Quiz 4 - Parenteral Calculations

1.     Your patient's finger stick blood sugar at 0730 is 225.  An order from the MARS reads:

Novolin R insulin ac and HS per sliding scale:

FSBS Glucose level	Amount of regular insulin
0 - 150 mg/dl 151 - 250  mg/dl 251 - 350 mg/dl 351 - 400 mg/dl > 400 mg/dl	0 units 8 units 14 units 18 units Call MD

Mark the syringe: 

 

2.     Order reads: Morphine sulfate gr. 1/8
        Label reads: Morphine sulfate 10 mg per mL.

        How many mL will you give?        

3.     Order: Atropine 0.3 mg IM now
        Label: Atropine 400 mcg/mL
        How many mL would be administered?

4.     Order reads: Phenobarbital gr ii IM q3h.
        Label reads: Phenobarbital 130 mg per mL
        Administer _________ mL

5.     Order: Codeine gr 1/4 IM q4h prn
        Codeine 30 mg per mL is on hand in a single dose Carpojet syringe.
        How many mL would you have to waste?
        How many mL would you administer?

6.     Order: Digoxin 0.25 mg IM qd.
        Supply: Digoxin 500 mcg per mL
        Give _____________ mL

7.     Order: Promethazine 50 mg IM stat for restlessness.
        The ampoule is labeled 25 mg per mL
        Give ____________ mL

8.     Order: Morphine sulfate 4 mg IV push q6h prn for pain.
        Label reads: Morphine sulfate 10 mg per mL
        Give: ____________ mL

9.     Order: Heparin 6000 units sc q 12 h
         Label: Heparin sodium injection 10,000 U per mL
         Give ________ mL

10.   Order: Penicillin G 200,000 units IM q8h
         Label: Penicillin G 250,000 U/mL
         Give ________mL

11.   On the following drug label, identify the routes for administration for which this preparation can be used. 

 

12.    After reconstitution with 2.5 mL diluent, the strength of the Kefzol solution is 330 mg/ mL.  
         To administer a dose of  500 mg, how many mL would you give?

13.    Order: Chloromycetin 800 mg IV q8h.
         The vial reads: 1g per mL.  How many cc would you give?

         Mark the syringe.  

 

14.     Order: Tigan 0.2 g IM q6h prn for nausea.
           Label reads: Tigan 100 mg per mL
           Give: _______ mL

15.      Order: Ampicillin 125 mg IM q4h
            Supply: A powder form of medication.  The directions for reconstitution read:
            "add 1.8 mL Sterile Water for Injection to yield 250 mg/ mL"
            How many mL would you draw up in the syringe to give the ordered dose?

16.      Order: Add 30 mEq Potassium Chloride to 1000 cc NS
            Supply: KCl 2 mEq/ mL
            How many cc would you add to the bag of NS?

17.      Order: Compazine 7.5 mg IM q6h prn for nausea or vomiting
            Label reads: Compazine 10 mL multi-dose vial 5 mg/mL
            Give: _________mL

18.        Order: Codeine gr i IM q4h for pain
            Label: Codeine 50 mg per 2 mL
            How many cc would be administered?

19.        Order: Vitamin B 12  1 mg IM monthly for pernicious anemia
            Supply: Vitamin B 12 1000 mcg per mL
            Give ________ mL

20.        Order: Novolin N NPH insulin U-100 32 units and Novolin R insulin U-100  4 units ac breakfast daily.
            Give: ___________ units total

            Mark the best syringe.  

20.        Order: Novolin N NPH insulin U-100 32 units and Novolin R insulin U-100  4 units ac breakfast daily.
            Give: ___________ units total

            Choose the best syringe.  

               a.    

               b.    

Reconstitution Practice

1. Order: Prostaphlin 500 mg IM q6h

Label reads:

Prostaphlin oxacillin sodium for injection For IM use add 11.5 mL Sterile Water for Injection U.S.P.  Each 1.5 mL of solution contains 250 mg oxacillin.

Give ________ mL

2. Order: Ticar 500 mg IM stat and q8h

Label reads:

Ticar ticarcillin disodium For IV or IM use.  Add 12 mL Sterile Water for Injection, U.S.P. or 1% Lidocaine HCl solution (without epinephrine). Each 2.5 mL of solution will then contain 1 g ticarcillin.

How many mL would be given?

3. Order: Kefzol 1 g IM q6h

See label in Dimensional Analysis text on page 106, figure 50.
a. What diluents may be used for reconstitution?
b. How many cc will need to be given for the ordered dose?
c. What size syringe (s) should be used?
d. What needle size for a 150 lb. client?
e. How many syringes are needed for administering this dose?

4. Order: Penicillin G 500, 000 units IV q4h

Refer to figure 52, page 107 in the Dimensional Analysis text to answer these questions.
a. If  33 mL diluent is added, what is the dosage strength?
b. If 75 mL diluent is added, what is the dosage strength?
c. How many cc of each strength would you give to administer the ordered dose?

5. Order: Tazicef 1 g IM q6h

See label and reconstitution directions in Dimensional Analysis text on page 110
to answer the questions.
a. Add ____ mL of ______________.
b. Give _______mL

6. Order: Ancef 225 mg IM q6h

Stock: on the shelf there are three vial sizes of powder: 250 mg, 500 mg, and 1g

RECONSTITUTION Preparation of Parenteral Solution For IM injection, IV direct (bolus) injection, or IV infusion, reconstitute with Sterile Water for Injection according to the following table.  SHAKE WELL Vial size     Amt. diluent     Approx. concentration     Approx. available volume 250 mg       2.0 mL             125 mg/mL                    2.0 mL 500 mg       2.0 mL             225 mg/mL                    2.2 mL 1 gram        2.5 mL             330 mg/mL                    3.0 mL

Stock chosen: _________    Add _____ mL  Give _____ mL

Stock chosen: _________    Add _____ mL  Give _____ mL

7. Order: carbenicillin disodium 1 g IM q6h for an adult

Stock: vial of powder labeled 2 g
Use the following label for reconstitution.

For intramuscular use: The 2 g vial should be reconstituted with 4.0 mL of Sterile Water for Injection,  0.5% Lidocaine Hydrochloride (without epinephrine), or Bacteriostatic Water containing 0.9% benzyl alcohol. In order to facilitate reconstitution up to 7.2 mL diluent can be used. Amount of Diluent to be                  Volume to be Withdrawn for a Added to the 2 g vial                        1 g Dose 4.0 mL                                                      2.5 mL 5.0 mL                                                      3.0 mL 7.2 mL                                                      4.0 mL The 5 g vial should be reconstituted with 7.0 mL Sterile Water for Injection,  0.5% Lidocaine Hydrochloride (without epinephrine), or Bacteriostatic Water containing 0.9% benzyl alcohol. In order to facilitate reconstitution up to 17 mL diluent can be used. Amount of Diluent to be                          Volume to be Withdrawn for a Added to the 5 g vial                               1 g dose 7.0 mL                                                      2.0 mL 9.5 mL                                                      2.5 mL 12.0 mL                                                    3.0 mL 17.0 mL                                                    4.0 mL After reconstitution, no significant loss of potency occurs for up to 24 hours at room temperature, and for 72 hours if refrigerated.  Any of these unused solution should be discarded.

1. Add _____ mL and give _____ mL
2. Add _____ mL and give _____ mL

8. Order: 200,000 units Penicillin G IV q8h

Use the label in your Dimensional Analysis book on page 112 to answer the following questions.

1. How much diluent must be added to obtain a 200,000 unit per mL concentration?
2. If 8 mL diluent is added, what is the concentration strength of the prepared solution?
3. How long can the prepared solution be kept without significant loss of potency?  

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Key

1.    Give 8 units ( 1 line to the left of 10 units)

2.    Give 0.75 mL and draw up to the heavy line between 0.7 and 0.8

3.    Give 0.75 mL

4.    Give 0.92 mL

5.    Waste 0.5 mL; Give 0.5 mL

6.    Give 0.5 mL

7.    Give 2 mL

8.    Give 0.4 mL

9.    Give 0.6 mL

10.    Give 0.8 mL

11.    IM or IV use

12.    Give 1.5 mL

13.    Give 0.8 mL (draw up to 2 lines to the left of the 1 mL mark)

14.    Give 2 mL

15.    Give 1/2 mL

16.    Add 15 mL

17.    Give 1.5 mL

18.    Give 2.4 mL

19.    Give 1 mL

20.    Give 36 units total; use insulin syringe

Key for Reconstitution Problems

1. 3cc 
2. 1.3cc
3a. Sterile Water for Injection or Normal Saline Injection 
3b. 4.4 mL 
3c. 3cc 
3d. 21 or 22 gauge, 1 1/2 inch needle 
3e. 2 syringes 
4a. 500,000 units/ mL 
4b. 250,000 units/ mL 
4c. for "a" - 1cc; for "b" - 2cc 
5a. Add 3 mL Sterile Water for Injection 
5b. Give 3.6 mL
6. Stock chosen: 250 mg vial; add 2 mL Sterile Water for Injection; give 1.8 mL
    Stock chosen: 500 mg vial; add 2 mL Sterile Water for Injection; give 1 mL
7a. Add 4 mL and give 2.5 mL 
7b. Add 5 mL and give 3 mL 
8a. 23 mL 
8b. 500, 000 units/ mL 
8c. 1 week in the refrigerator