Pharm. Ch. 5 - Pediatric Considerations

5. The nurse will administer an intravenous medication to an adolescent patient. When preparing the adolescent for the IV insertion, which is an appropriate action by the nurse? a. Allowing the patient to verbalize concerns about the procedure b. Covering the insertion site with a bandage after the procedure is completed c. Explaining any possible adverse drug reactions d. Reassuring the patient that only one body part will be used

ANS: A Allowing the adolescent to verbalize concerns about the medication and its regimen may offer opportunities to clarify misconceptions and teach new information. Preschool-age children may have concerns about harm to their body and need to have sites covered. Adolescents still have a present focus, so discussing future adverse reactions is not especially helpful. Preschool and school-age children fear bodily harm and require reassurance that only one body part will be affected. DIF: COGNITIVE LEVEL: Applying (Application) REF: Pages 84-85 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A 2-year-old child will receive several doses of an intramuscular medication. The nurse caring for this child will use which intervention to help the child cope with this regimen? a. Allowing the child to give "pretend" shots to a doll with an empty syringe b. Allowing the child to select a Band-Aid to wear after each medication is given c. Ensuring privacy while giving the medication d. Explaining that the medicine will help the child to feel better

ANS: A Simple explanations, a firm approach, and enlisting the imagination of a toddler through play may enhance cooperation. Allowing the child to practice on a doll may help the toddler tolerate the injections. Preschool and school-age children fear bodily injury, and Band-Aids are important with those age groups. Adolescents need privacy, and school-age children and adolescents can understand the use of a medication in relation to future outcomes. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 83 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. An infant will receive a topical medication. What instruction will the nurse include when teaching the parents how to administer the medication? a. "Apply a thin layer to the affected area." b. "Apply liberally to the skin on and around the area." c. "Use the medication less frequently than what is recommended for adults." d. "Use the medication more frequently than what is recommended for adults."

ANS: A Topical medications may be altered by skin tissue condition. Children have thinner, more porous skin and have a proportionately higher skin surface area than adults and thus absorb topical medications more readily. Caregivers should be advised to use only a thin layer on the affected body part. This difference in skin does not affect the frequency of administering topical medications. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 81 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Health Promotion and Maintenance

13. The nurse is preparing to administer an intramuscular medication to a 4-year-old child who starts to cry and screams, "I don't want a shot!" What is the nurse's next action? a. Acknowledge that shots hurt and tell the child to be brave. b. Engage the child in a conversation about preschool and favorite activities. c. Enlist the assistance of another nurse to help restrain the child. d. Explain to the child that it will only hurt for a few seconds.

ANS: B Distraction may be used for pain and anxiety control in this age group. Engaging the child in a conversation may distract the child from the anxiety of the imminent injection. It is not correct to tell the child to be brave since this belittles the feelings expressed by the child. Preschool children have a limited sense of time, so telling the child that the pain will only last a few seconds may not be effective. Restraining the child with other staff should be used last after other methods have failed. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 83 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The provider has ordered that vitamin D drops be given to a newborn. Based on the knowledge of drug distribution in infants, the nurse understands that the infant may need a. a higher dose. b. a lower dose. c. less frequent dosing. d. more frequent dosing.

ANS: B Neonates and young infants tend to have less body fat than older children, meaning that they need less of fat-soluble medications since these medications won't be bound in fat tissue. Higher doses would lead to drug toxicity. Body fat does not affect the frequency of dosing. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 81 TOP: NURSING PROCESS: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. The nurse is preparing to administer a medication to a 6-month-old infant. The nurse will monitor closely for signs of drug toxicity based on the knowledge that, compared to adults, infants have a. an increased percentage of total body fat. b. immature hepatic and renal function. c. more protein receptor sites. d. more rapid gastrointestinal transit time.

ANS: B The liver and kidneys are the primary organs for metabolism and excretion and are immature in infants. This allows drugs to accumulate and increases the risk for drug toxicity. Infants have a lower proportion of body fat than adults and fewer protein receptors. They do have more rapid gastrointestinal transit time, but this decreases the amount of drug absorbed. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Pages 81-82 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The nurse assumes care for an infant who is showing signs of drug toxicity to a drug given several hours prior. The nurse checks the dose and confirms that the dose is consistent with standard dosing guidelines. Which characteristic of the drug will likely explain this response in this patient? a. It is acidic. b. It is highly protein-bound. c. It is not fat-soluble. d. It is water-soluble.

ANS: B With fewer protein-binding sites, there is more active drug available. This requires a reduction in the dose for infants. Drugs that are acidic are not as readily absorbed in infants, since their gastric pH tends to be more alkaline. Infants have a lower proportion of body fat; fat-soluble drugs would need to be decreased to prevent toxicity. Until about age 2 years of age, pediatric patients require larger than usual doses of water-soluble drugs to achieve therapeutic effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 81 TOP: NURSING PROCESS: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. The nurse reviews information about a drug and learns that it is best absorbed in an acidic environment. When giving this drug to a 1-year-old patient, the nurse will expect to administer a dose that will be a. equal to an adult dose. b. less than an adult dose. c. more than an adult dose. d. twice the usual adult dose.

ANS: C Because the child's gastric pH is more alkaline than the adult's, less drug will be absorbed. Therefore, the dose should be increased. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 80 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. A 14-year-old female who has type 1 diabetes mellitus that has been well-controlled for several years is admitted to the hospital for treatment of severe hyperglycemia. The patient's lab values indicate poor glycemic control for the past 3 months. The nurse caring for this patient will suspect which cause for the change in diabetic control? a. Adolescent rebellion and noncompliance b. Changes in cognitive function c. Hormonal fluctuations d. Possible experimentation with drugs or alcohol

ANS: C In adolescence, hormonal changes and growth spurts may necessitate changes in medication dosages; many children with chronic illness require dosage adjustments in the early teen years. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 84 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is caring for a 5-year-old child. The child is taking a drug that has a known therapeutic range in adults, and the nurse checks that the ordered dose is correct and notes that the child's serum drug level is within normal limits. The child complains of a headache, which is a common sign of toxicity for this drug. Which action will the nurse take? a. Administer the drug since the drug levels are normal. b. Attribute the headache to non-drug causes. c. Hold the next dose and contact the provider. d. Request an order for an analgesic medication.

ANS: C The therapeutic ranges established for many drug levels are based on adult studies, so it is important for the nurse to assess pediatric patients in conjunction with monitoring drug levels. The nurse should notify the provider of the reaction. Because headaches are a symptom of toxicity for this drug, the nurse should not ignore the symptom. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 82 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Health Promotion and Maintenance

15. The nurse is teaching a 15-year-old female patient and her parents about an antibiotic the adolescent will begin taking. The drug is known to decrease the effectiveness of oral contraceptive pills (OCPs). The nurse will a. ask the adolescent and her parents whether she is taking OCPs. b. tell her parents privately that pregnancy may occur if she is taking OCPs. c. tell her privately that the medication may decrease the effectiveness of OCPs. d. warn her and her parents that she may get pregnant if she is relying on OCPs.

ANS: C When soliciting adolescent health histories, the nurse should consider issues related to sexual practices and should provide privacy when asking sensitive questions or giving sensitive information. The other actions do not allow for patient privacy. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 86 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The parent is concerned about giving a child medication because of the lack of knowledge about the effects of drugs on children. The nurse discusses legislation passed in 2002 and 2003 about pediatric pharmacology. Which is true about these laws? a. They forbid providers from prescribing medications unless they have been FDA- approved for use in children. b. They mandate consistent, evidence-based dosing guidelines for use in children. c. They provide federal grants to fund pediatric pharmaceutical research. d. They require drug manufacturers to study pediatric medication use.

ANS: D In 2003, a law known as the Pediatric Research Equity Act joined the Best Pharmaceuticals Act of 2002 to require drug manufacturers to study pediatric medication use and offer incentives for pediatric pharmacology research. Providers are not forbidden to prescribe drugs in children that are not FDA-approved. The laws do not mandate the use of evidence-based guidelines and do not provide grants to fund research. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 80 TOP: NURSING PROCESS: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A preschool-age child has moderate dehydration and needs a rapid bolus of fluids. To provide atraumatic care and administer fluids most effectively, what action will the nurse take? a. Apply a eutectic mixture of local anesthetic (EMLA) just before inserting an intravenous line. b. Ask the child's parents to restrain the child during venipuncture so fluids may be administered. c. Request an order for nasogastric (NG) fluids to avoid the trauma of venipuncture. d. Use a powdered lidocaine preparation prior to insertion of the intravenous needle.

ANS: D One method to ensure atraumatic care is through the use of topical analgesics before IV injections. Powdered lidocaine preparations are effective in reducing the pain and fear associated with invasive procedures, such as venipuncture. EMLA is useful only if applied 1 to 2.5 hours prior to IV insertion. Asking parents to restrain the child for a painful procedure can cause stress and anxiety for both the child and the parents. NG fluids are traumatic and are uncomfortable long past the insertion of the NG tube. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 83 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. The nurse is preparing to give a 7-year-old child a bitter-tasting oral medication. The child asks the nurse if the medicine tastes bad. To help the child take this medication, which action will the nurse take? a. Allow the child to delay taking the medication until the parent arrives. b. Enlist the assistance of other staff to help restrain the child. c. Tell the child that it doesn't taste bad if it is swallowed quickly. d. Tell the child that it tastes bad and offer a choice of beverages to drink afterwards.

ANS: D School-age children should be permitted more control, involvement in the process, and honest information. The nurse should tell the child the truth and offer the child a choice about what to drink to wash down the medicine. Medications must be given on schedule, so allowing the child a choice about when to take a medication is not acceptable. Restraining a child should not be used unless other methods have failed. Telling the child the medication doesn't taste bad is not honest and will reduce the child's trust in the nurse. DIF: COGNITIVE LEVEL: Applying (Application) REF: Pages 83-84 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. The nurse is preparing to administer an oral liquid medication to an 11-month-old child who is fussy and uncooperative. Which action will the nurse take to facilitate giving this medication? a. Adding honey to the medication to improve the taste b. Putting the medication in the infant's formula c. Requesting an injectable form of the medication d. Using a syringe and allowing the parent to give the medication

ANS: D When possible, family members or caregivers should be solicited to assist in medication administration. Infants should not receive honey because of the risk of botulism. A syringe allows more control over the amount of medication in the infant's mouth and should be used. Mixing the medication in a bottle requires ensuring that the infant takes the entire bottle in order to get the medication dose. Using an injectable form of medication is more traumatic and should be used only when an oral route is not possible or is contraindicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: Pages 82-83 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies