Pharm Ch. 5: Pediatric Considerations
The half-life of which drug is higher in the infant than in the adult? 1 Caffeine 2 Diazepam 3 Phenytoin 4 Phenobarbital
1 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
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? 1 Decrease the amount of drug given. 2 Increase the amount of drug given. 3 Shorten the time interval between doses. 4 Administer the medication intravenously.
1 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
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? 1 A decrease in the dosage of drug given 2 An increase in the dosage of drug given 3 A shorter time interval between doses 4 Intravenous administration of the drug
1 A lower binding capacity leaves more drug available for action; thus, a lower dose would be required to 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 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? 1 Probiotic 2 Thiamine 3 Vitamin D 4 Magnesium
1 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
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? 1 Administering a low dose of the drug to the infant 2 Administering the medication by the rectal route 3 Increasing the frequency of the drug administration 4 Assessing the hydration status of the infant
1 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 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? 1 Botulism 2 Diabetes 3 Hypothermia 4 Hypertension
1 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
Gastric emptying and gastrointestinal (GI) motility are unpredictable in neonates and infants; however, these processes approach that of adults by what age? 1 6 to 8 months 2 8 to 10 months 3 10 to 12 months 4 12 to 14 months
1 Gastric emptying and GI motility are unpredictable in neonates and infants, but they approach that of adults by 6 to 8 months of age. The processes become similar to those in adults before 8 to 10 months, 10 to 12 months, and 12 to 14 months of age p 44
The primary health care provider prescribes an intravenous, water-soluble medication to a 2-year-old child. What is the priority nursing intervention in this situation? 1 Identify whether the dosage is appropriate 2 Evaluate the patency of the site 3 Assess for adverse reactions 4 Check the time of administration
1 In neonates and young infants, the proportion of water in the body is 75%. Due to the increased body fluid proportion, the distribution of medication decreases the concentration of the drug in the body. Therefore, children up to 2-years of age require higher doses of water-soluble medications to achieve the desired therapeutic levels. The priority nursing intervention in this situation is to check for the dosage. The nurse should check for the patency of the site when the parenteral route of administration is prescribed. The nurse should monitor for adverse reactions after administering the medication to ensure the child's safety. The nurse can also check for the time of administration, but this can be done after checking the dosage. 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? 1 Enhanced drug absorption 2 Enhanced drug elimination 3 Enhanced drug metabolism 4 Enhanced drug distribution
1 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
Which organ is primarily involved in the metabolism of medications? 1 Liver 2 Lungs 3 Kidneys 4 Pancreas
1 The liver is primarily involved in the metabolism of medications. The enzymes present in the liver convert complex drug molecules into a simple form. The lungs are mainly involved in the excretion of water-soluble medications. The kidneys eliminate drug molecules along with urine. The pancreas is a mixed gland that secretes insulin in the body and promotes glucose metabolism, but is not involved in the metabolism and excretion of drugs. 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? 1 Administering the medication through an oral syringe 2 Administering the medication through the intravenous route 3 Administering the medication by mixing it with the child's formula or milk 4 Administering the medication by placing the dropper at the back of the child's mouth
1 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
Limited pediatric pharmacologic research results in drugs being used in the pediatric population despite lacking federally approved indications for use in children. What term describes the use of drugs in this manner? 1 Off label 2 Anecdotal 3 Research equity 4 Informed consent
1 Only half of all drugs carry federally approved indications for use in children. This means many drugs prescribed for children are being prescribed "off label," which means the drug is being used for some purpose for which it has not been approved. Anecdotal evidence may provide a basis for this use in lieu of scientific research. Research equity describes efforts to require drug manufacturers to study pediatric drug use and offer incentives for pediatric pharmacology research. Informed consent is difficult to obtain in the pediatric population. p 44
Which term describes the study of the time course of drug absorption, distribution, metabolism, and excretion? 1 Pharmacokinetics 2 Pharmacogenetics 3 Pharmacodynamics 4 Pharmacotherapeutics
1 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
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. p 48
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
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? 1 The patient provides exact reasoning for taking medications. 2 The patient is unable to comprehend potential drug implications. 3 The patient comprehends complex information related to drug administration. 4 The patient takes extra precautions necessary to combat drug effects.
2 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
As children grow and develop, what generally happens to the absorption of drugs? 1 Becomes less effective throughout life 2 Becomes more effective but may slow in adolescence 3 Becomes less effective until adolescence, when it becomes more effective 4 Becomes more effective, peaking in adolescence and slowing in early adulthood
2 As children grow and develop, the absorption of drugs generally becomes more effective; therefore less developed absorption in neonates and infants must be considered in dosage and administration. However, poor nutritional habits, changes in physical maturity, and hormonal differences during the adolescent years may cause slowing of drug absorption. Absorption does not become less effective throughout life, more effective in adolescence, or peak in adolescence and slow in early adulthood. p 44
At what age does hepatic blood flow match that of an adult? 1 6 months 2 12 months 3 18 months 4 24 months
2 By 12 months of age, hepatic blood flow has reached that of an adult. It does not match that of an adult by age 6 months, but it does before 18 months or 24 months. p 45
Which term describes therapeutic care that eliminates or minimizes the psychological and physical distress experienced by children and families? 1 Research equity 2 Atraumatic care 3 Informed consent 4 Age-appropriate dosing
2 Donna Wong's principle of atraumatic care is "the philosophy of providing therapeutic care through the use of interventions that eliminate or minimize the psychologic and physical distress experienced by children and families." Research equity describes efforts to require drug manufacturers to study pediatric drug use and offer incentives for pediatric pharmacology research. Informed consent is difficult to obtain in the pediatric population. Age-appropriate dosing involves taking into consideration the developmental and metabolic differences in the pediatric population. p 47
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? 1 Increase dosage 2 Decrease dosage 3 Follow adult recommended dosage 4 Avoid prescribing this drug in the pediatric population
2 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
At what age does intestinal surface area match that of adults? 1 20 days 2 20 years 3 20 weeks 4 20 months
2 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
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? 1 Increase dosage 2 Decrease dosage 3 Follow adult recommended dosage 4 Avoid prescribing this drug in the pediatric population
2 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? 1 Increase dosage 2 Decrease dosage 3 Follow adult recommended dosage 4 Avoid prescribing this drug in the pediatric population
2 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
After administering an intravenous medication to a preschooler, the nurse places a decorative bandage at the site of injection. What is the rationale for this intervention? 1 To reduce pain 2 To relieve anxiety 3 To prevent infection 4 To enhance containment
2 The fear of injection is common among children. The preschooler may perceive that the insertion of the needle will cause his or her skin to open and blood to leak from the area. In order to prevent the fear of "leakage," the nurse should apply a colorful bandage at the site of the injection. This intervention helps reduce fear and anxiety in the child. Additionally, to reduce pain, the nurse should apply a local, topical anesthetic prior to administration at the selected site of administration. The nurse cleanses the site of injection with an antiseptic solution to prevent infection. The nurse applies a transparent dressing at the site of administration to enhance the containment of the drug. p 48
How many hours would it take for the lidocaine level in a child to reach 50% of the intake level? 1 2 to 3 hours 2 1 to 5 hours 3 1 to 2 hours 4 2 to 7 hours
2 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
What is the minimum number of patient identification methods the nurse must use prior to drug administration? 1 1 2 2 3 3 4 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
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? 1 Increase dosage 2 Decrease dosage 3 Follow adult recommended dosage 4 Avoid prescribing this drug in the pediatric population
2 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
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, 3, 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
Which factors affect the distribution of medications in the body? Select all that apply. 1 Hydration status 2 Body fluid composition 3 Body tissue composition 4 Gastrointestinal enzymes 5 Protein-binding capability
2, 3, 5 The distribution of medication is the reversible transfer of medication from one location to another in the body. The factors affecting the distribution of medications are: body fluid composition, body tissue composition, and protein-binding capability. The amount of medication distributed in body fluids and body tissues increases or decreases the therapeutic efficacy. The amount of medication bound to the proteins also alters the distribution and the therapeutic efficacy. Hydration status effects the excretion of the drug from the body. Gastrointestinal enzymes affect the drug absorption of lipid-soluble drugs in the body, but not the drug distribution. p 45
The nurse is responsible for dispensing medications to children. Which characteristics of pediatric children have significant impact on dosage of drugs? Select all that apply. 1 Risk of excessive hydration 2 Lack of acid in stomach 3 Thin skin with reduced permeability 4 Immature liver and kidney function
2, 4 Pediatric patients lack acid production in the stomach, and therefore have a decreased ability to kill intestinal bacteria. In addition, some drugs may not get metabolized or dissolved in the stomach. Pediatric patients have immature liver and kidneys, which impair drug metabolism and excretion. Pediatric patients are at risk of dehydration due to a larger surface area. They have thin skin, which is more permeable, and topical drugs may be absorbed readily. p 44-45
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? 1 Administer the lowest dose of the safe range. 2 Administer the highest dose of the safe range. 3 Contact the primary health care provider. 4 Administer the calculated dose irrespective of the safe range.
3 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
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? 1 To prevent the risk of aspiration 2 To prevent damage to the taste buds 3 To prevent the risk of gagging or choking 4 To prevent damage to the oral mucosa
3 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
What difference between breast-fed and formula-fed infants is relevant to drug administration? 1 Breast-fed infants have higher gastric pH than do formula-fed infants. 2 Breast-fed infants have lower enzyme function than do formula-fed infants. 3 Breast-fed infants have faster gastric emptying than do formula-fed infants. 4 Breast-fed infants have less intestinal surface area than do formula-fed infants.
3 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
The nurse is caring for an adolescent child with appendicitis. The child tells the nurse, "Some of my school friends drink alcohol and pressure me to drink with them." What should the nurse do in this situation? 1 Advise the child to avoid interacting with these friends. 2 Inform the child's parents of the child's concern. 3 Explain the adverse effects of alcohol to the child. 4 Suggest the child spend as much time as possible at home for few days.
3 Children may exhibit high-risk behavior during adolescence and may drink alcohol. An adolescent child has concrete and abstract reasoning; therefore, the nurse should explain the adverse effects of alcohol and suggest that the child refrain from consuming it. However, the child may feel rejected and isolated if the nurse advises that he or she avoid interacting with friends who drink. An adolescent will have proper cognition and would be able to understand the situation. The nurse should explain the adverse effects of alcohol consumption directly to the child rather than informing his or her parents about the child's concern. Moreover, suggesting that the child spend more time at home may not prevent high-risk behaviors and may alter the child's social interactions. p 48-49
According to regulatory agencies, drug administration errors are more common in which patient population? 1 Male 2 Female 3 Pediatric 4 Older adult
3 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
The nurse is evaluating a student nurse's knowledge on the physiology of drug absorption in different age groups. Which statement by the student nurse indicates the need for further teaching? 1 "An adolescent will have slow absorption of a drug due to hormonal changes." 2 "A child who has a delay in gastric emptying will have a delay in drug absorption." 3 "A 1-year-old infant will have effective absorption of low-pH medications." 4 "A child who has a developed gastrointestinal tract will have effective absorption."
3 The absorption of medications depends on the age, health, and weight of the child. A 1-year-old infant will have an alkaline intestinal pH. Therefore, medications with higher pH are more easily absorbed. A low pH indicates that the medication has acidic pH and is effectively absorbed in the child who has an acidic gastrointestinal tract (GI) pH. Hormonal changes and nutritional habits affect the physical maturity of an adolescent, thereby decreasing the absorption of the medication. A delay in gastric emptying causes a delay in absorption because it reduces the peak serum concentration of the medication. Complete development of the GI tract will result in effective absorption of the medications because the GI tract will have intestinal flora, and proper pH and enzyme levels. p 44
Why is the dosage of medications prescribed for neonates lesser than adult dosages? 1 Neonates have high body fat 2 Neonates have highly acidic gastric pH 3 Neonates have low protein levels 4 Neonates have low bilirubin levels
3 The concentration of a drug in the body depends on its distribution. Neonates have decreased protein concentrations, resulting in decreased protein binding of the drug. This increases the systemic bioavailability of the drug. Reducing the dose of the medication helps prevent drug toxicity in neonates. A neonate will have low body fat, which results in lower distribution of fat-soluble medications and indicates the need to reduce the dose of the drug for neonates. The gastric pH of a neonate is less than that of an adult due to less gastric acid secretion, increasing the absorption of an alkaline drug. Neonates may have high bilirubin levels due to hemolysis, but it does not affect the dose of the drug. p 45
What effect does the neonate's high gastric pH have on drug absorption? 1 Increases drug absorption 2 Decreases drug absorption 3 Increases absorption of basic drug formulations 4 Increases absorption of acidic drug formulations
3 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 preparing to intramuscularly administer a vaccine to an infant. Which nursing intervention ensures safe administration of the vaccine? 1 Administering medication at the abdomen 2 Administering medication at the dorsogluteal site 3 Administering medication at the ventrogluteal site 4 Administering medication at the leg or upper arm
3 The ventrogluteal muscle is well developed in infants and enhances the absorption of the drug. The nurse should administer the vaccine at the ventrogluteal site to ensure effective absorption of the medication. In the case of adults, subcutaneous medications should be administered in the abdomen because it contains a high amount of subcutaneous tissue. The nurse should not administer medication at the dorsogluteal site, which is not well developed in infants; administering the medication at the dorsogluteal site may cause sciatic nerve damage. When administering subcutaneous medication to an infant, the nurse should select the leg or upper arm, because they contain high amounts of subcutaneous tissue. p 48
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 mg 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). p 45
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
Individualization of drug dosage is most relevant in which pediatric population? 1 Child 2 Infant 3 Neonate 4 Adolescent
4 Adolescents of similar ages are of very different sizes, height-to-weight proportions, timing of secondary sex characteristics, and other indicators of physical maturity. These differences may warrant individualization of drug dosage. Individualization is less relevant for the child, infant, and neonate, who are closer in size and stages of physical development. p 48
A 3-year-old child has been started on a new medication. What is the most important information to convey to the parents? 1 "Make sure that you give the medication at the same time every day." 2 "Make sure that the child likes the taste of the medication." 3 "Mix the medication with the child's favorite food or beverage." 4 "Observe the child for potential adverse effects of the medication."
4 Adverse effects of medications can be difficult to discern in young children, especially things such as ringing in the ears, because the child might not be able to communicate this symptom. Parents are in the best position to observe the child and note changes in behaviors that might be related to side effects. Medications should never be mixed with food or beverages because proper dosing may not be achieved if child does not consume all of the food or beverage. Depending on the dosage schedule, there may be some flexibility of administration times to fit with the child's normal routine. Not all medications can be made palatable. The nurse can work with parents to help with successful medication administration even with medications that do not taste good. p 45, 49-50
When does gastrointestinal (GI) microbial colonization reach adult levels? 1 Birth 2 Infancy 3 Childhood 4 Adolescence
4 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 factor requires the pediatric patient until about 2 years of age to have higher doses of water-soluble drugs to achieve therapeutic levels? 1 Higher fat stores 2 Higher bilirubin levels 3 Lower protein concentrations 4 Higher proportion of body fluid
4 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
Individuals aged 28 days to 23 months fall under which pediatric age classification? 1 Children 2 Adolescent 3 Term neonate 4 Infant/toddler
4 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. p 44
The nurse is caring for a 2-year-old infant suffering from constipation. The nurse finds that the child has been prescribed a lipid-soluble medication. What factor does the nurse expect to alter the absorption of the medication? 1 Gastric PH 2 Gastric motility 3 Gastric emptying 4 Gastric enzyme levels
4 Infants have immature enzymatic functioning, which reduces drug absorption. Infants have low lipase levels, resulting in the reduced absorption of lipid-soluble medications. The nurse expects that gastric enzyme levels will decrease the drug's absorption. The nurse should consider that gastric PH affects the absorption of acidic or alkaline medications, but not lipid-soluble substances. Gastric motility and gastric emptying time are interrelated and help determine the amount of time spent by the drug in the stomach. Gastric motility and gastric emptying do not directly affect the absorption of a lipid-soluble drug. p 44-45
The student nurse is discussing pharmacokinetics in infants. Which statement of the student nurse indicates effective learning? 1 "Medications do not reach the brain in infants." 2 "The elimination rate of medications is high in infants." 3 "The distribution of fat-soluble medications is high in infants." 4 "The distribution of water-soluble medications is high in infants."
4 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
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? 1 Social 2 Behavioral 3 Psychological 4 Developmental
4 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
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? 1 Probiotic 2 Thiamine 3 Vitamin D 4 Magnesium
4 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
How many hours would it take for caffeine levels in an infant to reach 50% of the intake level? 1 9 hours 2 33 hours 3 50 hours 4 95 hours
4 The half-life for caffeine in an infant is 95 hours. Therefore the caffeine level in an infant would reach 50% of the intake level at 95 hours. The level would remain higher than 50% at 9, 33, and 50 hours. p 46
Which guideline should be followed for time-released and enteric-coated drugs? 1 These drugs should be avoided in the pediatric population. 2 These drugs should be deposited close to the front of the mouth. 3 Parents and caregivers are unqualified to administer these drugs to children. 4 Nurses should avoid crushing or dissolving these drugs prior to administration.
4 The nurse should work closely with the pharmacist and in compliance with hospital policies to determine the advisability of crushing or dissolving a drug before administration; some drugs, particularly timed-release and enteric-coated drugs, should not be crushed or dissolved. These drugs may be appropriate in the pediatric population. Depositing a drug too close to the front of the mouth increases the likelihood that the child will spit it out. Parents and caregivers are qualified to administer these drugs to children with adequate guidance from the provider. p 47
Which inadequacy in neonates results in reduced absorption of lipid-soluble drugs? 1 Water and electrolytes 2 Cholesterol and triglycerides 3 Gastric acid and intrinsic factor 4 Bile salts and pancreatic enzymes
4 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
