EAQ # 6 Immunological Agents and Age Considerations

An infant weighing 22 lb is prescribed an antibiotic. The prescription reads 10 mg/kg body weight/24 h to be divided into two equal doses and administered every 12 hours. How many milligrams of the antibiotic would the infant receive per dose? Record your answer as a whole number. ___ mg

50 mg The infant weighs 22 lb; divide 22 by 2.2 kg to determine that the child weighs 10 kg. The prescription calls for 10 mg/day for each kilogram of body weight. Use ratio and proportion to solve the problem. 1. Calculate weight in kg. 22lb ÷ 2.2(lb/kg) = 10kg 2. Multiply weight in kg by weight ratio. 10kg × 10(mg/kg) = 100 mg 3. Divide 24hr dose into two equal 12hr doses. 100mg ÷ 2 = 50mg

A client is receiving doxorubicin as part of a chemotherapy protocol. The nurse will assess the client for which system toxicity? 1 Neurotoxicity 2 Cardiotoxicity 3 Ototoxicity 4 Nephrotoxicity

2 Heart failure and dysrhythmias secondary to cardiotoxicity are the primary life-threatening toxic effects unique to doxorubicin. Neurotoxicity, nephrotoxicity, and ototoxicity are not associated with this medication.

The chemotherapy protocol prescribed for a client with tuberculosis includes vitamin B6 and isoniazid (INH). Which would the nurse identify as the reason for prescribing vitamin B6? 1 To improve the nutritional status of the client 2 To enhance the tuberculostatic effect of INH 3 To accelerate the destruction of dormant tubercular bacilli 4 To counteract the peripheral neuritis that INH may cause

4 One of the most common side effects of INH is peripheral neuritis, and vitamin B6 will counteract this problem. It does help nutrition, but that is not the specific reason it is given. It counters the side effects of isoniazid; it does not act to enhance its action. It does not speed the destruction of the causative organism.

An infant with cardiopulmonary disease displays signs and symptoms of bronchiolitis and pneumonia. Which condition would the nurse anticipate when planning care? 1 Poliomyelitis 2 Pneumococcal infection 3 Meningococcal infection 4 Respiratory syncytial virus infection

4 Respiratory syncytial virus infections are the most common cause for hospitalization of infants younger than 1 year of age; this disease especially affects premature infants and infants with cardiopulmonary disease. Poliomyelitis is caused by the poliovirus. Streptococcus pneumonia infections cause meningitis, sepsis, pneumonia, and otitis media. Neisseria meningitidis causes meningitis.

he nurse understands which medication increases the risk of Reye syndrome in children? 1 Aspirin 2 Naloxone 3 Ibuprofen 4 Acetaminophen

1 Aspirin increases the risk of Reye syndrome in children. Naloxone, ibuprofen, and acetaminophen can be used, but the child should be assessed for renal and liver functioning before prescribing.

A client is to receive intraarterial chemotherapy for cancer of the liver. Which benefit would this method provide? 1 It reduces systemic toxicity. 2 It provides for rapid dilution of chemotherapy. 3 The medication bypasses the blood-brain barrier. 4 The chemotherapy is delivered to the peritoneal cavity.

1 Higher concentrations of the medication can be delivered to the specific site of the tumor, with reduced systemic toxicity. Providing for rapid dilution of chemotherapy is the purpose of central vascular access devices. The ability to pass the blood-brain barrier is the purpose of intrathecal or intraventricular access devices. Delivering chemotherapy to the peritoneal cavity is the purpose of intraperitoneal chemotherapy.

Which action by the nurse would increase comfort of a toddler or preschool-age child when giving oral medications? Select all that apply. One, some, or all responses may be correct. 1 Place the tablet or capsule near the back of the tongue. 2 Allow the child to choose which medication to take first. 3 Allow the toddler to become familiar with the oral dosing device. 4 Allow the toddler to choose a position for taking the medication. 5 Disguise the taste of the medicine with a small volume of flavored drink or a small amount of food.

1, 2, 3, 4, 5 To increase comfort in the toddler or preschool-age child, the nurse can place the medication near the back of the tongue, allow the child to choose which medicine to take first, allow the child to touch and become familiar with the oral dosing device, allow the child to choose a position for receiving the medication, and disguise the medicine with a beverage or food.

For which side effects will the nurse assess a client with cancer who is being treated with chemotherapeutic agents? Select all that apply. One, some, or all responses may be correct. 1 Diarrhea 2 Leukocytosis 3 Bleeding tendencies 4 Lowered sedimentation rate 5 Increased hemoglobin levels

1, 3 Most chemotherapeutic agents interfere with mitosis. The rapidly dividing cells of the mucous membranes of the gastrointestinal tract are affected, causing stomatitis and diarrhea. Bone marrow depression often causes thrombocytopenia, resulting in bleeding tendencies. The bone marrow consists of rapidly dividing cells, and its activity is depressed. Leukopenia, not leukocytosis, can occur. The erythrocyte sedimentation rate generally increases in the presence of tissue inflammation or necrosis. Hemoglobin and hematocrit levels may decrease because of an inadequate number of red blood cells related to bone marrow depression.

Which suggestion would the nurse provide to the mother whose child has been constipated for 3 days? Select all that apply. One, some, or all responses may be correct. 1 Give laxatives to the child. 2 Reduce the child's fluid intake. 3 Include dairy products in the child's diet daily. 4 Increase the child's physical activity. 5 Include food with a high fiber content in the child's diet.

1, 4, 5 Constipation is the infrequent and difficult passage of stools, and it can be managed by following certain measures. Laxatives may help ease the passage of stools to relieve constipation. Bowel movements can also be promoted by increasing physical activity and adding fiber to the diet to add bulk to the stool to relieve constipation. Low fluid intake and consumption of dairy products can increase the risk for constipation.

A client with cancer is receiving leucovorin as part of a chemotherapy protocol. Which purpose does leucovorin serve? 1 Potentiating the effect of alkylating agents 2 Diminishing toxicity of folic acid antagonists 3 Limiting vomiting associated with chemotherapy 4 Preventing alopecia

2 Leucovorin limits toxicity of folic acid antagonists, such as methotrexate sodium, by competing for transport into cells. Leucovorin does not potentiate the effect of alkylating agents. It does not have antiemetic properties. It will not prevent hair loss.

A client is receiving chemotherapy with doxorubicin. Which development will the nurse teach the client to report immediately? 1 Nausea 2 Sore throat 3 Loss of hair 4 Constipation

2 A sore throat is indicative of a respiratory tract infection, which may be the first clinical sign of bone marrow suppression, which can be life-threatening. Nausea is an expected side effect of doxorubicin, but it is not life-threatening. Hair loss is not a side effect of doxorubicin but, regardless, is not life-threatening. Constipation is an expected side effect of doxorubicin, but it is not life-threatening.

A child is ordered a broad-spectrum antibiotic to be administered three times a day. Which times would the nurse instruct the parents to administer the medication at home? 1 8:00 AM, 2:00 PM, 8:00 PM 2 6:00 AM, 2:00 PM, 10:00 PM 3 6:00 AM, 12:00 PM, 8:00 PM 4 10:00 AM, 4:00 PM, 10:00 PM

2 Antibiotics should be administered with the doses equally spaced to ensure maintenance of the blood level of the medication within the therapeutic range. The 12-hour period between the 8:00 PM and the 8:00 AM doses and between the 10:00 PM and 10:00 AM doses is too long; the medication level in the blood will become subtherapeutic during this interval. The 10-hour period between the 8:00 PM and 6:00 AM doses is also too long.

A client receives doxorubicin as part of a chemotherapy protocol. The nurse would assess the client for signs and symptoms of which adverse effect? 1 Toxic epidermal necrolysis 2 Heart failure 3 Pulmonary fibrosis 4 Ototoxicity

2 Heart failure and dysrhythmias are life-threatening toxic effects unique to doxorubicin. It is a vesicant that can cause severe tissue damage if the medication infiltrates; however, this is different from the tissue destruction associated with toxic epidermal necrolysis. Pulmonary fibrosis and ototoxicity are not adverse effects of doxorubicin.

After surgery for cancer, a client is to receive chemotherapy. When teaching the client about the side effects of chemotherapy, which information will the nurse share about alopecia characteristics? 1 Usually rare 2 Not permanent 3 Frequently prolonged 4 Usually preventable

2 Once the medications that interfere with cell division are stopped, the hair will grow back; sometimes the hair will be a different color or texture. Alopecia is a common side effect of chemotherapy. Hair loss persists while the medications are being received; once the medications are withdrawn, the hair grows back. Although ice caps on the head and rubber bands around the scalp have been used to try to limit alopecia, they have not been particularly effective.

The nurse understands which are the pharmacokinetic reasons for medication sensitivity in infants? Select all that apply. One, some, or all responses may be correct. 1 Small body size 2 Medication absorption 3 Renal medication excretion 4 Protein binding of drugs 5 Hepatic medication metabolism

2, 3, 4, 5 Increased medication sensitivity in infants is a result of the immature state of pharmacokinetic processes such as medication absorption, renal medication excretion, protein binding of drugs, and hepatic medication metabolism. A small body is not a pharmacokinetic parameter.

A client receiving chemotherapy develops bone marrow suppression. The nurse will monitor for which thrombocytopenic effect? Select all that apply. One, some, or all responses may be correct. 1 Deep vein thrombosis 2 Melena 3 Purpura 4 Emboli 5 Hematuria

2, 3, 5 Black, tarry feces (melena) caused by the action of intestinal secretions on blood are associated with bleeding in the gastrointestinal tract; bleeding is related to a reduced number of thrombocytes, which are part of the coagulation process. Hemorrhages into the skin and mucous membranes (purpura) may occur with reduced numbers of thrombocytes, which are part of the coagulation process. Blood in the urine (hematuria) may occur with a reduced number of thrombocytes, which are part of the coagulation process. Deep vein thrombosis and emboli are effects of thrombocytosis.

Which vaccine would the nurse administer to provide protection from precancerous lesions and cancers of the vulva, cervix, and vagina in young girls and women? 1 Rotavirus vaccine 2 Varicella virus vaccine 3 HPV vaccine 4 Meningococcal conjugate vaccine

3 Human papilloma virus (HPV) vaccine is used to help prevent precancerous lesions of the cervix, vulva, and vagina caused by HPV types 16 and 18. Rotavirus vaccine is a monovalent vaccine developed to provide protection against certain rotaviruses, such as G1, G3, G4, and G9. Varicella virus vaccine is a vaccine administered to provide protection against the varicella virus. Meningococcal conjugate vaccine is a tetravalent conjugate vaccine that provides protection against certain serotypes of meningococcus, such as A, C, Y, and W-135.

A client is receiving combination chemotherapy for the treatment of metastatic carcinoma. For which systemic side effect would the nurse monitor the client? 1 Ascites 2 Nystagmus 3 Leukopenia 4 Polycythemia

3 Leukopenia, a reduction in white blood cells, is a systemic effect of chemotherapy as a result of myelosuppression. Ascites is not a side effect of chemotherapy. Chemotherapy does not affect the eyes; nystagmus is an involuntary, rapid rhythmic movement of the eyeballs. Also, nystagmus is a local, not a systemic, response. The red blood cells will be decreased, not increased.

A client has surgery for the insertion of an implanted infusion port for chemotherapy. How often will the port need to be flushed when not in use? 1 Every day 2 Once a week 3 Every month 4 Twice a year

3 Once-a-month flushes usually are adequate to keep an implanted infusion port from clotting. Every day or once a week is unnecessary. Twice a year may jeopardize the viability of the port.

The nurse understands which group of the pediatric population is at a higher risk of developing respiratory complications upon administration of general anesthesia? 1 Infants 2 Children 3 Neonates 4 Adolescents

3 The physical characteristics of the larynx and small airway diameter, the structure of the respiratory system, and the high metabolic rate of neonates place them at a higher risk of developing respiratory complications from anesthesia than infants, children, or adolescents.

A child is prescribed tetracycline. The nurse understands which possible medication-related reaction is associated with this medication? 1 Kernicterus 2 Gray syndrome 3 Reye syndrome 4 Staining of teeth

4 Tetracycline causes staining or discoloration of developing teeth in children. Sulfonamides may cause kernicterus in neonates. Chloramphenicol may cause Gray syndrome in infants. Aspirin may cause Reye syndrome in pediatric clients with a history of chickenpox or influenza.

The nurse is preparing to administer a diphtheria, tetanus, and pertussis vaccine to a child. After completing an assessment, the nurse concludes that the child cannot receive the vaccine safely. Which assessment finding supports the nurse's conclusion? 1 Fever has developed within 48 hours of previous vaccinations. 2 The child exhibited a shock-like state after a previous vaccination. 3 The child has a history of anaphylactic reactions after vaccinations. 4 The child has an upper respiratory tract infection and mild febrile illness.

3 Vaccines are contraindicated in children who exhibit anaphylactic reactions because these reactions may be life-threatening. If a fever develops after a child's first vaccination, subsequent vaccines should be administered with caution. If a shock-like state has previously developed after a vaccination, subsequent vaccines should be administered with caution. When a child has an upper respiratory tract infection, vaccinations may be postponed until the infection is resolved.

The nurse identifies that a client receiving chemotherapy has lost weight. Which interventions would the nurse take to improve client nutrition? Select all that apply. One, some, or all responses may be correct. 1 Provide low-carbohydrate meals. 2 Decrease fluid intake at mealtime. 3 Encourage the intake of preferred foods. 4 Promote the intake of small, frequent meals 5 Administer prescribed antiemetics before meals

3, 4, 5 Selecting preferred foods increases the likelihood of the client eating the food. Small, frequent feedings are better tolerated than large meals. Antiemetics should be administered prophylactically to decrease nausea and enhance appetite. The diet should provide maximum protein and carbohydrates to meet demands related to restoration of body cells and energy. Decreasing fluid intake may have deleterious effects.

A child is receiving 45 units of intermediate-acting insulin at 7:00 AM and 7:00 PM. Which statement by the nurse is most appropriate when discussing bedtime snacks with the parents? 1 "Offer a snack at bedtime if there are signs of hyperglycemia." 2 "Provide a bedtime snack to prevent hypoglycemia during the night." 3 "Withhold the snack after dinner to prevent hyperglycemia during sleep." 4 "Leave a snack at the bedside in case the child becomes hungry during the night."

2 Intermediate-acting insulin peaks in 4 to 12 hours; a bedtime snack will prevent hypoglycemia during the night. Offering a snack at bedtime if there are signs of hyperglycemia is unsafe because it will intensify the hyperglycemia; if hyperglycemia is present, the child needs insulin. Bedtime snacks are recommended for people taking intermediate-acting insulin. When hypoglycemia develops, the child will be asleep; the snack should be eaten before bed.