Pharm 220 Chapter 4 Quiz

The nurse teaches a parent the importance of administering appropriate dosages of acetaminophen when the client's infant has a fever. What information should the nurse provide to this client? Select all that apply. - "Infant's and children's doses should be based on their weight or age." - "It is important to give the right dose to prevent toxic effects of the medication." - "Children's dosages will change with time as they grow." - "In most cases, infants cannot be given medications because of their immature organs." - "An infant's dose of acetaminophen is about ½ of an adult dose."

- "Infant's and children's doses should be based on their weight or age." - "It is important to give the right dose to prevent toxic effects of the medication." - "Children's dosages will change with time as they grow." Pg. 71

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? -0.65 - 0.6 -6.5 -6

- 0.6 1lb/2.2kg = .45lbs per kg .45 x 44lbs= 20kg 20kg x .03mg/kg/d= .6 Pg. 72

At what age do children have the same pharmacokinetic response as an adult? -15 years of age -8 years of age -5 years of age - 12 years of age

- 12 years of age Pg. 72

The nurse is to administer an off-label medication to a premature infant. To check for an appropriate dose for this client, the nurse refers to - The Food and Drug Administration Web site -The Physician's Desk Reference - A pediatric drug reference - Information provided by the manufacturer

- A pediatric drug reference PG. 75 -For pediatric dosages, the nurse refers to a pediatric drug reference. The other references will provide only label dosage information for pediatric clients.

The nurse is administering a drug metabolized in the liver to an infant. Because of the immaturity of the infant liver, what does the nurse determine should be done for dosing of this drug? -Ensure that a higher drug dosage is given because the liver will rapidly metabolize the drugs. - Ensure that lower drug dosages or an increased interval between doses is scheduled. -Inform the health care provider that drugs metabolized in the liver should not be used for an infant. - Have the pharmacy lower the dose but decrease the interval between dosages.

- Ensure that lower drug dosages or an increased interval between doses is scheduled. Pg. 73

The nurse is caring for a 7-year-old hospitalized client who is taking several different medications. The nurse educates the family about all of the medications being administered in order to best achieve which safety related nursing goal? -Families should be aware of all the medications given so that they can check their bill when the child is discharged. -Families need to understand the importance of the different classifications and actions of the drugs administered. - Families become active partners with the rest of the health care team in preventing medication errors. -Families should be aware of medications that the child is taking so that they can administer them if necessary

- Families become active partners with the rest of the health care team in preventing medication errors. PG.75

The nurse is instructing a mother in applying a topical medication to her infant's diaper area. The nurse instructs the mother to place the cream only on the affected area and use it sparingly. These instructions are necessary because of what physiologic characteristic of neonates? -abnormally strong muscle contractions - small percentage of total body water of neonates as compared to adults -high blood flow to the skeletal muscles - highly permeable skin tissue

- highly permeable skin tissue Pg. 74

A nurse is going to administer medication to an infant using a medicine dropper. The best method is to open the child's mouth by gently squeezing the cheeks and placing the drops: - in the buccal pouch. - under the tongue. -on top of the tongue. -at the back of the mouth.

- in the buccal pouch. Pg. 74

A pediatric nurse is caring for several clients. Which client has reached the developmental milestone that will maximize the chances of the medication therapy being pharmacokinetically effective? -the 5-year-old who can print their name - the 12-year-old showing signs of puberty - the 22-month-old who has been walking independently for 2 months - the 8-year-old who plays the piano

- the 12-year-old showing signs of puberty Pg. 72

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? -"I would rather have my medication in a liquid." -"Please don't give me a shot. Blood leaks out when I have a shot." -"I don't want to be without my mother." -"I hate getting shots. The last time I got one it hurt so bad."

-"I hate getting shots. The last time I got one it hurt so bad." Pg. 74

The pediatric nurse is precepting a new graduate on the unit. When administering medications, the new graduate draws up an oral medication in a syringe used for injections. What is the best response by the preceptor? - "It really does not matter what syringe is used. They are all the same." -"It is very important to use an oral syringe when giving oral medications so that it is not given by the incorrect route." -"Since we don't have any oral syringes on the floor, go ahead and use this syringe." -"Don't you know that you cannot use this syringe? It is only for shots."

-"It is very important to use an oral syringe when giving oral medications so that it is not given by the incorrect route." PG. 74

The nursing student incorrectly calculated a pediatric medication that should read 0.12 mg. The student calculated 1.2 mg and stated to the instructor, "It was only off by a decimal point. I got the numbers correct." What is the best response by the instructor? -"Why don't you see the significance of your mistake? You are going to kill someone!" -"Pediatric dosages must be accurate because even small errors can cause adverse effects, toxicity, or death." - "Until you can do correct drug dosage calculations, you will not be able to take care of pediatric clients." -"Yes, you did get the numbers correct and it is not a big problem. The dose is still small."

-"Pediatric dosages must be accurate because even small errors can cause adverse effects, toxicity, or death." Pg. 73

A toddler has been prescribed a liquid anti-epileptic medication. Following discharge from the hospital, the toddler has experienced an increase in seizure activity. The question the nurse asks that provides the most information is -"Does your child spit out the medication?" "Are you giving the prescribed dose of the medication to your child?" -"What difficulties have you experienced giving the medication to your child?" "Were you able to get the prescription filled?" -"Does your child spit out the medication?" - "Are you giving the prescribed dose of the medication to your child?"

-"What difficulties have you experienced giving the medication to your child?"

The nurse is aware that renal function of a child reaches that of an adult at which age? -5 years -15 years -10 years -2 years

-2 years Pg. 73

What is the total water body percentage in adults? -95% -60% -50% -80%

-60% Pg.72

What is the total water body percentage in infants? -95% -60% -50% -80%

-80% Pg.72

The nurse is checking a drug label prior to administering a medication to a child, but the drug label does not include a recommended pediatric dose. What should the nurse do to find this information? -Access a computerized pharmacology database. - Discuss the situation with another nurse. -Call and have the supervisor obtain a drug label. -Call and inform the prescriber that the medication will not be given until this information is on the label.

-Access a computerized pharmacology database.

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? -Administer the medication in the infant's vastus lateralis with a 25-gauge needle. -Administer the medication in the vastus lateralis with a 20-gauge needle. -Administer the medication in the dorsogluteal with a 25-gauge needle. -Administer the medication in the deltoid muscle with a 20-gauge needle. Most appropriate site with smallest needle

-Administer the medication in the infant's vastus lateralis with a 25-gauge needle. Pg. 74

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? - Allow the toddler to draw up the medication with supervision. -Allow the toddler to hold the medication cup if able. -Teach the toddler how the medication will help the infection. -Teach the toddler why taking the medication regularly is important.

-Allow the toddler to hold the medication cup if able. Pg. 74

The nurse is aware that CNS adverse effects of medications given to infants are higher because of what immature function? -Liver function -Peripheral nervous system function -Renal function -Blood-brain barrier

-Blood-brain barrier Pg. 72-73

Which statements are true regarding pharmacodynamics and the pediatric client? Select all that apply. -Excretion and its impact on the client are influenced by the route of ingestion. -The immune system of the pediatric client can affect drug absorption. -Body composition is a cause of pharmacodynamic variability in the pediatric client. -Medication effectiveness is influenced by water, electrolyte, and protein levels. -Genetics and nutrition have little impact on the target cell sites and protein receptors.

-Body composition is a cause of pharmacodynamic variability in the pediatric client. -Medication effectiveness is influenced by water, electrolyte, and protein levels. Pg. 72

The nurse is preparing to administer an oral medication to a toddler. To elicit cooperation from the child, what should the nurse do before administering the medication? -Tell the child if he or she does not cooperate, you will obtain help to hold him or her down. -Communicate with the child at the appropriate developmental level. - Communicate with the parent, not the child. - Tell the child that he or she can get a toy if good.

-Communicate with the child at the appropriate developmental level. Pg. 74

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? -Avoid intravenous administration of drugs whenever possible. -Record drug administration in both the nurse's notes and the medication administration record (MAR) -Have nurses check their math calculations with a colleague before administering a drug. -Ensure that a full assessment takes place no more than 30 minutes before giving a drug.

-Have nurses check their math calculations with a colleague before administering a drug. Pg. 71

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)? -The blood-brain barrier will block the passage of drugs from the blood to the CNS. -The blood-brain barrier is not present until 4 months of age. -In neonates, the blood-brain barrier is poorly developed. -Effects of the drug on the neonate's CNS will be muted.

-In neonates, the blood-brain barrier is poorly developed. Pg. 72-73

Suppositories are a very appropriate method of medication delivery in what age group? -Infant -Toddler -Preschooler - School age

-Infant PG. 73

Which is the best area to place oral medications in infants? -Inner aspect of the cheek -Between the cheek and gums - Under the tongue - Back of the tongue

-Inner aspect of the cheek PG.74

What is the best device for administering oral medications to an infant? -Calibrated teaspoon -Plastic medicine cup -Feeding nipple -Oral syringe

-Oral syringe PG. 74

The nurse is aware that the use of antidepressants in adolescents is associated with what issue? Pg. 76 -Bulimia -Anorexia nervosa -Suicide -Schizophrenia

-Suicide Pg. 76

The nurse is administering medications to a 2-year-old child with impaired renal function. What does the nurse understand about the dosage of medication for this child? -Only medications not excreted through the urine should be administered to this child. -The dose should be adjusted to achieve and maintain therapeutic drug levels. -The dose should be increased to achieve and maintain therapeutic drug levels. - The medication should be used in a half-dose so that the child will not become nephrotoxic.

-The dose should be adjusted to achieve and maintain therapeutic drug levels. PG. 71 -Drug elimination requires a functioning renal system, and its effectiveness depends on glomerular filtration rate, tubular reabsorption, and maturity of the renal system. In children with impaired renal function, drug dosage should be altered to achieve and maintain therapeutic drug levels.

An 8-year-old is going home on medication for a chronic condition. The nurse preparing to review the discharge instructions with the mother should include what basic information and/or instructions to help minimize the child's risk for injury? (Select all that apply.) -The drugs' potential side effects -Description of the intended therapeutic drug effect -The cost of the drugs prescribed -References to books on teaching children about medicines -Schedule and duration of administration

-The drugs' potential side effects - Description of the intended therapeutic drug effect -Schedule and duration of administration Pg. 74-75

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? -The infant's skin has greater permeability than that of an adult. -There are decreased absorption rates of topical drugs in infants. - The infant's skin is generally softer than that of an adult - There is less body surface area to be concerned about.

-The infant's skin has greater permeability than that of an adult. Pg. 72

Which child would the nurse categorize as being an infant? -a child who is 3 weeks old -a child who is 18 months old -a child who is 9 months old -a child who is 15 months old

-a child who is 9 months old Pg.71 -Infancy is considered to span the time from 4 weeks of age to 1 year of age. Considering this accepted definition, none of the other options are correct.

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.) -adverse effects -when the child feels better, the child can stop the medication -what the medication is being taken for - the name of the drug -how the drug works

-adverse effects -what the medication is being taken for - the name of the drug -how the drug works PG.74-75

The pediatric nurse is caring for clients of different acuity. Which child will the nurse determine has the greatest risk for developing medication toxicity? -a 13-month-old prescribed ampicillin - a 9-month-old prescribed acetaminophen -an 8-month-old prescribed phenytoin - a 6-month-old prescribed digoxin

-an 8-month-old prescribed phenytoin Pg. 72

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

-ask if the child would like to take the medicine in a cup or through an oral syringe. Pg.74

A 2-year-old client is diagnosed with stomach flu and is suffering from vomiting and diarrhea. What is the most important factor in determining the correct dosage for his infection? - past experience -age -body surface area -adult dosage

-body surface area Pg. 71

What factors influence the unique nature of drug distribution in pediatric clients? Select all that apply. -immature liver function in young children -the relative lack of antibodies in children's immune systems -children's high percentage of body water -the unique characteristics of the blood-brain barrier - differences in protein binding

-children's high percentage of body water Pg. 72

What factors influence the unique nature of drug distribution in pediatric clients? Select all that apply. -differences in protein binding -immature liver function in young children -children's high percentage of body water - the unique characteristics of the blood-brain barrier -the relative lack of antibodies in children's immune systems

-differences in protein binding -immature liver function in young children -children's high percentage of body water - the unique characteristics of the blood-brain barrier -the relative lack of antibodies in Pg. 72

A nurse is preparing to calculate a medication dose for a toddler who requires antibiotic therapy. In addition to knowing the child's weight, what other data should the nurse assess for? -ethnicity -body mass index (BMI) -height -developmental stage

-height Pg. 71

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: -immature liver and kidney function in infants and children. - increased body surface area relative to body volume in infants and children. - increased heart rate and subsequently rapid drug distribution among infants and children. - the inability of infants and children and describe symptoms of adverse drug reactions.

-immature liver and kidney function in infants and children. Pg. 72

What physiologic characteristic of infants is responsible for medications being absorbed differently in this age group when compared to older children and adults? -irregular gastric emptying -low gastric pH -increased permeability of the GI tract -increased bowel motility

-irregular gastric emptying Pg. 72

The nurse is working in a pediatric Emergency Department and uses caution when administering medications. The client most at risk for a medication error is the client who: -has a minor injury. - is being admitted to the pediatric unit for observation. -is 18 months old. -demonstrates a decrease in weight of 2 pounds due to vomiting.

-is 18 months old. Pg. 73 -The client most at risk for a medication error is the client younger than 2 years. Other clients at risk would be ones whose weight is not documented and who are seriously ill.

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

-metabolism Pg. 73

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: - have the mother hold the child firmly and sooth him while the drugs are administered. -teach the boy fact that he will feel much better after he takes his medications. - insert a central intravenous line. -offer a choice between liquid and chewable medications, if possible.

-offer a choice between liquid and chewable medications, if possible. PG. 74

A nurse is having difficulty administering a bitter drug to a 5-year-old child. The nurse should: -offer the child a flavored ice chip or ice pop prior to administering the drug. -involve the child in a play therapy session, and then tell the child that the medicine is candy. -give the drug in a pill form. -have the parent gently force the child's mouth open.

-offer the child a flavored ice chip or ice pop prior to administering the drug. Pg. 74

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: - putting the drops in a bottle nipple. - mixing the drops in a small amount of fluid. - adding the drops to the infant's formula. -placing the drops in the buccal pouch.

-placing the drops in the buccal pouch. Pg.74

The nurse is preparing to administer an intramuscular injection to an 8-month-old infant. Which site would the nurse select? -rectus femoris -deltoid -vastus lateralis -dorsogluteal muscle

-vastus lateralis Pg. 74

A 5-year-old needs an IM injection. The least painful and most effective injection site would be the: -dorsogluteal muscle. -ventrogluteal muscle. -deltoid muscle. -rectus femoris muscle.

-ventrogluteal muscle. Pg. 74

To assure appropriate dosing, the nurse should obtain and document what information before administering any prescribed medication to a hospitalized 2 year old child diagnosed with pneumonia? -weight. - recent respiratory rate -recent temperature -degree of mobility

-weight. Pg.71

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? -If the child is going to play with the pocketbook, be sure the medications have child-proof containers. - Allow the child to play with the empty bottle containers so that the child won't play with the real ones. Eliminate accessibility to all medications and provide safe storage in the home. -Keep pocketbooks zipped so it won't be so easy for the child to get into it.

Eliminate accessibility to all medications and provide safe storage in the home.

What factors must the nurse consider as part of core drug knowledge when administering a medication to a pediatric client rather than an adult? (Select all that apply.) -The child's smaller skeletal frame -the child's immature body systems -Cognitive development age -weight

The child's smaller skeletal frame -the child's immature body systems -weight PG. 71

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? -The nurse is not allowed to administer medications to a child unless the parent is in the room. -Toddlers experience separation anxiety; having the parent nearby will help the child's cooperation. - Toddlers are able to take medications only from their parent. - Toddlers do not like anyone in the health care field and should not be subjected to procedures without parent

Toddlers experience separation anxiety; having the parent nearby will help the child's cooperation. Pg. 74

An antineoplastic medication is prescribed for a child. The nurse is verifying the dose is the recommended dose for a child with a certain body surface area (BSA). The child's BSA is 0.43 m2. The average adult BSA is 1.7 m2, and the usual adult dose of this medication is 40 mg. What is the recommended child's dose? (Round to the nearest whole number.)

pediatric dose = BSA/1.73 × adult dose. ?= .43m2 /1.73 x 40mg ?= .248 x 40mg Pediatric dose= 10mg Pg. 71