PEDIATRIC SUCCESS PHARMACOLOGY CHAPTER 14

13. A child is going to start growth hormone therapy. Which of the following should the nurse include in the discharge teaching plan? 1. The child is expected to grow 3 to 5 inches during the first year of treatment. 2. The parents must measure the child's weight and height daily. 3. The parents must remember that once the growth hormone therapy is started, they will need to continue the therapy until the child is 21 years old. 4. There are no side effects from taking growth hormones.

13. 1. The expected growth rate with growth hormone therapy is 3 to 5 inches in the first year.

15. A child has been started on metoclopramide (Reglan) for gastric esophageal reflux disease. Which of the following should the nurse include in the teaching plan? 1. This drug increases gastrointestinal motility. 2. The drug decreases tone in the lower esophageal sphincter. 3. The drug prevents diarrhea. 4. The drug induces the release of acetylcholine.

15. 1. Metoclopramide (Reglan) is a gas trointestinal stimulant that increases motility of the gastrointestinal tract, shortens gastric emptying time, and reduces the risk of the esophagus be ing exposed to gastric content.

16. High-dose prednisone is given to a 5-year-old with leukemia as part of the treatment protocol. The nurse will monitor the child for which of the following? 1. Diabetes. 2. Deep vein thrombosis. 3. Nephrotoxicity. 4. Hepatotoxicity.

16. 1. One of the side effects of high-dose steroids can be diabetes mellitus. The child needs to be evaluated so prompt treatment can be initiated. The dia betes is self-limiting and after the steroids are discontinued should no longer be present. Other side effects include mood changes, hirsutism, trunk obesity, thin extremities, gastric bleeding, poor wound healing, hyper tension, immunosuppression, insomnia, and increased appetite.

49. A 10-month-old with heart failure weighs 10 kg. Digoxin (Lanoxin) is prescribed as 10 mcg/kg/day to be given every 12 hours. How much is given as each dose? 1. 10 mcg. 2. 50 mcg. 3. 100mcg. 4. 500 mcg.

2. 10 kg 10 mcg/kg/day 100 mcg 2 doses a day 50 mcg/dose.

11. A child has been receiving prednisone for the past 3 weeks, and the parent wants to stop the medication. What is the nurse's best response? 1. "There should be no problem in stopping the medication since the child's symptoms have gone away." 2. "It is dangerous for steroids to be withdrawn immediately." 3. "Your child may develop severe psychological symptoms when prednisone is stopped." 4. Stopping the prednisone will require serum blood work."

2. Abrupt cessation of long-term steroid therapy can cause acute adrenal insuffi ciency that could lead to death. Long term steroid use can cause shrinkage of the adrenal gland, which decreases the production of the hormone.

45. A child with cystic fibrosis is placed on an oral antibiotic to be given four times a day for 14 days. Which of the following schedules is the most appropriate for the child? 1. 8 a.m., 12 p.m., 4 p.m., 8 p.m. 2. 7 a.m., 1 p.m., 7 p.m. 12 midnight. 3. 9 a.m., 1 p.m., 5 p.m., 9 p.m. 4. 10 a.m., 2 p.m., 6 p.m., 10 p.m.

2. Antibiotics should be scheduled to maintain therapeutic blood levels and not interfere with the child's sleep. This schedule allows for dosing every 6 hours during the day and allows the child to get 7 hours of uninterrupted sleep.

29. A nurse is caring for a child with spastic cerebral palsy. Which of the following medications should be used for the treatment of spasticity? 1. Dexamethasone (Decadron). 2. Baclofen. 3. Diclofenac (Voltaren). 4. Carbamazepine (Tegretol).

2. Baclofen is used to treat the spasticity in cerebral palsy. It is a centrally acting muscle relaxant.

4. Morphine sulfate 2 mg IV q2h prn for pain is ordered for a 12-year-old who has had abdominal surgery. Which of the following is the most appropriate nursing action? 1. Administer the morphine sulfate using a syringe pump over 1 hour. 2. Encourage the child to do incentive spirometer every hour during the day and when awake at night. 3. Ask the physician to change the medication to Demerol (meperidine). 4. Administer the morphine sulfate with Benadryl (diphenhydramine) to prevent itching.

2. Because morphine sulfate can depress respirations and the child has just had abdominal surgery, deep breathing should be encouraged.

27. The nurse informs a parent of a teenager that the most effective treatment of acne is with which of the following medications? 1. Salicylic acid. 2. Benzoyl peroxide. 3. Chlorhexidine (Hibiclense). 4. Collagenase (Santyl).

2. Benzoyl peroxide inhibits growth of Propionibacterium acnes (a gram positive microorganism). It is effective against inflammatory and anti inflammatory acne.

36. A 22-lb child is to receive treatment for Kawasaki syndrome. The physician has or dered an intravenous infusion of gamma globulin 2 g/kg over 12 hours. Which of the following doses is correct? 1. 11 g. 2. 20 g. 3. 22 g. 4. 44 g.

2. Convert pounds to kilograms: 2.2 kg = 1 lb Divide 22 pounds by 2.2 kg 22 lb. ÷ 2.2 kg = 10 kg Calculate the dose: 2 g/kg = 2 g × 10 kg = 20 g

19. Chelation therapy is used to prevent organ damage from the presence of too much iron in the body as a result of frequent transfusions. Which of the following should a nurse anticipate to be prescribed in chelation therapy? 1. Dalteparin sodium (Fragmin). 2. Deferoxamine (Desferal). 3. Diclofenac (Voltaren). 4. Diltiazem (Cardizem).

2. Deferoxamine (Desferal) is an antidote for acute iron toxicity.

17. A nurse is administering cyclophosphamide (Cytoxan) to a child with leukemia. Which of the following actions by the nurse would be appropriate? 1. Monitoring serum potassium levels. 2. Checking for hematuria. 3. Obtaining daily weights. 4. Getting neurological checks every 4 hours.

2. Hemorrhagic cystitis is a major side effect of cyclophosphamide (Cytoxan); by checking the urine for blood, appro priate interventions can be made.

37. A 7-year-old is diagnosed with head lice. The physician has ordered lindane (G-Well) shampoo to be used once to treat the lice. The nurse knows that the shampoo is used only once for which of the following reasons? 1. Causes hypertension. 2. Associated seizures. 3. Associated with elevated liver functions. 4. Can cause alopecia.

2. Lindane (Kwell) with topical use is associated with seizures after absorption.

1. After sustaining a closed head injury, a child is admitted to the pediatric intensive care unit. The child is ordered to receive phenytoin (Dilantin) 100 mg intravenously for seizure prophylaxis. Which of the following interventions should be done when ad ministrating this drug? 1. Mix it in dextrose 5% in water and give over 1 hour. 2. Administer as an intravenous bolus using a syringe pump no faster than 50 mg/min. 3. An inline filter should not be used. 4. Monitor temperature prior to and after administration.

2. Phenytoin (Dilantin) should be given slowly (1-2 mg/kg/min) via pump. Rapid infusion may cause hypotension, ar rhythmias, and circulatory collapse.

54. A child who weighs 20 kg is to receive 8 g of gamma globulin for the treatment of idiopathic thrombocytopenia purpura. The order is to give the gamma globulin over 12 hours. The concentration is 8 g in 300 mL of normal saline. How many milliliters per hour will the child receive? 1. 12 mL/hr. 2. 25 mL/hr. 3. 50 mL/hr. 4. 40 mL/hr.

2. Take the total volume (300 mL) and divide it by the number of hours (12 hours) 300 mL 12 hours 25 mL/hr

40. A 15-kg child is started on amoxicillin/clavulanate potassium (Augmentin) for treat ment of cellulitis. The dose is 40 mg/kg/day, given three times a day. The nurse has a bottle of Augmentin that indicates there is 200 mg/5 mL. How many milliliters must the nurse draw up for each dose? 1. 2.5 mL. 2. 5 mL. 3. 15 mL. 4. 20 mL.

2. The dose is calculated by multiplying the weight by the milligrams. That re sult is divided by the three doses. The milligrams are then used to determine the milliliters based on the concentra tion of the drug. 40 mg × 15 kg = 600 mg/3 doses = 200 mg/dose The concentration of the drug is 200 mg/5 mL, so the answer is 5 mL

58. A nurse is caring for a child with cystic fibrosis. Which of the following should the nurse include in teaching the parents about administrating pancreatic enzymes? 1. The enzymes may be chewed or swallowed. 2. The capsules may be opened and sprinkled over acidic food. 3. Give the same amount of the medicine with meals and snacks. 4. Store the enzymes in the refrigerator.

2. When administrating enzymes to in fants, the capsule may be opened and sprinkled over an acidic food, such as applesauce or mashed fruit.

21. A child comes to the clinic for diphtheria, pertussis, and tetanus and inactivated po liovirus vaccines. The child has a temperature of 101°F (38.3°C). The nurse should take which of the following actions? 1. Withhold the vaccines, and reschedule when the child is afebrile. 2. Administer Tylenol, and give the vaccine. 3. Give the vaccine, and instruct the parent to give Tylenol every 4 hours for the next 2 days. 4. Have the physician order an antibiotic and give the vaccine.

21. 1. Because fever is a side effect of the vaccine, the immunization should be withheld as it would be difficult to determine if the fever was due to the vaccine or another febrile illness. Immunizations can be given when the child has a low-grade fever.

22. A child comes to clinic with a pediculosis infestation. The nurse instructs the parent to do which of the following to treat the problem? 1. Apply lindane (Kwell) to the scalp, leave it in place for 4 minutes, and then add water. 2. Apply chlorhexidine (Hibiclens) to the scalp with sterile gloves. 3. Apply terbinafine (Lamisal) as a thin layer to the scalp twice a day. 4. Apply collagenase (Santyl) to the scalp with cotton applicator.

22. 1. Lindane (Kwell) is the drug of choice because it is well absorbed by the cen tral nervous system of the parasite (lice) and results in death.

24. A child with a heart defect is placed on a maintenance dose of digoxin (Lanoxin) elixir. The dose is 0.07 mg/kg/day, and the child's weight is 16 lb. The medication is to be given two times a day. The nurse prepares how much digoxin (Lanoxin) to be given to the child? 1. 0.25 mg. 2. 0.37 mg. 3. 0.5 mg. 4. 2.5 mg.

24. 1. 0.25 mg.

9. A nurse is administrating vancomycin intravenously to a child and sets the pump to infuse the medication over 90 minutes. Which of the following adverse reactions is the nurse trying to prevent? 1. Vomiting. 2. Headache. 3. Flushing of the face, neck, and chest. 4. Hypertension.

3. "Red man syndrome" or "red neck syndrome" is flushing of the face, neck, and upper chest associated with too rapid an infusion of vancomycin. This can be prevented with infusing the vancomycin over 90 to 120 minutes and pretreating the patient with Ben adryl (diphenhydramine) prior to the infusion.

23. Amoxicillin (Amoxil) 250 mg by mouth every 8 hours is prescribed for a child who weighs 42 lb. The nurse knows that the safe pediatric dosage is 25 to 90 mg/kg/day. The nurse determines that: 1. The prescribed dose is too low. 2. The prescribed dose is too high. 3. The prescribed dose is within a safe range. 4. There is not enough information to determine the safe dose.

3. 750 mg/day is between 477.25 mg/day and 954.5 mg/day. The nurse first must determine what the safe dosage range is.

57. A nurse is caring for an 11-month-old who has received atropine to treat sinus bradycardia. The nurse knows that a common adverse reaction to atropine is which of the following? 1. Diarrhea. 2. Increased urine output. 3. No tears when crying. 4. Lethargy.

3. Atropine dries up secretions and also lessens the response of ciliary and iris sphincter muscles in the eye, causing mydriasis.

59. A child who has been diagnosed with enuresis has been started on oxybutynin (Ditropan). The nurse knows that common side effects of oxybutynin (Ditropan) are which of the following? 1. Increase in heart rate and blood pressure. 2. Sodium retention and edema. 3. Constipation and dry mouth. 4. Insomnia and hyperactivity.

3. Common side effects are constipation and dry mouth as the oxybutynin (Ditropan) has an atropine-like effect.

25. Ciprofloxacin (Cipro) 300 mg is ordered for a child with a urinary tract infection. The medication comes 250 mg/5 mL. The nurse has determined that the dosage prescribed is safe. How much of the medication will the nurse prepare to give to the child? 1. 1.2 mL. 2. 3 mL. 3. 6 mL. 4. 12 mL.

3. Desired over Available × Volume = amount to be given 300mg × 5 mL = 6 mL 250mg

52. Penicillin is given to a 2-year-old prior to dental work. The child weighs 22 lb. The order is for 25 mg/kg to be given 2 hours before the procedure. The penicillin comes in 250 mg/5 mL. How much of the medication will the nurse administer? 1. 2.5 mL. 2. 5 mL. 3. 10 mL. 4. 15 mL.

3. Determine the child's weight in kilo grams by dividing 44 lb by 2.2 (2.2 kg 1 lb). Then determine how many mil ligrams need to be given by multiplying the child's weight in kilograms by 25 mg. 44 lb 2.2 kg 22 kg 22 kg 25 mg 500 mg Use the formula: Desired over Available × Volume Desired dose 500 mg 5 mL 10 mL 250 mg

48. Which of the following is a toxic reaction in a child taking digoxin (Lanoxin)? 1. Weight gain. 2. Tachycardia. 3. Nausea and vomiting. 4. Seizures.

3. Digoxin (Lanoxin) toxicity in infants and children may present with nausea, vomiting, anorexia, or a slow, irregular, apical heart rate.

41. A child with hives is prescribed diphenhydramine (Benadryl) 5 mg/kg per day in di vided doses over 6 hours. The child weighs 40 lb. How many milligrams should the nurse give with each dose? 1. 4.5 mg. 2. 11.45 mg. 3. 22.75 mg. 4. 50 mg.

3. First convert 40 pounds to kilograms by dividing the pounds by 2.2 kg (2.2 kg 1 lb) 40 2.2 18.18 kg Multiply 5 mg by the weight (18.18) gives the amount of milligrams for 24 hours 18.18 kg 5 mg 90.9 mg/day Divide the total milligrams (90.9 mg) by 4, as that is the number of doses 90.9 mg 4 22.75 mg

10. The parents of an 8-year-old come to the clinic and ask the nurse if their child should receive growth hormone to boost short stature. Which is the nurse's best response? 1. "Growth hormone only works if the child has short bones." 2. "Can your child remember to take the pills every day?" 3. "Scientific evidence is required before growth hormone can be started in children." 4. "How tall do you think your child should be?'

3. Growth hormone is approved for use only in children to treat a documented lack of growth hormone.

14. The nurse is caring for a child with diabetes. There is an order for Humalog insulin for this child. The nurse knows that the onset of Humalog insulin is which of the following? 1. 1 to 2 hours. 2. 30 minutes to 1 hour. 3. 10 to 15 minutes. 4. 2 to 4 hours.

3. Humalog insulin is rapid-acting and has an onset of 10 to 15 minutes.

28. A nurse is caring for an adolescent female who is going to be treated with isotretinoin (Accutane) for acne. Which of the following does the nurse know is true about the medication? 1. The adolescent needs to apply a thin layer to the skin affected with acne twice a day. 2. The use of a tanning bed will be an added benefit to help dry up the acne. 3. The adolescent needs to have a pregnancy test done prior to starting treatment. 4. The adolescent needs to keep the lips moistened to prevent inflammation.

3. It is mandatory to have a pregnancy test done before starting treatment as spontaneous abortions and/or fetal ab normalities have been associated in pregnancy with the use of isotretinoin (Accutane).

18. A nurse is giving ifosfamide as chemotherapy for a child who has leukemia. Mixed in with the ifosfamide is mesna (Mesnex). The nurse knows that mesna is given for which of the following reasons? 1. Combination chemotherapy. 2. An antiarrhythmic. 3. Prevent hemorrhagic cystitis. 4. Increase absorption of the chemotherapy.

3. Mesna (Mesnex) is a detoxifying agen used as a protectant against hemor rhagic cystitis induced by ifosfamide and cyclophosphamide (Cytoxin).

3. A nurse is caring for an adolescent with diabetes. The nurse gives the adolescent NPH insulin at 0730. What time would the nurse most likely see signs and symptoms of hypoglycemia? 1. 0930 to 1030. 2. 1130 to 1430. 3. 1130 to 1930. 4. 1530 to 1930.

3. Peak time for NPH insulin is 4 to 12 hours.

44. A child in the emergency room is being treated with albuterol (Proventil) aerosol mist treatments for an acute asthma attack. She requires treatment every 2 hours. Which of the following adverse effects of the medication should the nurse expect? 1. Lethargy and bradycardia. 2. Decreased blood pressure and dizziness. 3. Nervousness and tachycardia. 4. Increased blood pressure and fatigue.

3. Potential side effects of this medication are stimulation of the central nervous system and cardiovascular system. Tachycardia is the most frequent side effect of albuterol (Proventil).

51. Administration of which of the following drugs is most important in treating an infant with transposition of the great vessels? 1. Digoxin (Lanoxin). 2. Antibiotics. 3. Prostaglandin E. 4. Diuretics.

3. Prostaglandin E is necessary to maintain patency of the patent ductus arteriosus and improve systemic arterial flow in children with inade quate intracardiac mixing.

35. A child has been started on sulfamethoxazole (Septra) for treatment of a urinary tract infection. How should the medication be given? 1. At breakfast and dinner. 2. With a snack. 3. With water. 4. With a cola beverage.

3. Sulfamethoxazole (Septra) should be administered with a full glass of water on an empty stomach. If nausea and vomiting occur, giving the drug with food may decrease gastric distress.

26. A nurse is caring for a child with congenital heart disease who is being treated with digoxin (Lanoxin). The nurse knows that which of the following needs to be included in the family's discharge teaching? 1. Make sure the medication is taken with food. 2. Repeat the dose of the medication if the child should vomit. 3. Take the child's pulse prior to administrating the medication. 4. Weigh the child daily.

3. The child's pulse should be monitored before each dose. The dose should be withheld according to the physician's parameters.

12. A child who has been diagnosed with hypothyroidism is being started on levothyrox ine (Synthroid). Which of the following should be included in the nurse's teaching plan about this medication? 1. The child will have more energy the next day after starting the medication. 2. Optimum effectiveness of the medication may not occur for several weeks. 3. The medication should be taken once a day at any time. 4. The medication should be taken with milk.

3. The drug works best when taken on an empty stomach; the patient should se lect a time each day when the stomach is empty. In children, just prior to bed may be the best time, as most children do not eat prior to bedtime.

2. The parent of a child who is being discharged from the clinic wants to know if there is a difference between Advil and ibuprofen, saying "I can buy ibuprofen over the counter at a cheaper price than the Advil that was ordered." What is the nurse's best response? 1. "Advil and ibuprofen are two different drugs with similar effects." 2. "There is no difference between the two medications, so you should use whichever one is cheaper." 3. "Similarities exist between the drugs, but you need to consult the physician about the specific order." 4. "Ibuprofen is usually cheaper, so you should use it."

3. This response answers the question and tells the parent the physician is the only one who can change a name brand to a generic drug.

30. After administrating a narcotic, the nurse will monitor the child for pain relief. Which of the following assessments should be a priority in addition to pain relief? 1. Respirations. 2. Bowel sounds. 3. Blood pressure. 4. Oxygen saturation.

30. 1. The primary purpose of administrating an opioid analgesic is to relieve pain. Side effects placing the child at great est risk are respiratory depression and decreased level of consciousness.

32. A physician has ordered amoxicillin (Amoxil) 500 mg intravenous piggyback every 8 hours for a child with tonsillitis. Which of the following actions by the nurse is appropriate? 1. Call the physician, and question the order because the route is incorrect. 2. Give the medication as ordered. 3. Call the physician because the dosing frequency is incorrect. 4. Call the physician, and question the dose of the drug.

32. 1. Amoxicillin is given only orally, so the order should be questioned.

34. Decongestant nasal drops are prescribed for a child with nasopharyngitis. The nurse should include which of the following instructions for the parents about the nasal drops? 1. "Do not use the drops for any other family member." 2. "Administer the drops as often as necessary until the nasal congestion subsides." 3. "Insert the dropper tip as far back as possible to make sure you get the medication in the nasal passage." 4. "You can save the drops for the next time your child has the same symptoms."

34. 1. The medication should not be shared because of the risk of spreading the in fection to another family member.

39. A 6-month-old is prescribed 2.5% hydrocortisone for topical treatment of eczema. The nurse instructs the parent not to use the cream for more than a week. What is the primary reason for this instruction? 1. Adverse effects, such as skin atrophy and fragility, can occur with long-term treatment. 2. If, after a week there is no improvement, then a stronger dose is required. 3. The drug loses its efficacy after prolonged use 4. If no improvement is seen after a week, an antibiotic should be prescribed.

39. 1. Hydrocortisone cream should be used for brief periods because it can thin the skin and cause skin breakdown.

6. A 2-year-old child has been prescribed amoxicillin (Amoxil) three times a day for treatment of pharyngitis. Which of the following statements by the parent indicates the parent knows how to give the medication? 1. "If I miss giving my child a dose at lunch, I will double up on the dose at night." 2. "I will give the medication at breakfast, lunch, and dinner." 3. "I know that amoxicillin (Amoxil) is a chewable tablet, but sometimes my child likes to swallow it whole." 4. "I will continue giving the amoxicillin (Amoxil) for 10 days even if my child's cough gets better."

4. A full course of the antibiotic must be taken to decrease the risk of resistance to the antibiotic or recurrence of the infection.

38. Each member of the family of a child diagnosed with pinworms is prescribed a single dose of pyrantel pamoate (Antiminth). Which of the following should the nurse teach the parents regarding administration of this drug? 1. Fever and rash are common adverse effects. 2. The medication kills the eggs in about 48 hours. 3. The drug may stain the feces red. 4. The dose may be repeated in 2 weeks.

4. As the first treatment kills the adult worms, a second treatment is done in 2 weeks to treat emerging parasites.

53. Which of the following is the most common adverse reaction from erythromycin? 1. Weight gain. 2. Constipation. 3. Mouth sores. 4. Nausea and vomiting.

4. Common adverse reactions to erythro mycin include nausea, vomiting, diar rhea, abdominal pain, and anorexia. Erythromycin should be given with a full glass of water and after meals. Because these gastrointestinal adverse reactions occur commonly, it may be necessary to give erythromycin with food.

60. Ribavirin (Virazole) is prescribed for a hospitalized child with respiratory syncytial virus. The nurse prepares to administer the medication by which of the following routes? 1. Oral. 2. Subcutaneous. 3. Intramuscular. 4. Oxygen tent.

4. Ribavirin (Virazole) is an antiviral res piratory medication used in the hospi tal for children with severe respiratory syncytial virus. Administration is via hood, face mask, or oxygen tent.

55. The treatment for a child with sinus bradycardia is atropine 0.02 mg/kg/dose. How much should the nurse give a child who weighs 20 kg? 1. 0.02 mg. 2. 0.04 mg. 3. 0.2 mg. 4. 0.4 mg.

4. Take the dose of atropine (0.02 mg/kg) times the child's weight (20 kg) 0.02 mg/kg × 20 kg = 0.4 mg

31. The nurse is to administer eardrops to a 5-year-old who has a draining ear. Which of the following is the correct method of instillation? 1. Pull the pinna of the ear downward and back for instillation. 2. Place cotton tightly in the ear after instillation. 3. Have the child remain upright after instillation. 4. Pull the pinna of the ear upward and back for instillation.

4. The correct way to administer eardrops in a child older than 3 years of age is to pull the pinna up and back, the same as for an adult.

20. Filgrastim (Neupogen) is given to a child who has received chemotherapy. The nurse knows that this drug is given for which of the following reasons? 1. Reduce fatigue level. 2. Prevent infection. 3. Reduce nausea and vomiting. 4. Increase mobilization of stem cells.

4. The drug mobilizes stem cells to produce neutrophils.

7. A nurse is caring for a child who is receiving amphotericin B intravenously daily for a fungal infection. Prior to starting the therapy, the nurse should review which of the following? 1. Aspartate aminotransferase and alanine aminotransferase levels. 2. Serum amphotericin level. 3. Serum protein and sodium levels. 4. Blood, urea, and nitrogen and creatinine levels.

4. The drug tends to be nephrotoxic. Ele vation of blood, urea, and nitrogen and creatinine levels indicates renal damage. If elevated, the physician must be noti fied to determine if the drug must be withheld for the day.

33. A child who has been diagnosed with conjunctivitis is ordered to have eye ointment applied three times a day. Which of the following should the nurse do first? 1. Remove any discharge from the affected eye. 2. Ensure the ointment is at room temperature. 3. Hold the tip of the eye ointment parallel to the eye. 4. Wash hands.

4. The procedure for instilling eye oint ment begins with washing hands fol lowed by donning clean gloves.

46. An adolescent is about to have a tuberculin skin test. Which is the best area for this intradermal test? 1. Upper thigh. 2. Scapular area. 3. Back. 4. Ventral forearm.

4. The ventral forearm is the preferred site for the tuberculin skin test.

42. A child is receiving furosemide (Lasix) 20 mg daily. The parent asks the nurse what is the best time of day for giving the medication. The nurse indicates which of the fol lowing times? 1. 8:00 a.m. 2. 12 noon. 3. 6:00 p.m. 4. Bedtime.

42. 1. The onset of Lasix is 20 to 60 minutes. It peaks at 60 to 70 minutes, with a du ration of 2 hours. By 24 hours, 50% is eliminated. Because the child may not respond as expected, the mother should be instructed to give the Lasix at 8:00 a.m. to avoid interruption of sleep with frequent urination.

43. A school nurse administers albuterol (Proventil) to a 10-year-old who is having an acute asthma attack. Which of the following assessment findings should the nurse observe? 1. Decrease in wheezing. 2. Decrease in respiratory rate from 34 to 22. 3. Decrease in dyspnea. 4. Decrease in heart rate.

43. 1. The symptoms of an acute asthma at tack are related to constriction of the airway, which leads to dyspnea and an increased respiratory rate. The albuterol (Proventil) is a beta-adrenergic agent that relaxes the smooth muscles of the bronchial tree, which will decrease the wheezing.

47. A hospitalized child is to receive 75 mg of acetaminophen (Tylenol) for fever of 101°F (38.3°C). If the acetaminophen (Tylenol) is 80 mg per 0.8 mL, how much will the nurse administer? 1. 0.75 mL. 2. 1.5 mL. 3. 2.5 mL. 4. 3 mL.

47. 1. Desired over Available × Volume = Desired dose 75 mg × 0.8 mL = 0.75 mL 80 mg

5. The parent of a child who is being treated for Haemophilus influenzae meningitis tells the nurse that the family is being treated prophylactically with rifampin (Rifadin). Which of the following should the nurse include in teaching about this medication? 1. "The drug will change the color of the urine to orange-red, so you should protect your undergarments as it will cause staining." 2. "Adverse effects of the drug may cause urinary retention." 3. "The drug is given to treat meningitis." 4. "You will need to continue taking the drug for 7 days."

5. 1. Rifampin (Rifadin) causes an orange-red discoloration of body fluids, including urine. Knowledge of this can decrease anxiety when it occurs.

50. A preterm neonate is admitted to the hospital. The physician orders indomethacin. The nurse informs the parents that the medication is given for which of the following reasons? 1. To encourage ductal closure. 2. To prevent hypertension. 3. To promote release of surfactant. 4. To protect the immature liver.

50. 1. Preterm neonates with good renal function may receive indomethacin, a prostaglandin inhibitor, to encourage ductal closure.

56. A nurse is giving atropine for sinus bradycardia. The nurse knows that atropine is which of the following? 1. Anticholinergic. 2. Beta-adrenergic agonist. 3. Bronchodilator. 4. Sympathomimetic.

56. 1. Atropine is an anticholinergic drug. It blocks vagal impulses to the myo cardium and stimulates the cardioin hibitory center in the medulla. It increases heart rate and cardiac output.

61. A 5-year-old is admitted to the pediatric unit. The child has an infusion of dextrose 5% via a line with a volume control chamber on a pump. The nurse knows that this system is used for administration of intravenous solutions for which of the following reasons? 1. Prevents accidental fluid overload. 2. Reduces the potential for bacterial infection. 3. Makes administering of intravenous fluids easier. 4. Is less costly.

61. 1. The volume control chamber functions as a safety device. No more than 2 hours of solution is placed in the chamber at a time. If the pump should be pro grammed incorrectly, the child would get only 2 hours of fluids; then the pump would alarm. The nurse is thereby alerted that the pump was programmed incorrectly.

8. Which of the following are specific toxicities to gentamycin? 1. Hepatatoxicity. 2. Ototoxcity. 3. Anaphylaxis. 4. Neurological.

Nephrotoxicity and ototoxicity are the most significant adverse effects.