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UNIVERSITY OF MOBILE SCHOOL OF NURSING DOSAGE CALCULATION TESTING POLICY PURPOSE: The Dosage Calculation Testing Policy exists to facilitate dosage calculation competence necessary for safe nursing practice. It is imperative that nursing students assume personal responsibility for maintenance of math skills throughout the nursing curriculum. The dosage calculation test serves as a means for continued assessment of these important skills by faculty. TESTING ADMINISTRATION (BSN STUDENTS): Students will take the Dosage Calculation Test: 1. 1st week of Spring Semester, Junior Year for the following courses: NU 314 Nursing the Childbearing Family NU316 Psychiatric-­‐Mental Health Nursing Passing Score > 80% 2. 1st week of Fall Semester, Senior Year for the following courses: NU 404 Child Health Nursing NU 412 Community Health Nursing Passing Score > 90% 3. 1st week of Spring Semester, Senior Year for the following course: NU 414 Adult Health Nursing II Passing Score 100% TESTING ADMINISTRATION (ADN STUDENTS): Students will take the Dosage Calculation Test: 1. 1st week of Spring Semester, Junior Year for the following course: NU 110 Medical-­‐Surgical Nursing I Passing Score > 80% 2. 1st week of Fall Semester, Senior Year for the following course: NU 210 Medical-­‐Surgical Nursing II Passing Score > 90% 3. 1st week of Spring Semester, Senior Year for the following courses: NU 209 Psychosocial Nursing NU 208 Maternal-­‐Child Nursing Passing Score 100% TESTING POLICY: Students will be given 3 opportunities to achieve the benchmark percentage established by the School of Nursing faculty. Failure to pass the Dosage Calculation Testing on the third attempt will result in withdrawal from all clinical nursing courses. In all cases, readmission to the clinical course will be prioritized and on a space-­‐available basis. The student will be required to demonstrate evidence of math remediation for return to the program. Multiple math failures within the clinical courses will be considered failure to progress. If failure to progress inhibits the student from completing the nursing program within five years, the student will be dismissed from the nursing program. TESTING PROCEDURE: 1. Students should arrive at the testing site at least 5-­‐10 minutes before the test is scheduled to begin. 2. The testing format will be paper and pencil. Students should bring two #2 pencils with intact erasers. 3. Calculators will be provided by the UM School of Nursing. 4. Students will have 30 minutes to complete the Dosage Calculation test. 5. Students should not bring any personal items to the testing site. Additionally, no cell phones, PDA’s, computers, or other electronic devices are allowed. TESTING PREPARATION: Henkes Med-­‐Math Dosage Calculation, Preparation, and Administration textbook (7th Edition) by Susan Buchholz published by Lippincott, Williams & Wilkins is available in the UM Bookstore. The book includes access to the publishers website for supporting instruction and practice problems. TESTING GUIDELINES AND OTHER RULES SUMMARY: 1. Rounding off Decimals rules. The determination of how many places to carry your division when calculating dosages is based on the equipment used. Some syringes are marked in tenths and some in hundredths. To ensure accuracy, most calculation problems require that you carry your division at least two decimal places (hundredths place) and round off to the nearest tenth. There are some exceptions, typically found in the administration of pediatric or critical care medications. It may be necessary to compute decimal calculations to thousandths (three decimal places) and round to hundredths (two decimal places). a. To express an answer to the nearest tenth, carry the division to the hundredths place (two places after the decimal). If the number in the hundredths place is 5 or greater, add one to the tenths place. If the number is less than 5, drop the number to the right of the desired decimal place. If the final answer that goes on the answer sheet is greater than one, it should be rounded to tenths (one space beyond the decimal). If the answer is greater than 1, carry to the hundredths place and round to the tenths place. Example: Express 4.15 to nearest tenth = answer 4.2 Explanation: The number in the hundredths place is 5; the number is the tenths place is increased by one. 4.1 becomes 4.2 Example: Express 1.24 to the nearest tenth = answer 1.2 Explanation: The number in the hundredths place is less than 5; the number in the tenths place does not change. The 4 is dropped. b. To express an answer to the nearest hundredth, carry the division to the thousandths (three places after the decimal). If the number in the thousandths place is 5 or greater, add one to the hundredths place. If the number is less than 5, drop the number to the right of the desired place. If the final answer that goes on the answer sheet is less than one, it should be rounded to hundredths (two spaces beyond the decimal). If the answer is less than 1, carry the decimal answer to the thousandths place and round to the hundredths place. Example: Express 0.176 to the nearest hundredth = answer 0.18 Explanation: The number in the thousandths place is 6; the number in the hundredths place is increased by one. Example: Express 0.554 to the nearest hundredth = answer 0.55 Explanation: The number in the thousandths place is less than 5; the number in the hundredths place does not change. c. A decimal is a fraction that has a denominator that is a multiple of 10. The decimal point indicates place value. Numbers that are written to the right of the decimal represent a value of less than one. Numbers that are written to the left of the decimal represent a value of greater than one. Leading Zero Rule: When there is no whole number before a decimal point, it is important to place a zero to the left of the decimal point to emphasize the number has a value of less than one. This is a JCAHO requirement and more importantly, a safety issue. Example: answer = .75 (incorrect). The answer, according to the Leading Zero Rule, is 0.75 (correct) Trailing Zero Rule: When writing decimals, unnecessary zeros should not be placed at the end of the number to avoid misinterpretation of a value and overlooking a decimal point. This is a JCAHO requirement and more importantly, a safety issue. Example: answer = 1 tablet (correct). The answer, according to the Trailing Zero Rule, should not be written as 1.0 tablet (incorrect) d. All intravenous (IV) problems having an answer in drops per minute are to be rounded to the nearest whole number. Example: 41.25 gtts per minute = 41 gtts per minute (correct) Example: 30.5 gtts per minute = 31 gtts per minute (correct) Explanation: Drops per minute (gtts per minute) are always expressed in whole numbers. e. Any intravenous (IV) problem solving for mL/hr should be carried to the tenths decimal place Example: 41.25 mL/hr = 41.3 mL/hr (correct) 41mL/hr (incorrect) Explanation: With technological advances, there are some IV pumps that are capable of delivering IV fluids in tenths of a milliliter. 2. All answers on the Dosage Calculation test must include the proper unit of measure. The answer is incorrect if it is not labeled appropriately. 3. All calculations for each drug dosage problem must be shown on the test. The answer will be considered incorrect, even if a correct answer is provided, if the student fails to write out how the problem was solved. 4. Students will be required to show in writing the steps for solving Dosage Calculation problems. The answer will be marked correct only if directions in the following areas are evident: • A structured formula is used (Ratio and Proportion, Formula Method, or Dimensional Analysis) • Method of calculation is shown (math work is included with each problem) • Final answer is complete (both the numerical answer and the unit of measure are correct) 5. Fractional (partial) credit will not be given to answers. If any part of the answer is wrong, the entire answer is wrong. 6. No fractions will be accepted as answers. All answers must be in decimals. 7. Answers should be placed in the space provided. If no answer is in the space provided, then the question is determined to be unanswered and will be marked incorrect. PRACTICE PROBLEMS: 1. Ordered: Robinul 100 mcg IM stat. Available: Robinul 0.2 mg per 1 mL 2. Ordered: Heparin 750 units subcutaneously daily Available: Heparin 1,000 units per mL 3. Ordered: Digoxin 0.375mg p.o. daily Available: Digoxin (scored tablets) labeled 0.25 mg 4. Ampicillin 0.5 g orally every 6 hours Available: Ampicillin capsules labeled 250 mg per capsule 5. Ordered: Phenobarbital 120 mg IM at bedtime Available: Phenobarbital 130 mg/mL 5. The physician ordered Kaon-­‐Cl (potassium chloride) 40 mEq orally daily. Label: 20 mEq/15mL 6. The physician prescribes Diphenhydramine hydrochloride 25 mg orally twice daily as needed for agitation. The label reads: Diphenhydramine hydrochloride elixir 12.5 mg per 5 mL 7. A patient has an order for Pencillin G 800,000 units IVPB every four hours. The nurse reads that the vial has 100,000 U/mL. How many mL will the nurse withdraw from the vial? 8. The health care provider writes an order for 1500 mL D5RL in 24 hours by infusion pump. Calculate the flow rate in mL/hr. 9. Order: 1,000 mL D5W to infuse in 8 hours. Drop factor: 20 gtt/mL At what rate in gtt/min should the IV be regulated? 10. Ordered: Thiamine Hydrochloride 75 mg IM daily Available: Thiamine Hydrochloride 100mg/mL