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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

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To find this flower, your eyes must be brighter than usual. It grows
close to the ground, and is usually hidden from sight by the pair of
round, woolly leaves shooting up from the underground stem, which
tastes like ginger. This thick underground stem is the storehouse
whose stock of food makes it possible for the plant to flower and leaf
so early in the year.
Fig. 215 shows you the pretty wake-robin. This is a lily. But it is
unlike the lilies we already know, in that its calyx and corolla are
quite distinct, each having three separate leaves. It has six stamens,
and one pistil with three branches.
Fig. 215
Fig. 216
The general building plan of the violet (Fig. 216) is the old one of
calyx, corolla, stamens, pistil. But the leaves of this calyx (Fig. 217)
are put together in a curious, irregular fashion; and the different
leaves of the corolla are not of the same shape and size as in the
cherry blossom. Then the five stamens of the violet are usually
joined about the stalk of the pistil in a way that is quite confusing,
unless you know enough to pick them apart with a pin, when they
look like this picture you see above, to the right (Fig. 218).
Fig. 217 Fig. 219 Fig. 220 Fig. 218
Fig. 221
Fig. 222
The garden pansy (Figs. 219, 220) is cousin to the violet. You
notice at once that it uses just the same building plan.
The wild geranium (Figs. 221, 222) is put together almost as
simply as the cherry blossom.
A more beautiful flower than the columbine it would be difficult to
find (Fig. 223). Its graceful hanging head and brilliant coloring make
it a delight to the passer-by.
Fig. 223
It has not the fragrance of some other flowers, but for this there is
a good reason.
The columbine is so brightly colored that the nectar-hunting bee
can see it from a great distance.
It is only when a blossom is so small and faintly colored as to be
unlikely to attract the eye, that it needs to make its presence known
in some other way than by wearing gay clothes. By giving out
fragrance it notifies the bee that material for honey making is on
hand.
So you see that a pale little flower with a strong fragrance is just
as able to attract the bee’s attention as is a big flower with its bright
flower handkerchiefs. A big flower with bright flower handkerchiefs
does not need to attract the bee by its perfume.
Perhaps you will be somewhat surprised to learn that this
columbine uses the old plan, calyx, corolla, stamens, pistil.
In the columbine the calyx as well as the corolla is brightly and
beautifully colored, and only the botanist can tell which is which. In
this way many flowers confuse one who is only beginning their study.
So you must try to be patient when you come across a flower whose
coloring and shape make it impossible for you to say what is calyx
and what is corolla. You should turn both over into the one division of
flower leaves, and when older you may be able to master the
difficulty.
Fig. 224
Fig. 225
The pretty fringed polygala (Fig. 224) is one of these confusing

flower. You find it in the May woods. Its discovery is such a delight,
that one is not apt to make himself unhappy because he cannot
make out all its parts.
The jewelweed (Fig. 225), the plant which blossoms down by the
brook in August, is another of these puzzling blossoms.
A CELEBRATED FAMILY
D O you know this pretty flower (Fig. 226)?
Fig. 226
It is the yellow lady’s slipper. It lives deep in the woods of May,

perhaps part way up the mountain side. It has several sisters. One of
these is the pink lady’s slipper, which blossoms just a little later.
Another is the white lady’s slipper. This comes late in June, and is
one of the loveliest of our wild flowers.
These three sisters belong to a celebrated family, that of the
Orchids.
The Orchid family is noted for the beauty of its flowers, and for the
pains which these take to attract the attention of the bees.
The building plan used by the orchids is too difficult for you to
learn yet awhile. Perhaps the orchids take more trouble than any
other flowers to have their pistils well dusted with pollen. A good
landing place for the bee is provided; signs are hung out to point the
way to the hidden nectar; and if directions are followed, the pistil is
sure to receive the wished-for pollen.
This picture (Fig. 227) shows you an orchid which you see in the
windows of flower shops during the winter. It comes to us from far
South, not growing out of doors in our climate.
Fig. 227
Its building plan would almost serve for a wayside tavern. You can
see that the pocket would answer as a front doorstep, making a
convenient landing place for bee or butterfly.
The dark spots on the upper flower leaf point downward to the
refreshment room.
Even more curious than this one are other orchids which grow in
far-away places.
In their efforts to please, they wear the most striking colors, and
take on a variety of fantastic shapes.
One of them dresses itself much like a bee. In this way perhaps it
secures a visit from the real bee.
Another is called the baby orchid, because in the center of each
flower is an object which really looks like a fairy baby.
There are some ten or twelve orchids which are common in our
Northern woods. I hope you children will keep on the lookout for
them all summer.
Just now you could not tell whether or not a flower was an orchid.
But if you come across a plant whose flowers look as though they
were built to serve as wayside taverns for the bees, why, carry them
to your teacher, and ask her to find out for you whether they belong
to the Orchid family.
But it is only fair to tell you that some of our orchids bear flowers
so small and insignificant that you would hardly guess them to be
members of so distinguished a family.
CLEVER CUSTOMS
O N this page you see a picture of the garden foxglove.

The garden foxglove is an English wild flower. It is so striking
and beautiful that it was brought across the sea to decorate our
gardens.
We can guess that the spots within each bell are the signposts
leading to the refreshment room.
The yellow false foxglove (Fig. 228), which grows wild in our
woods in midsummer, is a less brilliant flower than its English cousin,
and is without the spots that serve as signposts.
Fig. 228
Our wood and meadow lilies (Figs. 229, 230) are well fitted to
secure bee visitors. Their colors are brilliant enough to catch the eye
of the most unobserving of bees in its voyage across the meadow,
and their spots vivid enough to lead it at once to the refreshment
room.
Fig. 229
Try for yourselves to follow these markings with your tongue, and
you will win the bee’s reward, a sweet drop of nectar.
Whenever you see a flower with such vivid markings as these, it
will be worth your while to play the bee, and start a honey hunt.
Sometimes the sweet drop lies at the base of the flower leaves, as
in the lilies; sometimes in a pocket, as in many of the orchids;
sometimes it is in the bottom of a long spur such as you see in the
columbine, violet, and nasturtium (Fig. 231).
Fig. 230
Fig. 232 shows you the beautiful flowers of the mountain laurel.
These flowers play a clever trick on their bee visitors. They wish to
make perfectly sure that their pollen will be carried from one blossom
to another, and so they set a little trap.
Fig. 231
In a freshly opened blossom each stamen is bent over, as you see

they are bent over in the picture (Fig. 233).
Their dust boxes are caught in little pockets of the flower cup.
When a bee lights on a flower (Fig. 234), the jar causes the dust
boxes to spring from the pockets with so much violence that the
pollen is shaken over the body of the visiting bee, which is sure to
leave some of it on the pistil of the next flower.
Fig. 232
Some flowers take special care to prevent their pistils from being
dusted with pollen from the dust boxes of the same blossom. The
fireweed bears such blossoms as these.
Fig. 233
In Fig. 235 you see that the stamens of the fireweed are large and
ripe, and ready to shed their pollen; but the pistil is bent sideways,
pushing its closed tip quite out of the corolla, and out of reach of any
pollen from a neighboring stamen.
Fig. 234 Fig. 235 Fig. 236
Fig. 236 shows you another blossom from this same plant. The
stamens have shed their pollen, and are quite dry and withered; but
its pistil has straightened itself, and spreads out its four tips so as to
receive the pollen from another flower.
Fig. 237
It is believed that those seeds which are touched with life by pollen
from another flower are more likely to change into healthy, hardy
plants than those which are quickened by the pollen of their own
flower.
Such of you as live near the sea know the lovely sea pinks (Fig.
237), which make a rosy carpet across the salt meadows early in
August. The stamens and pistils of this sea pink act in the same way.
FLOWERS THAT TURN NIGHT INTO DAY
A LREADY we have read that certain flowers attract insects rather

by their fragrance than by their brilliancy of coloring.
It is interesting to learn that some blossoms open usually only
during the night. Of course, if these flowers hope to receive visitors,
and get their share of pollen, they must devise some means of
making known their presence to those insects which are awake and
at work in the darkness.
You can understand that at night the brightest colors would be
useless. A red flower is less easily seen in the darkness than a white
or a yellow one; so night-opening flowers nearly always wear a white
or yellow dress.
And not only this: to make sure that they will not be overlooked,
and so miss the chance of ripening their seeds, they send out a
strong fragrance as soon as the night falls. Through the deepest
gloom this message of invitation reaches the wandering moth.
Do you know the evening primrose (Fig. 238)? There ought to be
no need of asking you this, for it is one of our commonest wayside
plants. But perhaps you have hardly noticed it, because ordinarily
only at night is its flower wide awake.
Fig. 238
When the sun has set, this pale yellow blossom unfolds, and gives
out a strong, sweet fragrance, which means that it is “at home” to
visitors.
After one short summer night it dies.
But during its little life the chances are that its invitation has been
accepted by the pretty pink moth which oftentimes you find asleep in
the faded flower cup.
The moth visitor has brought its hostess the pollen from another
blossom, and has powdered the pistil’s four spreading tips, so that
the little primrose seeds below get the needed touch of life, and the
short life of the flower has not been in vain.
If you keep on the lookout, you are likely to come across one of
these yellow flowers with the sleepy pink moth inside its cup. I have
caught this little fellow napping so often, that I have wondered if the
nectar of the evening primrose might not have the effect of a
sleeping potion. But after all, I suppose that pretty pink moths, like
boys and girls, are likely to be dull and sleepy in the daytime if they
have been up too late the night before.
HORRID HABITS
D ID you ever know that some plants manage to attract insects in

ways that are quite disgusting to us human beings?
While spending a morning in the woods, some of you may have
noticed an odor so unpleasant that you were driven to find another
resting place.
Perhaps you thought that this unpleasant smell was caused by the
decaying body of some dead animal; but had you known the truth,
you would have laid the blame where it rightly belonged.
And where was that, do you think?
Why, to that beautiful climbing plant close by, with large, thick
leaves, and clusters of pale, greenish flowers, that were twisting all
about the bushes. This plant it was that caused all the disturbance. It
is called the “carrion vine” on account of the carrionlike odor of its
flowers. Its pollen is carried from one little blossom to another by tiny
flies, drawn to the spot by a smell like that of decaying flesh. These
flies would pass carelessly over the sweet-smelling carpet of the
partridge vine, they would scorn the invitation of the evening
primrose; but the odor which drives us hurriedly from our cozy corner
induces them to gather together in hundreds. Whether they come,
actually expecting to find decaying flesh, I cannot say.
In some countries grows a plant which not only smells like
decaying flesh, but which adds to the deception by its red, beefy
look, thus doubly attracting the flies which like this sort of food.
THE STORY OF THE STRAWBERRY
I N the wood which edges the meadow is a hollow where it is almost

sure to be cool and shady. Let us find our way there this morning,
and see how we can amuse ourselves.
At first we want only to enjoy the wind which is coming through the
trees, or to lie back on the grass and spy out the bird which is
singing overhead, or else to laugh at the red squirrel which is
scolding away at a great rate above us.
Suddenly our eyes fall on a cluster of ripe, shining wild
strawberries. Bird and squirrel are forgotten, for no fruit of all the
year is prettier to look at than the wild strawberry; and, what is more
important, no other fruit has such a delicious flavor of the woods and
fields.
Soon we have eaten all the berries within reach. The creeping
vines lead us out into the meadow, where we push aside the long
grasses and pick one ripe mouthful after another. At last we are
satisfied to go back to our shady nook.
The little white blossoms that a few weeks ago were so plentiful
have nearly all disappeared. Who among you can tell me how these
juicy berries have managed to take the place of the blossoms?
Fig. 239 Fig. 240 Fig. 241
Fig. 242
Fig. 243
Why, ever so many of you can tell me much of the story, at any
rate. It is very nearly that of the apple and cherry and plum and pear.
The nectar-hunting bee carried the pollen of its many stamens from
one strawberry blossom to another, leaving some of it on the flat tips
of its numerous pistils. Down the pistils’ stalks went the tiny life
bearing tubes which pushed their way into the little seeds below.
Fig. 244
So far, the story of the strawberry is not new to us; but just here it
begins to differ from the stories of the apple and pear, of the plum
and peach and cherry. The flowers of all these trees had but one
seedbox. But each of the many little strawberry pistils has a separate
seedbox; and when the little seeds within get their touch of new life,
the flat, cushionlike object (Fig. 241) which bears these many pistils
begins to act in a most surprising manner.
This flat flower cushion swells upward and outward (Fig. 242),
growing big and juicy and sweet, bearing its pistils (Fig. 243) with it.
And so in the strawberry blossom it is the flat cushion hidden out
of sight which grows into the delicious fruit.

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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

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