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Pediatric Success : NCLEX-style QandA Review (2019)

Pediatric Success : NCLEX-style QandA Review (2019) helps you pass with expert-reviewed materials and study tips.

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    Richardson • • r1c THIRD EDITION NCLEX~Style Q&A Review

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    BE PREPARED FOR SUCCESS SAVE 20% + FREE SHIPPING Order today online at www.FADavis.com Use Promo Code: REVIEW20 Promotion subject to change without notice. Valid for purchases from www.FADavis.com by individuals in the U.S. only. “The most essential facts you will ever need from a trusted series.” —Amazon student reviewer Don’t have time to read your textbook? Try the Essential Nursing Content + Practice Questions series Content Review | Case Studies | NCLEX ® -Prep

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    Pediatric Success NCLEX ® -Style Q&A Review THIRD EDITION Beth Richardson, PhD, RN, CPNP, FAANP Associate Professor Emeritus Indiana University School of Nursing Indianapolis, Indiana Pediatric Nurse Practitioner HealthNet Indianapolis, Indiana

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    F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2019 by F. A. Davis Company Copyright © 2019 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor: Jacalyn Sharp Senior Content Project Manager: Julia L. Curcio Electronic Project Editor: Sandra A. Glennie Illustration and Design Manager: Carolyn O’ Brien As new scientifi c information becomes available through basic and clinical research, rec- ommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with profes- sional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Report- ing Service is: 978-0-8036-6812-6 / 19 0 + $.25.

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    I thank my children, Jason, Sarah, and Walker; my grandchildren, Caroline, Darren, Sadie, and Sam; and my friends, especially David, for all their love and support. To students, graduates, and colleagues: thank you for all you do in caring for children and their families.

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    vii Contributors to Previous Editions Susan P. Wade, MSN, RN, CPN, CCRN Clinical Assistant Professor Indiana University Purdue University Fort Wayne, Indiana Sherrilyn Coffman, DNS, RN, CPN Professor and Assistant Dean Nevada State College Henderson, Nevada Dawn Marie Daniels, DNS, RN, PHCNS-BC Clinical Nurse Specialist Riley Hospital for Children Indianapolis, Indiana Mary Jo Eoff, RN, MSN, CPNP Clinical Instructor Indiana University Indianapolis, Indiana Joyce Foresman-Capuzzi, BSN, RN, CEN, CPN, CCRN, CTRN, CPEN, SANE-A, EMT-P Clinical Nurse Educator/Emergency Department Lankenau Hospital Wynnewood, Pennsylvania Paige Johnson, RN, MSN, MPH, CRNP Pediatric Nurse Practitioner Children ’s Mercy Hospital, Department of Hematology/Oncology Kansas City, Missouri Dominique Leveque, MSN, RN, CPNP, FNP-C Workplace Health Services Clarian Health Partners Indianapolis, Indiana Christina Bittles McCarthy, MSN, RN, CPNP Pediatric Nurse Practitioner Indiana University, Department of Orthopedic Surgery Indianapolis, Indiana Patricia A. Normandin, RN, MSN, CEN, CPN, CPEN, DNP(c) Pediatric Nursing Instructor University of Massachusetts, Lowell Lowell, Massachusetts Julie A. Poore, RN, MSN Visiting Lecturer Indiana University Indianapolis, Indiana Susan P. Wade, MSN, RN, CPN, CCRN Clinical Assistant Professor Indiana University Purdue University Fort Wayne, Indiana Cele Walter, BSN, RN, CPN, NCSN High School Nurse Paul VI High School Haddonfield, New Jersey Candace F. Zickler, RN, MSN, CPNP Supervisor, Health Services Metropolitan School District of Perry Township Indianapolis, Indiana

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    ix Reviewers for Previous Editions Jacoline Sommer Albert, ADN, RN, BScN, DI Senior Instructor The Aga Khan University Karachi, Pakistan Monique Alston-Davis, MSN, Ed, CPN Assistant Professor Montgomery College Silver Spring, Maryland Cathryn J. Baack, PhD, RN, CPNP Assistant Professor MedCentral College of Nursing Mansfield, Ohio Joyce Beard, MSN, PHCNS-BC, NCSN, RN Assistant Clinical Professor University of North Carolina, Pembroke Pembroke, North Carolina Vicky H. Becherer, MSN, RN Assistant Teaching Professor University of Missouri, St. Louis St. Louis, Missouri Stacee Bertolla, RN, MSN, CPNP Instructor University of South Alabama Mobile, Alabama María del Rosario C. Biddenback, RN, MSN, FNP-C Professor Napa Valley College Napa, California Kathleen Borge, MS, RNC Faculty Chair, Women and Children’s Health Samaritan Hospital Troy, New York Pam Bowden, RN, MS, PNP Faculty North Hennepin Community College Brooklyn Park, Minnesota Twila J. Brown, PhD, RN Assistant Professor Southeast Missouri State University Cape Girardeau, Missouri Katherine Bydalek, MSN, FNP-BC, PhD Assistant Professor University of South Alabama Mobile, Alabama Dena Christianson, MSN, PNP Adjunct Faculty Nova Southeastern University Fort Lauderdale, Florida Karen Clancy, MS, RN, CNP Clinical Instructor Ohio State University Neonatal Nurse Practitioner Columbus Children’s Hospital Columbus, Ohio Myra L. Clark, MS, FNP-C Assistant Professor North Georgia College and State University Dahlonega, Georgia Lori Clay, MSN, RN Assistant Professor Arkansas State University Jonesboro, Arkansas Sallie Coke, PhD, APRN, CPNP, CFNP Associate Professor Georgia College and State University Milledgeville, Georgia

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    x P EDIATRIC S UCCESS Georgina Colalillo, MS, RN, CNE Associate Professor, Nursing Department Queensborough Community College Bayside, New York Judith Drumm, DNS, RN, CPN Professor/Nursing Palm Beach Atlantic University West Palm Beach, Florida Elizabeth Fiske, PhD, RN, NNP-BC, PCNS, BC Associate Professor Carson-Newman University Jefferson City, Tennessee Jennifer Bell Frank, MSN, APRN, BC Instructor Jacksonville State University Jacksonville, Alabama Marianne Fraser, MSN, RN, BC Assistant Professor University of Utah Salt Lake City, Utah Susan Golden, MSN, RN Nursing Faculty Eastern New Mexico University, Roswell Roswell, New Mexico Heather Janiszewski Goodin, PhD, RN, AHN-BC Professor Capital University Columbus, Ohio Kathy L. Ham, RN, EdD Assistant Professor Southeast Missouri State University Cape Girardeau, Missouri Brenda J. Walters Holloway, APRN, FNP, DNSc Clinical Assistant Professor University of South Alabama Spanish Fort, Alabama Teresa L. Howell, DNP, RN, CNE Associate Professor of Nursing Morehead State University Morehead, Kentucky Mary C. Kishman, PhD, RN Associate Professor College of Mount St. Joseph Cincinnati, Ohio Katherine R. Kniest, RN, MSN, CNE Professor William Rainey Harper College Palatine, Illinois Robyn Leo, MSN Associate Professor Worcester State College Worcester, Massachusetts Barbara J. MacDougall, MSN, ARNP Nova Southeastern University Ft. Lauderdale, Florida Sheila Matye, MSN, RN, CNE Associate Clinical Professor Montana State University, College of Nursing Great Falls, Montana Kathleen T. Mohn, RN, MSEd, CLNC Instructor College of Southern Nevada Las Vegas, Nevada Jennifer Morton, MS, MPH, RN Assistant Professor University of New England Portland, Maine Irene Owens, MSN, APRN Instructor Lake Sumter Community College Leesburg, Florida Brenda Pavill, RN, FNP, PhD, IBCLC Professor Misericordia University Dallas, Pennsylvania Delia Pittman, PhD Nursing Professor MidAmerica Nazarene University Olathe, Kansas Janine T. Reale, MS, RN, CNE Instructor, Nursing Faculty Rivier University Nashua, New Hampshire

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    R EVIEWERS FOR P REVIOUS E DITIONS xi Deborah A. Roberts, RN, BSN, MSN, EdD Instructor Sonoma State University, Department of Nursing Sonoma, California Rebecca L. Shabo, RN, PNP-BC, PhD Associate Professor Kennesaw State University Kennesaw, Georgia Cynthia A. Shartle, RN, MSN, APRN, BC-FNP ADN Faculty South Texas College McAllen, Texas Patsy M. Spratling, RN, MSN Nursing Instructor Holmes Community College Ridgeland, Mississippi Linda Strong, MSN, RN, CPNP, CNE Assistant Professor, Pediatric Nursing Cuyahoga Community College Cleveland, Ohio Bev Valkenier, BScN, RN, MSN Lecturer University of British Columbia Vancouver, British Columbia, Canada Linda Walters, RN, MSN, PhD (a.b.d.) Nursing Instructor Indiana State University Terre Haute, Indiana Elizabeth M. Wertz, RN, BSN, MPM, EMT-P, PHRN, FACMPE Chief Executive Officer Pediatric Alliance, PC Carnegie, Pennylvania Sarah Whitaker, DNS, RN Nursing Program Director Dona Ana Community College Las Cruces, New Mexico Barbara White, RN, MSN, CCRN Nursing Instructor Southwestern Michigan College Dowagiac, Michigan

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    xiii Contents 1 Fundamentals of Critical Thinking Related to Test Taking: The RACE Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 HOW TO USE THIS REVIEW BOOK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Test Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 RACE Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2 Pharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 KEYWORDS 3 ABBREVIATIONS 3 CONVERSIONS 4 QUESTIONS 4 ANSWERS AND RATIONALES 12 3 Growth and Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 KEYWORDS 21 ABBREVIATIONS 21 QUESTIONS 21 ANSWERS AND RATIONALES 31 4 Pediatric Health Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 KEYWORDS 43 ABBREVIATIONS 43 QUESTIONS 44 ANSWERS AND RATIONALES 53 5 Respiratory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 KEYWORDS 67 ABBREVIATIONS 67 QUESTIONS 68 ANSWERS AND RATIONALES 77 6 Cardiovascular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 KEYWORDS 91 ABBREVIATIONS 91 QUESTIONS 91 ANSWERS AND RATIONALES 100 7 Gastrointestinal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 KEYWORDS 109 ABBREVIATIONS 110 QUESTIONS 110 ANSWERS AND RATIONALES 121 8 Genitourinary Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 KEYWORDS 133 ABBREVIATIONS 133 QUESTIONS 133 ANSWERS AND RATIONALES 144 9 Endocrine Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 KEYWORDS 155 ABBREVIATIONS 155

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    xiv P EDIATRIC S UCCESS QUESTIONS 155 ANSWERS AND RATIONALES 165 10 Hematological/Oncology Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 KEYWORDS 177 ABBREVIATIONS 177 QUESTIONS 177 ANSWERS AND RATIONALES 186 11 Neuromuscular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 KEYWORDS 197 ABBREVIATIONS 197 QUESTIONS 197 ANSWERS AND RATIONALES 207 12 Orthopedic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 KEYWORDS 219 ABBREVIATIONS 219 QUESTIONS 219 ANSWERS AND RATIONALES 229 13 Neurological Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 KEYWORDS 239 ABBREVIATIONS 239 QUESTIONS 240 ANSWERS AND RATIONALES 250 14 Leadership and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261 KEYWORDS 261 ABBREVIATIONS 261 QUESTIONS 261 ANSWERS AND RATIONALES 271 15 Comprehensive Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285 QUESTIONS 285 ANSWERS AND RATIONALES 301 Glossary of English Words Commonly Encountered on Nursing Examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323

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    1 1 Fundamentals of Critical Thinking Related to Test Taking: The RACE Model Pediatric Success: NCLEX ® -Style Q&A Review is designed to help you, the student, complete your nursing program as well as succeed on the NCLEX-RN ® examination. This book applies critical-thinking skills primarily to multiple choice questions and to some alternate test items. It provides practice test questions and test-taking hints to help you analyze each item and choose the correct response. Another book in the Success series, Fundamentals Success by Nugent and Vitale, explains critical thinking and the RACE Model, which are used in each book in the series. This information will help you answer questions on tests in your nursing courses and on the NCLEX-RN ® examination. The key to successful studying is knowing the material that will be covered on the examinations. Course notes should be studied every night and cor- responding readings done before class. This will help you learn the material and retain it longer. Once you know the material, it is important for you to be able to answer primarily multiple choice questions correctly. The RACE Model will help you succeed with answer- ing questions. HOW TO USE THIS REVIEW BOOK The book contains 14 chapters, a final comprehensive examination, and practice questions online. Test-taking hints are included with each question. This chapter, Chapter 1, provides guidelines for course test preparation and includes an example of how to use the RACE Model. Chapter 2 focuses on pharmacology and has been included because of the expressed need of students for extra testing in this area. In the NCLEX-RN ® test plan (www. ncsbn.org), pharmacology and management of care have a large number of test items. This chapter includes questions centered on what the student nurse caring for children of all ages needs to know about administering medications, drug actions, dosages, expected effects, adverse effects, and teaching families. Chapter 3 covers growth and development of children from infancy through adolescence. Chapter 4 covers material on issues related to pediatric health. Chapters 5 through 13 follow pediatric health problems through each of the body systems. Each chapter contains practice questions, answers, and rationales for the correct answer, including test-taking hints, keywords, and abbreviations. Chapter 14, “Leadership and Management,” relates to pediatric nursing. Graduates need to have a working knowledge of issues in these areas. Chapter 15 is a final 100-ques- tion comprehensive examination. There are also questions available online that you can access free for 30 days. Questions in this book are written primarily at the application and analysis level and are either multiple choice, with four response choices, or alternate item format. Nursing faculty members write tests in these formats to familiarize students with the NCLEX-RN ® examination style. Test Preparation One of the most important strategies for you is to study your course materials thoroughly and know the assigned concepts for each examination in your class. It is best to study daily

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    2 P EDIATRIC S UCCESS so that you really learn the material. Don’t wait and try to learn it all at once. The more time you spend studying the topic, the better you will retain the material. After you feel confident that you know the material, choose the chapter(s) in this book that correspond(s) with the assigned test material in your nursing course. Answer the prac- tice questions to determine your level of knowledge about the topic. Carefully review the questions you miss, making sure you read and understand the rationale for choosing the wrong distracter and why the correct response is indeed correct. The rationales provide a great deal of information about the correct and incorrect options, which helps you under- stand the content more completely. The test-taking hints are strategies to help you logi- cally determine the correct response. If you still feel uncomfortable with the content area, review that chapter in your textbook for better understanding. This method of preparing for an examination will help you identify your strengths and areas to focus on as you con- tinue to study. You may want to start with Chapter 2, “Pharmacology,” because you will be admin- istering medications to children throughout your pediatric nursing course. This chapter will help you focus on teaching strategies for families of children receiving medications, differences in delivering drugs to children, and calculating dosages. RACE Model The RACE Model is a critical-thinking strategy to be used when answering multiple choice questions. The RACE Model helps you analyze the question stem and determine the correct response. For more detailed information about the RACE Model, see Test Success: Test-Taking Techniques for Beginning Nursing Students by Nugent and Vitale. The RACE Model comprises: R - Recognize the keywords in the stem. A - Ask what the question is asking the nurse to do. C - Critically analyze each option in relation to the information in the stem. E - Eliminate as many options as possible to narrow your choice to the correct response. Some students believe they know the material but have difficulty choosing the correct response when answering multiple choice questions. Using the RACE Model will greatly increase your chances of choosing the correct response. To use it effectively during timed tests, you need to practice. Using the RACE Model as you prepare yourself with the chapter tests will help you. Following is a sample question: 1. A 6-month-old is being seen in the clinic for a well-child checkup. The parents want to know about starting solid foods. How should the nurse counsel them? 1. “Since you started rice cereal from a spoon 2 months ago, you can add a new strained vegetable each week.” 2. “Introduce some mashed fruits first. After the infant is eating that well, start vegetables and rice cereal.” 3. “Infants do best eating solids if you spoon-feed a new strained vegetable every other day to see what their preferences are.” 4. “Add rice cereal to each bottle. Next you can add fruits and vegetables fed by spoon.” Using the RACE Model: R - The client in the stem is the parent. A - The parents want to know how to add solid foods to their infant’s diet. C - Infants start rice cereal between 4 and 6 months. This is fed to the infant by spoon unless there is an indication to place it in the bottle. That is not stated in the stem of this question. Either strained fruits or vegetables are added to the infant’s diet at about 6 months of age. The infant stays on that choice for several days to determine whether the infant is allergic. E - Now you can eliminate choices 2, 3, and 4 because they do not contain choices that you know are correct. The remaining choice is 1, the correct response.

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    3 2 Pharmacology KEYWORDS The following words include English vocabulary, nursing/medical terminology, concepts, princi- ples, or information relevant to content specifically addressed in the chapter or associated with topics presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as Taber ’ s Cyclopedic Medical Dictionary are resources that can be used to expand your knowl- edge and understanding of these words and related information. Acetaminophen (Tylenol) Albuterol (Proventil) Amoxicillin (Amoxil) Amoxicillin/clavulanate potassium (Augmentin) Amphotericin B Anticholinergic Baclofen Diphenhydramine (Benadryl) Benzoyl peroxide Carbamazepine (Tegretol) Chlorhexidine (Hibiclens) Ciprofl oxacin (Cipro) Collagenase (Santyl) Cyclophosphamide (Cytoxan) Dexamethasone (Decadron) Diclofenac (Voltaren) Digoxin (Lanoxin) Diltiazem (Cardizem) Erythromycin Filgrastim (Neupogen) Gamma globulin Gentamicin (Garamycin) Growth hormone Ibuprofen (Advil, Motrin) Ifosfamide (Ifex) Indomethacin (Indocin) Intradermal Isotretinoin (Accutane) Levothyroxine (Synthroid) Lindane (Kwell, G-Well) Mesna (Mesnex) Metoclopramide (Reglan) Morphine sulfate (Duramorph) Nasal decongestant NPH insulin Oxybutynin (Ditropan) Pancreatic enzymes Penicillin Phenytoin (Dilantin) Prednisone Prostaglandin E Pyrantel pamoate (Antiminth) Ribavirin (Virazole) Rifampin (Rifadin) Salicylic acid Sympathomimetic Terbinafine (Lamisil) Trimethoprim/sulfamethoxazole (Septra, Bactrim) Vancomycin Vastus lateralis ABBREVIATIONS Cerebral palsy (CP) grain (gr) gram (g) milligram (mg) pound (lb)

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    4 P EDIATRIC S UCCESS CONVERSIONS 1 fl ounce = 30 mL (fluid volume) 1 g = 15 gr 1 g = 1000 mg 1 gr = 60 mg (or 65 mg for Tylenol or aspirin) 1 in = 2.54 cm 1 kg = 2.2 lb 1 L = 1000 mL 1 lb = 454 g 1 lb = 16 ounces 1 mg = 1000 mcg 1 ounce = 28 g (weight) QUESTIONS 1. A child is to receive phenytoin (Dilantin) 100 mg IV for seizure prophylaxis. Which intervention is appropriate when administering this drug? 1. Mix it in dextrose 5% in water and give over 1 hour. 2. Administer no faster than 2 mg/kg/min. 3. Do not use an inline fi lter. 4. Monitor temperature prior to and after administration. 2. The parent of a child who is being discharged from the clinic wants to know if there is a difference between Advil and ibuprofen, saying, “I can buy ibuprofen over the counter at a cheaper price than Advil.” What is the nurse’s best response? 1. “Advil and ibuprofen are two different drugs with similar effects.” 2. “There is no difference between the two medications, so you should use whichever one is cheaper.” 3. “Similarities exist between the drugs, but you need to consult the health-care provider about the specific order.” 4. “Ibuprofen is usually cheaper, so you should use it.” 3. What time would the nurse most likely see signs and symptoms of hypoglycemia after administering NPH insulin at 0730? 1. 0930 to 1030. 2. 1130 to 1430. 3. 1130 to 1930. 4. 1530 to 1930. 4. Morphine sulfate (Duramorph) 2 mg IV q2h prn for pain is ordered for a 12-year- old who has had abdominal surgery. Which is the most appropriate nursing action? 1. Administer the morphine sulfate (Duramorph) using a syringe pump over 1 hour. 2. Encourage the child to use incentive spirometer every hour during the day and when awake at night. 3. Ask the health-care provider to change the medication to meperidine (Demerol). 4. Administer the morphine sulfate (Duramorph) with Benadryl (diphenhydramine) to prevent itching. 5. The parent of a child who is being treated for Haemophilus influenzae meningitis tells the nurse that the family is being treated prophylactically with rifampin (Rifadin). Which should the nurse include in teaching about this medication? 1. “The drug will change the color of the urine to orange-red, and it will cause staining.” 2. “Adverse effects of the drug may cause urinary retention.” 3. “The drug is given to treat meningitis.” 4. “You will need to continue taking the drug for 7 days.”

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    C HAPTER 2 P HARMACOLOGY 5 6. A 2-year-old child has been prescribed amoxicillin (Amoxil) bid for treatment of pharyngitis. Which statement indicates that the parent knows how to give the medication? 1. “If I miss giving my child a dose at breakfast, I will double up on the dose at night.” 2. “I will give the medication at breakfast and dinner.” 3. “I know that amoxicillin (Amoxil) is a pill, but sometimes my child will not take it.” 4. “I will continue giving the amoxicillin (Amoxil) for 10 days even after my child is better.” 7. A nurse is caring for a child who is receiving amphotericin B IV daily for a fungal infection. Prior to starting the therapy, which should the nurse review? 1. Aspartate aminotransferase and alanine aminotransferase serum levels. 2. Serum amphotericin level. 3. Serum protein and sodium levels. 4. Blood urea, nitrogen, and creatinine levels. 8. Which toxicity is specific to gentamicin (Garamycin)? 1. Hepatatoxicity. 2. Ototoxicity. 3. Myocardial toxicity. 4. Neurotoxicity. 9. A nurse is administrating vancomycin intravenously and sets the pump to infuse the medication over 90 minutes. Which adverse reaction is the nurse trying to prevent? 1. Vomiting. 2. Headache. 3. Flushing of the face, neck, and chest. 4. Hypertension. 10. The parents of an 8-year-old come to the clinic and ask the nurse if their child should receive growth hormone to boost short stature. Which is the nurse’s best response? 1. “Growth hormone only works if the child has short bones.” 2. “Can your child remember to take the pills every day?” 3. “Test results are required before growth hormone can be started in children.” 4. “How tall do you think your child should be?” 11. A child has been receiving prednisone for the past 3 weeks, and the parent wants to stop the medication. What is the nurse’s best response? 1. “There is no problem in stopping the medication since the child’s symptoms are gone.” 2. “It is dangerous for steroids to be stopped suddenly.” 3. “Your child may develop severe psychological symptoms when prednisone is stopped suddenly.” 4. “Stopping the prednisone will require blood work.” 12. A child who has been diagnosed with hypothyroidism is started on levothyroxine (Synthroid). Which should be included in the nurse’s teaching plan? 1. The child will have more energy the next day after starting the medication. 2. Optimal effectiveness of the medication may not occur for several weeks. 3. The medication should be taken once a day at any time. 4. The medication should be taken with milk.

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    6 P EDIATRIC S UCCESS 13. Which should the nurse include in the discharge teaching plan for a child beginning growth hormone therapy? 1. The child is expected to grow 3 to 5 inches during the first year of treatment. 2. The parents must measure the child’s weight and height weekly. 3. The child will need to continue the therapy until he or she is 21 years old. 4. There are no side effects from taking growth hormones. 14. The onset of Humalog insulin is: 1. 10 to 15 minutes. 2. 30 minutes to 1 hour. 3. 1 to 2 hours. 4. 2 to 4 hours. 15. Which should the nurse include in the teaching plan for a child started on metoclopramide (Reglan)? 1. The drug increases gastrointestinal motility. 2. The drug decreases tone in the lower esophageal sphincter. 3. The drug prevents diarrhea. 4. The drug induces the release of acetylcholine. 16. The nurse will monitor a child on high-dose prednisone for: 1. Diabetes. 2. Deep vein thrombosis. 3. Nephrotoxicity. 4. Hepatotoxicity. 17. A nurse is administering cyclophosphamide (Cytoxan) to a child with leukemia. Which action by the nurse would be appropriate? 1. Monitoring serum potassium levels. 2. Checking for hematuria. 3. Obtaining daily weights. 4. Obtaining neurological checks every 4 hours. 18. A nurse is giving ifosfamide (Ifex) as chemotherapy for a child who has leukemia. Mixed in with the ifosfamide (Ifex) is mesna (Mesnex). Mesna is given for which reason? 1. As combination chemotherapy. 2. As an antiarrhythmic. 3. To prevent hemorrhagic cystitis. 4. To increase absorption of the chemotherapy. 19. Which should a nurse anticipate be prescribed in chelation therapy for a child receiving frequent blood transfusions? 1. Dalteparin sodium (Fragmin). 2. Deferoxamine (Desferal). 3. Diclofenac (Voltaren). 4. Diltiazem (Cardizem). 20. Why is filgrastim (Neupogen) given to a child who has received chemotherapy? 1. Reduce fatigue level. 2. Prevent infection. 3. Reduce nausea and vomiting. 4. Increase mobilization of stem cells. 21. A child comes to the clinic for diphtheria, pertussis, and tetanus (DTaP) and inactivated poliovirus vaccines. The child does not appear ill but has a temperature of 101°F (38.3°C). The nurse should take which action? 1. Withhold the vaccines and reschedule when the child is afebrile. 2. Administer acetaminophen (Tylenol) and give the vaccines. 3. Give the vaccines and instruct the parent to give acetaminophen (Tylenol) every 4 hours as needed. 4. Have the health-care provider order an antibiotic and give the vaccine.

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    C HAPTER 2 P HARMACOLOGY 7 22. Which of the following would the nurse instruct the parent about treating a pediculosis infestation? 1. Apply spinosad (Natroba) to the scalp, leave it in place for 4 minutes, and then add water. 2. Apply chlorhexidine (Hibiclens) to the scalp with sterile gloves and leave on overnight. 3. Apply terbinafine (Lamisil) as a thin layer to the scalp twice a day for 5 days. 4. Apply collagenase (Santyl) to the scalp with cotton applicator, leave in place overnight, then shampoo. 23. Amoxicillin (Amoxil) 250 mg PO twice a day is prescribed to treat strep throat in a child who weighs 42 lb. The desired dose is 50 mg/kg/day. The nurse determines that: 1. The prescribed dose is too low. 2. The prescribed dose is too high. 3. The prescribed dose is safe. 4. Not enough information is given to determine the safe dose. 24. A child with a heart defect is placed on a maintenance dose of digoxin (Lanoxin) elixir. The dose is 0.07 mg/kg/day, and the child’s weight is 16 lb. The medication is to be given two times a day. The nurse prepares how much digoxin (Lanoxin) for the morning dose? 1. 0.25 mg. 2. 0.37 mg. 3. 0.5 mg. 4. 2.5 mg. 25. Ciprofloxacin (Cipro) 300 mg daily is ordered for a child with a urinary tract infection. The medication comes 250 mg/5 mL. How much of the medication will the nurse prepare to give to the child? 1. 1.2 mL. 2. 3 mL. 3. 6 mL. 4. 12 mL. 26. A nurse is caring for a child with congenital heart disease who is being treated with digoxin (Lanoxin). Which is included in the family’s discharge teaching? 1. Make sure the medication is taken with food. 2. Repeat the dose if the child vomits. 3. Take the child’s pulse prior to administration. 4. Weigh the child daily. 27. Which medication is the most effective treatment for acne? 1. Salicylic acid. 2. Benzoyl peroxide. 3. Fluconazole (Diflucan). 4. Clotrimazole (Lotrimin). 28. Which would the nurse include when teaching an adolescent female beginning isotretinoin (Accutane) therapy? 1. Apply a thin layer to the affected skin twice a day. 2. Use Dove Sensitive Skin soap for added benefit. 3. A pregnancy test will be done prior to starting treatment. 4. Keep lips moistened to prevent inflammation. 29. Which medication is used for the treatment of spasticity in cerebral palsy (CP)? 1. Dexamethasone (Decadron). 2. Baclofen (Lioresal) 3. Diclofenac (Voltaren). 4. Carbamazepine (Tegretol).

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    8 P EDIATRIC S UCCESS 30. Which assessment should be a priority to monitor in a child receiving a narcotic for pain relief? 1. Respirations. 2. Bowel sounds. 3. Blood pressure. 4. Oxygen saturation. 31. Which is the correct method to instill eardrops in a 5-year-old? 1. Pull the pinna of the ear downward and back for instillation. 2. Place cotton tightly in the ear after instillation. 3. Have the child remain upright after instillation. 4. Pull the pinna of the ear upward and back for instillation. 32. A health-care provider has ordered amoxicillin (Amoxil) 500 mg IVPB q8h for a child with tonsillitis. Which action by the nurse is appropriate? 1. Question the order because the route is incorrect. 2. Give the medication as ordered. 3. Call the health-care provider because the dosing frequency is incorrect. 4. Call the health-care provider and question the dose of the drug. 33. Which should the nurse do first for a child diagnosed with conjunctivitis and ordered to have eye ointment applied three times a day? 1. Remove any discharge from the affected eye. 2. Ensure the ointment is at room temperature. 3. Hold the tip of the eye ointment tube parallel to the eye. 4. Wash hands with soap and water. 34. Which instruction about nose drops should be included in the teaching plan for the parents of a child with nasopharyngitis? 1. “Do not use the drops for any other family member.” 2. “Administer the drops as often as necessary until the nasal congestion subsides.” 3. “Insert the dropper tip as far back as possible in the nasal passage.” 4. “You can save the drops for the next time your child has the same symptoms.” 35. Trimethoprim/sulfamethoxazole (Septra, Bactrim) should be given with: 1. Breakfast and dinner. 2. A snack. 3. Glass of water. 4. Glass of juice. 36. An IV infusion of gamma globulin 2 g/kg over 12 hours has been ordered for a 22-lb child. Which dose is correct? 1. 11 g. 2. 20 g. 3. 22 g. 4. 44 g. 37. Lindane (Kwell) shampoo is used only once because it can cause: 1. Hypertension. 2. Seizures. 3. Elevated liver functions. 4. Alopecia. 38. Which is essential for the nurse to teach the parent regarding administration of albendazole (Albenza)? 1. Fever and rash are common adverse effects. 2. The medication kills the eggs in about 48 hours. 3. The drug should be given with a meal. 4. The dose should be repeated in 2 weeks.

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    C HAPTER 2 P HARMACOLOGY 9 39. A 6-month-old is prescribed 2.5% hydrocortisone for topical treatment of eczema. The nurse instructs the parent not to use the cream for more than a week. What is the primary reason for this instruction? 1. Adverse effects, such as skin atrophy and fragility, can occur with long-term treatment. 2. If after a week there is no improvement, then a stronger dose is required. 3. The drug loses its efficacy after prolonged use. 4. If no improvement is seen after a week, an antibiotic should be prescribed. 40. A 15-kg child is started on cephalexin (Keflex) for treatment of cellulitis. The dose is 40 mg/kg/day, given twice a day. The nurse has a bottle of Keflex that indicates there are 250 mg/5 mL. How many milliliters must the nurse draw up for each dose? 1. 2.5 mL. 2. 6 mL. 3. 12 mL. 4. 20 mL. 41. A child with hives is prescribed diphenhydramine (Benadryl) 5 mg/kg per day in divided doses every 6 hours. The child weighs 40 lb. How many milligrams should the nurse give for each dose? 1. 4.5 mg. 2. 11.45 mg. 3. 22.73 mg. 4. 50 mg. 42. When is the best time to give furosemide (Lasix)? 1. 8:00 a.m. 2. 12 noon. 3. 6:00 p.m. 4. Bedtime. 43. Which assessment finding should the nurse observe following administration of albuterol (Proventil)? 1. Decrease in wheezing. 2. Decrease in respiratory rate from 34 to 22. 3. Decrease in blood pressure. 4. Decrease in heart rate. 44. A child in the emergency room is being treated with albuterol (Proventil) aerosol treatments for an acute asthma attack. She requires treatments every 2 hours. Which adverse effect of the medication would the nurse expect? 1. Lethargy and bradycardia. 2. Decreased blood pressure and dizziness. 3. Nervousness and tachycardia. 4. Increased blood pressure and fatigue. 45. A child with cystic fibrosis (CF) is placed on an oral antibiotic to be given four times a day for 14 days. Which of the following schedules is the most appropriate? 1. 8 a.m., 12 p.m., 4 p.m., 8 p.m. 2. 7 a.m., 1 p.m., 7 p.m., 12 midnight. 3. 9 a.m., 1 p.m., 5 p.m., 9 p.m. 4. 10 a.m., 2 p.m., 6 p.m., 10 p.m. 46. Which is the best area for the tuberculin skin test to be placed? 1. Upper thigh. 2. Scapular area. 3. Back. 4. Ventral forearm.

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    10 P EDIATRIC S UCCESS 47. A hospitalized child is to receive 75 mg of acetaminophen (Tylenol) for fever of 101°F (38.3°C). If the acetaminophen (Tylenol) is 160 mg per 5 mL, how much will the nurse administer? 1. 0.4 mL. 2. 1.5 mL. 3. 2.3 mL. 4. 3 mL. 48. Which is a toxic reaction in a child taking digoxin (Lanoxin)? 1. Weight gain. 2. Tachycardia. 3. Nausea and vomiting. 4. Seizures. 49. A 10-month-old with heart failure weighs 10 kg. Digoxin (Lanoxin) is prescribed as 10 mcg/kg/day to be given every 12 hours. How much is given for each dose? 1. 10 mcg. 2. 50 mcg. 3. 100 mcg. 4. 500 mcg. 50. Why is indomethacin (Indocin) given to a preterm neonate? 1. Encourage ductal closure. 2. Prevent hypertension. 3. Promote release of surfactant. 4. Protect the immature liver. 51. Which drug is most important in treating an infant with transposition of the great vessels? 1. Digoxin (Lanoxin). 2. Antibiotics. 3. Prostaglandin E. 4. Diuretics. 52. Penicillin is given to a 2-year-old prior to dental work. The child weighs 44 lb. The order is for 25 mg/kg to be given 2 hours before the procedure. The penicillin comes in 250 mg/5 mL. How much of the medication will the nurse administer? 1. 2.5 mL. 2. 5 mL. 3. 10 mL. 4. 15 mL. 53. Which is the most common adverse reaction to erythromycin? 1. Weight gain. 2. Constipation. 3. Mouth sores. 4. Nausea and vomiting. 54. A child who weighs 20 kg is to receive 8 g of gamma globulin over 12 hours for the treatment of idiopathic thrombocytopenia purpura. The concentration is 8 g in 300 mL of normal saline. How many milliliters per hour will the child receive? 1. 12 mL/hr. 2. 25 mL/hr. 3. 50 mL/hr. 4. 40 mL/hr. 55. The treatment for a child with sinus bradycardia is atropine 0.02 mg/kg/dose. How much should the nurse give a child who weighs 20 kg? 1. 0.02 mg. 2. 0.04 mg. 3. 0.2 mg. 4. 0.4 mg.

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    C HAPTER 2 P HARMACOLOGY 11 56. The effect of atropine is: 1. Anticholinergic. 2. As a beta-adrenergic agonist. 3. As a bronchodilator. 4. Sympathomimetic. 57. A common adverse reaction to atropine is: 1. Diarrhea. 2. Increased urine output. 3. No tears when crying. 4. Lethargy. 58. Which should the nurse include in teaching parents about administering pancreatic enzymes to their child? 1. The enzymes may be chewed or swallowed. 2. The capsules may be opened and sprinkled over acidic food. 3. Give the same amount of the medicine with meals and snacks. 4. Store the enzymes in the refrigerator. 59. Common side effects of oxybutynin (Ditropan) are: 1. Increase in heart rate and blood pressure. 2. Sodium retention and edema. 3. Constipation and dry mouth. 4. Insomnia and hyperactivity. 60. Ribavirin (Virazole) is prescribed for a hospitalized child with respiratory syncytial virus (RSV). The nurse prepares to administer the medication by which route? 1. Oral. 2. Subcutaneous. 3. Intramuscular. 4. Nebulizer. 61. A child has an infusion of dextrose 5% via a line with a volume control chamber on the pump. The nurse knows this system is used for administration of intravenous solutions for which reason? 1. Prevent accidental fluid overload. 2. Reduce the potential for bacterial infection. 3. Make administering of intravenous fluids easier. 4. Is less costly.

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    12 ANSWERS AND RATIONALES The correct answer number and rationale for why it is the correct answer are given in boldface blue type. Rationales for why the other possible answer options are incorrect also are given, but they are not in bold- face type. 1. 1. Mix intravenous doses in normal saline as mixtures precipitate with dextrose 5% in water. 2. Phenytoin (Dilantin) should be given slowly (1–2 mg/kg/min) via pump. Rapid infusion may cause hypotension, arrhythmias, and circulatory collapse. 3. An inline filter is recommended. 4. Continuous monitoring of electrocardiogram, blood pressure, and respiratory status is essential because of potential side effects. TEST-TAKING HINT: The test taker must know both the side effects of the drug and how to administer it safely. 2. 1. This does not answer the parent ’s question. 2. This is not a true statement because Advil is enteric coated, and not all ibuprofens are enteric coated. 3. This response answers the question and tells the parent the physician is the only one who can change a name brand to a generic drug. 4. The nurse should not make that judgment. The physician should be consulted. TEST-TAKING HINT: The nurse needs to answer the parent’s question and be aware that a physician chooses name brand or generic. 3. 1. Peak time for regular insulin is 2 to 3 hours. 2. Peak time for Semilente insulin is 4 to 7 hours. 3. Peak time for NPH insulin is 4 to 12 hours. 4. Peak time for Lente insulin is 8 to 12 hours. TEST-TAKING HINT: NPH insulin works in an intermediate range; select an appropriate period of time. 4. 1. Giving morphine sulfate (Duramorph) over 1 hour takes too long to relieve the pain. It can be given by slow IV push. 2. Because morphine sulfate (Duramorph) can depress respirations and the child has just had abdominal surgery, deep breathing should be encouraged. 3. Meperidine (Demerol) is not used in children because of the risk of induced seizures. 4. One of the side effects of morphine sulfate (Duramorph) is itching, and diphenhydramine (Benadryl) is a good medication to give as needed in case of itching. It should not be given together with the morphine sulfate (Duramorph). TEST-TAKING HINT: The test taker must be aware of the major side effects of morphine (Duramorph) and the age of the client who is receiving the morphine (Duramorph). 5. 1. Rifampin (Rifadin) causes an orange-red discoloration of body fluids, including urine. Knowledge of this can decrease anxiety when such discoloration occurs. 2. Urinary retention is not a side effect. Rifampin (Rifadin) is metabolized in the liver and should be used with caution in clients with elevated liver enzymes. 3. The drug is ordered prophylactically to guard against developing meningitis. 4. The drug is given for 2 days as prophylactic treatment. TEST-TAKING HINT: Associate the “R” in rifampin (Rifadin) with the red in orange- red body fluids. 6. 1. Missed doses should be given as soon as possible and not doubled with the next dose. 2. Doses of antibiotics should be taken at regular intervals over 24 hours without interrupting sleep to maintain maximum blood levels. 3. Attempting to have the child take it whole could cause the child to aspirate. 4. A full course of the antibiotic must be taken to decrease the risk of resistance to the antibiotic or recurrence of the infection. TEST-TAKING HINT: The test taker must know specific information about antibiotic therapy. 7. 1. Liver damage is not associated with amphotericin therapy. 2. Serum levels of the drug are not done. 3. The drug should not cause a change in sodium or protein levels. 4. The drug tends to be nephrotoxic. Elevation of blood urea, nitrogen, and creatinine levels indicates renal damage. If these levels are elevated, the health- care provider must be notified to determine if the drug must be withheld for the day.

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    C HAPTER 2 P HARMACOLOGY 13 TEST-TAKING HINT: This drug is nephrotoxic. Some nurses refer to the drug as “amphoterrible.” 8. 1. Hepatic and neurological toxicities are more common in fluoroquinolones. 2. Nephrotoxicity and ototoxicity are the most significant adverse effects. 3. Myocardial toxicity is not a common reaction. 4. Hepatic and neurological toxicities are more common in fluoroquinolones. TEST-TAKING HINT: Aminoglycosides cause kidney damage and loss of hearing. Levels are checked before and after dosing so that toxicity can be prevented. 9. 1. Vomiting is a side effect but is not related to the rate of infusion. 2. Headache is not related to the rate of infusion. 3. “Red man syndrome” or “red neck syndrome” is flushing of the face, neck, and upper chest associated with too rapid an infusion of vancomycin. This can be prevented with infusing the vancomycin over 90 to 120 minutes and pretreating the patient with diphenhydramine (Benadryl) prior to the infusion. 4. Hypotension with shock can result from a histamine release from rapid infusion. TEST-TAKING HINT: “Red man syndrome” is a side effect of too rapid an infusion of vancomycin. 10. 1. This response does not answer the parents’ question. 2. Growth hormone is available as a parenteral medication and is given intramuscularly or subcutaneously. 3. Growth hormone is approved for use only in children to treat a documented lack of growth hormone. 4. The nurse must first answer the parents’ question about growth hormone. TEST-TAKING HINT: Recall the reason for giving growth hormone. 11. 1. Abrupt withdrawal can cause severe side effects. 2. Abrupt cessation of long-term steroid therapy can cause acute adrenal insufficiency that could lead to death. Long-term steroid use can cause shrinkage of the adrenal glands, which decreases the production of the hormone. 3. Central nervous system symptoms such as confusion and psychosis are adverse effects of steroids. 4. Gradual tapering of the dosages will prevent severe side effects and no blood work is required. TEST-TAKING HINT: The test taker must know about abrupt withdrawal of steroids and the effects of steroids on the adrenal glands. 12. 1. The energy level takes much longer than 1 day to increase. 2. After starting therapy, peak levels of the drug may not be expected for many weeks to months. Clients need to know this to prevent them from stopping the medication because they think it is not working. 3. The drug works best when taken on an empty stomach; the patient should select a time each day when the stomach is empty. In children, just prior to bed may be the best time, as most children do not eat prior to bedtime. 4. The drug works best when taken on an empty stomach. Taking it with milk is contraindicated. TEST-TAKING HINT: Know the effects of levothyroxine and how to administer it. 13. 1. The expected growth rate with growth hormone therapy is 3 to 5 inches in the first year. 2. Height and weight are measured monthly. 3. Growth hormone is discontinued when optimal adult height is attained and fusion of the epiphyseal plates has occurred. 4. Side effects include glucose intolerance, hypothyroidism, adrenocorticotropic hormone deficiency, hypercalciuria, renal calculi, gastrointestinal upset, and intracranial tumor growth. TEST-TAKING HINT: Answer 2 is not correct as “must” is too strong. Answer 4 states “no side effects,” and this is unrealistic. To choose the correct answer, the test taker must rely on knowledge of growth hormones. 14. 1. Humalog insulin is rapid-acting and has an onset of 10 to 15 minutes. 2. Regular insulin has an onset of 30 minutes to 1 hour. 3. NPH insulin has an onset of 1 to 2 hours and is intermediate-acting.

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    14 P EDIATRIC S UCCESS 4. Ultralente insulin has an onset of 2 to 6 hours and is a long-acting insulin. TEST-TAKING HINT: Review the onset, peak, and duration of all types of insulin. 15. 1. Metoclopramide (Reglan) is a gastrointestinal stimulant that increases motility of the gastrointestinal tract, shortens gastric emptying time, and reduces the risk of the esophagus being exposed to gastric content. 2. Decreased tone in the esophageal sphincter increases the risk of gastric contents being regurgitated upward into the esophagus. 3. There can be an increase in diarrhea because of the increase in gastrointestinal motility. 4. Methyl scopolamine blocks effects of acetylcholine and relaxes sooth muscles. TEST-TAKING HINT: Gastroesophageal reflux disease results in backward flow of gastric contents, so it is logical that a drug prescribed should promote forward movement of gastric content. 16. 1. One of the side effects of high-dose steroids can be diabetes mellitus. The child needs to be evaluated so that prompt treatment can be initiated. The diabetes is self-limiting and after the steroids are discontinued should no longer be present. Other side effects include mood changes, hirsutism, trunk obesity, thin extremities, gastric bleeding, poor wound healing, hypertension, immunosuppression, insomnia, and increased appetite. 2. This is not a side effect of steroids. Deep vein thrombosis is related to clotting abnormalities. 3. This is not a side effect of steroids. 4. This is not a side effect of steroids. TEST-TAKING HINT: Review side effects of high-dose steroid use. 17. 1. There should not be a change in potassium level, as the drug does not cause potassium loss. 2. Hemorrhagic cystitis is a major side effect of cyclophosphamide (Cytoxan); checking the urine for blood is an appropriate intervention. 3. Weights are obtained daily with clients receiving chemotherapy because of nausea and vomiting. 4. There are no central nervous system side effects with cyclophosphamide (Cytoxan). TEST-TAKING HINT: Review major side effects of cyclophosphamide. 18. 1. Mesna (Mesnex) is not a chemotherapeutic agent. 2. Mesna (Mesnex) does not prevent arrhythmias. 3. Mesna (Mesnex) is a detoxifying agent used as a protectant against hemorrhagic cystitis induced by ifosfamide (Ifex) and cyclophosphamide (Cytoxan). 4. There is no medication that increases absorption of chemotherapy. TEST-TAKING HINT: Review the action of mesna (Mesnex). 19. 1. Dalteparin sodium (Fragmin) is an anticoagulant used as prophylaxis for post- operative deep vein thrombosis. 2. Deferoxamine (Desferal) is an antidote for acute iron toxicity. 3. Diclofenac (Voltaren) is an anti-inflammatory drug. 4. Diltiazem (Cardizem) is an antianginal agent for chronic stable angina. TEST-TAKING HINT: Deferoxamine (Desferal) is used to prevent iron overload. 20. 1. Chemotherapy may cause anemia, which can compound the feeling of fatigue rather than reduce fatigue. 2. The drug does not prevent infection, but it does increase the number of neutrophils. 3. The drug may cause nausea and vomiting rather than reduce it. 4. The drug mobilizes stem cells to produce neutrophils. TEST-TAKING HINT: Recall the function of the neutrophils and how to stimulate them. 21. 1. Immunizations can be given when the child has a low-grade fever as long as the child is not ill appearing. 2. Diagnose the problem before giving the vaccine. Just giving the acetaminophen (Tylenol) would not allow a diagnosis to be made, as it may mask symptoms. 3. Immunizations can be given when the child has a low-grade fever as long as the child is not ill appearing. 4. The nurse would not want to give an antibiotic until a bacterial infection was diagnosed. TEST-TAKING HINT: Immunizations should not be given when a child has a high fever and appears ill.

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    C HAPTER 2 P HARMACOLOGY 15 22. 1. Spinosad (Natroba) causes neuronal excitation leading to lice paralysis and death. 2. Chlorhexidine (Hibiclens) is a skin cleanser. Clean gloves, not sterile gloves, should be used in treating lice. 3. Terbinafine (Lamisil) is an oral or nasal antifungal agent for the treatment of tinea infections. 4. Collagenase (Santyl) is an enzyme used in skin débriding. TEST-TAKING HINT: Associate the nature of the parasite with the drug and application method. 23. 1. The dose prescribed is too low. Strep throat is treated with amoxicillin at 50 mg/kg/day. Convert pounds to kilograms by dividing by 2.2 (2.2 lb = 1 kg) 42 lb ÷ 2.2 = 19.09 kg Dosing parameters: 50 mg/kg/day × 19.09 = 954.5 mg/day Ordered dose: 250 mg bid = 500 mg/day 2. The dose prescribed is too low. 3. The dose prescribed is too low. 4. The dose prescribed is too low. TEST-TAKING HINT: First change pounds to kilograms. Calculate the ordered dose using the formula given in the question. Compare the order against the calculated appropriate dose. 24. 1. 0.25 mg. Convert pounds to kilograms by dividing by 2.2 (2.2 lb = 1 kg) 16 lb ÷ 2.2 = 7.27 kg Calculate the dosage by weight: 0.07 mg/day × 7.27 = 0.5 mg/day Divide the dose by 2 because it is to be given 2 times a day: 0.5 mg/day ÷ 2 doses = 0.25 mg for each dose 2. This dose is too high. Change the pounds to kilograms; the correct answer is 0.25 mg. 3. This is the total amount of drug for an entire day. Change the pounds to kilograms; the correct answer is 0.25 mg. Remember to divide by 2. 4. This dose is much too high. Change the pounds to kilograms; the correct answer is 0.25 mg. TEST-TAKING HINT: Change the pounds to kilograms. The total amount is to be given twice a day, so calculate each dose. 25. 1. The formula to determine the correct answer is: Desired over Available × Volume = amount to be given 2. The formula to determine the correct answer is: Desired over Available × Volume = amount to be given 3. Desired over Available × Volume = amount to be given 300 mg/250 mg × 5 mL = 6 mL 4. The formula to determine the correct answer is: Desired over Available × Volume = amount to be given TEST-TAKING HINT: Use the formula to determine the correct answer. 26. 1. Digoxin (Lanoxin) should not be taken with food. Administer the medication 1 hour before or 2 hours after a meal. 2. The dose should not be repeated if the child vomits. 3. The child’s pulse should be monitored before each dose. The dose should be withheld according to the health-care provider ’s parameters. 4. Checking weight is not related to the medication. TEST-TAKING HINT: Know the principles of giving digoxin (Lanoxin). Knowing that the drug is given to decrease the heart rate and increase cardiac output should be a key to the answer involving checking pulse. 27. 1. Salicylic acid is used in the treatment of corns and warts. 2. Benzoyl peroxide inhibits growth of Propionibacterium acnes (a gram-positive microorganism). It is effective against infl ammatory and anti-inflammatory acne. 3. Fluconazole (Diflucan) is an oral antifungal. 4. Clotrimazole (Lotrimin) is a topical antifungal. TEST-TAKING HINT: The test taker needs to know the specific treatment for acne. 28. 1. The drug is not topical. 2. Dove Sensitive Soap is used for dry or easily irritated skin. 3. It is mandatory to have a pregnancy test done before starting treatment because spontaneous abortions and/or fetal abnormalities have been associated in pregnancy with the use of isotretinoin (Accutane). 4. Inflammation of the lips is a side effect of isotretinoin (Accutane), but moisture will not prevent the inflammation. TEST-TAKING HINT: Consider birth defects associated with isotretinoin (Accutane).

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