Ch 38 Medication Administration
A nurse has just given otic medication instructions to the parents of a 12-year-old. Which statement would indicate that the parents need further education concerning the medication?
"I will pull the outer ear down and back before administering the medication."
The nurse educator is teaching the class of nurses about infusion control in children. The nurse knows that more education is needed when the student nurse states:
"No special pumps are needed for the pediatric patient; I can use the same one that we use with adult patients."
Communication with children and families regarding medication administration is important in soliciting cooperation. Which statement by the mother may indicate a need for further teaching?
"That medicine is just like candy."
The nurse has been caring for a 12-year-old boy during his 5-day hospitalization. The child's IV has infiltrated, and the care provider is getting ready to change the intravenous line site. Which statement made by the nurse would be appropriate in supporting the child?
"The client is left-handed and likes to draw; an IV site in his right arm would be best."
A father believes his 2-year-old son is frightened by seeing an intramuscular (IM) medication injected into his thigh and requests that the child's "butt" be used. What will be the nurse's response?
"The muscle in his butt is not well enough developed to receive this injection until he has walked for 1 year."
The nurse is caring for a child who weighs 31 kg. A medication is ordered for this child with a dosage range of 20 to 40 mg per kg of body weight per dose. Which dosage would be appropriate for the nurse to administer to this child in one dose?
1,000 mg per dose
Before giving an injection to a young child, the nurse would make which of the following statements about the pain the child will feel?
"You can yell or scream when the needle is inserted if you want."
The nurse is teaching a parent how to administer medications to her young child. Which instructions are appropriate? Select all that apply.
-Gently restrain the child's head and arms. -Have the parent administer the medication. -Hold the child against the body with the head raised.
A 12-month-old child weighing 11 lb has an order for gentamycin sulfate 13 mg IM q 36 hour. The pharmacy has 20 mg/2 mL on hand. How may milliliters would the infant receive, and what is the best site for the injection?
1.3 mL; vastus lateralis
A child with HIV, weighing 25 kg (55.1 lbs), is about to receive an infusion of IVIG. The recommended dose is 400 mg/kg/dose. The medication is available in a concentration of 50 mg/mL. What is the proper amount of infusion that the child will receive?
200 mL
The nurse is caring for a child who weighs 75 lb. The medication ordered for the child has a therapeutic dosage range of 33 mg/kg per day to 48 mg/kg per day. The medication ordered is to be given 4 times per day. Which dosages would be appropriate for the nurse to administer to this child in one dose?
375 mg per dose
The nurse is preparing an intravenous solution of D5 ¼ NS @ 20 mL/hour for a 6-month-old client. Which safety device will be added to protect against fluid overload?
A volume control device
The mother of a 9-year-old girl calls the physician's office complaining that her daughter continues to vomit soon after being given an oral amoxicillin capsule for her strep throat. The nurse recognizes that the child's vomiting will interfere with which pharmacokinetic process?
Absorption
An infant is to receive a hepatitis B vaccine within a few hours after birth. What 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 administering a liquid medication to a 3-year-old using an oral syringe. Which action would be most appropriate?
Allow the child time to swallow the medication in between amounts.
A 4-year-old was recently poisoned when he found a bottle of ibuprofen on the bathroom counter and swallowed the entire contents. At the emergency room, the child was treated successfully, and now the nurse is counseling the parents before discharge. Which nursing instruction is best to give the parents?
Always store medicine in a locked cabinet
A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. Which method of dosage calculation provides the most accurate dose of medication?
Body surface area
The nurse is caring for a pediatric client who requires vitamins, minerals, lipids and amino acids through the circulatory system instead of the gastrointestinal tract. Which type of intravenous therapy is anticipated for long-term therapy?
Central venous catheter infusions
The nurse is preparing to administer phytonadione to a newborn. What would the nurse do next?
Clean the newborn's thigh with alcohol.
A nursing instructor informs students that isotonic fluids are the best choice to give infants and children. The nurse teaches that this type of fluid exerts the same osmotic pressure as the bloodstream, thus helping to prevent which of the following complications? (Select all that apply.)
Destruction of red blood cells Water intoxication
A child is receiving intravenous fluids for dehydration. The nurse notes coarse breath sounds and increased pulse and blood pressure. What does the nurse do first?
Discontinue the IV infusion.
The nurse has an order to administer a rectal suppository to a 3-month-old child. In addition to lubricating the suppository, which intervention will help assure appropriate adminstration of the medication?
Holding the buttocks tightly together for 1 to 2 minutes after insertion
A nurse has been administering normal saline intravenously to a pediatric client and notes edema, pallor, and blanching at the intravenous site. What should the nurse do next?
Discontinue the infusion and remove the cannula.
A toddler is ordered amoxicillin for bilateral otitis media. The mother complains that the child refuses to take the oral medication. The nurse knows that more education is needed when the mother states:
I will shake the medication well, and draw up the medication to the top of the syringe. My husband and I will hold the child down and force the medication down his throat.
The mother of a child on the pediatric unit states that she understands that her infant's kidneys are not mature. She wants to know how kidney immaturity will affect medications that may be given to the infant. The nurse explains to her that the kidneys are used in what process of pharmacokinetics?
Excretion
A child is prescribed multiple intravenous medications. Which nursing action demonstrates the best practice to maintain medication safety?
Flush the intravenous line between each medication.
The nurse is giving discharge instructions to a mother of a 3-month-old infant. What is the best information to give the mother concerning oral medication administration?
Give the medication with a syringe and direct the liquid toward the posterior side of the mouth while holding the infant upright.
The pediatric nurse recognizes that what statement is true regarding medications administered via the intravenous route?
Giving medications through the intravenous route is less traumatic than other routes.
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?
Having nurses check their math calculations with a colleague before administering a drug
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.
A nursing instructor is teaching students about intravenous (IV) fluid administration to infants and children. Which type of fluid does the nurse say must be administered to children and infants to prevent water intoxication?
Isotonic
The nurse is caring for a preschooler who has become dehydrated due to an intestinal virus. Which approach to replace the fluid loss is initially anticipated?
Isotonic
A nurse knows that a child's metabolism is faster than an adult's and, therefore, certain medications for children need to be administered in which way?
More frequently
The nurse is caring for a preschooler who has become dehydrated due to an intestinal virus. Which approach to replace the fluid loss is initially anticipated?
Oral rehydration
A nursing student is preparing to apply a medication patch for a pediatric patient with supervision by the instructor. Where is the best place for the student to apply this patch on the patient?
Over the trunk
A child is having difficulty swallowing pills. What is the best action for the nurse to take to help this child swallow medications?
Place the pills in a bite of ice cream or applesauce.
A nurse is administering ear drops to a 7-year-old girl. What should the nurse do?
Pull the pinna of the ear up and back to straighten the external ear canal.
A child with gastroenteritis has been unable to keep oral medication down. What nursing intervention would be appropriate for this client?
Request an intravenous form of the medication.
The nurse has been teaching an adolescent about the treatment for hypothyroidism. Which outcome indicates that the teaching has been successful?
The client states understanding that this is a lifetime medication.
The nurse is administering oral medications to an 11-year-old child. Which intervention should the nurse implement to encourage the child to be medication adherent?
The nurse encourages the child to develop a chart of times when medications are due.
When administering medications to an infant, what information would be most important for the nurse to consider?
The oral medication should be directed toward the posterior side of the mouth when using a syringe or dropper.
A nursing student is administering medications to her client, Tommy, on a pediatric floor. What action by the student demonstrates a need for further instruction?
The student asks the client if he is Tommy before giving the medication.
The nurse is preparing to administer an IV antibiotic to a child. After calculating the recommended dose with the child's weight, she discovers the ordered dose exceeds the safe dose range in a pediatric drug book. The medication has been given to the child at this dose for three days. What should the nurse's next action be?
Verify the dose with the prescribing practitioner.
If a medication is being administered by the otic route, it will be administered in which way?
Warmed to room temperature and dropped into the ear
The nurse is administering an oral medication that comes in an elixir form. When giving the medication, the child begins to choke and sputter. The nurse confers with the pharmacist about alternate ways to give the medication to this child. The pharmacist might recommend that the nurse should:
dilute the elixir so that the medication is not as hard to swallow.
A medical/surgical nurse has been floated to the pediatric unit. Which action by the float nurse would require the pediatric nurse to intervene?
asking the child his or her name prior to giving medications
The new graduate nurse is preparing to administer medication to a 4-year-old client. When would it be appropriate for the supervising nurse to intervene? The new graduate:
had two whole tablets to administer to the child.
The charge nurse is assisting the new graduate nurse in administering eye drops to a child. The charge nurse would stop the new graduate if which action was observed?
holds the eyelids apart for about 30 seconds