PHARMACOLOGY PEDIATRIC FINAL HESI EVOLVE
A preschooler is to have a peripheral intravenous catheter inserted. How can the nurse make the experience minimally traumatic for the child?
By applying a topical analgesic before the procedure
A peripherally inserted central venous catheter has just been inserted into the arm of a 7-year-old child. A peripheral intravenous (IV) line is still in place, and an antibiotic is to be administered immediately. What is the nurse's first action?
Connecting the IV antibiotic to the peripheral line
A 6-month-old infant is to receive scheduled immunizations. The parents ask why two influenza vaccines are given: Haemophilus influenzae type B (Hib) and pneumococcal conjugate vaccine (PCV). How should the nurse respond?
Hib and PCV prevent different bacterial diseases.
A nurse is completing the discharge protocol for a 14-year-old adolescent with osteomyelitis. The nurse teaches the parents how and when to administer the intravenous antibiotic at home. The schedule for administration is four times a day. At what times should the parents administer the antibiotic?
6:00 AM, 12:00 PM, 6:00 PM, 12:00 AM
A nurse is assessing the status of a school-aged child with leukemia who is receiving vincristine. What laboratory test result alerts the nurse that fluid intake should be increased?
Blood uric acid level of 7.5 mg/dL
The alkylating chemotherapeutic agent cyclophosphamide is prescribed for a school-aged child with cancer. What is the most important nursing assessment while the child is receiving this medication?
Daily intake and output
A 6-year-old child with Reye syndrome is receiving an intravenous solution of 10% glucose and mannitol to reduce cerebral edema. For which complication of this therapy does the nurse monitor the child?
Hypovolemic shock
A 12-month-old infant is to receive ferrous sulfate for iron-deficiency anemia. How will the nurse administer the medication?
In a syringe directed toward the back of the mouth
A nurse is admitting a 2-year-old toddler with a tentative diagnosis of cystic fibrosis to the pediatric unit. Pilocarpine is used as part of the diagnostic process. The nurse knows that the pilocarpine will stimulate which process?
Activity of sweat glands
A platelet transfusion is to be administered to a child with acute lymphocytic leukemia. What will the nurse do first?
Administer the platelets rapidly through the intravenous (IV) line
A 4-year-old child diagnosed with sickle cell anemia is at a high risk of acquiring pneumococcal diseases even after receiving one or two doses of the pneumococcal conjugate vaccine (PCV). Based on the immunization protocol, what dose of PCV should the nurse administer?
Administer two more doses of PCV
A 7-year-old child contracts a urinary tract infection. A sulfonamide preparation is prescribed. What is the priority nursing responsibility when the nurse is administering this drug?
Administering the drug at the prescribed times
A nurse is interviewing an adolescent who is to start a chemotherapeutic drug regimen that includes vincristine. Which side effect is it most important for the nurse to prepare the adolescent to expect?
Alopecia
A 1-year-old infant is receiving zidovudine for management of human immunodeficiency (HIV) infection. The nurse determines that the infant is exhibiting signs of life-threatening zidovudine toxicity. What clinical finding supports this conclusion?
Bruises over the body
What is an important nursing assessment for a school-aged child who is undergoing long-term steroid therapy?
Frequent testing of stools for occult blood
Chelation therapy with calcium disodium edetate (EDTA) has effects besides the desired effect of removing lead from the blood. What side effect does the nurse anticipate?
Hypocalcemia
A 4-year-old child is admitted to the pediatric unit with the diagnosis of acute lymphocytic leukemia (ALL). A blood transfusion is ordered, and an intravenous line is started. What will the nurse do in regard to administering the transfusion?
Infuse the blood over no more than 4 hours.
The laboratory report of a pediatric client who is taking psychotherapeutic drugs indicates decreased bone density. Which drug might be responsible for this condition?
Lithium
A school-aged child with leukemia is receiving vincristine as part of the medical regimen. For what toxic response does the nurse assess the child?
Peripheral neuropathy
A 5-month-old infant experiences severe diarrhea and is given intravenous (IV) fluids. What is the most important reason for the nurse to closely monitor the IV flow rate?
Prevention of cardiac overload
A child with beta-thalassemia is receiving therapy that includes multiple blood transfusions. This child is at risk for which most common complication?
Pulmonary edema
A child with Wilms tumor is undergoing chemotherapy in a protocol that includes vincristine and doxorubicin hydrochloride. Which common side effect unique to doxorubicin will the nurse expect to observe in the child?
Red urine
A nurse is preparing to administer vaccinations to four different babies.Which baby's vaccination requires correction?
The 12-month-old baby
Status epilepticus develops in an adolescent with a seizure disorder who is taking antiseizure medication. What does the nurse identify as the most common reason for the development of status epilepticus?
The prescribed antiseizure drug probably is not taken consistently.
A neonate diagnosed with congestive heart failure has been prescribed furosemide. What changes to the dosage or time intervals between doses should be made?
The time between doses should be lengthened.
After administration of the MMR vaccine, a child develops pain, fever, and soreness. The primary healthcare provider asks the nurse to assess the child for joint swelling and to send a blood sample for a blood platelet count. Which is the most appropriate reason behind these interventions?
To assess the risk of thrombocytopenia
The nurse is caring for a child with a very low platelet count related to chemotherapy. The nurse will monitor this child's urine for the presence what component?
Erythrocytes
A nurse is monitoring a 6-year-old child for toxicity precipitated by digoxin. For what sign of digoxin toxicity will the nurse assess the child?
Vomiting
When considering the side effects of dactinomycin and doxorubicin therapy, the nurse can suggest to the parents of a child receiving these medications that the child should take which precaution?
Wear a baseball cap
A school nurse is teaching a 12-year-old child with recently diagnosed type 1 diabetes about the action of insulin injections. What statement indicates that the child understands how insulin works in the body?
"Glucose is carried into cells, where it is used for energy."
A senior nurse teaches a nursing student about how to treat poisoning in young children. Which statement by the nursing student indicates the need for further teaching?
"Syrup of ipecac should be administered immediately after poisoning."
After reviewing the immunization record of a 4-year-old child with acute bronchitis and mild febrile illness, the nurse notices the need for a consecutive vaccination of DTaP. What advice should the nurse give to the child's mother?
"The child needs to receive another Tdap vaccine."
An intravenous (IV) line is inserted in the scalp vein of an infant. The mother asks why the IV is not placed in the hand or arm as for an adult. How should the nurse respond?
"Usually veins in the arm or hand are used, but your baby's were too small."
A nurse teaches the parents of a 4-year-old child who is to receive digoxin elixir twice a day at home about the basic principles regarding its administration. What statement indicates to the nurse that they need further teaching?
"We should give the digoxin twice a day, at breakfast and dinner."
Which client needs a correction in the nursing intervention?
(Client 2) Administration of analgesics only when pain intensifies.
A nurse is preparing to give a 3-year-old toddler an intramuscular injection when the child starts to cry. What is the most therapeutic approach for the nurse to take?
"It's all right to cry, it will be quick."
Penicillin G and probenecid are prescribed for an adolescent who has syphilis. The adolescent asks the nurse why two medicines are needed. What should the nurse explain about the rationale for this combination therapy?
"Probenecid delays excretion of penicillin so the blood level of penicillin stays stable longer."
A toddler is scheduled to receive methotrexate for treatment of leukemia. The mother asks the nurse whether the child should be started on vitamin supplements because the child seems so weak. How will the nurse respond?
"Supplements that contain folic acid interfere with the effectiveness of chemotherapy."
A nurse is caring for a 10-year-old child with cystic fibrosis who is taking a pancreatic enzyme replacement. Which effect of the medication will the nurse look for that may indicate the enzyme is inadequate?
Abdominal cramping
The student who presents to the emergency department with a deep laceration of his leg does not remember the date of the last tetanus immunization received. The nurse explains that tetanus immunoglobulin and tetanus toxoid are required. What explanation underlies the nurse's statement?
Antibodies provide protection, while the toxoid stimulates a response.
The nurse is teaching an adolescent with type 1 diabetes who is prescribed a combination of regular insulin and an intermediate-acting insulin to be administered in the morning and throughout the day. The nurse asks the adolescent at what time of day the second dose of NPH insulin should be administered. Which response by the adolescent demonstrates the teaching has been effective?
At dinnertime
A 4-year-old child with newly diagnosed leukemia is admitted for chemotherapy. While assisting with morning care the nurse observes bloody expectorant after the child has brushed the teeth. How will the nurse respond to this occurrence?
By documenting and reporting the incident
After an infant undergoes surgery for the repair of a myelomeningocele, diarrhea and metabolic acidosis develop, accompanied by decreased urine output. In light of the infant's status, what prescription does the nurse anticipate?
Sodium lactate
Etanercept is prescribed for an adolescent with juvenile idiopathic arthritis. What route of administration should the nurse expect the practitioner to specify?
Subcutaneous
A school-aged child with a seizure disorder is to start taking divalproex. What will the nurse teach the parents about caring for their child in regard to this medication?
Take the child for regularly scheduled blood tests.
A nurse is reviewing medication instructions with the parents of an infant who is receiving digoxin and spironolactone. What parental response concerning their infant's care indicates that the instructions have been understood?
Vomiting should be reported to the healthcare provider.
Which pharmacokinetic condition of a drug may result in a high intensity and long duration of response?
When absorption is rapid but elimination is delayed
A nurse is teaching a 10-year-old child with type 1 diabetes about insulin requirements. When does the nurse explain that insulin needs will decrease?
When active exercise is performed
A senior nurse educates a nursing student about measures to reduce vaccine-related pain in children. Which statement by a nursing student indicates a need for further teaching?
"I should give antipyretics to the child."
A nurse counsels an infant's mother about drug dosage. Which statement indicates the need for further counseling?
"I should not re-administer any spilled drugs to avoid overcompensation."
A registered nurse teaches a nursing student about considerations for administering medication in infants. Which statement of the nursing student indicates a need for additional learning?
"I should pull the ear pinna up and back while administering ear drops."
A healthcare provider prescribes inhaled corticosteroids for a 6-year-old child with asthma. The nurse concludes that the mother understands the teaching about the side effects of this medication when the mother makes which statement?
"I'll check for white patches in the mouth."
An adolescent with leukemia is receiving vincristine. The mother reports that the child is complaining of feeling "tingles" all over. What is the best response by the nurse regarding this effect of the medication?
"It is a neurological side effect."
An infant with a seizure disorder is receiving phenobarbital at home. The mother calls the pediatric clinic and states that the infant has become lethargic and sleeps for long periods. How should the nurse respond to ease the mother's anxiety?
"This is a temporary response to the drug; it usually stops after a few weeks."
A nurse teaches the parents of a 7-year-old girl who has been prescribed long-term phenytoin therapy about care pertinent to this medication. Which statement indicates that the teaching has been effective?
"We'll have her massage her gums and floss her teeth frequently."
A 13-year-old child with type 1 diabetes is receiving 15 units of regular insulin and 20 units of NPH insulin at 7:00 AM each day. At what time does the nurse anticipate a hypoglycemic reaction from the NPH insulin to occur?
In the afternoon
A combination of drugs, including vincristine and prednisone, is prescribed for a child with leukemia. For which adverse effect of vincristine will the nurse assess the child?
Neurologic complications
Ferrous fumarate 30 mg is prescribed for an infant. The ferrous fumarate solution contains 45 mg/0.6 mL. How much solution will the nurse administer? Record your answer using one decimal place. Include a leading zero if applicable. _____ mL
0.4
The nurse is caring for a 7-year-old child with the diagnosis of plumbism. Edetate calcium disodium (calcium EDTA), a chelating agent, is prescribed. What is the most appropriate assessment before the calcium EDTA is administered?
Checking for protein in the urine
A toddler with a puncture wound to the sole is brought to the emergency department. Because of a language barrier the caregiver cannot provide a clear history of previous tetanus immunizations. Tetanus immunoglobulin (TIG) is prescribed by the healthcare provider. The nurse explains to the caregiver that this medication is given because it has what action?
Confers short-term passive defense against tetanus
An 18-month-old toddler who stepped on a rusty nail 4 days ago shows signs of generalized tetanus, including neck and jaw stiffness and facial muscle spasms. The toddler is receiving intravenous diazepam as a muscle relaxant every 4 hours. What response to the medication does the nurse anticipate?
Control of hypertonicity and prevention of seizures
A nurse is reviewing the admission laboratory report of an infant with severe gastroenteritis. The serum potassium is 3 mEq/L. Potassium chloride 20 mEq/L is prescribed to be added to the infant's intravenous (IV) line. What should the nurse do next?
Find out when the infant last had a wet diaper.
The nurse is assessing the vaccination profile for a diphtheria, tetanus, and pertussis (DTaP) vaccine and a Haemophilus influenzae type b (Hib) conjugate vaccine in a 5-year-old child. Which dose was incorrectly given to the child?
Fourth dose
Which immunization protocol should be followed by a nurse administering a hepatitis B vaccine to an infant whose mother is diagnosed HBsAg-positive during pregnancy?
Hepatitis B immune globulin 0.5 mL is given along with the first dose of recombivax HB.
By what route does the nurse administer the chelating agent calcium disodium edetate (EDTA) to a toddler?
Intravenous infusion
A parent of three young children has contracted tuberculosis. Which does the nurse expect the healthcare provider to prescribe for members of the family who have a positive reaction to the tuberculin skin test and are candidates for treatment?
Isoniazid
A 5-year-old child is receiving dactinomycin and doxorubicin therapy after nephrectomy for Wilms tumor. What intervention does the nurse include when planning care?
Offering warm saline mouthwash
What will a nurse teach the parents of a toddler with newly diagnosed cystic fibrosis about the administration of vitamins A, D, E, and K?
Offer them in a water-miscible form.
After oral surgery the dentist writes a prescription for pain medication for an 18-month-old child. Which medication does the nurse question?
Oxycodone/aspirin
A child who has attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate hydrochloride. Which behavior indicates that the child needs further treatment?
The child experiences difficulty keeping school assignments organized.
A nurse assesses a child who is scheduled to receive the diphtheria, tetanus, and pertussis vaccine. After an assessment, the nurse concludes that the child cannot receive the vaccine safely. Which assessment finding supports the nurse's conclusion?
The child has a history of anaphylactic reactions after vaccinations.
An infant with congenital hypothyroidism receives levothyroxine for three months. During the return appointment, which statement by the mother indicates to the nurse that the drug is effective?
The infant is alert and interactive.
A child undergoing treatment in the hospital has fatigue, elevated blood pressure, sleep problems, nervousness, and gastrointestinal tract upset. Which type of drug is the child being given?
Tricyclic antidepressants
A 15-year-old high school student with hay fever has been taking a prescribed first-generation antihistamine every 8 hours for the past 2 days. The adolescent tells the nurse, "This medicine is making me sleepy. Can you change it to something else?" How should the nurse respond?
"The drowsiness usually decreases after several days."
Severe hypertension develops in a child with acute glomerulonephritis. What medication does the nurse anticipate that the healthcare provider will prescribe?
Captopril
A healthcare provider prescribes steroid therapy for a 4-year-old child who has nephrotic syndrome. What goal of this treatment does the nurse explain to the child's parents?
Stimulates diuresis
A 16-year-old adolescent with recently diagnosed type 1 diabetes will receive NPH insulin subcutaneously. The nurse teaches the adolescent about peak action of the drug and the risk for hypoglycemia. How many hours after NPH insulin administration does the insulin peak?
4 to 12 hours
Which immunosuppressant drug interacts with allopurinol and may cause bone marrow suppression in children?
Azathioprine
A child being treated with cardiac drugs developed vomiting, bradycardia, anorexia, and dysrhythmias. Which drug toxicity is responsible for these symptoms?
Digoxin
A primary healthcare provider instructs a nurse to administer opioids to a child. During an assessment, the nurse finds that the infant is showing symptoms of lightheadedness, drowsiness, and hallucinations. Which is the first nursing action in this situation?
Stop administration of the drug.
An adolescent with leukemia is to be sent home on a protocol that includes several antineoplastic agents. Before discharge, what medication instructions should the nurse give the parents?
Schedule laboratory blood tests to evaluate response to the medication.
A pediatric client with a past history of chicken pox reports a fever and headache. Which drug should the nurse avoid giving to the client?
Aspirin
A 2-month-old infant with the diagnosis of heart failure is discharged with a prescription for oral digoxin 0.05 mg every 12 hours. The bottle of digoxin is labeled "0.05 mg/mL." Which item should the nurse teach the mother to use when administering the medication?
Calibrated syringe
The nurse observes the practices of the parents of several pediatric clients who have been admitted and finds that one child's parents require an intervention for medication adherence. Which client's parents need a nursing intervention?
Client 2 (uses a bottle cap or soup spoon to dose liquid drug formulations.)
A 15-year-old adolescent is admitted to the hospital with a diagnosis of status asthmaticus. An intravenous infusion of methylprednisolone is initiated. What adverse effect requires the nurse to intervene immediately?
Polyuria
A nurse is planning to give a preschool child an immunization consisting of bacteria that have been modified. What is the substance called?
A vaccine
What medication does a nurse expect to administer to control bleeding in a child with hemophilia A?
Factor VIII concentrate
Which condition may be the result of an adverse drug effect associated with administration of chloramphenicol in infants?
Gray syndrome
