Pharmacology Chapter 10
When administering a medication known to be metabolized by the liver, the nurse will closely monitor for adverse drug reactions in which patient? A) A 3-month-old infant B) A 12-month-old infant C) An 18-month-old toddler D) A 13-year-old adolescent
Correct: A Neonates are especially sensitive to drugs that are eliminated primarily by hepatic metabolism. When these drugs are used, dosages must be reduced. The capacity of the liver to metabolize many drugs increases rapidly about 1 month after birth and approaches adult levels a few months later. The liver has matured completely by 1 year of age.
Which intervention would the nurse choose to minimize the risk of drug toxicity in neonates and infants? A) Reduce the amount of drug given B) Administer the medication before meals C) Shorten the interval between doses D) Administer the medication intravenously
Correct: A The albumin in neonates and infants has a lower binding capacity for medication. A lower binding capacity leaves more of the free drug available for action; therefore, a lower dose is required to prevent toxicity.
The nurse is teaching young parents about medication administration in their child. Which statements are appropriate to include in the teaching plan? (Select all that apply.) A) "Guard against spills and spitting to ensure that your child gets an accurate dose." B) "Do not mix your child's medication with food or drink." C) "This calibrated spoon will help your child get an accurate dose." D) "Keep a medication record to make sure you do not give more than one dose at a time." E) "If your child spits some medication out, give another full dose at that time."
Correct: A, C, D Spills and spitting are common causes of inaccurate dosing in children. It is often helpful to mix medication with food or juice to mask the taste when allowed. Calibrated spoons and medication records can improve accuracy. To prevent overdosing, parents should estimate the amount a child spits out and replace only that amount
Which statements about transdermal absorption are correct? (Select all that apply.) A) The stratum corneum of the infant's skin is very thin. B) Transdermal administration is the safest route of administration. C) Blood flow to the skin is greater in infants than in older patients. D) Infants are at increased risk of toxicity from topical drugs. E) Absorption through the skin is more rapid and complete with infants.
Correct: A, C, D, E Drug absorption through the skin is more rapid and complete with infants than with older children and adults because the stratum corneum of the infant's skin is very thin and blood flow to the skin is greater in infants than in older patients. Because of this enhanced absorption, infants are at increased risk of toxicity from topical drugs.
The nurse is caring for a group of very young patients receiving a variety of medications. Which concept guides the nurse's care of these patients? A) Drugs given intravenously (IV) leave the body more quickly in infants than in adults. B) Drugs given subcutaneously (SC) remain in the body longer in infants than in adults. C) Gastric emptying time is shorter in infants than in children and adults. D) The blood-brain barrier protects the infant's brain from toxic drugs
Correct: B The very young are at risk for drug effects that are more intense and prolonged than those seen in adults. Drugs given by the SC route reach higher levels and remain in the system longer than in adults. Drugs given IV leave the body more slowly in infants than in adults. Gastric emptying time is prolonged in infants. The blood-brain barrier is not fully developed in infants.
Why are infants especially sensitive to drugs that affect CNS function? A) The blood-brain barrier is especially strong in infants. B) The blood-brain barrier does not exist until 1 year of age. C) The blood-brain barrier is not fully developed at birth. D) The blood-brain barrier is weakened by the birth process.
Correct: C The blood-brain barrier is not fully developed at birth. The other statements are not true.
Which statement about renal excretion in infants is true? A) Renal blood flow is high during infancy. B) Renal drug excretion is significantly increased at birth. C) Adult levels of renal function are achieved by 1 year. D) Drugs that are eliminated primarily by renal excretion must be given in higher doses.
Correct: C Adult levels of renal function are achieved by 1 year. Renal blood flow, glomerular filtration, and active tubular secretion are low during infancy. Renal drug excretion is significantly reduced at birth. Drugs that are eliminated primarily by renal excretion must be given in reduced dosage and/or at longer dosing intervals.
Which statement about intramuscular (IM) administration is incorrect? A) Drug absorption following IM injection in the neonate is slow and erratic. B) Absorption of IM drugs becomes more rapid in infancy than in neonates. C) Neonates experience low blood flow through muscle during the first days of postnatal life. D) Absorption of IM drugs becomes slower and more erratic in infancy than in neonates.
Correct: D Drug absorption following IM injection in the neonate is slow and erratic. Delayed absorption is due in part to low blood flow through muscle during the first days of postnatal life. By early infancy, absorption of IM drugs becomes more rapid than in neonates and adults.
Which of the following is not an example of age-related adverse drug effects? A) Growth suppression B) Discoloration of developing teeth C) Kernicterus D) Toxicity
Correct: D Like adults, pediatric patients are subject to adverse reactions when drug levels rise too high. In addition, pediatric patients are vulnerable to unique adverse effects related to organ system immaturity and to ongoing growth and development. Among these age-related effects are growth suppression (caused by glucocorticoids), discoloration of developing teeth (caused by tetracyclines), and kernicterus (caused by sulfonamides).
For medications that do not have established pediatric doses, the most common method of extrapolating the appropriate dose is based on which measurement? A) Age B) Weight C) Height/length D) Body surface area
Correct: D Pediatric doses have been established for a few drugs but not for most. For drugs that do not have an established pediatric dose, dosage can be extrapolated from adult doses. The method of conversion employed most commonly is based on body surface area.
