Chapter 07: Pediatric Pharmacology NCLEX

Chapter 07: Pediatric Pharmacology NCLEX

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PEDIATRIC NURSING (NCLEX-PN)

24 terms sperez1990Preview Pediatr 27 terms katr . The nurse is preparing to administer a medication to a 6- month-old infant. The nurse will monitor closely for signs of drug toxicity based on the knowledge that, compared to adults, infants have a.an increased percentage of total body fat.b.immature hepatic and renal function.c.more protein receptor sites.d.more rapid gastrointestinal transit time.

ANS: B

The liver and kidneys are the primary organs for metabolism and excretion and are immature in infants. This allows drugs to accumulate and increases the risk for drug toxicity. Infants have a lower proportion of body fat than adults and fewer protein receptors. They do have more rapid gastrointestinal transit time, but this decreases the amount of drug absorbed.

• The nurse reviews information about a drug and learns

that it is best absorbed in an acidic environment. When giving this drug to a 1-year-old patient, the nurse will expect to administer a dose that will be a.equal to an adult dose.b.less than an adult dose.c.more than an adult dose.d.twice the usual adult dose.

ANS: C

Because the child's gastric pH is more alkaline than the adult's, less drug will be absorbed. Therefore, the dose should be increased.

• The nurse assumes care for an infant who is showing

signs of drug toxicity to a drug given several hours prior.The nurse checks the dose and confirms that the dose is consistent with standard dosing guidelines. Which characteristic of the drug will likely explain this response in this patient?a.It is acidic.b.It is highly protein-bound.c.It is not fat-soluble.d.It is water-soluble.

ANS: B

With fewer protein-binding sites, there is more active drug available. This requires a reduction in the dose for infants. Drugs that are acidic are not as readily absorbed in infants, since their gastric pH tends to be more alkaline. Infants have a lower proportion of body fat; fat-soluble drugs would need to be decreased to prevent toxicity. Until about age 2 years of age, pediatric patients require larger than usual doses of water-soluble drugs to achieve therapeutic effects.

• The parent is concerned about giving a child

medication because of the lack of knowledge about the effects of drugs on children. The nurse discusses legislation passed in 2002 and 2003 about pediatric pharmacology. Which is true about these laws?a.They forbid providers from prescribing medications unless they have been FDA- approved for use in children.b.They mandate consistent, evidence-based dosing guidelines for use in children.c.They provide federal grants to fund pediatric pharmaceutical research.d.They require drug manufacturers to study pediatric medication use.

ANS: D

In 2003, a law known as the Pediatric Research Equity Act joined the Best Pharmaceuticals Act of 2002 to require drug manufacturers to study pediatric medication use and offer incentives for pediatric pharmacology research.Providers are not forbidden to prescribe drugs in children that are not FDA- approved. The laws do not mandate the use of evidence-based guidelines and do not provide grants to fund research.

• The nurse will administer an intravenous medication to

an adolescent patient. When preparing the adolescent for the IV insertion, which is an appropriate action by the nurse?a.Allowing the patient to verbalize concerns about the procedure b.Covering the insertion site with a bandage after the procedure is completed c.Explaining any possible adverse drug reactions d.Reassuring the patient that only one body part will be used

ANS: A

Allowing the adolescent to verbalize concerns about the medication and its regimen may offer opportunities to clarify misconceptions and teach new information. Preschool-age children may have concerns about harm to their body and need to have sites covered. Adolescents still have a present focus, so discussing future adverse reactions is not especially helpful. Preschool and school-age children fear bodily harm and require reassurance that only one body part will be affected.

• An infant will receive a topical medication. What

instruction will the nurse include when teaching the parents how to administer the medication?a."Apply a thin layer to the affected area." b."Apply liberally to the skin on and around the area." c."Use the medication less frequently than what is recommended for adults." d."Use the medication more frequently than what is recommended for adults."

ANS: A

Topical medications may be altered by skin tissue condition. Children have thinner, more porous skin and have a proportionately higher skin surface area than adults and thus absorb topical medications more readily. Caregivers should be advised to use only a thin layer on the affected body part. This difference in skin does not affect the frequency of administering topical medications.

• The provider has ordered that vitamin D drops be given

to a newborn. Based on the knowledge of drug distribution in infants, the nurse understands that the infant may need a.a higher dose.b.a lower dose.c.less frequent dosing.d.more frequent dosing.

ANS: B

Neonates and young infants tend to have less body fat than older children, meaning that they need less of fat-soluble medications since these medications won't be bound in fat tissue. Higher doses would lead to drug toxicity. Body fat does not affect the frequency of dosing.

• The nurse is caring for a 5-year-old child. The child is

taking a drug that has a known therapeutic range in adults, and the nurse checks that the ordered dose is correct and notes that the child's serum drug level is within normal limits. The child complains of a headache, which is a common sign of toxicity for this drug. Which action will the nurse take?a.Administer the drug since the drug levels are normal.b.Attribute the headache to non-drug causes.c.Hold the next dose and contact the provider.d.Request an order for an analgesic medication.

ANS: C

The therapeutic ranges established for many drug levels are based on adult studies, so it is important for the nurse to assess pediatric patients in conjunction with monitoring drug levels. The nurse should notify the provider of the reaction.Because headaches are a symptom of toxicity for this drug, the nurse should not ignore the symptom.

• The nurse is preparing to give a 7-year-old child a

bitter-tasting oral medication. The child asks the nurse if the medicine tastes bad. To help the child take this medication, which action will the nurse take?a.Allow the child to delay taking the medication until the parent arrives.b.Enlist the assistance of other staff to help restrain the child.c.Tell the child that it doesn't taste bad if it is swallowed quickly.d.Tell the child that it tastes bad and offer a choice of beverages to drink afterwards.

ANS: D

School-age children should be permitted more control, involvement in the process, and honest information. The nurse should tell the child the truth and offer the child a choice about what to drink to wash down the medicine. Medications must be given on schedule, so allowing the child a choice about when to take a medication is not acceptable. Restraining a child should not be used unless other methods have failed. Telling the child the medication doesn't taste bad is not honest and will reduce the child's trust in the nurse.

• The nurse is preparing to administer an oral liquid

medication to an 11-month-old child who is fussy and uncooperative. Which action will the nurse take to facilitate giving this medication?a.Adding honey to the medication to improve the taste b.Putting the medication in the infant's formula c.Requesting an injectable form of the medication d.Using a syringe and allowing the parent to give the medication

ANS: D

When possible, family members or caregivers should be solicited to assist in medication administration. Infants should not receive honey because of the risk of botulism. A syringe allows more control over the amount of medication in the infant's mouth and should be used. Mixing the medication in a bottle requires ensuring that the infant takes the entire bottle in order to get the medication dose.Using an injectable form of medication is more traumatic and should be used only when an oral route is not possible or is contraindicated.

• A 2-year-old child will receive several doses of an

intramuscular medication. The nurse caring for this child will use which intervention to help the child cope with this regimen?a.Allowing the child to give "pretend" shots to a doll with an empty syringe b.Allowing the child to select a Band-Aid to wear after each medication is given c.Ensuring privacy while giving the medication d.Explaining that the medicine will help the child to feel better

ANS: A

Simple explanations, a firm approach, and enlisting the imagination of a toddler through play may enhance cooperation. Allowing the child to practice on a doll may help the toddler tolerate the injections. Preschool and school-age children fear bodily injury, and Band-Aids are important with those age groups.Adolescents need privacy, and school-age children and adolescents can understand the use of a medication in relation to future outcomes.