HESI: Pediatric Pharm
A nurse is planning to administer albuterol to a 4-year-old child. How will the nurse evaluate the effectiveness of this medication?
Conduct a brief neurologic examination Albuterol is an adrenergic drug that stimulates beta-receptors, leading to relaxation of the smooth muscles of the airway. The lungs should be auscultated to evaluate the effectiveness of this medication. Albuterol does not affect the consistency of pulmonary secretions. Albuterol will not cause central nervous system stimulation. Albuterol does not affect intercostal contractility; chest excursion is not the appropriate assessment.
A teenager with allergies is using oxymetazoline nasal spray. What effect should the nurse assess the client for if more than the recommended dose is taken?
Increased nasal congestion
The nurse is teaching parents about the side effects of immunization vaccines. What expected side effect associated with the Haemophilus influenzae (Hib) vaccine will the nurse include in the teaching?
Low grade fever The Hib vaccine may cause a low-grade fever as the body reacts to the vaccine. Urticaria is more likely to occur with the tetanus and pertussis vaccines. Lethargy is not expected. There may be a mild reaction at the injection site, but a generalized rash is not expected.
According to the Healthcare Personnel Vaccination Recommendations, what meningococcal conjugate vaccine dose should a nurse administer to a 12-year-old with an HIV infection?
Two initial doses and a booster dose at 16 years old A 12-year-old with HIV would require two primary meningococcal conjugate vaccine delivered two months apart initially and a booster dose at the age of 16 years old. The client would require two initial doses, not a single initial dose, and a booster at 16 years old, not 3, 5, or 7 years later.
The parent of a child with hemophilia asks the nurse, "If my son hurts himself, is it all right if I give him two baby aspirins?" What is the best response by the nurse?
"Aspirin may cause more bleeding. Give him acetaminophen instead." Aspirin, which has an anticoagulant effect, is contraindicated because it may harm a child with bleeding problems; in addition, aspirin is contraindicated for all children because of its relationship to Reye syndrome. Stating that the parent seems concerned about giving drugs to the child does not answer the mother's question and may cause the mother to feel defensive. Acetaminophen cannot prevent bleeding episodes; it is an analgesic.
When is the first dose of Rotarix vaccine administered in infants?
Birth to 6 weeks The Rotarix vaccine prevents rotavirus gastroenteritis and diarrhea-related problems. The vaccination requires two doses. The first dose of Rotarix should be given between 6 and 12 weeks followed by the second dose, which is given four or more weeks after the first dose. Administering the vaccine before the age of 6 weeks is too early, and administering it at 12-18 weeks or 18-24 weeks is too late.
A nurse is teaching the parents of an 8-year-old child who is taking a high dose of oral prednisone for asthma. What critical information about prednisone will be included?
It should be stopped gradually Gradual weaning from prednisone is necessary to prevent adrenal insufficiency or adrenal crisis. Prednisone depresses the immune system, thereby increasing susceptibility to infection. The drug usually suppresses growth. A moon face may occur, but it is not a critical, life-threatening side effect.
Permethrin 1% lotion is prescribed for a 5-year-old child with pediculosis capitis (head lice). What instruction does the nurse include while teaching the parents about treating the head lice?
The child's hair must be combed with a fine-toothed comb to remove nits. A fine-toothed comb removes any nits that remain after the application of permethrin 1% lotion. Personal belongings do not need to be disposed of; clothing and linens should be laundered in hot water and dried in a hot dryer, and other personal items may be soaked in a pediculicidal solution. Excessive use of permethrin 1% lotion may cause the lice to develop resistance to the shampoo. Once the hair has been shampooed there is no reason to isolate the child.
A teenage client has a prescription for oral solution levofloxacin to treat a sinus infection, and the nurse explains when the medication should be taken. The nurse concludes that the teaching has been effective when the client makes which statement?
"I should take the medication 1 hour before a meal." Absorption of the oral solution levofloxacin is enhanced when the stomach is empty, and it should be taken one hour before meals or two hours after meals. Tablets can be taken without regard to food. Food in the stomach will interfere with absorption. If the medication is taken just before a meal, food in the stomach shortly afterward will interfere with absorption. If the medication is taken 30 minutes after a meal, food remaining in the stomach will interfere with absorption.
Which anesthetic drug is commonly used for short procedures on pediatric clients?
Fentanyl Fentanyl is recommended for short procedures on pediatric clients. For long procedures in which pain is anticipated even after the procedure, morphine should be administered. Meperidine and hydromorphone are used to achieve mild to moderate sedation in pediatric clients.
Which vaccine is administered orally in children?
Rotavirus vaccine Rotavirus vaccines are generally administered orally because these live viruses should replicate in the gut of the infant. MMR vaccines are generally administered subcutaneously in the upper region of the arm. Live influenza vaccines are administered nasally. Meningococcal conjugate vaccines (MCV4) are administered intramuscularly in the deltoid region.
The mother of a 7-month-old infant who becomes irritable when teething tells the nurse, "My aunt said to wipe my baby's gums with wine to ease the pain." What is the best response by the nurse?
"An over-the-counter topical gel can be used, but make sure it's for teething. Providing information is a nonjudgmental way to address unsafe child care practices. There are safe over-the-counter analgesic products specifically formulated to ease the discomfort of teething. Alcohol ingestion is contraindicated and illegal for all children. Being judgmental about the aunt's approach may close communication; the nurse should offer acceptable alternatives.
Trimethoprim/sulfamethoxazole is prescribed for a child with a urinary tract infection. Which statement by the parent about the drug indicates that the nurse's instructions about administration have been understood?
"I'll make sure to give each pill with 6 to 8 oz (180 to 240 mL) of fluid." This is a sulfa drug; water must be encouraged to prevent urine crystallization in the kidneys. This drug does not have to be given with meals; it is administered every 12 hours. Orange juice causes an alkaline urine; water is the best fluid to be administered with this drug. This drug maintains the blood level for 8 to 12 hours; it is an intermediate-acting drug.
After surgery for a ruptured appendix, a 12-year-old child is receiving morphine for pain control by way of a patient-controlled analgesia (PCA) infusion. A bolus of morphine can be delivered every 6 minutes. A parent will be staying with the child during the immediate postoperative period. What statement indicates to the nurse that the instructions about the PCA pump have been understood?
"She needs to push the PCA button whenever she needs pain medication." Morphine, an opioid analgesic, relieves pain; when control of pain is given to the child, anxiety and pain are usually diminished, resulting in a decreased need for the analgesic; only the child should press the PCA button. Having the child press the PCA button every 6 minutes is unnecessary. Although pain medication can be delivered as often as every 6 minutes, it should be used only if necessary. If the child is sleeping, the pain is under control; waking the child will interfere with rest. If the child is sleeping, the pain is under control; also, this will result in an unnecessary and excessive dosage of the opioid.
A parent calls the outpatient clinic requesting information about the appropriate dosage of acetaminophen for a 16-month-old child. The directions on the bottle of acetaminophen elixir are 120 mg every 4 hours when needed. At the toddler's 15-month visit, the healthcare provider prescribed 150 mg. What is the best response by the nurse?
"The prescribed dose of the drug was based on weight, and this is a more accurate way of determining a therapeutic dose." A specific dose per kilogram of body weight prevents overdose; there is a large range in weight for specific ages, and a uniform dosage based on age could be unsafe or ineffective. Stating that the dose is close enough may result in an inadequate dose. Medication is important; the child has a fever. Using dosages based on age is unsafe because of the wide range of weights for a specific age group.
Allopurinol is prescribed for a 6-year-old child undergoing chemotherapy for cancer of the bone. When given the medication, the child asks, "Why do I have to take this pill?" What is the best response by the nurse?
"With the other medicines, it helps you get rid of the things that are making you sick." Telling the child it helps get rid of the things making the child sick is the most accurate and age-appropriate response to the child's question. Telling the child that the medicine protects the body from new problems is inaccurate, and not being truthful will interfere with the development of the child's trust in the nurse. Telling the child that it stops sick white cells from spreading is inaccurate and may instill more fear. Telling the child that it is needed because the healthcare provider says so is insensitive to the question and does not provide an explanation.
A healthcare provider prescribes 160 mg of acetaminophen (Tylenol) elixir for a child. The label on the bottle reads "100 mg/mL." How many milliliters of acetaminophen will the nurse instruct the mother to administer? Record your answer using one decimal place. _____ mL
1.6
The nurse administers an initial dose of Haemophilus influenzae type b (Hib) vaccine to a 2-month-old infant. When should the nurse administer the final dose of the vaccine to the infant?
12-15 months of age The Haemophilus influenzae type b (Hib) vaccine is administered in four doses, finishing at the age of 12-15 months. Following the first dose at 2 months, the second is administered at 4 months, and the third at 6 months. For the final dose, 6-8 months and 8-10 months would be too soon; 16-18 months would be too late.
The healthcare provider has prescribed 700 mL of intravenous fluid to be infused over 24 hours. At what rate should the nurse set the volume-control device? Express your answer as a whole number. ___ mL/hr
29 Divide the amount to be infused by 24 hours: 700 ÷ 24 = 29.1. The pump should be set at 29 mL/hr because a volume-control pump delivers milliliters per hour.
A broad-spectrum oral antibiotic is prescribed for an adolescent with a bacterial infection. The prescription reads, "Take three times a day." At which times should the nurse recommend that the medication be taken to maintain a therapeutic blood level?
6:00 AM, 2:00 PM, 10:00 PM Antibiotics should be administered with the doses equally spaced to ensure maintenance of the blood level of the medication within the therapeutic range. The 12 hours between the 8:00 PM and the 8:00 AM doses and between the 10:00 PM and 10:00 AM doses is too long; the blood level of the drug will become subtherapeutic during this interval. The 10 hours between the 8:00 PM and 6:00 AM doses is also too long.
A 6-year-old child is experiencing tonic-clonic seizures, and carbamazepine 15 mg/kg/day divided equally into two doses is prescribed. The child weighs 44 lb (20 kg). The medication available is carbamazepine suspension 100 mg/5 mL. How many milliliters should the nurse administer in one dose? Record your answer using one decimal place. ___ mL
7.5 Convert the child's weight of 44 lb to kilograms (44 ÷ 2.2 = 20); 20 kg × 15 mg/kg = 300 mg for the entire day. Divide 300 mg into two doses (300 mg ÷ 2 = 150 mg/dose). Use ratio and proportion to calculate the dose.
What is the percentage of total body water in a premature newborn?
85% The total body water in a premature newborn is 85%. In full-term infants, body water ranges from 70% to 80%. The total body water in a child between the ages of 1 and 12 is approximately 64%.
A 1-year-old infant is in the pediatric unit for management of AIDS. One of the medications that has been prescribed for the child is zidovudine. What clinical finding indicates to the nurse that the infant is experiencing life-threatening zidovudine toxicity?
Bruises on the limbs and trunk Zidovudine can cause life-threatening blood dyscrasias, including thrombocytopenia. With zidovudine toxicity the infant will demonstrate agitation, restlessness, and insomnia, not fatigue and lethargy. Urine output is unrelated to zidovudine toxicity; decreased urine output may be related to decreased fluid intake, vomiting, and diaphoresis associated with the illness. Weight loss is usually a response to the illness rather than to the therapy.
Loratadine, 10 mg by mouth once a day in the morning, is prescribed for a 15-year-old girl with hay fever. The girl tells the school nurse that she is concerned that she will be sleepy for a quiz the next day. How should the nurse respond?
By explaining that this medication rarely causes drowsiness Loratadine causes little or no drowsiness or anticholinergic side effects. Even if the medication did cause drowsiness, the nurse does not have the legal authority to alter the prescribed dose. It is not necessary to call the allergist because loratadine rarely causes drowsiness.
A 2-year-old toddler is to have intravenous (IV) antibiotic therapy. What will the nurse plan to do to prevent the child from pulling out the IV line?
Cover the IV site with a protective device. Restraints are a last resort; they cause more anxiety and agitation as the child attempts to get free. Verbal instructions are not sufficient for a 2-year-old child. Securing the IV site and putting protection around it decreases the likelihood that the IV line will be pulled out. Although the family should be involved in care, the staff, not the family, is responsible for preventing the child from pulling out the IV line
Which vaccination is given to young children to provide protection against tetanus and diphtheria but not pertussis?
DT DT is given to children to provide protection from both tetanus and diphtheria. Td is used as a booster dose to protect adolescents and adults from tetanus and diphtheria. DTaP is given to children to provide protection from tetanus, diphtheria, and acellular pertussis. Tdap is used as a booster dose to protect adolescents and adults from tetanus, diphtheria, and acellular pertussis.
The nurse is teaching a parent of a 2-year-old toddler how to administer ear drops. In what direction does the nurse teach the parent to gently pull the pinna?
Down and Back In children younger than 3 years of age the eustachian tube is shorter, wider, and more horizontal. Pulling the pinna down and back facilitates passage of fluid by way of gravity to the eardrum. Pulling the pinna forward does not help position the canal for passage of the drops to the eardrum. Pulling the pinna up and back is the technique used for administering ear drops to children older than 3 years of age and adults. Pulling the pinna straight back does not position the canal for passage of the drops to the eardrum.
A 5-year-old child is being given dactinomycin and doxorubicin therapy after nephrectomy for Wilms tumor. What will the nursing care include?
Ensuring meticulous oral hygiene Oral hygiene is essential, especially during the administration of medications that have a negative effect on the oral mucosa. Although pain may be present, aspirin is avoided because doxorubicin is also being used, and a side effect of this medication is thrombocytopenia. Aspirin is contraindicated for children because it is associated with Reye syndrome. Citrus juice will aggravate stomatitis, which is a common side effect of dactinomycin. Spicy foods may aggravate the stomatitis that occurs with chemotherapy. However, usually any food that the child requests is permitted.
S/S Fluoroquinolones Nalidixic acid Hexachlorophene
Fluoroquinolones may cause tendon rupture in children. Nalidixic acid can cause cartilage erosion, and tetracycline can cause staining of developing teeth. Hexachlorophene may cause central nervous system toxicity in infants.
Intravaneous (IV) Penicillin
IV penicillin destroys the cell wall of Treponema pallidum, the causative organism of syphilis. Vidarabine is an antiviral drug; it does not treat congenital syphilis in an infant. Pyrimethamine and trimethoprim-sulfamethoxazole are ineffective in the treatment of syphilis.
Mebendazole is prescribed for a 3-year-old child with a pinworm infestation. What information will the nurse include when teaching the parents about this medication?
It may cause transient diarrhea Diarrhea is expected with the administration of mebendazole; the parents should be informed so they do not become alarmed. Reinfestation is common; the medication should be taken again in 2 weeks. The medication will not affect rectal itching; it will eradicate the pinworms, and this takes time to accomplish. All family members should take the medication because cross-contamination frequently occurs.
What is the priority nursing intervention for a young infant who has an intravenous (IV) line in place after undergoing abdominal surgery?
Maintaining patency of the intravenous catheter and tubing. It is imperative that the nurse monitor the IV site and tubing for patency. Signs of obstruction or infiltration must be detected and, if needed, a new means of circulatory access must be obtained quickly. Oral fluids are not administered after abdominal surgery until peristalsis has returned. There is no reason to limit handling the infant as long as the IV site is not disturbed. Parent-infant contact should be encouraged. Although an accurate output record, which includes the number of voidings, is important, maintenance of the IV infusion is the priority.
An intravenous (IV) antibiotic is prescribed for a child with fever of unknown origin. Within 10 minutes of the antibiotic infusion, the child's face and neck are flushed but the remainder of the body is unchanged. The nurse checks the child's record. In light of this information, what will the nurse do?
Notify the primary healthcare provider after stopping the infusion. The child is exhibiting a common vancomycin reaction called red man syndrome or red neck syndrome. Flushing usually begins in the chest area and spreads upward to the neck and face, usually during the first 15 minutes of administration. This reaction is caused by a release of histamine, which results in vasodilation. If not treated, the syndrome can lead to circulatory collapse. The appropriate response is to stop the infusion and notify the primary healthcare provider. The provider will usually prescribe diphenhydramine hydrochloride (Benadryl) and then resume the vancomycin infusion. Diphenhydramine will be administered before each vancomycin dose, and the infusion will be set at a slower rate. Normal temperature is 98.6° F (37° C). It is not necessary to administer acetaminophen for a temperature below 100.4° F (38° C). The child's laboratory results indicate a bacterial infection. Protective (or reverse) isolation is not necessary. Increasing the vancomycin infusion rate will exacerbate the reaction and lead to circulatory collapse.
An 8-year-old child is being given insulin glargine before breakfast. What is the most appropriate information for the nurse to give the parents concerning a bedtime snack?
Offer a snack to prevent hypoglycemia during the night Insulin glargine is released continuously throughout the 24-hour period; a bedtime snack will prevent hypoglycemia during the night. Providing a snack when signs of hyperglycemia are present is unsafe because it intensifies hyperglycemia; if hyperglycemia is present, the child needs insulin. Because insulin glargine is a long-acting insulin, bedtime snacks are recommended to prevent a hypoglycemic episode during the night. When hypoglycemia develops, the child will be asleep; the child should eat the snack before going to bed.
Osmotic diuretics Loop diuretics Potassium Sparing
Osmotic diuretics, such as mannitol, increase the osmotic pressure of glomerular filtrate and thus decrease absorption of sodium; they are used to treat cerebral edema and increased intraocular pressure. Loop diuretics, such as furosemide, inhibit resorption of sodium and potassium in the loop of Henle; they are used for heart failure and pulmonary edema. Potassoim Sparing,, such as spironolactone, interfere with sodium resorption in the distal tubules, thus decreasing potassium excretion; they are used to treat cirrhotic ascites and pulmonary edema. Carbonic anhydrase inhibitors, such as acetazolamide, increase sodium excretion by decreasing sodium-hydrogen ion exchange. They are used to treat seizure disorders and open-angle glaucoma.
The healthcare provider prescribes mebendazole for a 4-year-old child with pinworms. For which expected response to the medication does the nurse teach the parents to be alert?
Passage of worms Passage of worms is the expected response because the medication causes the death of the worms. Neither the drug nor the worms cause intestinal bleeding. Transient diarrhea, not constipation, may occur. The medication may color the stool red, not yellow.
Which preparations use toxoids but not live viruses? A. Rotarix B. Varivax C. MMRII D. Pediarix E. Daptacel
Pediarix Daptacel PEDIARIX consists of diphtheria and tetanus toxoids plus inactivated bacterial components of pertussis, inactive viral antigen of hepatitis B, and inactivated poliovirus vaccine. DAPTACEL is a preparation consisting of toxoids plus inactive bacterial and viral components of diphtheria and tetanus toxoids and acellular pertussis vaccine. Rotarix, Varivax, and M-M-R II are preparations containing live viruses.
Methylphenidate has been prescribed for a 7-year-old child with attention deficit-hyperactivity disorder (ADHD) and is to be taken with meals. What rationale does the nurse provide for the parents about the timing of medication administration?
Ritalin depresses the appetite A side effect of methylphenidate is anorexia; it should be given during or immediately after breakfast. The absorption rate is not affected by the timing of when it is given. Oral mucous membrane irritation is not a side effect of methylphenidate. In a child of this age the parents are responsible for administering medications.
A toddler with cystic fibrosis has been hospitalized with bacterial pneumonia. The nurse determines that the child has no known allergies. What does the nurse conclude is the reason that the healthcare provider selected a specific antibiotic?
Sensitivity of the bacteria When the causative organism is isolated, it is tested for antimicrobial susceptibility (sensitivity) to various antimicrobial agents. When a microorganism is sensitive to a medication, the medication is capable of destroying the microorganism. The tolerance of the child of the particular antibiotic is unknown because up to this time the child has not exhibited any allergies. Bacteria are not selective. Although the healthcare provider may have a preference for a particular antibiotic, it first must be determined whether the bacteria are sensitive to it.
A nurse is teaching parents of toddlers about why children receiving specific medications should not receive varicella vaccines. Which medication will be included in the discussion?
Steroids Steroids have an immunosuppressive effect. It is thought that resistance to certain viral diseases, including varicella, is greatly decreased when a child takes steroids regularly. There is no known correlation between varicella and insulin. Because varicella is a viral disease, antibiotics will have no effect. There is no known correlation between varicella and anticonvulsants.
Which drug class may cause kernicterus in neonates?
Sulfonamides Sulfonamides may cause kernicterus in neonates. Salicylates may cause Reye syndrome. Tetracyclines may cause the discoloration of developing teeth. Glucocorticoids may cause growth suppression.
A 5-month-old infant is admitted with a diagnosis of respiratory syncytial virus (RSV) infection. The infant's condition suddenly deteriorates, and a dose of epinephrine is prescribed to relieve bronchospasm. For what side effect of the medication should the nurse assess the infant?
Tachycardia Epinephrine stimulates beta- and alpha-receptors; its actions include increasing heart rate and blood pressure and inducing bronchodilation. Increased blood pressure, not hypotension, is a potential side effect. Epinephrine relieves respiratory problems; it does not cause respiratory arrest. Epinephrine stimulates, not depresses, the central nervous system.
An intravenous injection of morphine sulfate, 2 mg, is prescribed for an 8-month-old infant weighing 15 lb 7 oz (7 kg). The recommended dose for an infant is 0.1 mg/kg. Why should the nurse question the prescription?
This amount of morphine sulfate is unsafe for an infant of this weight. The infant should not receive more than 0.7 mg of morphine per dose. A 2-mg dose is excessive, and the prescription should be questioned. Solve the problem with the use of ratio and proportion: First, convert pounds to kilograms using this conversion factor: 2.2 lb = 1 kg. This amount is contraindicated because it constitutes an overdose. All of the information that is needed to calculate the dosage is available. Morphine sulfate is safe for newborns in the correct dosage.
Which type of vaccines triggers the recipient's immune system to produce antitoxins?
Toxoid vaccines Toxoids are a nontoxic form of bacterial toxins that induce the formation of antitoxins by the recipient's immune system. Examples of these types of vaccines include tetanus toxoid and diphtheria toxoid. Both live and killed vaccines induce the body's immune system to produce antibodies, making the individual actively immune to the microbes. Specific immune globulins are high concentration of antibodies prepared from donated blood directed against specific antigens.
After 3 months of supplemental oral iron therapy, there is no significant increase in an adolescent's hemoglobin level. Iron dextran is prescribed. What is the best way for the nurse to administer this medication?
With the use of the Z-track method The Z-track injection method prevents seepage of iron dextran through the needle track, thereby limiting irritation of subcutaneous tissue and staining of the skin. The length of a transdermal needle is too short to reach a muscle; a 1.5-inch (3.8 centimeters) needle is required. Massage will force iron dextran into the subcutaneous tissue, causing irritation and staining. Although an injection may be uncomfortable, a local anesthetic is unnecessary.