CHAPTER 19: MEDICATION ADMINISTRATION My Nursing Test Banks

CHAPTER 19: MEDICATION ADMINISTRATION

MULTIPLE CHOICE

1.Infants and children are especially at risk for adverse reactions to medications, including age-specific adverse reactions and ineffective treatment, for which of the following reasons?

a.

Drug companies make less money on pediatric clients than on other ages, so they do less research on drugs for this age group.

b.

Ethical constraints related to informed consent severely limit the amount of testing of most drugs used with the pediatric population.

c.

Mothers are a powerful lobbying group in Congress, the Department of Health and Human Services, and the Food and Drug Administration.

d.

The response to medications varies significantly among children of similar weights and heights.

ANS: B

Feedback

A

Incorrect. Infants and children are especially at risk for adverse reactions to medications, but not primarily as a consequence of the fact that the drug companies make less money on pediatric clients than on other ages.

B

Correct. Until recently children have been excluded from drug trials due to ethical constraints related to informed consent and research risks. Since most drugs have not been adequately tested in the pediatric population, there is a relative lack of information on drug safety and efficacy in infants and children. Consequently, infants and children are at risk for adverse reactions, including age-specific adverse reactions and ineffective treatment.

C

Incorrect. Infants and children are especially at risk for adverse reactions to medications, but not primarily as a consequence of the fact that mothers are a powerful lobbying group.

D

Incorrect. Infants and children are especially at risk for adverse reactions to medications, but not primarily as a consequence of the fact that the response to medications varies significantly among children of similar weights and heights.

PTS:1REF:p. 608 Medication Administration

OBJ: Cognitive Level: Comprehension

2.Which of the following groups have the most sensitivity to medications and increased risk of adverse medication reactions?

a.

clients with psychiatric diagnoses

c.

infants and children

b.

the elderly population

d.

clients with a diagnosis of cancer

ANS: C

Feedback

A

Incorrect. Clients with psychiatric diagnoses do not represent the group to have the most sensitivity to medications and increased risk of adverse medication reactions.

B

Incorrect. The elderly population is not the group to have the most sensitivity to medications and increased risk of adverse medication reactions.

C

Correct. In general, physiological differences between children and adults make children more sensitive to drugs and increase the risk of adverse medication reactions.

D

Incorrect. Clients with a diagnosis of cancer do not represent the group to have the most sensitivity to medications and increased risk of adverse medication reactions.

PTS:1REF:p. 608 Medication Administration

OBJ: Cognitive Level: Knowledge

3.Which of the following factors makes children more sensitive to medications and have an increased risk of adverse medication reactions as compared to adults?

a.

Physiological differences exist between children and adults.

b.

They have not been exposed to all the drugs that adults have.

c.

Their intestinal tract is more sensitive to medications.

d.

Caregivers do not tend to measure medicines correctly, thus often overmedicating the child.

ANS: A

Feedback

A

Correct. Physiological differences between children and adults makes children more sensitive to medications and increases the risk of adverse medication reactions as compared to adults.

B

Incorrect. Exposure to all the drugs that adults have does not make children more sensitive to medications and increase the risk of adverse medication reactions as compared to adults.

C

Incorrect. Body fluid composition and differences in cardiovascular, gastrointestinal, renal and neurological system functioning are the primary differences making children more sensitive to medications and increase the risk of adverse medication reactions as compared to adults, not that their intestinal tract is more sensitive to medications.

D

Incorrect. Over\-medication does not make children more sensitive to medications and increase the risk of adverse medication reactions as compared to adults.

PTS:1REF:p. 608 Medication Administration

OBJ: Cognitive Level: Comprehension

4.Which of the following factors influence the absorption of orally administered medications?

a.

gastric emptying time and pH

c.

condition of the kidneys

b.

time of day administered

d.

iron content of the blood

ANS: A

Feedback

A

Correct. Gastric emptying time and pH are two factors influencing the absorption of orally administered medications.

B

Incorrect. The time of day a medication is administered is marginally a factor in the absorption of orally administered medications, but only as related to mealtimes, the content of the stomach.

C

Incorrect. The condition of the kidneys is related to the excretion of the medication, and has nothing to do with the absorption of orally administered medications.

D

Incorrect. The iron content of the blood does not turn on or shut off or limit the absorption of orally administered medications via the stomach.

PTS:1REF:p. 609 Physiological Considerations

OBJ: Cognitive Level: Comprehension

5.The gastric emptying time in neonates is how many hours?

a.

1/2 hour

c.

3-5 hours

b.

1-2 hours

d.

6-8 hours

ANS: D

Feedback

A

Incorrect. Even adult values for gastric emptying time is greater than 1/2 hour.

B

Incorrect. Even adult values for gastric emptying time is greater than 1-2 hours, around 2 hours.

C

Incorrect. The gastric emptying time is slower in neonates and infants than 3-5 hours.

D

Correct. The gastric emptying time is slower in neonates and infants (up to 6-8 hours). It reaches adult values (2 hours) around 6 months of age.

PTS:1REF:p. 609 Physiological Considerations

OBJ: Cognitive Level: Knowledge

6.The study or concern with movement of medications throughout the body by the processes of absorption, distribution, biotransformation, and excretion is called by which of the following terms?

a.

absorption-related field

c.

pharmacokinetics

b.

bioavailability

d.

pharmacological motility

ANS: C

Feedback

A

Incorrect. Pharmacokinetics is not concerned with absorption-related field.

B

Incorrect. Bioavailability is the portion of a drug that reaches general circulation and is available to exert its effect at the site of action.

C

Correct. Pharmacokinetics is concerned with the movement of drugs throughout the body by the processes of absorption, distribution, biotransformation, and excretion.

D

Incorrect. Pharmacokinetics is not concerned with pharmacological motility.

PTS:1REF:p. 608 Medication Administration

OBJ: Cognitive Level: Knowledge

7.The gastric pH of the newborn is:

a.

more acidic than the adult

b.

more alkaline than the adult

c.

about the same pH as throughout the life cycle

d.

in a state of constant change from alkaline to acidic

ANS: B

Feedback

A

Incorrect. The gastric pH of the adult is more acidic than the newborn.

B

Correct. The gastric pH of the newborn is higher (more alkaline) and gradually decreases (becomes more acidic) to reach adult levels around 2-3 years of age.

C

Incorrect. The gastric pH of the newborn is not about the same pH as throughout the life cycle, it is more basic (alkaline).

D

Incorrect. The gastric pH of the newborn is not in a state of constant change from alkaline to acidic, instead by age 2-3 years of age goes from alkaline to acidic and remains acidic.

PTS:1REF:p. 609 Physiological Considerations

OBJ: Cognitive Level: Knowledge

8.The neonate will more readily absorb which of the following types of medications?

a.

acidic drugs

c.

slightly alkaline

b.

neutral drugs

d.

very alkaline

ANS: D

Feedback

A

Incorrect. Acidic drugs are better absorbed from an acidic environment; therefore the neonate with a higher gastric pH (more alkaline) will not more readily absorb acidic drugs.

B

Incorrect. The neonate with a higher gastric pH (more alkaline) will not more readily absorb pH neutral drugs.

C

Incorrect. Basic drugs are better absorbed from an alkaline environment, the more alkaline, the more readily absorbed. The slightly alkaline pH is better than acidic or neutral, but not as good as very alkaline.

D

Correct. Basic drugs are better absorbed from an alkaline environment, the more alkaline, the more readily absorbed.

PTS:1REF:p. 609 Physiological Considerations

OBJ: Cognitive Level: Comprehension

9.The amount of medication absorbed in the small intestine of the neonate and the young infant may be unpredictable because:

a.

the pH is unpredictable

b.

peristalsis is irregular

c.

growth of the small intestine is irregular

d.

the diet is irregular

ANS: B

Feedback

A

Incorrect. The pH is predictable in the neonate and the young infant, not unpredictable.

B

Correct. Peristalsis is irregular in the neonate and the young infant. Therefore, the amount of drug absorbed in the small intestine may be unpredictable.

C

Incorrect. Irregularity of the growth of the small intestine is not the primary predictor of absorption of medication in the neonate and the young infant.

D

Incorrect. Irregularity of diet is not the primary predictor of absorption of medication in the neonate and the young infant.

PTS:1REF:p. 609 Physiological Considerations

OBJ: Cognitive Level: Comprehension

10.During the first 6 months of life, the infants absorption of orally administered medications will be:

a.

slower and more erratic

c.

somewhat faster

b.

about the same as later in life

d.

much faster

ANS: A

Feedback

A

Correct. Overall, variations in the gastrointestinal system result in slower, more erratic absorption of orally administered drugs during the first 6 months of life.

B

Incorrect. During the first 6 months of life, the infants absorption of orally administered medications will not be about the same as later in life, but slower and more erratic.

C

Incorrect. During the first 6 months of life, the infants absorption of orally administered medications will not be somewhat faster, but slower and more erratic.

D

Incorrect. During the first 6 months of life, the infants absorption of orally administered medications will not be much faster, but slower and more erratic.

PTS:1REF:p. 609 Physiological Considerations

OBJ: Cognitive Level: Comprehension

11.Absorption of medications administered intramuscularly in neonates and infants is best described as:

a.

much more rapid than by any other age group

b.

more predictable than in adults

c.

not influenced by perfusion to the area there administered

d.

slow and unreliable

ANS: D

Feedback

A

Incorrect. Absorption of medications administered intramuscularly in neonates and infants is not best described as much more rapid than by any other age group, but slower and unreliable.

B

Incorrect. Absorption of medications administered intramuscularly in neonates and infants is not best described as more predictable than in adults, in fact slower and less predictable.

C

Incorrect. Absorption of medications administered intramuscularly in neonates and infants is not best described as not influenced by perfusion to the area there administered, but is definitely influenced by reduced perfusion.

D

Correct. Absorption of medications administered intramuscularly in neonates and infants is affected by muscle mass and perfusion of the area. Neonates and infants have less muscle mass than older children or adults (25% of body weight compared to 40% of body weight in adults). The smaller muscle size results in less volume capacity and less absorptive surface. There is decreased muscle tone and lower muscle oxygenation and vasomotor instability with diminished and unpredictable peripheral blood flow. Thus, absorption of drugs administered intramuscularly in neonates and infants is best described as slower and unreliable.

PTS:1REF:p. 609 Physiological Considerations

OBJ: Cognitive Level: Comprehension

12.Topical medication absorption in infants and children is:

a.

greater due to thinner skin and greater surface-to-weight ratio

b.

slower due to less vascularity in infants and children

c.

about the same as in older children

d.

not typically used in infants due to poor tolerance

ANS: A

Feedback

A

Correct. There is more rapid absorption of topical medication in infants and children due to greater body surface area (BSA) to weight ratio. The skin is also thinner and more permeable.

B

Incorrect. Topical medication absorption in infants and children is unrelated to vascularity in infants and children.

C

Incorrect. Topical medication absorption in infants and children is not about the same as in older children, as the body surface area to weight ratio is decreasing.

D

Incorrect. Topical medication absorption in infants and children is unrelated to poor tolerance.

PTS:1REF:p. 609 Physiological Considerations

OBJ: Cognitive Level: Comprehension

13.The nurse notices that the infant is wearing a plastic-coated diaper. If a topical medication were to be prescribed and it were to go on the stomach or buttocks, the nurse would teach the caregivers to:

a.

put the diaper on as usual

b.

apply an ice pack for 5 minutes to the outside of the diaper

c.

avoid covering the area of the topical medication with the diaper

d.

avoid the use of clothing on top of the diaper

ANS: C

Feedback

A

Incorrect. Teaching the caregivers in the use of a topical medication, and noticing that the infant is wearing a plastic-coated diaper, the nurse would not advise the caregivers to put the diaper on as usual, which would lead to over-medication.

B

Incorrect. Teaching the caregivers in the use of a topical medication, and noticing that the infant is wearing a plastic-coated diaper, the nurse would not advise the caregivers to apply an ice pack for 5 minutes to the outside of the diaper. This action would have no effect on the absorption of the medication.

C

Correct. Teaching the caregivers in the use of a topical medication, and noticing that the infant is wearing a plastic-coated diaper, the nurse would advise the caregivers to avoid covering the area of the topical medication with the diaper. Absorption is increased by an occlusive dressing such as a plastic-coated diaper.

D

Incorrect. Teaching the caregivers in the use of a topical medication, and noticing that the infant is wearing a plastic-coated diaper, the nurse would not advise the caregivers to avoid the use of clothing on top of the diaper. This action would have a more negative effect on the over-absorption of the medication.

PTS:1REF:p. 609 Physiological Considerations

OBJ: Cognitive Level: Application

14.The percentage of body water in children under 2 years of age compared with that of older children and adults is:

a.

lower in intra- and extracellular fluid

b.

higher mostly in extracellular fluid

c.

about the same

d.

varies significantly between all children

ANS: B

Feedback

A

Incorrect. The percentage of body water in children under 2 years of age compared with that of older children and adults is never lower in intra- and extracellular fluid.

B

Correct. Neonates, infants, and young children have a higher percentage of body water than adults (85% in a premature neonate, 70-75% in a neonate, compared to 50-60% in an adult), with a greater portion of this water in the extracellular fluid.

C

Incorrect. The percentage of body water in children under 2 years of age compared with that of older children and adults is never about the same.

D

Incorrect. The percentage of body water in children under 2 years of age compared with that of older children and adults does not vary significantly between all children, but becomes lower as children age into adulthood.

PTS:1REF:p. 609 Physiological Considerations

OBJ: Cognitive Level: Comprehension

15.The medication nurse notices that a 12-year-old overweight boy with considerable adiposity is receiving a larger dose of a lipid-soluble medication than a 10-year-old, average-weight female peer. The nurse realizes that the major reason for this is that:

a.

females require less medication than males

b.

older children require more medication than younger peers

c.

lipid-soluble medications have an affinity for fat and can be stored in body fat

d.

boys have more muscle, which uses more lipid-soluble drug faster

ANS: C

Feedback

A

Incorrect. The nurse realizes that an order for a larger dose of a lipid-soluble medication is indicated because the 12-year-old male is overweight, not because females require less medication than males.

B

Incorrect. The nurse realizes that an order for a larger dose of a lipid-soluble medication is indicated because the 12-year-old male is overweight, not because older children require more medication than younger peers.

C

Correct. An individual with a higher percentage of body fat requires a higher mg/kg dose of a lipid-soluble medication than an individual with lower percentage of body fat. Lipid-soluble medications have a high affinity for adipose tissue and can be stored in body fat

D

Incorrect. The nurse realizes that an order for a larger dose of a lipid-soluble medication is indicated because the 12-year-old male is overweight, not because boys have more muscle, which uses more lipid-soluble drug faster.

PTS:1REF:p. 610 Physiological Considerations

OBJ: Cognitive Level: Application

16.To achieve therapeutic blood levels of a lipid-soluble medication, which of the following must happen first to get medication blood levels to rise?

a.

The body fat must get saturated.

b.

The blood sodium content must be constant.

c.

Fat-soluble vitamins must be out of the blood.

d.

The body must be hydrated.

ANS: A

Feedback

A

Correct. To achieve therapeutic blood levels of a lipid-soluble medication, the body fat must first get saturated.

B

Incorrect. To achieve therapeutic blood levels of a lipid-soluble medication, the body fat must first get saturated, and has nothing to do with blood sodium content constancy.

C

Incorrect. To achieve therapeutic blood levels of a lipid-soluble medication, the body fat must first get saturated, and has nothing to do with the presence of fat-soluble vitamins in the blood.

D

Incorrect. To achieve therapeutic blood levels of a lipid-soluble medication, the body fat must first get saturated, and has nothing to do with body hydration.

PTS:1REF:p. 610 Physiological Considerations

OBJ: Cognitive Level: Comprehension

17.Distribution is concerned with which of the following activities of medications?

a.

movement of a medication from blood to interstitial spaces and then into cells, and the amount of medication in various areas

b.

speed at which medications move through the body and out of the body

c.

route of administration of the medications and the area of the body there metabolism of the medication mainly takes place

d.

which children the medication has been given to in order to facilitate studies of untoward effects and allergic reactions

ANS: A

Feedback

A

Correct. Distribution is concerned with the movement or transport of drugs throughout the body (i.e., the process by which drugs are made available to body fluids and tissues). Factors influencing drug distribution in the body include body composition and fluid distribution, protein binding, blood flow to the tissues, and special membrane barriers.

B

Incorrect. Distribution is not concerned with the speed at which medications move through the body and out of the body.

C

Incorrect. Distribution is not concerned with the route of administration of the medications and the area of the body there metabolism of the medication mainly takes place.

D

Incorrect. Distribution is not concerned with which children the medication has been given to in order to facilitate studies of untoward effects and allergic reactions.

PTS:1REF:p. 610 Physiological Considerations

OBJ: Cognitive Level: Comprehension

18.In neonates, the number of protein-binding sites is limited. What is the danger of competitive medication binding?

a.

kernicterus or bilirubin encephalopathy

b.

Wernicke-Korsakoff syndrome

c.

bilirubinuria

d.

xanthoendothelioma or pantanencephaly

ANS: A

Feedback

A

Correct. In neonates, the number of protein-binding sites is limited. Consequently, competitive drug binding may lead to increased concentrations of unbound, unconjugated bilirubin leading to Kernicterus or bilirubin encephalopathy. Lower drug doses or higher levels of endogenous substances, such as free fatty acids, bilirubin, or steroids to provide increase binding potential are indicated.

B

Incorrect. Wernicke-Korsakoff syndrome is the coexistence of Wernickes encephalopathy (inflammatory, hemorrhagic, degeneration of the brain) and Korsakoffs psychosis (a form of amnesia often seen in chronic alcoholics), totally unrelated to the danger of competitive medication binding in the neonate.

C

Incorrect. Bilirubinuria is the presence of bilirubin in the urine, may be present as a symptom, but is not the primary danger of competitive medication binding.

D

Incorrect. Xanthoendothelioma (yellow interior tumor, not actually real) or the pantanencephaly (congenital absence of all or nearly all brain tissue) have nothing to do with the danger of competitive medication binding.

PTS:1REF:p. 610 Physiological Considerations

OBJ: Cognitive Level: Comprehension

19.During the first month to 24 months of age, the liver of the neonate is immature. While the liver is immature, medications metabolized by the liver have:

a.

a shorter half-life

c.

a longer half-life

b.

no half-life

d.

about the same half-life

ANS: C

Feedback

A

Incorrect. During the first month to 24 months of age, the liver of the neonate is immature. While the liver is immature, medications metabolized by the liver have a longer half-life, not a shorter half-life.

B

Incorrect. Not one medication lacks a half-life.

C

Correct. Due to liver immaturity, the drug-metabolizing capacity of premature infants and neonates is low. Although liver function develops rapidly during the first few months after birth, complete maturation of hepatic enzyme activity is not reached until 1 to 2 years of age. During this time, drugs metabolized by the liver have a longer half-life and there is an increased risk of toxicity.

D

Incorrect. During the first month to 24 months of age, the liver of the neonate is immature. While the liver is immature, medications metabolized by the liver have a longer half-life, not about the same half-life.

PTS:1REF:p. 610 Physiological Considerations

OBJ: Cognitive Level: Knowledge

20.Biotransformation is also called:

a.

metabolism

c.

excretion

b.

absorption

d.

anabolism

ANS: A

Feedback

A

Correct. Biotransformation is also called metabolism, refers to the transformation or alteration of chemical structures from their original form. This transformation facilitates excretion.

B

Incorrect. Absorption is the process thereby drugs move from the site of administration into the bloodstream, not biotransformation.

C

Incorrect. Excretion is the removal of the modified substances, but is not the same as biotransformation.

D

Incorrect. Though anabolism is a constructive metabolism characterized by the conversion of simple substances into more compounds of living matter, building up, not he same as biotransformation.

PTS:1REF:p. 610 Physiological Considerations

OBJ: Cognitive Level: Knowledge

21.Most biotransformation of medications occurs in the:

a.

liver

c.

stomach

b.

kidneys

d.

small intestine

ANS: A

Feedback

A

Correct. Most biotransformation of medications occurs in the liver.

B

Incorrect. Most biotransformation of medications occurs in the liver, not in the kidneys.

C

Incorrect. Most biotransformation of medications occurs in the liver, not in the stomach.

D

Incorrect. Most biotransformation of medications occurs in the liver, not in the small intestine.

PTS:1REF:p. 610 Physiological Considerations

OBJ: Cognitive Level: Knowledge

22.Which of the following conditions in the newborn causes a longer half-life and increased risk of toxicity to medications excreted primarily by the renal system?

a.

fetal alcohol syndrome

c.

unstable urine filtration

b.

immature kidneys

d.

small bladder capacity

ANS: B

Feedback

A

Incorrect. Fetal alcohol syndrome is unrelated to a longer half-life and increased risk of toxicity to medications excreted primarily by the renal system among newborns.

B

Correct. Immature kidneys in the newborn causes a longer half-life and increases the risk of toxicity to medications excreted primarily by the renal system.

C

Incorrect. Unstable urine filtration is unrelated to a longer half-life and increased risk of toxicity to medications excreted primarily by the renal system among newborns.

D

Incorrect. Small bladder capacity is unrelated to a longer half-life and increased risk of toxicity to medications excreted primarily by the renal system among newborns.

PTS:1REF:p. 610 Physiological Considerations

OBJ: Cognitive Level: Comprehension

23.The nurse is preparing to administer oral medication to an infant. Based on knowledge of the developmental stage of infants, the nurse would:

a.

give the medication quickly

b.

have a parent give the medication

c.

play a game with the baby, then give medication

d.

let the baby hold the medicine and take it

ANS: B

Feedback

A

Incorrect. Preparing to administer an oral medication to an infant, the nurse would not give the medication quickly.

B

Correct. Infants are developing trust and are helped by consistency, both in caregivers and in approaches to nursing care. In later infancy, stranger anxiety may make the infant less receptive to care by the nurse. Involving parents in medication administration can make this experience less stressful for infants.

C

Incorrect. Gaming playing is more appropriate for preschoolers, not infants.

D

Incorrect. It is never appropriate to let the baby hold the medicine and take it.

PTS:1REF:p. 611 Physiological Considerations

OBJ: Cognitive Level: Application

24.Based upon the toddlers developmental stage, the nurse giving medications to a toddler would most likely say:

a.

You must take this medicine right now.

b.

Would you like me to give you your medicine, or would you like your mommy to give it to you?

c.

I have to give you this medicine on time because the health care practitioner ordered it.

d.

Be a good child and take your medicine, as it will make your mommy and daddy very happy.

ANS: B

Feedback

A

Incorrect. Toddlers are developing autonomy and commonly display negativism. Hence, the nurse would not most likely say: You must take this medicine right now. The toddler will very likely respond with no.

B

Correct. Giving choices and allowing toddlers to handle equipment also foster a sense of control and may enhance cooperation. At this age, choices should be kept simple, that is, a choice between two things. Would you like me to give you your medicine, or would you like your mommy to give it to you?

C

Incorrect. Toddlers are developing autonomy and commonly display negativism. Hence, the nurse would not most likely say: I have to give you this medicine on time because the health care practitioner ordered it. The toddler will very likely respond with no.

D

Incorrect. Toddlers are developing autonomy and commonly display negativism. Hence, the nurse would not most likely say: Be a good child and take your medicine, as it will make your mommy and daddy very happy. The toddler will very likely respond with no.

PTS:1REF:p. 611 Physiological Considerations

OBJ: Cognitive Level: Application

25.The nurse is preparing to give a bitter liquid medication to a child. Which of the following statements by the nurse would be best?

a.

This medicine will probably taste worse than anything you have ever tasted before.

b.

This medicine may taste different from anything you have tasted before.

c.

Sometimes medicines are awful, but they help you more than good-tasting medicines.

d.

This is a magic medicine with a special taste, and it will make you get better.

ANS: B

Feedback

A

Incorrect. Although it is essential that explanations be truthful, they should be mildly threatening, not: This medicine will probably taste worse than anything you have ever tasted before.

B

Correct. It is essential explanations be truthful: however, the language used should be minimally threatening. For example, This medicine may taste different from anything you have tasted before.

C

Incorrect. Since it is essential explanations be truthful, a half-truth is not the best approach, such as saying: Sometimes medicines are awful, but they help you more than good-tasting medicines.

D

Incorrect. Since it is essential explanations be truthful, an appeal to fantasy is not the best approach, such as saying: This is a magic medicine with a special taste, and it will make you get better.

PTS:1REF:p. 612 Developmental Considerations

OBJ: Cognitive Level: Application

26.The nurse is preparing to give a medication to an adolescent client. The nurse prepares to check the wristband, but it is missing. The nurse needs to:

a.

ask the adolescent to self-identify

b.

have a nearby peer identify the client

c.

compare the adolescent to a picture ID

d.

wait for the parents to identify the adolescent

ANS: C

Feedback

A

Incorrect. In preparing to give a medication to an adolescent client, finding the wristband missing, the nurse will not ask the adolescent to self-identify as adolescents may consider it fun to misidentify themselves.

B

Incorrect. In preparing to give a medication to an adolescent client, finding the wristband missing, the nurse will not rely upon a peer to identify the client.

C

Correct. In preparing to give a medication to an adolescent client, finding the wristband missing, the nurse needs to compare the adolescent to a picture ID.

D

Incorrect. In preparing to give a medication to an adolescent client, finding the wristband missing, the nurse will not wait for the parents to identify the adolescent.

PTS:1REF:p. 613 Medication Administration

OBJ: Cognitive Level: Application

27.At what age can a child be trusted to self-identify for medication administration?

a.

preschool

c.

adolescent

b.

school-aged

d.

none

ANS: D

Feedback

A

Incorrect. Infants and preverbal children are unable to self identify, young children may disavow their identity in an attempt to avoid an unpleasant experience.

B

Incorrect. Young children may disavow their identity in an attempt to avoid an unpleasant experience.

C

Incorrect. Adolescents may consider it fun to misidentify themselves to authority figures.

D

Correct. The nurse should not expect the pediatric client to correctly self-identify.

PTS:1REF:p. 613 Medication Administration

OBJ: Cognitive Level: Comprehension

28.The nurse is trying to give oral medication to an uncooperative child. The nurses best course of action is to:

a.

tell the child that you dont think the child dares to take the medication

b.

tell the child that he will get a prize if he takes the medication

c.

let the child know he will become sicker if he doesnt take the medicine

d.

allow the child to pretend he is giving medicine to a stuffed animal first

ANS: D

Feedback

A

Incorrect. In trying to give oral medication to an uncooperative child, the nurses best course of action is not to dare the child to take the medication.

B

Incorrect. In trying to give oral medication to an uncooperative child, the nurses best course of action is not to bribe the child to take the medication.

C

Incorrect. In trying to give oral medication to an uncooperative child, the nurses best course of action is not to coerce the child to take the medication.

D

Correct. The administration of oral medication in the pediatric population may be a challenge since the appearance, smell, or taste of the medication may make children reluctant to accept them. Therefore, a matter-of-fact approach, based on developmental level and ability, usually results in cooperation. For example, ask children to administer the oral drug to themselves.

PTS:1REF:p. 614 Medication Administration

OBJ: Cognitive Level: Application

29.Nurses today would use which of the following methods to calculate a medication dosage for a child?

a.

Clarks rule, using the childs weight in the calculation

b.

Youngs rule

c.

Frieds rule

d.

unit of drug per kilogram of body weight or body surface area

ANS: D

Feedback

A

Incorrect. Nurses today would not use Clarks rule, using the childs weight in the calculation.

B

Incorrect. Nurses today would not use Youngs rule.

C

Incorrect. Nurses today would not use Frieds rule.

D

Correct. Appropriate drug dosages in children are most commonly calculated on the basis of unit of drug per kilogram of body weight or unit of drug per Body Surface Area (BSA).

PTS:1REF:p. 613 Medication Administration

OBJ: Cognitive Level: Comprehension

30.The nurse is teaching caregivers about the administration of phenobarbital in suspension form. The most important thing the nurse will say to the caregivers to ensure an accurate dose is:

a.

Hold the medicine cup or syringe at eye level to read the amount to be given.

b.

Use a syringe to measure the medicine instead of a medicine cup or teaspoon.

c.

Shake the suspension before measuring and administering this medication.

d.

Always buy the medicine from the same drug company.

ANS: C

Feedback

A

Incorrect. In teaching caregivers about the administration of phenobarbital in suspension form, the most important thing the nurse will say to the caregivers to ensure an accurate dose is not: Hold the medicine cup or syringe at eye level to read the amount to be given.

B

Incorrect. In teaching caregivers about the administration of phenobarbital in suspension form, the most important thing the nurse will say to the caregivers to ensure an accurate dose is not: Use a syringe to measure the medicine instead of a medicine cup or teaspoon.

C

Correct. In teaching caregivers about the administration of phenobarbital in suspension form, the most important thing the nurse will say to the caregivers to ensure an accurate dose is: Shake the suspension before measuring and administering this medication. Suspensions require shaking before administration to distribute the medication evenly throughout the liquid.

D

Incorrect. In teaching caregivers about the administration of phenobarbital in suspension form, the most important thing the nurse will say to the caregivers to ensure an accurate dose is not: Always buy the medicine from the same drug company.

PTS:1REF:p. 614 Medication Administration

OBJ: Cognitive Level: Application

31.The nurse is preparing to give a medicine that comes in tablet form to a 10-month-old child. The nurse checks with the pharmacy and it can be crushed. After the tablet is crushed, which of the following liquids or soft foods would be best to mix the tablet with?

a.

honey

c.

whole milk

b.

formula

d.

pudding

ANS: D

Feedback

A

Incorrect. The nurse would not mix the crushed tablet in honey for a 10-month old child due to the risk of botulism.

B

Incorrect. The nurse would not mix the medication into the formula, as this is an essential food and its taste may not cover the bitterness of the crushed tablet.

C

Incorrect. The nurse would not mix the medication into whole milk, as this is an essential food and its taste may not cover the bitterness of the crushed tablet.

D

Correct. Crushed tablets or capsule contents generally have a bitter taste. To make the medication more palatable it can be missed with a pleasant tasting liquid or non-essential food before administering. Common vehicles include flavored syrups provided by the pharmacy, jelly, honey (not for the infant since there is risk of botulism), pudding, ice cream or applesauce.

PTS:1REF:p. 614 Medication Administration

OBJ: Cognitive Level: Application

32.The nurse administering liquid medication to children would teach the caregivers to give the medicine at home using which of the following utensils?

a.

an ordinary teaspoon from the family kitchen

b.

kitchen measuring spoons

c.

a kitchen tablespoon

d.

a calibrated medication spoon, dropper, or syringe

ANS: D

Feedback

A

Incorrect. The nurse administering liquid medication to children would not teach the caregivers to give the medicine at home using an ordinary teaspoon from the family kitchen.

B

Incorrect. The nurse administering liquid medication to children would not teach the caregivers to give the medicine at home using kitchen measuring spoons.

C

Incorrect. The nurse administering liquid medication to children would not teach the caregivers to give the medicine at home using a kitchen tablespoon.

D

Correct. Teach caregivers about acceptable measuring devices for liquid medications, for example, oral syringes, measured medicine spoons, or medicine droppers calibrated for a specific medication.

PTS:1REF:p. 616 Medication Administration

OBJ: Cognitive Level: Application

33.The pediatric nurse is working with a hospitalized child and his family. The child is preparing to go home and back to school. The child is to take medication three times a day for 1 week. The nurse will advise the family to:

a.

give the medication before school, after school, and at bedtime

b.

check with the school about policies regarding medicine taken at school and talk with the school nurse about the medication

c.

have the child stay home until the medication is completely finished

d.

take the medicine as ordered until school starts and then change the medication to a dosage able to be given twice daily

ANS: B

Feedback

A

Incorrect. Giving the medication before school, after school, and at bedtime may be perfectly acceptable, but the nurse will advise the family to inform the school nurse of the medication being administered so that she can be in tune with precautions or other considerations that may apply.

B

Correct. Have caregivers inform appropriate school personnel of the medication the child is taking, the purpose of the medication, how long the child will be taking the medication, and any special precautions or considerations needed then the child is taking the medication. Teach caregivers to be aware of and follow local school policy regarding medications taken at school.

C

Incorrect. Having the child stay home until the medication is completely finished is not the advice the nurse would give, as the child will fall behind in their schoolwork.

D

Incorrect. The nurse will not advise the family to alter the number of times per day the medicine is taken as this will affect the efficacy.

PTS:1REF:p. 616 Medication Administration

OBJ: Cognitive Level: Application

34.You are the nurse working with the caregivers of a child who is being discharged from the pediatric unit of the hospital. You have been teaching the caregivers about safe storage, use, and disposal of medicines. Which of the following statements by one of the caregivers would indicate he or she had understood your teachings?

a.

When we get home, we are going to give our baby her candy (medicine) just like you told us: every day at the same times.

b.

We will give her the antibiotic every day until it is finished and not save any of it.

c.

My brothers boy is coming down with something similar to what our girl had, so I told him he should try some of our medicine.

d.

I think I have this same prescription at home already from my sickness, so I understand I can use it, as long as its the correct dosage for a child.

ANS: B

Feedback

A

Incorrect. Teaching the caregivers of a child being discharged from the hospital about safe storage, use, and disposal of medicines, you would also teach them not to refer to medicine as candy.

B

Correct. Teaching the caregivers of a child being discharged from the hospital about safe storage, use, and disposal of medicines, you would know they have understood your family teaching if they said: We will give her the antibiotic every day until it is finished and not save any of it.

C

Incorrect. Teaching the caregivers of a child being discharged from the hospital about safe storage, use, and disposal of medicines, you would also teach them not to give the medication to any other member of the family even if the illness is similar.

D

Incorrect. Teaching the caregivers of a child being discharged from the hospital about safe storage, use, and disposal of medicines, you would also teach them not to give any medication other than the one prescribed by the discharge physician.

PTS:1REF:p. 617 Medication Administration

OBJ: Cognitive Level: Application

35.The nurse is preparing to give an intravenous medication to a child. Which of the following actions by the nurse would most help avoid unnecessary anxiety?

a.

Have the medication prepared and ready to administer before entering the childs room.

b.

Have the health care practitioner talk to the caregivers about the intravenous medication.

c.

Tell the child about the needle stick, the hurt, the medication, and why the child needs it.

d.

Give the caregivers the medication insert or the drug guide so they can read about the medicine firsthand.

ANS: A

Feedback

A

Correct. If possible, the intravenous medication should be ready for administration before entering the childs room to avoid causing unnecessary anxiety.

B

Incorrect. In preparing to give an intravenous medication to a child, to help avoid unnecessary anxiety, the nurse would not have the health care practitioner talk to the caregivers about the intravenous medication.

C

Incorrect. In preparing to give an intravenous medication to a child, to help avoid unnecessary anxiety, the nurse would not tell the child about the needle stick, the hurt, the medication, and why the child needs it.

D

Incorrect. In preparing to give an intravenous medication to a child, to help avoid unnecessary anxiety, the nurse would not give the caregivers the medication insert or the drug guide so they can read about the medicine firsthand.

PTS:1REF:p. 615 Medication Administration

OBJ: Cognitive Level: Application

36.You are the nurse preparing to give an injection to an infant. Which of the following sites is preferred for giving an intramuscular injection?

a.

vastus lateralis

c.

ventrogluteal

b.

rectus femoris

d.

deltoid

ANS: A

Feedback

A

Correct. The preferred injection site for infants is vastus lateralis. The rectus femoris is also an acceptable site and may be used as an alternative or to rotate injection sites.

B

Incorrect. The preferred injection site for infants is vastus lateralis. The rectus femoris is also an acceptable site and may be used as an alternative or to rotate injection sites.

C

Incorrect. The ventrogluteal injection site may be used for children older than 3 years of age who have been walking for several years.

D

Incorrect. The deltoid muscle is generally used only in children over 4-5 years of age due to the small muscle mass, but it can also be used for immunizations in the child over 1 1/2 years of age since only a small amount of fluid is injected.

PTS:1REF:p. 619 Medication Administration

OBJ: Cognitive Level: Comprehension

37.You are the nurse assigned to care for several children of varying ages from newborn to toddler. All of these children are to get intramuscular injections. What is the most important criterion you will assess prior to using the dorsogluteal site for the intramuscular injection?

a.

how tall the child is

b.

degree of fear that the child has

c.

whether the child has been walking for at least 1 full year

d.

location of veins and arteries

ANS: C

Feedback

A

Incorrect. Caring for children of varying ages from newborn to toddler, the most important criterion you will assess prior to using the dorsogluteal site for an intramuscular injection is not how tall the child is.

B

Incorrect. Caring for children of varying ages from newborn to toddler, the most important criterion you will assess prior to using the dorsogluteal site for an intramuscular injection is not the degree of fear that the child has.

C

Correct. Caring for children of varying ages from newborn to toddler, the most important criterion you will assess prior to using the dorsogluteal site for an intramuscular injection is whether the child has been walking for at least 1 full year.

D

Incorrect. Caring for children of varying ages from newborn to toddler, the most important criterion you will assess prior to using the dorsogluteal site for an intramuscular injection is not the location of veins and arteries.

PTS:1REF:p. 619 Medication Administration

OBJ: Cognitive Level: Application

38.The nurse is selecting an injection site for a child. The nurse knows that muscle sites in children are determined primarily by muscle development and which of the following other criteria?

a.

vascularity of area

c.

amount of fluid to be given

b.

size of the syringe

d.

amount of adipose tissue the child has

ANS: C

Feedback

A

Incorrect. Injection sites are determined primarily on muscle development and the amount of fluid to be injected, not the vascularity of area.

B

Incorrect. Injection sites are determined primarily on muscle development and the amount of fluid to be injected, not the size of the syringe.

C

Correct. Injection sites are determined primarily on muscle development and the amount of fluid to be injected.

D

Incorrect. Injection sites are determined primarily on muscle development and the amount of fluid to be injected, not the amount of adipose tissue the child has.

PTS:1REF:p. 619 Medication Administration

OBJ: Cognitive Level: Comprehension

39.The nurse is preparing to give an injection to a preschooler. The nurse has selected the deltoid muscle. What is the maximum amount of solution that the nurse can give in the deltoid of a preschooler?

a.

0.25 cc

c.

0.5 cc

b.

0.05 cc

d.

1 cc

ANS: C

Feedback

A

Incorrect. The maximum amount of solution that the nurse can give in the deltoid muscle of a preschooler is limited to 0.5 cc, not 0.25 cc.

B

Incorrect. The maximum amount of solution that the nurse can give in the deltoid muscle of a preschooler is limited to 0.5 cc, not 0.05 cc.

C

Correct. The maximum amount of solution that the nurse can give in the deltoid muscle of a preschooler is limited to 0.5 cc.

D

Incorrect. The maximum amount of solution that the nurse can give in the deltoid muscle of a preschooler is limited to 0.5 cc, 1 cc is 2X more than recommended.

PTS:1REF:p. 619 Medication Administration

OBJ: Cognitive Level: Comprehension

40.What is the maximum amount of solution a nurse can give an adolescent in the deltoid muscle?

a.

0.5 cc

c.

1.5 cc

b.

1 cc

d.

2 cc

ANS: B

Feedback

A

Incorrect. The maximum amount of solution a nurse can give an adolescent in the deltoid muscle is 1 cc, not 0.5 cc.

B

Correct. The maximum amount of solution a nurse can give an adolescent in the deltoid muscle is 1 cc.

C

Incorrect. The maximum amount of solution a nurse can give an adolescent in the deltoid muscle is 1 cc, not 1.5 cc.

D

Incorrect. The maximum amount of solution a nurse can give an adolescent in the deltoid muscle is 1 cc, not 2 cc.

PTS:1REF:p. 619 Medication Administration

OBJ: Cognitive Level: Comprehension

MULTIPLE RESPONSE

1.When providing pharmacologic interventions for children, it is important for the nurse to consider which of the following differences between adults and children? Select all that apply.

a.

anatomical

c.

psychological

b.

physiological

d.

cognitive

ANS: A, B, C, D

Feedback

Correct

The anatomical, physiological, psychological, and cognitive differences between children and adults must be considered then planning to initiate pharmacological interventions. Such developmental differences are essential considerations for the safe administration of medications.

Incorrect

All answers are correct.

PTS:1REF:p. 608 Medication Administration

OBJ: Cognitive Level: Comprehension

2.A nurse is preparing to administer an intramuscular injection to a 9-month-old child. Which of the following injection sites would be appropriate for the nurse to consider using? Select all that apply.

a.

vastus lateralis

c.

rectus femoris

b.

dorsogluteal

d.

ventro gluteal

ANS: A, C

Feedback

Correct

For the infant, the preferred injection site is the vastus lateralis.

The rectus femoris is also an acceptable option.

Incorrect

The dorsogluteal site should be used only for the child who has been walking for at least 1 full year.

The ventro gluteal muscle is used for children who are older than 3 years of age.

PTS:1REF:p. 619 Medication Administration

OBJ: Cognitive Level: Application

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