CLICK HERE TO DOWNLOAD THE FULL ORIGINAL PDF

CALCULATE with CONFIDENCE

SEVENTH EDITION

Deborah C. Gray Morris, RN, BSN, MA, LNC

Chairperson, Department of Nursing and Allied Health Sciences, Bronx Community College of the City
University of New York (CUNY), Bronx, New York

2
Contents

Cover image

Title page

Copyright

Dedication

Reviewers

Preface to the Instructor

Acknowledgments

Unit One Math Review

Pre-Test

1 Roman Numerals

2 Fractions
Types of Fractions

Converting Fractions

Comparing Fractions

Reducing Fractions

Adding Fractions

Subtracting Fractions

Multiplying Fractions

Dividing Fractions

3 Decimals
Reading and Writing Decimals

Comparing the Value of Decimals

Adding and Subtracting Decimals

Multiplying Decimals

3
 Dividing Decimals Rounding Off

Decimals Changing Fractions to

Decimals

Changing Decimals to Fractions

4 Ratio and Proportion

Ratios

Proportions

Solving for x in Ratio and Proportion

Applying Ratio and Proportion to Dosage Calculation

5 Percentages
Converting Percentages to Fractions, Decimals, and Ratios

Percentage Measures

Comparing Percents and Ratios

Determining the Percent of a Quantity

Determining What Percent One Number Is of Another

Calculating the Percent of Change

Post-Test

Unit Two Systems of Measurement

6 Metric System
Particulars of the Metric System

Rules of the Metric System

Units of Measure

Conversions Between Metric Units

7 Apothecary and Household Systems

Apothecary System

Household System

Other Medication Measurements Used in Dosage Calculation

8 Converting Within and Between Systems

Equivalents Among Metric and Household Systems

Converting Methods of Converting Converting Within

the Same System Converting Between Systems

Calculating Intake and Output

4
9 Additional Conversions Useful in the Health Care Setting
Converting Between Celsius and Fahrenheit

Formulas for Converting Between Fahrenheit and Celsius Scales

Metric Measures Relating to Length

Conversions Relating to Weight

Military Time

Calculating Completion Times

Unit Three Methods of Administration and Calculation

10 Medication Administration
Medication Errors

Critical Thinking and Medication Administration

Factors That Influence Medication Dosages and Action

Special Considerations for the Elderly

The Rights of Medication Administration

Medication Reconciliation

Client Education

Home Care Considerations

Routes of Medication Administration

Equipment Used for Medication Administration

Equipment for Administering Oral Medications to a Child

11 Understanding and Interpreting Medication Orders

Verbal Orders

Transcription of Medication Orders

Writing a Medication Order

Components of a Medication Order

Interpreting a Medication Order

12 Medication Administration Records and Medication Distribution Systems

Medication Orders

Medication Administration Record

Essential Components on a Medication Record

Documentation of Medications Administered

Explanation of Medication Administration Records

Use of Computers in Medication Administration

Medication Distribution Systems

Unit-Dose System

Computer-Controlled Dispensing System

Barcode Medication Delivery

5
 Additional Technology in Medication Administration

Advantages and Disadvantages of Technology

Scheduling Medication Times

Military Time

13 Reading Medication Labels

Reading Medication Labels

Generic Name

Trade Name

Dosage Strength

Dosage Expressed as Ratio or Percent

Form

Barcoding Symbols

Route of Administration

Total Volume

Total Amount in Container

Directions for Mixing or Reconstituting a Medication

Precautions

Expiration Date

Controlled Medication Labeling

Medication Labels for Combined Medications

Unit-Dose Packaging

Medication Information

Over-the-Counter (OTC) Labels

Answers to Chapter Review

14 Dosage Calculation Using the Ratio and Proportion Method

Use of Ratio and Proportion in Dosage Calculation

Part I

Part II

Answers to Practice Problems

Answers to Chapter Review Part I

Answers to Chapter Review Part II

15 Dosage Calculation Using the Formula Method

Formula for Calculating Dosages

Using the Formula Method

16 Dosage Calculation Using the Dimensional Analysis Method

Understanding the Basics of Dimensional Analysis

Dosage Calculation Using Dimensional Analysis

6
Unit Four Oral and Parenteral Dosage Forms and Insulin

17 Oral Medications
Forms of Solid Medications

Calculating Oral Liquids

Measuring Oral Liquids

18 Parenteral Medications
Parenteral Medication Packaging

Syringes

Medications Labeled in Percentage Strengths

Solutions Expressed in Ratio Strength

Parenteral Medications Measured in Units

Parenteral Medications in Milliequivalents

Calculating Parenteral Dosages

Calculating Injectable Medications According to the Syringe

Calculating Dosages for Medications in Units

Mixing Medications in the Same Syringe

19 Reconstitution of Solutions
Basic Principles for Reconstitution

Reconstituting Medications with More Than One Direction for Mixing (Multiple Strength)

Reconstitution from Package Insert Directions and Medications with Different Reconstitution Directions Depending on Route of
Administration
Medications with Instructions to “See Accompanying Literature” (Package Insert) for Reconstitution and Administration

Calculation of Dosages

Reconstitution of Noninjectable Solutions

20 Insulin
Types of Insulin

Labels

Insulin Action Times

Appearance of Insulin

Insulin Administration

Insulin Orders

Current Recommendations for Use of the Sliding Scale Protocol

Preparing a Single Dosage of Insulin in an Insulin Syringe

Measuring Two Types of Insulin in the Same Syringe

Unit Five Intravenous, Heparin, and Critical Care Calculations and

Pediatric and Adult Calculations Based on Weight

7
21 Intravenous Solutions and Equipment
IV Delivery Methods

IV Solutions

Administration of IV Fluids

22 Intravenous Calculations
IV Flow Rate Calculation

Manually Regulated IVs

Calculating Flow Rates in Drops Per Minute

Using a Formula

Calculating IV Flow Rates When Several Solutions Are Ordered

Calculating IV Flow Rates Using a Dial-Flow Controller

Calculating Intermittent IV Infusions Piggyback

Determining the Amount of Medication in a Specific Amount of Solution

Determining Infusion Times and Volumes

Steps to Calculating a Problem with an Unknown with the Formula Method

Recalculating an IV Flow Rate

Calculating Total Infusion Times

Calculating Infusion Time When Rate in mL/hr Is Not Indicated for Large Volumes of Fluid

Calculating Infusion Time for Small Volumes of Fluid

Charting IV Therapy

Labeling Solution Bags

Administration of Medications by IV Push

23 Heparin Calculations
Heparin Errors

Heparin Dosage Strengths

Reading Heparin Labels

Calculation of Subcutaneous Dosages

Calculation of IV Heparin Solutions

Calculating Heparin Dosages Based on Weight

24 Critical Care Calculations

Calculating Rate in mL/hr

Calculating Critical Care Dosages per Hour or per Minute

Medications Ordered in Milligrams per Minute

Calculating Dosages Based on mcg/kg/min

IV Flow Rates for Titrated Medications

Developing a Titration Table

25 Pediatric and Adult Dosage Calculations Based on Weight

8
 Formula for Calculating BSA From Kilograms and Centimeters

Pediatric IV Administration

Comprehensive Post-Test

References

Appendix Table of Contents

Appendix A: Apothecary System

Appendix B: FDA and ISMP Lists of Look-Alike Drug Names with Recommended Tall Man Letters

Appendix C: TJC’s “Do Not Use” List of Abbreviations

Appendix D: ISMP’s List of Error-Prone Abbreviations, Symbols, and Dose Designations

Appendix E: ISMP List of High-Alert Medications in Acute Care Settings

Appendix F: ISMP List of High-Alert Medications in Community/Ambulatory Healthcare

Index

Drug Label Index

Inside Back Cover

9
Copyright

3251 Riverport Lane

St. Louis, Missouri 63043
CALCULATE WITH CONFIDENCE ISBN: 978-0-323-39683-7
Copyright © 2018, Elsevier Inc. All rights reserve.d
Previous editions copyrighted 2014, 2010, 2006, 2002, 1998, 1994

No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher. Details on how to seek
permission and further information about the Publisher’s permissions policies and our
arrangements with organizations such as the Copyright Clearance Center and the Copyright
Licensing Agency can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein). Although for mechanical reasons all pages of this
publication are perforated, only those pages imprinted with an Elsevier Inc. copyright notice are
intended for removal.

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein. In
using such information or methods, they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the
most current information provided (i) on procedures featured or (ii) by the manufacturer of each
product to be administered, to verify the recommended dose or formula, the method and duration
of administration, and contraindications. It is the responsibility of practitioners, relying on their
own experience and knowledge of their patients, to make diagnoses, to determine dosages and the
best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
assume any liability 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 Cataloging-in-Publication Data

Names: Morris, Deborah C. Gray, author.

Title: Calculate with confidence / Deborah C. Gray Morris.
Description: Seventh edition. | St. Louis, Missouri : Elsevier, [2018] | Includes bibliographical
references and index.
Identifiers: LCCN 2017015434 | ISBN 9780323396837 (pbk. : alk. paper)
Subjects: | MESH: Drug Dosage Calculations | Nursing Care–methods | Pharmaceutical
Preparations–administration & dosage | Mathematics | Problems and Exercises
Classification: LCC RS57 | NLM QV 18.2 | DDC

10
615/.1401513–dc23 LC record available at
https://lccn.loc.gov/
2017015434
Senior Content Strategist: Yvonne Alexopoulos
Content Development Manager: Lisa Newton
Senior Content Development Specialist: Danielle M. Frazier
Publishing Services Manager: Jeff Patterson
Senior Project Manager: Tracey Schriefer
Design Direction: Ashley Miner
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1

11
 To my children, Cameron, Kimberly, Kanin, and Cory, thanks for your love and support. You
light up my life. To my mother, your love, support, guidance, and nurturing helped me to become
the person I am today. To my husband, Reggie, thank you for all the hard work you did in helping
me with this edition. Your support and encouragement throughout this project kept me on track
and focused.

To the two special additions and loves of my life, my two grandsons, Ryan and Eison, you touch
my life more than you know.

Thank you to friends, nursing colleagues, and students past and present. To future and current
practitioners of nursing, I hope this book will be valuable in teaching the principles of dosage
calculation and reinforcing the importance of safety in administration of medications to all clients
regardless of the setting.

12
Reviewers
Lou Ann Boose, RN, BSN, MSN, Professor, Department of Nursing, Harrisburg Area Community
College, Harrisburg, Pennsylvania
Jessica Gonzales, ARNP, RN, MSN, Psychiatric Mental Health Nurse Practitioner, Harborview
Medical Center, Seattle, Washington;, The Evergreen Clinic, Kirkland, Washington
Jane C. Parish, BBA, PhD, RN, CPN, CNE, Professor of Nursing, Walters State Community
College, Morristown, Tennessee
Bobbi Steelman, BS, Ed, M.A.Ed, CPhT, Director of Education, Pharmacy Technician Program
Director, Daymar College, Bowling Green, Kentucky
Anne S. Van Landingham, RN, BSN, MSN, Instructor, Orange Technical College - OCPS, Apopka
High School, Apopka, Florida

13
Preface to the Instructor
INTRODUCTION
Safety is a priority in the delivery of health care. To advance client safety and its importance in
health care delivery worldwide, several organizations are involved in reinforcing the promotion of
client safety in health care, which includes emphasis on improving safety in medication
administration. These organizations include the Institute of Medicine (IOM), the Institute for Safe
Medication Practices (ISMP), and The Joint Commission (TJC).

The Quality and Safety Education for Nurses (QSEN) looks at six competencies, two of which are
relevant to medication administration: safety and informatics. Safety refers to reducing the risk of
harm to clients, and informatics refers to technology used to mitigate errors. Safety and informatics
will be referred to in this text where applicable. The text uses the term client to denote one who is
the recipient of nursing care and can also be referred to as patient, resident, and health care consumer.
The seventh edition of Calculate with Confidence not only teaches the aspects of dosage
calculation; it also emphasizes the importance of safety in medication administration. Calculate
with Confidence is written to meet the needs of nursing students as well as nurses returning to the
workforce after being away from the clinical setting. It is also suitable for courses within nursing
curricula whose content reflects the calculation of dosages and solutions. The text can generally be
used as a reference by any health care professional whose responsibilities include safe
administration of medications and solutions to clients in diverse clinical settings.
Calculate with Confidence, seventh edition, has incorporated feedback from users of previous
editions, including students, instructors, and reviewers. This edition has maintained a style similar
to previous editions. The text presents three methods of dosage calculation—dimensional analysis,
formula method, and ratio and proportion. Each method is illustrated, empowering students to
choose the method that suits their learning style and works for them. It also enables the instructor
to teach a preferred method or multiple methods to students.
The new edition responds to changes in the health care field and includes the introduction of new
medications, discussion of new methods for medication administration, and an emphasis on clinical
reasoning in prevention of medication errors. Principles of QSEN have been incorporated where
applicable. An ample number of practice problems that include the shading of syringes where
indicated continues to be featured to allow for visualization of dosages, reinforcement of clinical
thinking skills, and prevention of medication errors. Safety alerts are also incorporated throughout
the chapters to further reinforce the importance of error prevention in medication administration.
Despite technological advances in equipment, health care professionals must continue to use
clinical reasoning skills and have a consistent focus on safety to minimize the risk of harm to clients.
Answers to practice problems include rationales to enhance understanding of principles and
answers related to dosages. Answers have been placed at the end of chapters to allow for
immediate feedback.
In response to the increased need for competency in basic math as an essential prerequisite for
dosage calculation, practice problems in the basic math section are provided to allow the student to
identify his or her strengths and weaknesses in basic math areas that provide the foundation for
math skills applied in dosage calculation.
The once controversial use of calculators is now a more accepted practice, and they are used on
many nursing examinations, including the NCLEX; however, their use is individualized. Many
health care agencies have policies that require the use of calculators to verify calculations (e.g.,
critical care calculations) to avoid medication errors. A basic handheld calculator that has functions
of addition, subtraction, multiplication, division, and a square root key is usually sufficient for
medical dosage calculation, and students should know how to use such a calculator.

14
15
ORGANIZATION OF CONTENT
The seventh edition continues to be organized in a progression from simple topics to more complex
ones, making content relevant to the needs of the student and using realistic practice problems to
enhance learning and make material clinically applicable.
The 25 chapters are arranged into 5 units.
Unit One includes Chapters 1 through 5. This unit provides a review of basic arithmetic skills,
including roman numerals, fractions, decimals, ratio and proportion, and percentages. A pre-test
and post-test are included. This unit allows the student to determine his or her weaknesses and
strengths in arithmetic and provides a review of basic math, which includes fractions, decimals, and
ratio and proportion. Ample practice problems as well as word problems are included in the basic
math sections.
Unit Two includes Chapters 6 through 9. Chapters 6 through 8 introduce the student to the three
systems of measurement: metric, household, and apothecary. The metric system is emphasized, and
some aspects relating to household measures are discussed because of their implications for care at
home. Apothecary measures are not emphasized because they are outdated and not recommended
for use. Apothecary measures have been placed in Appendix A. Chapter 9 provides conversions
relating to temperature, length, weight, and international time. Calculation of completion times for
IV therapy is also discussed.
Unit Three includes Chapters 10 through 16. This unit provides essential information that is
needed as a foundation for dosage calculation and safe medication administration. Chapter 10
includes an expanded discussion of medication errors; routes of medication administration;
equipment used in medication administration; the six basic rights of medication administration, as
well as additional rights to be considered when administering medications; and the nursing role in
preventing medication errors. Chapter 11 presents the abbreviations used in medication
administration and interpretation of medication orders. Chapter 12 introduces students to
medication administration records and has been updated to include the various medication
distribution systems. Chapter 13 provides the student with the skills necessary to read medication
labels to calculate dosages. Medication labels include medications in current use as well as some of
the newer medication labels on the market. The important skill of reading labels is developed by
providing practice with identification of information on labels. Resources that include TJC’s official
“Do Not Use” list and ISMP’s list of Error-Prone Abbreviations, Symbols, and Dose Designations
are emphasized and have been included in the appendices, along with other resources. Emphasis is
placed on the nurse’s responsibility to stay abreast of standards regarding medication orders to
ensure client safety and prevent errors in medication administration. Chapters 14 through 16
introduce the various methods used for dosage calculation (ratio and proportion, formula method,
and dimensional analysis). Practice problems are provided for each method, giving the student the
opportunity to practice the various methods and choose the one preferred.

Unit Four includes Chapters 17 through 20. In Chapter 17, the student learns the principles and
calculations related to oral medications (solid and liquids). In Chapter 18, the student learns about
the various types of syringes and the skills needed for calculating injectable medications. Chapter
19 introduces concepts of solutions. Calculations associated with reconstituted solutions for
injectable and oral medications are discussed. Calculations associated with preparation of
noninjectable solutions, including nutritional feedings, determining the strength of solutions, and
calculation of solutions, are also included. Chapter 20 introduces the student to insulin types, the
addition of U-500 insulin, and calculations involving U-500 insulin. The chapter has also been
expanded to include discussion of insulin pens and current information on the use of the sliding
scale and basal prandial insulin therapy. Three methods of dosage calculation are illustrated in the
chapters (ratio and proportion, formula method, and dimensional analysis), and practice problems
are provided in each chapter.

Unit Five includes Chapters 21 through 25. Chapters 21 and 22 provide a discussion of
intravenous (IV) fluids and associated calculations related to IV therapy. Content includes focus on
safety with IV administration and recalculating IV flow rate with an alternative method of
determining the percentage of variation. IV labels have been added throughout the chapter, with a
discussion of additives to IV solutions. Chapter 23 presents a discussion of heparin and has been
updated to include the new heparin labels. Heparin weight-based protocol has been expanded to

16
include adjusting IV heparin based on activated partial thromboplastin time (APTT). Chapter 24
provides the student with the skills necessary to calculate critical care IV medications. Titration of
IV flow rates for titrated medications is explained, as well as how to develop a titration table.
Additional practice problems have also been added to the chapter. Chapter 25 provides the student
with the skills and principles for calculation of pediatric and adult dosages, with emphasis on
calculation based on body weight and verification of safe dosages. Calculation of daily fluid
maintenance for children has also been included, with practice problems.
Safety Alerts, Practice Problems, Clinical Reasoning scenarios, and Points to Remember are
included throughout the text. A Comprehensive Post-Test is included at the end of the text and
includes practice problems covering content from all 25 chapters.

17
NEW FEATURES TO THE SEVENTH EDITION
• Update of the insulin chapter (Chapter 20)
• Addition of new medication labels
• Additional practice problems throughout the text
• Continual integration of QSEN principles and competencies in text to alert the student to the
importance of client safety and reduction of medication errors
• Expansion of content relating to medication errors, including the use of tall man lettering and in-
depth discussion of the six basic rights of medication administration and additional rights of
medication administration
• Addition of appendices that include the apothecary system, TJC’s official “Do Not Use” list, ISMP
standards, and a medication label index that includes labels found in the text
• Calculation of daily fluid maintenance
• Updating of section on intake and output to include basic and complex
• Updating of the IV chapter to include content on the Dial-A-Flow IV infusion device
• Addition of new heparin labels
• Increased discussion on preventing medication errors in chapters dealing with high-alert
medications (heparin and insulin)
• Additional Safety Alert boxes to direct the student to common errors that can be made

18
ANCILLARIES
Evolve Resources for Calculate with Confidence, seventh edition, are available to enhance student
instruction. These online resources can be found at http://evolve.elsevier.com/GrayMorris/.
These resources correspond with the chapters of the main book and includes the following:
• Student Review Questions and Sample NCLEX Review Questions
• 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 calculator 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.
It is my hope that this book will be a valuable asset to current and future practitioners. May it
help you calculate dosages accurately and with confidence, using calculation and critical thinking
skills to ensure that medications are administered safely to all clients regardless of the setting. This
is both a priority and a primary responsibility of the nurse.

Deborah C. Gray Morris

19
Acknowledgments
I wish to extend sincere gratitude and appreciation to my family, friends, and colleagues at Bronx
Community College of the City University of New York (CUNY) for their support and
encouragement during the writing of the seventh edition. A special thanks to my daughter-in-law
who we call Marcy (Marcella Willis-Gray, MD) for taking the time out of her busy schedule to
answer questions relating to medication orders and researching information for me regarding
specific dosages of medications and calculations when indicated. A special thanks to Professor Lois
Augustus, former chairperson of the Department of Nursing and Allied Health Sciences, for all of
her encouragement. A special thank you to my colleague, Mr. Clarence Hodge (Lecturer), who
currently teaches Pharmacology Computations with me; your feedback, suggestions, and validation
of answers while revising this text were invaluable. Thank you to Professor Helen Papas-Kavalis for
your help with questions regarding pediatrics. Special thanks also to the reviewers of this text; your
comments and suggestions were invaluable. Particular thanks to the math reviewers. A special
thanks to Dr. Andrew McInerney, Professor in the Department of Mathematics and Computer
Science at Bronx Community College, for your help with checking my mathematical answers and
the suggestions you made when indicated.

Thanks to past students at Bronx Community College who brought questions regarding basic
math and calculations and helped me have an appreciation for the problems that students
encounter with basic math and calculation of medication dosages. Thanks for your valuable
feedback.
I am particularly grateful to former colleagues who provided me with the encouragement and
nurturing I needed to consider publication. Who would have thought this book would now be in its
seventh edition? Thank you to Professor Germana Glier, former chairperson of Mathematics and
Computer Science at Bronx Community College; your mathematical expertise was invaluable.
Thanks to former Chairpersons of The Department of Mathematics and Computer Sciences at Bronx
Community College, Professor Germana Glier and the late Dr. Gerald S. Lieblich, whose
mathematical expertise was invaluable.
I am especially grateful to the staff at Elsevier for their support and help in planning, writing, and
producing the seventh edition of this text. A special thanks to Danielle M. Frazier for her time,
support, patience, and understanding with this revision; thanks for your encouragement and
sincere concern at the times when I needed them most. Thanks also to Tracey L. Schriefer, whose
help was invaluable in revising this text.
To Anna Nunnally, my dearest friend who is like a sister, thanks for all of your support and
encouragement. To my friend the late Frank A. Rucker, your encouragement, inspiring words, and
admiration for me as an author will always remain with me. A special note of thanks to Professor
Ellen Hoist, a colleague and friend who has given me encouragement and support from the
beginning with the first edition of this text. You could see the potential for this text beyond the first
edition even when I expressed doubt.
Thank you to all!
Deborah C. Gray Morris

20
UNIT ONE
Math Review
An essential role of the nurse is providing safe medication administration to all clients. 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 clients, regardless of the setting. Serious harm to clients can
result from a mathematical error during calculation and administration of a medication dosage. The
nurse must practice and be proficient in the basic math used in dosage calculations. Knowledge of
basic math is a prerequisite for the prevention 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 recommended 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.

OUT LIN E

21
PRE-TEST
This test is designed to evaluate your ability in the basic math areas reviewed in Unit One. The test
consists of 72 questions. If you are able to complete the pre-test with 100% accuracy, 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. Express the following in Roman numerals. 1. 9 2. 16 3.
23 4. 10½ 5. 22 Express the following in Arabic numbers.

6.
7.
8.
9.
10.
Reduce the following fractions to lowest terms.
11.

12.

13.

14.

15.

Perform t_h_e_i ndi_c_a_te_ d o_p_e_r a_ t_i o_ n s ; reduce to lowest terms where necessary.
16.

17.

18.

19.

20.

21.

22.

23.

24. __

25.

26.

27.

22
28.
Change the following fractions to decimals; express your answer to the nearest tenth.
29.

30.

31.

32.

Indicate the largest fraction in each group.

33.

34.
Perform the indicated operations with decimals. Provide the exact answer; do not round off.
35. 20.1 + 67.35 =
36. 0.008 + 5 =
37. 4.6 × 8.72 =
38. 56.47 – 8.7 =
Divide the following decimals; express your answer to the nearest tenth.
39. 7.5 ÷ 0.004 =
40. 45 ÷ 1.9 =
41. 84.7 ÷ 2.3 =
Indicate the largest decimal in each group.
42. 0.674, 0.659
43. 0.375, 0.37, 0.38
44. 0.25, 0.6, 0.175
Solve for x, the unknown value.
45. 8:2 = 48:x
46. x:300 = 1:150

47.
48.
Round off to the nearest tenth.
49. 0.43
50. 0.66
51. 1.47
Round off to the nearest hundredth.
52. 0.735
53. 0.834
54. 1.227
Complete the table below, expressing the measures in their equivalents where indicated. Reduce to
lowest terms where necessary.

Find the following percentages. Express your answer to the hundredths place as indicated.
59. 5% of 95
60. ¼% of 2,000
61. 2 is what % of 600
62. 20 is what % of 100

23
63. 30 is what % of 164
64. A client is instructed to take 1½ teaspoons of a cough syrup three (3) times a day. How many
teaspoons of cough syrup will the client take each day?
65. A tablet contains 0.75 milligrams (mg) of a medication. A client receives three (3) tablets a day
for five (5) days. How many mg of the medication will the client receive in five (5) days?

66. A client took 0.44 micrograms (mcg) of a medication every morning and 1.4 mcg each evening
for five (5) days. What is the total amount of medication taken?
67. Write a ratio that represents that every tablet in a bottle contains 0.5 milligrams (mg) of a
medication.
68. Write a ratio that represents 60 milligrams (mg) of a medication in 1 milliliter (mL) of a liquid.

69. A client takes 10 milliliters (mL) of a medication three (3) times a day. How long will 120 mL of
medication last?
70. A client weighed 275 pounds (lb) before dieting. After dieting, the client weighed 250 lb. What is
the percentage of change in the client’s weight?
71. A client was prescribed 10 milligrams (mg) of a medication for a week. After a week, the health
care provider reduced the medication to seven (7) mg. What was the percentage of decrease in
medication?
72. A client received 22.5 milligrams (mg) of a medication in tablet form. Each tablet contained 4.5
mg of medication. How many tablets were given to the client?
Answers on p. 5

24
 ANSWERS
1. ix, , IX
2. xvi, , XVI
3. xxiii, , XXIII
4. xss,
5. xxii, , XXII
6. 11½
7.
12
8. 18
9.
24
1 10 . 6
_
1_2_
. _¼
13.

14.

15.
16.
17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29. 0.9
30.
0.3
31. 0.7
32.
3
0.39. ______________________________________
34.
35. 87.45
36.
5.008
37. 40.112

25
38. 47.77
39. 1,875
40. 23.7
41. 36.8
42. 0.674
43. 0.38
44. 0.6
45. x = 12
46. x=2
47. x=3
48. x=2
49. 0.4
50. 0.7
51. 1.5
52. 0.74
53. 0.83
54. 1.23

59. 4.75 60. 5

61. 0.33%
62. 20%
63. 18.29%
64. 4½ teaspoons
65. 11.25 milligrams
(mg) 66. 9.2
micrograms (mcg) 67.
0.5 mg:1 tablet _________________________ 68. 60
mg:1 mL 69. 4 days
70. 9%
71. 30%
72. 5 tablets

26
CHAPTER 1

27
Roman Numerals

OBJECTIVES

After reviewing this chapter, you should be able to:

Recognize the symbols used to represent numbers in the Roman numeral system

The Roman numeral system dates back to ancient Roman times and uses letters to designate
amounts. Although it appears that Roman numerals are obsolete, they are still in use in the modern
times. There are no commas or zeros in this system. Roman numerals are arranged and combined in
a specific order to represent numbers.
Box 1-1 lists the common Arabic equivalents for Roman numerals (review them if necessary).
They are often expressed with lowercase letters. Review this list before proceeding to the rules
pertaining to Roman numerals. You will most commonly see Roman numerals up to the value of 30
when they are used in relation to medications. Larger Roman numerals, such as L(l) = 50, C(c) = 100,
and larger, are usually not used in relation to medications. It is recommended to use uppercase
letters when smaller numbers are part of a number over 30, for example, 60 = LX not lx.

Box 1-1
Arabic Equivalents for Roman Numerals
Arabic Number Roman NumeralA rabic NumberRo man Numeral
½ ss or 9 10 ix or , IX
1 i or , I 15 x or , X
2 ii or iii, II 20 xv or , XV
3 or iv , III 30 xx or , XX
4 or v or IV 50 xxx or , XXX
5 vi or, V 100 L(l)
6 vii or , VI 500 C(c)
7 viii or , VII 1,00 D(d)
8 , VIII 0 M(m)

Although the Roman numerals for 50, 100, 500, and 1,000 are not used in relation to medications,
a well-known mnemonic: “Lovely Cats Don’t Meow,” can help you to remember the order and
value of the Roman numerals (L, C, D, M) for 50, 100, 500, and 1,000 (Box 1-2).

Box 1-2
Mnemonic Device: Note the pattern:
50-100-500-1,000
L = 50 Lovely
C = 100 Cats
D = 500 Don’t
M = 1,000 Meow

Rules Relating to the Roman System of Notation

28
1. The same Roman numeral is never repeated more than three times.
a. Example: Convert the Arabic number 4 to a Roman numeral.
i. Right: 4 = iv
ii. Wrong: 4 = iiii
b. Example: Convert the Arabic number 9 to a Roman numeral.
i. Right: 9 = ix
ii. Wrong: 9 = viiii
2. When a Roman numeral of a lesser value is placed after one of equal or greater value, the
numerals are added.
a. Example: Convert the Arabic number 25 to a Roman numeral.
i. Right: 25 = xxv (10 + 10 + 5 = 25)
b. Example: Convert the Roman numeral xvi to an Arabic number.
i. Right: xvi = 16 (10 + 5 + 1 = 16)
3. When a Roman numeral of a lesser value is placed before a numeral of greater value, the
numerals are subtracted.
a. Example: Convert the Roman numerals ix and xxiv to Arabic numbers.
i. Right: ix = 9 (10 – 1 = 9)
ii. Right: xxiv = 24 [10 1 10 + (5 – 1) = 24]
b. Example: Convert the Arabic numbers 19 and 14 to Roman numerals.
i. Right: 19 = xix [10 1 (10 – 1) = 19]
ii. Right: 14 = xiv [10 1 (5 – 1) = 14]

Roman numerals are still used today. An example of their current use is hour marks on time
pieces (e.g., watches, clocks). In this context, inconsistencies can be seen. Some clock faces that
use Roman numerals show IIII for four o’clock (as opposed to IV) but IX for nine o’clock. The clock
on the Palace of Westminster in London (also known as “Big Ben”) uses IV to indicate four o’clock.

29
 Other uses include names of monarchs and popes (e.g., Louis XIV, Pope Benedict XVI); Super Bowl
XXVII, sequels of movies (e.g., Rocky IV); generational suffixes, particularly in the United States, for
people sharing the same name across generations (e.g., Robert Griffin III); car styles (e.g., Mach V);
and Mach V computers.
Roman numerals are used in the apothecary system of measurement for writing medication
dosages.
Example:

Roman numerals are also seen on the labels of medications to designate Drug Enforcement
Administration (DEA) schedules for controlled substances (medications that can lead to abuse or
dependence). Controlled substances can be readily recognized by a large “C” (control) on the
medication label. A Roman numeral (I–V), written as a capital letter, is inserted in the center of the
“C” to indicate the potential for abuse, as shown in Figures 1-1 and 1-2. This will be discussed in
more detail in Chapter 13, Reading Medication Labels.

FIGURE 1-1 Vicodin (hydrocodone bitartrate and acetaminophen) is a controlled substance schedule III
medication as indicated by CIII on the label.

CLICK HERE TO DOWNLOAD THE FULL ORIGINAL PDF

30