Math for Nursing (Heparin Calculations)

1. Directions: Fill in the correct number or word(s) to answer the question. The IV line that can be used to administer medications and solutions and can be connected to a port on the main infusion is called _______________. ANS: secondary line 2. Directions: Fill in the correct number or word(s) to answer the question. The name for the main infusion administration set is _______________. ANS: primary line 3. Directions: Fill in the correct number or word(s) to answer the question. In IV fluid abbreviations, D5NS identifies what IV fluid? _______________ ANS: 5% dextrose in normal saline 4. Directions: Fill in the correct number or word(s) to answer the question. An IV pump is an example of an ___________ infusion device. ANS: electronic 5. Directions: Fill in the correct number or word(s) to answer the question. _______________ devices allow a client to self-administer pain medication. ANS: Patient-controlled analgesia (PCA) 6. Directions: Fill in the correct number or word(s) to answer the question. List the components and percentage strengths of the following IV solutions. a. D S b. D5NS 10 mEq KCl c. D5RL ANS: a. 5% Dextrose in 0.225% saline b. 5% Dextrose in 0.9% saline with 10 mEq potassium chloride c. 5% Dextrose in lactated Ringer solution 7. Directions: Identify the letter of the label corresponding to the IV fluid abbreviation. D NS with 20 mEq KCL ANS: B 8. Directions: Identify the letter of the label corresponding to the IV fluid abbreviation. NS ANS: C 9. Directions: Identify the letter of the label corresponding to the IV fluid abbreviation. D5NS ANS: A 10. Directions: Interpret the following IV orders. 1,000 mL (1 L) D5W to infuse at a rate of 100 mL per hour ANS: Administer 1,000 mL 5% dextrose in water at a rate of 100 mL per hour 11. Directions: Interpret the following IV orders. 1,000 mL (1 L) of L/R q8h ANS: Administer 1,000 mL of lactated Ringer solution every 8 hours 12. Directions: Calculate the number of grams of NaCl and /or dextrose in the following solutions. 5 L D10W dextrose: _______________ ANS: 500 g dextrose 13. Directions: Calculate the number of grams of NaCl and /or dextrose in the following solutions. 500 mL 1/2 NS sodium chloride (NaCl): _____ ANS: 2.25 g NaCl 14. Directions: Calculate the number of grams of NaCl and /or dextrose in the following solutions. 250 mL D5NS _______ g dextrose ________ g NaCl ANS: 12.5 g dextrose; 2.25 g NaCl 15. Directions: Calculate the number of grams of NaCl and /or dextrose in the following solutions. 0.5 L D51/4NS ________ g dextrose ________ g NaCl ANS: 25 g dextrose; 1.125 g NaCl Heparin Calculations COMPLETION 1. Directions: Calculate the following hourly dosage of heparin (units/hr). Order: 50,000 units of heparin in 1 L D5 0.9% NS to infuse at 40 mL/hr units/hr = _____ ANS: 2,000 2. Directions: Calculate the following hourly dosage of heparin (units/hr). Order: 30,000 units of heparin in 500 mL D5W to infuse at 15 mL/hr units/hr = _____ ANS: 900 3. Directions: Calculate the following hourly dosage of heparin (units/hr). Order: 25,000 units of heparin in 250 mL D5W to infuse at 8 mL/hr units/hr = _____ ANS: 800 4. Directions: Calculate the following hourly dosage of heparin (units/hr). Order: 10,000 units of heparin in 500 mL 0.9% NS to infuse at 120 mL/hr units/hr = _____ ANS: 2,400 5. Directions: Calculate the following hourly dosage of heparin (units/hr). Order: 45,000 units of heparin in 1,000 mL D5 /2 NS at 25 mL/hr units/hr = _____ ANS: 1,125 6. Directions: Calculate the following hourly dosage of heparin (units/hr). Order: Infuse heparin at 2,000 units/hr IV from a solution containing 20,000 units of heparin in 500 mL D5W. How many milliliters will infuse per hour? _____ mL ANS: 50 7. Directions: Calculate the following hourly dosage of heparin (units/hr). Order: Infuse heparin at 800 units/hr IV from a solution containing 40,000 units in 1,000 mL D5W. How many milliliters will infuse per hour? _____ mL ANS: 20 8. Directions: Calculate the following hourly dosage of heparin (units/hr). Order: 25,000 units heparin IV in 250 mL 0.9% NS to infuse at 20 units/kg/hr. The client weighs 165 lb. a. Weight in kilograms: _____ b. How many units will the client receive per hour? _____ ANS: a. 165 lb ÷ 2.2 = 75 kg b. 20 units/kg/hr 75 kg = 1,500 9. Directions: Calculate the following hourly dosage of heparin (units/hr). Order: 40 units/kg/hr heparin IV. The client weighs 50 kg. How many units should the client receive per hour? _____ ANS: 2,000 10. Directions: Calculate the following hourly dosage of heparin (units/hr). Order: 40 units/kg/hr heparin IV. The client weighs 116 lb. How many units should the client receive per hour? _____ ANS: 116 lb ÷ 2.2 = 52.72 = 52.7 kg 40 units/kg/hr 52.7 kg = 2,108 11. Directions: Calculate the following hourly dosage of heparin (units/hr). A client weighs 165 lb. Order: Administer a bolus of heparin sodium IV. The hospital protocol is 80 units/kg. How many units will you administer? _____ ANS: 165 lb ÷ 2.2 = 75 kg 75 kg 80 units/kg = 6,000 units 12. Directions: Calculate the following hourly dosage of heparin (units/hr). A client weighs 220 lb. The hospital protocol for IV heparin drip is 14 units/kg/hr. How many units per hour should the client receive? _____ ANS: 220 lb ÷ 2.2 = 100 kg 100 kg 14 units/kg/hr = 1,400 13. Directions: Calculate the following hourly dosage of heparin (units/hr). Which solution of heparin is more concentrated: 1,000 units per mL or 10,000 units per mL? _____ ANS: 10,000 units per mL 14. Directions: Calculate the following hourly dosage of heparin (units/hr). If a U for units was misread as a zero by the nurse for a heparin dose, the consequences to the client receiving the heparin could be ____________________________. ANS: bleeding or hemorrhage 15. Directions: Calculate the following hourly dosage of heparin (units/hr). A client weighs 70 kg. Heparin infusion: Heparin 25,000 units in 1,000 mL 0.9 % sodium chloride. Order: Bolus with heparin sodium at 90 units/kg, then initiate drip at 20 units/kg/hr. a. Calculate the heparin bolus dosage: _____ b. Calculate the infusion rate for the IV dosage: _____ c. Determine the rate in mL/hr at which to set the infusion device: _____ ANS: a. 90 units/kg 70 kg = 6,300 units b. 20 units/kg/hr 70 kg = 1,400 units/hr c. 1,000 mL : 25,000 units = x mL : 1,400 units; x = 56 mL/hr 16. Directions: Calculate the following hourly dosage of heparin (units/hr). A client weighs 88 kg. Order: Bolus with heparin at 80 units/kg; initiate drip at 18 units/kg/hr. Heparin infusion 25,000 units in 500 mL 0.9 % sodium chloride. a. Calculate the heparin bolus dosage: _____ b. Calculate the infusion rate for the IV dosage: _____ ANS: a. 80 units/kg 88 kg = 7,040 units b. 18 units/kg/hr 88 kg = 1,584 units/hr 17. Directions: Calculate the following hourly dosage of heparin (units/hr). Order: Heparin 4,600 units subcut 2 hours before surgery Available: a) How many milliliters will you administer? _______ b) Shade the dosage in on the syringe provided. ANS: 0.92 mL 18. Directions: Calculate the following hourly dosage of heparin (units/hr). Order: Heparin 5,600 units subcut stat Available: a) How many milliliters will you administer? ___________ b) Shade the dosage in on the syringe provided. ANS: 0.56 mL 19. Directions: Use the following weight-based heparin protocol for the following problems. 1. Bolus heparin at 80 units/kg 2. Begin intravenous infusion of heparin at 18 units/kg/hr using 25,000 units of heparin in 250 mL of 0.45% NaCl for 100 units per mL 3. Adjust intravenous heparin daily on the basis of APTT results.  APTT less than 35 sec. Rebolus with 80 units/kg and increase rate by 4 units/kg/hr  APTT 35-45 sec. Rebolus with 40 units/kg and increase rate by 2 units/kg/hr  APTT 46-70 sec. No change  APTT 71-90 sec. Decrease rate by 2 units/kg/hr  APTT greater than 90 sec. Stop heparin infusion for 1 hour and decrease rate by 3 units/kg/hr A client weighs 158.4 lb. Determine the bolus dose of heparin, the initial infusion rate, and then adjust the hourly infusion rate based on the APTT results. APTT is reported as 88. The IV pump is calibrated to deliver in tenths of an mL/hr. ANS: a. Convert weight to kg. 158.4 lb ÷ 2.2 = 72 kg b. Calculate heparin bolus dosage 80 units/kg 72 kg = 5,760 units 100 units: 1 mL = 5,760 units mL 100 100 = 5,760 100 = 57.6 mL c. Calculate infusion rate 18 unit/kg/hr x 72 kg = 1,296 units/hr 100 units: 1 mL = 1,296 units mL 100 = 1,296 100 100 = 13 mL/hr d. Client’s APTT is 88. According to the protocol, decrease rate by 2 units/kg/hr. 2 units/kg/hr 72 kg = 144 units/hr decrease. 100 units:1 mL = 144 units: mL 100 = 144 100 100 = 1.4 mL/hr e. Decrease rate by 1.4 mL/hr 13 mL/hr (initial rate) - 1.4 mL/hr (decrease) 11.6 mL/hr New rate 11.6 mL/hr (rate not rounded to whole number, pump delivers in tenths of a mL/hr). 20. Directions: Use the following weight-based heparin protocol for the following problems. 1. Bolus heparin at 80 units/kg 2. Begin intravenous infusion of heparin at 18 units/kg/hr using 25,000 units of heparin in 250 mL of 0.45% NaCl for 100 units per mL 3. Adjust intravenous heparin daily on the basis of APTT results.  APTT less than 35 sec. Rebolus with 80 units/kg and increase rate by 4 units/kg/hr  APTT 35-45 sec. Rebolus with 40 units/kg and increase rate by 2 units/kg/hr  APTT 46-70 sec. No change  APTT 71-90 sec. Decrease rate by 2 units/kg/hr  APTT greater than 90 sec. Stop heparin infusion for 1 hour and decrease rate by 3 units/kg/hr A client weighs 81 kg. Determine the bolus dose of heparin, the initial infusion rate, and then adjust the hourly infusion rate up or down on the basis of the APTT results. APTT is reported as 43. The IV pump is calibrated in tenths of a milliliter. ANS: a. No weight conversion required b. Calculate heparin bolus dosage 80 units/kg 81 kg = 6,480 units 100 units: 1 mL = 6,480 units: mL 100 = 6,480 100 100 = 64.8 mL c. Calculate infusion rate 18 units/kg/hr 81 kg = 1,458 units/hr 100 units:1 mL = 1,458 units: mL 100 x = 1,458 100 100 = 14.6 mL/hr (Rate not rounded to a whole number, pump delivers in tenths of a mL/hr) d. Client’s APTT is 43. According to the protocol, rebolus with 40 units/kg and increase rate by 2 units/kg/hr. 40 units/kg 81 kg = 3,240 units 100 units:1 mL = 3,240 units: mL 100 = 3,240 100 100 = 32.4 mL e. Determine the infusion rate increase. 2 units/kg/hr x 81 kg = 162 units/hr increase Calculate adjustment rate. 100 units:1 mL = 162 units: mL 100 = 162 100 100 = 1.6 mL/hr increase 14.6 mL/hr (initial rate) + 1.6 mL/hr (increase) 16.2 mL/hr New rate 16.2 mL/hr. (rate not rounded to whole number, pump capable of delivering in tenths of a mL/hr)