Case Studies
Case studies
This section contains case studies simulating typical orders that might be written for patients with selected disorders. In each case, the orders include multiple situations that require the nurse to perform clinical calculations before being able to implement the order. After reading the short scenario, read through the list of orders.
Place a check mark in the box next to the physician’s order that probably requires further calculations before implementing.
Case Study 1 Congestive Heart Failure
A patient is admitted to the hospital with a diagnosis of dyspnea, peripheral edema with a 10-lb weight gain, and a history of congestive heart failure. The orders from the physician include:
Bed rest in Fowler’s position
O2 at 4 L/min per nasal cannula
Chest x-ray, complete blood count, electrolyte panel, BUN, serum creatinine levels, and a digoxin level
IV of D5W/½ NS at 50 mL/hr
Daily AM weight
Antiembolism stockings
Furosemide 40 mg IV daily
Digoxin 0.125 mg PO daily
KCl 20 mEq PO tid
Low-Na diet
Restrict PO fluids to 1500 mL/day
Vitals every 4h
Accurate intake/output
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
Calculate gtt/min using microtubing (60 gtt/mL).
Calculate the weight gain in kilograms.
Calculate how many mL of Lasix the patient will receive IV from a multidose vial labeled 10 mg/mL.
Calculate how many tablets of digoxin the patient will receive from a unit dose of 0.25 mg/tablet.
Calculate how many tablets of K-Dur the patient will receive from a unit dose of 10 mEq/tablet.
Case Study 2 COPD/Emphysema
A patient is admitted to the hospital with dyspnea and COPD exacerbation. The orders from the physician include:
Stat ABGs, chest x-ray, complete blood count, and electrolytes
IV D5W/½ NS 1000 mL/8 hr
Aminophylline IV loading dose of 5.6 mg/kg over 30 minutes followed by 0.5 mg/kg/hr continuous IV
O2 at 2 L/min per nasal cannula
Albuterol respiratory treatments every 4h
Chest physiotherapy every 4h
Erythromycin 800 mg IV every 6h
Bed rest
Accurate intake/output
High-calorie, protein-rich diet in six small meals daily
Encourage PO fluids to 3 L/day
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
Calculate mL/hr to set the IV pump.
Calculate mL/hr to set the IV pump for the loading dose of aminophylline for a patient weighing 140 lb. Aminophylline supply: 100 mg/100 mL D5W.
Calculate mL/hr to set the IV pump for the continuous dose of aminophylline for a patient weighing 140 lb. Aminophylline supply: 1 g/250 mL D5W.
Calculate mL/hr to set the IV pump to infuse erythromycin 800 mg. Erythromycin supply: 1-g vial to be reconstituted with 20 mL sterile water and further diluted in 250 mL NS to infuse over 1 hr.
Calculate the PO fluids in mL/shift.
Case Study 3 Small Cell Lung Cancer
A patient with small cell lung cancer is admitted to the hospital with fever and dehydration. The orders from the physician include:
O2 at 2 L/min per nasal cannula
Chest x-ray; complete blood count; electrolytes; blood, urine, and sputum cultures; BUN and serum creatinine levels; type and cross for 2 units of PRBCs
IV D5W/½ NS 1000 mL with 10 mEq KCl at 125 mL/hr
2 units of PRBCs if Hg is below 8
6 pack of platelets if under 20,000
Neupogen 5 mcg/kg SQ daily
Gentamicin 80 mg IV every 8h
Decadron 8 mg IV daily
Fortaz 1 g IV every 8h
Accurate intake/output
Encourage PO fluids
Vitals every 4h (call for temperature above 102°F)
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
Calculate gtt/min using macrotubing (20 gtt/mL).
Calculate how many mcg of Neupogen will be given SQ to a patient weighing 160 lb.
Calculate mL/hr to set the IV pump to infuse gentamicin. The vial is labeled 40 mg/mL and is to be further diluted in 100 mL D5W to infuse over 1 hr.
Calculate how many mL of Decadron the patient will receive from a vial labeled dexamethasone 4 mg/mL.
Calculate mL/hr to set the IV pump to infuse Fortaz 1 g over 30 minutes. Supply: Fortaz 1 g/50 mL.
Case Study 4 Acquired Immunodeficiency Syndrome (AIDS)
A patient who is HIV+ and a Jehovah’s Witness is admitted to the hospital with anemia, fever of unknown origin, and wasting syndrome with dehydration. The orders from the physician include:
O2 at 4 L/min per nasal cannula
IV D5W/½ NS at 150 mL/hr
CD4 and CD8 T-cell subset counts; erythrocyte sedimentation rate; complete blood count; urine, sputum, and stool cultures; chest x-ray
Acyclovir 350 mg IV every 8h
Neupogen 300 mcg SQ daily
Epogen 100 units/kg SQ three times a week
Megace 40 mg PO tid
Zidovudine 100 mg PO every 4h
Vancomycin 800 mg IV every 6h
Respiratory treatments with pentamidine
High-calorie, protein-rich diet in six small meals daily
Encourage PO fluids to 3 L/day
Accurate intake/output
Daily AM weight
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
Calculate gtt/min using macrotubing (20 gtt/mL).
Calculate mL/hr to set the IV pump to infuse acyclovir 350 mg. Supply: 500-mg vial to be reconstituted with 10 mL sterile water and further diluted in 100 mL D5W to infuse over 1 hr.
Calculate how many mL of Neupogen will be given SQ. The vial is labeled 300 mcg/mL.
Calculate how many mL of Epogen will be given SQ to the patient weighing 100 lb. The vial is labeled 4000 units/mL.
Calculate how many mL/hr to set the IV pump to infuse vancomycin 800 mg. Supply: 1-g vials to be reconstituted with 10 mL NS and further diluted in 100 mL D5W to infuse over 60 min.
Case Study 5 Sickle Cell Anemia
A patient is admitted to the hospital in sickle cell crisis. The orders from the physician include:
Bed rest with joint support
O2 at 2 L/min per nasal cannula
Complete blood count, erythrocyte sedimentation rate, serum iron levels, and chest x-ray
IV D5W/½ NS at 150 mL/hr
Zofran 8 mg IV every 8h
Morphine sulfate 5 mg IV prn
Hydrea 10 mg/kg/day PO
Folic acid 0.5 mg daily PO
Encourage 3000 mL/daily PO
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
Calculate gtt/min using macrotubing (10 gtt/mL).
Calculate mL/hr to set the IV pump to infuse Zofran 8 mg. Supply: Zofran 8 mg in 50 mL D5W to infuse over 15 min.
Calculate how many mL of morphine sulfate will be given IV. The syringe is labeled 10 mg/mL.
Calculate how many mg/day of Hydrea will be given PO to the patient weighing 125 lb.
Calculate how many tablets of folic acid will be given PO. Supply: 1 mg/tablet.
Case Study 6 Deep Vein Thrombosis
A patient is admitted to the hospital with right leg erythema and edema to R/O DVT. The orders from the physician include:
Bed rest with right leg elevated
Warm, moist heat to right leg with Aqua-K pad
Doppler ultrasonography
Partial thromboplastin time (PTT) and prothrombin time (PT)
IV D5W/½ NS with 20 mEq KCl at 50 mL/hr
Heparin 5000 units IV push followed by continuous IV infusion of 1000 units/hr
Lasix 20 mg IV bid
Morphine 5 mg IV every 4h
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
Calculate gtt/min using microtubing (60 gtt/mL).
Calculate how many mL of heparin the patient will receive IV from a multidose vial labeled 10,000 units/mL.
Calculate mL/hr to set the IV pump for the continuous dose of heparin. Heparin supply: 25,000 units/250 mL D5W.
Calculate how many mL of Lasix the patient will receive IV from a multidose vial labeled 10 mg/mL.
Calculate how many mL of morphine the patient will receive from a syringe labeled 10 mg/mL.
Case Study 7 Bone Marrow Transplant
A patient is admitted to the hospital with a rash after an allogeneic bone marrow transplant. The orders from the physician include:
IV D5W/½ NS with 20 mEq KCl/L at 80 mL/hr
Complete blood count; electrolytes; sputum, urine, and stool cultures; blood cultures ×3; liver panel; BUN; and creatinine
Vitals every 4h
Strict intake/output
Fortaz 2 g IV every 8h
Vancomycin 1 g IV every 6h
Claforan 1 g IV every 12h
Erythromycin 800 mg IV every 6h
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
Calculate how many mEq/hr of KCl the patient will receive IV.
Calculate mL/hr to set the IV pump to infuse Fortaz 2 g. Supply: Fortaz 2-g vial to be reconstituted with 10 mL of sterile water and further diluted in 50 mL D5W to infuse over 30 min.
Calculate mL/hr to set the IV pump to infuse vancomycin 1 g. Supply: vancomycin 500-mg vial to be reconstituted with 10 mL of sterile water and further diluted in 100 mL of D5W to infuse over 60 min.
Calculate mL/hr to set the IV pump to infuse Claforan 1 g. Supply: Claforan 600 mg/4 mL to be further diluted with 100 mL D5W to infuse over 1 hr.
Calculate mL/hr to set the IV pump to infuse erythromycin 800 mg. Supply: Erythromycin 1-g vial to be diluted with 20 mL sterile water and further diluted in 250 mL of NS to infuse over 60 min.
Case Study 8 Pneumonia
A patient is admitted to the hospital with fever, cough, chills, and dyspnea to rule out pneumonia. The orders from the physician include:
IV 600 mL D5W every 8h
Intake/output
Vitals every 4h
Complete blood count, electrolytes, chest x-ray, ABGs, sputum specimen, blood cultures, and bronchoscopy
Bed rest
Humidified O2 at 4 L/min per nasal cannula
High-calorie diet
Encourage oral fluids of 2000 to 3000 mL/day
Pulse oximetry every AM
Clindamycin 400 mg IV every 6h
Albuterol respiratory treatments
Guaifenesin 200 mg PO every 4h
Terbutaline 2.5 mg PO tid
MS Contrin 30 mg PO every 4h prn
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
Calculate mL/hr to set the IV pump to infuse clindamycin 400 mg. Supply: Clindamycin 600 mg/4 mL to be further diluted with 50 mL D5W to infuse over 1 hr.
Calculate gtt/min to infuse the clindamycin using macrotubing (20 gtt/mL).
Calculate how many mL of guaifenesin the patient will receive from a stock bottle labeled 30 mg/tsp.
Calculate how many tablets of terbutaline the patient will receive from a unit dose of 5 mg/tablet.
Calculate how many tablets of MS Contrin the patient will receive from a unit dose of 30 mg/tablet.
Case Study 9 Pain
A patient is admitted to the hospital with intractable bone pain secondary to prostate cancer. The orders from the physician include:
IV D5W/½ NS with 20 mEq KCl/L at 60 mL/hr
IV 500 mL NS with 25 mg Dilaudid and 50 mg Thorazine at 21 mL/hr
Heparin 25,000 units/250 mL D5W at 11 mL/hr
Bed rest
Do not resuscitate
O2 at 2 L/min per nasal cannula
Bumex 2 mg IV every AM after albumin infusion
Albumin 12.5 g IV every AM
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
Calculate how many mEq/hr of KCl the patient is receiving.
Calculate how many mg/hr of Dilaudid the patient is receiving.
Calculate how many mg/hr of Thorazine the patient is receiving.
Calculate how many units/hr of heparin the patient is receiving.
Calculate how many mL of Bumex the patient will receive from a stock dose of 0.25 mg/mL.
Case Study 10 Cirrhosis
A patient is admitted to the hospital with ascites, stomach pain, dyspnea, and a history of cirrhosis of the liver. The orders from the physician include:
IV D5W/½ NS with 20 mEq KCl at 125 mL/hr
IV Zantac 150 mg/250 mL NS at 11 mL/hr
O2 at 2 L/min per nasal cannula
Type and crossmatch for 2 units of packed red blood cells, complete blood count, liver panel, PT/PTT, SMA-12.
Carafate 1 g every 4h PO
Vitamin K 10 mg SQ every AM
Spironolactone 50 mg PO bid
Lasix 80 mg IV every AM
Measure abdominal girth every AM
Sodium restriction to 500 mg/day
Fluid restriction to 1500 mL/day
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
Calculate the gtt/min using macrotubing (20 gtt/mL).
Calculate the mg/hr of Zantac the patient is receiving.
Calculate how many mL of vitamin K the patient will receive SQ from a unit dose labeled 10 mg/mL.
Calculate how many tablets of spironolactone the patient will receive from a unit dose labeled 25 mg/tablet.
Calculate how many mL of Lasix the patient will receive from a unit dose labeled 10 mg/mL.
Case Study 11 Hyperemesis Gravidarum
A 14-year-old patient is admitted to the hospital with weight loss and dehydration secondary to hyperemesis gravidarum. The orders from the physician include:
Bed rest with bathroom privileges
Obtain weight daily
Vital every 4h
Test urine for ketones
Urinalysis, complete blood count, electrolytes, liver enzymes, and bilirubin
NPO for 48 hr, then advance diet to clear liquid, full liquid, and as tolerated
IV D5 ½ NS at 150 mL/hr for 8 hr, then decrease to 100 mL/hr
Observe for signs of metabolic acidosis, jaundice, or hemorrhage
Monitor intake and output
Droperidol (Inapsine) 1 mg IV every 4h prn for nausea
Metoclopramide (Reglan) 20 mg IV in 50 mL of D5W to infuse over 15 min
Diphenhydramine (Benadryl) 25 mg IV every 3h prn for nausea
Dexamethasone (Decadron) 4 mg IV every 6h
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
Calculate gtt/min using macrotubing (20 gtt/mL) to infuse 150 mL/hr, then 100 mL/hr.
Calculate how many mL of droperidol the patient will receive IV. Supply: 2.5 mg/mL
Calculate mL/hr to set the IV pump to infuse metoclopramide (Reglan) 20 mg in 50 mL of D5W to infuse over 15 min.
Calculate how many mL of diphenhydramine (Benadryl) the patient will receive IV. Supply: 10 mg/mL.
Calculate how many mL of dexamethasone (Decadron) the patient will receive IV. Supply: 4 mg/mL.
Case Study 12 Preeclampsia
A nulliparous female is admitted to the hospital with pregnancy-induced hypertension. The orders from the physician include:
Complete bed rest in left lateral position
Insert Foley catheter and check hourly for protein and specific gravity
Daily weight
Methyldopa (Aldomet) 250 mg PO tid
Hydralazine (Apresoline) 5 mg IV every 20 min for blood pressure over 160/100
Complete blood count, liver enzymes, chemistry panel, clotting studies, type and crossmatch, and urinalysis
Magnesium sulfate 4 g in 250 mL D5LR loading dose to infuse over 30 min
Magnesium sulfate 40 g in 1000 mL LR to infuse at 1 g/hr
Keep calcium gluconate and intubation equipment at the bedside
Nifedipine (Procardia) 10 mg sublingual for blood pressure over 160/100 and repeat in 15 min if needed.
Keep lights dimmed and maintain a quiet environment
Monitor blood pressure, pulse, and respiratory rate, fetal heart rate (FHR) contractions every 15 to 30 min, and deep tendon reflexes (DTR) hourly
Monitor intake and output, proteinuria, presence of headache, visual disturbances, and epigastric pain hourly
Restrict hourly fluid intake to 100 to 125 mL/hr
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
Calculate how many tablets of methyldopa (Aldomet) will be given PO. Supply: 500 mg/tablet.
Calculate how many mL of hydralazine (Apresoline) will be given IV. Supply: 20 mg/mL.
Calculate mL/hr to set the IV pump to infuse magnesium sulfate 4 g in 250 mL D5W loading dose to infuse over 30 min.
Calculate mL/hr to set the IV pump to infuse magnesium sulfate 40 g in 1000 mL LR to infuse at 1 g/hr.
Calculate how many capsules of nifedipine (Procardia) will be needed to give the sublingual dose. Supply: 10 mg/capsule.
Case Study 13 Premature Labor
A 35-year-old female in the 30th week of gestation is admitted to the hospital in premature labor. The orders from the physician include:
Bed rest in left lateral position
Monitor intake and output
Daily weights
Continuous fetal monitoring
Monitor blood pressure, pulse rate, respirations, fetal heart rate, uterine contraction pattern, and neurologic reflexes
Keep calcium gluconate at the bedside
Initiate magnesium sulfate 4 g in 250 mL LR loading dose over 20 min, then 2 g in 250 mL LR at 2 g/hr until contractions stop
Continue tocolytic therapy with terbutaline (Brethine) 0.25 mg SQ every 30 min for 2 hr after contractions stop
Give nifedipine (Procardia) 10 mg sublingual now, then 20 mg PO every 6h after infusion of magnesium sulfate and contractions have stopped
Betamethasone 12 mg IM × 2 doses 12 hr apart
IV LR 1000 mL over 8 hr
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
Calculate mL/hr to set the IV pump to infuse the loading dose magnesium sulfate 4 g in 250 mL LR over 20 min and the 2 g/hr maintenance dose.
Calculate how many mL of terbutaline (Brethine) will be given SQ. Supply: 1 mg/mL.
Calculate how many capsules of nifedipine (Procardia) will be given PO every 6h. Supply: 10 mg/capsule.
Betamethasone 12 mg IM × 2 doses 12 hr apart. Supply: 6 mg/mL.
Calculate mL/hr to set the IV pump to infuse LR 1000 mL over 8 hr.
Case Study 14 Cystic Fibrosis
A 10-year-old child weighing 65 lb is admitted to the hospital with pulmonary exacerbation. The orders from the physician include:
Complete blood count with differential, ABGs, chest x-ray, urinalysis, chemistry panel, and sputum culture
IV 0.9% normal saline at 75 mL/hr
Daily weights
Monitor vitals every 4h
Oxygen at 2 L/min with pulse oximetry checks to maintain oxygen saturation above 92%
Pancrease 2 capsules PO with meals and snacks
High-calorie, high-protein diet
Multivitamin 1 tablet PO daily
Tagamet 30 mg/kg/day PO in four divided doses with meals and HS with a snack.
Clindamycin 10 mg/kg IV every 6h
Postural drainage and percussion after aerosolized treatments
Albuterol treatments with 2 inhalations every 4h to 6h
Terbutaline PO 2.5 mg every 6h
Tobramycin 1.5 mg/kg every 6h
Tobramycin peak and trough levels after fourth dose
Identify the orders that require calculations.
Set up and solve each problem using dimensional analysis.
Calculate gtt/min using macrotubing (15 gtt/mL).
Calculate how many tablets of Tagamet will be given PO with meals and HS snack. Supply: 200 mg/tablet.
Calculate how many mg of clindamycin the patient will receive, how many mL to draw from the vial, and mL/hr to set the IV pump. Supply: 150 mg/mL vial to be further diluted in 50 mL of NS and infused over 20 min.
Calculate how many tablets of terbutaline will be given PO. Supply: 2.5 mg/tablet.
Calculate how many mg of tobramycin the patient will receive, how many mL to draw from the vial, and mL/hr to set the IV pump. Supply: 40 mg/mL vial to be further diluted in 50 mL of NS and infused over 30 min.
Case Study 15 Respiratory Syncytial Virus (RSV)
A 2-year-old child weighing 30 lb is admitted to the hospital for severe respiratory distress. The orders from the physician include:
Complete blood count with differential, electrolytes, blood culture, chest x-ray, and nasal washing
Humidified oxygen therapy to keep oxygen saturation >92%
Continuous pulse oximetry
IV D5W½ NS at 50 mL/hr
Elevate HOB
Vitals every 2h
Contact isolation
Cardiorespiratory monitor
Strict intake and output with urine specific gravitiesStay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree