Chapter 6: Life Span: Children
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 don't want to be without my mother." "Please don't give me a shot. Blood leaks out when I have a shot." "I would rather have my medication in a liquid." "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." usually related to negative past experiences
A 1-month-old baby is severely ill and has been prescribed an injection as part of drug therapy. What is the preferred injection site? ventrogluteal muscle deltoid muscle vastus lateralis muscle dorsogluteal muscle
vastus lateralis muscle
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." "Your behavior was inappropriate and I hope that the next time you come to get your shots, you behave better." "You were a bad boy today. You were so good the last time you had your shots." "You cannot get a prize today because of your behavior, but next time, when you are better, you can get one."
"I know that was not very comfortable for you. Let's go to the prize drawer and get something."
An 8-month-old infant who is being treated for respiratory syncytial virus does not process her prescribed antiviral in the same way as an adult. Which of the following statements regarding infant pharmacokinetics is most accurate? The blood-brain barrier is impermeable to drugs until 6 months of age. Infants have a lower percentage of body water than older children and adults. The immature liver of infants makes drug metabolism less effcient. Decreased skin permeability makes topical medications less effective in young children.
The immature liver of infants makes drug metabolism less effcient.
A new graduate working on a pediatric unit is giving a 3-year-old an injection intramuscularly (IM). The nurse uses the dorsogluteal site and the child screams and says it hurts down his leg. What potential damage may have been done using this site for a preschooler? damage to the sciatic nerve damage to the perineal nerve damage to the pudential nerve damage to the posterior femoral nerve
damage to the sciatic nerve
The nurse administers an oral liquid medication to a child. The child spits out some of the medication. The nurse next: notifies the health care provider. administers additional medication. estimates the amount of medication lost. charts administration of the full dose of the medication.
estimates the amount of medication lost.
An 8-year-old is going home on medication after surgery. The nurse is preparing to review the discharge instructions with the mother. What basic information and/or instructions should be given to her to continue the drug therapy at home? (Select all that apply.) description of the intended therapeutic drug effect schedule and duration of administration generic and trade names of drugs refer to books on teaching children about medicines
generic and trade names of drugs schedule and duration of administration description of the intended therapeutic drug effect
Parents of a 10-year-old child with asthma are concerned about their child's lack of growth. The parents say that the child is much shorter than anyone in the class and want to know what could have caused the problem. What medication may this child have taken that contributed to the growth suppression? cephalosporin brethine (Terbutaline) phenobarbital glucocorticoid
glucocorticoid
The client is an active 30-month-old child. The nurse is to start an intravenous access to provide fluids and medications. The nurse starts the access site in the: scalp. antecubital fossa. foot. hand.
hand.
An antibiotic has been ordered for a toddler who is showing signs and symptoms of sepsis. The dose will be determined based on the child's body surface area (BSA). In addition to knowing the child's weight, the care team will also have to consider the child's: developmental stage. height. body mass index (BMI). ethnicity.
height
Pharmacokinetics involves the study of how medications are absorbed, distributed, metabolized, and eliminated. What are the two key factors that influence pharmacokinetics in children? body surface area height and weight body mass index age and size
height and weight ?
An infant's antiseizure medication has been ordered after careful consideration of the unique pharmacokinetics among this population. What characteristic of neonates has the greatest bearing on drug metabolism? the undeveloped state of the blood-brain barrier immaturity of the infant's liver increased gastric motility in infants the infant's undeveloped renal function
immaturity of the infant's liver
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: demonstrates a decrease in weight of 2 pounds due to vomiting. is being admitted to the pediatric unit for observation. has a minor injury. is 18 months old.
is 18 months old.
The nurse is administering regular insulin (Novolog) using a weight-based protocol. The nurse administers the insulin by using calculations performed by the: hospital pharmacist. computer system. health care prescriber. nurse with verification by a second nurse.
nurse with verification by a second nurse.
The nurse is preparing to administer an intramuscular injection to an 8-month-old infant. Which site would the nurse select? vastus lateralis deltoid dorsogluteal muscle rectus femoris
vastus lateralis
The client is a 5-year-old child with minor burns to the lower extremities. The client is prescribed a medication to be administered by the intramuscular route. The nurse administers the medication in this muscle site: deltoid dorsogluteal vastua lateralis ventrogluteal
ventrogluteal b/c injury to lower extremity, will not use vastus lateralis
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 immature body systems The child's smaller size weight age
weight the child's immature body systems The child's smaller size
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 A pediatric drug reference The Food and Drug Administration Web site Information provided by the manufacturer The Physician's Desk Reference
A pediatric drug reference
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? Call and inform the physician that the medication will not be given until this information is on the label. Call and have the supervisor obtain a drug label. Access a computerized pharmacology database. Ask another nurse what should be done.
Access a computerized pharmacology database.
The nurse is about to administer a Category C drug to a pregnant client. Which of the following describes this FDA category of risk potential during pregnancy? Animal studies show no risk, but there is inadequate documentation in humans. Animal studies show adverse affects but there are no adequate studies in humans. A risk has not been documented during pregnancy. There is evidence of human fetal risk, but the benefits may outweigh risks.
Animal studies show adverse affects but there are no adequate studies in humans.
The nurse is caring for a 3-year-old child admitted with pneumonia. The physician 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. Calculate the adult dosage, minus 25%. Contact the physician for clarification of the order. Calculate the dose according to the child's weight and a standard mg/kg dosage of the drug.
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? Tell the child that he or she can get a toy if good. 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.
Communicate with the child at the appropriate developmental level.
A pediatric client is admitted to the hospital. The nurse weighs the client and expresses the weight as: 22.2 pounds. 10,136 grams. 22 pounds 3 ounces. 10.1 kilograms.
10.1 kilograms.
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? deltoid muscle rectus femoris muscle vastus lateralis muscle dorsogluteal muscle
vastus lateralis muscle
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 "What difficulties have you experienced giving the medication to your child?" "Are you giving the prescribed dose of the medication to your child?" "Does your child spit out the medication?" "Were you able to get the prescription filled?"
"What difficulties have you experienced giving the medication to your child?" open ended questions
approach for the nurse to take when giving this medication? Administer the medication in the deltoid muscle with a 20-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 infant's vastus lateralis with a 25-gauge needle.
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. Ask the child if the nurse can give the injection now. Tell the child it won't hurt a bit. Tell the child to hold very still and be very quiet during the injection.
Allow the child to pick which arm the injection will go in.
What intervention by the nurse can reduce pain for a 4-year-old child who is to receive an intramuscular (IM) injection? Inject the site with 2% Lidocaine prior to administering the medication. Apply a topical anesthetic cream (EMLA) 30 minutes prior to administering the injection. Use an ice pack to numb the area prior to administering the medication. Use the dorsogluteal site to decrease the pain felt from the injection.
Apply a topical anesthetic cream (EMLA) 30 minutes prior to administering the injection.
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? Tell the child that the medication is candy. Tell the child that the medication has to be taken so that the child can leave the hospital. Tell the child that the child can sit on the parent's lap. Ask the child if the child would prefer the liquid form of the medication.
Ask the child if the child would prefer the liquid form of the medication.
The nurse is reviewing a client's current medication list at her first prenatal visit to determine if there should be any changes. The nurse is aware that some drugs may produce greater effects during pregnancy for which of the following reasons? Decreased serum albumin Decreased cardiac output Decreased estrogen Decreased renal blood flow
Decreased serum albumin Serum albumin levels fall during pregnancy because of plasma volume expansion. The decreased capacity for drug binding leaves more free drug available for therapeutic or adverse effects.
The client is a 7-year-old boy who has chronic kidney disease and is in the 5th percentile range on a growth chart. The client receives many medications and peritoneal dialysis every day, both managed by the parents. Siblings are in the home. The nurse is seeing the client and his mother in the home. Data supports the nursing diagnosis of: Deficient knowledge. Ineffective family therapeutic regimen management. Caregiver role strain. Delayed growth and development.
Delayed growth and development. The client is below the height and weight for a 7-year-old boy. Thus, the information supports delayed growth and development. Not enough information supports the other nursing diagnoses.
Many drugs prescribed to pediatric clients are used off label. What is the main reason that this occurs? The prescribing community realizes that the dosage of any drug can be safely calculated, even if there is not a recommended pediatric range given. Pharmaceutical companies have no financial incentive to seek FDA approval for a drug that is already on the market. Drug studies do not typically involve children. Physicians and prescribing providers do not need to follow drug label recommendations if their particular practice dictates the need to prescribe the medication.
Drug studies do not typically involve children.
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. Eliminate accessibility to all medications and provide safe storage in the home. Allow the child to play with the empty bottle containers so that the child won't play with the real ones. 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.
Ms. Masters is currently breast-feeding her 1-month-old daughter. She calls the physician's office because she is concerned about the severe diarrhea her daughter has had for the past week. You review current medications Ms. Masters is taking and discover she is taking aspirin three times a day for headaches. What advice would the nurse give to minimize any risk of adverse effects? Suggest that the mother limit the dosage of aspirin to just one tablet a day. Encourage the mother to take the aspirin just after having breast-fed or when the infant is expected to sleep for a long time and will not be feeding. Encourage the mother to take a nonaspirin product just after having breast-fed or when the infant is expected to sleep for a long time and will not be feeding. Make no suggestions regarding the use of aspirin, since aspirin is not known to have any effect on the breast-fed infant.
Encourage the mother to take a nonaspirin product just after having breast-fed or when the infant is expected to sleep for a long time and will not be feeding. aspirin has been associated with adverse effects in breastfeeding infants (ex. use acetaminophen)
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. 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. Inform the physician that drugs metabolized in the liver should not be used for an infant.
Ensure that lower drug dosages or an increased interval between doses is scheduled.
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. What is the importance of this education for the family? Families should be aware of all the medications given so that they can check their bill when the child is discharged. Families should be aware of medications that the child is taking so that they can administer them if the nurse is busy. Families become active partners with the rest of the health care team in preventing medication errors. 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.
The nurse is performing an assessment on a 7-year-old child in the clinic. The nurse observes the child's teeth are darkly stained. What information should the nurse obtain from the parent? Has the child taken a corticosteroid for treatment? Has the child taken a cephalosporin for treatment? Has the child taken tetracycline for treatment? Has the child taken a sulfonamide for treatment?
Has the child taken tetracycline for treatment? Tetracycline administered to a child between the ages of 4 months and 8 years will stain the permanent teeth.
A pregnant woman is diagnosed with a deep vein thrombosis in her left lower extremity. Which medication does the nurse anticipate administering to this patient? Coumadin Plavix Aspirin Heparin
Heparin
A pregnant woman arrives in the emergency department, reporting severe vomiting. The nurse assesses that the patient has tenting skin turgor, pale, dry mucous membranes, and ketones in her urine. What complication of pregnancy does the nurse suspect in this patient? Hyperemesis gravidarum Eclampsia Preeclampsia Gestational diabetes
Hyperemesis gravidarum Hyperemesis gravidarum is commonly called pernicious vomiting of pregnancy. Dehydration, ketonuria, and vitamin deficiency can be a complication.
The nurse is providing education about a liquid antibiotic medication to the parent of a toddler. The prescribed medication is one teaspoon three times a day for 10 days. Other young children are in the home. How should the nurse instruct the parent to proceed? (Select all that apply.) Keep the medication out of reach of any child. Discontinue the medication when the toddler feels well. Use a household spoon to measure the medication. Prepare the toddler at least half an hour before administration. Separate each dose by 8 hours.
Keep the medication out of reach of any child. Separate each dose by 8 hours.
When administering a continuous intravenous drip (IV) to a child, what special precaution should the nurse perform so that the child does not receive an excess of fluid? Administer a diuretic prophylactically. Use the smallest IV catheter possible. Place an armboard on the affected extremity to avoid dislodging the IV. Supply no more than 1 hour's worth of fluid.
Supply no more than 1 hour's worth of fluid. in case the pump malfunctions
The nurse is planning the care of a 10-year-old child with asthma who will be placed on long-term corticosteroids. What desired outcome would be indicated for this child? The child will not require hospitalization for complications from drug therapy. The child will not have an allergic reaction to the drug therapy. The child will achieve normal growth and development during drug therapy. The child will have a hemoglobin and hematocrit within normal range.
The child will achieve normal growth and development during drug therapy.
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 increased to achieve and maintain therapeutic drug levels. 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 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.
A 5-week-old infant is being administered a drug that affects the central nervous system. What characteristic of the infant's blood-brain barrier must be considered? The blood-brain barrier does not develop until 6 to 8 weeks of age. The blood-brain barrier will block the passage of drugs from the blood to the CNS. The blood-brain barrier does not develop until 4 months of age. The drug will affect the infant's CNS more readily than in an older child.
The drug will affect the infant's CNS more readily than in an older child.
When administering an oral medication to an infant whose primary diet is formula, why is it important for the nurse to be concerned about food and drug interactions? The formula decreases the acidity and decreases gastric pH and will affect drug absorption. The formula increases the acidity and decreases gastric pH and will affect drug absorption. The formula increases the acidity and increases gastric pH and will affect drug absorption. The formula decreases the acidity and increases gastric pH and will affect drug absorption.
The formula decreases the acidity and increases gastric pH and will affect drug absorption.
A 14-year-old girl 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 girl should manage her medication regimen independently. The girl should be encourage to manage her medications with with oversight from her parents. The girl's parents should pour and administer each dose of her anticonvulsant. The girl should liaise with a community-health nurse to ensure safe medication administration.
The girl should be encourage to manage her medications with with oversight from her parents.
An infant with recent seizures is being treated in the neonatal intensive care unit with phenytoin (Dilantin). The infant's low plasma protein levels during the first year of life have what consequence? The infant will have an increased rate of drug metabolism. The infant may have an increased risk of toxicity. The infant may experience impaired elimination of the drug. The infant may have an unpredictable drug response.
The infant may have an increased risk of toxicity.
A neonate has been prescribed a water-soluble drug for the treatment of an acute infection. The nurse recognizes that the percentage of body water in an infant is significantly higher than that of an adult. What implication does this have for pharmacotherapy of an infant? The drug will need to be emulsified before administration. The infant's fluid intake will be reduced before and after administration. The infant will have a fat-soluble drug substituted. The infant may require an increased dose of the drug.
The infant may require an increased dose of the drug.
A physician has ordered a drug for a pregnant woman to treat fetal tachycardia and congestive heart failure. What drug does the nurse anticipate administering? haloperidole (Haldol) Digitalis (Digoxin) Brethine (Terbutaline) Tenormin (Atenolol)
The risk for developing fetal hydantoin syndrome
The nurse is educating a patient who is attempting to get pregnant about the risk of taking phenytoin for her seizures during pregnancy. What concerns does the nurse convey to the patient? The risk for the development of of spina bifida The risk for developing fetal hydantoin syndrome The risk for developing Tay-Sachs disease The risk for developing Down's syndrome
The risk for developing fetal hydantoin syndrome
The Food and Drug Administration (FDA) has determined that some drugs are too dangerous for a woman to use during her pregnancy due to the potential harm to the fetus. Which of the following medications fall in the pregnancy risk category X? Select all that apply. Atorvastatin Tetracycline Lorazepam Methotrexate Warfarin Acetampnophen
Warfarin Methotrexate Atorvastatin Tetracycline and lorazepam are category D.
To gain a preschooler's cooperation to swallow an oral medication, the nurse's best approach would be to: 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. ask if the child would like to take the medicine in a cup or through an oral syringe. 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.
The nurse is administering a medication to a child. The nurse withholds the medication and obtains the data when the chart lacks the child's: body surface area. weight. vital signs within 4 hours. height.
based on the body surface area
The nurse is preparing to administer a medication to a pediatric client but does not see a child dose specified. How can a correct dose be determined from the adult dose? based on the water content of the child based on the child's age based on the weight of the child based on the body surface area
based on the body surface area
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? age past experience body surface area adult dosage
body surface area
An emergency department nurse is confirming that a child's ordered dose of IV analgesia is congruent with the body surface area (BSA). In order to calculate the child's BSA, the nurse must know which variables? (Select all that apply.) child's age in months child's percentage of body water child's height usual adult dose of the drug child's weight
child's height child's weight
The client is a 10-year-old child prescribed 0.5 mL of a vaccine to be administered intramuscularly. The setting is a one-day vaccination clinic, and no privacy can be provided. The nurse administers the vaccine in the muscle site: vastus lateralis. ventrogluteal. rectus femoris. deltoid.
deltoid
A nurse has viewed a bulletin from the FDA that has been posted in a children's hospital. The bulletin includes a warning about potentially adverse effects of a drug that has been used safely in adults. Differences between the effects of a drug in children and the effects of the same drug in adults reflect what aspect of pharmacotherapy? differences in pharmacodynamics in children differences in drug administration in children differences in drug adherence among children differences in drug absorption in children
differences in pharmacodynamics in children
A 4-year-old boy is postoperative day one following surgery for trauma suffered in a motor vehicle accident. The boy is in pain, and the nurse is preparing to administer a dose of hydromorphone syrup as ordered. To administer this drug, the nurse should use a(n): teaspoon. parenteral syringe with the needle removed. oral syringe. transparent, 2-ounce medication cup.
oral syringe.
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: adding the drops to the infant's formula. mixing the drops in a small amount of fluid. putting the drops in a bottle nipple. placing the drops in the buccal pouch.
placing the drops in the buccal pouch.
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: places the medication in a medicine cup instead of oral syringe provides a flavored ice pop (Popsicle) first mixes the medication in applesauce offers the child a choice about times to take the medication
provides a flavored ice pop (Popsicle) first numbs the taste buds
The clinic nurse is to administer a vaccine by the intramuscular route to an infant. Which muscle site may the nurse choose to administer this medication? (Select all that apply.) deltoid rectus femoris ventrogluteal dorsogluteal vastus lateralis
rectus femoris vastus lateralis
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.) what the medication is being taken for how the drug works adverse effects the name of the drug when the child feels better, the child can stop the medication
the name of the drug what the medication is being taken for how the drug works adverse effects
The nurse is to administer an intramuscular medication to a 2-year-old toddler. The nurse uses: a 45-degree angle when inserting the needle into the muscle. the vastus lateralis muscle as the site for administration. a 20-gauge needle for injection. a 1-inch needle for injection.
the vastus lateralis muscle as the site for administration.