Mixed Review Drug Calculations: 100 Challenge Questions & Answers | Drug Calculation Mastery

DRUG CALCULATION MASTERY: MIXED REVIEW &
CHALLENGE QUESTIONS




100 Expert-Level Challenge Calculations
Nursing & Pharmacy Exam Preparation



Perfect for: NCLEX-RN • NCLEX-PN • CCRN • Pharmacy Technician • Nursing School Finals • Clinical
Competency Exams • Board Certification Review

Topics Covered: TPN Calculations • Syringe Pump Dosing • PCA Pumps • Insulin Sliding Scales
• Unit Conversions • Complex Reconstitution • Pediatric Fluid Resuscitation • Warfarin Dosing • Multi-Medication
IV Protocols • Comprehensive Clinical Scenarios




Every question includes step-by-step solutions, clinical context, and safety notes.

Designed by healthcare educators for maximum exam success.




TABLE OF CONTENTS
Section Questions Topic

1 1–10 Total Parenteral Nutrition
(TPN)

2 11–20 Syringe Pump Calculations

3 21–30 Patient-Controlled Analgesia
(PCA)
4 31–40 Insulin Sliding Scales

5 41–50 Unit Conversion Challenges

6 51–60 Complex Reconstitution
7 61–70 Pediatric Fluid Resuscitation

8 71–80 Warfarin Dosing

9 81–90 Multi-Medication IV Protocols

10 91–100 Comprehensive Clinical
Scenarios




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, HOW TO USE THIS DOCUMENT
1. Attempt each question independently before checking the answer.
2. Show all your work — examiners award partial credit for correct methodology.
3. Review the safety notes — these questions combine multiple high-risk concepts.
4. Time yourself — aim for 4–5 minutes per question on exam day.
5. Flag difficult questions for later review.




CLINICAL SAFETY REMINDERS
• Always verify the order against the medication administration record (MAR).
• Double-check all calculations — especially when multiple medications are involved.
• Check drug compatibility before mixing in the same IV line.
• Monitor for drug interactions — especially with warfarin and antibiotics.
• Use the correct equipment — oral syringes for liquids, insulin syringes for insulin.
• Label everything clearly — concentration, rate, and patient identifiers.
• When in doubt, ask — patient safety is everyone’s responsibility.




Question 1: Mixed Review – Syringe Pump Calculation
Patient: Baby Ava, neonate, 31 weeks gestational age, weight 2.0 kg

Order: Morphine 20 mcg/kg/hr IV continuous infusion via syringe pump

Available: Morphine 1 mg/mL in a 10 mL syringe

Question: a) What is the hourly dose in mcg/hr? b) At what rate (mL/hr) will you set the syringe pump?




Answer
Part a – Hourly dose:

Step 1: Calculate weight-based dose.

• Dose = 20 mcg/kg/hr × 2.0 kg = 40.0 mcg/hr

Part b – Syringe pump rate:

Step 1: Convert concentration to mcg/mL.

• 1 mg/mL = 1,000 mcg/mL

Step 2: Calculate rate.

• Rate = 40.0 mcg/hr / 1,000 mcg/mL = 0.04 mL/hr

Note: At this low rate, ensure the syringe pump is capable of delivering such small volumes accurately.
Consider diluting the Morphine to a lower concentration if the pump cannot deliver precisely.

Answer: a) 40.0 mcg/hr | b) 0.04 mL/hr

2

,Question 2: Mixed Review – Patient-Controlled Analgesia (PCA)
Patient: Mr. Patel, 41 years old, post-operative pain

Order: Morphine PCA: 0.5 mg IV q6min PRN, lockout 6 minutes, 4-hour limit 30 mg

Available: Morphine 50 mg in 50 mL NS (1 mg/mL)

Question: a) What is the maximum number of doses the patient can receive in 4 hours? b) If the patient uses the
maximum allowed, what is the total volume infused in 4 hours? c) What is the infusion rate (mL/hr) if running at
maximum use?




Answer
Part a – Maximum doses in 4 hours:

Step 1: Calculate doses based on lockout.

• 4 hours = 240 minutes

• Lockout = 6 minutes

• Maximum doses by lockout = = 40 doses

Step 2: Check against 4-hour limit.

• 4-hour limit = 30 mg

• Each dose = 0.5 mg

• Maximum doses by limit = .5 = 60 doses

Step 3: The limiting factor determines the maximum.

• Maximum doses = 40 doses

Part b – Total volume in 4 hours:

• Total volume = 40 doses × 0.5 mL/dose = 20.0 mL

Part c – Infusion rate:

• Rate = 20.0 mL / 4 hr = 5.0 mL/hr

Answer: a) 40 doses | b) 20.0 mL | c) 5.0 mL/hr




Question 3: Mixed Review – Total Parenteral Nutrition (TPN)
Patient: Mrs. Adams, 49 years old, weight 55 kg, NPO post-surgery Order: TPN to

provide 30 kcal/kg/day with amino acids at 1.0 g/kg/day

Available:


3

, • Amino acid solution: 10% (10 g per 100 mL)

• Dextrose solution: 50% (50 g per 100 mL)

• Lipid emulsion: 20% (20 g per 100 mL, provides 2 kcal/mL)

Question: a) How many mL of amino acid solution are needed per day? b) If dextrose provides 70% of total
calories, how many mL of 50% dextrose are needed? (Dextrose provides 3.4 kcal/g)




Answer
Part a – Amino acid solution:

Step 1: Calculate total amino acid needed.

• Amino acids = 1.0 g/kg/day × 55 kg = 55.0 g/day

Step 2: Calculate volume.

• 10% solution = 10 g/100 mL

• Volume = (55.0 g / 10 g) × 100 mL = 550.0 mL

Part b – Dextrose solution:

Step 1: Calculate total daily calories.

• Total calories = 30 kcal/kg/day × 55 kg = 1650 kcal/day

Step 2: Calculate calories from dextrose.

• Dextrose calories = 1650 kcal × 70% = 1155.0 kcal

Step 3: Calculate grams of dextrose needed.

• Grams = 1155.0 kcal / 3.4 kcal/g = 339.71 g

Step 4: Calculate volume of 50% dextrose.

• 50% dextrose = 50 g/100 mL

• Volume = (339.71 g / 50 g) × 100 mL = 679.41 mL

Answer: a) 550.0 mL | b) 679.41 mL




Question 4: Mixed Review – Insulin Sliding Scale
Patient: Ms. Patel, 62 years old, Type 2 Diabetes

Order: Regular insulin sliding scale SC q6h based on blood glucose (BG):
Blood Glucose (mg/dL) Insulin Dose

140–170 2 units

171–200 4 units
201–230 6 units


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