Calculate with Confidence, 6e

755 Pages·2013·92.75 MB·English

by  Deborah C. Gray Morris RN BSN MA LNC

YOU’VE JUST PURCHASED
MORE THAN

A TEXTBOOK!
*
Evolve Student Resources for Gray Morris: Calculate with
Confi dence, sixth edition, offer the following features:
• Drug Calculations Companion, Version 5
A completely updated, interactive
student tutorial that includes an
extensive menu of various topic areas
within drug calculations such as oral,
parenteral, pediatric, and intravenous
calculations to name a few. It contains
over 600 practice problems covering
ratio and proportion, formula, and
dimensional analysis methods.
• Student Review Questions
Provide additional practice and promotes
active learning and application of content.
• Sample NCLEX Review Questions
Illustrate various types of alternate item
formats for student to practice.
Activate the complete learning experience that comes with each
NEW textbook purchase by registering with your peel-off access code at
http://evolve.elsevier.com/Gray Morris/
If you purchased a used book and the peel-off code at right has
already been revealed, the code may have been used and cannot
be re-used for registration. To purchase a new code to access these
FPO:
valuable study resources, simply follow the link above.
Peel Off Sticker
REGISTER TODAY!
You can now purchase Elsevier products on Evolve!
Go to evolve.elsevier.com/html/shop-promo.html to search and browse for products.
*Evolve Student Resources are provided free with each NEW book purchase only.
C a l c u l a t e
Confi dence
with
This page intentionally left blank
C a l c u l a t e
Confi dence
with
Sixth Edition
Deborah Gray Morris, RN, BSN, MA, LNC
Professor of Nursing
Department of Nursing and Allied Health Sciences
Bronx Community College of the City University of New York (CUNY)
Bronx, New York
3251 Riverport Lane
St. Louis, Missouri 63043
CALCULATE WITH CONFIDENCE ISBN: 978-0-323-08931-9
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Copyright © 2010, 2006, 2002, 1998, 1994 by Mosby, Inc., an affi liate of Elsevier Inc.
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 fi eld 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 identifi ed, 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
Morris, Deborah Gray, author.
Calculate with confi dence / Deborah Gray Morris. -- Sixth edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-323-08931-9 (pbk. : alk. paper)
I. Title.
[DNLM: 1. Drug Dosage Calculations--Problems and Exercises. 2. Nursing Care--methods--Problems
and Exercises. 3. Mathematics--Problems and Exercises. 4. Pharmaceutical Preparations--administration &
dosage--Problems and Exercises. QV 18.2]
RS57
615'.1401513--dc23
2013027894
Senior Content Strategist: Yvonne Alexopoulos
Senior Content Development Specialist: Danielle M. Frazier
Publishing Services Manager: Jeff Patterson
Senior Project Manager: Clay S. Broeker
Design Direction: Paula Catalano

Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To my family, friends, nursing colleagues, and students
past and present, but especially with love to my children,
Cameron, Kimberly, Kanin, and Cory.
You light up my life and have been proud of whatever I do.
To my mother, whose guidance and nurturing
has made me what I am today.
Thanks for always being there to support me.
To current practitioners of nursing and future nurses,
I hope this book will be valuable in teaching the basic
principles of medication administration and will ensure
safe administration of medication to all clients
regardless of the setting.
Reviewers
Lou Ann Boose, RN, BSN, MSN Deborah L. Marshall, MSN, RN
Professor of Nursing Assistant Professor of Nursing
Harrisburg Area Community College Dunigan Family Department of Nursing
Harrisburg, Pennsylvania and Health Sciences
University of Evansville
Timothy B. Campbell, MSN, CRNP, PNP-BC
Evansville, Indiana
Nursing Instructor
Department of Nursing Bobbi Steelman, BS, Ed, M.A.Ed, CPhT
East Stroudsburg University Daymar Colleges Group
East Stroudsburg, Pennsylvania Daymar College
Bowling Green, Kentucky
Patricia Brown Dominguez, RN, MSN
Assistant Professor Karen B. Taliaferro, RN, BSN
Houston Baptist University Instructor
Houston, Texas Rappahannock Community College
Registered Nurse
Jessica Gonzales, RN, MSN
Tappahannock Dialysis Center
Instructor and Primary Care Registered Nurse
Warsaw, Virginia
Lake Washington Institute of Technology
and Polyclinic Anne Simons Van Landingham, RN, BSN,
Seattle, Washington MSN
Instructor
Rochelle Goodlitt
Medical Careers Magnet
Graduate Nurse Tutor
Apopka High School
Bronx Community College
Apopka, Florida
Bronx, New York
Jane K. Walker, BBA, PhD, RN, CPN, CNE
Nancy Lyons, RN, BSN
Associate Professor of Nursing
Instructor
Walters State Community College
Holy Name Medical Center School of Practical
Morristown, Tennessee
Nursing
Teaneck, New Jersey
vi
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Preface to the Instructor
Safety has become a focus and priority in the delivery of healthcare. To advance client
safety and its importance in healthcare delivery worldwide, several organizations have be-
come involved in reinforcing the promotion of client safety in healthcare, 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), discussed in the text, looks at
six competencies, one of which—safety—is relevant to medication administration. It is
referred to in this text where applicable.
The sixth edition of Calculate with Confi dence not only teaches the aspects of dosage
calculation, it also emphasizes the importance of safety in medication administration.
Calculate with Confi dence is written to meet the needs of current and future practitioners
of nursing at any level. The text can be used for in-service education programs and as a
reference for inactive nurses returning to the workforce. It is also suitable for courses
within nursing curricula whose content refl ects the calculation of dosages and solutions.
The text can generally be used as a reference by any healthcare professional whose re-
sponsibilities include safe administration of medications and solutions to clients in diverse
clinical settings.
Calculate with Confi dence, sixth edition, is based on feedback from users of previous
editions, including students, instructors, and reviewers. This edition has maintained a style
similar to previous editions. The text offers all the standard methods of dosage calculation
(dimensional analysis, formula method, and ratio and proportion). Each method is illus-
trated, allowing students to choose the method that suits their learning style and allowing
the instructor to teach a preferred method or multiple methods to students.
The new edition responds to changes in the healthcare fi eld and includes the introduc-
tion 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 throughout. The number of practice problems has been increased,
and the shading of syringes continues to be featured to allow for visualization of dosages.
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 prerequi-
site for dosage calculation, additional practice problems have been added to the basic math
section. The once controversial use of calculators is now a more accepted practice, and they
are used on many nursing exams, including the NCLEX; however, their use is individual-
ized. Many healthcare 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 suffi cient for medical dosage calculation, and students should know
how to use such a calculator. Calculator use is not encouraged in the basic math section
of this text because of the expectation that students should be able to perform calculations
profi ciently and independently without their use.
vii
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
viii Preface to the Instructor
Despite decreased errors in dosage calculation and administration due to technological
advances in equipment, healthcare professionals must continue to use clinical reasoning
skills and have a consistent focus on safety to minimize the risk of harm to clients.
The sixth edition of Calculate with Confi dence clearly addresses the increasing respon-
sibility of the nurse in medication administration, prioritizes client safety, and refl ects the
current scope of practice.
ORGANIZATION OF CONTENT
The sixth 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 prac-
tice 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 percent-
ages. 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.
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 empha-
sized because they are outdated and not recommended for use. Students also learn to
convert measurements in the chapters. Chapter 9 provides conversions relating to tem-
perature, 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 rights of medication ad-
ministration, and the nursing role in preventing medication errors. Chapter 11 presents
the abbreviations used in medication administration and interpretation of medication or-
ders. Chapter 12 introduces the learner to medication administration records and has been
updated to include the various medication distribution systems. Chapter 13 provides the
learner with the skills necessary to read medication labels to calculate dosages. Labels of
medications in current use have been added, and this section has been updated to include
newer medication labels. Chapters 14 through 16 introduce the learner to the various meth-
ods used for dosage calculation (ratio and proportion, formula method, and dimensional
analysis). Practice problems are provided for each method.
Unit Four includes Chapters 17 through 20. In Chapter 17, the student learns the prin-
ciples and calculations related to oral medications (solid and liquids). In Chapter 18, the
student learns about the various types of syringes and skills needed for calculating inject-
able medications. Chapter 19 introduces the learner to 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 in-
cluded. 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.
Unit Five includes Chapters 21 through 25. Chapters 21 and 22 provide the learner with
a discussion of intravenous (IV) fl uids and associated calculations related to IV therapy.
Recalculating IV fl ow rate has been expanded to include an alternate method to determin-
ing 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 labeling of heparin. Heparin weight-based protocol
has been expanded to include adjusting IV heparin based upon APTT (activated partial
thromboplastin time). Chapter 24 provides the learner with the skills necessary to calculate
critical care IV medications. Titration of IV fl ow rates for titrated medications has been
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.