Insulin dosage calculation practice problems


Calculating days supply is a daily part of community pharmacy practice. Are you up for this week's challenge? LZ is a 56 year old female with a history of hypertension, Type 2 diabetes, and hyperlipidemia is in your pharmacy today.

The patient is currently on metformin mg PO twice daily, Victoza 1. Calculate the days supply LZ is picking up today for both Tresiba and Apidra. Insulin is commonly dispensed in community pharmacies and due to ease of administration, many patients prefer insulin pens over vials.

Both the Tresiba vials and the pens can be stored at room temperature once punctured for up to 56 days. LZ is using 28 units daily and is picking up a total of 3 pens which is equivalent to a 32 days supply, making Answer A and B incorrect. The math is shown below. LZ is also using Apidra insulin glulisine which is a rapid acting insulin.

Apidra pens and vials can be stored refrigerated up to the expiration date on the box, but once punctured each pen has a beyond-use date BUD of 28 days whether at room temperature or refrigerated. LZ is using a total of 10 units daily and is picking up a total of 3 pens. Each pen contains units which should last LZ 30 days however due to the 28 day BUD of each pen once opened, the 3 pens will only last LZ 84 days, making Answer C incorrect.

Knowing the storage information for each insulin formulation is an important part of counseling patients when dispensing insulin. Patients should also be counseled on the proper administration techniques ie.

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These trackers help us to deliver personalized marketing content and to operate, serve and track ads. These trackers help us to deliver personalized marketing content to you based on your behaviour and to operate, serve and track social advertising.You will need to figure out calculate your bolus insulin dose based on carbohydrate eaten, blood glucose level or both added together.

NOTE: You may give insulin right after a meal if do not know the amount of carbohydrates that will be eaten, like with a very young child or sickness. Do not give rapid-acting insulin when you eat carbohydrate to treat a low blood glucose or to prevent a low blood glucose.

Tips for calculating a total daily dose of insulin

NOTE: You should not need to correct a high blood glucose with each meal. If you need insulin to correct high blood glucose often, the insulin dose may need to be changed at each meal. The goal is to predict and prevent high blood glucose. We will tell you if you need to round to whole units or half units. You may be told to use a different correction factor at bedtime or during the night. Skip to Content. Urgent Care. In This Section. ICR is the amount of rapid-acting insulin I you need for a specific amount of carbohydrate C in food.

This is the number of grams of carbohydrates that 1 unit of rapid-acting insulin will cover. Example: 1 unit of rapid-acting insulin will cover 10 grams carbohydrates. This may also be written The ratio may be different at different meals.

Using the ICR will control blood glucose best if insulin is given before meals. We strongly suggest that rapid-acting insulin be given before meals. Example: A meal has 60 grams of carbohydrates. Your carbohydrate ratio is Use this to calculate the correction bolus. Correction factor is how much 1 unit of rapid-acting insulin will reduce the blood glucose number. The target number is the blood glucose number that you want. If rapid-acting insulin is given with a meal, the correction dose is added to meal dose.

This combined dose is rounded up or down. If rapid-acting insulin is given after a meal, check the blood glucose before the meal. Use that blood glucose number to calculate the correction dose. It has been less than 3 hours since your last meal or correction bolus.

It has been less than 1 hour since intense exercise. At bedtime or during the night unless told otherwise. Rounding Insulin Doses We will tell you if you need to round to whole units or half units.Travel across the International Date Line adds to the confusion, as 7z to wbfs resources and dosing calculators often do not account for the date change.

We review recommendations from available guidelines and dosage calculators used for long-distance travel basal insulin adjustments and then present our patient handouts which allow for a safe, specific, single dose adjustment for eastward and westward travel.

The included handouts are easy to use and can be freely reproduced for use in diabetes clinics. Patients with diabetes who take insulin face many unique challenges related to travel to include dehydration and hypoglycemia. Dehydration, a well documented risk associated with long-distance air travel, is accentuated in patients with diabetes; and extreme dehydration without proper insulin adjustment has been reported to trigger DKA [ 1 ].

Air travel also increases the risk of hypoglycemia, requiring adjustment of the dosage and timing of insulin administration [ 2 ]. Only a handful of resources offer travel guidance to patients who take insulin. These include publications targeting physicians, generalized information for patients and online dosage calculators. While they are all well written and offer good advice, many limit their scope to storage and transportation of supplies, immunizations and diet advice making them too generalized to answer specific insulin dosing questions [ 3 — 6 ].

Older publications generally review adjusting intermediate acting insulin Lente, NPHoften used in combination with regular insulin, and are therefore less helpful for patients taking multiple daily injection basal-bolus regimens [ 78 ]. Other guidelines, while extremely detailed and well done, are lengthy and contain complex accompanying figures which can potentially be overwhelming for patients and providers looking for a simple guide to adjusting insulin [ 910 ].

Few publications explicitly address the issue of crossing the International Date Line IDL with sufficient detail to create a patient-friendly insulin adjustment plan.

Electronic dosage calculators, while helpful, require the patient to enter a significant amount of information online [ 11 ]. We are not aware of any online calculator that consistently accounts for crossing the IDL. Our diabetes clinic, in a tertiary care medical center located in Honolulu, Hawaii is only 2 time zones away from the IDL and provides care to children and adult patients from across the western Pacific.

Given our remote location, patients presenting for care frequently travel across multiple time zones east or west and routinely ask how to adjust their insulin when traveling back and forth across the IDL. In response to this need, we have developed detailed yet user-friendly patient handouts allowing physicians to offer patient-specific basal insulin dosing adjustment recommendations for long distance travel using only a single dose change [see Additional file 1 ].

In this review we discuss general rules for adjusting insulin during travel for patients on multiple daily injection basal-bolus regimens. We also include our patient handouts for eastward and westward travel that incorporate a single insulin dose adjustment for basal insulin, and review examples for multiple travel scenarios. As there are only a limited number of publications that provide advice for adjusting insulin for travel, and little scientific evidence to support their recommendations, we must emphasize that the advice given in this review is expert opinion based on our extensive clinical experience and knowledge of insulin pharmacokinetics, and is not evidence based.

Avoidance of hypoglycemia is the well-accepted primary goal during air travel. Many factors contribute to this increased risk, including changes in dietary patterns and difficulties in adjusting insulin dose and timing appropriately [ 2 ].

To reduce this risk of hypoglycemia recommendations have included removal and replacement of syringe plungers to allow pressure equalization prior to use for in-flight injections, and reduction in the amount of air normally injected into the insulin vials [ 13 ].

Changes in air pressure also affect insulin pumps with a reduction in air pressure occurring during ascent potentially resulting in unintended insulin delivery, yet no specific practice guideline currently recommends changes to insulin pump settings for travel [ 14 ]. Although many physicians appear reluctant to offer detailed advice on adjusting insulin doses for travel [ 15 ], the goal is actually quite straightforward; design an insulin regimen that is very simple and avoids hypoglycemia, even if this leads to a short period of suboptimal glycemic control hyperglycemia.

In general it is best to avoid complicated advice, such as to give frequent rapid acting insulin doses until it is time for basal insulin at the new location.

In our experience complicated plans generally confuse patients and are therefore not well followed. Instead, adjusting basal insulin with a single dose change is the simplest method. Short duration trips are typically easy. When traveling across fewer than 5 time zones or for trips less than 3 days duration, we recommend patients keep their watches set at their home local time, continue their basal insulin at the usual times and administer bolus doses before meals.

Similarly, patients on insulin pumps taking only rapid acting insulin continue with their usual regimen regardless of duration of travel, simply adjusting the time on their insulin pump to local time on arrival so their basal rates adjust accordingly.

As noted sweet pea possessive imagine, similar to short duration travel, patients on insulin pumps taking only rapid acting insulin continue with their usual regimen, adjusting the time on their insulin pump to local time on arrival so their basal rates adjust accordingly. Rapid acting bolus doses via insulin pump or subcutaneous injection are still given before meals.

Traveling across 5 time zones or more thereby necessitates a dose adjustment to prevent a clinically significant change in blood glucose. In the following section, we offer 4 examples of long distance travel scenarios for patients on once or twice daily basal insulin regimens, demonstrate how to fill out our patient handouts and provide detailed yet easily understood patient instructions for basal insulin dosage adjustment.

He currently takes glargine 20 units at 8 PM every night and rapid acting insulin before meals as part of his basal-bolus regimen. Total travel time is 11 hours.If your child takes too much insulin, their blood sugar can become lowwhich can cause symptoms such as a rapid heartbeat, nausea, fatigue, and even loss of consciousness.

Sometimes, your child may have high blood sugar, which can mean they ate more than they planned, got sick, or were stressed, among other things. Your child will also need insulin for the food they eat.

Remember, there is no such thing as a perfect insulin dose. Pattern control is used to help you make good decisions on making insulin adjustments.

Then, you can make adjustments as necessary. The insulin-to-carbohydrate ratio is important in helping your child get enough insulin for the amount of food they eat. The ratio includes the units of insulin and the carbohydrates your child eats. For example, a ratio of means your child will take one unit of mealtime insulin for every 15 grams of carbohydrate they eat.

Divide the result by 50, and multiply that result by the number of units. This means your child needs to take 1. Simply add their insulin-to-carbohydrate ratio dose together with their correction dose. By identifying patterns, you can adjust their insulin to meet their target blood sugar range. You can do this if your child uses an insulin pump or multi-dose injection therapy. You should always fix low blood sugars right away. Make An Appointment Phone Give Feedback On This Page. Give Feedback on this page.In this nursing test bankpractice dosage calculation problems to measure your competence in nursing math.

To use an insulin-to-carb ratio, you need to:

As a nurseyou must accurately and precisely calculate medication dosages to provide safe and effective nursing care. This quiz aims to help students and registered nurses alike grasp and master the concepts of medication calculation. In this section are the practice problems and questions for nursing dosage calculations. Included topics are dosage calculation, metric conversions, unit conversions, parenteral medications, and fluid input and output.

As you can tell, this NCLEX practice exam requires tons of calculations, so get your calculators ready! You are here to learn! Make sense of the rationales and review the drug dosage calculations study guide below.

Welcome to the first part of your drug dosage calculation practice! Included topics in this section are practice for unit conversions and medication dosage calculations. Get your calculators ready! Quiz complete. Results are being recorded. You have reached 0 of 0 point s0. Looking for the rationales? How will you instruct the patient to measure the dose using ordinary household measuring devices? Fill in the blanks. Record your answer to the nearest whole number.

Answer: tbsp. A patient has a bottle of warfarin Coumadin 5 mg tablets at home. After his most recent international normalized ratio INRthe doctor calls and tells him to take 7.For those of you who are in the application phase of nursing school or have yet to take your first medication calculation test, here it is in a nutshell—an assessment of your ability to correctly and accurately calculate and administer medication dosages safely to patients.

Topics covered are oral medications, parenteral medications, reconstituting, weight based calculations, IV calculations, heparin calculations, drop factor calculations, insulin dosages, and critical care calculations. Basic algebra and conversion skills are needed, such as the ability to set up proportions, multiply, divide, converting pounds to kilograms, and other various units of measurement kilograms, micrograms, ounces, etc.

How is medication calculation worked into nursing school? Every nursing school functions differently, and the requirements for passing may vary also.

Heparin, Insulin & other meds

The following is how medical calculation math works in my nursing school: Every semester you have three opportunities to pass. As you progress through the program, the amount of questions you may get wrong decreases. By your last semester, you are only allowed to get one wrong and need a score of 95 to pass. As there is no grade given for medical calculation math, it is a requirement that you have to pass.

It seems a little brutal, but the truth is, nurses need to be able to correctly calculate dosages, and be able to identify when a medication dose may be out of range or considered unsafe for that patient. How can you prepare for medication calculation? Everyone learns math differently.

Maybe you just need to see it once and you are good to go. Or, maybe you need to review a little bit each day until it sinks in. However you learn, here are some tips to help prepare for your medication calculation test: Tip 1 : Do as many review questions as you can.

Try and do a few that cover all of the topics that will be on the test. Asking your professor for good resources for extra practice can also be helpful. Tip 2 : Read every question and understand what the question is asking you. This is done to help reduce medication errors and discrepancies.

Insulin Dosage Calculator

Tip 4 : During the test, do at least every problem twice to double check your answer. If you are on your last attempt to pass, there is nothing wrong in doing the problem a few times to check and make sure your answer is correct. Tip 5 : Do a practice test at home prior to the test. Some programs may have a time limit to complete anywhere from questions, so you want to make sure you are able to do so in the allotted time.

Tip 6 : Make sure you have a backup calculator. Most programs only allow a basic calculator, so be sure you have a spare the day of the test in case yours breaks. Nurses have to do this every day and this is an important scope of practice for nursing. Medication calculation math may come easy for some, and yet difficult for others.

You may fail the first time and have to take it again. The more you practice, the more likely you will pass on your first time and the more comfortable you will be with medical calculations. Practice makes perfect. A Day in the Life of a Registered Nurse. Need Help? Outside the U. View our International Programs.Skip to content.

Skip to navigation. A Correction Factor sometimes called insulin sensitivityis how much 1 unit of rapid acting insulin will generally lower your blood glucose over 2 to 4 hours when you are in a fasting or pre-meal state. However, you should keep in mind:. To get your total daily dose, add up all your usual meal time insulin and basal insulin. For example, Tom wants to calculate his correction factor:.

The average adult needs approximately 1 unit of insulin for every 2 mmol increase in blood sugar, but this can vary a lot between individuals:. Before meal means there has been about 4 hours or more since you mbe 900 engine ate or took an insulin dose for carbohydrate containing food or beverage. The correction factor or insulin sensitivity can be used to make a scale for pre meal insulin doses.

Example: If your baseline dose of insulin at breakfast is 4 units and your before breakfast blood sugar is Others do not write out their scale; they just calculate an extra vlcc q88 using their Correction Factor and add it to their baseline usual dose at meals.

With this method people need to remember their target blood sugar level. Subtract the target blood sugar from the current sugar to calculate the gap. Then divide by the Correction sensitivity Factor to calculate the correction dose. Discuss your target levels with your health care team see Question 1. At 2 hours approximately 50 to 60 per cent of your bolus is used. There still is about 50 to 40 per cent of that dose remaining to lower blood sugars.

To correct for high blood sugars at 2 hours after a previous bolus, estimate what you would use as a correction factor and then divide by 2 — or use your insulin pump calculator! Skip to navigation Personal tools. Search Site. Advanced Search….

Staff Physicians Nurses Media Donate. An insulin sensitivity? A ratio? Info Share:. However, you should keep in mind: this is an estimate it may need to change as your baseline dose changes expect variations - sometimes 1 unit will lower it by more, and other times 1unit will lower it by less! Things to consider: how your insulin works the type of meal you ate - high fat carbohydrate meal vs.

Rapid acting Humalog or NovoRapid starts: minutes works strongest: 1 to 2 hours out of your body: 4 to 5 hours. Next page: How do I count carbs? And why? Navigation Services and Specialities. Connect with Sinai Health. Affiliated with. Recognized by. All rights reserved. Privacy Policy Contact Us. Insulin Dose Calculation: Problem 1. Blood sugar: Carb Intake: 40 grams of carbs. How much insulin do you give? Problem 2. Blood sugar: NCLEX reviewer for drug calculations! A nursing test bank to practice nursing dosage calculation problems.

Test your competence now! U Insulin Dosage Calculation (Two Examples).viewsK views. Jun 27, Dislike. Share. Save. Daniel Ozimek.

Dosage and Calculations Quiz for IV Drug Bolus for Nursing Students & Nurses

At what rate (mL/ h) would you deliver the medication if the physician's order was for units/ h? 3. The physician's order reads: Regular Insulin at 2 units. Basal/Background and Bolus Insulin Doses ; Example · Your total daily insulin dose (TDI) = lbs ÷ 4 = 40 units.

; This can be calculated using the Rule of “”. After completing the practice problems, you should feel comfortable and confident working dosage calculations. If not, seek additional instruction. Concentrate. 1. Order: Heparin units, subQ, q6h. Drugs available: How many milliliters will be administered for this dose?

· 2. Order: Regular Humulin insulin 12 units. Study Guide with Sample Questions. Dosage Calculation Competency. • Applicants to the Botfly larvae Degree "Bridge"Nursing Program must document.

Giving Insulin Injections. Answers to Calculation Practice Problems. This syringe is calibrated in units; insulin dosages are. Target blood glucose value used for insulin dose calculations when Bolus Insulin Calculation Worksheet. Insulin Practice Problem #1: Answers. In drip rate problems you will often have to convert both the amount of the drug (usually the quantity in the numerator of the drip. Practice Problems # 1 The answers are on page 34 of the dosage calculations To obtain credit for dosage calculation questions.

Sample 10 question insulin Calculation and Titration Quiz After completing all of the questions, go back to the first question and click on the “check”. Medication Calculation Practice Problems. Below is a section of the list of medications that are programmed in the Alaris IV. Comments for Insulin dosage math Insulin by: Kindred Hospital Pharmacy Technician Humulin N units/ml Join in and ASK your Questions! Calculate medication dosage problems using Ratio / Proportion, Formulas or For example, the physician orders 2 teaspoons of a medication.

Practice Dosage Calculations. Insulin and Heparin IV Therapy. 1. Order: Regular insulin 7 units/hr IV. Available: Regular insulin 50 units in mL NS. MATH PRACTICE PROBLEMS be the appropriate dose range for a patient with a BSA of m? How many units of insulin is the. insulin infusion; methods of calculating the safety of doses based on kilograms of body we can solve the problem and administer the drug in mL/hr per.

Need or want a larger snack. The insulin-to-carb ratio means you will take 1 unit of insulin for a certain amount of carbohydrate. For example, if your.