Pharmacology For the Primary Care Provider 4th Edition by Edmunds Mayhew - Test Bank

Pharmacology For the Primary Care Provider 4th Edition by Edmunds Mayhew – Test Bank

 

Instant Download – Complete Test Bank With Answers

 

 

Sample Questions Are Posted Below

 

Chapter 05: Special Populations: Pediatrics

Test Bank

 

MULTIPLE CHOICE

 

1. A nurse practitioner (NP) is preparing to prescribe a medication for a 5-year-old child. To determine the correct dose for this child, the NP should:

a.	calculate the dose at one third of the recommended adult dose.
b.	estimate the child’s body surface area (BSA) to calculate the medication dose.
c.	divide the recommended adult dose by the child’s weight in kilograms (kg).
d.	follow the drug manufacturer’s recommendations for medication dosing.

 

 

ANS:  D

The package insert provided by the manufacturer is the best source for pediatric dose recommendations. Approximated reduction in the adult dose is not a safe or effective way of calculating pediatric doses of medications, so using a third of the adult dose may not be safe. Errors inherent in determining BSA make this method less reliable than dose based on accurate weights. Dividing the adult dose by the child’s weight is incorrect.

 

DIF:    Cognitive Level: Understanding (Comprehension)             REF:   64 – 65

 

2. An NP is prescribing a drug that is known to be safe in children but is unable to find recommendations about drug dosing. The recommended adult dose is 100 mg per dose. The child weighs 14 kg. Using Clark’s rule, the NP should order _____ mg per dose.

a.	20
b.	10
c.	14
d.	9.3

 

 

ANS:  A

Clark’s rule suggests dividing the weight of the child in kg by the weight of an adult in kg and multiplying the result by the adult dose to get an approximation of the child’s dose. The average adult weighs 150 lb, or 70 kg. The equation is: 14 kg/70 kg = 0.2. 0.2 ´ 100 = 20 mg.

 

DIF:    Cognitive Level: Understanding (Comprehension)             REF:   65

 

3. A child who weighs 22 lb, 2 oz needs a medication. The NP learns that the recommended dosing for this drug is 25 to 30 mg per kg per day in three divided doses. The NP should order:

a.	100 mg daily.
b.	100 mg tid.
c.	300 mg daily.
d.	300 mg tid.

 

 

ANS:  B

The NP should first convert the child’s weight to kg, which is about 10 kg. The dose is then calculated to be 250 to 300 mg per day in three divided doses, which is 83 to 100 mg per dose given tid.

 

DIF:    Cognitive Level: Applying (Application)                           REF:   65

 

4. The mother of a 3-year-old child who weighs 15 kg tells the NP that she has liquid acetaminophen at home but does not know what dose to give her child. The NP should tell the mother:

a.	to give 1 teaspoon every 4 to 6 hours as needed.
b.	to throw away the old medication and get a new bottle.
c.	that she may give 5 to 7.5 mL per dose every 4 to 6 hours.
d.	to find out whether she has a preparation made for infants or children.

 

 

ANS:  D

Acetaminophen drops for infants are three times as concentrated as the oral liquid for children. The drops have been pulled from the market, but many parents may still have old preparations on hand. The NP should first determine which preparation this mother has before giving dosage recommendations. If the mother has the oral liquid for children, answers A and C would both be acceptable because the concentration is 160 mg per 5 mL. The mother should not be counseled to throw away the medication until the NP has more information.

 

DIF:    Cognitive Level: Applying (Application)                           REF:   65

 

5. The parent of a toddler asks the NP about using a topical antihistamine to treat the child’s atopic dermatitis symptoms. The NP should tell the parent that:

a.	topical medications have fewer side effects in children.
b.	medications given by this route are not absorbed well in young children.
c.	topical application of an antihistamine may result in drug toxicity in children.
d.	it is important to apply topical medications liberally over a large surface area.

 

 

ANS:  C

Children have the potential for increased absorption through the skin because their skin is thinner and more sensitive, increasing their risk for drug toxicity. Topical medications have enhanced side effects in children. Topical medications are readily absorbed by children. Applying topical medications liberally over a large surface area would increase the risk of toxicity.

 

DIF:    Cognitive Level: Understanding (Comprehension)             REF:   67 – 68

 

6. An NP is prescribing a medication for a 6-month-old infant. The medication comes in the following formulations. Which one should the NP select to improve absorption and distribution of the medication?

a.	Oral elixir
b.	Rectal suppository
c.	Lipid soluble compound
d.	Sustained-release capsule

 

 

ANS:  A

An elixir is a solution in which the drug molecules are dissolved and evenly distributed. Most oral drugs in soluble solutions are readily absorbed from the gastrointestinal tract, and the fact that the drug is evenly distributed helps to ensure that each dose will have equal amounts of the drug. Rectal suppositories generally should be avoided for drug administration, primarily because children may not retain the dosage form long enough to receive the entire dose. Drugs that are lipid soluble may not distribute well in infants. Drugs may pass quickly through the gastrointestinal tract in infants, making sustained-release preparations less well absorbed.

 

DIF:    Cognitive Level: Understanding (Comprehension)             REF:   60| 61| 66

 

7. An NP prescribes an oral elixir medication for a child who is to take 1 tsp PO bid. When counseling the child’s parents about administering this drug, the NP should tell them to:

a.	shake the medication well before giving each dose.
b.	mix the medication with cereal or applesauce to improve its taste.
c.	administer the medication on an empty stomach to enhance absorption.
d.	use a syringe purchased at the pharmacy to measure the medication accurately.

 

 

ANS:  D

Because the measured volume of “teaspoons” ranges from 2.5 to 7.8 mL, parents should obtain a calibrated medicine spoon or syringe from the pharmacy for dosing small children. Elixirs are solutions in which the drug molecules are dissolved and evenly distributed, so there is no need to shake the drug before each dose. Mixing a drug with food can be problematic if the child does not eat all of the food. An elixir does not need to be administered on an empty stomach.

 

DIF:    Cognitive Level: Understanding (Comprehension)             REF:   66 – 67| 69

 

8. A 4-month-old infant has a viral illness with high fever and cough. The infant’s parent asks the NP about what to give the infant to help with symptoms. The NP should prescribe which of the following?

a.	Aspirin to treat the fever
b.	Acetaminophen as needed
c.	Dextromethorphan for coughing
d.	An antibiotic to prevent increased infection

 

 

ANS:  B

Infants should not be given aspirin, which carries a risk of Reye’s syndrome, or dextromethorphan, which has an increased risk of respiratory depression in infants. An antibiotic is not indicated unless there is a known bacterial infection. Acetaminophen is safe for infants.

 

DIF:    Cognitive Level: Applying (Application)                           REF:   64

 

9. A parent brings a 5-year-old child to a clinic for a hospital follow-up appointment. The child is taking a medication at a dose equal to an adult dose. The parent reports that the medication is not producing the desired effects. The NP should:

a.	order renal function tests.
b.	prescribe another medication to treat this child’s symptoms.
c.	discontinue the drug and observe the child for toxic side effects.
d.	obtain a serum drug level and consider increasing the drug dose.

 

 

ANS:  D

By a child’s first birthday, the liver’s metabolic capabilities are not only mature but also more vigorous than the adult liver, meaning that certain drugs may need to be given in higher doses or more often. It is prudent to obtain a serum drug level and then consider increasing the dose to achieve the desired effect. Renal function tests are not indicated. Unless the child is experiencing toxic effects, the drug does not need to be discontinued.

 

DIF:    Cognitive Level: Applying (Application)                           REF:   62| 66 – 67

 

10. An NP is prescribing an antibiotic for a child who will need to take a total of 750 mg per day. Which dosing regimen should the NP prescribe to promote compliance?

a.	250 mg/5 mL—375 mg PO bid
b.	250 mg/5 mL—250 mg PO tid
c.	500 mg/5 mL—375 mg PO bid
d.	500 mg/5 mL—250 mg PO tid

 

 

ANS:  C

To improve compliance with a drug regimen, convenient dosage forms and dosing schedules should be chosen when possible. A 500 mg/5 mL preparation means that a smaller volume can be given to achieve the desired dose. A bid dosing schedule is more likely to be followed than one that is tid.

 

DIF:    Cognitive Level: Applying (Application)                           REF:   69

 

11. An NP sees a preschooler in clinic for the first time. When obtaining a medication history, the NP notes that the child is taking a medication for which safety and effectiveness in children has not been established in drug information literature. The NP should:

a.	discontinue the medication.
b.	order serum drug levels to evaluate toxicity.
c.	report the prescribing provider to the Food and Drug Administration (FDA).
d.	ask the parent about the drug’s use and side effects.

 

 

ANS:  D

Many of the drugs and biologic products most widely used in pediatric patients carry disclaimers stating that safety and effectiveness in pediatric patients have not been established. The NP should find out why the drug was prescribed and whether there are any significant side effects. The medication should not be discontinued unless there are known toxic effects. Serum drug levels may be warranted if side effects are reported. The NP would not report the prescribing provider to the FDA unless there are clear, evidence-based contraindications to prescribing a drug to children.

 

DIF:    Cognitive Level: Applying (Application)                           REF:   67 – 69