PREP-U CH 4 Life Span Infants

The nurse is determining the recommended dose of medication for a child. The nursing drug handbook reads "Recommended dose is 15 mg per kg." The child's weight is 25 kg. The recommended dose for this child is:

375 Explanation: Using the ratio-proportion formula, the nurse multiplies 15 mg by 25 kg and divides by 1 kg. This is equal to 375 mg.

The nurse tells a 9-year-old child that the child will be receiving an injection today. What statement by the child is most indicative of the fear that children of this age group feels? A. "I hate getting shots. The last time I got one it hurt so bad." B. "I would rather have my medication in a liquid." C. "I don't want to be without my mother." D. "Please don't give me a shot. Blood leaks out when I have a shot."

A. "I hate getting shots. The last time I got one it hurt so bad." Explanation: The school-aged child's greatest fears of drug therapy are usually related to negative past experiences.

A 21-month-old has been prescribed an oral antifungal to be taken twice daily. How can the nurse best involve this toddler in effectively implementing this medication regimen? A. Allow the toddler to hold the medication cup if able. B. Allow the toddler to draw up the medication with supervision. C. Teach the toddler how the medication will help the infection. D. Teach the toddler why taking the medication regularly is important.

A. Allow the toddler to hold the medication cup if able. Explanation: The nurse involves toddlers and preschoolers in medication administration by having them hold items or choose the cup. However, adults need to control administration. Health education is not normally appropriate for a child who is this young.

An adolescent is being discharged from the hospital and is prescribed medications for a cardiac rhythm abnormality. What interventions should the nurse provide? (Select all that apply.) A. Describe the intended effect of regulating the heart rate. B. Speak to both adolescent and parents. C. Review all possible side effects. D. Outline the time and frequency of each medication. E. Answer questions the adolescent may have.

A. Describe the intended effect of regulating the heart rate. B. Speak to both adolescent and parents. D. Outline the time and frequency of each medication. E. Answer questions the adolescent may have. Explanation: Instructions about medications should include the intended effect, the time, and frequency of each medication. The instructions are given to the mature adolescent who will be taking responsibility for the scheduling and administering of his or her own medications and to the adolescent's parents. The nurse answers questions. The nurse provides information about the most common side effects, but not all side effects.

The clinical nurse educator who oversees the emergency department in a children's hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children? A. Have nurses check their math calculations with a colleague before administering a drug. B. Ensure that a full assessment takes place no more than 30 minutes before giving a drug. C. Record drug administration in both the nurse's notes and the medication administration record (MAR) D. Avoid intravenous administration of drugs whenever possible.

A. Have nurses check their math calculations with a colleague before administering a drug. Explanation: Of all the problems that may contribute to an incorrect dose, the most common involve errors in math during dosage calculation. Dosage calculation can involve several steps, and a mathematical error can occur at each step. Asking a colleague to double-check your calculation is the best way to prevent an error from occurring. Documentation in multiple locations, rigorous assessment, and avoidance of IV administration are not practices that appreciably reduce the potential for incorrect doses.

Suppositories are a very appropriate method of medication delivery in what age group? A. Infant B. Toddler C. Preschooler D. School age

A. Infant Explanation: Many medications come in suppository form which makes administration easier. Toddlers and preschoolers have strong reactions to suppositories which may make it difficult to insert the medication. School age and adolescents are usually embarrassed by the insertion.

A 6-month-old child has developed skin irritation due to an allergic reaction. The child is prescribed a topical skin ointment. The nurse will consider what information before administering the drug? A. The infant's skin has greater permeability than that of an adult. B. There is less body surface area to be concerned about. C. There are decreased absorption rates of topical drugs in infants. D. The infant's skin is generally softer than that of an adult

A. The infant's skin has greater permeability than that of an adult. Explanation: Compared to adult skin, infants' skin exhibits greater permeability. This can result in increased absorption, which may result in adverse effects that usually do not occur in the adult. The nurse must consider this fact before administering skin ointment. Infants have greater, not lesser, body surface area. Greater body surface area plus increased permeability results in increased absorption of topical agents. Infants tend to have a higher concentration of water in their bodies than do adults. Skin soften is not relevant.

Pharmacokinetics involves the study of how medications are absorbed, distributed, metabolized, and eliminated. What are the two key factors that influence pharmacokinetics in children? A. age and size B. height and weight C. body surface area D. body mass index

A. age and size Explanation: A child's size and age are key factors that affect the ability of his or her key organ systems to handle the absorption, distribution, metabolism, and elimination of drugs. While height and weight determine a child's size, and body surface area and body mass index are good measurements of a child's size, age is also a key factor that determines pharmacokinetics in children.

To gain a preschooler's cooperation to swallow an oral medication, the nurse's best approach would be to: A. offer to play a game with the child if the preschooler takes the medicine. B. ask if the child would like to take the medicine in a cup or through an oral syringe. C. compare the taste of the medicine to a chocolate bar. D. leave the medicine on the stand so the child can take it independently.

A. ask if the child would like to take the medicine in a cup or through an oral syringe. Explanation: Medicine never should be compared to candy. Children cannot be depended on to take medicine without supervision; bribing is also ineffective.

An infant has been prescribed a 10-day course of an oral liquid antibiotic. The nurse should teach the infant's parents to administer the drug using an oral syringe and to place the liquid medication into which location? A. in the infant's cheek B. in the back of the infant's throat C. between the infant's gums and lips D. on the infant's tongue

A. in the infant's cheek Explanation: Oral medications are administered with a dropper or oral syringe into the inner aspect of the cheek, giving children time to swallow the medication as it is instilled. None of the other locations support effective administration of oral medication in an infant.

A neonate's highly immature liver and resulting low levels of the enzyme cytochrome P-450 (CYP450) affects what aspect of pharmacokinetics? A. metabolism B. distribution C. absorption D. elimination

A. metabolism Explanation: The enzyme cytochrome P-450 (CYP450) metabolizes drugs in the liver. This characteristic does not affect any of the other aspects of medication therapy

A child who has been hospitalized with pneumonia is being discharged with two new medications. What information does the nurse need to educate the family about? (Select all that apply.) A. the name of the drug B. what the medication is being taken for C. how the drug works D. adverse effects E. when the child feels better, the child can stop the medication

A. the name of the drug B. what the medication is being taken for C. how the drug works D. adverse effects Explanation: Parents need to be taught specific drug information, including the name of the drug, what it is for, how it works, its adverse effects, and the exact dose for the child.

The nurse is administering an intramuscular injection of an antibiotic to 3-month-old child. Which would be the best site for the nurse to give this medication? A. thigh B. buttocks C. arm D. abdomen

A. thigh Explanation: The muscle preferred for intramuscular injections in the infant is the vastus lateralis located on the thigh.

The nurse is preparing to administer an intramuscular (IM) injection to a 2-year-old-child. Which is the preferred site of injection for this child? A. vastus lateralis muscle B. rectus femoris muscle C. dorsogluteal muscle D. deltoid muscle

A. vastus lateralis muscle Explanation: The preferred injection site for infants and children up to 3 years is the vastus lateralis. This muscle is on the side of the thigh in the upper outer quadrant of the area between the greater trochanter and the knee. The vastus lateralis has few nerves and blood vessels and forms the largest muscle mass in this age group.

An infant is to receive a hepatitis B vaccine within a few hours after birth. Which is the best approach for the nurse to take when giving this medication? A. Administer the medication in the infant's vastus lateralis with a 25-gauge needle. B. Administer the medication in the vastus lateralis with a 20-gauge needle. C. Administer the medication in the dorsogluteal with a 25-gauge needle. D. Administer the medication in the deltoid muscle with a 20-gauge needle.

Administer the medication in the infant's vastus lateralis with a 25-gauge needle. Explanation: The vastus lateralis site is a safe choice for IM injections in an infant. A 25-gauge needle is recommended for infants. The dorsogluteal site should not be used until the child has been walking for one year. The deltoid muscle is not a recommended IM site for infants.

A grandmother brings a 2-year-old grandchild into the clinic for treatment of a cough and cold. The nurse observes that the child is playing with the grandmother's pocketbook that has several bottles of medications. What should the nurse educate the grandparent about? A. If the child is going to play with the pocketbook, be sure the medications have child-proof containers. B. Eliminate accessibility to all medications and provide safe storage in the home. C. Keep pocketbooks zipped so it won't be so easy for the child to get into it. D. Allow the child to play with the empty bottle containers so that the child won't play with the real ones.

B. Eliminate accessibility to all medications and provide safe storage in the home. Explanation: Ask the caretaker whether the home has a safe place to store prescription and nonprescription drugs away from children. Whether a drug is in a childproof container does not significantly affect whether accidental ingestion occurs.

What characteristic of a 5-week-old infant's blood-brain barrier must be considered when administering a drug that affects the central nervous system (CNS)? A. The blood-brain barrier will block the passage of drugs from the blood to the CNS. B. In neonates, the blood-brain barrier is poorly developed. C. Effects of the drug on the neonate's CNS will be muted. D. The blood-brain barrier is not present until 4 months of age.

B. In neonates, the blood-brain barrier is poorly developed. Explanation: A neonate has a blood-brain barrier, but it is poorly developed. This means that drugs and other chemicals easily affect the CNS in young infants.

The nurse is preparing to administer an oral medication to a toddler. Why would it be important to have the parent nearby when administering the medication? A. The nurse is not allowed to administer medications to a child unless the parent is in the room. B. Toddlers experience separation anxiety; having the parent nearby will help the child's cooperation. C. Toddlers do not like anyone in the health care field and should not be subjected to procedures without parents. D. Toddlers are able to take medications only from their parent.

B. Toddlers experience separation anxiety; having the parent nearby will help the child's cooperation. Explanation: Because toddlers experience anxiety when separated from their parents, having a parent nearby usually helps the child's cooperation during drug therapy.

The nurse is to administer an intramuscular medication to a 2-year-old toddler. The nurse uses: A. a 20-gauge needle for injection. B. the vastus lateralis muscle as the site for administration. C. a 1-inch needle for injection. D. a 45-degree angle when inserting the needle into the muscle.

B. the vastus lateralis muscle as the site for administration. Explanation: To administer a medication by the intramuscular route of a child up to 3 years of age, the nurse uses the vastus lateralis, which is the largest muscle mass in this age group. The smallest possible gauge needle is used. A 20-gauge needle is large. A needle less than 5/8 inch is also used. The 45-degree angle would be used with a 5/8-inch needle.

The exact dose of a medication for a pediatric client is based on what parameter? A. total body water B. weight C. height D. gastric acidity

B. weight Explanation: The prescriber uses weight alone to calculate pediatric dosages. Total body water, height, and gastric acidity are not used in the exact calculation.

The nurse is calculating the body surface area (BSA) of a neonate. The neonate is 22 inches long and weighs 3 kg. The BSA is: A. 0.14 m2. B. 0.18 m2. C. 0.2 m2. D. 0.23 m2.

C. 0.2 m2. Explanation: To calculate the BSA, the nurse identifies 22 inches in the column marked height and draws a line to 3 kilograms in the column marked weight on the nomogram. The line intersects at 0.2 m2, which is in the middle column.

A pediatric client is admitted to the hospital. The nurse weighs the client and expresses the weight as: A. 22.2 pounds. B. 22 pounds 3 ounces. C. 10.1 kilograms. D. 10,136 grams.

C. 10.1 kilograms. Explanation: The child's weight should be expressed in kilograms. This reduces the incidence of medication errors when calculating dosages based on weight.

What is the total water body percentage in infants? A. 50% B. 60% C. 80% D. 95%

C. 80% Explanation: In adults, total body water is approximately 60%, whereas in newborns, it is 80%.

The nurse is caring for a 3-year-old child admitted with pneumonia. The health care provider has ordered clarithromycin to be administered. The drug guide the nurse is using for a reference lists only the recommended adult dose. What should the nurse do to ensure that the proper dose of the medication is given to the child? A. Contact the provider for clarification of the order. B. Ask the pharmacist to calculate the appropriate dose. C. Calculate the drug dosage based on the child's BSA. D. Calculate the adult dosage, minus 25%.

C. Calculate the drug dosage based on the child's BSA It is not recommended that health care providers memorize pediatric dosages, because the weight of the pediatric client can vary greatly. Each medication has its specific mg/kg dosage range for administration to a pediatric client; there is no standard dosage range. The BSA is the most accurate method to determine the appropriate pediatric drug dosage when a recommended pediatric dosage is not available. While the pharmacist is a source of information the nurse should be able to effectively determine the dose.

Which is the best area to place oral medications in infants? A. Back of the tongue B. Between the cheek and gums C. Inner aspect of the cheek D. Under the tongue

C. Inner aspect of the cheek Explanation: Oral medications are best administered with a dropper or oral syringe into the inner aspect of the cheek, giving children time to swallow the medication as it is instilled. The infant may choke if the medication is placed on the back of the tongue, and there is less of a chance for the infant to swallow the medication effectively if placed between the cheek and gums or under the tongue.

A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should: A. teach the boy fact that he will feel much better after he takes his medications. B. have the mother hold the child firmly and sooth him while the drugs are administered. C. offer a choice between liquid and chewable medications, if possible. D. insert a central intravenous line.

C. offer a choice between liquid and chewable medications, if possible. Preschoolers are often uncooperative during drug administration. Strategies for enlisting cooperation include offering choices (e.g., between liquid medicines or chewable tablets) when feasible. This is preferable to forcibly administering a medication. Teaching is unlikely to influence a 3-year-old child's reluctance. A central IV line would not be a preferred strategy if oral medications are available

The nurse is to administer 10 drops of an oral liquid medication to an infant with a poor sucking reflex. The best way to administer the medication and ensure the medication will be swallowed is by: A. mixing the drops in a small amount of fluid. B. adding the drops to the infant's formula. C. placing the drops in the buccal pouch. D. putting the drops in a bottle nipple.

C. placing the drops in the buccal pouch. Explanation: The best way to administer medication drops to an infant with a poor sucking reflex and ensure the medication is swallowed is to place the drops in the buccal cavity. The infant needs a well-developed sucking reflex to take medication from a bottle nipple. By adding medication to formula, the infant may dislike the taste and refuse future formula feedings.

The pediatric nurse is caring for a child who weighs 44 pounds. The health care provider has prescribed methylprednisolone sodium succinate, 0.03 mg/kg/d IV in normal saline. How many milligrams of medication will the nurse prepare? A. 6.5 B. 6 C. 0.65 D. 0.6

D. 0.6 Explanation: First convert the child's weight to kilograms by dividing 44 pounds by 2.2 kg/1 pound = 20 kg. Multiply the dosage times the child's weight: 20 kg × 0.03 mg/kg/d = 0.6 mg/d.

The nurse is caring for a 5-year-old in a clinic setting. The child is due for a scheduled immunization. Which approach is the best for the nurse to take when administering the IM injection? A. Tell the child to hold very still and be very quiet during the injection. B. Ask the child if the nurse can give the injection now. C. Tell the child it won't hurt a bit. D. Allow the child to pick which arm the injection will go in.

D. Allow the child to pick which arm the injection will go in. Explanation: Offering the child a choice of arm gives the child a sense of control over the painful injection. Asking the child permission to give the injection is inappropriate. Lying to a child about pain is never appropriate. The child should hold still; however, it is not necessary for the child to remain quiet.

A 2-year-old has been prescribed an antibiotic as part of treatment. What should the nurse consider to minimize the adverse effects? A. Antibiotics should be given at bedtime B. Small doses of antibiotics like those prescribed for children seldom cause adverse effects. C. Drugs affect only adults; they cause few adverse effects in children. D. Altering the dosage of the drug according to the child's age

D. Altering the dosage of the drug according to the child's age Explanation: Adverse effects of some drugs are more severe and more likely to occur in children due to their immature body systems. Drug receptor sensitivity varies with age. It may be increased or decreased for certain drugs. This variability may promote adverse effects and may necessitate lower or higher drug dosages than would normally be expected. For example, tetracycline administered to a child between the age of 4 months and 8 years will stain the permanent teeth.

A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to: A. The inability of infants and children and describe symptoms of adverse drug reactions. B. increased body surface area relative to body volume in infants and children. C. increased heart rate and subsequently rapid drug distribution among infants and children. D. immature liver and kidney function in infants and children.

D. immature liver and kidney function in infants and children. Children are more at risk of the deleterious effects of drug errors because they have not physiologically matured. Immature liver or renal function, for example, can increase the circulating level of a drug beyond what would be expected in adults. This characteristic supersedes differences in body surface area, cardiac function, and ability to verbalize discomfort.