PEDIATRIC CONSIDERATIONS

Question 1

is limited to available research in the provision of dosing protocols, safe practices, key assessments, and important nursing implications.

Answer 1

Pediatric pharmacology

Question 2

______ and ______ are reluctant to provide permission for children to participate in research studies because of the risk involved and the potentially invasive nature of data gathering.

Answer 2

Parents and guardians

Question 3

Pharmaceutical companies invest fewer resources in pediatric drug research because of the _________ afforded to pediatric drugs.

Answer 3

smaller market share

Question 4

As a result, less is known about the effects, uses, and dosages of pediatric drugs, and nurses must investigate pediatric drugs carefully to provide __________ for children.

Answer 4

knowledgeable nursing care

Question 5

Safe use for children may be guided by _______ or the _________ and may be based on _______ rather than _______.

Answer 5

small studies; judgment of the clinician; anecdotal evidence; scientific study

Question 6

requires drug manufacturers to study pediatric drug use and offers incentives for pediatric pharmacology research

Answer 6

Pediatric Research Equity Act (PREA) in 2012

Question 7

Despite the permanent reauthorization of the Pediatric Research Equity Act (PREA) in 2012, which requires drug manufacturers to study pediatric drug use and offers incentives for pediatric pharmacology research, only ____ of all drugs carry ________ for use in children.

Answer 7

half; federally approved indications

Question 8

This means many drugs prescribed for children are being prescribed _____, which means the drug is being used for some purpose for which it has not been approved.

Answer 8

off label

Question 9

Preventing Drug Administration Errors in Pediatric Pharmacology

Owing to _______ and _______, infants and young children may receive drug dosages much different from those of adults.

Answer 9

developmental factors; smaller body size

Question 10

What can prevent errors in drug administration? (3)

Answer 10

Careful calculations, double-checking math, and checking with another RN

Question 11

Preventing Drug Administration Errors in Pediatric Pharmacology

Ensure that families understand the __________ for a drug. Confusion may occur with the discussion of ____, _____, and other ______ systems.

Answer 11

units of measurement; metric, household, and other measurement systems

Question 12

Preventing Drug Administration Errors in Pediatric Pharmacology

For safety when administering injectable drugs to children, use the ____ syringe that ensures the ____ measurement of the drug.

Answer 12

smallest; most exact

Question 13

Preventing Drug Administration Errors in Pediatric Pharmacology

Use the _____ and ____ to ensure safe dosing.

Answer 13

correct drug and procedure

Question 14

What can complicate administration of appropriate pediatric dosages? (3)

Answer 14

Dilutions, different concentrations, and different solutions of a prescribed drug

Question 15

Preventing Drug Administration Errors in Pediatric Pharmacology

Infants and children may not be able to confirm _____, _____, or _____. The nurse must be positive of such information before drug administration.

Answer 15

identity, allergies, or drugs

Question 16

Preventing Drug Administration Errors in Pediatric Pharmacology

Nurses must be vigilant for _______ or _______ to drugs because information on pediatric drug response is ____.

Answer 16

severe side effects or adverse reactions to drugs; limited

Question 17

Preventing Drug Administration Errors in Pediatric Pharmacology

Regulatory agencies caution that drug administration errors are more common in _____ patients, which warrants _____ precautions in drug administration.

Answer 17

pediatric; increased

Question 18

Pediatric Age Classification

Classification: Term neonate
Age: ?

Answer 18

Birth at 38 or more weeks gestation to 27 days

Question 19

Pediatric Age Classification

Classification: Infant/toddler
Age: ?

Answer 19

28 days to 23 months

Question 20

Pediatric Age Classification

Classification: Children
Age: ?

Answer 20

24 months to 11 years

Question 21

Pediatric Age Classification

Classification: Adolescent
Age: ?

Answer 21

12 years to 16 or 18 years

Question 22

Pharmacokinetics: Absorption

The degree and rate of drug absorption are based on factors such as ____, ______, _____, and _________.

Answer 22

age, health status, weight, and route of administration

Question 23

Pharmacokinetics: Absorption

As children grow and develop, the absorption of drugs generally becomes more ____; therefore less developed absorption in neonates and infants must be considered in ______ and ______.

Answer 23

effective; dosage and administration

Question 24

What may cause slowing of drug absorption? (3)

Answer 24

poor nutritional habits, changes in physical maturity, and hormonal differences during the adolescent years

Question 25

What may be significant factors in the absorption of drugs? (3)

Answer 25

Hydration status, presence of underlying disease, and GI disorders in the child

Question 26

Pharmacokinetics: Absorption _________ is most pronounced in infancy, making the ____ and _____ periods those most affected by changes in absorption physiology

Answer 26

Lack of maturation of the GI tract; neonatal and infancy periods

Question 27

Pharmacokinetics: Absorption _______ and _______ are unpredictable in neonates and infants; however, it approaches that of adults between _ and _ months of age.

Answer 27

Gastric emptying and GI motility; 6 and 8 months

Question 28

Pharmacokinetics: Absorption Gastric emptying is affected by ______, and _____ infants have faster gastric emptying than _____ infants.

Answer 28

feeding; breast-fed; formula-fed

Question 29

Pharmacokinetics: Absorption ________ may hinder or enhance absorption of oral drugs, depending on the usual site of chemical absorption.

Answer 29

Unpredictable GI motility

Question 30

Pharmacokinetics: Absorption ________ may also affect drug absorption; neonates have inadequate production of _______ and _______, which leads to reduced absorption of _______.

Answer 30

Immature enzyme function; bile salts and pancreatic enzymes; lipid- soluble drugs

Question 31

Pharmacokinetics: Absorption For drugs administered via the _______ or __ routes, absorption occurs at the tissue level. The level of _______ and effectiveness of _____ affects drug absorption.

Answer 31

subcutaneous or IM routes; level of peripheral perfusion and effectiveness of circulation

Question 32

What are the conditions that alter perfusion? (3)

Answer 32

dehydration, cold temperatures, and alterations in cardiac status

Question 33

Pharmacokinetics: Absorption Conditions that alter perfusion – dehydration, cold temperatures, and alterations in cardiac status – may impede (delay) ___________.

Answer 33

absorption of drugs in the tissues

Question 34

Pharmacokinetics: Absorption The skin of infants and young children is _____ than that of adults; additionally, the ratio of body surface area to body mass of infants and children is _______ than for adults such that many drugs are more readily absorbed in children, and ____ may result.

Answer 34

thinner; proportionately higher; toxicity

Question 35

Pharmacokinetics: Distribution Drug distribution is affected by factors such as: (4)

Answer 35

body fluid composition, body tissue composition, protein-binding capability, and effectiveness of various barriers to drug transport

Question 36

Pharmacokinetics: Distribution In neonates and infants, the body is about __ water, compared with __ in adults which allows for a ______ of fluid in which to distribute drugs, which results in a ____ drug concentration.

Answer 36

75%; 60%; greater volume; lower drug concentration

Question 37

Pharmacokinetics: Distribution Neonates and infants have _______ compared with adults, and they have fewer ______ with an affinity for drug binding in the first __ months after birth; this results in higher levels of ______ and an increased risk of _____.

Answer 37

decreased protein concentrations; protein receptor sites; 12; unbound drug; drug toxicity

Question 38

Pharmacokinetics: Distribution Anatomic barriers to drug distribution, such as the ___, must be considered when drugs are administered to _____ patients. This barrier in neonates is relatively _____ and allows drugs to pass easily into _____, thereby increasing the likelihood for toxicity.

Answer 38

BBB; pediatric; immature; CNS tissue

Question 39

Pharmacokinetics: Metabolism Metabolism is carried out primarily in the ____, with the ____ and ____ playing a small part in metabolism.

Answer 39

liver; kidneys and lungs

Question 40

Pharmacokinetics: Metabolism Infants have reduced ________ and ________; however, by the time they reach _ year of age, hepatic blood flow has reached that of an adult.

Answer 40

hepatic blood flow and drug- metabolizing enzyme; 1

Question 41

Pharmacokinetics: Metabolism Drug prescribing should be based on ________ and ________.

Answer 41

therapeutic effect and drug concentration

Question 42

Pharmacokinetics: Excretion ______ is the predominant means of drug elimination.

Answer 42

Renal excretion

Question 43

Pharmacokinetics: Excretion The GFR in term neonates is roughly __% that of adults.

Answer 43

30%

Question 44

Pharmacokinetics: Excretion During infancy, the GFR ____, and by __ months, it reaches adult levels.

Answer 44

rises; 12

Question 45

Pharmacokinetics: Excretion Nurses must carefully monitor ________, ________, and ________ to evaluate the effect of drug administration on patient status.

Answer 45

renal function, urine flow, and drug effectiveness

Question 46

Pharmacodynamics NURSING IMPLICATIONS: Pediatric Drug Dosing and Monitoring The calculation of pediatric dosages is based in part on _______ recommendations; as a result of the Best Pharmaceuticals for Children Act (BPCA) and PREA, pediatric dosing is now available for more than ___ drugs.

Answer 46

US Food and Drug Administration (FDA); 450

Question 47

Pharmacodynamics NURSING IMPLICATIONS: Pediatric Drug Dosing and Monitoring For those drugs without pediatric dosing schedules, dosing is based on ________, ________, and ________.

Answer 47

approved protocols, research studies, and provider experience

Question 48

Pharmacodynamics NURSING IMPLICATIONS: Pediatric Drug Dosing and Monitoring Drugs for pediatric patients are ordered based on either the child’s weight in ______ (__/__), or ______(___; __/__).

Answer 48

kilograms (mg/kg), or body surface area (BSA; mg/m2)

Question 49

Pharmacodynamics NURSING IMPLICATIONS: Pediatric Drug Dosing and Monitoring Dosing must also consider the individual child’s status, including ___, _______, _____, and _______.

Answer 49

age, organ function, health, and route of administration

Question 50

Pharmacodynamics NURSING IMPLICATIONS: Pediatric Drug Administration _______ and _______ differences must always be considered in pediatric drug administration. It is important for the nurse to differentiate the child’s _______ age from _______ age, because this difference has an effect on the child’s response to drug administration.

Answer 50

Developmental and cognitive differences; developmental; chronological

Question 51

Pharmacodynamics NURSING IMPLICATIONS: Pediatric Drug Administration The pediatric patient’s ability to _________, the _________, and the need to _________ must always figure prominently in the nurse’s plan of care.

Answer 51

understand the process, the reason for drug administration, and the need to cooperate with the procedure

Question 52

Pharmacodynamics NURSING IMPLICATIONS: Pediatric Drug Administration The concept of ______ is essential to ensuring safety during and after health care interventions, especially drug administration.

Answer 52

family-centered care

Question 53

Pharmacodynamics NURSING IMPLICATIONS: Pediatric Drug Administration Teaching is directed toward both _______ or _______ and _______, commensurate with the cognitive level of the child.

Answer 53

family members or caregivers and patients

Question 54

Pharmacodynamics NURSING IMPLICATIONS: Pediatric Drug Administration When possible, ______ or ______ should be solicited to assist in drug administration. These significant persons in the child’s life, individuals who see the child on a day-to-day basis, are usually in the best position to evaluate the effectiveness of a drug and observe for adverse reactions.

Answer 54

family members or caregivers

Question 55

Pharmacodynamics NURSING IMPLICATIONS: Pediatric Drug Administration TRUE OR FALSE Family members or caregivers may request not to participate in invasive procedures such as injections.

Answer 55

TRUE

Question 56

Pharmacodynamics NURSING IMPLICATIONS: Pediatric Drug Administration TRUE OR FALSE Family members or caregivers should always be supported in their caring function so that the child feels safe and secure.

Answer 56

TRUE

Question 57

Pharmacodynamics NURSING IMPLICATIONS: Pediatric Drug Administration Pediatric patients must be assessed for the ability to understand the ______ for the drug, the ______ for the drug despite unpleasant taste or method of administration, and the need to complete all ______ and ______ of the drug.

Answer 57

reason for the drug, the need for the drug despite unpleasant taste or method of administration, and the need to complete all doses and courses of the drug

Question 58

The following are tips to enhance safe drug administration and facilitate comfort: may react violently and negatively to drug administration. Simple explanations, a firm approach, enlisting the imagination of a ____ through play may enhance success.

Answer 58

Toddlers

Question 59

The following are tips to enhance safe drug administration and facilitate comfort: _______ are fairly cooperative and respond well to age-appropriate explanations. Allowing some level of choice and control may facilitate success with _____ children.

Answer 59

Preschoolers

Question 60

The following are tips to enhance safe drug administration and facilitate comfort: _______ children, although often cooperative, may fear bodily injury and should be permitted even more control, involvement in the process, and information.

Answer 60

School-age

Question 61

The following are tips to enhance safe drug administration and facilitate comfort: Age-appropriate fears related to pain, changes in body image, and injury are prevalent among _______ and _______ patients.

Answer 61

older school-age and adolescent patients.

Question 62

The following are tips to enhance safe drug administration and facilitate comfort: The nurse should establish a _____ with the patient, develop the ____ in collaboration with the patient, and ensure ____ in all aspects of drug administration.

Answer 62

positive rapport; plan of care; privacy

Question 63

The following are tips to enhance safe drug administration and facilitate comfort: Most pediatric drugs are administered via the ____ route. This is the least invasive and easiest to use and can be used by family members or caregivers.

Answer 63

oral

Question 64

The following are tips to enhance safe drug administration and facilitate comfort: ______, ______, and ______ routes are also used to deliver drugs to pediatric patients for whom the oral route is contraindicated.

Answer 64

Topical, rectal, and parenteral routes

Question 65

The following are tips to enhance safe drug administration and facilitate comfort: Because of tissue differences among children, the __ route is more predictable than other routes.

Answer 65

IV

Question 66

The following are tips to enhance safe drug administration and facilitate comfort: Most oral drugs administered to children under _ years of age are given using an oral syringe.

Answer 66

6

Question 67

The following are tips to enhance safe drug administration and facilitate comfort: Nurses may need to _____ pills or ____ the contents of capsules in ____ for administration to pediatric patients.

Answer 67

crush; dissolve the contents of capsules in fluid

Question 68

The following are tips to enhance safe drug administration and facilitate comfort: Some drugs, particularly ______ and ______ drugs, should not be crushed or dissolved.

Answer 68

timed-release and enteric-coated

Question 69

The following are tips to enhance safe drug administration and facilitate comfort: Based on the cognitive level of the child, other nonpharmacologic methods of pain and anxiety control such as ______, ______, ______, and ______ can also be used to decrease the perception of pain.

Answer 69

distraction, diversion, relaxation, and creative imagery d

Question 70

The following are tips to enhance safe drug administration and facilitate comfort: _____ sites must be protected, especially in infants and toddlers, who do not understand the rationale or importance of maintaining the __ site.

Answer 70

IV infusion

Question 71

The following are tips to enhance safe drug administration and facilitate comfort: Any injection site on a preschooler should be covered with a _____, preferably a decorated one, so that the child does not fear “_____” from the area.

Answer 71

bandage; leakage

Question 72

Considerations for the Adolescent Patient _________ and _________ may necessitate changes in drug dosages.

Answer 72

Hormonal changes and growth spurt

Question 73

Considerations for the Adolescent Patient _________ and _________ may greatly increase during the teen years, along with _________ and _________, which may affect the scheduling of and response to drugs.

Answer 73

Sleep requirements and metabolic rates; appetite and food consumption

Question 74

Considerations for the Adolescent Patient A _________ must be solicited from adolescent patients to ensure appropriate drug administration.

Answer 74

comprehensive history

Question 75

Considerations for the Adolescent Patient The nurse must also be conscious of the need to exercise care in offering _____.

Answer 75

confidentiality

Question 76

Nursing Process: Family-Centered Collaborative Care In working with pediatric patients, ________ must be considered when administering and monitoring drugs.

Answer 76

key developmental differences

Question 77

Nursing Process: Family-Centered Collaborative Care The ________ provides the framework to guide nursing practice in administering drugs, planning and evaluating nursing care, providing patient and family teaching, and incorporating the family into all aspects of treatment.

Answer 77

nursing process

Question 78

Nursing Process: Family-Centered Collaborative Care _______ and _____ teaching is a key role for the nurse.

Answer 78

Family and patient teaching

Question 79

Nursing Process: Family-Centered Collaborative Care ____ to the drug regimen is of paramount importance with children and families.