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Do You Fear Tests of Medication Calculations? Fear No More! Colonel Cook is Here!

Updated on July 9, 2011
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Barbara worked at Thomas Hospital Home Health and is certified for home health from ANCC. She received her MSN from Mobile University, Ala.


Having been a nurse for over three decades, a medication calculation test did not really bother me. I did have presence of mind to request a refresher course. I received six of seven medication tests designed for medication technicians and relaxed. Obviously, if it were a test designed for registered nurses, then the questions would be more of critical thinking than of mathematics.

Man, was I in for a shock! The test was in pediatrics conversions as well as what I was to later learn was ratio and proportions. Where were the questions on why cardiologists order three medications to treat stage two to four heart disease? Where were the questions of why certain antibiotics if given to diabetic patients will cause their blood sugar to rise over 300? Where were the questions of long-term side effects related to medications given for the control of Congestive Heart Failure?

The test may have well been written in Sanskrit. The questions made no sense at all. I tried to set each question up in the age-old formulae of what you want over what you need divided by how long it is to be given. I tried to break each side down by halves until I got to zero. I tried to take all the numbers out and put in colors. OK, I admit, by that time it was over the two-hour limit and I was fishing. I did have the courage to sit and watch, as one answer after another was marked incorrect. I had the courage to ask what I had done wrong. I was given reassurance that it was due to not being taught this type of formulae during nursing school. I was reassured it was not to be worried over and to set up another test date. I asked for a review book or other types of review questions. There was none.

I admit that is when my courage gave out and I wanted to run. I was thoroughly humiliated and ashamed. Here I was, still just an RN with this La-de-dah masters in nursing education and I could not pass the medication test. This had to be the sign that I was, now and forever, a failure. 

But Am I Really That Different From Other Nurses?


Now, I am really not that different from other nurses. Most of us rely too heavily on the unit dose, the pharmacist; dial a flows and our medication pumps to back us up. I am not going to delve into the consequences of that on this generation as well as myself on that course of action. This article is about teaching anyone to do any calculation for any type of conversion question you could ever thing of dreaming up!

Thank you Colonel Cook! I do not know what angel sent you but I and all the rest of us on your team are so grateful you are here! Colonel Cook had to take the same test the day after I flunked it. Of course, he did not. The best part is he came to me and taught me, out of the kindness of his heart, how to ace this and any other conversion test for the rest of my life! This article will be for anyone like myself, who looks at a series of numbers and dots with an ‘X’ thrown in there somewhere and start to hyperventilate.

Col. Cook took me to his office and in less than forty minutes my mind expanded and I was going at questions so fast I was stumbling to get to the answer! Of course, that meant the Colonel had to slow me down; going too fast is not the way to go. It was so exciting though to have an answer and to know I could get to that answer with ease! I immediately felt compelled to tell everyone this wonderfully easy, quick, fun way to calculate dosages of any kind in a nursing setting!

This is How the Colonel Taught Me Not Only To Pass the Test But to Have No Fear of Any Test!!

Colonel Cook started me off by saying the following life-altering sentence.

“I want you to forget everything you have ever been taught about how to calculate medication dosages.”

He went on to say that regardless of the type of question, look for and write down two things.

1. What is the physician ordering?

2. What am I solving for?

Write it down every time and make sure it is written not as an answer, but as if you are setting up for a simple number over a number equation separated by a horizontal line. Now, don’t get discouraged, all will be revealed in due course! If it is a ratio to proportion question, whatever is on the right of the four dots is what the physician ordered and whatever is on the left is what you have on hand. If it is written as a word problem, remember most of what you read can be deleted at the start. Whew, was that ever a relief! Don’t get me wrong, I love to read, I am a wordsmith! Well, not an expert, but still, I do love words and…

OK I get it I hear you yawning! Back to the subject.

That is the next rule as a matter of fact. Stay focused. You can make the equation go on and on and on forever but it is not necessary most of the time. The rules that must always be followed are easy.

1. Write the above two questions at the top of your scratch paper.

2. Now draw a long line horizontally across the paper.

3. Write whatever the physician ordered at the top left of the line. (Usually the number one will be directly underneath this number.)

4. Now draw a vertical line through the horizontal line.

5. Never forget to look at what you wrote down as what you are solving for and do not get these numbers on the wrong part of the long line you wrote across the page!

6. What goes next is whatever you have on hand.

7. Remember, if the physician ordered mg, then what you have on hand in mg will go on the bottom and the quantity, whether one pill or one ml will go on top. Keep looking to see if you have to add something else. Do you have to add how many minutes it should be given? If so, draw another vertical line and write that part down, always keeping in the back of your mind that it needs to match whatever you are solving for.

8. Next, cross or cancel out everything you do not need except what you are solving for. Remember, it is easier if you break it down at the start into smallest increments but it doesn’t really matter, you will get to the answer at any rate.

9. Next, you can cancel out the zeros! How cool is that! What if you have a number with a zero, followed by a whole number? Can I still use it to cancel out another zero? No, you can only use tailing zeros to cancel other zeros out on the bottom.

10. Once you have done that, multiple the numbers across the top and do the same thing on the bottom.

11. Double-check your work.

12. Do you have what the physician ordered on top and what you are solving for on the bottom?

13. Have you crossed out everything except these two items on both top and bottom line?

14. Did you cross out the correct number of zeros on top to bottom line? (This is where I mess up…I get to seeing way too many zeros!! Ouch!)

15. Re-check your math/use your calculator! Do not try to show off!!

16. There you go, all done.

Really difficult right? Now, I admit, the want you have over what you want time the amount on hand is the old tried and true; remember the one I was trying to do when I freaktestitis? However, for the pediatric math calculations test with the mg per kilogram of weight per minute thingy? I am so doing Colonel Cook’s math! Thank you again Colonel Cook!!


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    • RNMSN profile image

      Barbara Bethard 7 years ago from Tucson, Az

      well I havent taken it yet...the Lt Col was off and today eeryone is off/veterans day/so I'm afraid it will be Fri afternoon and have to wait till Mon for the do you do the many calculations needed, as with your lidocaine per kg of pt wt per min? did you have the number for ml per hour from the tubing? or from the pump? I tink I will be all right/change the lb of child from lb into kg first and remember what the MD ordered and what I am solving for...wish me luck!!

    • elisabethkcmo profile image

      elisabethkcmo 7 years ago from Just East of Oz

      hope your Peds test went ok, right now I work at a LTAC (on the high observation unit most of the time with vent patients)...before that I was in dialysis and L&D...

      but the drip rate in question was a Lidocaine drip, at 4am of course with several calculations needed... but it worked, and the pt got better! take care, I value your info!

    • RNMSN profile image

      Barbara Bethard 7 years ago from Tucson, Az

      you are welcome/I will say thank you again to the Col tomorrow at work :) funny thing though the drip rate for me is not too bad...its all those words in a word test...all that stuff that doesnt pertain to the question!! for drip rate I hold the bag in my hand, how many ml in the bag? hold the tubing bag in other hand? multiply these two numbers many minutes to run in? divide that number into the numbers you mutiplied and that is drops per minute...pump acts just like a dial a flow...only dial in what the pump calls for by the hour if its a dial a flow and the primary set stays on the pump (easiest and my personal fav!!) then set the dial a flow for whatever the MD orders in mg/ vanco that has to be at least 60 min...if the bag is 250 ml easy peasy dial a flow only goes to just over 200! but omg tomorrow elisabeth I have to take that peds test pray for me!! I promise if I can just pass it I will NOT go work the peds clinic ha...I love med surg/what do you work?

    • elisabethkcmo profile image

      elisabethkcmo 7 years ago from Just East of Oz

      You're not the only one who has trouble with calculations, just last weekend on the night shift at the small hospital where I work, it took 3 nurses to confirm a drip rate before we felt comfortable... thanks for the info!