1 .

The nurse is preparing an educational program on immunizations for

parents of children 11 to 12 years of age. To ensure the information presented
is accurate for this age group, which immunizations should the nurse plan to
address?
A. Haemophilus influenza, varicella, and human papillomavirus (HPV)
B. Mumps, measles, and rubella (MMR); pneumococcal (PPSV); and hepatitis A
C. Diphtheria-tetanus-pertussis (DTaP), meningococcal, and haemophilus influenza
D. Mumps, measles, and rubella (MMR); diphtheria-tetanus-pertussis (DTaP); and hepatitis B

ANSWER: C

A. Varicella vaccines are administered at 12 to 15 months, with the second dose at 4 to 6 years-
B. The first dose of hepatitis A vaccine is administered before 1 year of age, with the second dose 6
months after the first dose.
C. The recommended immunization schedule for children 11 to 12 years old includes a DTaP
booster and meningococcal and haemophilus influenza vaccines. Others include HPV, PPSV, and
hepatitis A series.
D. MMR vaccines are administered at 12 to 15 months, with the second dose at 4 to 6 years. A
hepatitis B vaccine is administered to all newborns prior to hospital discharge, with the second
dose at 1 to 2 months and the third dose at 6 to 18 months.

2. The nurse is storing vaccines for future use. What should the nurse do so
they are properly stored? Select all that apply.
A. Place all vaccines in a temperature-controlled refrigerator.
B. Complete periodic checks of the expiration date on the vaccines.
C. Place bulk supplies of vaccines in a temperature- controlled freezer.
D. Avoid storing vaccines on the shelf in the door of the refrigerator.
E. Do not store food or beverage in the same refrigerator or freezer as the vaccines.

ANSWER: B, D, E, F

A. Not all vaccines are refrigerated; some vaccines will be inactivated by refrigeration and freezing.
B. Periodic checking for expiration dates is necessary to ensure that outdated vaccines are not
administered.
C. Not all bulk supplies should be placed in a freezer; some vaccines are inactivated by freezing.
D. When refrigeration is required, a main shelf inside the refrigerator is best because a shelf in the
door will have frequent temperature changes that will alter the potency of the vaccine.
E. Storing food and beverage in the same unit may result in frequent opening of the unit, leading
to greater chance of temperature instability and light exposure. Contamination may also result.
F. Aluminum foil or packaging can be used to protect light-sensitive vaccines.
3. The new nurse asks the experienced nurse why the first dose of the MMR
vaccine is normally given at 12 to 15 months of age and not earlier, except
with international travel. Which explanation by the experienced nurse is
correct?
A. “Giving the first dose of the vaccine at 12 to 15 months of age allows the correct interval before
the next booster at age 12 years.”
B. “A live virus is being given; the chance of measles, mumps, or rubella developing is much higher
if given at an earlier age.”
C. “A first dose at this age provides passive immunity and decreases the incidence of a child
developing any of the diseases-”
D. “If given earlier, the vaccine may neutralize the passive immunity to measles from the child’s
mother and no immunity may result.”

ANSWER: D

A. The second dose of the MMR vaccine can be given earlier, provided that at least 4 weeks has
elapsed since the first dose. However, a second dose is usually not given earlier because
sufficient immunity is usually present.
B. The chance of developing only measles is greater if the vaccine is given at a younger age
because the vaccine may neutralize the passive antibodies.
C. The MMR provides active (not passive) immunity.
D. Because the MMR vaccine is a live virus, a person develops a mild form of the diseases after
administration, stimulating the body to develop immunity. The passively acquired antibodies to
measles can interfere with the child’s immune response to the vaccine, and no immunity may
result.

4. The nurse observes a colleague about to administer an IM injection to the

12-month-old. Which intervention requires the nurse to intervene?
A. Prepares to give no more than 2 mL of fluid
B. Plans to give the injection using a 1-inch needle
C. Plans to give the injection in the dorsal gluteal site
D. Plans to give the injection after applying lidocaine/ prilocaine cream

ANSWER: C

A. No more than 2 mL of fluid should be injected into a muscle.

B. The appropriate needle length for an IM injection for children ages 2 to 12 months is 1 inch and
1% inch for toddlers.
C. Use of the dorsal giuteal site is not recommended due to a high risk of nerve damage.
D. Use of lidocaine/prilocaine cream (EMLA) to numb the area is suggested when time allows but is
not required.
5. The nurse working on the pediatric unit has scheduled medications to
administer at this time. Which assessments should prompt the nurse to
conclude that the prescribed medication should be withheld and the HCP
immediately notified?
A. Oral hydrocodone with acetaminophen to the 10-year-old with burn injuries who is feeling dizzy
and light-headed
B. Oral acetaminophen to the 6—month-old with a fever of 102°F (389°C) from an infection who
has developed a rash
C. Clindamycin IV to the 16-year-old male with aspiration pneumonia from near-drowning who has
a BP of 92/56 mm Hg
D. Phenobarbital IV to the 5-year-old with intermit- tent seizures who states feeling tired and
appears to be drowsy

ANSWER: C

A. Dizziness and light-headedness are side effects of hydrocodone with acetaminophen (Vicodin),
and the nurse may choose to withhold a scheduled dose. These are not potentially life-
threatening or warranting an immediate call to the HCP.
B. A rash is a side effect of acetaminophen (Tylenol). However, the rash is not potentially life-
threatening or warranting an immediate call to the HCP.
C. An adverse effect of clindamycin (Cleoein) is hypotcnsion. A BP of 92/56 mm Hg is low for a 16-
year-old. Normal BP for a 16-year-old male is 111/63 mm Hg to 136/90 mm Hg, depending on
height percentile. The nurse should compare the previous BP readings with the current one to
determine the degree of BP variation and then immediately notify the HCP because the BP can
decrease further.
D. Tiredness and drowsiness are side effects of phenobarbital (Luminal). However, these are
expected. The nurse would not withhold phenobarbital unless there were additional
neurological alterations that would warrant contacting the HCP.

6. The nurse notes from the child’s MAR illustrated that the child is to receive
the first dose of a newly prescribed medication at 0800 hours. The drug
reference book recommends an initial pediatric dose of lamotrigine of 0.6
mg/kg/day in two divided doses for the first 2 weeks. Which action by the
nurse is most appropriate?
 A. Administer the medication as written on the MAR.
B. Telephone the health care provider to question the dose.
C. Ask the parent If this is the dose the child had been taking.
D. Consult the pharmacist to verify whether the dose is correct.

ANSWER: B

A. Although the medication is written on the MAR, an error still exists in the dose, and the
medication should not be administered.
B. The nurse should notify the HCP. The child weighs 30 kg; the recommended initial daily
dose of lamotrigine (Lamictal) for this child would be 18 mg (0.6 x 30 = 18 mg). If given
18 mg bid, the child would receive a daily dose of 36 mg, twice the recommended initial
pediatric dose.
C. The child has a new-onset seizure disorder; it is unlikely that the child was taking this
medication prior to hospitalization.
D. Consulting the pharmacist is unnecessary; the nurse still needs to seek clarification from
the HCP.

7. The hospitalized child who has a blood lead level of 50 mcg/dL is to receive
succimer 10 mg/kg oral capsule q8h for 5 days. The child weighs 20 kg. Which
intervention by the student nurse should be corrected by the observing
nurse?

A. Prepares to give the total dose of one 1OO-mg capsule with applesauce
B. Sprinkles the beads of two 1OO-mg capsules into pudding for administration
C. Offers fluids frequently during the shift to increase the child’s urine output
D. Explains to a parent that chelation therapy removes the lead from the blood
ANSWER: A

A. The 20-kg child should receive two capsules of succimer (Chemet), not one. Dose (mg) =
20 kg x 10 mg/kg = 200 mg.
B. Succimer capsules can be opened and sprinkled on a small amount of food or in liquid to
be swallowed; two 1OO-mg capsules = 200 mg, which is the correct dose.
C. Fluids should be increased to prevent renal damage because succimer is excreted by the
kidneys.
D. Suecimer forms a water-soluble compound with lead, allowing urinary elimination of
excessive amounts of lead. Lead is removed from the blood, and theoretically some lead
is removed from tissues and organs.

8. The child, admitted to the ED, is experiencing nausea and vomiting,

salivation, respiratory muscle weakness, and depressed reflexes an hour after
exposure to pesticides. Which medications should the nurse anticipate
administering to the child?
A. Atropine and flumazenil
B. Atropine and pralidoxime
C. Epinephrine and naloxone
D. Epinephrine and digoxin immune Fab

ANSWER: B

A. Flumazenil (Romazieon) antagonizes the effects of benzodiachincs on the CNS, such as

sedation, impaired recall, and psycho motor impairment.
B. An organophosphate base in pesticides causes acetylcholine to accumulate at
neuromuscular junctions. Atropine (Atropine), an anticholinergic medication, and
pralidoxime chloride (Protopam), a cholinesterase reactivator, are effective antidotes to
reverse the symptoms.
C. Epinephrine (EpiPen) is an alpha- and betaadrenergic agonist and cardiac stimulant that
strengthens myocardial contractions, increases systolic BP, increases cardiac rate and
output, and constricts bronchial arterioles, inhibiting histamine release. Naloxone
(Narcan) is a narcotic antagonist that reverses the effects of opiates.
D. Digoxin immune Fab (Digibind) is the antidote for digoxin and digitoxin, which acts by
complexing with circulating digoxin or digitoxin, preventing the drug from binding at
receptor sites.

9. The 5-year-old is receiving an IV infusion of D5 with 0.45 NaCl at 100 mL/hr.

Which assessment findings suggest excessive parenteral fluid intake? Select
all that apply.
A. Dyspnea
B. Lethargy
 C. Gastric distention
D. Crackles in lung bases
E. Temperature of 102°F (389°C)

ANSWER: A, B, D

A. Dyspnea indicates fluid volume overload and occurs from fluid rapidly shifting between
the intracellular and extracellular compartments.
B. Lethargy and change in level of consciousness can occur from fluid shifting in brain cells.
C. Gastric distention can occur from excessive oral (not IV) fluid intake or infection.
D. Crackles indicate fluid volume overload and occur from fluid rapidly shifting into the
alveoli.
E. An elevated temperature is a sign of fluid volume deficit, not excess.

10. The nurse has completed swaddling the 2-month-old infant, prepared
supplies to cannulate the scalp vein for an IV infusion, and cleansed and
shaved the hair at the site over the temporal bone. Place the remaining steps
in the order that they should be performed by the nurse.
A. Return in 60 minutes and reswaddle the infant ill a mummy restraint.
B. With an assistant holding the infant’s head, insert a scalp vein needle and observe for
blood return.
C. Apply lidocaine/prilocaine cream to the site selected and unswaddle the infant after the
cream application.
D. Cleanse the shaved area with an antiseptic solution.
E. Remove the mummy restraint after initiating the infusion and comfort the infant.
F. Initiate the infusion and cover the infusion needle with a gauze dressing.

ANSWER: C, A, D, B, F, E

C. Apply litlocainclprilocaine (EMLA) cream to the site selected anti unswaddle the infant after the cream
application. An anesthetic cream will numb the site and help reduce the infant’s pain during insertion.
The infant does not need to remain swaddled while the cream reaches its therapeutic effectiveness in
about an hour.

A. Return in 60 minutes and reswaddie the infant in a mummy restraint. It takes about an hour for the
lidocaine/prilocaine cream to reach its therapeutic effectiveness. The infant should be reswaddled to
minimize movement during insertion.

D. Cleanse the shaved area with an antiseptic solution. Cleansing the area with an antiseptic solution will
help prevent inadvertent introduction of microorganisms into the vascular system.

B. With an assistant holding the infant’s head, insert a scalp vein needle and observe for blood return.
Movement of the infant’s head can result in loss of the vein access or a needle—stick injury to the infant
or nurse.
F. initiate the infusion and cover the infusion needle with a gauze dressing. Once the vein has been
successfully cannulatcd, the site can be dressed and 1V fluids started.

E. Remove the mummy restraint after initiating the infusion and comfort the infant. The mummy
restraint is no longer needed after the IV catheter has been successfully inserted into a scalp vein.

11 . The 8-year-old child with gastroenteritis is prescribed to receive 500 mL

of lactated Ringer’s (LR) solution over the next 10 hours. How many milliliters
per hour should the nurse administer? __________ mL (Record your answer as a
whole number.)
ANSWER: 50

500 mL / 10 hr = 50 mL/hr

12. The new nurse is initiating TPN for four hospitalized pediatric clients. The
experienced nurse should intervene when observing the new nurse attach the
TPN infusion tubing to which IV line?
A. The catheter inserted in the right external jugular vein of the 2-year-old
B. The catheter inserted in the right subclavian vein of the 4-year-old
C. The peripherally inserted IV catheter in a hand vein of the l2-year—old
D. The PICC located in the right upper arm of the 6-year-old

ANSWER: C

A. The external jugular vein is a central IV access site.

B. The subclavian vein is a central 1V access site.
C. TPN is a concentrated hypertonic solution containing glucose, vitamins. electrolytes,
trace minerals, and protein. Because it is hypertonic, it should be administered through
a central IV access site or a PICC. A major vein is used to avoid inflammatory reactions
and venous thrombosis from the high-caloric and high-osmotie fluid.
D. A PICC is a central IV access site.

13. The child with CF is prescribed vitamin A supplements. Which finding by

the clinic nurse indicates that the vitamin has been effective?
A. Skill is supple and healthy.
B. Viscosity of secretions is decreased.
C. Number of bleeding episodes is reduced-
D. Pancreatic enzyme absorption is increased.

ANSWER: A

A. A water-miscible form of vitamin A is given in children diagnosed with CF because the

uptake of the fat solublie vitamins is decreased. One of the functions of vitamin A is to
keep epithelial tissue healthy by aiding the differentiation of specialty cells.
 B. Other treatments for CF, such as bronchodilators and recombinant human
deoxyribonuelease dornase alfa (Pulmozymefl, decrease the viscosity of secretions.
C. Vitamin K, another fat—soluble vitamin administered in CF, increases coagulation.
D. Vitamin A has no effect on pancreatic enzyme absorption.

14. The child with CF is receiving albuterol. Which response should the nurse
expect if albuterol is achieving the desired therapeutic effect?
A. Increased heart rate
B. Improved weight gain
C. Fewer hospitalizations
D. Fewer adventitious lung sounds

ANSWER: D

A. Albuterol may increase HR, but this is not the desired therapeutic effect.
B. Weight should not be affected by albuterol.
C. The use of a bronchodilator has not been demonstrated to decrease hospitalization
frequency.
D. The desired therapeutic effect of a bronchodilator such as albuterol (Proventil) is a
reduction in adventitious (abnormal) breath sounds.

15. While the nurse is completing the assessment of the child with Reye’s
syndrome, the parent states that multiple OTC medications were given before
hospitalization to treat the child’s influenza symptoms. Which medication
stated by the parent is most important for the nurse to report to the HCP?
A. Acetaminophen
B. Bismuth subsalicylate
C. Pseudoephedrine
D. Diphenhydramine

ANSWER: B

A. Acetaminophen (Tylenol) is an aspirin-free analgesic and antipyretic.

B. Although the etiology of Reye’s syndrome is unknown, the condition typically occurs
after a viral illness, such as influenza, and is associated with aspirin (acetylsalicylic acid)
use during the illness. Bismuth subsalicylate (Pepto-Bismol) contains aspirin.
C. Pseudoephedrine (Sudafed) is an allergy and/or cold remedy used for nasal drying and
decongestion. This does not contain aspirin.
D. Diphenhydramine (Benadryl) is an antihistamine. This does not contain aspirin.
16. The nurse is caring for the child from Italy. The child is crying, and the
interpreter is stating that the child has extreme pain. What should be the
nurse’s priority?
A. Administer morphine sulfate 1 mg intravenously as prescribed.
B. Have the child’s mother, who knows limited English, ask the child what hurts.
C. Assess the level of the child’s pain using an appropriate FACES pain rating scale.
D. Ask the HCP to change the pain medication dosage due to inadequate pain control.

ANSWER: C

A. The nurse’s judgment regarding the choice of pain medication and dose should be based
on the reported level of pain.
B. The nurse should do an independent assessment because sometimes information can
be misinterpreted if there is limited knowledge of the language.
C. Assessment should be completed prior to a pain intervention. The FACES pain-rating
scale has been translated into a variety of languages.
D. There is no information indicating the need for the pain medication dose to be changed.

17. The HCP prescribed a dose of acetaminophen according to weight

recommendations for the child weighing 48 1b. The package insert states that
the recommended dose is 15 mg per kg. What dose should the nurse
administer? _____ mg (Record your answer as a whole number.)

ANSWER: 327

First change 48 lb into kilograms (48 / 2.2 = 21.8 kg). Next determine the dose (21.8 kg x 15 = 327 mg).
The child should receive 327 mg of acetaminophen (Tylenol).

18. The adolescent, who is receiving morphine sulfate via PCA, has itching.
Which medication listed on the client’s MAR should the nurse plan to
administer to relieve the itching?
A. Diazepam
B. Diphenhydramine
C. Naloxone hydrochloride
D. Butenafine hydrochloride

ANSWER: B

A. Diazepam (Valium) acts on the CNS to produce sedation, hypnosis, skeletal muscle
relaxation, and anticonvulsant activity.
B. Diphenhydramine (Benadryl) is an antihistamine that hlocks histamine release by
competing for the histamine receptors.
 C. Naloxone (Narcan) is a narcotic antagonist that reverses the effects of opiates.
D. Butenafine (Mentax) is an antifungal antibiotic used to treat tinea pedis, tinea corporis,
and tinea eruris.

19. The nurse is preparing to administer morphine sulfate IV to the child in

severe pain. The child has an IV infusion of DSW at 50 mL/hr through a PICC.
Which intervention is best when administering the medication?
A. Disconnect the infusion, inject 3 mL of normal saline, and give the morphine sulfate
undiluted.
B. Question the prescribed medication because morphine sulfate cannot be given through
a PICC line.
C. Give the morphine sulfate undiluted into the existing IV tubing’s medication port closest
to the child-
D. Dilute the morphine sulfate with 5 mL of NS and give over 5 minutes into the IV tubing
port closest to the child.

ANSWER: D

A. Unnecessary IV disconnections increase the risk for infection. Morphine sulfate is

compatible with DSW.
B. Morphine sulfate can be administered into a PICC access device.
C. Administering undiluted morphine sulfate to a child increases the risk of adverse effects.
D. The nurse should dilute the morphine sulfate before administration to prevent too-rapid
administration and adverse effects. A single dose should be given over 4 to 5 minutes.

20. The HCP’s progress notes state a plan to initiate an oral NSAID for the
child’s pain. Based on this information, the nurse should consult with the HCP
when noting that which medication was the only analgesic prescribed?
A. Naproxen
B. Tolmetin
C. Ibuprofen
D. Hydromorphone

ANSWER: D

A. Naproxen (Aleve) is an NSAID.

B. Tolmetin (Tolectin) is an NSAID.
C. Ibuprofen (Advil, Motrin) is an NSAID.
D. Hyd romorphone (Dilaudid) is an opioid analgesic, not an NSAID.
21 . A dose of albuterol 5 mg by nebulization is prescribed for the pediatric
client experiencing wheezing from an asthma episode. The medication vial
contains 2.5 mg per 3 mL. How many milliliters of medication should the
nurse prepare for administration by nebulization? _________ mL (Record your
answer as a whole number.)

ANSWER: 6

Use a proportion formula:

2.5 mg : 3 mL :: 5 mg :X mL;

multiply the outside values and then the inside values and solve for X;

2.5X=15;

X= 6 mL

22. The home care nurse is observing the child with asthma self-administer a
dose of albuterol via a metered-dose inhaler with a spacer. Within a short
time, the child begins to wheeze loudly. What should the nurse do?
A. Reassure the parent that this usually only occurs with the initial dose.
B. Notify the HCP; wheezing may indicate paradoxical bronchospasms.
C. Consult with the HCP to have the child’s medication dosage increased.
D. Reassess the technique; eye contact with albuterol can cause wheezing.

ANSWER: B

A. Reassuring the parent is an inappropriate action; the wheezing is not a normal reaction.
There is no indication that this is an initial dose.
B. The client’s wheezing suggests paradoxical bronchospasms, which can occur with
excessive use of adrenergic bronchodilators such as albuterol (Proventil). The
medication should be withheld and the HCP notified.
C. A paradoxical bronchospasm can occur from excessive use, so the dosage should not be
increased.
D. Contact with the eyes can cause eye irritation, not wheezing.

23. The parent of the 2—year—old with asthma has been given instructions
about asthma control and Step Therapy. Which statement, if made by the
parent, should indicate to the nurse that the parent has an adequate
understanding of the instructions?
A. “If my child has wheezing twice a week or less, I should add the nebulized corticosteroid
and make an appointment.”
 B. “If my child has a respiratory tract infection I should add the nebulized corticosteroid
and make an appointment.”
C. “If my child has to use the nebulizer less than twice a week, I should add the nebulized
corticosteroid and make an appointment.”
D. “If my child has nighttime awakenings with wheezing twice a month or more, I should
add the nebulized corticosteroid and make an appointment.”

ANSWER: D

A. Asthma symptoms (wheezing) occurring 2 or fewer days per week should be treated at
Step 1.
B. A respiratory tract infection may require the increased use of short-acting beta agonists,
but an inhaled corticosteroid should not be added until the child is evaluated by the
HCP.
C. The use of the nebulizer twice a week or less should be treated at Step I.
D. Nighttime waking with asthma symptoms 1 to 2 times per month indicates the need to
proceed to Step 2 therapy, which includes the use of an inhaled corticosteroid.

24. The 3-year-old with LTB is receiving aerosolized racemic epinephrine.

Which assessment finding should the nurse recognize as indicating that the
treatment is having an adverse effect?
A. Heart rate of 180 beats/min
B. Blood pressure of 60/40 mm Hg
C. Respiratory rate of 25 breaths/min
D. Pulse oximetry of 90% on room air

ANSWER: A

A. Tachycardia is an adverse effect of racemic epinephrine (AsthmaNefrin).

B. Hypertension, not hypotension, is an adverse effect of racemic epinephrine; a BP of
60/40 mm Hg in a 3-year—old indicates hypotension.
C. A respiratory rate of 25 breaths/min is normal for a 3-year—old.
D. A pulse oximetry reading of90% is concerning and may indicate the need for
supplemental oxygen, but it is not an adverse effect from the medication.

25. The initial treatment regimen of isoniazid, rifampin, and ethambutol is

prescribed for the adolescent who has a positive tuberculin skin test. The
client confides that she thinks she may be pregnant and asks if she should be
taking these medications. Which rationale should be the basis for the nurse’s
response?
A. These drugs cross the placental barrier, and treatment should be withheld until the
postpartum period.
 B. The medications should be taken, but the diagnosis is an indication for tennination of
the pregnancy.
C. The medications should be postponed because the risk for hepatitis is greatly increased
ill the intrapartum period.
D. The medications should be taken; untreated TB represents a far greater hazard to the
pregnant woman and her fetus.

ANSWER: D

A. The medications do not cross the placental barrier, so treatment should not be
withheld.
B. Administering antituberculosis medications would not be an indication for termination
of pregnancy because the medications are safe during pregnancy.
C. The risk of hepatitis is slightly increased with the use of antituberculosis medications in
pregnant women; however, the benefits of treatment strongly outweigh postponement
of treatment.
D. Infants born to women with untreated TB may be of lower birth weight, but rarely
would the infant acquire congenital TB. Isoniazid (Nydrazid), rifampin (Rifadin), and
ethambutol (Myambutol) are all considered safe for use in pregnancy.

26. The HCP prescribes amoxicillin for the 8—month-old with acute otitis
media that has not resolved- Which statement to the parents is correct
regarding the primary purpose of amoxicillin?
A. “It will reduce the child’s fever.”
B. “It will reduce the child’s severe ear pain.”
C. “lit will shrink swollen tissue in the Eustachian tube.”
D. “It will treat the probable organism, Haemoplrilus influenzae.”

ANSWER: D

A. As the infection is treated, the fever will be reduced, but this is not the primary reason
for treatment with amoxicillin.
B. Treating the ear infection will reduce the pain, but that is not the primary purpose for
treatment with amoxicillin.
C. Reducing inflammation of the eustachian tube will occur, but this is not the primary
purpose for treatment with amoxicillin.
D. Acute otitis media is frequently caused by the Haemophilus influenzae and
Streptococcus pneumoniae bacteria. The primary purpose of amoxicillin (Amoxil) is to
treat the infection caused by these two organisms.
27. The nurse is assessing the child’s ear with an otoscope prior to
administering medications to treat persistent otitis media. Which assessment
finding should the nurse expect?
ANSWER: A

A. This illustration shows otitis media characterized by a bulging contour to the tympanic
membrane, unclear ossicular landmarks, and yellowish middle ear effusion.
B. This illustration shows a perforated meanic membrane, not otitis media.
C. This illustration shows a normal left ear tympanic membrane. The ossicular landmarks
can be identified through the tympanic membrane. The nurse would not expect to see a
normal tympanic membrane when the child has persistent otitis media.
D. This illustration shows the presence of a foreign body in the ear canal.
28. The child weighing 20 kg is to receive ceftriaxone 2 g IVPB q12h and
dexamethasone 3 mg IV—push q6h for 4 days to treat Haemopllilus influenzae
type b meningitis. The drug reference states that the usual dose of ceftriaxone
is 100 mg/kg/dose with a maximum daily dose of 4 g. The recommended dose
of dexamethasone for treating H. influenzae type b meningitis is 0.15 mg/kg
q6h for 2 to 4 days. Based on the medications prescribed and these findings,
which conclusion by the nurse is correct?
A. The dose of ceftriaxone is too high.
B. The dose of dexamethasone is too low.
C. Both medications are safe to administer as Prescribed.
D. The ceftriaxone should be given before the Dexamethasone.

ANSWER: C

A. The dose for ceftriaxone is correct (100 mg x 20 kg = 2000 mg; 1000 mg = 1 gm; 2000 mg
= 2 gm).
B. The dose of dexamethasone is correct (0.15 mg .Y. 20 kg = 3 mg).
C. The doses of ceftriaxone (Rocephin) and dexamethasone (Decadron) are at the
recommended doses. The dose for ceftriaxone is correct (1th mg x 20 kg = 2000 mg;
1000 mg = 1 g; 2000 mg = 2 g). The dose of dexamethasone is correct (0.15 mg X 20 kg =
3 mg).
D. A11 IV-push medication takes less time to administer than an IV piggyback (IVPB)
medication. The dexamethasone should be administered first.

29. The 12-year-old weighing 50 kg is hospitalized with bacterial pneumonia

and an upper respiratory tract infection. The nurse is reviewing the child’s
serum laboratory report illustrated. Based on the findings, which HCP order is
most important for the nurse to question?
 A. Amikacin sulfate 375 mg IVPB q12h
B. Guaifenesin 50-100 mg q4h pm for cough
C. Dextrose 5% in 0.25 NaCl with 20 mEq/L KCL at 90 mL/hr
D. Acetaminophen 325—650 mg q4—6h prn, not to exceed 3000 ing/24 hr

ANSWER: A

A. Amikacin (Amikin) is an aminoglycoside, which is nephrotoxic and should be questioned.

The serum creatinine and BUN levels are elevated, suggesting decreased renal function.
B. Guaifenesin (Robitussin) is used for cough. The dose is within the range for a child of 12
years.
C. The serum osmolality is high, suggesting dehydration, and the potassium is low. DS in
0.25 NaCl with 20 mqu’L at 90 mL/hr will treat the dehydration and hypokalemia. The
rate is appropriate [1500 mL./day, plus 20 mL/kg/day for each kg over 20 kg = 1500 +
(20 X 30) = 2100; 2100 + 24 = 87.5].
 D. The acetaminophen (Tylenol) dose is within parameters (IO—15 mg/kg/dose q4—6h
prn, not to exceed five doses/24 hr), but it is concerning with the decreased renal
function. Because acetaminophen is pro and amikacin is timed, the amikacin is more
important to question-

30. The nurse is teaching the 14-year-old who is being given captopril for the
first time. Which explanation would be most appropriate?
A. “Captopril will help to control your asthma.”
B. “Captopril will help to control your heart rate.”
C. “Captopril will help to control your blood sugar.”
D. “Captopril will help to control your blood pressure.”

ANSWER: D

A. Captopril does not have any effect on asthma.

B. While I-IR may slow in response to lowered BP , this is not the desired effect for which
captopril is given.
C. Captopril does not have any effect on blood sugar.
D. Captopril (Capoten) is an ACE inhibitor and is indicated for the treatment of
hypertension in children.

31 . The HCP orders a digitalizing dose of digoxin 225 mcg IV now to be given
to a 3-year—old. The pharmacy sends a solution of 500 mcg in 50 mL Of D 5W.
How many mL should the nurse administer? ____ mL (Round your answer to
the nearest tenth.)
32. The nurse is discharging the child with sickle cell disease who has
undergone a splenectomy. The child has an allergy to penicillin. The nurse
should anticipate teaching about which prophylactic medication?
A. Epoetin
B. Amoxicillin
C. Morphine sulfate
D. Erythromycin ethylsuccinate

ANSWER: D

A. Epoetin (Epogen) stimulates the bone marrow to produce RBCs (erythropoiesis). In

sickle cell disease, the RBCs “sickle,” increasing the levels of hemoglobin S (HbS).
Increasing the production of sickled RBCs can worsen the condition.
B. Amoxicillin (Amoxil) is an aminopenicillin and is contraindicated when allergies to
penicillin are present; the nurse should question this medication if prescribed
C. Opioids such as morphine sulfate are administered in sickle cell crises or for severe pain;
its use depends on pain severity. It is usually not given prophylactically.
D. The ability to fight infection is decreased following a splenectomy. Daily prophylactic
antibiotics are given. Erythromycin ethylsuccinate (E.E.S.) is a macrolide antibiotic and
safe to administer when a penicillin allergy exists.

33. The 16-year-old, hospitalized for barbiturate overdose, is receiving low-

dose dopamine at 1 mcg/kg/min. Which finding in the client’s medical record
illustrated should prompt the nurse to conclude that dopamine is effective?

A. Decrease in PACs
B. Increase in urine output
C. Decrease in pulse pressure
D. Increase in the diastolic BP
ANSWER: B

A. Dopamine (Intropin) will have no effect on decreasing the incidence of PAC 5.

B. Low-dose dopamine, 0.5—2.0 meg/kg/min, acts on dopaminergic receptor sites along
afferent arterioles in the glomerulus, dilates the renal vasculature, and improves urine
output.
C. Positive inotropic effects of dopamine include an increase in systolic BP with an increase
(not decrease) in pulse pressure. Pulse pressure is the difference between the systolic
BP and diastolic BP. The pulse pressure at 0800 is 40; at 1000 it is 30.
D. Positive inotropic effects of dopamine include an increase in systolic BP with little or no
effect on DBP.

34. The nurse is showing the parents the preferred site for their child’s insulin
administration via an insulin pump. Place an X within the oval for the
preferred site.
The abdomen allows for a more consistent rate of absorption of insulin and is the preferred site for
insulin administration via an insulin pump; it can be placed on either side of the umbilicus. The site is
rotated within the abdominal area (green shaded area of the abdomen). More rapid absorption of
insulin can occur when administered into the arms or legs.

35. The l1-year—old with type 1 DM is learning to use insulin pens for basal-
bolus insulin therapy with both a very-long-acting insulin and rapid-acting
insulin. Which action by the child should indicate to the nurse that additional
teaching is needed?
A. The child holds the insulin glargine pen against the skin for 10 seconds after
administering the correct amount of insulin.
B. The child counts the number of carbohydrates eaten at breakfast and selects the insulin
lispro pen for covering the carbohydrates eaten.
C. The child counts the number of carbohydrates eaten at lunch and selects the insulin
glargine pen for covering the carbohydrates eaten.
D. The child determines that the blood glucose level at bedtime is within the normal range,
eats a piece of turkey, and tells the nurse that coverage is not needed with insulin lispro.

ANSWER: C

A. To ensure that the medication is administered with the insulin pens, the pen is held in
place for 10 seconds after delivery of the medication. This action is correct.
B. Insulin lispro (Humalog) is rapid-acting insulin with an onset of 5 to 10 minutes- This
action is correct.
C. Insulin glargine (Lantus) is very-long-acting insulin administered once daily and is not
used for covering the number of carbohydrates eaten. This action indicates that the
child needs additional teaching.
D. The rapid-acting insulin lispro (Humalog) is not needed if the glucose level is WNL.
Turkey does not contain carbohydrates; insulin is administered to cover only the
carbohydrates eaten. This action is correct.

36. The nurse completes teaching insulin administration to the parent of the
toddler newly diagnosed with type 1 DM. The nurse concludes that the
teaching was successful when the parent makes which statement?
A. “NPH insulin is only given at night immediately before the bedtime snack.”
B. “I should use only the buttocks for the insulin injections until the child is older.”
C. “Insulin lispro acts within 15 minutes and peaks 30 to 90 minutes after injection.”
D. “Insulin detemir can be added to the insulin lispro pen to reduce the number of
injections.”

ANSWER: C
 A. NPH (Humulin N) insulin can be given in the morning, but there is better glucose control
if given at night. NPl-I peaks in 4 to 14 hours, so there is no need to make sure food is
given immediately after administration.
B. Insulin injections should always be rotated to prevent subcutaneous tissue damage from
giving the injections in the same location.
C. Lispro (Humalog) is rapid-acting insulin that peaks in 30 to 90 minutes and may last as
long as 5 hours in the blood. This statement is correct, indicating teaching is effective.
D. Detemir (Levemir) is long-acting and lispro (Humalog) is rapid~acting insulin. An insulin
pen uses prefilled, multiple-use insulin cartridges; adding other types of insulins should
not be attempte.

37. The nurse is evaluating the effectiveness of lispro and glargine insulins
being administered to the 2-year-old with type 1 DM. Which findings 011 the
serum laboratory report indicate that treatment is effective? Place an X next
to each laboratory result that reflects that treatment is effective-
The treatment goal for children with type 1 DM is blood glucose levels within the normal range (60—105
mg/dL for a 2-year-old). Hgb A“. levels are indicative of the average blood glucose levels over the past 2
to 3 months; normal A1c is 3.9% to 7.7 0/o. Although the other laboratory values are normal, these do
not indicate the effectiveness of insulin therapy.

38. The parent of the child brought to the ED states to the nurse, “My child is
sweaty and shaky; I think some of my medication is gone.” The parent hands
the nurse the medication bottle illustrated- Which action should the nurse
take first?

A. Start an infusion of D5W at 40 mL./hr.

B. Give glucagon 1 mg subcutaneously-
C. Check the child’s blood glucose level.
D. Determine how many tablets were taken.

ANSWER: C

A. Initiating an IV access for glucose administration is more time-consuming than giving

glucose by the oral route or glucagon (GlucaGen) subcutaneously to a child Who is still
responsive.
B. An oral form of glucose should be administered if the child is responsive and glucagon
given only if the child is unresponsive or too uncooperative or upset to take oral
glucose. Glucagon stimulates the release of liver glycogen and releases glucose into the
circulation.
 C. The child may have ingested the glipizide (Glucotrol XL), a sustained-released
hypoglycemic agent. The child’s blood glucose level should be checked first to
determine the appropriate treatment.
D. Determining the number of tablets taken may delay the child’s treatment.

39. Trimethoprim-sulfamethoxazole is prescribed for the child who develops

a UTI. What infonnation should the nurse address when teaching the parents
about administering the medication? Select all that apply.
A. Weigh the child daily ill the morning.
B. Take the child’s temperature once daily.
C. Encourage the child to drink plenty of fluids.
D. Administer the medication at the prescribed times.
E. If a rash occurs, report this immediately to the HCP-

ANSWER: C, D, E

A. Weighing is unnecessary; it is important With medications that affect fluid balance, but
not with an antibiotic.
B. Monitoring temperature would be important to evaluate the effectiveness of antipyretic
Medications.
C. Fluids should be increased to dilute bacterial toxins and increase urinary output.
D. The medication should be given in the exact amount at the times directed to maintain a
therapeutic blood level. If the therapeutic blood level falls, organisms can build a
resistance to the medication.
E. Trimethoprim-sulfamethoxazole (Bactrim) is a sulfonamide antibiotic. A rash can
indicate an allergy to sulfonamides.

40. The 9—year-old with SLE is receiving large doses of prednisolone- Which
laboratory finding should the nurse recognize as an untoward effect of the
medication?
A. Total bilirubin of 4 mg/dL
B. WBC count of 18,000/mm3
C. Serum sodium of 130 mEq/L
D. Random glucose of 130 mg/dL

ANSWER: B

A. The liver is not affected by prednisolone use, so an increased total bilirubin of 4 mg/dL is
not related to the use of the drug- Normal total bilirubin in a 9-year-old should be less
than 2 nig/dL.
B. A WBC count of 18,000/mm3 may indicate an infection, an untoward effect of
prednisolone (Omnipred). Prednisolone, a corticosteroid used to reduce inflammation,
 may increase the risk of infection. The normal WBC in a 9-year-old is
4500—11,100/mm3.
C. Prednisolone has been associated with the adverse effect of hypokalemia, but not
hyponatremia (serum sodium of 130 mEq/L). Norma serum sodium is 135—145 mEq/L.
D. Although corticosteroids may have the effect of increasing blood glucose, a random
glucose of 130 mg/dL is not abnormal.

41 . The child is to start on medication therapy for enuresis that has not
resolved with behavioral interventions. Which medication should the nurse
anticipate being prescribed for the child?
A. Lorazepam
B. Desmopressin
C. Nitrofurantoin
D. Spironolactone

ANSWER: B

A. Lorazepam (Ativan) is a benzodiazepine used to treat anxiety. A side effect is

drowsiness, which could impair a child’s ability to waken for voiding.
B. Desmopressin (DDAVP) is an analog of arginine vasopressin, which acts as an
antidiuretic. It promotes resorption of water in the renal tubule or decreases bladder
filling.
C. Nitrofurantoin (Macrobid) is a urinary tract antiseptic used to treat UTIs and would not
be used with enuresis.
D. Spironolactone (Aldactone) is a potassium-sparing diuretic that would promote, not
inhibit, diuresis.

42. Oral ranitidine 2 mg/kg twice daily is prescribed for the infant weighing
16 lb 8 oz. The medication is supplied as 15 mg/mL. How many milliliters
should the nurse instruct the parent to withdraw in the syringe provided with
the ranitidine to administer one dose?

___________ mL (Record your answer as a whole number.)

ANSWER: 1

Use a proportion formula to calculate the dose. First determine the dose for the child’s weight: 16 lb 8
ounces = 16.5 lb + 2.2 lb/kg = 7.5 kg Next determine the prescribed dose. 7.5 kg X 2 mg = 15 mg.

The medication is supplied in 15 mg per 1 mL. The dose to administer is 1 mL of ranitidine (Zantac).
43. The nurse is reviewing information for the 6-month-old who is being given
ranitidine. Which filldillg should the nurse identify as an adverse effect of
ranitidine?
A. A heart rate of 110 bpm
B. Oral temperature of 102.7°F (393°C)
C. Spitting up some formula after each feeding
D. A hard, pebble-like bowel movement every 2 days

ANSWER: D

A. An HR of 110 bpm is normal for a 6-month-old; the range is 80-170 bpm.

B. Fever (temperature of 102.7°F) is not an adverse effect of ranitidine.
C. Ranitidine is indicated for GERD; spitting up after feedings should improve. If not, then
the medication dose may be too low or the medication itself ineffective- S pitting up is
not a side effect.
D. The nurse should identify that a hard, pebblelike bowel movement every 2 days
demonstrates constipation; constipation is an adverse effect of ranitidine (Zantac).

44. The 14-year-old who has GERD is receiving lansoprazole. Which response
should the nurse expect if lansoprazole is achieving the desired therapeutic
effect?
A. Increased appetite
B. Increased GI motility
C. Decreased epigastric pain
D. Decreased rectal flatulence

ANSWER: C

A. Lansoprazole would not be expected to change appetite-

B. Lansoprazole is not a gastric motility agent.
C. Lansoprazole (Prevacid) is a PPI of stomach acid secretion. Decreasing the overall Ph
allows the gastric mucosa to heal.
D. Flatulence is not affected.

45. The nurse is preparing to care for the 14-month-old newly hospitalized
toddler with bacterial gastroenteritis and severe dehydration- Which initial
collaborative interventions should the nurse expect to implement? Select. all
that apply.
A. IV antibiotic to treat infection
B. Oral fluids for fluid rehydration
C. 1V fluid therapy for rehydration
D. Analgesics for pain and discomfort
 E. An antidiarrheal to control diarrhea
F. Antipyretic for elevated temperature

ANSWER: A, C, F

A. Antibiotics may be prescribed to treat bacterial gastroenteritis to ensure complete

recovery.
B. Oral fluid rehydration will be initiated later, but not initially, when the toddler presents
with severe dehydration.
C. The child who presents with severe dehydration needs IV therapy to stabilize the balance
of fluids and electrolytes.
D. The pain and discomfort the toddler will have are due to fever and cramping from the GI
illness; thus, analgesics are usually not prescribed.
E. An antidiarrheal medication is contraindicated.
F. Fever is often a symptom of gastroenteritis. Ensuring that the fever is controlled will
provide some comfort.

46. The nurse is preparing to administer IV fluids to the 13-kg child who has
dehydration. The daily IV fluid requirement is to administer 1000 mL / 50
mL/kg over 10 kg. How many milliliters per hour should the nurse calculate to
administer the IV therapy correctly?

____________ mL/hr (Record your answer as a whole number)

ANSWER: 54

This child weighs 13 kg; the daily requirement is 1000 mL / (50 mL X 3) = 1150 mL/24 hr. The hourly rate
is 1150 mL / 24 hr = 48 mL/hr.

47. The 6-month-old hospitalized with dehydration is being rehydrated with

IV fluids. Which findings should indicate to the nurse that the treatment is
having the desired effect? Select all that apply.
A. Flat fontanelle
B. Absence of crying
C. Light yellow urine
D. Rapid respirations
E. Moist mucous membranes

ANSWER: A, C, E

A. Flat (rather than depressed) fontanelles indicate good hydration, which is the desired
effect of IV rehydration.
B. Absence of crying is not related to improved hydration status.
 C. Light-colored urine indicates good hydration, which is the desired effect of IV
rehydration.
D. Rapid respirations may indicate dehydration.
E. Moist mucous membranes indicate good hydration, which is the desired effect of IV
rehydration.

48. The nurse is developing the plan of care for the 7-year-old with encopresis
who has been started on lactulose. Which outcome would be most appropriate
for the nurse to establish?
A. 2-pound weight gain
B. Nighttime continence
C. Blood glucose 70—1 10 mg/dL
D. Normal bowel movement daily

ANSWER: D

A. Weight gain is not expected with an osmotic laxative.

B. Nighttime continence is not expected to be altered by an osmotic laxative.
C. Blood glucose is not expected to be altered by an osmotic laxative-
D. Lactulose (Constulose) is an osmotic laxative used in treating encopresis to prevent
constipation; the nurse should establish an outcome of a normal daily bowel movement.

49. The clinic nurse is teaching the parent how to give eye drops to the 3-year
—old who has bacterial conjunctivitis and purulent drainage out of both eyes,
swollen eyelids, and inflamed conjunctiva. What information should the
nurse provide?
A. Restrain the child prior to administering the eye drops.
B. Have the child sitting when administering the eye drops.
C. Place the child in a head-down position to instill the eye drops-
D. Obtain the child’s cooperation by describing the procedure in detail.

ANSWER: A

A. It is necessary to secure the child prior to instilling eye drops to ensure that the child
receives the entire prescribed dose. The child is likely to resist instillation of the eye
drops because a child is told not to put anything in the eyes and is likely to remember
painful experiences such as dust or a foreign object that has gotten into the eye.
B. The child should be supine, not sitting, when instilling eye drops.
C. The child should be supine, not in a head-down position, when instilling eye drops.
D. Telling the child what is happening is important, but at the age of 3, a detailed
explanation will not make the child more cooperative.
50. The clinic nurse is reviewing prescriptions with the parents of the school-
aged child with newly diagnosed generalized contact dermatitis. Which
prescription should the nurse question with the HCP?
A. Oral prednisone
B. Calamine lotion
C. Oral diphenhydramine
D. Hydrocortisone cream

ANSWER: A

A. Prednisone (Deltasone) would not be a first-line treatment for contact dermatitis, and
its use should be questioned. Prednisone maybe added later if the contact dermatitis
has not resolved.
B. Calamine lotion is used to promote drying and help relieve itching.
C. Diphenhydramine (Benadryl) helps to relieve itching.
D. Hydrocortisone cream is an anti-inflammatory agent used to treat contact dermatitis.

51 . Methylphenidate hydrochloride is prescribed for the child with ADHD.

The nurse should teach the parents to administer the medication in which
way?
A. Whenever the child exhibits inattention behaviors
B. Whenever the child exhibits hyperactive behaviors
C. With a snack before bed to calm the child for sleep
D. During or after meals if the medication decreases appetite

ANSWER: D

A. Methylphenidate is usually given twice daily at or before breakfast and at noon, not
whenever inattention behaviors occur.
B. Methylphenidate is usually given twice daily at or before breakfast and at noon, not
whenever hyperactive behaviors occur.
C. The last dose of the medication should be given before 6 pm- to prevent insomnia.
D. A side effect of methylphenidate hydrochloride (Ritalin) is anorexia. It should be given
during or immediately after breakfast and lunch to prevent a decreased intake.

52. The nurse is administering Phenobarbital 300 mg IV to the child weighing

18 kg who is in status epilepticus. Which actions should the nurse take to
safely administer the medication? Select all that apply.
A. Administer the phenobarbital over 20 minutes.
B. Monitor the IV site for signs of extravasation.
C. Dilute the phenobarbital dose in 10 mL DSW.
D. Administer the phenobarbital via IV piggyback.
 E. Identify incompatible medications or solutions being infused.
F. Inject the phenobarbital over 10 minutes in the port closest to the child.

ANSWER: B, E, F

A. This dose of phenobarbital should be administered as an IV—push medication over 10

minutes; administering it over 20 minutes will delay the medication’s effects to treat
status epilepticus.
B. Whenever IV medications are being administered by any route, the site should be
evaluated for irritation and extravasation. An extravasation of phenobarbital (Luminal)
may cause necrotic tissue changes that necessitate skin grafting.
C. Phenobarbital, if diluted, should be mixed with sterile water for injection and not DSW.
D. Phenobarbital should be prepared for direct IV administration and not as an IV
piggyback because this would delay the child’s receiving the medication to terminate
the seizure.
E. When administering IV medications, identification of medications or solutions that
would be incompatible with that medication must occur so that the tubing can be
flushed to ensure that crystallization does not occur in the IV tubing.
F. Phenobarbital should be administered no faster than '1 mg/kg/min, with a maximum of
30 mg over 1 minute in infants and children.

53. The 4-year-old with meningitis is to receive ceftriaxone 750 mg IVPB over
30 minutes. The pharmacy provided 750 mg in 50 mL DSW to be infused IVPB
through a microdrip infusion sys- tem (tubing drop factor 60 gtt/min). At what
rate, in gtt per min, should the nurse program the IVPB pump?

________ gtt/min (Record your answer as a whole number.)

54. The 17-year-old female is about to have a drug screen test for
employment. The adolescent tells the nurse of a recent UTI that was treated
with antibiotics- Which antibiotic, if identified by the client, could produce a
false-positive urine screening test for opioids?
A. Cephalexin
B. Ceftazidime
C. Amoxicillin
D. Ciprofloxacin

ANSWER: D

A. Cephalexin (Keflex) does not interfere with urine testing for opioids.
B. Ceftazidime (Fortaz), a cephalosporin, does not interfere with urine testing for opioids.
C. Amoxicillin (Amoxil), an aminopenicillin, does not interfere with mine testing for opioids.
D. Fluoroquinolones, such as ciprofloxacin (Cipro), can cause false-positive urine opiate
screens.

55. The nurse is assessing the 13-year-old who has been taking somatropin
recombinant. Which findings should the nurse report to an HCP?
A. Erythematous palmar rash
B. Blood pressure of 122/74 mm Hg
C. Random blood glucose of 158 mg/dL
D. X-ray report noting epiphyseal closure

ANSWER: D
 A. Erythematous palmar rash is not associated with the use of GH-
B. BF of 132/84 in a 13-year-old is considered normal-
C. Although GH use may be associated with blood glucose changes, a random blood
glucose of 15 8 mg/dL is nomial.
D. Somatropin (Cenotropin) recombinant is an injectable GH indicated for children with a
deficiency of the hormone. It cannot be given once the epiphyses have closed. The
nurse should notify the HCP.

56. The 16-year-old is taking acyclovir. Which statement, if made by the

adolescent, should indicate to the nurse that the medication is having the
desired therapeutic effect?
A. “I am having a regular menstrual cycle now.”
B. “That bad odor from my vagina is now gone.”
C. “All those sores on my labia are getting better.”
D. “I don’t have that green vaginal discharge anymore.”

ANSWER: C

A. A side effect of acyclovir is a change in the menstrual cycle; however, having a regular
menstrual cycle is not the desired therapeutic effect-
B. A bad odor from the vagina is a symptom of bacterial vaginosis or trichomoniasis
vaginalis, and usually not a symptom of genital herpes simplex-
C. Acyclovir (Zovirax), an antiviral medication, is indicated for the treatment of genital
herpes simplex virus, shingles, or chicken pox. Labial sores are associated with genital
herpes simplex. Improvement of labial sores indicates that acyclovir is having the
desired therapeutic effect-
D. A green vaginal discharge may be a symptom of Trichomonas, which is treated with
metronidazole (Flagyl), an amebicide.

57. The nurse is developing the plan of care for the 4-year-old client who is
taking metronidazole for giardiasis. Which measures should be included in
the plan of care? Select all that apply.
A. Assess cardiac status.
B. Assess for signs of infection.
C. Reinforce strict hand washing.
D. Give metronidazole with food.
E. Monitor results of stool samples.

ANSWER: B,C, E

A. Metronidazole is not associated with any cardiac changes or adverse events.

B. Giardiasis is an infectious diarrheal disease; the plan of care should include assessing for
infection. Infection should subside when treated with metronidazole (Flagyl).
 C. Giardiasis is an infectious diarrheal disease; the plan of care should include reinforcing
strict hand washing.
D. Metronidazole should be given on an empty stomach.
E. Giardiasis is an infectious diarrheal disease; the plan of care should include monitoring
the results of stool samples.

58. The nurse is concerned that the adolescent may be developing a side effect
of methotrexate. Which test or exam results should the nurse review prior to
administration?
A. Folic acid level
B. Serum electrolytes
C. Complete blood count
D. Activated partial prothrombin time

ANSWER: C

A. Although methotrexate is a folic acid antagonist, it does not alter serum levels-
B. Methotrexate has no effect on electrolytes.
C. An adverse effect of methotrexate (Trexall) is aplastic anemia; thus, the nurse should
review the CBC results before administration.
D. Methotrexate has no effect on coagulation.

59. Prior to administering filgrastirn, the nurse reviews the laboratory report
results for the 3-year-old who completed the second round of chemotherapy
three weeks ago. Which finding indicates a therapeutic response to filgrastim?
A. Hematocrit of 31%
B. Eosinophil count of 6%
3
C. WBC count of 6800/mm
3
D. Platelet count of 150,000/mm

ANSWER: C

A. The Hct of 3 1% is normal but is unaffected by filgrastim, a colony-stimulating factor.

B. The eosinophil count of 6 is elevated (0 to 2% is normal) but is not related to filgrastim
use.
C. Filgrastim (Neupogen) is a colony-stimulating factor used to increase the production of
WBCs in persons who have bone marrow depression from chemotherapy.
D. The platelet count of 150,000/mm3 is normal but is not used to evaluate the
therapeutic effective- ness of filgrastim.
60. The nurse is teaching the parent of the 3-year—~old being treated with
vincristine sulfate for Wilms’ tumor. The nurse should inform the parents to
immediately notify the HCP of which most significant adverse effect?
A. The child develops diarrhea-
B. The child’s hair begins to fall out.
C. The child develops dysphagia and paresthesia.
D. 4- The child has signs or symptoms of depression.

ANSWER: C

A. Both diarrhea and severe constipation are adverse effects of vincristine, and
prophylactic treatment is implemented at the beginning of therapy to decrease the
potential of these occurring.
B. Hair loss is a common adverse reaction to the medication and is reversible.
C. Dysphagia and paresthesia are CNS adverse effects from vincristine sulfate (Oncovin).
The nurse should teach the parent to notify the HCP immediately if these occur.
D. Three-year—olds may not show signs or symptoms of depression. If present, the signs
and symptoms should be distinguished as being associated with the neoplastic disease
itself or as side effects of the medication.