Medication Dosage and IV Rate Calculations for Safe Nursing Practice | Chapter 15 from Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition)

Welcome to Chapter 15 of the Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri. This essential chapter provides the foundational skills every nurse needs for medication calculation and IV administration—two of the most critical areas for NCLEX-PN success and safe clinical care.

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Measurement Systems and Unit Conversions

• Metric, Household, Apothecary: Learn to convert between milligrams, grams, micrograms, mL, teaspoons, tablespoons, ounces, and more.
• Master conversion formulas for large to small units (move decimal to the right), and small to large (move to the left).
• Ratio and proportion, dimensional analysis, and standard formulas (D ÷ A × Q = X) for all medication types.

Medication Labels and Prescription Interpretation

• Read all elements of a med label: drug name, strength, dosage form, expiration date, storage, and manufacturer.
• Interpret prescriptions for route, dose, frequency, and administration times.
• Check for abbreviations and avoid look-alike/sound-alike errors.

Dosage Calculation and Administration Techniques

• Oral Medications: Scored tablets, capsules, liquids, droppers, and oral syringes—know rounding rules: tenths for adults, hundredths for peds and high-alerts.
• Parenteral Routes: IM, SQ, ID, and IV—select appropriate syringes: 3 mL, 5 mL, insulin, tuberculin, and measure doses accurately to calibration marks.
• Reconstitution: Safely mix powdered meds with correct diluent and label vial with strength, time, and date.
• Insulin Administration: Remember “RN” (draw up Regular, then NPH insulin).

IV Flow Rate and Infusion Calculations

• Calculate mL/hr for pumps: Total volume (mL) ÷ hours = mL/hr.
• Manual IVs (gtt/min): (Volume × Drop factor) ÷ time (min) = gtt/min; know macrodrip vs. microdrip tubing calibrations.
• Do not attempt to “catch up” missed infusions—adjust rates safely to prevent errors.

Critical Thinking, Safety, and Practice Questions

• Apply dimensional analysis and logical checks: does the dose make sense for age, weight, and diagnosis?
• Double-check calculations, especially with high-alert meds like heparin or insulin.
• Work through NCLEX-style sample problems for oral, parenteral, and IV meds to build confidence and speed.

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Conclusion: Safe and Accurate Medication Calculation for Nurses

Chapter 15 of Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition) provides the tools, formulas, and strategies you need to calculate medication dosages and IV flow rates with accuracy. By mastering conversions, rounding, and stepwise calculations, you’ll prevent errors and ensure safe medication administration—on the NCLEX and in clinical practice.

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