Chapter 1 —Medication Orders & Tablet
Calculations
Stem: A hospital order reads: Heparin 8000 units subcut daily.
Before giving the dose the nurse notices the patient’s body
weight is 48 kg and the usual heparin range for this patient is
80–100 units/kg/day. Which action is safest?
A. Administer 8,000 units as ordered.
B. Hold the medication and contact prescriber to clarify dosing.
C. Give 4,000 units now and 4,000 units tonight.
D. Reduce the dose by 10% and give 7,200 units.
Correct Answer: B
Rationales:
, • Correct (B): Calculate expected range: 48 kg × 80 units/kg
= 3,840 units; 48 kg × 100 units/kg = 4,800 units. The
ordered 8,000 units is well above the expected range —
nurse should hold and clarify to prevent overdose.
(Calculation shown stepwise: 48×80=
(40×80)+(8×80)=3,200+640=3,840; 48×100=4,800.)
• A: Administering 8,000 units ignores weight-based
expectation and risks overdose — reflects failing to verify
orders against safe dosing ranges.
• C: Splitting without prescriber approval assumes order
timing and dose flexibility; unsafe and reflects
improvisation error.
• D: Arbitrary 10% reduction has no pharmacologic basis
and still exceeds expected range (7,200 > 4,800); reflects
inappropriate dose modification without clarification.
Teaching Point: Always verify unusual doses against weight-
based ranges and clarify ambiguous orders.
2)
Chapter Reference: Chapter 1 — Section: The Rights of
Medication Administration — Safety in Medication
Administration
Stem: Which of the following demonstrates correct application
of the “rights” when administering a new oral tablet?
,A. Checking patient name bracelet once, then giving
medication.
B. Checking order, medication, patient, dose, route, time, and
documentation before administration.
C. Relying on MAR and administering when a nurse confirms
verbally.
D. Checking the medication label after placing the tablet in the
patient’s hand.
Correct Answer: B
Rationales:
• Correct (B): The “rights” include right patient, drug, dose,
route, time, documentation (and others); check all before
administration. This prevents errors.
• A: Single check of bracelet is insufficient; reflects
incomplete verification.
• C: Relying solely on MAR and a verbal confirmation may
miss transcription errors; reflects overreliance on
documentation.
• D: Checking label after giving dose risks wrong-drug
administration; reflects post-administration verification
error.
Teaching Point: Perform all “rights” checks before giving
medication to ensure safety.
, 3)
Chapter Reference: Chapter 1 — Section: Medication Label
Reading — Safety in Medication Administration
Stem: A vial label lists drug strength as Ampicillin 250 mg/5 mL.
The order is for 500 mg IV. How many milliliters should the
nurse draw up?
A. 5 mL
B. 7.5 mL
C. 10 mL
D. 2.5 mL
Correct Answer: C
Rationales:
• Correct (C): Set up ratio: 250 mg : 5 mL = 500 mg : x mL.
Calculate x = (500 mg × 5 mL) ÷ 250 mg = (2,500) ÷ 250 =
10 mL. Stepwise: 500×5=2,500; 2,500/250=10.
• A: 5 mL would deliver 250 mg (250 mg/5 mL). This reflects
failing to double the volume for double dose.
• B: 7.5 mL corresponds to 375 mg — reflects a decimal
misplacement or incorrect proportional setup.
• D: 2.5 mL corresponds to 125 mg — reflects dividing
instead of multiplying (wrong direction).
Teaching Point: Use equivalent ratios and solve stepwise:
desired × available-volume ÷ available-dose.
Calculations
Stem: A hospital order reads: Heparin 8000 units subcut daily.
Before giving the dose the nurse notices the patient’s body
weight is 48 kg and the usual heparin range for this patient is
80–100 units/kg/day. Which action is safest?
A. Administer 8,000 units as ordered.
B. Hold the medication and contact prescriber to clarify dosing.
C. Give 4,000 units now and 4,000 units tonight.
D. Reduce the dose by 10% and give 7,200 units.
Correct Answer: B
Rationales:
, • Correct (B): Calculate expected range: 48 kg × 80 units/kg
= 3,840 units; 48 kg × 100 units/kg = 4,800 units. The
ordered 8,000 units is well above the expected range —
nurse should hold and clarify to prevent overdose.
(Calculation shown stepwise: 48×80=
(40×80)+(8×80)=3,200+640=3,840; 48×100=4,800.)
• A: Administering 8,000 units ignores weight-based
expectation and risks overdose — reflects failing to verify
orders against safe dosing ranges.
• C: Splitting without prescriber approval assumes order
timing and dose flexibility; unsafe and reflects
improvisation error.
• D: Arbitrary 10% reduction has no pharmacologic basis
and still exceeds expected range (7,200 > 4,800); reflects
inappropriate dose modification without clarification.
Teaching Point: Always verify unusual doses against weight-
based ranges and clarify ambiguous orders.
2)
Chapter Reference: Chapter 1 — Section: The Rights of
Medication Administration — Safety in Medication
Administration
Stem: Which of the following demonstrates correct application
of the “rights” when administering a new oral tablet?
,A. Checking patient name bracelet once, then giving
medication.
B. Checking order, medication, patient, dose, route, time, and
documentation before administration.
C. Relying on MAR and administering when a nurse confirms
verbally.
D. Checking the medication label after placing the tablet in the
patient’s hand.
Correct Answer: B
Rationales:
• Correct (B): The “rights” include right patient, drug, dose,
route, time, documentation (and others); check all before
administration. This prevents errors.
• A: Single check of bracelet is insufficient; reflects
incomplete verification.
• C: Relying solely on MAR and a verbal confirmation may
miss transcription errors; reflects overreliance on
documentation.
• D: Checking label after giving dose risks wrong-drug
administration; reflects post-administration verification
error.
Teaching Point: Perform all “rights” checks before giving
medication to ensure safety.
, 3)
Chapter Reference: Chapter 1 — Section: Medication Label
Reading — Safety in Medication Administration
Stem: A vial label lists drug strength as Ampicillin 250 mg/5 mL.
The order is for 500 mg IV. How many milliliters should the
nurse draw up?
A. 5 mL
B. 7.5 mL
C. 10 mL
D. 2.5 mL
Correct Answer: C
Rationales:
• Correct (C): Set up ratio: 250 mg : 5 mL = 500 mg : x mL.
Calculate x = (500 mg × 5 mL) ÷ 250 mg = (2,500) ÷ 250 =
10 mL. Stepwise: 500×5=2,500; 2,500/250=10.
• A: 5 mL would deliver 250 mg (250 mg/5 mL). This reflects
failing to double the volume for double dose.
• B: 7.5 mL corresponds to 375 mg — reflects a decimal
misplacement or incorrect proportional setup.
• D: 2.5 mL corresponds to 125 mg — reflects dividing
instead of multiplying (wrong direction).
Teaching Point: Use equivalent ratios and solve stepwise:
desired × available-volume ÷ available-dose.
