PHARMACOLOGICAL AND PARENTERAL THERAPIES FOR CHILDREN
1 . The nurse is preparing an educational program on immunizations for parents of children 11 to 12
... [Show More] years of age. To ensure the information presented is accurate for this age group, which immunizations should the nurse plan to address?
A. Haemophilus influenza, varicella, and human papillomavirus (HPV)
B. Mumps, measles, and rubella (MMR); pneumococcal (PPSV); and hepatitis A
C. Diphtheria-tetanus-pertussis (DTaP), meningococcal, and haemophilus influenza
D. Mumps, measles, and rubella (MMR); diphtheria-tetanus-pertussis (DTaP); and hepatitis B
ANSWER: C
A. Varicella vaccines are administered at 12 to 15 months, with the second dose at 4 to 6 years-
B. The first dose of hepatitis A vaccine is administered before 1 year of age, with the second dose 6 months after the first dose.
C. The recommended immunization schedule for children 11 to 12 years old includes a DTaP booster and meningococcal and haemophilus influenza vaccines. Others include HPV, PPSV, and hepatitis A series.
D. MMR vaccines are administered at 12 to 15 months, with the second dose at 4 to 6 years. A hepatitis B vaccine is administered to all newborns prior to hospital discharge, with the second dose at 1 to 2 months and the third dose at 6 to 18 months.
2. The nurse is storing vaccines for future use. What should the nurse do so they are properly stored? Select all that apply.
A. Place all vaccines in a temperature-controlled refrigerator.
B. Complete periodic checks of the expiration date on the vaccines.
C. Place bulk supplies of vaccines in a temperature- controlled freezer.
D. Avoid storing vaccines on the shelf in the door of the refrigerator.
E. Do not store food or beverage in the same refrigerator or freezer as the vaccines.
ANSWER: B, D, E, F
A. Not all vaccines are refrigerated; some vaccines will be inactivated by refrigeration and freezing.
B. Periodic checking for expiration dates is necessary to ensure that outdated vaccines are not administered.
C. Not all bulk supplies should be placed in a freezer; some vaccines are inactivated by freezing.
D. When refrigeration is required, a main shelf inside the refrigerator is best because a shelf in the door will have frequent temperature changes that will alter the potency of the vaccine.
E. Storing food and beverage in the same unit may result in frequent opening of the unit, leading to greater chance of temperature instability and light exposure. Contamination may also result.
F. Aluminum foil or packaging can be used to protect light-sensitive vaccines.
3. The new nurse asks the experienced nurse why the first dose of the MMR vaccine is normally given at 12 to 15 months of age and not earlier, except with international travel. Which explanation by the experienced nurse is correct?
A. “Giving the first dose of the vaccine at 12 to 15 months of age allows the correct interval before the next booster at age 12 years.”
B. “A live virus is being given; the chance of measles, mumps, or rubella developing is much higher if given at an earlier age.”
C. “A first dose at this age provides passive immunity and decreases the incidence of a child developing any of the diseases-”
D. “If given earlier, the vaccine may neutralize the passive immunity to measles from the child’s mother and no immunity may result.”
ANSWER: D
A. The second dose of the MMR vaccine can be given earlier, provided that at least 4 weeks has elapsed since the first dose. However, a second dose is usually not given earlier because sufficient immunity is usually present.
B. The chance of developing only measles is greater if the vaccine is given at a younger age because the vaccine may neutralize the passive antibodies.
C. The MMR provides active (not passive) immunity.
D. Because the MMR vaccine is a live virus, a person develops a mild form of the diseases after administration, stimulating the body to develop immunity. The passively acquired antibodies to measles can interfere with the child’s immune response to the vaccine, and no immunity may result.
4. The nurse observes a colleague about to administer an IM injection to the 12-month-old. Which intervention requires the nurse to intervene?
A. Prepares to give no more than 2 mL of fluid
B. Plans to give the injection using a 1-inch needle
C. Plans to give the injection in the dorsal gluteal site
D. Plans to give the injection after applying lidocaine/ prilocaine cream
ANSWER: C
A. No more than 2 mL of fluid should be injected into a muscle.
B. The appropriate needle length for an IM injection for children ages 2 to 12 months is 1 inch and 1% inch for toddlers.
C. Use of the dorsal giuteal site is not recommended due to a high risk of nerve damage.
D. Use of lidocaine/prilocaine cream (EMLA) to numb the area is suggested when time allows but is not required.
5. The nurse working on the pediatric unit has scheduled medications to administer at this time. Which assessments should prompt the nurse to conclude that the prescribed medication should be withheld and the HCP immediately notified?
A. Oral hydrocodone with acetaminophen to the 10-year-old with burn injuries who is feeling dizzy and light-headed
B. Oral acetaminophen to the 6—month-old with a fever of 102°F (389°C) from an infection who has developed a rash
C. Clindamycin IV to the 16-year-old male with aspiration pneumonia from near-drowning who has a BP of 92/56 mm Hg
D. Phenobarbital IV to the 5-year-old with intermit- tent seizures who states feeling tired and appears to be drowsy
ANSWER: C
A. Dizziness and light-headedness are side effects of hydrocodone with acetaminophen (Vicodin), and the nurse may choose to withhold a scheduled dose. These are not potentially life-threatening or warranting an immediate call to the HCP.
B. A rash is a side effect of acetaminophen (Tylenol). However, the rash is not potentially life-threatening or warranting an immediate call to the HCP.
C. An adverse effect of clindamycin (Cleoein) is hypotcnsion. A BP of 92/56 mm Hg is low for a 16-year-old. Normal BP for a 16-year-old male is 111/63 mm Hg to 136/90 mm Hg, depending on height percentile. The nurse should compare the previous BP readings with the current one to determine the degree of BP variation and then immediately notify the HCP because the BP can decrease further.
D. Tiredness and drowsiness are side effects of phenobarbital (Luminal). However, these are expected. The nurse would not withhold phenobarbital unless there were additional neurological alterations that would warrant contacting the HCP.
6. The nurse notes from the child’s MAR illustrated that the child is to receive the first dose of a newly prescribed medication at 0800 hours. The drug reference book recommends an initial pediatric dose of lamotrigine of 0.6 mg/kg/day in two divided doses for the first 2 weeks. Which action by the nurse is most appropriate?
A. Administer the medication as written on the MAR.
B. Telephone the health care provider to question the dose.
C. Ask the parent If this is the dose the child had been taking.
D. Consult the pharmacist to verify whether the dose is correct.
ANSWER: B
A. Although the medication is written on the MAR, an error still exists in the dose, and the medication should not be administered.
B. The nurse should notify the HCP. The child weighs 30 kg; the recommended initial daily dose of lamotrigine (Lamictal) for this child would be 18 mg (0.6 x 30 = 18 mg). If given 18 mg bid, the child would receive a daily dose of 36 mg, twice the recommended initial pediatric dose.
C. The child has a new-onset seizure disorder; it is unlikely that the child was taking this medication prior to hospitalization.
D. Consulting the pharmacist is unnecessary; the nurse still needs to seek clarification from the HCP.
7. The hospitalized child who has a blood lead level of 50 mcg/dL is to receive succimer 10 mg/kg oral capsule q8h for 5 days. The child weighs 20 kg. Which intervention by the student nurse should be corrected by the observing nurse?
A. Prepares to give the total dose of one 1OO-mg capsule with applesauce
B. Sprinkles the beads of two 1OO-mg capsules into pudding for administration
C. Offers fluids frequently during the shift to increase the child’s urine output
D. Explains to a parent that chelation therapy removes the lead from the blood
ANSWER: A
A. The 20-kg child should receive two capsules of succimer (Chemet), not one. Dose (mg) = 20 kg x 10 mg/kg = 200 mg.
B. Succimer capsules can be opened and sprinkled on a small amount of food or in liquid to be swallowed; two 1OO-mg capsules = 200 mg, which is the correct dose.
C. Fluids should be increased to prevent renal damage because succimer is excreted by the kidneys.
D. Suecimer forms a water-soluble compound with lead, allowing urinary elimination of excessive amounts of lead. Lead is removed from the blood, and theoretically some lead is removed from tissues and organs.
8. The child, admitted to the ED, is experiencing nausea and vomiting, salivation, respiratory muscle weakness, and depressed reflexes an hour after exposure to pesticides. Which medications should the nurse anticipate administering to the child?
A. Atropine and flumazenil
B. Atropine and pralidoxime
C. Epinephrine and naloxone
D. Epinephrine and digoxin immune Fab
ANSWER: B
A. Flumazenil (Romazieon) antagonizes the effects of benzodiachincs on the CNS, such as sedation, impaired recall, and psycho motor impairment.
B. An organophosphate base in pesticides causes acetylcholine to accumulate at neuromuscular junctions. Atropine (Atropine), an anticholinergic medication, and pralidoxime chloride (Protopam), a cholinesterase reactivator, are effective antidotes to reverse the symptoms.
C. Epinephrine (EpiPen) is an alpha- and betaadrenergic agonist and cardiac stimulant that strengthens myocardial contractions, increases systolic BP, increases cardiac rate and output, and constricts bronchial arterioles, inhibiting histamine release. Naloxone (Narcan) is a narcotic antagonist that reverses the effects of opiates.
D. Digoxin immune Fab (Digibind) is the antidote for digoxin and digitoxin, which acts by complexing with circulating digoxin or digitoxin, preventing the drug from binding at receptor sites.
9. The 5-year-old is receiving an IV infusion of D5 with 0.45 NaCl at 100 mL/hr. Which assessment findings suggest excessive parenteral fluid intake? Select all that apply.
A. Dyspnea
B. Lethargy
C. Gastric distention
D. Crackles in lung bases
E. Temperature of 102°F (389°C)
ANSWER: A, B, D
A. Dyspnea indicates fluid volume overload and occurs from fluid rapidly shifting between the intracellular and extracellular compartments.
B. Lethargy and change in level of consciousness can occur from fluid shifting in brain cells.
C. Gastric distention can occur from excessive oral (not IV) fluid intake or infection.
D. Crackles indicate fluid volume overload and occur from fluid rapidly shifting into the alveoli.
E. An elevated temperature is a sign of fluid volume deficit, not excess.
10. The nurse has completed swaddling the 2-month-old infant, prepared supplies to cannulate the scalp vein for an IV infusion, and cleansed and shaved the hair at the site over the temporal bone. Place the remaining steps in the order that they should be performed by the nurse.
A. Return in 60 minutes and reswaddle the infant ill a mummy restraint.
B. With an assistant holding the infant’s head, insert a scalp vein needle and observe for blood return.
C. Apply lidocaine/prilocaine cream to the site selected and unswaddle the infant after the cream application.
D. Cleanse the shaved area with an antiseptic solution.
E. Remove the mummy restraint after initiating the infusion and comfort the infant.
F. Initiate the infusion and cover the infusion needle with a gauze dressing.
ANSWER: C, A, D, B, F, E
C. Apply litlocainclprilocaine (EMLA) cream to the site selected anti unswaddle the infant after the cream application. An anesthetic cream will numb the site and help reduce the infant’s pain during insertion. The infant does not need to remain swaddled while the cream reaches its therapeutic effectiveness in about an hour.
A. Return in 60 minutes and reswaddie the infant in a mummy restraint. It takes about an hour for the lidocaine/prilocaine cream to reach its therapeutic effectiveness. The infant should be reswaddled to minimize movement during insertion.
D. Cleanse the shaved area with an antiseptic solution. Cleansing the area with an antiseptic solution will help prevent inadvertent introduction of microorganisms into the vascular system.
B. With an assistant holding the infant’s head, insert a scalp vein needle and observe for blood return. Movement of the infant’s head can result in loss of the vein access or a needle—stick injury to the infant or nurse.
F. initiate the infusion and cover the infusion needle with a gauze dressing. Once the vein has been successfully cannulatcd, the site can be dressed and 1V fluids started.
E. Remove the mummy restraint after initiating the infusion and comfort the infant. The mummy restraint is no longer needed after the IV catheter has been successfully inserted into a scalp vein.
11 . The 8-year-old child with gastroenteritis is prescribed to receive 500 mL of lactated Ringer’s (LR) solution over the next 10 hours. How many milliliters per hour should the nurse administer? __________ mL (Record your answer as a whole number.)
ANSWER: 50
500 mL / 10 hr = 50 mL/hr
12. The new nurse is initiating TPN for four hospitalized pediatric clients. The experienced nurse should intervene when observing the new nurse attach the TPN infusion tubing to which IV line?
A. The catheter inserted in the right external jugular vein of the 2-year-old
B. The catheter inserted in the right subclavian vein of the 4-year-old
C. The peripherally inserted IV catheter in a hand vein of the l2-year—old
D. The PICC located in the right upper arm of the 6-year-old
ANSWER: C
A. The external jugular vein is a central IV access site.
B. The subclavian vein is a central 1V access site.
C. TPN is a concentrated hypertonic solution containing glucose, vitamins. electrolytes, trace minerals, and protein. Because it is hypertonic, it should be administered through a central IV access site or a PICC. A major vein is used to avoid inflammatory reactions and venous thrombosis from the high-caloric and high-osmotie fluid.
D. A PICC is a central IV access site.
13. The child with CF is prescribed vitamin A supplements. Which finding by the clinic nurse indicates that the vitamin has been effective?
A. Skill is supple and healthy.
B. Viscosity of secretions is decreased.
C. Number of bleeding episodes is reduced-
D. Pancreatic enzyme absorption is increased.
ANSWER: A
A. A water-miscible form of vitamin A is given in children diagnosed with CF because the uptake of the fat solublie vitamins is decreased. One of the functions of vitamin A is to keep epithelial tissue healthy by aiding the differentiation of specialty cells.
B. Other treatments for CF, such as bronchodilators and recombinant human deoxyribonuelease dornase alfa (Pulmozymefl, decrease the viscosity of secretions.
C. Vitamin K, another fat—soluble vitamin administered in CF, increases coagulation.
D. Vitamin A has no effect on pancreatic enzyme absorption.
14. The child with CF is receiving albuterol. Which response should the nurse expect if albuterol is achieving the desired therapeutic effect?
A. Increased heart rate
B. Improved weight gain
C. Fewer hospitalizations
D. Fewer adventitious lung sounds
ANSWER: D
A. Albuterol may increase HR, but this is not the desired therapeutic effect.
B. Weight should not be affected by albuterol.
C. The use of a bronchodilator has not been demonstrated to decrease hospitalization frequency.
D. The desired therapeutic effect of a bronchodilator such as albuterol (Proventil) is a reduction in adventitious (abnormal) breath sounds.
15. While the nurse is completing the assessment of the child with Reye’s syndrome, the parent states that multiple OTC medications were given before hospitalization to treat the child’s influenza symptoms. Which medication stated by the parent is most important for the nurse to report to the HCP?
A. Acetaminophen
B. Bismuth subsalicylate
C. Pseudoephedrine
D. Diphenhydramine
ANSWER: B
A. Acetaminophen (Tylenol) is an aspirin-free analgesic and antipyretic.
B. Although the etiology of Reye’s syndrome is unknown, the condition typically occurs after a viral illness, such as influenza, and is associated with aspirin (acetylsalicylic acid) use during the illness. Bismuth subsalicylate (Pepto-Bismol) contains aspirin.
C. Pseudoephedrine (Sudafed) is an allergy and/or cold remedy used for nasal drying and decongestion. This does not contain aspirin.
D. Diphenhydramine (Benadryl) is an antihistamine. This does not contain aspirin.
16. The nurse is caring for the child from Italy. The child is crying, and the interpreter is stating that the child has extreme pain. What should be the nurse’s priority?
A. Administer morphine sulfate 1 mg intravenously as prescribed.
B. Have the child’s mother, who knows limited English, ask the child what hurts.
C. Assess the level of the child’s pain using an appropriate FACES pain rating scale.
D. Ask the HCP to change the pain medication dosage due to inadequate pain control.
ANSWER: C
A. The nurse’s judgment regarding the choice of pain medication and dose should be based on the reported level of pain.
B. The nurse should do an independent assessment because sometimes information can be misinterpreted if there is limited knowledge of the language.
C. Assessment should be completed prior to a pain intervention. The FACES pain-rating scale has been translated into a variety of languages.
D. There is no information indicating the need for the pain medication dose to be changed.
17. The HCP prescribed a dose of acetaminophen according to weight recommendations for the child weighing 48 1b. The package insert states that the recommended dose is 15 mg per kg. What dose should the nurse administer? _____ mg (Record your answer as a whole number.)
ANSWER: 327
First change 48 lb into kilograms (48 / 2.2 = 21.8 kg). Next determine the dose (21.8 kg x 15 = 327 mg). The child should receive 327 mg of acetaminophen (Tylenol).
18. The adolescent, who is receiving morphine sulfate via PCA, has itching. Which medication listed on the client’s MAR should the nurse plan to administer to relieve the itching?
A. Diazepam
B. Diphenhydramine
C. Naloxone hydrochloride
D. Butenafine hydrochloride
ANSWER: B
A. Diazepam (Valium) acts on the CNS to produce sedation, hypnosis, skeletal muscle relaxation, and anticonvulsant activity.
B. Diphenhydramine (Benadryl) is an antihistamine that hlocks histamine release by competing for the histamine receptors.
C. Naloxone (Narcan) is a narcotic antagonist that reverses the effects of opiates.
D. Butenafine (Mentax) is an antifungal antibiotic used to treat tinea pedis, tinea corporis, and tinea eruris.
19. The nurse is preparing to administer morphine sulfate IV to the child in severe pain. The child has an IV infusion of DSW at 50 mL/hr through a PICC. Which intervention is best when administering the medication?
A. Disconnect the infusion, inject 3 mL of normal saline, and give the morphine sulfate undiluted.
B. Question the prescribed medication because morphine sulfate cannot be given through a PICC line.
C. Give the morphine sulfate undiluted into the existing IV tubing’s medication port closest to the child-
D. Dilute the morphine sulfate with 5 mL of NS and give over 5 minutes into the IV tubing port closest to the child.
ANSWER: D
A. Unnecessary IV disconnections increase the risk for infection. Morphine sulfate is compatible with DSW.
B. Morphine sulfate can be administered into a PICC access device.
C. Administering undiluted morphine sulfate to a child increases the risk of adverse effects.
D. The nurse should dilute the morphine sulfate before administration to prevent too-rapid administration and adverse effects. A single dose should be given over 4 to 5 minutes.
20. The HCP’s progress notes state a plan to initiate an oral NSAID for the child’s pain. Based on this information, the nurse should consult with the HCP when noting that which medication was the only analgesic prescribed?
A. Naproxen
B. Tolmetin
C. Ibuprofen
D. Hydromorphone
ANSWER: D
A. Naproxen (Aleve) is an NSAID.
B. Tolmetin (Tolectin) is an NSAID.
C. Ibuprofen (Advil, Motrin) is an NSAID.
D. Hyd romorphone (Dilaudid) is an opioid analgesic, not an NSAID.
21 . A dose of albuterol 5 mg by nebulization is prescribed for the pediatric client experiencing wheezing from an asthma episode. The medication vial contains 2.5 mg per 3 mL. How many milliliters of medication should the nurse prepare for administration by nebulization? _________ mL (Record your answer as a whole number.)
ANSWER: 6
Use a proportion formula:
2.5 mg : 3 mL :: 5 mg :X mL;
multiply the outside values and then the inside values and solve for X;
2.5X=15;
X= 6 mL
22. The home care nurse is observing the child with asthma self-administer a dose of albuterol via a metered-dose inhaler with a spacer. Within a short time, the child begins to wheeze loudly. What should the nurse do?
A. Reassure the parent that this usually only occurs with the initial dose.
B. Notify the HCP; wheezing may indicate paradoxical bronchospasms.
C. Consult with the HCP to have the child’s medication dosage increased.
D. Reassess the technique; eye contact with albuterol can cause wheezing.
ANSWER: B
A. Reassuring the parent is an inappropriate action; the wheezing is not a normal reaction. There is no indication that this is an initial dose.
B. The client’s wheezing suggests paradoxical bronchospasms, which can occur with excessive use of adrenergic bronchodilators such as albuterol (Proventil). The medication should be withheld and the HCP notified.
C. A paradoxical bronchospasm can occur from excessive use, so the dosage should not be increased.
D. Contact with the eyes can cause eye irritation, not wheezing.
23. The parent of the 2—year—old with asthma has been given instructions about asthma control and Step Therapy. Which statement, if made by the parent, should indicate to the nurse that the parent has an adequate understanding of the instructions?
A. “If my child has wheezing twice a week or less, I should add the nebulized corticosteroid and make an appointment.”
B. “If my child has a respiratory tract infection I should add the nebulized corticosteroid and make an appointment.”
C. “If my child has to use the nebulizer less than twice a week, I should add the nebulized corticosteroid and make an appointment.”
D. “If my child has nighttime awakenings with wheezing twice a month or more, I should add the nebulized corticosteroid and make an appointment.”
ANSWER: D
A. Asthma symptoms (wheezing) occurring 2 or fewer days per week should be treated at Step 1.
B. A respiratory tract infection may require the increased use of short-acting beta agonists, but an inhaled corticosteroid should not be added until the child is evaluated by the HCP.
C. The use of the nebulizer twice a week or less should be treated at Step I.
D. Nighttime waking with asthma symptoms 1 to 2 times per month indicates the need to proceed to Step 2 therapy, which includes the use of an inhaled corticosteroid.
24. The 3-year-old with LTB is receiving aerosolized racemic epinephrine. Which assessment finding should the nurse recognize as indicating that the treatment is having an adverse effect?
A. Heart rate of 180 beats/min
B. Blood pressure of 60/40 mm Hg
C. Respiratory rate of 25 breaths/min
D. Pulse oximetry of 90% on room air
ANSWER: A
A. Tachycardia is an adverse effect of racemic epinephrine (AsthmaNefrin).
B. Hypertension, not hypotension, is an adverse effect of racemic epinephrine; a BP of 60/40 mm Hg in a 3-year—old indicates hypotension.
C. A respiratory rate of 25 breaths/min is normal for a 3-year—old.
D. A pulse oximetry reading of90% is concerning and may indicate the need for supplemental oxygen, but it is not an adverse effect from the medication.
25. The initial treatment regimen of isoniazid, rifampin, and ethambutol is prescribed for the adolescent who has a positive tuberculin skin test. The client confides that she thinks she may be pregnant and asks if she should be taking these medications. Which rationale should be the basis for the nurse’s response?
A. These drugs cross the placental barrier, and treatment should be withheld until the postpartum period.
B. The medications should be taken, but the diagnosis is an indication for tennination of the pregnancy.
C. The medications should be postponed because the risk for hepatitis is greatly increased ill the intrapartum period.
D. The medications should be taken; untreated TB represents a far greater hazard to the pregnant woman and her fetus.
ANSWER: D
A. The medications do not cross the placental barrier, so treatment should not be withheld.
B. Administering antituberculosis medications would not be an indication for termination of pregnancy because the medications are safe during pregnancy.
C. The risk of hepatitis is slightly increased with the use of antituberculosis medications in pregnant women; however, the benefits of treatment strongly outweigh postponement of treatment.
D. Infants born to women with untreated TB may be of lower birth weight, but rarely would the infant acquire congenital TB. Isoniazid (Nydrazid), rifampin (Rifadin), and ethambutol (Myambutol) are all considered safe for use in pregnancy.
26. The HCP prescribes amoxicillin for the 8—month-old with acute otitis media that has not resolved- Which statement to the parents is correct regarding the primary purpose of amoxicillin?
A. “It will reduce the child’s fever.”
B. “It will reduce the child’s severe ear pain.”
C. “lit will shrink swollen tissue in the Eustachian tube.”
D. “It will treat the probable organism, Haemoplrilus influenzae.”
ANSWER: D
A. As the infection is treated, the fever will be reduced, but this is not the primary reason for treatment with amoxicillin.
B. Treating the ear infection will reduce the pain, but that is not the primary purpose for treatment with amoxicillin.
C. Reducing inflammation of the eustachian tube will occur, but this is not the primary purpose for treatment with amoxicillin.
D. Acute otitis media is frequently caused by the Haemophilus influenzae and Streptococcus pneumoniae bacteria. The primary purpose of amoxicillin (Amoxil) is to treat the infection caused by these two organisms.
27. The nurse is assessing the child’s ear with an otoscope prior to administering medications to treat persistent otitis media. Which assessment finding should the nurse expect?
ANSWER: A
A. This illustration shows otitis media characterized by a bulging contour to the tympanic membrane, unclear ossicular landmarks, and yellowish middle ear effusion.
B. This illustration shows a perforated meanic membrane, not otitis media.
C. This illustration shows a normal left ear tympanic membrane. The ossicular landmarks can be identified through the tympanic membrane. The nurse would not expect to see a normal tympanic membrane when the child has persistent otitis media.
D. This illustration shows the presence of a foreign body in the ear canal.
28. The child weighing 20 kg is to receive ceftriaxone 2 g IVPB q12h and dexamethasone 3 mg IV—push q6h for 4 days to treat Haemopllilus influenzae type b meningitis. The drug reference states that the usual dose of ceftriaxone is 100 mg/kg/dose with a maximum daily dose of 4 g. The recommended dose of dexamethasone for treating H. influenzae type b meningitis is 0.15 mg/kg q6h for 2 to 4 days. Based on the medications prescribed and these findings, which conclusion by the nurse is correct?
A. The dose of ceftriaxone is too high.
B. The dose of dexamethasone is too low.
C. Both medications are safe to administer as Prescribed.
D. The ceftriaxone should be given before the Dexamethasone.
ANSWER: C
A. The dose for ceftriaxone is correct (100 mg x 20 kg = 2000 mg; 1000 mg = 1 gm; 2000 mg = 2 gm).
B. The dose of dexamethasone is correct (0.15 mg .Y. 20 kg = 3 mg).
C. The doses of ceftriaxone (Rocephin) and dexamethasone (Decadron) are at the recommended doses. The dose for ceftriaxone is correct (1th mg x 20 kg = 2000 mg; 1000 mg = 1 g; 2000 mg = 2 g). The dose of dexamethasone is correct (0.15 mg X 20 kg = 3 mg).
D. A11 IV-push medication takes less time to administer than an IV piggyback (IVPB) medication. The dexamethasone should be administered first.
29. The 12-year-old weighing 50 kg is hospitalized with bacterial pneumonia and an upper respiratory tract infection. The nurse is reviewing the child’s serum laboratory report illustrated. Based on the findings, which HCP order is most important for the nurse to question?
A. Amikacin sulfate 375 mg IVPB q12h
B. Guaifenesin 50-100 mg q4h pm for cough
C. Dextrose 5% in 0.25 NaCl with 20 mEq/L KCL at 90 mL/hr
D. Acetaminophen 325—650 mg q4—6h prn, not to exceed 3000 ing/24 hr
ANSWER: A
A. Amikacin (Amikin) is an aminoglycoside, which is nephrotoxic and should be questioned. The serum creatinine and BUN levels are elevated, suggesting decreased renal function.
B. Guaifenesin (Robitussin) is used for cough. The dose is within the range for a child of 12 years.
C. The serum osmolality is high, suggesting dehydration, and the potassium is low. DS in 0.25 NaCl with 20 mqu’L at 90 mL/hr will treat the dehydration and hypokalemia. The rate is appropriate [1500 mL./day, plus 20 mL/kg/day for each kg over 20 kg = 1500 + (20 X 30) = 2100; 2100 + 24 = 87.5].
D. The acetaminophen (Tylenol) dose is within parameters (IO—15 mg/kg/dose q4—6h prn, not to exceed five doses/24 hr), but it is concerning with the decreased renal function. Because acetaminophen is pro and amikacin is timed, the amikacin is more important to question-
30. The nurse is teaching the 14-year-old who is being given captopril for the first time. Which explanation would be most appropriate?
A. “Captopril will help to control your asthma.”
B. “Captopril will help to control your heart rate.”
C. “Captopril will help to control your blood sugar.”
D. “Captopril will help to control your blood pressure.”
ANSWER: D
A. Captopril does not have any effect on asthma.
B. While I-IR may slow in response to lowered BP , this is not the desired effect for which captopril is given.
C. Captopril does not have any effect on blood sugar.
D. Captopril (Capoten) is an ACE inhibitor and is indicated for the treatment of hypertension in children.
31 . The HCP orders a digitalizing dose of digoxin 225 mcg IV now to be given to a 3-year—old. The pharmacy sends a solution of 500 mcg in 50 mL Of D5W. How many mL should the nurse administer? ____ mL (Round your answer to the nearest tenth.) [Show Less]