Case Studies



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:

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Jun 30, 2016 | Posted by in PHARMACY | Comments Off on Case Studies

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