NCLEX Practice Exam for Pharmacology: Pediatric Medications

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Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam.

Text Mode – Text version of the exam

1. A nurse provides medication instructions to a first-time mother. Which statement made by the mother indicates a need for further instructions?

1. “I should mix the medication in the baby food and give it when I feed the child”.
2. “I should administer the oral medication sitting in an upright position and with the head elevated”.
3. “I will give my child a toy after giving the medication”.
4. “I will offer my child a juice drink after swallowing the medication”.

2. A nurse prepares to administer an intramuscular injection to a 6-month-old infant. The nurse selects which site to administer the medication?

1. Rectus femoris.
2. Dorsal gluteal.
3. Ventrogluteal.
4. Vastus lateralis.

3. A nurse prepares to administer a 3ml injection via intramuscular injection to a 5-year-old child. The nurse selects which site to administer the medication?

1. Rectus femoris.
2. Deltoid.
3. Ventrogluteal.
4. Vastus lateralis.

4. A nurse is providing instructions to a mother who has a child with congestive heart failure regarding Digoxin (Lanoxin). Which statement made by the mother indicates further teaching?

1. “I will administer the medication 1 hour before or 2 hours after meal”.
2. “I will use a special dose-measuring spoon or cup, not a regular table spoon for the liquid preparation”.
3. “If my child vomits after administration, I will repeat the dose”.
4. “If more than one dose is missed, I will inform the physician”.

5. A physician prescribes an IV solution of 500 ml 0.45% Saline with an incorporation of 20mEq potassium chloride for a child with dehydration. The nurse should check which of the following before administering this IV prescription?

1. Blood pressure.
2. Height.
3. Weight.
4. Urine output.

6. A child was brought to the emergency department with complaints of nausea, vomiting, fruity-scented breath. The resident on duty diagnosed the child with diabetes ketoacidosis. Which of the following should the nurse expect to administer?

1. Potassium chloride IV infusion.
2. Dextrose 5% IV infusion.
3. Ringer’s Lactate.
4. Normal saline IV infusion.

7. A 1-year-old child is diagnosed with scabies. Which of the following medicine is expected to be prescribed?

1. Permethrin.
2. Lindane.
3. Both.
4. None.

8. A nurse is monitoring the intake and output of an infant receiving furosemide (Lasix) IV. Which of the following method is the most appropriate in measuring the urine output?

1. Ask the mother regarding the number of diaper changes.
2. Compare intake with output.
3. Weighing the diaper.
4. Insert Foley catheter.

9. An infant with a patent ductus arteriosus is admitted to the pediatric unit ward. The nurse anticipates which of the following medications will be given to the infant?

1. Prednisone.
2. Ibuprofen.
3. Penicillin.
4. Albuterol.

10. Hydrocortisone cream 1% is given to a child with eczema. The nurse gives instruction to the mother to apply the cream by?

1. Apply a thin layer of cream and spread it into the area thoroughly.
2. Avoid cleansing the area before the application.
3. Apply a thick layer of the cream to affected areas only.
4. Apply the cream to other areas to avoid occurrence.

11. The nurse is giving instructions to a mother with a child receiving a liquid oral iron supplement. The nurse tells the mother to:

1. Take it with meals.
2. Mix it with food.
3. Mix it with milk.
4. Administer it using a straw.

12. A child with β-thalassemia is undergoing a blood transfusion. To prevent organ damage from the excessive amount of iron, chelation therapy is prescribed. Which of the following medications will be added to this therapy?

1. Dextromethorphan.
2. Desirudin.
3. Deferasirox.
4. Desipramine.

13. A child with Kawasaki disease is admitted to the pediatric ward. Which of the following medications will you expect to be a part of the treatment? Select all that apply:

1. Gamma Globulin.
2. Warfarin.
3. Acetaminophen.
4. Aspirin.
5. Atenolol.

14. A child with known hemophilia A was brought to the emergency room with complaints of nose bleeding and some bruises in the joints. Which of the following should the nurse anticipate to be given to the child?

1. Oral iron supplement.
2. Cyclosporine.
3. Factor X.
4. Factor VIII

15. The nurse is reviewing the child’s record who is scheduled to receive inactivated polio vaccine (IPV). Which of the following would prompt the nurse to withhold the administration?

1. History of upper respiratory infections.
2. History of an anaphylactic reaction to streptomycin.
3. History of recent diarrheal episodes.
4. History of redness at the previous injection site.

16. A 4 month-year-old infant has just received diphtheria, tetanus, and acellular pertussis (DtaP). Hours later, the mother report to the clinic because her child develops redness and swelling at the injection site. The nurse instruct the mother to do which of the following?

1. Application of cold compress.
2. Application of hot compress.
3. Monitor for signs of fever.
4. Report to the clinic for a repeat injection on the other site.

17. A 6-year-old child is scheduled to have measles, mumps, and rubella (MMR) vaccine. Which of the following route will you expect the nurse to administer the vaccine?

1. Intramuscularly in the vastus lateralis muscle.
2. Intramuscularly in the deltoid muscle.
3. Subcutaneously in the gluteal area.
4. Subcutaneously in the outer aspect of the upper arm.

18. Which of the following is not true regarding varicella vaccine?

1. It is administered subcutaneously.
2. Children 13 years and older (With no history of chickenpox or have not previously vaccinated) need two doses given at least 28 days apart.
3. Give aspirin for any injection-related pain.
4. The most common mild side effects are pain, redness, or swelling at the injection site.

19. A nurse is handling a child who is on a Furosemide (Lasix) IV infusion. The nurse instruct the mother to encourage the child to eat which of the following?

1. Apricot and baked potato skin.
2. Bread and butter.
3. Gelatin and Cauliflower.
4. Ginger ale and cereal.

20. An unconscious child is brought to the emergency room due to Tylenol poisoning. Which of the following is the most appropriate nursing action?

1. Administer mucomyst P.O.
2. Gastric lavage with activated charcoal.
3. Gastric Lavage with activated charcoal and mucomyst.
4. Administer ethylenediaminetetraacetic acid (EDTA).

Answers and Rationale

1. Answer: A. “I should mix the medication in the baby food and give it when I feed the child”. The nurse would teach the mother to avoid putting medications in foods because it may cause an unpleasant taste to the food, and the child may refuse to accept the same food in the future. Additionally, the child may not consume the entire serving and would not receive require medication dosage.

• Option B: Administering the medication in an upright position and head elevation will prevent the risk of aspiration.
• Option C: Offering a toy will provide comfort measures to the child.
• Option D: The mother should offer drink such as juice or a soft drink to lessen the aftertaste of the medication.

2. Answer: D. Vastus lateralis.Intramuscular injection sites are selected based on the child’s age and muscle development of the child. The vastus lateralis is the only safe muscle group to use for intramuscular injection in a 6 month-old infant.

• Options A, B, and D are unsafe for that age.

3. Answer: C. Ventrogluteal. Intramuscular injection sites are chosen based on the child’s age and muscle development of the child. The ventrogluteal muscle is the ideal choice to administer 0.5ml-3ml amount of injection on a 3-12-year-old child.

• Options A and D only allows 2ml amount of injection.
• Option B allows 0.5-1ml amount of injection.

4. Answer: C. “If my child vomits after administration, I will repeat the dose”. Digoxin is a cardiac glycoside. The mother needs to be instructed not to repeat the dose once the child vomits it.

• Options A, B, and D are correct instructions regarding this medicine.

5. Answer: D. Urine output. When it comes to hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment for the nurse is to check the urinary output before the administration. Potassium chloride is contraindicated for patients with oliguria or anuria.

• Options A, B, and C are not related to the administration of this medicine.

6. Answer: D. Normal saline IV infusion. The initial priority in the treatment of diabetic ketoacidosis is the restoration of extracellular fluid volume through the intravenous administration of a normal saline(0.9 percent sodium chloride) solution.

• Option A is not part of the initial treatment.
• Options B and C which are dextrose solutions will be used only when the blood glucose level is decreased.

7. Answer: A. Permethrin. Permethrin and Lindane are used against scabies, but lindane is contraindicated for children below two years old because of the risk of seizures and neurotoxicity.

8. Answer: C. Weighing the diaper. The most appropriate method for measuring urine output of an infant is by weighing the diaper.

• Options A and B will not provide the accurate measure of the urine output.
• Option D: Inserting a foley catheter will provide the most accurate measurement but it gives the infant the risk of urinary tract infection.

9. Answer: B. Ibuprofen. When surgical ligation is not indicated, prostaglandin inhibitors (e.g., nonsteroid anti-inflammatory drugs [NSAIDs]) are used to close the ductus arteriosus.

• Options A, C, and D are not used for the management of patent ductus arteriosus.

10. Answer: A. Apply a thin layer of cream and spread it into the area thoroughly. Topical corticosteroids are administered sparingly and rubbed into the area thoroughly.

• Option B: The area should be cleaned first before administration.
• Options C and D: Thickly application and rubbing it on other areas will likely lead to systemic absorption.

11. Answer: D. Administer it using a straw. An oral liquid iron supplement should be given with a straw because the medicine will stain the teeth.

• Option A: Taking it with meals will decrease the absorption.
• Options B and C: Iron is not mixed with any food/drink.

12. Answer: C. Deferasirox. Chelation therapy with deferasirox (Exjade) or deferoxamine (Desferal) is prescribed to prevent organ damage from the presence of too much iron in the body as a result of the transfusion.

• Option A is a cough suppressant.
• Option B is a thrombin inhibitor.
• Option D is an antidepressant.

13. Answer: A. Gamma Globulin, B. Warfarin.,D. Aspirin. The principal goal of treatment for Kawasaki disease is to prevent coronary artery disease and to relieve symptoms such as fever and joint pain so an antipyretic, antiplatelet, and gamma globulin is used.

• Option C is antipyretic but is not responsive to this disease.
• Option E is a beta blocker.

14. Answer: D. Factor VIII. Hemophilia A, also called factor VIII (FVIII) deficiency or classic hemophilia, is a genetic disorder caused by missing or defective factor VIII, a clotting protein. The initial treatment is the administration of factor VIII to replace the missing factor and decreases the bleeding episode.

• Options A, B, and C are not used in this case.

15. Answer: B. History of an anaphylactic reaction to streptomycin. Inactivated polio vaccine (IPV) contains a trace amount of streptomycin, neomycin, and polymyxin.

• Options A, C, and D are not contraindicated with this vaccine.

16. Answer: A. Application of cold compress. Redness, tenderness or swelling may happen at the site of injection. This will be relieved through cool application for the first 24 hours, followed by warm compress if inflammation persists.

• Options B, C, and D are inappropriate intervention.

17. Answer: D. Subcutaneously in the outer aspect of the upper arm. (MMR) the vaccine is administered subcutaneously in the outer aspect of the upper arm.

• Options A and B: MMR is not administered intramuscularly.
• Option C: Gluteal area is not used as a site.

18. Answer: C. Give aspirin for any injection-related pain. Children receiving varicella vaccine should avoid aspirin or aspirin containing products because of the risk of Reye’s syndrome.

19. Answer: A. Apricot and baked potato skin. One of the side effects of taking furosemide is hypokalemia, so a supplemental food rich in potassium is encouraged.

• Options B, C, and D are low in potassium.

20. Answer: B. Gastric lavage with activated charcoal. In an unconscious child with Tylenol poisoning, the priority intervention is to administer gastric lavage with activated charcoal to decrease the absorption of Tylenol.

• Option A is not correct due to the risk of aspiration.
• Option C: Activated charcoal inactivates mucomyst.
• Option D is the drug of choice for lead poisoning.