Evolve Pediatric Drugs

A 1-year-old exhibits a runny nose and cough after being administered a vaccine via the intranasal route. Which vaccine may have been administered to the child?

Live attenuated influenza Live attenuated influenza vaccines administered intranasally may cause such mild side effects as a runny nose and cough. Rotavirus vaccines may cause a runny nose, but these vaccines are administered orally. Inactivated influenza vaccine is administered intramuscularly. Haemophilus influenzae type b vaccine is administered intramuscularly and may cause fever and local reactions.

Phenytoin 75 mg twice daily is prescribed for a school-aged child with a seizure disorder. What instruction will the nurse include when teaching the parents about activities to limit the consequences of long-term phenytoin therapy?

Provide oral hygiene, including gum massage and flossing of the teeth These procedures reduce the risk for gingival hyperplasia, a side effect of phenytoin. This drug is strongly alkaline and should be administered with meals to help prevent gastric irritation. Discoloration of the urine may occur during drug excretion; it does not cause physiologic problems. Avoiding overeating and overhydration may result in better seizure control.

What are the pharmacokinetic reasons for drug sensitivity in infants? Select all that apply.

Drug absorption Renal drug excretion Protein binding of drugs Hepatic drug metabolism

An infant with congenital heart disease is to be discharged with prescriptions for digoxin and furosemide. The nurse discusses the danger signs of digoxin toxicity with the parents. What danger sign requires a call to the healthcare provider?

Difficulty feeding with vomiting Vomiting and feeding issues are early signs of digoxin toxicity. Cyanosis is expected in a crying infant with heart disease because the energy expenditure exceeds the body's ability to meet the oxygen demand. Long naps are expected; infants routinely require several naps, and an infant with heart disease requires long rest periods. The pulse rate of an infant receiving digoxin should remain faster than 100 beats/min.

What is an important nursing assessment for a school-aged child who is undergoing long-term steroid therapy?

Frequent testing of stools for occult blood Because steroids decrease production of prostaglandins that have a role in protecting the stomach, gastrointestinal bleeding may occur; stools should be checked for frank and occult blood. Steroids do not cause pulse irregularities, mucus in the urine, or ulceration of mucous membranes.

A school nurse is teaching a 12-year-old child with recently diagnosed type 1 diabetes about the action of insulin injections. What statement indicates that the child understands how insulin works in the body?

Glucose is carried into cells, where it is used for energy Specialized insulin receptors on insulin-sensitive cells transport glucose through cell membranes, making it available for use. Insulin does not break down fats to release glucose, prevent glucose from being stored in the liver, or convert glucose into glycogen.

Which statements are true about fentanyl use in children? Select all that apply.

It is an opioid analgesic. Its dose must be reduced when given along with midazolam It can be used along with midazolam

The mother of an infant complains to the nurse, "My child is rejecting the oral medication because it tastes bitter." What suggestion should the nurse give to the mother?

Mix the medication with a teaspoon of sherbet Oral medications should be mixed with a teaspoon of sherbet or jelly to mask the bitter taste and make it palatable. Honey should not be given to infants because of the risk of botulism. Avoid mixing the medication in essential food items such as milk, formula, and orange juice because the child may reject that food later. A flavored frozen ice pop should be given after administering the medication but not before.

Which points should be included when the mother of an epileptic child is being counseled? Select all that apply.

The child should wear a medical alert bracelet, the parent should keep a journal of signs and symptoms before, during, and after seizures, The child should discontinue the drug immediately and the parent should notify the primary healthcare provider if rash develops

In what ways can a nurse prevent medication errors? Select all that apply.

Avoid using abbreviations and acronyms Minimize the use of verbal and telephone orders Check three times before giving a drug by comparing the drug order and medication profile

What are the goals of the Childhood Immunization Initiative Program? Select all that apply.

To reduce the costs of a vaccine To involve more federal agencies To improve vaccine delivery systems To prevent the occurrence of indigenous infections such as diphtheria, rubella, and measles

A nurse teaches the parents of a 4-year-old child who is to receive digoxin elixir twice a day at home about the basic principles regarding its administration. What statement indicates to the nurse that they need further teaching?

We should give the digoxin twice a day, at breakfast and dinner Doses given at breakfast and dinner will not be spaced equally; the child should be given digoxin (Lanoxin) at 12-hour intervals. The sweetened elixir may cause tooth decay; it should be directed to the side and back of the mouth, and the teeth should be brushed after each administration. Digoxin should be given on an empty stomach 1 hour before a meal or 2 hours after. Some of the medication may be absorbed before the child vomits, so a second dose could result in an overdose.

When considering the side effects of dactinomycin and doxorubicin therapy, the nurse can suggest to the parents of a child receiving these medications that the child should take which precaution?

wear a baseball cap Antineoplastic drugs exert their effect on rapidly dividing tissues such as hair follicles, resulting in alopecia. Eating regular meals, avoiding dairy products, and wearing certain types of clothing are not related to the side effects of the antineoplastics that are being used.

When will a nurse plan to administer pancrelipase to a child with cystic fibrosis?

with meals and snacks Pancrelipase must be taken with food and snacks because it is essential for the digestion of nutrients. The enzyme is ineffective when taken without food; it is contraindicated at any other time.

Which strategies should be used to reduce pain during or after vaccination? Select all that apply.

Applying topical anesthetic Providing tactile stimulation Holding the child upright during vaccination

Which immunosuppressant drug interacts with allopurinol and may cause bone marrow suppression in children?

Azathioprine When used with allopurinol, azathioprine may cause bone marrow suppression in children. Tacrolimus should be administered only after a careful assessment of a child's kidney functioning, history of past anaphylactic reactions, and availability of resuscitative equipment. The functioning level of various systems must be assessed before administering cyclosporine because this drug has a toxic effect on numerous organs. Baseline vital signs including weight should be assessed before administering muromonab-DC3 because of the potential risk for fluid retention.

Which criteria should a nurse assess before preparing to discharge a pediatric client after the administration of conscious or moderate sedation? Select all that apply.

Check if gag reflexes are intact, check if pain and ambulation are at a base level, check if an adult is accompanying the child and can remain with him or her for at least two half-lives of the drug

The nurse is preparing to administer a vaccine to a child. Which conditions, if present, would allow for the safe administration of the vaccine? Select all that apply.

Current Antimicrobial Therapy, Mild to Moderate local reactions, Recent exposure to infectious diseases A vaccine can be safely administered even if the child is on any antimicrobial therapy or develops a mild to moderate local reaction. Recent exposure to an infectious disease is not a contraindication. A vaccine is contraindicated if the child has moderate to severe illness with or without fever or develops an anaphylactic reaction.

DTaP vaccines are contraindicated when prior DTaP vaccination caused which of the following side effects? Select all that apply.

Immediate anaphylactic reaction Encephalopathy within seven days

A 4-year-old child is to be treated with intravenous immunoglobulin (IVIG) for Kawasaki disease. Before administration of the IVIG, what action(s) will the nurse take? Select all that apply.

Start an intravenous line, Have the parents sign permission for blood product administration IVIG is administered intravenously, so an IV line would be required. Because IVIG is a blood product, the parents will need to sign the appropriate permission form. A cardiac monitor is not required. The child does not need to be on nothing-by-mouth status. Common side effects include headache and kidney issues. Shortness of breath and back pain may be reported. IVIG is not an antibiotic. The parents should be asked about reactions to previously administered blood products.

An 8-year-old girl who is receiving methotrexate and undergoing cranial radiation is very weak. Her mother asks the nurse whether she may give her daughter vitamins. How does the nurse respond?

That won't be possible. Vitamins interfere with the action of methotrexate. Many vitamin supplements contain folic acid, which negates the action of methotrexate, a folic acid antagonist. Vitamin therapy is contraindicated, so the nurse would not try to obtain a prescription, and vitamins will not be prescribed after the lab reports have come back. Although vitamins contribute to well-being, stating that the client won't feel any better does not answer the question.

After reviewing the immunization record of a 4-year-old child with acute bronchitis and mild febrile illness, the nurse notices the need for a consecutive vaccination of DTaP. What advice should the nurse give to the child's mother?

The child needs to receive another Tdap vaccine. The nurse should advise the mother that the child needs to receive the consecutive dose of Tdap in accordance with the immunization schedule. The DTP vaccine should not be administered when the child's DTaP vaccination has already been started. Children who are not fully immunized against pertussis do not receive a single dose of Tdap; the nurse should not advise immediate immunization against pertussis. Tdap may be administered in the presence of acute bronchitis associated with mild febrile illness.

Which nursing interventions should the nurse perform during the administration of a medication to make the procedure more acceptable to school-aged children? Select all that apply.

Providing outlets for the child to release any aggression and anger Explaining to the child why the medication is necessary Teaching the child the relationship between the use of medication and its effect on the body

Which statement is true regarding drug absorption in infants?

Absorption of drugs through the intramuscular route is rapid. Blood flow through the muscle is fast during the infancy; therefore, intramuscular absorption is rapid, more so than in neonates and older children. Acid-labile drugs have increased absorption because infants have low gastric acidity until 2 years of age. Absorption of drugs is not dependent on gastric emptying. This is because delayed gastric emptying for the drugs absorbed through the stomach results in faster absorption, while that in the intestine results in delayed absorption. The stratum corneum of the skin in infants is very thin, and the blood flow is much faster through it than in older children and adults. Therefore, transdermal drug absorption is much faster in infants than in children.