Pediatric Medications

1. A child’s weight is 34 lb 8 oz.

Weight in kilograms to the nearest tenth:

a. Estimated weight:

b. DA verification:

c. Evaluation:

ANS:

a. Estimate: approximately 17 kg (34 lb 8 oz ÷ 2)

b.

c. Equations are balanced. Only kg remains. Estimate supports answer.

2. Ordered: Drug X 125 mg 4 times daily

SDR for children: 20-30 mg per kg per day in 4 divided doses

Child’s weight: 50 lb. Use a calculator.

a. Estimated weight in kg:

b. Child’s weight in kilograms to the nearest tenth:

c. Calculate the SDR for this child. Low safe dose:

High safe dose:

d. Decision: safe or unsafe order? State the reason.

ANS:

a. Estimate: approximately 25 kg (50 ÷ 2)

b. 22.7 kg

c. 454 mg per day (20 × 22.7); 681 mg per day (30 × 22.7)

d. Safe. Order falls within SDR.

3. Ordered: kanamycin 45 mg IV stat, for a child with an infection

SDR: 15 mg per kg per day divided in 2 or 3 doses

Child’s weight: 13.2 lb. Use a calculator.

Available:

a. Estimated weight in kilograms:

b. Child’s weight in kilograms:

c. SDR for this child:

d. Decision: safe or unsafe order? If unsafe, state the reason.

If safe to give, how many milliliters should the nurse prepare?

e. Estimate:

f. DA equation:

g. Evaluation:

ANS:

a. Estimate: 6.5 kg (13.2 ÷ 2)

b. 6 kg

c. 90 mg per day (15 mg × 6 kg) divided in 2 to 3 doses

d. Safe

e. Will give less than 2 mL

f. mL =

g. Equation is balanced. Estimate supports answer.

4. Ordered: cefaclor 0.4 g PO q8h, for a child with otitis media

Child’s weight: 30 kg. Use a calculator.

Available:

a. SDR (refer to label):

b. SDR for this child:

c. Decision: safe or unsafe order? If unsafe, state the reason.

If safe to give, how many milliliters should the nurse prepare?

d. Estimate:

e. DA equation:

f. Evaluation:

Shade in the medicine cup to the nearest measurable dose. Indicate with an arrow on the syringe the additional amount to be added.

ANS:

a. 40 mg kg per day in 3 divided doses for otitis media

b. 1200 mg per day (40 mg × 30 kg)

c. Safe. 0.4 g = 400 mg q 8h; 400 × 3 = 1200 mg

d. Estimate: More than 5 mL

e. mL =

f. Equation is balanced. Estimate supports answer.

5. Ordered: doxycycline suspension 100 mg bid PO on admission day, for a 10-year-old child with Haemophilus influenzae

Child’s weight: 40 kg

Available:

a. SDR (refer to label):

b. Child’s estimated weight in pounds:

c. Child’s actual weight in pounds:

d. SDR for this child:

e. Decision: safe or unsafe order? If unsafe, state the reason.

If safe to give, how many milliliters should the nurse prepare?

f. Estimated dose:

g. DA equation:

h. Evaluation:

Shade in the medicine cup to the nearest measurable dose. Indicate with an arrow on the syringe the additional amount to be added.

ANS:

a. 2 mg per lb divided into 2 doses on the first day followed by 1 mg per lb on subsequent days

b. 80 lb (40 kg × 2)

c. 88 lb (40 kg × 2.2)

d. 176 mg per day ÷ 2 doses = 88 mg bid

e. Unsafe order. Ordered dose is an overdose. Hold medication and notify prescriber promptly. Document.

f. N/A

g. N/A

h. N/A

6. Ordered: leucovorin 10 mg stat, for a child who has been receiving IV antineoplastic agents

SDR: 10 mg per m2

Child’s BSA: 1.0 m2

Available:

a. What does the acronym BSA mean?

b. How would you say m2 aloud?

c. Does m2 = mg?

d. Decision: safe or unsafe order? If unsafe, state the reason.

If safe to give, how many tablets should the nurse give?

e. Estimated dose:

f. DA equation:

g. Evaluation:

ANS:

a. Body surface area

b. Square meters

c. No, they are two different units of metric measurement.

d. Safe

e. Estimate: Give two 5-mg tablets.

f. tab =

g. Equation is balanced. Estimate supports answer.

7. Ordered: atropine 0.15 mg IM on call to OR

Pediatric SDR: 0.01 mg per kg

Child’s weight: 33 lb

Available:

a. Child’s weight in kilograms:

If safe to give, how many milliliters should the nurse prepare?

b. Estimated dose:

c. DA equation:

d. Evaluation:

Indicate with an arrow on the syringe the nearest measurable dose.

ANS:

a. 15 kg (33 ÷ 2.2)

b. Estimate: Less than 0.5 mL

c. mL =

d. Equation is balanced. Estimate supports answer.

8. Ordered: potassium chloride (KCl) IV 0.5 mEq per hr, for a baby with hypokalemia

Pediatric SDR: up to 3 mEq per kg per 24 hr

Child’s weight: 16 lb

Available: 10 mEq KCl in 100 mL D5W

a. Child’s weight in kilograms to the nearest tenth:

b. SDR for this child:

c. Decision: safe or unsafe order? State the reason.

If safe to give, what flow rate should the nurse set on an infusion pump?

d. DA equation:

e. Evaluation:

f. The IV is to be infused with a volume-control device. Agency policy states that only a 2-hour supply may be placed in the device. How many milliliters should the nurse place in the chamber?

ANS:

a. 7.3 kg (16 ÷ 2.2)

b. Up to 21.9 mEq per 24 hours (3 × 7.3)

c.

d.

e. Equation is balanced. Only mL per hour remains.

f. 10 mL (5 × 2 hr)

9. Ordered: Lanoxin pediatric elixir 100 mcg PO tid loading dose, for a child with heart failure.

SDR for child over 2 years of age: loading dose 0.02-0.04 mg per kg per 24 hr in 3 divided doses; maintenance dose 0.006-0.012 mg per kg per 24 hr in 2 divided doses

Child’s weight: 12 kg

Available:

a. SDR for this child in milligrams:

In micrograms:

b. Decision: safe or unsafe order? State the reason.

If safe to give, how many milliliters should the nurse prepare?

c. Estimated dose:

d. DA equation:

e. Evaluation:

f. What is the difference between a loading dose and a maintenance dose?

ANS:

a. 0.24 mg to 0.48 mg divided in 3 doses; 240 mcg to 480 mcg per day divided in 3 doses

b. Safe. 100 mcg × 3 = 300 mcg or 0.3 mg is within the SDR

c. Estimate: 2 mL (2 × 50 mcg = 100 mcg)

d.

e. Equation is balanced. Estimate supports answer.

f. A loading dose is the first dose of a drug. It is larger than a maintenance dose. The purpose is to achieve a therapeutic level quickly when patient’s condition necessitates it.

10. Ordered: amikacin sulfate 600 mg IV infusion q8h, for a child with an infection

Pediatric SDR: 5-7.5 mg per kg q8h, not to exceed 1.5 g per 24 hr

Child’s weight: 40 kg

Available: IV amikacin 1 g in 250 mL D5W

a. SDR for this child:

b. Decision: safe or unsafe order? State the reason.

If safe to give, what flow rate should the nurse set on the pump?

c. DA equation:

d. Evaluation:

ANS:

a. 200 mg low safe dose

300 mg high safe dose

b. Unsafe. Order exceeds SDR. Hold medication and contact prescriber immediately for orders. Document.

c. N/A

d. N/A

11. Ordered: A diuretic, furosemide 15 mg IV initial dose, for a child with edema

The child’s weight is 14 kg.

SDR: 1-2 mg per kg per dose every 6 to 12 hr

The nurse plans to deliver the medication in a volume control device, filling the container up to20 mL with Ringer’s lactate Sol from an existing infusion, gently mixing it. It will be infused at the rate of 1 minute per mL.

a. SDR for this child’s weight (mental math):

b. Evaluation: Safe to give or hold and clarify promptly?

c. Dose to be prepared if safe:

Estimate; more or less than drug concentration?

DA:

d. Flow rate if applicable (mental math):

e. Evaluation:

ANS:

a. SDR: 14-29 mg per dose

b. Evaluation: Safe to give. The order of 15 mg is within SDR for this child.

c. Dose: 0.75 mL

Estimate: Will give less than drug concentration—about of drug concentration

Estimate of mL supports answer.

d. Flow rate:

Estimate: To deliver 20 mL total volume over 20 minutes would be 20 × 3 or 60 mL per hr for 20 minutes (60 min)

DA:

e. Estimate supports answer. Equation is balanced.

12. Ordered: An anticholinergic, Scopolamine 300 mcg IV stat for a child with nausea and vomiting

SDR: 6 mcg per kg per dose up to a maximum of 0.3 mg per dose. May repeat every 6-8 hr. The child’s weight is 40 kg.

Dilute with an equal volume of sterile water for injection (SWI) and administer by direct IV injection over 2 minutes using the syringe calibrations shown.

a. SDR for this child:

b. Safe to give or hold and contact prescriber promptly?

c. Total amount of diluted medication in mL to be administered:

d. Total minutes to administer if applicable:

e. mL per min to be administered:

f. Total seconds to administer medication:

g. Total seconds per calibration to administer:

ANS:

a. SDR: 6 mcg × 40 kg = 240 mcg dose (0.3 mg) is maximum safe dose.

b. Evaluation: Safe to give

c.

d. mL per min = 0.6 mL per min

e. = 0.6 mL per min

f. 2 min = 60 × 2 or 120 seconds

g.

13. Ordered: A bronchodilator, Aminophylline, 8 mg per hr continuous infusion, for a child who received an appropriate loading dose, on a pump based upon frequent and current serum theophylline levels for a child with asthma. Obtain a serum theophylline concentration level 4 hours after infusion is started and call prescriber.

SDR: 0.8 mg per kg per hr for continuous infusion after appropriate loading dose. Child’s weight is 40 kg.

Remove 20 mL from a 500 mL D5W IV and add the Aminophylline. Total mL will remain approximately 500 mL.

a. SDR for this child:

b. Evaluation: Safe to give or hold and clarify promptly with prescriber?

c. Flow rate if applicable:

DA:

d. Evaluation:

ANS:

a. SDR: 0.8 mg × 40 kg = 32 mg per hr

b. Evaluation: Hold and clarify promptly with the prescriber: Is an underdose.

c. N/A

d. N/A

14. Ordered: Hydrocortisone, IV push, 50 mg bolus dose, for an adolescent with adrenal insufficiency. Patient weight is 45 kg.

SDR: 1-2 mg per kg

IV bolus: Dilute each 250 mg or fraction thereof with 2 mL bacteriostatic SW and give over 3 minutes.

a. SDR for this patient:

b. Evaluation: Safe to administer or hold and contact prescriber promptly?

c. Amount to withdraw from the vial:

Estimate:

DA:

Evaluation:

Total mL for IV bolus (prepared dose plus diluent added):

d. mL per minute to administer:

DA:

e. Draw an arrow indicating the volume administered at end of first minute and second minute.

ANS:

a. SDR: 45-90 mg

b. Evaluation: Safe to administer

c. Estimate: of 2 mL; less than 0.5 mL

Estimate support Answer. Equation is balanced.

d. Total mL for IV bolus: 2.4 mL – 0.4 mL medication = 2 mL diluent

e. 0.8 mL per minute

DA:

15. Vancomycin HCl 0.3g IV intermittent infusion, for a child with methicillin resistant Staphylococcus aureus infection (MRSA).

Child’s weight: 30 kg

SDR: Infants and children. 40 mg per kg per day in divided doses q 6-8 hr not to exceed 5 mg per mL concentration.

Available from pharmacy: An IV piggyback solution of 60 mL containing 300 mg of Vancomycin with directions to infuse over 30 minutes.

a. SDR for this patient:

DA:

b. Evaluation:

c. Is the pharmacy-supplied dilution safe for 0.3 g drug according to the label directions?

DA:

d. Flow rate on pump in mL per hr based on pharmacy directions.

Estimate:

DA:

e. Evaluation:

ANS:

a. 40 × 30 = 1200 total mg per day ÷ 6 = 200 mg per dose or ÷ 4 = 300 mg per dose

b. Safe. The label says that 500 mg must be prepared in 100 mL solution. 300 mg can be prepared in 60 mL solution.

c. Flow rate on pump in mL per hr: estimate: 120 mL per hr would deliver 60 mL in hour.

d. DA verification:

e. Tip: Pharmacies usually prepare these “piggyback solutions,” however, it is good for the nurse to understand why first and second dilutions are often necessary and how they are handled. The first dilution is to just to get the powder mixed with sufficient diluent so that only the amount of drug needed can be withdrawn: When a second dilution is required as with this drug, the purpose is to make the solution a safe concentration to administer. Once you have the correct dose in solution, the flow rate is based on the order and the mL available.