McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach,
11th Edition
MULTIPLE CHOICE
1. The nurse is preparing to administer a medication to a 6-month-old infant. The nurse will
monitor closely for signs of drug toxicity based on the knowledge that, compared to
adults, infants have
a. an increased percentage of total body fat.
b. immature hepatic and renal function.
c. more protein binding sites.
d. more rapid and predictable gastrointestinal transit time.
ANS: B
The liver and kidneys are the primary organs for metabolism and excretion and are
immature in infants. This allows drugs to accumulate and increases the risk for drug
toxicity. Infants have a lower proportion of body fat than adults and fewer protein
binding sites. They do have more rapid gastrointestinal transit time, but is less
predictable than in adults and rapid gastrointestinal time decreases the amount of drug
absorbed.
DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing
Process: Evaluation MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
2. The nurse reviews information about a drug and learns that it is best absorbed in an acidic
environment. When giving this drug to a 1-year-old patient, the nurse will expect
a. equal absorption when compared to an adult.
b. less absorption when compared to an adult.
c. more absorption when compared to an adult.
d. twice the rate of absorption when compared to an adult.
ANS: B
Because the child’s gastric pH is more alkaline than the adult’s, the nurse would
expect less absorption in a child when compared to an adult.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Nursing Intervention MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
3. The nurse assumes care for an infant who is showing signs of toxicity in response to a
drug given several hours prior. The nurse checks the dose and confirms that the dose is
, consistent with standard dosing guidelines based on body weight. Which characteristic of
the drug could explain this response in an infant?
a. It is acidic.
b. It is highly protein-bound.
c. It is not fat-soluble.
d. It is water-soluble.
ANS: B
With fewer protein-binding sites, there is more active drug available for highly
proteinbound medications in infants. This would require a reduction in the dose for
infants. Drugs that are acidic are not readily absorbed in infants since their gastric pH
tends to be more alkaline. Infants have a lower proportion of body fat; fat-soluble
drugs would need to be decreased to prevent toxicity. Until about 2 years of age,
pediatric patients require larger doses of water-soluble drugs to achieve therapeutic
effects.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
N/A MSC: NCLEX: Physiological Integrity: Pharmacological and
Parenteral Therapies
4. A parent is concerned about giving a child a medication that carries an indication for use
in children because of the lack of knowledge about the effects of drugs on children. The
nurse discusses legislation passed in 2012 about pediatric pharmacology. Which is true
about this law?
a. It forbids providers from prescribing medications unless they have been U.S. Food
and Drug Administration (FDA) approved for use in children.
b. It mandates consistent, evidence-based dosing guidelines for use in children.
c. It provides federal grants to fund pediatric pharmaceutical research.
d. It requires drug manufacturers to study pediatric medication use.
ANS: D
In 2003, a law known as the Pediatric Research Equity Act (PREA) requires drug
manufacturers to study pediatric medication use and offers incentives for pediatric
pharmacology research.
Providers are not forbidden to prescribe drugs in children that are not FDA approved
for use in children. The law does not mandate the use of evidence-based guidelines
and does not provide grants to fund research.
DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing
Process: N/A MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
5. The nurse will administer an intravenous (IV) medication to an adolescent patient. When
preparing the adolescent for the IV insertion, which is an appropriate action by the nurse?
a. Allowing the patient to verbalize concerns about the procedure
, b. Covering the insertion site with a bandage after the procedure is completed
c. Explaining any possible adverse drug reactions
d. Reassuring the patient that only one body part will be used
ANS: A
Allowing the adolescent to verbalize concerns about the medication and its regimen
may offer opportunities to clarify misconceptions and teach new information.
Preschool-age children may have concerns about harm to their body and need to have
sites covered. Adolescents still have a present focus, so discussing future adverse
reactions is not especially helpful. Preschool and school-age children fear bodily harm
and require reassurance that only one body part will be affected.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Planning MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
6. Which of the following actions is NOT consistent with the concept of “atraumatic care”?
a. Minimizing separation of children from their family members
b. Identifying family and patient stressors
c. Providing care within the framework of a collaborative partnership
d. Recognizing that interventions to decrease pain are not feasible
ANS: D
Atraumatic care is achieved by decreasing the separation of children from their family
members or caregivers, identifying family and patient stressors, decreasing pain, and
providing care within the framework of a collaborative partnership. While total
elimination of pain may not always be feasible, efforts to minimize psychologic and
physical stress should be minimized where possible.
DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing
Process: N/A MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
7. The provider has ordered that vitamin D drops be given to a newborn. Based on the
knowledge of drug distribution in infants, the nurse understands that the infant may need
a. a higher dose.
b. a lower dose.
c. less frequent dosing.
d. more frequent dosing.
ANS: B
Neonates and young infants tend to have less body fat than older children, meaning
that they need lower doses of fat-soluble medications since these medications won’t
be bound in fat tissue. Higher doses would potentially lead to drug toxicity. Body fat
does not affect the frequency of dosing.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
, N/A MSC: NCLEX: Physiological Integrity: Pharmacological and
Parenteral Therapies
8. The nurse is caring for a 5-year-old child. The child is taking a drug that has a known
therapeutic range in adults, and the nurse checks that the ordered dose is correct and notes
that the child’s serum drug level is within normal limits. The child complains of a
headache, which is a common sign of toxicity for this drug. Which action will the nurse
take prior to administration of the next scheduled dose?
a. Administer the drug since the drug levels are normal.
b. Attribute the headache to nondrug causes.
c. Hold the next dose and contact the provider.
d. Request an order for an analgesic medication.
ANS: C
The therapeutic ranges established for many drug levels are based on adult studies, so
it is important for the nurse to assess pediatric patients in conjunction with monitoring
drug levels. The nurse should notify the provider of the reaction. Because headaches
are a symptom of toxicity for this drug, the nurse should not ignore the symptom.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Nursing Intervention MSC: NCLEX: Health Promotion and Maintenance
9. The nurse is preparing to give a 9-month-old child a bitter-tasting oral medication. The
nurse is working with the child’s parents to create a plan to help with administration of
this medication. Which of the following would be the most appropriate next step?
a. Advise the parents to add honey to the medication to make it more palatable.
b. Advise the parents to dilute the medication in a large volume (>25 mL) to dilute
the bitter taste.
c. Advise the parents to add the medication to the child’s bottle during their next
feed.
d. Contact the pharmacist to determine if the medicine can be mixed with jam or
yogurt.
ANS: D
It is always a good idea to double check if the medication can be dissolved or mixed
with other food items to help with palatability. If the medication can be mixed with
jam or yogurt, that advice can be provided to the parents. Because the child is younger
than 1 year, it is not recommended to give them honey due to the risk of botulism.
Medications should not be diluted in large volumes or added to a bottle to ensure the
full dose is taken.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Nursing Intervention MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
11th Edition
MULTIPLE CHOICE
1. The nurse is preparing to administer a medication to a 6-month-old infant. The nurse will
monitor closely for signs of drug toxicity based on the knowledge that, compared to
adults, infants have
a. an increased percentage of total body fat.
b. immature hepatic and renal function.
c. more protein binding sites.
d. more rapid and predictable gastrointestinal transit time.
ANS: B
The liver and kidneys are the primary organs for metabolism and excretion and are
immature in infants. This allows drugs to accumulate and increases the risk for drug
toxicity. Infants have a lower proportion of body fat than adults and fewer protein
binding sites. They do have more rapid gastrointestinal transit time, but is less
predictable than in adults and rapid gastrointestinal time decreases the amount of drug
absorbed.
DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing
Process: Evaluation MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
2. The nurse reviews information about a drug and learns that it is best absorbed in an acidic
environment. When giving this drug to a 1-year-old patient, the nurse will expect
a. equal absorption when compared to an adult.
b. less absorption when compared to an adult.
c. more absorption when compared to an adult.
d. twice the rate of absorption when compared to an adult.
ANS: B
Because the child’s gastric pH is more alkaline than the adult’s, the nurse would
expect less absorption in a child when compared to an adult.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Nursing Intervention MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
3. The nurse assumes care for an infant who is showing signs of toxicity in response to a
drug given several hours prior. The nurse checks the dose and confirms that the dose is
, consistent with standard dosing guidelines based on body weight. Which characteristic of
the drug could explain this response in an infant?
a. It is acidic.
b. It is highly protein-bound.
c. It is not fat-soluble.
d. It is water-soluble.
ANS: B
With fewer protein-binding sites, there is more active drug available for highly
proteinbound medications in infants. This would require a reduction in the dose for
infants. Drugs that are acidic are not readily absorbed in infants since their gastric pH
tends to be more alkaline. Infants have a lower proportion of body fat; fat-soluble
drugs would need to be decreased to prevent toxicity. Until about 2 years of age,
pediatric patients require larger doses of water-soluble drugs to achieve therapeutic
effects.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
N/A MSC: NCLEX: Physiological Integrity: Pharmacological and
Parenteral Therapies
4. A parent is concerned about giving a child a medication that carries an indication for use
in children because of the lack of knowledge about the effects of drugs on children. The
nurse discusses legislation passed in 2012 about pediatric pharmacology. Which is true
about this law?
a. It forbids providers from prescribing medications unless they have been U.S. Food
and Drug Administration (FDA) approved for use in children.
b. It mandates consistent, evidence-based dosing guidelines for use in children.
c. It provides federal grants to fund pediatric pharmaceutical research.
d. It requires drug manufacturers to study pediatric medication use.
ANS: D
In 2003, a law known as the Pediatric Research Equity Act (PREA) requires drug
manufacturers to study pediatric medication use and offers incentives for pediatric
pharmacology research.
Providers are not forbidden to prescribe drugs in children that are not FDA approved
for use in children. The law does not mandate the use of evidence-based guidelines
and does not provide grants to fund research.
DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing
Process: N/A MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
5. The nurse will administer an intravenous (IV) medication to an adolescent patient. When
preparing the adolescent for the IV insertion, which is an appropriate action by the nurse?
a. Allowing the patient to verbalize concerns about the procedure
, b. Covering the insertion site with a bandage after the procedure is completed
c. Explaining any possible adverse drug reactions
d. Reassuring the patient that only one body part will be used
ANS: A
Allowing the adolescent to verbalize concerns about the medication and its regimen
may offer opportunities to clarify misconceptions and teach new information.
Preschool-age children may have concerns about harm to their body and need to have
sites covered. Adolescents still have a present focus, so discussing future adverse
reactions is not especially helpful. Preschool and school-age children fear bodily harm
and require reassurance that only one body part will be affected.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Planning MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
6. Which of the following actions is NOT consistent with the concept of “atraumatic care”?
a. Minimizing separation of children from their family members
b. Identifying family and patient stressors
c. Providing care within the framework of a collaborative partnership
d. Recognizing that interventions to decrease pain are not feasible
ANS: D
Atraumatic care is achieved by decreasing the separation of children from their family
members or caregivers, identifying family and patient stressors, decreasing pain, and
providing care within the framework of a collaborative partnership. While total
elimination of pain may not always be feasible, efforts to minimize psychologic and
physical stress should be minimized where possible.
DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing
Process: N/A MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
7. The provider has ordered that vitamin D drops be given to a newborn. Based on the
knowledge of drug distribution in infants, the nurse understands that the infant may need
a. a higher dose.
b. a lower dose.
c. less frequent dosing.
d. more frequent dosing.
ANS: B
Neonates and young infants tend to have less body fat than older children, meaning
that they need lower doses of fat-soluble medications since these medications won’t
be bound in fat tissue. Higher doses would potentially lead to drug toxicity. Body fat
does not affect the frequency of dosing.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
, N/A MSC: NCLEX: Physiological Integrity: Pharmacological and
Parenteral Therapies
8. The nurse is caring for a 5-year-old child. The child is taking a drug that has a known
therapeutic range in adults, and the nurse checks that the ordered dose is correct and notes
that the child’s serum drug level is within normal limits. The child complains of a
headache, which is a common sign of toxicity for this drug. Which action will the nurse
take prior to administration of the next scheduled dose?
a. Administer the drug since the drug levels are normal.
b. Attribute the headache to nondrug causes.
c. Hold the next dose and contact the provider.
d. Request an order for an analgesic medication.
ANS: C
The therapeutic ranges established for many drug levels are based on adult studies, so
it is important for the nurse to assess pediatric patients in conjunction with monitoring
drug levels. The nurse should notify the provider of the reaction. Because headaches
are a symptom of toxicity for this drug, the nurse should not ignore the symptom.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Nursing Intervention MSC: NCLEX: Health Promotion and Maintenance
9. The nurse is preparing to give a 9-month-old child a bitter-tasting oral medication. The
nurse is working with the child’s parents to create a plan to help with administration of
this medication. Which of the following would be the most appropriate next step?
a. Advise the parents to add honey to the medication to make it more palatable.
b. Advise the parents to dilute the medication in a large volume (>25 mL) to dilute
the bitter taste.
c. Advise the parents to add the medication to the child’s bottle during their next
feed.
d. Contact the pharmacist to determine if the medicine can be mixed with jam or
yogurt.
ANS: D
It is always a good idea to double check if the medication can be dissolved or mixed
with other food items to help with palatability. If the medication can be mixed with
jam or yogurt, that advice can be provided to the parents. Because the child is younger
than 1 year, it is not recommended to give them honey due to the risk of botulism.
Medications should not be diluted in large volumes or added to a bottle to ensure the
full dose is taken.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Nursing Intervention MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
