CHAPTER 4 ATI: PHARM

A 2-year-old is about to receive treatment for an ear infection by intramuscular injection. To assure effective, safe treatment, what factors must the nurse consider? (Select all that apply.)

the child's body surface area the child's weight

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.)

the name of the drug what the medication is being taken for how the drug works adverse effects

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 acheive which safety related nursing goal?

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

A pregnant client asks the nurse about what medications are safe during pregnancy. Which statement is correct?

"It is safe to take any medication in the pregnancy risk category A."

A pediatric client is admitted to the hospital. The nurse weighs the client and expresses the weight as:

10.1 kilograms.

A 12-year-old is being discharged from the hospital after major surgery. The client will be taking two medications at home for an extended period. The nurse who is discharging the client should provide medication teaching specifically to:

both the child and his mother regarding all medication issued.

What factors affect drug absorption in neonates? (Select all that apply.)

delayed gastric emptying increased gastric pH irregular gastric emptying

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.

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

What is the total water body percentage in infants?

80%

Which is the best area to place oral medications in infants?

Inner aspect of the cheek

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?

vastus lateralis muscle

A 5-year-old needs an IM injection. The least painful and most effective injection site would be the:

ventrogluteal muscle.

The exact dose of a medication for a pediatric client is based on what parameter?

weight

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

An infant, diagnosed with asthma, has been prescribed nebulized bronchodilators and corticosteroids for use at home. The nurse's health education for the parents should prioritize which area of focus?

the technique for correct administration of the medications in the home

The nurse is to administer an intramuscular medication to a 2-year-old toddler. The nurse uses:

the vastus lateralis muscle as the site for administration.

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?

thigh

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

The nurse is administering an injection to a toddler who is screaming, kicking, and trying to bite the nurse. After the injection is over, what is the best statement by the nurse?

"I know that was not very comfortable for you. Let's go to the prize drawer and get something."

The pediatric nurse is caring for a child who weighs 44 pounds. The health care provider has ordered methylprednisolone sodium succinate, 0.03 mg/kg/d IV in normal saline. How many milligrams of medication will the nurse prepare?

0.6

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

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.

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 lower drug dosages or an increased interval between doses is scheduled.

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.

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?

Allow the child to pick which arm the injection will go in.

When preparing to administer a tablet by mouth to a hospitalized 4-year-old child, what can the nurse do to enlist cooperation of the child to take the medication while supporting autonomy?

Ask the child if the child would prefer the liquid form of the medication.

What legislation has been put in place to ensure that proper drug testing is done on medication prescribed to the pediatric population?

Best Pharmaceuticals for Children Act

The nurse is aware that CNS adverse effects of medications given to infants are higher because of what immature function?

Blood-brain barrier

The nurse knows that pharmacodynamics across the lifespan are affected by what variables? (Select all that apply.)

Body composition Genetic makeup Immature organ systems

Which statements are true regarding pharmacodynamics and the pediatric client? Select all that apply.

Body composition is a cause of pharmacodynamic variability in the pediatric client.

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?

Calculate the drug dosage based on the child's BSA.

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?

Communicate with the child at the appropriate developmental level.

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.)

Describe the intended effect of regulating the heart rate. Speak to both adolescent and parents. Outline the time and frequency of each medication. Answer questions the adolescent may have.

Which statements regarding pharmacokinetic responses are true when considering the pediatric client? Select all that apply.

Drug absorption is affect by gastric motility. By age 12, children have grown and matured to mimic responses similar to adults. Children have more total body of water than adults.

The nurse is administering amoxicillin drops to an 8-month-old child. What technique of administration will be effective for this child?

Gently squeeze the child's cheeks to open the mouth, and then place the drops in the buccal pouch.

The nurse must start an IV on a 4-year-old child. What sites would be best for IV placement in this child? (Select all that apply.)

Hands Feet Antecubital fossa

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?

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

Which factors should the nurse consider regarding the elimination of medications prescribed to pediatric clients? Select all that apply.

Immature renal function A reduced glomerular filtration rate

Suppositories are a very appropriate method of medication delivery in what age group?

Infant

An infant with a seizure disorder who must take phenytoin (Dilantin) is at risk for developing toxic levels of the medication. This is because of what immature organ function?

Liver

The nurse is aware that the use of antidepressants in adolescents is associated with what issue?

Suicide

A 14-year-old has been diagnosed with a seizure disorder necessitating long-term treatment with an oral anticonvulsant. What principle should guide this child's medication management in the home?

The child should be encouraged to manage medications but with oversight from the parents.

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?

The dose should be adjusted to achieve and maintain therapeutic drug levels.

A 3-year-old child is being treated with dilantin (Phenytoin) for epilepsy. Dilantin levels indicate that therapeutic levels are not being achieved. What does the nurse determine may be the foundamental cause of the nontherapeutic drug levels?

The drug is more rapidly metabolized in children.

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 Schedule and duration of administration Description of the intended therapeutic drug effect

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.

What topics are important for the nurse to share with an adolescent related to self-care and medication administration? (Select all that apply.)

Use of acne medications Adverse effects of prescribed medications Birth control pills and other drug interactions

The nursing student is preparing to administer an IM injection to a 7-month-old infant. What is the best site for injecting a medication into an infant?

Vastus lateralis

Which child would the nurse categorize as being an infant?

a child who is 9 months old

The client is a 5-year-old child prescribed a bitter-tasting liquid medication. To best aid in having the child take the medication, the nurse:

provides a flavored ice pop (Popsicle) first

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.

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?

body surface area

A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. The nurse will calculate the drug dosage using:

body surface area.

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?

highly permeable skin tissue

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.

The nurse is to administer an intravenous medication to an infant and needs to start a peripheral intravenous site. The nurse chooses the best site to use as:

in front of the pinna of the ear.

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.

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 oral location?

in the infant's cheek

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:

is 18 months old.

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

metabolism

To promote a positive outcome when administering drug therapy to a child, what type of knowledge should the nurse have?

normal growth and development

The nurse administering pediatric medications understands that it is important to double check each calculated dose for accuracy. Who is responsible for ensuring the accuracy of a prescribed drug dose before it is administered

nurse administering the drug

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:

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

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:

placing the drops in the buccal pouch.