PEDS Chapter 35: Key Pediatric Nursing Interventions

Question 1

Eight Rights of Pediatric Medication

Answer 1

Right medication
Right patient
Right time 
Right route of administration
Right dose
Right documentation
Right to be educated
Right to refuse

Question 2

Pharmacodynamics

Answer 2

Behavior of medication at the cellular level

Affected by the physiologic immaturity of some body systems in a child

Question 3

Pharmacokinetics

Answer 3

Movement of drugs throughout the body via absorption, distribution, metabolism, and excretion
Affected by the child’s age, weight, body surface area, and body composition

Question 4

Oral medications

Answer 4

slower gastric emptying, increased intestinal motility, a proportionately larger small intestine surface area, higher gastric pH, and decreased lipase and amylase secretion compared with adults

Question 5

Intramuscular absorption

Answer 5

amount of muscle mass, muscle tone and perfusion, and vasomotor instability

Question 6

Subcutaneous absorption

Answer 6

decreased perfusion

Question 7

Topical absorption of medications

Answer 7

increased due to greater body surface area and greater permeability of infant’s skin

Question 8

Factors Affecting Distribution of Medication in Children

Answer 8

Higher percentage of body water than adults
More rapid extracellular fluid exchange
Decreased body fat
Liver immaturity, altering first-pass elimination
Decreased amounts of plasma proteins available for drug binding
Immature blood–brain barrier, especially neonates, allowing permeation by certain medications

Question 9

The nurse is administering amoxicillin orally to an infant with a bacterial infection. Which of the following developmental factors might affect the absorption of this medication?

a. slower gastric emptying
b. vasomotor instability
c. decreased perfusion
d. greater body surface area

Answer 9

a. slower gastric emptying. Slower gastric emptying might affect the absorption of amoxicillin.
Rationale: Slower gastric emptying might affect the absorption of amoxicillin since it is being given orally. Vasomotor instability might affect intramuscular absorption of medication. Decreased perfusion alters subcutaneous administration of medication and may decrease absorption. Greater body surface area may increase the effect of topical administration of medication.

Question 10

Factors Affecting Metabolism of Medications in Children

Answer 10

Differences in hepatic enzyme production
Increased metabolic rate
Biotransformation
Is affected by the same variations affecting distribution in children

Question 11

Developmentally Appropriate Explanations for Medications for Children

Answer 11

Why the drug is needed
What the child will experience
What is expected of the child
How the parents can participate and support their child

Question 12

Determining Children’s Doses by Body Weight

Answer 12

Weigh the child.
If the child’s weight is in pounds, convert it to kilograms (divide the child’s weight in pounds by 2.2).
Check a drug reference for the safe dose range (e.g., 10 to 20 mg/kg of body weight).
Calculate the low safe dose.
Calculate the high safe dose.
Determine if the dose ordered is within this range.

Question 13

The safe dose of a medication is 10 to 20 mg/kg. What would the nurse calculate as the low safe dose for a child who weighs 40 kg?

a. 100 mg
b. 200 mg
c. 300 mg
d. 400 mg

Answer 13

d. 400 mg. 400 mg is the low safe dose for a child who weighs 40 kg if the safe dose of a medication is 10 to 20 mg/kg.
Rationale: to calculate the low safe dose use the following proportion:
10 mg/1 kg = x mg/40 kg
Solve for x by cross-multiplying
1 × x = 10 × 40
x = 400 mg

Question 14

Guidelines to Determine BSA

Answer 14

Measure the child’s height.
Determine the child’s weight.
Using the nomogram, draw a line to connect the height measurement in the left column and the weight measurement in the right column.
Determine the point where this line intersects the line in the surface area column. This is the BSA, expressed in meters squared (m2).

Question 15

Forms of Oral Medications

Answer 15

• Liquids
• Elixirs
• Syrups
• Suspensions
• Powders
• Tablets
• Capsules

Question 16

Is the following statement true or false?

The nurse crushing a tablet to administer it to a child should mix the medication with the child’s formula.

Answer 16

False. The nurse crushing a tablet to administer it to a child should not mix the medication with the child’s formula.
Rationale: The crushed tablet or inside of a capsule may taste bitter, so it should never be mixed with formula or other essential foods. Otherwise, the child may associate the bitter taste with the food and later refuse to eat it. It could be mixed with a small amount of applesauce or other nonessential food.

Question 17

Subcutaneous (SQ) administration

Answer 17

Distributes medication into the fatty layers of the body

Insulin administration, heparin, and certain immunizations

Question 18

Intradermal (ID) administration

Answer 18

Deposits medication just under the epidermis

Tuberculosis screening and allergy testing

Question 19

Providing Atraumatic Care When Administering Medications

Answer 19

Using comforting positions
Using topical anesthetic prior to injections
Educating the child and parents
Preventing medication errors

Question 20

Is the following statement true or false?

The nurse assessing the veins of a 5-month-old infant for peripheral IV therapy correctly chooses the baby’s foot.

Answer 20

True. The nurse assessing the veins of a 5-month-old infant for peripheral IV therapy correctly chooses the baby’s foot.
Rationale: Peripheral IV therapy sites commonly include the hands, feet, and forearms. In infants up to about the age of 9 months, the scalp veins may be used. However, use of the scalp veins can be frightening to parents who may think the fluid is infusing into the infant’s brain. Thus, scalp veins are usually used only if attempts at other sites have been unsuccessful.

Question 21

Factors Affecting the Choice of Equipment for IV Therapy

Answer 21

The solution or medication to be administered
The duration of the therapy
The age and developmental level of the child
The child’s status
The condition of the child’s veins

Question 22

Principles of Atraumatic Care Managing IV Therapy

Answer 22

Gather equipment before approaching child.
Select hand rather than wrist or upper arm veins.
Ensure adequate pain relief.
Allow anesthetic to prepared site to dry.
Use a barrier to avoid pinching the skin.
If needed, use a device to transilluminate the vein.

Question 23

Principles of Atraumatic Care Managing IV Therapy (cont.)

Answer 23

Make only two attempts to gain access.
Encourage parental participation.
Coordinate care with other departments.
Secure line with minimal amount of tape.
Protect the site from bumping.

Question 24

Measures to Reduce Complications With TPN

Answer 24

Monitor the child’s vital signs closely for changes.
Adhere to strict aseptic technique .
Ensure that the system remains a closed system at all times.
Use occlusive dressings.
Adhere to agency policy for flushing of the catheter and maintaining catheter patency.
Assess intake and output frequently.
Monitor blood glucose levels and obtain laboratory tests as ordered to evaluate for changes in fluid and electrolytes