UNRS 314
Medication Practice Problems
Oral Medications
1. Child with rheumatic fever
Order: penicillin V potassium 250 mg po, q 8 hours
Weight: 45 lbs, age 4 year
Pediatric dose: 25-50 mg/kg/day
Drug available: Penicilin V potassium 125 mg / 5 mL
2. Child with seizures
Order: phenobarbital 25 mg, po, bid
Weight: 7.2 kg, age 9 months
Pediatric dose: 5-7 mg/kg/day
Drug available: phenobarbiral 20 mg / 5 mL
3. Child with lower respiratory tract infection
Order: cefprozil (Cefzil) 120 mg, po, q 12 hr
Weight 17 lb, age 6 months
Pediatric dose for child > 6 months: 15 mg /kg/q12 hour
Drug available: Cefzil 125 mg / 5 mL
4. Child with seizures
Order: Zarontin 100 mg, po, bid
Weight: 13 kg, age 13 months
Pediatric dose:
15.4 mg / kg/day
Drug available: 250 mg / 5 mL
5. Child with seizures
Order: Dilantin 40 mg, po, bid
Weight: 6.7 mg/kg/day
Drug available: Dilantin 125 mg/5mL
6. Child with urinary tract infection
Order: Augmentin oral suspension 75 mg, po, q 8h
Weight: 8 kg, age 7 months
Pediatric dose: 20-40 mg/kg/day
Drug available: 125 mg/5mL
7. Child with poison ivy
Order: Benadryl 30 mg po, q6h
Weight: 25 kg, 7 years
Pediatric dose: 5mg/kg/day
Drug available: Benadryl 12.5 mg/5mL
8. Child with cellulitis
Order: cefaclor (Ceclor) 50 mg qid
Weight: 15 lb, age 4 months
Pediatric dose: 20-40 mg/kg/day in three to four divided doses
Drug available: 125 mg / 5 mL
Intramuscular medications
9. Child with pain after surgery
Order: morphine sulfate 4.5 mg/IM x 1
Weight: 45 kg, 14 years
Pediatric dose: 0.1 mg/kg
Drug available: morphine 10 mg/mL
10. Child with strep throat
Order: Bicillin C.R. 1,000,000 units IM x 1
Weight: 44 lbs
Pediatric dose: 30 – 60 lb: 900,000 to 1,200,000 units daily
Drug available: Bicillin C.R., 1,200,000 units / 2 mL
11. Preoperative medication
Order: atropine 0.2 mg, IM
Weight: 12 kg
Pediatric dose: 0.01 – 0.02 mg/kg/dose, not to exceed 0.4 mg/dose
Drug available: 0.4 mg/mL
12. Child with cellulitis
Order: Rocephin (ceftriaxone)
Weight: 54 lbs, 10 years
Pediatric dose: 50 to 75 mg/kg q 12 hours
Drug available: 1 g / 10 mL
Intravenous Medications
There are two new concepts being introduced in administering pediatric IV medications.
 Often the doses of the mediation are very small so they have to be further diluted
with IV solution when administering.
 The second concept is the “Flush”. Since we are working with small doses and
administering the medication via pump or volutrol. The nurse has to “flush” the
medication through the IV tubing after the medication is given.
 In a drug administered via pump the flush will be a few mLs in a medication
administered through a volutrol (see pediatric medication power point) the flush
is 15 to 20 mL. That amount needs to be included in the total IV amount to be
infused.
 Most mediation can be administered (followed by flush) in 15 minutes to an hour.
13. Adolescent with pain secondary to ruptured appendix
Order: morphine sulfate 2.5 mg IV in 10 mL NSS over 5 minutes
Weight 50 kg, 16 years of age
Pediatric dose: 50-100 mcg/kg/dose
Drug available: 5 mg/mL
How many mL of medication? __________
How many mL of fluid would you be infusing over 5 minutes? ________
14. Treatment to reverse opioid overdose
Order: Narcan (naloxone) 1.8 mg IV push
Weight: 18 kg, 3 years
Pediatric dose: 0.1 mg / kg
Drug available: 400 mcg / mL
How many mL of medication _________________ (amount of drug to = correct dose)
15. Infant with sepsis
Order: Amikin 40 mg, IV q 12 h, in 5 mL in D5W, over 30 minutes, Flush with 3 mL
Weight: 5.3 kg
Pediatric dose: 15 mg/kg/day
Drug available: 100 mg / 2 mL
How many mL of medication ___________ (amount of drug to = correct dose)
How much fluid would you be infusing over the 30 minutes? __________
16. Treatment for child with cerebral palsy having spasticity
Order: lorazepam 3 mg IV q 6h dilute in 15 mL IV solution + 20 mL flush
Weight: 47 kg, 17 years
Pediatric dose: 0.05 – 0.1 mg/kg
Drug available: lorazepam 4 mg/mL
How many mL of medication ___________ (amount of drug to = correct dose)
How much fluid would you be infusing over the 30 minutes? __________
17. Child with pneumonia
Order: cefazolin (Ancef) 500 mg, IV, q6h, in D5W 20 mL, over 30 minutes
Flush with 10 mL
Weight: 5.6 kg
Pediatric dose: 25-100 mg/kg/day in four divided doses
Drug available: 1 g / 2.5 mL
How many mL of medication ___________ (amount of drug to = correct dose)
How much fluid would you be infusing over the 30 minutes? __________
18. Child with sepsis
Order: gentamicic 10 mg, VI, q8h, D5W 4mL, Flush with 3 mL
Weight: 4 kg, 1 month
How many mL of medication ___________ (amount of drug to = correct dose)
Pediatric dose: greater than 7 days of age: 5 to 7.5 mg/kg/day, three divided doses
Drug available: Gentamicin 10 mg/mL
How many mL of medication ___________ (amount of drug to = correct dose)
How much fluid would you be infusing? __________
19. Child with postoperative wound infection
Order: cefazolin 185 mg, IV q 6h, in D5w 20 mL over 20 minutes. Flush with 15 mL
Weight: 15 kg
Pediatric dose: 25-50 mg/kg/day
Drug available: 250 mg/2mL
How many mL of medication ___________ (amount of drug to = correct dose)
How much fluid would you be infusing over the 30 minutes? __________
20. Child with staphylococcus scalded skin syndrome
Order: clindamycin 50 mg IV q 8h
Dilution instructions: mix in 10 mL NSS over 15 minutes via syringe pump
Flush: 3 mL
Weight: 7.5 kg and 5 months
Pediatric dose: 16-20 mg/kg/day
Drug available: clindamycin 150 mg/mL
How many mL of medication ___________ (amount of drug to = correct dose)
How much fluid would you be infusing over the 30 minutes? __________
21. Child with congestive heart failure
Order: digoxin 40 mcg, IV bid in NSS 2 mL over 1 minute
Weight: 6 lbs
Pediatric dose: 2 weeks to 2 years: 25 – 50 mcg/kg
Drug available: digoxin 0.1 mg/mL
How many mL of medication? _____________
Calculating 24 hour fluids:
NOTE: you will need to memorize this formula for quiz
Formula:
100 mL x 1st 10 kg
50 mL x 2nd 10 kg
20 mL x any additional kg
22. An infant weighing 6 lbs 8 ounces
Fluid for 24 hours ____________
IV rate / hour _______________
23. A child weighing 26 pounds
Fluid for 24 hours__________
IV rate / hour _____________
24. A child weighing 44 kg
Fluid for 24 hours
IV rate / hour
In a sick child the fluid needs will be greater. The physician may order fluids 1 ½ times
maintenance or 2 times maintenance. In this case you would multiple the 24 hour amount times
1.5 or 2 to get the 24 hour fluid needs.
25. A 6 week old infant is admitted for pyloric stenosis:
The infant weighs 6 lbs 2 ounces
The physician want IV fluids at 1 ½ times maintenance
Calculate fluids for24 hour maintenance _________ for 1 ½ times maintenance _____how many
mL / hour would you run the IV