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1.The nurse caring for a 6-year-old client enters the room to administer an oral medication in the form of a pill. The dad at the bedside looks at the pill and tells the nurse that his daughter has a hard time swallowing pills. What is the best response by the nurse? A) Ask the child to try swallowing the pill and offer a choice of drinks to take with it. B) Crush the pill and add it to applesauce. C) Request that the healthcare provider prescribe the medication in liquid form. D) Call the pharmacy and ask if the pill can be crushed. - correct answer โ
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Ans: D Feedback: The father is the best source of knowledge on medication administration for the child. The pharmacy should be called to determine if the pill might be crushed. Asking the child to try swallowing the pill disregards the information the father has just given.
Requesting that the healthcare provider order the medication in liquid form is not necessary at this point. 2.The nurse is administering acetaminophen PRN to a 9- year-old child on the pediatric ward of the hospital. Which answers reflect nursing actions that follow the rules of the rights of pediatric medication administration? Select all that apply. A) The nurse identifies the child by checking the name on the child's chart. B) The nurse makes sure the medication is given within the hour of the ordered time. C) The nurse checks the documented time of the last dosage administered. D) The nurse calculates the dosage according to the child's weight. E) The nurse explains the therapeutic effects of the medication to the child and parents. F) The nurse administers the medication even though the child is adamant
B) Weight C) Body surface D) Body composition - correct answer โ
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Ans: A Feedback: Although a drug's mechanism of action is the same in any individual, the physiologic immaturity of some body systems in a child can affect a drug's pharmacodynamics (behavior of the medication at the cellular level). The child's age, weight, body surface area, and body composition also can affect the drug's pharmacokinetics (movement of drugs throughout the body via absorption, distribution, metabolism, and excretion). When describing the differences affecting the pharmacokinetics of drugs administered to children, which would the nurse include? A) Oral drugs are absorbed more quickly in children than adults. B) Absorption of intramuscularly administered drugs is fairly constant.
C) Topical drugs are absorbed more quickly in young children than adults. D) Absorption of drugs administered by subcutaneous injection is increased. - correct answer โ
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Ans: C Feedback: Topical absorption of drugs is increased in infants and young children because the stratum corneum is thinner and well hydrated. The absorption of oral drugs is slowed by slower gastric emptying, increased intestinal motility, a proportionately larger small intestine surface area, high gastric pH, and decreased lipase and amylase secretion. The absorption of drugs given intramuscularly or subcutaneously is erratic and may be decreased. 5.The nurse is providing teaching for the mother of an infant who receives all of his nutrition through a nasogastric feeding tube. The nurse is reviewing interventions to promote growth and development. Which response from the mother indicates a need for further teaching?
Feedback: To calculate the dosage, the nurse would set up a proportion to calculate the low dose as follows: 50 mg/1 kg = x mg/40 kg; solve for x by cross- multiplying: 1 ร x = 50 ร 40; x = 2,000 mg divided by 4 doses per day = 500 mg. Then calculate the high safe dose range using the following proportion: 100 mg/1 kg = x mg/40 kg; solve for x by cross-multiplying: 1 ร x = 100 ร 40; x = 4,000 mg divided by 4 doses per day = 1,000 mg. 7.The nurse is preparing to administer a medication to a 5-year-old who weighs 35 lb. The prescribed single dose is 1 to 2 mg/kg/day. Which is the appropriate dose range for this child? A) 8 to 16 mg B) 16 to 32 mg C) 35 to 70 mg D) 70 to 140 mg - correct answer โ
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Ans: B Feedback:
The nurse should convert the child's weight in pounds to kilograms by dividing the child's weight in pounds by 2.2. (35 lb divided by 2.2 = 16 kg). The nurse would then multiply the child's weight in kilograms by 1 mg for the low end (16 kg ร 1 mg = 16 mg) and then by 2 mg for the high end (16 kg ร 2 mg = 32 mg). 8.The nurse is administering a crushed tablet to an 18- month-old infant. What is a recommended guideline for this intervention? A) Mix the crushed tablet with a small amount of applesauce. B) Place the crushed tablet in the infant's formula. C) Mix the crushed tablet with the infant's cereal. D) Crushed tablets should only be mixed with water. - correct answer โ
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Ans: A Feedback: If a tablet or capsule is the only oral form available for children younger than 6 years, it needs to be crushed or opened and mixed with a pleasant-tasting liquid or a small amount (generally no more than a tablespoon) of a nonessential food such as
medication, crushing tablets and mixing with warm water to prevent tube occlusion, opening up capsules and mixing the contents with warm water, and flushing the tube with water after administering medications. The nurse should give liquid medications directly into the tube and mix powdered medications well with warm water first. 10.The nurse is administering immunizations to children in a neighborhood clinic. What is the most frequent route of administration? A) Oral B) Intradermal C) Intramuscular D) Topical - correct answer โ
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Ans: C Feedback: Intramuscular (IM) administration delivers medication to the muscle. In children, this method of medication administration is used infrequently because it is painful, and children often lack adequate muscle mass for medication absorption. However, IM
administration is used to administer certain medications, such as many immunizations. 11.The nurse is preparing to administer insulin to a diabetic child. Which would be the recommended route for this administration? A) Subcutaneous B) Intradermal C) Intramuscular D) Oral - correct answer โ
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Ans: A Feedback: Subcutaneous (SQ) administration distributes medication into the fatty layers of the body. It is used primarily for insulin administration, heparin, and certain immunizations, such as MMR. Intradermal administration is used primarily for tuberculosis screening and allergy testing. Intramuscular administration is used to administer certain medications, such as many immunizations. Insulin is not administered orally.
B) "She needs to remain still for at least 10 minutes after administration." C) "Our daughter should lie on her back with her head hyperextended." D) "We must not let the dropper make contact with the nasal membranes." - correct answer โ
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Ans: B Feedback: Once the drops are instilled, the child should remain in hyperextension for at least 1 minute to ensure the drops have come in contact with the nasal membranes. Ten minutes would be excessive. The other statements are correct. 14.The nurse is administering a liquid medication to a 3- year-old using an oral syringe. Which action would be most appropriate? A) Direct the liquid toward the anterior side of the mouth. B) Keep the child's hand away from the oral syringe when squirting the medication. C) Give all of the drug in the syringe at one time with one squirt. D) Allow the child time to swallow the medication in between amounts. - correct answer โ
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Ans: D Feedback:
When using an oral syringe to administer liquid medications, give the drug slowly in small amounts and allow the child to swallow before placing more medication in the mouth. The syringe is directed toward the posterior side of the mouth. The toddler or young preschooler may enjoy helping by squirting the medication into his or her mouth. 15.After administering eye drops to a child, the nurse applies gentle pressure to the inside corner of the eye at the nose for which reason? A) To promote dispersion over the cornea B) To enhance systemic absorption C) To ensure the medication stays in the eye D) To stabilize the eyelid - correct answer โ
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Ans: C Feedback: Punctal occlusion, or gentle pressure to the inside corner of the eye at the nose, helps to slow systemic absorption and ensure that the medication stays in the eye. Having the head lower than the body aids in dispersing the medication over the cornea.
A) A child who is receiving an IV push B) A child who is receiving chemotherapy for leukemia C) A child who is receiving IV fluids for dehydration D) A child who is receiving a one-time dose of a medication - correct answer โ
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Ans: B Feedback: Although central venous access devices can be used short term, the majority are used for moderate- to long-term therapy, such as chemotherapy. Central venous access devices are indicated when the child lacks suitable peripheral access, requires IV fluid or medication for more than 3 to 5 days, or is to receive specific treatments, such as the administration of highly concentrated solutions or irritating drugs that require rapid dilution. Peripheral IV devices are used for most other IV therapies. 18.The nurse is determining the amount of IV fluids to administer in a 24-hour period to a child who weighs 40 kg. How many milliliters should the nurse administer? A) 1,000 mL
B) 1,500 mL C) 1,750 mL D) 1,900 ml - correct answer โ
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Ans: D Feedback: Typically, the amount of fluid to be administered in a day (24 hours) is determined by the child's weight (in kg) using the following formula: 100 mL per kg of body weight for the first 10 kg (1,000) 50 mL per kg of body weight for the next 10 kg (500) 20 mL per kg of body weight for the remainder of body weight in kg (400). 19.A nurse has just administered medication via an orogastric tube. What is the priority nursing action following administration? A) Check tube placement. B) Retape the tube. C) Flush the tube. D) Remove the tube. - correct answer โ
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Ans: C Feedback: After administration, the nurse should flush the tube to maintain patency and ensure
Skin around the gastrostomy or jejunostomy insertion site may become irritated from movement of the tube, moisture, leakage of stomach or intestinal contents, or the adhesive device holding the tube in place. Keeping the skin clean and dry is important and will help prevent most of these problems. If any drainage is present, a presplit 2 ร 2 can be placed loosely around the site and changed when soiled. If no drainage is present, the nurse should not place a dressing as it can cause undue pressure and trap moisture, leading to skin irritation. Preventing movement of the tube helps reduce skin irritation; however, the tube should be able to move slightly in and out of the child's stomach. 21.The nurse is explaining to the student nurse the therapeutic effects of total parenteral nutrition (TPN). What accurately describes the use of TPN? A) It is used short term to supply additional calories and nutrients as needed.
B) It is delivered via the peripheral vein to allow rapid dilution of hypertonic solution. C) It is a highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals. D) It is usually used when the child's nutritional status is within acceptable parameters. - correct answer โ
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Ans: C Feedback: TPN is a highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals. TPN provides all nutrients to meet a child's needs. It is delivered via central venous access to allow rapid dilution of hypertonic solution. It is usually used in a child with a nonfunctioning gastrointestinal (GI) tract, such as a congenital or acquired GI disorder; a child with severe failure to thrive or multisystem trauma or organ involvement; and preterm newborns. 22.The nurse is caring for a 6-year-old child who has multisystem trauma due to a
