Pediatric Nurse Exam Pediatric Nurse Pharmacology and Medication Administration 5 — Questions and Answers
Question 1: A pediatric nurse is caring for a 5-year-old prescribed ceftriaxone. Before administration, which assessment is the highest priority?
- Ask about allergy to penicillin or other cephalosporins (Correct answer)
- Obtain a urine sample for culture
- Check the child's weight for dose verification
- Confirm IV access is patent
Correct answer: Ask about allergy to penicillin or other cephalosporins
Cross-reactivity between penicillins and cephalosporins is possible, so allergy history must be confirmed before the first dose.
Question 2: An 8-year-old with type 1 diabetes presents with blood glucose of 54 mg/dL and is alert and oriented. Which is the most appropriate initial intervention?
- Give 15 g of fast-acting carbohydrate orally and recheck in 15 minutes (Correct answer)
- Administer 50% dextrose IV push immediately
- Give glucagon IM and call rapid response
- Start D10W IV infusion at maintenance rate
Correct answer: Give 15 g of fast-acting carbohydrate orally and recheck in 15 minutes
The 15-15 rule: give 15 g of fast-acting carbohydrate for mild hypoglycemia in a conscious child and recheck glucose in 15 minutes.
Question 3: Which of the following is a key nursing responsibility when a child is receiving a blood transfusion?
- Remain with the child and monitor vital signs during the first 15 minutes of infusion (Correct answer)
- Infuse the unit rapidly to complete within 30 minutes
- Pre-medicate every child with diphenhydramine prior to transfusion
- Administer the transfusion through the same IV line as any running IV fluids
Correct answer: Remain with the child and monitor vital signs during the first 15 minutes of infusion
Transfusion reactions most commonly occur within the first 15 minutes; close monitoring during this period is mandatory.
Question 4: A child is prescribed codeine for pain management after tonsillectomy. Which concern has led major health organizations to advise against this practice?
- Ultra-rapid metabolizers of CYP2D6 can convert codeine to dangerously high morphine levels causing respiratory depression (Correct answer)
- Codeine is ineffective for post-operative pain in children under 12
- Codeine causes prolonged sedation lasting more than 24 hours in all pediatric patients
- Children eliminate codeine too quickly for it to provide adequate analgesia
Correct answer: Ultra-rapid metabolizers of CYP2D6 can convert codeine to dangerously high morphine levels causing respiratory depression
Ultra-rapid CYP2D6 metabolizers convert codeine to toxic morphine levels, causing fatal respiratory depression, especially in post-tonsillectomy patients.
Question 5: A nurse must verify a high-alert medication before administration to a pediatric patient. According to best practice, what process should be followed?
- Independent double-check with a second licensed nurse using the original order and drug calculations (Correct answer)
- Have the parent verify the medication name against their home medication list
- Confirm the dose verbally with the pharmacist by phone
- Scan the medication barcode and proceed if no alert appears
Correct answer: Independent double-check with a second licensed nurse using the original order and drug calculations
An independent double-check by two licensed nurses — each calculating separately — is the gold standard for high-alert pediatric medications.
Question 6: A 14-year-old is started on isotretinoin for severe acne. Which monitoring requirement is unique to this medication?
- Monthly pregnancy tests and enrollment in the iPLEDGE program (Correct answer)
- Weekly CBC and renal function panels
- Baseline and monthly pulmonary function tests
- Daily blood pressure monitoring
Correct answer: Monthly pregnancy tests and enrollment in the iPLEDGE program
Isotretinoin is highly teratogenic; all patients must be enrolled in the iPLEDGE REMS program, which requires monthly pregnancy testing for those who can become pregnant.
Question 7: When using the SALAD (Sound-Alike, Look-Alike Drugs) safety strategy in pediatric settings, which pair represents a commonly confused medication set?
- Hydroxyzine and hydralazine
- Amoxicillin and amphotericin B (Correct answer)
- Ibuprofen and acetaminophen
- Prednisone and prednisolone
Correct answer: Amoxicillin and amphotericin B
Amoxicillin and amphotericin B are a classic high-risk SALAD pair; amphotericin B has a much narrower safety margin and potentially fatal if given in place of amoxicillin.
Pediatric Nurse Exam Pediatric Nurse Pharmacology and Medication Administration 5
A pediatric nurse is caring for a 5-year-old prescribed ceftriaxone.
Before administration, which assessment is the highest priority?