ST. DAVID’S HEALTHCARE SYSTEM
NEONATAL INTENSIVE CARE
Study Guide
Information
The medication test emphasizes essential, basic knowledge required for safe practice.
It is a multiple-choice format.
The quiz evaluates:
1. dosage calculations
2. principles of drug administration and nursing implications
3. effects of commonly used drugs.
An 80% is required to pass. In the event that a passing score is not achieved, a
second exam will be given.
Please refer to the study guide for review.
A Neofax will be provided for the medication exam.
1
List the drug classification of each of the following and identify some of the most
important nursing implication(s) related to the drug.
1. Acyclovir (Zovirax)
2. Alprostadil (PGE1) (Prostin VR Pediatric)
3. Ampicillin sodium
4. Beractant (Survanta)
5. Caffeine citrate
6. Calfactant (Infasurf)
7. Clindamycin sodium (Cleocin)
8. Dexamethasone (Decadron)
9. Dobutamine hydrochloride (Dobutrex)
10. Dopamine hydrochloride (Intropin)
11. Erythropoietin [EPO] (Epogen)
12. Fentanyl sulfate (Sublimaze)
13. Furosemide (Lasix)
14. Gentamicin (Garamycin)
15. Indomethacin (Indocin)
16. Metochlopramide (Reglan)
17. Palivizumab (Synagis)
18. Phenobarbital (Luminol)
19. Phenytoin (Dilantin)
20. Ranitidine (Zantac)
21. Theophylline
22. Tromethamine (THAM)
23. Vancomycin (Vancocin)
2
RIGHT MEDICATION
RIGHT PATIENT
RIGHT TIME
RIGHT ROUTE
RIGHT AMOUNT
NOTES:
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3
Identify major nursing implications when administering medications in the following ways:
A. Subcutaneous (sub-q):
B. Intramuscular (IM):
C. Into the eye:
D. Rectal (suppositories):
E.
Into the ear:
G. Reconstitution (diluting):
H. Central line VS. Peripheral line:
Universal Precautions should be applied to any situation where the nurse may come into contact with secretions or fluids from
a patient. The assessment for, and wearing of, personal protective equipment IS part of professional nursing behavior.
ORAL Medications:




This is the easiest, safest and therefore, most desirable route of medication administration.
The nurse must guard the patient against aspiration. Correctly positioning the patient is an important
function of the nurse.
Transferring the liquid from bottle to medicine cup should be done without touching the medication.
Liquid medications should be poured into a medication cup held at eye level to ascertain that the meniscus
is at the appropriate level on the scale. Liquid volumes less than l0cc should be drawn up into a syringe.
OPTHALMIC Medications:


If administering an eye ointment, run a thin stream along inside edge of lower eyelid. Do the same for the
upper lid margin.
After instillation of either drips or ointment the client should close their eyes.
OTIC Medications:


Bring fluid to room temperature prior to instillation. Ear structures are sensitive to temperature extremes.
Help patient to side lying position with affected ear up.
Straighten ear canal by pulling the pinna up and out for an adult and down and back for children. Pulling
the pinna in the proper direction ensures that the medication will be delivered to the appropriate inner
structures.
4
RECTAL Medications:

Apply gloves. Remove suppository from wrapper. Lubricate tip of the suppository before insertion. Insert
suppository PAST external sphincter at least 4 inches in an adult and 1 inches in a child or infant.
PARENTERAL Medications:
Parenteral administration of medications is given by injection into body tissues. There are four common routes:
Subcutaneous (SQ); Intradermal (ID); Intramuscular (1M); and Intravenous (IV).




_Subcutaneous: medication is placed into the loose connective tissue under the dermis. If circulatory
status is normal then drug absorption from this site is complete. The patient's body weight will indicate the
depth of the SQ layer. Only water-soluble medications should be given by this route.
Intradermal: is typically used for skin testing.
Intramuscular: the greater the vascularity of muscle tissue allows for speedier absorption of medication. In
this procedure, weight is a determining factor in choosing the length of the needle to be used.
IV Administration: Typically, three different methods are used: m; an admixture with large volumes of IV
fluids, as an injection or bolus of a small amount of medication usually through an existing IV line or
heparin or sa1ine lock, or as a piggyback infusion. The tissue circulation is the most important factor
affecting the rate of drug absorption from the parenteral route.
Advantages
 fast acting drugs may be delivered quickly
 constant therapeutic levels of a drug may be maintained
 some medications which are highly irritating to tissues would not be administered comfortably either by
the IM or SQ routes
Weight
1 ounce
1000 mcg
1000 mg
16 ounces
1 kg
30 grams
1 mg
1g
1 lb
2.2 lbs
Volume
1 mL
0.001 liter (l)
1000 mL
1 liter (1)
1000 liters
1 kiloliter (kl) .
16 fluid ounces
60 drops
1 minim
4 teaspoon (tsp)
8 ounces
1 pint (pt)
1 teaspoon (tsp)
1 drop (gtt)
1 tablespoon (tbsp)
1 glassful
5
1000
kiloone
thousand
100
hectoone
hundred
10
decaten
1
0.1
meter
liter
gram
decione
tenth
0.01
centione
hundredth
0.001
millione
thousandth
0.000001
microone
millionth
Practice Problems:
1. 1000 mL = ______________ liter(s)
6. 10 g = _______________ kg
2. 60 mL = _______________ liter(s)
7. 500 L = ______________ mL
3. 25 mm = _______________ m
8. 6 g = ________________ mg
4. 250 mg = ______________ g
9. 250 cc = _____________ mL
5. 20000 g = ________________ kg
10. 500 mg = ______________g
Define each:
ABBREV
TRANSLATION
ABBREV
TRANSLATION
mEq
tid
hs
SL
pc
OD
ac
1M
gtt
q4h
___
s
OS
LOC
Gm
SQ
mg
NPO
STAT
___
c
6
Medication Calculation:
(ordered dose x total volume) = dose
available dose
Dopamine drip calculations:
Weight (kg) x 6 x desired dose (mck/kg/min) = mg of drug/100 ml
Desired IV fluid rate (ml/hr)
PRACTICE PROBLEMS:
1.
Dopamine is ordered: 5mcg.kg/min. The infant weighs 3 kg. Infusion rate is
ordered at 3 ml/hr. How many mg of Dopamine do you add to 100 ml for this
drip?
2.
Oral solution of Caffeine is supplied as 10mg/ml. You need to give 7.5 mg P.O.
How many ml's do you give?
3.
Gentamicin is supplied as 20 mg/2ml. Dosage for Gentamicin is 2.5 mg/kg/dose.
Your infant weighs 3415 gm.
Order reads: 8.5 mg Gentamicin I.V. q 12 hours.
Questions:
How many kilograms is this infant weight?
Is this an appropriate dose for this infant?
How many ml do you administer?
4.
Pediatric oral digoxin is supplied as 50 mcg/ml. You need to administer 44 mcg,
How many ml's do you give?
5.
You have a vial of Ampicillin that contains 250 mg per 5 ml. Your order reads:
325 mg Ampicillin IV q 8 hours. How many ml's do you draw up into the syringe?
7
6.
Phenytoin is supplied in a concentration of 50 mg/ml. Your ordered reads 36mg
Phenytoin IV now.
Volume: __________
Sodium bicarbonate is supplied in a 4.2% concentration which is 0.5 mEq/ml.
MD order reads: “3 mEq NaHCO3 IV now. How many ml will you give?
7.
8.
Baby Jim weighs 1200 gm and is 28 weeks in gestation. What would the correct
dose of Acyclovir be using the following information.
Dose: 20 mg/kg
Interval for neonates: 8 hours for infants 34 weeks and over; 12 hours for 34 weeks and under
Vial contains 500 mg diluted in 10 ml of normal saline. This is further diluted by adding 1 ml to
9 ml of normal saline.
Infusion solution should be < 7 mg/ml
Dose: __________
Interval: Every __________ hours
Volume: __________ ml/dose IV over __________ hour(s)
Answer Sheet
1.
2.
3.
4.
5.
1 liter
0.06 liter
0.025 m
0.25 g
20 kg
6. 0.01 kg
7. 500,000 ml
8. 6000 mg
9. 250 ml
10. 0.5 g
8
ABBR
mEq
tid
hs
pc
ac
gtt
TRANSLATION
milliequivalent
three times a day
hour of sleep
after meals
before meals
drop
ABBR
TRANSLATION
SL
OD
IM
sublingual
right eye
intramuscular
without
left eye
q4h
every 4 hours
___
s
OS
LOC
level of consciousness/laxative of
choice
gram
nothing by mouth
SQ
mg
subcutaneously
milligram
___
c
with
Gm
NPO
STAT immediately
1. 3 x 6 x 5
3
= 90
3
= 30 mg Dopamine to be added to 100 ml
2. 0.75 ml
3. 3.4 kg – Yes, it is correct – 0.85 ml
4. 0.88 ml
5. 6.5 ml
6. 0.72 ml
7. 6 ml
8. Dose: 24 mg, Every 12 hours, 4.8 ml/dose IV over 1 hour
9