Ch.5- Pediatric Med Considerations (mine)

What difference between breast-fed and formula-fed infants is relevant to drug administration? Breast-fed infants have higher gastric pH than do formula-fed infants. Breast-fed infants have lower enzyme function than do formula-fed infants. Breast-fed infants have faster gastric emptying than do formula-fed infants. Breast-fed infants have less intestinal surface area than do formula-fed infants.

Breast-fed infants have faster gastric emptying than do formula-fed infants. Breast-fed infants have faster gastric emptying than formula-fed infants, which affects drug absorption. Gastric pH, enzyme function, and intestinal surface area reach adult levels in breast-fed and formula-fed infants at similar times. p. 44

Which term describes the study of the time course of drug absorption, distribution, metabolism, and excretion? Pharmacokinetics Pharmacogenetics Pharmacodynamics Pharmacotherapeutics

Pharmacokinetics Pharmacokinetics describes the study of the time course of drug absorption, distribution, metabolism, and excretion. Pharmacogenetics is the study of the effect of genetic factors on reactions to drugs. Pharmacodynamics refers to the mechanisms of action and effects of a drug on the body and includes the onset, peak, and duration of effect of a drug. Pharmacotherapeutics is the study of the therapeutic uses and effects of drugs. p. 44

How many hours would it take for the lidocaine level in a child to reach 50% of the intake level? 2 to 3 hours 1 to 5 hours 1 to 2 hours 2 to 7 hours

1 to 5 hours The half-life for lidocaine in a child is 1 to 5 hours. Therefore the lidocaine level in a child would reach 50% of the intake level at 1 to 5 hours. The half-life range for lidocaine in a child is not 2 to 3, 1 to 2, or 2 to 7 hours. p. 46

Which nonpharmacologic methods of pain and anxiety control are appropriate for the nurse to use with pediatric patients when administering drugs? Select all that apply. 1 Diversion 2 Relaxation 3 Distraction 4 Creative imagery 5 Administration during sleep

1, 2, 3, 4 Based on the cognitive level of the child, nonpharmacologic methods of pain and anxiety control such as diversion, relaxation, distraction, and creative imagery can be used to decrease the perception of pain. Medications should never be given to a sleeping child with the intent to surprise the child with a quick procedure. The child may subsequently experience a lack of trust and may be reluctant to sleep in the future.

Health care providers may base pediatric dosing on which factors? Select all that apply. 1 Body weight 2 Lean body mass 3 Body surface area 4 Body fat percentage 5 Body water percentage

1, 3 Drugs for pediatric patients are ordered based on either the child's weight in kilograms (mg/kg) or body surface area (mg/m 2). Body surface is based on a percentage of adult surface area (1.73 m 2). It is not safe or practical to base pediatric dosing on lean body mass, body fat percentage, or body water percentage. P.45

Which factors impede the absorption of drugs delivered intramuscularly or subcutaneously? Select all that apply. 1 Dehydration 2 Low gut motility 3 Cold temperatures 4 Altered cardiac status 5 Reduced enzyme levels

1, 3, 4 Conditions that alter perfusion, like dehydration, cold temperatures, and alterations in cardiac status, may impede absorption of drugs in the tissues when delivered intramuscularly or subcutaneously. Gut motility and enzyme levels affect absorption of drugs administered via the oral route. p. 44

Which parameters should be considered while prescribing medications to an adolescent? Select all that apply. 1 Physical activity 2 Lean-to-fat body mass 3 Cognitive development 4 Presence of growth spurts 5 Appetite and food consumption

2, 4, 5 When prescribing medication to an adolescent, the primary health care provider considers the patient's lean-to-fat body mass. It helps to determine the amount of fat in the body and its effects on the concentration of a fat-soluble drug. Because puberty occurs during adolescence, it results in a change in hormone levels and alters the pharmacokinetic parameters of the drug. The primary health care provider should consider the appearance of a growth spurt. Appetite and food consumption help determine the response of the medication in the adolescent and eliminate food-drug interactions. They also help determine the scheduling of the medication. Physical activity and cognitive ability do not alter the pharmacokinetics of the drug and need not be considered when prescribing medications to an adolescent. p. 48

How many hours would it take for the theophylline level in an infant to reach 50% of the intake level? 3 to 9 hours 12 to 21 hours 24 to 36 hours 60 to 160 hours

24 to 36 hours The half-life for theophylline in an infant is 24 to 36 hours. Therefore the theophylline level in an infant would reach 50% of the intake level at 24 to 36 hours. The level would remain higher than 50% at 3 to 9 and 12 to 21 hours and lower than 50% at 60 to 160 hours. p. 46

A 5-year-old child with diarrhea has been prescribed 0.2 mg/kg of loperamide (Imotil). The child's weight is 15 kg. What dose of medication should the nurse administer to the child to ensure safety? Record your answer using a whole number. _____mg

3 In order to prevent overdose and toxic medication effects, the primary health care provider prescribes the medication dosage based on the child's body weight in kilograms. The nurse should check the child's weight and calculate the dosage appropriately before administering the medication. Here, the child's weight is 15 kg and the dosage prescribed is 0.2 mg/kg; therefore, the daily dose of loperamide (Imotil) that the nurse should administer to the child to ensure safety is 3 mg (0.2 mg × 15 kg = 3 mg).

What solid drug dosage forms are most appropriate for children ages 6 to 11 years? Select all that apply. 1 Syrups 2 Capsules 3 Oral films 4 Chewable tablets 5 Orally disintegrating tablets

3, 4, 5 Solid drug dosage forms most appropriate for children age 6 to 11 years include oral films, chewable tablets, and orally disintegrating tablets. Syrups are a liquid drug dosage form more appropriate for infants and children 2 to 5 years. Capsules are more appropriate for adults. p. 47

Knowing that the proteins in neonates and infants has a lower binding capacity for medications, the nurse anticipates that the health care provider will order which adjustment to minimize the risk of toxicity? A decrease in the dosage of drug given An increase in the dosage of drug given A shorter time interval between doses Intravenous administration of the drug

A decrease in the dosage of drug given prevent toxicity. An increase in the drug dose would result in higher risk of toxicity. A shorter time interval between doses would increase the risk of toxicity. IV administration of a drug may increase the risk of toxicity due to quicker onset of action. p. 45

The laboratory reports of an infant with jaundice indicate high serum bilirubin levels. The primary health care provider prescribes a medication that that is highly bound to albumin. Which intervention helps provide safe and effective treatment to the infant? Administering a low dose of the drug to the infant Administering the medication by the rectal route Increasing the frequency of the drug administration Assessing the hydration status of the infant

Administering a low dose of the drug to the infant An infant with jaundice may have high serum bilirubin levels. These high bilirubin levels reduce the availability of protein-binding sites to the drug. This increases the availability of free drugs in the blood, which may lead to toxicity. A low dose of the drug is therefore administered to prevent toxicity in the infant. Administering the medication by the rectal route decreases the drug absorption and delays the therapeutic action of the drug. Increasing the frequency of drug administration increases the concentration of the drug in the blood, resulting in drug toxicity. Assessing the hydration status of the infant helps to enhance the elimination of the drug metabolites. It does not decrease the concentration of the drug in the blood. p. 45

The primary health care provider prescribes a cough syrup for an infant who has a cold. Which method of administration does the nurse expect to be safe and effective? Administering the medication through an oral syringe Administering the medication through the intravenous route Administering the medication by mixing it with the child's formula or milk Administering the medication by placing the dropper at the back of the child's mouth

Administering the medication through an oral syringe The oral route is a safe administration route for syrups. The nurse should administer the medication through an oral syringe because it is easy to use and ensures exact dosing. Syrups are viscous, have thick consistency, and may cause hemolysis. The nurse should not administer them intravenously. The nurse should not mix medications with child's formula or milk; administering the medication mixed with formula or milk may change the taste of the formula and may cause the infant to reject the formula or milk. The nurse should avoid administering the medication by placing the dropper at the back of the child's mouth, which can cause gagging and choking. p. 47

When does gastrointestinal (GI) microbial colonization reach adult levels? Birth Infancy Childhood Adolescence

Adolescence GI microbial colonization reaches adult levels in adolescence. Intestinal microbial colonization begins in the first few hours after birth. Adult levels are not yet reached in infancy or childhood. p. 44

Which inadequacy in neonates results in reduced absorption of lipid-soluble drugs? Water and electrolytes Cholesterol and triglycerides Gastric acid and intrinsic factor Bile salts and pancreatic enzymes

Bile salts and pancreatic enzymes Immature enzyme function may affect drug absorption; neonates have inadequate production of bile salts and pancreatic enzymes, which leads to reduced absorption of lipid-soluble drugs. Reduced absorption of lipid-soluble drugs in the neonate is not a result of inadequate water and electrolytes, cholesterol and triglycerides, or gastric acid and intrinsic factor. p.44

The parent of an 8-month-old infant tells the nurse, "While administering the medication to my child, I add a small amount of honey to mask the bitter taste." For which condition is this infant at risk due to this method of medication administration? Botulism Diabetes Hypothermia Hypertension

Botulism An infant's immune system is not well developed; honey is associated with an increased risk of botulism. Honey does not impair pancreatic functioning or elevate glucose; there will not be any increased risk for diabetes. Honey does not affect thermoregulation; therefore, it would not lead to hypothermia. Honey does not cause vasoconstriction; therefore, it would not cause hypertension. p. 45

The half-life of which drug is higher in the infant than in the adult? Caffeine Diazepam Phenytoin Phenobarbital

Caffeine The half-life of caffeine is higher in the infant (seven hours) than in the adult (four hours). The half-lives of diazepam, phenytoin, and phenobarbital are higher in the adult than in the infant. p. 46

A 10-year-old is prescribed the antidepressant drug fluoxetine. Based on known isoenzyme activity at this age, how should the provider's recommended dosing change for this patient? Increase dosage Decrease dosage Follow adult recommended dosage Avoid prescribing this drug in the pediatric population

Decrease dosage Fluoxetine is metabolized by the CYP2D6 isoenzyme. Activity of this enzyme is lower in the pediatric population until about 12 years of age compared to adults. Therefore the dosage should be decreased. The dosage should not be increased or equivalent to the adult recommended dosage. This drug may be prescribed in appropriate doses in the pediatric population. p. 46

A 6-year-old is prescribed the antiepileptic drug lamotrigine. Based on known isoenzyme activity at this age, how should the provider's recommended dosing change for the 6-year-old patient? Increase dosage Decrease dosage Follow adult recommended dosage Avoid prescribing this drug in the pediatric population

Decrease dosage Lamotrigine is metabolized by N-methyltransferases UGTs. Activity of this enzyme is lower in the pediatric population until about 7 to 10 years of age compared to adults. Therefore the dosage should be decreased. The dosage should not be increased or equivalent to the adult recommended dosage. This drug may be safely prescribed in appropriate doses for the pediatric population. p. 46

A 9-year-old is prescribed omeprazole. Based on known isoenzyme activity at this age, how should the provider's recommended dosing change for this patient? Increase dosage Decrease dosage Follow adult recommended dosage Avoid prescribing this drug in the pediatric population

Decrease dosage Omeprazole is a proton pump inhibitor metabolized by the CYP2C19 isoenzyme. Activity of this enzyme is lower in the pediatric population until about 10 years of age compared to adults. Therefore the dosage should be decreased. The dosage should not be increased or equivalent to the adult recommended dosage. This drug is safe to prescribe in appropriate doses in the pediatric population. p. 46

A 1-year-old is prescribed the bronchodilator theophylline. Based on known isoenzyme activity at this age, how should the provider's recommended dosing change for the 1-year-old patient? Increase dosage Decrease dosage Follow adult recommended dosage Avoid prescribing this drug in the pediatric population

Decrease dosage Theophylline is metabolized by the CYP1A2 isoenzyme. Activity of this enzyme is lower in the pediatric population until 2 years of age compared to adults. Therefore the dosage should be decreased. It is not safe for the dosage to be increased or equivalent to the adult recommended dosage. This drug may be prescribed in appropriate dosages in the pediatric population. p. 46

Knowing that albumin in neonates and infants has a lower binding capacity for medications, the nurse can expect the prescriber to perform which action to minimize the risk of toxicity? Decrease the amount of drug given. Increase the amount of drug given. Shorten the time interval between doses. Administer the medication intravenously.

Decrease the amount of drug given. A lower binding capacity leaves more drug available for action; thus, a lower dose would be required to prevent toxicity. All of the other options would increase the risk for toxicity for neonates and infants. p. 45

The nurse is caring for a 1-month-old infant with diarrhea who has been prescribed an antidiarrheal medication. Upon checking the composition of the medication, the nurse finds that the active ingredient is an alkaline and fat-soluble substance. Which pharmacokinetic variation does the nurse expect to find in the child when compared to an adult? Enhanced drug absorption Enhanced drug elimination Enhanced drug metabolism Enhanced drug distribution

Enhanced drug absorption The gastrointestinal tract is not well developed in an infant; this greatly influences the absorption of the drug. Alkaline drugs are absorbed largely in alkaline pH, whereas acidic drugs are absorbed largely in acidic pH. An infant's gastric pH is alkaline when compared to that of adults. Therefore, infants will have increased drug absorption when compared to adults. The kidneys eliminate most of the drug from the body. A 1-month-old infant will not have enhanced elimination of the drug due to the absence of well-developed kidneys. The metabolism of the drug depends on hepatic functioning. Infants may have reduced metabolism of drugs due to the presence of a less-developed hepatic system. The distribution of the drug depends on the body composition. An infant has less fat; therefore, a fat-soluble drug will not be distributed effectively in an infant. p. 44

Individuals aged 28 days to 23 months fall under which pediatric age classification? Children Adolescent Term neonate Infant/toddler

Infant/toddler Individuals aged 28 days to 23 months are classified as infant/toddler. Children are aged 24 months to 11 years. Adolescents are aged 12 years to 16 or 18 years depending on region. Term neonates are aged from birth at 38 or more weeks gestation to 27 days.

According to regulatory agencies, drug administration errors are more common in which patient population? Male Female Pediatric Older adult

Pediatric Regulatory agencies caution that drug administration errors are more common in pediatric patients, which warrants increased precautions in drug administration. Regulatory agencies do not cite more errors among male, female, or older adult patients. p. 43

While assessing the cognitive skills of an adolescent patient, the nurse finds that the patient is in the concrete operational stage. Which action of the patient supports the nurse's conclusion? The patient provides exact reasoning for taking medications. The patient is unable to comprehend potential drug implications. The patient comprehends complex information related to drug administration. The patient takes extra precautions necessary to combat drug effects.

The patient is unable to comprehend potential drug implications. The adolescent patient who is in the concrete operational stage will not be able to understand potential drug implications. The patient has difficulty understanding concepts such as drug interactions, side effects, adverse reactions, and therapeutic levels. If the patient is able to provide exact reasoning for taking the medications, it indicates that the patient is in the abstract reasoning stage. If the patient is unable to demonstrate an understanding of complex information, it indicates that the patient remains in the concrete operational stage. If the patient avoids taking extra precautions that are necessary to combat drug effects, it indicates that the patient is in the concrete operational stage. p. 48

The nurse is caring for an infant who has been prescribed ranitidine (Zantac) syrup. While administering the medication, the nurse avoids pointing the oral syringe directly towards the back of the infant's mouth. What is the rationale behind this intervention? To prevent the risk of aspiration To prevent damage to the taste buds To prevent the risk of gagging or choking To prevent damage to the oral mucosa

To prevent the risk of gagging or choking Administering medication directly into the back of the mouth may lead to direct dumping of the medication into the pharynx, possibly leading to gagging and choking in the infant. To prevent this, the nurse should avoid pointing the oral syringe directly toward the back of the infant's mouth. Aspiration can be prevented by placing the infant in the side-lying position while administering the medication. Pointing the oral syringe at the back of the mouth does not damage the taste buds or oral mucosa. p.47

The student nurse is discussing pharmacokinetics in infants. Which statement of the student nurse indicates effective learning? "Medications do not reach the brain in infants." "The elimination rate of medications is high in infants." "The distribution of fat-soluble medications is high in infants." "The distribution of water-soluble medications is high in infants."

"The distribution of water-soluble medications is high in infants." Infants have increased body fluids, resulting in the greater distribution of water-soluble drugs. The blood-brain barrier is not well developed in the infants; therefore, the medications may more easily cross the blood-brain barrier. Renal functions are not well developed in pediatric patients under 9 years of age; infants will not have a high rate of elimination. Infants have less adipose tissue, which will reduce the distribution of fat-soluble medications. p. 45

What is the minimum number of patient identification methods the nurse must use prior to drug administration? 1 2 3 4

2 The nurse should use at least two methods of patient identification prior to drug administration. The nurse should follow the organization's protocol, but generally, one method is not enough, and three and four are more than necessary. p. 50

At what age does intestinal surface area match that of adults? 20 days 20 years 20 weeks 20 months

20 weeks Intestinal surface area in neonates reaches that of adults at about 20 weeks. Prior to this, the reduced surface area leads to reduced drug absorption. It is not reached yet at 20 days, but it matches that of adults before 20 years or 20 months. p.44

The nurse is administering medications by mouth to a 2-year-old child who is belligerent. What action is the best strategy for the nurse to use? Explain the reason for the medication to the child. Ask the parent's permission before the medication is administered. Ask the parents to assist in calming the child. Administer medications intravenously.

Ask the parents to assist in calming the child. The child needs to cooperate in the medication process. At this age, the best strategy is to ask the parents to assist in calming the child so that the child will take the medications. The child is too young to understand reasoning. The parents have given consent for care, so the nurse does not need to ask again before administering the medication. Obtaining the parent's permission will not make the child any more cooperative. The fact that the child is being uncooperative is not a reason to change the route of administration. p. 47

The nurse has calculated the drug dosage for a child and finds the dosage to be higher than the safe range. What will the nurse do? Administer the lowest dose of the safe range. Administer the highest dose of the safe range. Contact the primary health care provider. Administer the calculated dose irrespective of the safe range.

Contact the primary health care provider. The ideal nursing measure is to contact the primary health care provider or the prescriber immediately, because the dosage needs to be readjusted as per the weight and the safe range. Administering the lowest dose of the safe range may deprive the patient of the therapeutic effect. Administering the highest dose of the safe range and administering a calculated dose irrespective of the safe range is not ethically or professionally accepted because these may lead to adverse effects. p. 45

In the pediatric population, differentiating between the chronologic age and what other age is important for its impact on the child's response to drug administration? Social Behavioral Psychological Developmental

Developmental It is important for the nurse to differentiate the child's developmental age from chronologic age, because this difference has an impact on the child's response to drug administration. Social, behavioral, and psychological are not quantifiable ages relevant to drug administration. p. 46

Which factor requires the pediatric patient until about 2 years of age to have higher doses of water-soluble drugs to achieve therapeutic levels? Higher fat stores Higher bilirubin levels Lower protein concentrations Higher proportion of body fluid

Higher proportion of body fluid In neonates and infants, the body is about 75% water compared with 60% in adults. This increased body fluid proportion allows for a greater volume of fluid in which to distribute drugs, which results in a lower drug concentration. Therefore until about age 2 years, the pediatric patient requires higher doses of water-soluble drugs to achieve therapeutic levels. Higher fat stores alter the distribution of some lipid-soluble drugs. Higher bilirubin levels and lower protein concentrations may result in higher levels of unbound drug and an increased risk of drug toxicity. p.45

What effect does the neonate's high gastric pH have on drug absorption? Increases drug absorption Decreases drug absorption Increases absorption of basic drug formulations Increases absorption of acidic drug formulations

Increases absorption of basic drug formulations The neonate's high pH creates an alkaline environment that favors basic drug formulations, increasing their absorption. Differences in pH may increase or decrease drug absorption depending on the formulation. A low pH, or acidic environment, would increase absorption of acidic drug formulations. p.44

The nurse is teaching a student nurse about the factors that affect the absorption of orally administered drugs in infants. Which statement should the nurse include in the teaching plan? Low gastric pH increases the absorption of alkaline drugs. Low pancreatic enzyme levels reduce the absorption of lipid-soluble drugs. High pancreatic enzyme levels increase the absorption of water-soluble drugs. An increase in bilirubin levels decreases the drug absorption from the intestine.

Low pancreatic enzyme levels reduce the absorption of lipid-soluble drugs. Immature enzyme functioning in infants results in an altered absorption of oral medications. Pancreatic enzymes are necessary for the absorption of fat-soluble drugs. Therefore, the presence of low pancreatic enzyme levels may reduce the absorption of fat-soluble drugs. An intestinal environment with alkaline pH favors the absorption of alkaline drugs. Therefore, acidic gastric pH does not increase the absorption of alkaline drugs. Pancreatic enzyme levels cannot influence the absorption of water-soluble drugs. Bilirubin levels influence the availability of protein binding sites to the drugs. Therefore, they affect drug distribution, but not drug absorption. p. 44

The nurse is reviewing the patient's current medication and nutritional supplement intake. Which nutritional supplement is most likely to affect absorption of an orally administered drug by altering gut motility? Probiotic Thiamine Vitamin D Magnesium

Magnesium Magnesium can have a laxative effect, altering the patient's gut motility, which impacts drug absorption. A probiotic, thiamine supplement, and vitamin D are less likely to alter gut motility. p. 44

Which factor increases the risk of central nervous system toxicity in infants? Presence of less adipose tissue Presence of high bilirubin levels Presence of high plasma proteins Presence of an immature blood-brain barrier

Presence of an immature blood-brain barrier Infants have a relatively immature blood-brain barrier that allows medications to pass easily into the nervous tissues, thereby increasing the risk of neurotoxicity. The presence of less adipose tissue decreases the absorption of lipid-soluble drugs, but it does not increase the risk of neurotoxicity. The presence of excess bilirubin decreases the available protein binding sites for the drug. This can increase serum drug concentrations but does not increase the specific risk for neurotoxicity. High plasma proteins reduce the concentration of free drug in the body and prevent toxicity. p. 45

The nurse is reviewing the patient's current medication and nutritional supplement intake. Which nutritional supplement is most likely to affect absorption of an orally administered drug by altering the gut microbiome? Probiotic Thiamine Vitamin D Magnesium

Probiotic A probiotic supplement will alter the patient's gut microbiome, which impacts drug absorption. Thiamine supplement, vitamin D, and magnesium are less likely to have this effect. p. 44