Chapter 38: Medication Administration and Safety for Infants and Children

A provider orders odansetron 0.15 mg/kg IV push for a child who weighs 15 pounds. How much medication does the nurse draw up?

1ml Calculate the weight in kilograms: 15/2.2 = 6.818181 Multiply by 0.15=1.0227272 Round as your final answer = 1 mL

Which muscle should the nurse select to give a 6-month-old infant an intramuscular injection? a. Deltoid b. Ventrogluteal c. Dorsogluteal d. Vastus lateralis

d. Vastus lateralis The vastus lateralis is not located near any vital nerves or blood vessels. It is the best choice for intramuscular injections for children younger than 3 years of age.

What is the main purpose for using a volume-control device or an infusion pump to administer intravenous fluids to children? a. To avoid fluid overload b. To aid in measuring intake c. To administer antibiotics d. To ensure adequate intravenous fluid intake

a. To avoid fluid overload A volume-control device or an infusion pump allows the nurse to set a specific volume of fluid to be given in a specific period of time and decreases the risk of inadvertently administering a large amount of fluid.

What nursing action is indicated when a child receiving a unit of packed red blood cells complains of chills, headache, and nausea? a. Continue the infusion, and take the child's vital signs. b. Stop the infusion immediately, and notify the provider. c. Slow the infusion, and assess for cessation of symptoms. d. Start a dextrose solution, and stay with the child.

b. Stop the infusion immediately, and notify the provider. If a reaction is suspected, as in this case, the transfusion is stopped immediately, and the provider is notified. The transfusion cannot continue. Dextrose solutions are never infused with blood products because the dextrose causes hemolysis, but more important, the infusion must be stopped.

Guidelines for intramuscular administration of medication in school-age children include a. inject medication as rapidly as possible. b. insert needle quickly, using a dart-like motion. c. penetrate skin immediately after cleansing site. d. have child stand, if possible and if child is cooperative.

b. insert needle quickly, using a dart-like motion. The needle should be inserted quickly in a dart-like motion at a 90-degree angle unless contraindicated. Inject medications slowly. Allow skin preparation to dry completely before skin is penetrated. Place child in lying or sitting position.

When liquid medication is given to a crying 10-month-old infant, which approach minimizes the possibility of aspiration? a. Administer the medication with a syringe (without needle) placed along the side of the infant's tongue. b. Administer the medication as rapidly as possible with the infant securely restrained. c. Mix the medication with the infant's regular formula or juice and administer by bottle. d. Keep the child upright with the nasal passages blocked for a minute after administration.

a. Administer the medication with a syringe (without needle) placed along the side of the infant's tongue. Administer the medication with a syringe without a needle placed alongside of the infant's tongue. The contents are administered slowly in small amounts, allowing the child to swallow between deposits. Medications should be given slowly to avoid aspiration. The medication should be mixed with only a small amount of food or liquid.

What should the nurse use to prepare liquid medication in volumes less than 5 mL? a. Calibrated syringe b. Paper measuring cup c. Plastic measuring cup d. Household teaspoon

a. Calibrated syringe For volumes of 5 mL or less, an oral syringe designed for oral medication administration only should be used. Measuring cups would be too large. A household teaspoon may or may not be accurate and the AAP recommends metric-only measuring devices.

The nurse administering an IV piggyback medication to a preschool child should a. use a "Smart" pump if available. b. flush the IV tubing before and after the infusion with normal saline solution. c. inject the medication into the IV catheter using the port closest to the child. d. inject the medication into the IV tubing in the direction away from the child.

a. use a "Smart" pump if available. Programmable infusion pumps are frequently used to facilitate safe intermittent infusion of IV medications for children via the piggyback method. Some pumps have preprogrammed drug libraries to assist in the prevention of medication errors. Administering medications via this route does not require flushing unless the medication is incompatible with the maintenance fluid. The nurse is using the IV push method when injecting medication into the IV tubing using the port closest to the child. The medication is not injected away from the child.

What is the best action for the nurse to take when giving medications to a 3-year-old child? a. Tell the child to take the medication "right now." b. Tell the child to take the medication or she will have to get a shot. c. Allow the child to choose fruit punch or apple juice when giving the medication. d. Tell the child that another child her age just took his medication like a "good girl."

c. Allow the child to choose fruit punch or apple juice when giving the medication. Realistic choices such as type of juice to drink with medications allow the child to feel some control. Direct confrontation typically results in a "no" response. Threatening a child with a shot is inappropriate. Comparisons are not helpful in getting a child this age to cooperate.

A registered nurse is watching a student nurse give an IM injection to a 1-year-old. The student identifies the following site for the injection. What action by the registered nurse is best? a. Remind the student to don gloves. b. Hand the student an alcohol wipe. c. Ask the student to find another site. d. Assess for the correct needle length.

c. Ask the student to find another site.

What action is appropriate when using an EMLA cream before intravenous catheter insertion? a. Rub a liberal amount of cream into the skin thoroughly. b. Cover the skin with a gauze dressing after applying the cream. c. Leave the cream on the skin for 1 to 2 hours before the procedure. d. Use the smallest amount of cream necessary to numb the skin surface.

c. Leave the cream on the skin for 1 to 2 hours before the procedure. The cream should be left in place for a minimum of 1 hour and no more than 2 hours. The EMLA cream should not be rubbed into the skin. After the cream is applied to the skin surface, it is covered with a transparent occlusive dressing. The nurse should use a liberal amount of EMLA cream.

What is the 24-hour maintenance fluid requirement for a child weighing 18.7 pounds?

850 mL Calculate weight in kilograms: 18.7 pounds = 8.5 kg. The formula for calculating daily fluid requirements is 0 to 10 kg: 100 mL/kg/day; 10 to 20 kg: 1000 mL for the first 10 kg of body weight plus 50 mL/kg/day for each kilogram between 10 and 20. To determine an hourly rate, divide the total milliliters per day by 24: 8.5 kg × 100 mL = 850 mL/24 hr.

What parameter should guide the nurse when administering a subcutaneous injection to a school-age child with cellulitis? a. Do not to give injections in edematous areas. b. Attach a clean 1-inch needle to the syringe. c. The maximum volume injected into one site is 2 mL. d. Do not pinch up tissue before inserting the needle.

a. Do not to give injections in edematous areas. Subcutaneous injections should never be given in areas of edema or infection because absorption is unreliable.

A child is receiving intravenous fluids. How frequently should the nurse assess and document the condition of the child's intravenous site? a. Every hour b. Every 2 hours c. Every 4 hours d. Every shift

a. Every hour The nurse assesses and documents an IV site at least every hour for signs and symptoms of infiltration and phlebitis.

When teaching a mother how to administer eye drops, where should the nurse tell her to place them? a. In the conjunctival sac that is formed when the lower lid is pulled down b. Carefully under the eyelid while it is gently pulled upward c. On the sclera while the child looks to the side d. Anywhere as long as drops contact the eye's surface

a. In the conjunctival sac that is formed when the lower lid is pulled down The lower lid is pulled down, forming a small conjunctival sac. The drops are applied to this area. The medication should not be administered directly onto the eyeball.

What is the appropriate nursing response to a parent who asks, "What should I do if my child cannot take a tablet?" a. "You can crush the tablet and put it in some food." b. "Find out if the medication is available in a liquid form." c. "If the child can't swallow the tablet, tell the child to chew it." d. "Let me show you how to get your child to swallow tablets."

b. "Find out if the medication is available in a liquid form."

What is the appropriate nursing response to a parent who asks, "What should I do if my child cannot take a tablet?" a. "You can crush the tablet and put it in some food." b. "Find out if the medication is available in a liquid form." c. "If the child can't swallow the tablet, tell the child to chew it." d. "Let me show you how to get your child to swallow tablets."

b. "Find out if the medication is available in a liquid form." A tablet should not be crushed without knowing whether it will alter the absorption, effectiveness, release time, or taste. Therefore, telling the parent to find out whether the medication is available in liquid form is the most appropriate response.

What is the hourly maintenance fluid rate for an intravenous infusion in a child weighing 19.5 kg? a. 19 mL b. 61 mL c. 195 mL d. 1475 mL

b. 61 mL The formula for calculating daily fluid requirements is 0 to 10 kg: 100 mL/kg/day; 10 to 20 kg: 1000 mL for the first 10 kg of body weight plus 50 mL/kg/day for each kilogram between 10 and 20. To determine an hourly rate, divide the total milliliters per day by 24. Calculations: Child weighs 19.5 kg. Therefore the child requires 1000 mL; plus 50 mL × 9.5 kg = 475 mL. Next add calculated amounts: 1000 + 475 = 1475 mL, and divide by 24 hours to equal 61.45 mL per hour. This rounds down to 61 mL/hr.

Which food is appropriate to mix with medication? a. Formula or milk b. Applesauce c. Baby food d. Orange juice

b. Applesauce Formula, milk, baby food, and orange juice are essential foods in a child's diet. Medications may alter their flavor and cause the child to avoid them in the future.

Which factor should the nurse remember when administering topical medication to an infant as compared with an adolescent? a. Infants require a larger dosage because of a greater body surface area. b. Infants have a thinner stratum corneum that absorbs more medication. c. Infants have a smaller percentage of muscle mass. d. The skin of infants is less sensitive to allergic reactions.

b. Infants have a thinner stratum corneum that absorbs more medication. Infants and young children have a thinner outer skin layer (stratum corneum), which increases the absorption of topical medication. A similar dose of a topical medication administered to an infant compared with an adult is approximately three times greater in the infant because of the greater body surface area. The

What nursing actions are correct when administering subcutaneously? (Select all that apply.) a. Insert the needle with the bevel up at a 15-degree angle. b. Insert the needle at a 45- to 90-degree angle. c. Insert the needle into the tissue on the upper back. d. Insert the needle into the abdominal tissue. e. Massage the injection site when the injection is complete.

b. Insert the needle at a 45- to 90-degree angle. d. Insert the needle into the abdominal tissue. For this subcutaneous injection, the nurse inserts the needle at a 45- to 90-degree angle and injects into the subcutaneous abdominal tissue. A 15-degree angle and injecting into the tissue on the upper back are appropriate for intradermal injections. The nurse should not massage the site.

A nurse should routinely ask a colleague to double-check a medication calculation and the actual medication before administering which medications? (Select all that apply.) a. Antibiotics b. Insulin c. Anticonvulsants d. Anticoagulants e. Narcotics/Opioids

b. Insulin d. Anticoagulants e. Narcotics/Opioids The nurse should ask another nurse to check the dosage calculation and the medication before administering the following: insulin, narcotics, chemotherapy, digoxin or other inotropic drugs, anticoagulants, and K+ and Ca++ salts. Institutions may require two nurses to check other medications also to prevent medication error. The nurse does not need a second check for antibiotics.

What action is correct when administering ear drops to a 2-year-old child? a. Administer the ear drops straight from the refrigerator. b. Pull the pinna of the ear back and down. c. Massage the pinna after administering the medication. d. Pull the pinna of the ear back and up.

b. Pull the pinna of the ear back and down. For children younger than 3 years, the pinna, or lower lobe, of the ear should be pulled back and down to straighten the ear canal.

A child is being discharged from the hospital on insulin. The mother is apprehensive about giving the medication. What action by the nurse is most important? a. Review the side effects of insulin with the mother. b. Have the mother verbalize that she knows the importance of follow-up care. c. Observe the mother while she administers an insulin injection. d. Help the mother devise a rotation schedule for injections.

c. Observe the mother while she administers an insulin injection. It is important that the nurse evaluate the mother's ability to give the insulin injection before discharge. Watching her give the injection to the child will give the nurse an opportunity to offer assistance and correct any errors.

What action indicates that a school-age child is using a metered-dose inhaler correctly? a. The child uses his inhaled steroid before the bronchodilator. b. The child exhales forcefully as he squeezes the inhaler. c. The child holds his breath for 10 seconds after the first puff. d. The child waits 10 minutes before taking a second puff.

c. The child holds his breath for 10 seconds after the first puff. After a puff, the child should hold his breath for about 10 seconds or until he counts slowly to 5. If one of the child's medications is an inhaled steroid, it should be administered last. The child should inhale slowly as the inhaler is squeezed or depressed. The child does not need to wait this long to take a second puff of medication. He can take a second puff after 1 to 2 minutes.

Which physiologic difference affects the absorption of oral medications administered to a 3-month-old infant? a. More rapid peristaltic activity b. More acidic gastric secretions c. Usually more rapid gastric emptying d. Variable pancreatic enzyme activity

d. Variable pancreatic enzyme activity Pancreatic enzyme activity is variable in infants for the first 3 months of life as the gastrointestinal system matures. Medications that require specific enzymes for dissolution and absorption might not be digested to a form suitable for intestinal action. Infants up to 8 months of age tend to have prolonged motility. The longer the intestinal transit time, the more medication is absorbed. The gastric secretions of infants are less acidic than in older children or adults. Gastric emptying is usually slower in infants.