemmen tulta, kevättoivoja kuuhut kultaa, lehdossa
utuisten unten maan kulkija rauhaton rauhan saan.
Kultia kuuhuen katselen, totta vai valhetta — tiedä en.

Kultia katselen taivahalla, kultia katselen aallon alla, kultia
katselen virran suun, lahjoja kummia öisen kuun.
Kuuhuelta mä kyselen: "Ken saa kultasi, lausu ken! Kelle
annat aartehes, kelle, yön ja usvanko lapsoselle?" Kuu ei
vastaa, ja usvissaan neidot Vellamon leikkii vaan.
Ainon kaiho.
Sopusointu rinnastani minne, minne haihtuikaan? Kaiho

kumma poveani aina, aina polttaa vaan.
Häntä rakastaako voisin,

sekö äidin tahto on,
mainettako unelmoisin,
ennen hoikka huoleton?
Rakastan ma vettä, mettä,

kultakummun kukkia,
kielon kastekyynelettä,
kotilahden lauluja.
Niiltä etsin lohdutusta,

nyt en niiltä löydäkkään,
mieleni on murheen musta,
nytkö lohduttomaks jään?
Kentät karkelen ja soitan, tuskat kummat tunnen vaan;

riemuella tyttö koitan, eipä riemu kuulukkaan.
Kerran lemmin…
Kerran lemmin koito lapsi, kerran raukka ma rakastin. Pois

on lenti lemmittyni, suistui armas surman suuhun; mieli
mustaksi mureni, synkkeni sydänalani. Siks on kulkuni katala,
polku päivän paistamaton, edessä on korpi kolkko, taivas
tähdetön takana.
12-13.IV.1597.
En tahtonut kansalle tuskia, en tahtonut vääryyttä, sortoa, en

tahtonut kansaani kostaa. Minä tahdoin yöstä ja hallasta,
minä tahdoin vieraasta vallasta tämän kansan jaloille nostaa.
Mun käskyni kankailla Suomenmaan sai kodit liekkinä

leimuamaan, sai soimahan sotatorven. Sain taistella kansaani
vastahan, mut herättää tahdoin unestaan ylös kontion
Suomen korven.
Mun käskyni kankailla Suomenmaan sai veljet veljiä

surmamaan, sai vuotamaan kansani verta, minä tahdoin
sorrosta, vainosta ja taistojen taakasta, painosta ylös nostaa
kansani kerta.
Mun käteni kansalle Suomenmaan ei antaa saattanut

apuaan, se armoton oli kuin rauta. Mut armoa aika ei sallinut
se, ja armotonna myös minulle nyt aukenee äkkiä hauta.
Nään sinne uskoni sortuvan ja toivoni Suomen kansahan,

sen vapauteen, vastaisuuteen, en nousevan rautaista kouraa
nää, joka kansani voisi jännittää ja herättää elohon uuteen.
Valo vaipuu eloni auringon, pian yöhön pimeään peittynyt
on sen sammuva iltarusko. Kun kalman vuoteelle painan
pään, minä pirstoina toivoni suuren nään, nään sammuvan
eloni uskon.
Jo Manan neitoset maatavat, jo kalman tyttäret kaatavat

tään kontion Suomen korven… Mut kuulkaa ratsujen jyminää,
oi, kuulkaa! Mistä on melske tää ja toitotus sotatorven?
Minä kuulen tanteren töminää, maan perustuksetko

järkähtää, minä kuulen kalsketta kalpain! Minä kuulen
myrskyjen mylvintää, minä kuulen kuin raivoopi rajusää, minä
kuulen sortuvan salpain!
Minä kuulen sulavan Suomen jään,

minä kuulen: nuijilla isketään,
jo korven kontiot herää!
Läpi vuosisatojen harsojen,
sen kärsimyksien, tuskien
näen: paistaa jo päivänterä.
Minä näänkö vain haaveuniain,

minä vuoteellaniko houraan vain?
En, en, se uni se on totta —
Mut katso, katso, ken se on, ken?
Se käsi on kalman, tunnen sen! —
Nyt saat minut luoksesi ottaa!
Korven keskellä.
Karun korven keskellä Pohjassa eli katajainen kansa, ja se
korvet raatoi ja perkasi ja muokkasi aurallansa.
Ja keskellä korpea kolkkoa

se taisteli, taisteli, kesti,
ja hallan ja nälkäkuoleman
sen kuokka ja kirves esti.
Vaan milloinkaan se ei sortunut,

ei konsa sen pettänyt tarmo,
sen oma kuntonsa kohotti,
ei antimet eikä armo.
Ja keskellä korpea kolkkoa

se kannelta helkytteli,
ja metsän pimeässä pirtissä
sen laulujen henki eli.
Ja se peistä ja nuijaa heilutti

kun uhkasi sorto, väärä,
ja se tunsi sen: valohon, vapauteen
oli sillä matkansa määrä.
Ja siksi se valon ja vapauden

sydänverellä omakseen osti,
ja siksi se valon temppelin
joka korven laitahan nosti.
Mut pimeät vallat ne pelkäsivät

valonvirtaa voimakasta,
ja pimeät vallat ne tahtoivat
valon estää virtaamasta.
Ja pimeät vallat ne nousivat,
ukonpilvinä valon ne peitti,
ja keskelle kolkkoa korpea
ne kansan pimeään heitti.
Mut valonvirta on voimakas,

ken vois sen kulkua estää,
se ikuisuudesta syntynyt on
ja ikuisuutehen kestää.
Ukonpilvet ne valon jos peittääkin,

uhka haihtuva on se vain hetken;
sen jälkeen kahta näät kauniimman
valon valtavan voittoretken.
Sen jälkeen entistä uljaammin

taas nousee jumalan tammi,
sen jälkeen entistä armaampi
on loiskina metsälammin.
Sen jälkeen kahta kauniimmin taas sinelle siintää salo, sen

jälkeen kahta kirkkaammin joka majahan välkkyy valo.
Kylänkarkelo.
käy karkelohon kylän kasvava kansa, pelimanni jo soittaa

parhaillansa, ja kuluvi kesäinen ilta! Pian lampi tyyni on lailla
peilin, kera karkele, poikanen, nyt oman heilin, jotta notkuvi
sininen silta!
Vain virrassa lainehet lipattaa, liikkuu ja järvellä sorsat
soreasti kiikkuu ja aaltoaa vihannat viljat. Ylös poikaset,
kuuset te kevähäiset, ylös neitoset nuoret, pellavapäiset, te
tään kylän lempeät liljat!
Kas, heinät ne heiluu ja nurmet ne nuokkuu, ja illan tuuli

niin hiljaa huokuu ja sävelet soivat, soivat Kas, tuoresna
tuoksuu kuunahan kukka ja nuori on neitonen pellavatukka ja
vainiot vihannoivat
Oi, soios soitto ja vinkuos viulu, pois kirvehes poika, pois

neitonen kiulu, tää ilta se ilta on ilon! Ota, poikanen, heiliäs
hellää vyöstä ja karkele huoleti päivän työstä nyt päällä sen
sillan silon!
Ja sävelet soivat ja lintuset laulaa ja poika se neitoa norjaa

kaulaa ja laskevi kesäinen ilta. Ja murheet murtuu ja huolet
ne haihtuu ja arkisurut ne riemuksi vaihtuu ja notkuvi sininen
silta.
Kas, kentät ne kukkii ja läikkyy laihot ja nuoruus surmahan

suistaa kaihot ja haihtuu elämän arki. Ja yksin nyt itkee tuima
Tuoni, povet nuorten kun paisuu ja sykkii suoni ja rinta ei
huolia harki.
Ja soios soitto ja vinkuos viulu, pois kirvehes poika, pois

neitonen kiulu, tää ilta se ilta on ilon! Ota, poikanen, heiliäs
hellää vyöstä ja karkele huoleti päivän työstä nyt päällä sen
sillan silon!
Tarina Pekasta ja vallesmannista.
Hän korven kolkasta tullut on nyt tietojen, taitojen maille.

Hän kuokan jätti ja lapion, oli oppia jäänyt vaille, mut
vanhanakin hän tahtoi koittaa ja vanhanakin hän tahtoi voittaa
viel' oksan tiedon ja taidon puusta.
Vaan kotikylässä elämä nousi, ja sana kulki nyt suuhun

suusta, ja kaikki virttä yhtä soittaa: jo herraksi Pekka tahtoo
koittaa!
Ja vallesmannikin ihmeissänsä nyt yhtehen hykersi

käsiänsä: "Mikä mieheltä mielen vienyt on, hän mennyt on
kansanopistohon! Voi ihmettä kummaa! Voi herranen aika! On
miehelle varmaan tehty jo taika. En ymmärrä mikä päähän
pisti, hän kohta on täysi sosialisti. Hän lehtiä lukee ja lausehet
pukee kuin oppia paljonki saanut ois. Hänen kerran kummia
kertovan kuulin ja päästä jo pyörälle tulleen luulin. Hän lausui:
'laps mökin pienenkin on oikeutettu oppihin.' Ja yhtä hyvin
kuin viljan hinnat tuns' Juhani Ahot ja Päivärinnat, ja draamat
Shakespearen tunsi hän — ties mitä ne kaikki lienevätkään, ei
mulle hyötyä moisesta työstä, mä ilman niitäkin osaan
ryöstää. Mä nauroin hälle, vaan vakavana näin virkkoi mulle
tuo vanha aasi: 'Sua, herra, työhön käskee maasi." Mä
lausuin hälle: "mä työtä teen, mä rästit kannan ja ryöstöt
annan?' Hän huokasi silloin syvähän, ei mitään virkkanut
enemmän. Kai huomasi, turha on vastaan koittaa, kai näki:
tyhmän ja pöllöpään mies sivistynyt aina voittaa." — Ja
tyytyväisenä, mielissänsä hän yhteen hykersi käsiänsä.
Ja Perälän pitäjän vallasväki se eessään viisahan herran
näki, ja koko kylä se kertoa ties: "Niin viisas on meillä
nimismies, on sivistynyt ja vakainenki, ei häntä villitse ajan
henki. Ah, tällaisia jos kaikki ois, niin sovussa kansa elää vois,
ja Suomen kansa ja Suomen maa niin rauhassa saisi
kukoistaa!"
Pimeän pesä.
(Vuorilegenda.)
Ne tuikki ne tuhannet kynttilät ja valot kirkkahat välkkyivät,

oli valon juhla jalo. Ja vaikka joutui ilta ja yö ja vaikk' oli
päättynyt päivän työ, valoin välkkyi joka talo. Ja vaikka talvi
kattoi maan ja vaikka vihurit vinkui vaan, niin oli rinnoissa
kesä. Mut yks oli maja valoton, se pimeyden hengen asunto
on, se oli peikon pesä.
Ja valot ne välkkyi ja välkkyi vaan ja peikko katseli

kauhuissaan, hän silmiä siristeli ja vavistuksessa eli ja
huokasi: "ollappa oikea yö, niin silloin mullekin alkais työ,
minä valkeutta pelkään ja pelkään omaa selkään. Oi yö, sinä
suloinen lohtujen tuoja, oi yötä jos ijäti antais Luoja! Oi yöni, oi
yöni, mun peikon työni sä ijäti kätkisit maailmalta ja ijäti
kestäis peikkojen valta."
Ja peikko se tuimasti tirkisteli ja peikonsilmiään sirkisteli,

mut valoja syttyi ja syttyi vaan, ja peikko se potki kauhuissaan
ja pelosta pysähtyi veri. — "Mi joukko kumma kujalla käy, ei
muita kuin valon soihtuja näy, siell' aaltoaa tulimeri." Ja peikko
pakenee joukkoa ja etsii pimeintä loukkoa. "Oi, kohta nyt
hukka jo perii!"
Ja valot valtavat virtaili, mut yks oli pimeän pesä. Ja kansa

valosta riemuitsi ja rintahan koitti kesä. Mutta peikko se
pelkäsi valoja ja pelkäsi toisia taloja; ne kaikki valoa virtaili —
Mut yks oli pimeän pesä.
Voiton saatte!
Lietsokaatte, lietsokaatte valonahjot valkeaa! Pilvet raskaat,

taivas tumma pimeyttä uhkajaa, vaarassa on isänmaa, kaikin
voimin lietsokaa! Lietsokaatte, lietsokaatte valonahjot
valkeaa! Lietsokaatte, voiton saatte!
Valaiskaatte, valaiskaatte maata valon airuet! Valaiskaatte

rikkaan majat sekä salon sydämmet, valaiskaatte köyhän tie,
joka metsäpirttiin vie! Valaiskaatte, valaiskaatte maata valon
airuet! Valaiskaatte, voiton saatte!
Taistelkaatte, taistelkaatte eestä ikitotuuden! Taistelkaatte

vastaan yötä, vastaan valtaa vääryyden, taistelkaatte eestä
lain, eestä oikeuden vain! Taistelkaatte, taistelkaatte eestä
ikitotuuden! Taistelkaatte, voiton saatte!
Seisokaatte, seisokaatte rivissä nyt joka mies, että rauhass'

aina palaa saisi pyhä kotilies! Vapautta puoltakaa! Teitä
siunaa kansa, maa. Seisokaatte, seisokaatte rivissä nyt joka
mies! Seisokaatte, voiton saatte!
Lietsokaatte, lietsokaatte valonahjot valkeaa! Pilvet raskaat,

pilvet tummat vielä kerran halkeaa. Suomen, valon morsion
päivä silloin kirkas on. Lietsokaatte, lietsokaatte valonahjot
valkeaa! Lietsokaatte, voiton saatte!
Maamiehen kevätlaulu.
Oi kevään kauniin antaja, oi taivahainen Luoja! nyt viljaa

nuorta, nousevaa sä varjele ja suojaa.
Sä hoivaa hennot tähkäpäät

niit' ettei veisi halla,
niin paljon nuorta toivoa
nyt uhkuu kaikkialla.
Ja kevään hengen valaista suo pimeätä Pohjaa, ja poveen

salon synkänkin sä onni, rauha ohjaa.
Tahdon ikitulta.
Taivas! elä mulle anna kiiltokultaa; paljon, paljon enempi

tahdon, taivas, sulta.
Tahdon, taivas, sulta
vaadin valkeoita,
innon ikitulta,
tulta, salamoita.
Niillä isken yöhön,

niinkuin isket itse,
salamoita singotan
maitse, manteritse.

ohi tähtisarjain,
kautta avaruuden,
halki vuorten harjain.

mik' ei kestä, särjen,
vasten valtaa väärää
käännän nuoles kärjen.

kaadan konnat, peikot,
nostan valoon, valtaan
sorretut ja heikot.
Halpa lahjas oisi kunnia ja kulta — Tahdon, taivas, sulta

tahdon ikitulta!
*** END OF THE PROJECT GUTENBERG EBOOK LAULUJA ***
Updated editions will replace the previous one—the old editions will
be renamed.
Creating the works from print editions not protected by U.S.

copyright law means that no one owns a United States copyright in
these works, so the Foundation (and you!) can copy and distribute it
in the United States without permission and without paying copyright
royalties. Special rules, set forth in the General Terms of Use part of
this license, apply to copying and distributing Project Gutenberg™
electronic works to protect the PROJECT GUTENBERG™ concept
and trademark. Project Gutenberg is a registered trademark, and
may not be used if you charge for an eBook, except by following the
terms of the trademark license, including paying royalties for use of
the Project Gutenberg trademark. If you do not charge anything for
copies of this eBook, complying with the trademark license is very
easy. You may use this eBook for nearly any purpose such as
creation of derivative works, reports, performances and research.
Project Gutenberg eBooks may be modified and printed and given
away—you may do practically ANYTHING in the United States with
eBooks not protected by U.S. copyright law. Redistribution is subject
to the trademark license, especially commercial redistribution.
START: FULL LICENSE

THE FULL PROJECT GUTENBERG LICENSE
PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK
To protect the Project Gutenberg™ mission of promoting the free

distribution of electronic works, by using or distributing this work (or
any other work associated in any way with the phrase “Project
Gutenberg”), you agree to comply with all the terms of the Full
Project Gutenberg™ License available with this file or online at
www.gutenberg.org/license.
Section 1. General Terms of Use and

Redistributing Project Gutenberg™
electronic works
1.A. By reading or using any part of this Project Gutenberg™
electronic work, you indicate that you have read, understand, agree
to and accept all the terms of this license and intellectual property
(trademark/copyright) agreement. If you do not agree to abide by all
the terms of this agreement, you must cease using and return or
destroy all copies of Project Gutenberg™ electronic works in your
possession. If you paid a fee for obtaining a copy of or access to a
Project Gutenberg™ electronic work and you do not agree to be
bound by the terms of this agreement, you may obtain a refund from
the person or entity to whom you paid the fee as set forth in
paragraph 1.E.8.
1.B. “Project Gutenberg” is a registered trademark. It may only be

used on or associated in any way with an electronic work by people
who agree to be bound by the terms of this agreement. There are a
few things that you can do with most Project Gutenberg™ electronic
works even without complying with the full terms of this agreement.
See paragraph 1.C below. There are a lot of things you can do with
Project Gutenberg™ electronic works if you follow the terms of this
agreement and help preserve free future access to Project
Gutenberg™ electronic works. See paragraph 1.E below.
1.C. The Project Gutenberg Literary Archive Foundation (“the
Foundation” or PGLAF), owns a compilation copyright in the
collection of Project Gutenberg™ electronic works. Nearly all the
individual works in the collection are in the public domain in the
United States. If an individual work is unprotected by copyright law in
the United States and you are located in the United States, we do
not claim a right to prevent you from copying, distributing,
performing, displaying or creating derivative works based on the
work as long as all references to Project Gutenberg are removed. Of
course, we hope that you will support the Project Gutenberg™
mission of promoting free access to electronic works by freely
sharing Project Gutenberg™ works in compliance with the terms of
this agreement for keeping the Project Gutenberg™ name
associated with the work. You can easily comply with the terms of
this agreement by keeping this work in the same format with its
attached full Project Gutenberg™ License when you share it without
charge with others.
1.D. The copyright laws of the place where you are located also
govern what you can do with this work. Copyright laws in most
countries are in a constant state of change. If you are outside the
United States, check the laws of your country in addition to the terms
of this agreement before downloading, copying, displaying,
performing, distributing or creating derivative works based on this
work or any other Project Gutenberg™ work. The Foundation makes
no representations concerning the copyright status of any work in
any country other than the United States.
1.E. Unless you have removed all references to Project Gutenberg:
1.E.1. The following sentence, with active links to, or other

immediate access to, the full Project Gutenberg™ License must
appear prominently whenever any copy of a Project Gutenberg™
work (any work on which the phrase “Project Gutenberg” appears, or
with which the phrase “Project Gutenberg” is associated) is
accessed, displayed, performed, viewed, copied or distributed:
This eBook is for the use of anyone anywhere in the United
States and most other parts of the world at no cost and with
almost no restrictions whatsoever. You may copy it, give it away
or re-use it under the terms of the Project Gutenberg License
included with this eBook or online at www.gutenberg.org. If you
are not located in the United States, you will have to check the
laws of the country where you are located before using this
eBook.
1.E.2. If an individual Project Gutenberg™ electronic work is derived

from texts not protected by U.S. copyright law (does not contain a
notice indicating that it is posted with permission of the copyright
holder), the work can be copied and distributed to anyone in the
United States without paying any fees or charges. If you are
redistributing or providing access to a work with the phrase “Project
Gutenberg” associated with or appearing on the work, you must
comply either with the requirements of paragraphs 1.E.1 through
1.E.7 or obtain permission for the use of the work and the Project
Gutenberg™ trademark as set forth in paragraphs 1.E.8 or 1.E.9.
1.E.3. If an individual Project Gutenberg™ electronic work is posted

with the permission of the copyright holder, your use and distribution
must comply with both paragraphs 1.E.1 through 1.E.7 and any
additional terms imposed by the copyright holder. Additional terms
will be linked to the Project Gutenberg™ License for all works posted
with the permission of the copyright holder found at the beginning of
this work.
1.E.4. Do not unlink or detach or remove the full Project

Gutenberg™ License terms from this work, or any files containing a
part of this work or any other work associated with Project
Gutenberg™.
1.E.5. Do not copy, display, perform, distribute or redistribute this

electronic work, or any part of this electronic work, without
prominently displaying the sentence set forth in paragraph 1.E.1 with
active links or immediate access to the full terms of the Project
Gutenberg™ License.
1.E.6. You may convert to and distribute this work in any binary,
compressed, marked up, nonproprietary or proprietary form,
including any word processing or hypertext form. However, if you
provide access to or distribute copies of a Project Gutenberg™ work
in a format other than “Plain Vanilla ASCII” or other format used in
the official version posted on the official Project Gutenberg™ website
(www.gutenberg.org), you must, at no additional cost, fee or expense
to the user, provide a copy, a means of exporting a copy, or a means
of obtaining a copy upon request, of the work in its original “Plain
Vanilla ASCII” or other form. Any alternate format must include the
full Project Gutenberg™ License as specified in paragraph 1.E.1.
1.E.7. Do not charge a fee for access to, viewing, displaying,

performing, copying or distributing any Project Gutenberg™ works
unless you comply with paragraph 1.E.8 or 1.E.9.
1.E.8. You may charge a reasonable fee for copies of or providing

access to or distributing Project Gutenberg™ electronic works
provided that:
• You pay a royalty fee of 20% of the gross profits you derive from
the use of Project Gutenberg™ works calculated using the
method you already use to calculate your applicable taxes. The
fee is owed to the owner of the Project Gutenberg™ trademark,
but he has agreed to donate royalties under this paragraph to
the Project Gutenberg Literary Archive Foundation. Royalty
payments must be paid within 60 days following each date on
which you prepare (or are legally required to prepare) your
periodic tax returns. Royalty payments should be clearly marked
as such and sent to the Project Gutenberg Literary Archive
Foundation at the address specified in Section 4, “Information
about donations to the Project Gutenberg Literary Archive
Foundation.”
• You provide a full refund of any money paid by a user who

notifies you in writing (or by e-mail) within 30 days of receipt that
s/he does not agree to the terms of the full Project Gutenberg™
License. You must require such a user to return or destroy all
copies of the works possessed in a physical medium and
discontinue all use of and all access to other copies of Project
Gutenberg™ works.
• You provide, in accordance with paragraph 1.F.3, a full refund of

any money paid for a work or a replacement copy, if a defect in
the electronic work is discovered and reported to you within 90
days of receipt of the work.
• You comply with all other terms of this agreement for free
distribution of Project Gutenberg™ works.
1.E.9. If you wish to charge a fee or distribute a Project Gutenberg™

electronic work or group of works on different terms than are set
forth in this agreement, you must obtain permission in writing from
the Project Gutenberg Literary Archive Foundation, the manager of
the Project Gutenberg™ trademark. Contact the Foundation as set
forth in Section 3 below.
1.F.
1.F.1. Project Gutenberg volunteers and employees expend

considerable effort to identify, do copyright research on, transcribe
and proofread works not protected by U.S. copyright law in creating
the Project Gutenberg™ collection. Despite these efforts, Project
Gutenberg™ electronic works, and the medium on which they may
be stored, may contain “Defects,” such as, but not limited to,
incomplete, inaccurate or corrupt data, transcription errors, a
copyright or other intellectual property infringement, a defective or
damaged disk or other medium, a computer virus, or computer
codes that damage or cannot be read by your equipment.
1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except

for the “Right of Replacement or Refund” described in paragraph
1.F.3, the Project Gutenberg Literary Archive Foundation, the owner
of the Project Gutenberg™ trademark, and any other party

Ebook Gray Morriss Calculate With Confidence PDF Full Chapter PDF

Uploaded by

Copyright:

Available Formats

You might also like

Ebook Gray Morriss Calculate With Confidence PDF Full Chapter PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ebook Gray Morriss Calculate With Confidence PDF Full Chapter PDF

Uploaded by

Copyright:

Available Formats

Gray Morris's Calculate with

Confidence - eBook PDF

Activate the complete learning experience that comes with each

Library of Congress Control Number: 2020943609

VP Education Content: Kevonne Holloway

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Deborah C. Gray Morris

Features of the Second Canadian Edition

UNIT ONE Math Review 1

3 Ratio and Proportion, 40

UNIT TWO Systems of Measurement 69

6 Converting Within and Between Systems, 85

7 Additional Conversions Useful in the Health

UNIT THREE Methods of Administration and

9 Understanding and Interpreting Medication

10 Medication Administration Records and Drug

11 Reading Medication Labels, 163

12 Dosage Calculation Using the Ratio and

13 Dosage Calculation Using the Formula Method, 237

14 Dosage Calculation Using the Dimensional

UNIT FOUR Oral and Parenteral Dosage Forms

16 Parenteral Medications, 348

17 Reconstitution of Solutions, 420

UNIT FIVE Intravenous and Heparin Calculations,

20 Intravenous Calculations, 528

21 Heparin Calculations, 562

22 Pediatric and Adult Dosage Calculations Based

23 Critical Care Calculations, 653

COMPREHENSIVE POST-TEST 682

Appendix A: Arabic Equivalents for Roman Numerals, 705

Copyright © 2022, Elsevier Inc. All rights reserved. 1

Reduce the following fractions to lowest terms.

Perform the indicated operations; reduce to lowest terms where necessary.

Indicate the largest fraction in each group.

Copyright © 2022, Elsevier Inc. All rights reserved.

25. 20.1 + 67.35 = ___________________ 27. 4.6 × 8.72 = _____________________

26. 0.008 + 5 =  _____________________ 28. 56.47 − 8.7 = ____________________

29. 7.5 ÷ 0.004 = ____________________ 31. 84.7 ÷ 2.3 = _____________________

30. 45 ÷ 1.9 = ______________________

Indicate the largest decimal in each group.

32. 0.674, 0.659 _____________________ 34. 0.25, 0.6, 0.175  __________________

33. 0.375, 0.37, 0.38  _________________

Solve for x, the unknown value.

Round off to the nearest tenth.

39. 0.43 ___________________________ 41. 1.47 ___________________________

40. 0.66 ___________________________

Round off to the nearest hundredth.

42. 0.735 __________________________ 44. 1.227 __________________________

43. 0.834 __________________________

Percentage Decimal Ratio Fraction

45. 6% __________ __________ __________

46. __________ __________ 7 : 20 __________

47. __________ __________ __________ 1

Copyright © 2022, Elsevier Inc. All rights reserved.

49. 5% of 95 ________________________ 52. 20 is what % of 100 _______________

58. Write a ratio that represents 60 mg of a medication in 1 mL of a liquid.

Copyright © 2022, Elsevier Inc. All rights reserved.

Percentage Decimal Ratio Fraction

25. 20.1 + 67.35 = _ 27. 4.6 × 8.72 = ___

26. 0.008 + 5 = _ 28. 56.47 − 8.7 =

29. 7.5 ÷ 0.004 = 31. 84.7 ÷ 2.3 = _

30. 45 ÷ 1.9 = ______________________

32. 0.674, 0.659 ___ 34. 0.25, 0.6, 0.175

33. 0.375, 0.37, 0.38 _________________

39. 0.43 _ 41. 1.47 _

40. 0.66 ___________________________

42. 0.735 44. 1.227

43. 0.834 __________________________

45. 6% __

46. 7 : 20 __

47. __ 1

49. 5% of 95 __________ 52. 20 is what % of 100 _

1. 8.35 ___ 4. 5.0007 _

2. 11.001 _ 5. 10.5 ___

3. 4.57 _ 6. 0.163

7. four tenths ______________________ 10. two and twenty-three

9. seven hundredths 12. nine thousandths