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Nursing Orientation
Computerized Medication Assessment
Study Guide with Sample Problems
Revised December, 2011
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COMPUTERIZED MEDICATION ASSESSMENT PROCESS
What:
This is your Pediatric Medication Administration Assessment study guide. It is
highly recommended that you start reviewing this study packet. We find that
most nurses who do not pass the assessment say that they did not study. It
is an employment requirement that you pass the assessment.
Why:
To ensure an appropriate level of knowledge and skills for administering
medication to children.
When:
The medication assessment is taken on Tuesday afternoon following
Centralized Clinical Orientation
Where: Clinical Training & Development Computer Lab
Meyer 2nd Floor
How:
The medication assessment process:
 The assessment is done on a computer.
 There are 50 multiple-choice questions covering drug calculations,
administration, therapeutic and adverse effects.
 The time allowed to complete the assessment is 2 hours.
 You must pass the medication assessment with a score of 85%.
If you would like additional practice, search “drug calculations” on the internet. Many
different sites will appear and you can select one that meets your specific needs.
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PEDIATRIC MEDICATION ASSESSMENT
The Pediatric Medication Assessment will measure the knowledge and skills necessary for
nurses to administer medications to pediatric patients. Demonstration of adequate
knowledge and skills is required and will allow you to begin validation of medication
administration competencies at the unit/department level.
The Medication Assessment will cover:
1.
2.
3.
4.
Safe dosage calculations.
24-hour fluid maintenance calculations.
Administration techniques specific to the pediatric patient.
Developmental considerations for administering medications to pediatric patients.
Sample Problems
For problems 1 and 2 determine:
 If the dose is safe, and
 Only if the order is safe, then determine how many cc’s you would give to
equal one dose of the drug.
1. Treatment for a child with seizures.
Order is: Dilantin 40mg, po bid. Child’s weight = 6.7 kg
Pediatric dose: 7-9 mg/kg/day. Drug available: Dilantin 30mg/5ml suspension
2. Child has second-degree burns to 30% of body.
Order is: Morphine 3mg, IM, q 4 h, PRN pain. Child’s weight = 15kg
Pediatric dose: 0.1 - 0.2mg/kg/dose. Drug available: Morphine 10mg/ml
Use the following formula to answer questions 3 and 4.
24 Hour IV Fluid Maintenance:
Body Weight
1-10 kg
x 100 ml/kg
11-20 kg
x 50 ml/kg
> 20 kg
x 20 ml/kg
3. A 30 kg. child needs ___________________ /24 hours.
4. A 6-month-old infant who weighs 7 kilograms is to receive IV fluids at 2/3 the
maintenance rate. What is the appropriate hourly rate of the infusion?
_______________cc/hr
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5.
Physician ordered 4000 units of heparin subcutaneous for an adolescent. You have
heparin in a vial labeled 10,000 units per 1 ml. How many ml will you give?
________________ml
6.
The order reads 400 mg of Keflin IM. The vial reads add 10ml sterile water. 1
ml=1 Gm when reconstituted. How many ml will you give?
________________ml
7.
The order reads Penicillin-V 500 mg P.O. BID. The label reads Penicillin V oral
susp. 125mg/5ml. How many ml will you give?
________________ml
8.
Order for Benadryl 15 mg deep IM Q 6 hr. Stock vial contains 50 mg/ml. How many
ml will you give?
________________ml
9.
The order reads to give 37.5 mg of Leritine. The label on the 2 cc ampule reads
50 mg. How many cc’s will be given?
________________cc
10. The medication order reads 130 mg po amoxicillin. The drug label reads
100mg/2ml. How many ml must you administer?
________________ml
11. The medication order reads 0.15g IV gentamicin. The vial reads 200mg/ml. How
many cc’s would you give?
________________cc
12. The order is to give 1200 u of heparin S.Q. The available dosage strength is 1000 u
per 1.5 ml. How many cc’s would you give?
________________cc
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13.
The medication is Polymox 20 –40 mg/kg/day. The child’s weight is 18kg. The order
reads 225 mg po bid. Polymox 1 00mg/2cc is on hand. Is the order safe? If so,
how many ml would you administer?
_________________ml
24 Hour IV Fluid Maintenance:
Body Weight
1-10 kg
x 100 ml/kg
11-20 kg
x 50 ml/kg
> 20 kg
x 20 ml/kg
14.
What is the 24-hour maintenance IV fluid for a 15 kg child? What’s the hourly
rate?
_________________ml
15.
The patient weighs 7000 grams. The order is amoxicillin 5mg/kg. How many
micrograms does the patient receive?
_________________mcg
16.
A dopamine drip is ordered at rate of 10mcg/kg/min. The syringe contains 20mg in
40ml of D5W. The patient weighs 99 pounds. How many ml/hr should be
administered?
_________________cc
17.
The patient’s weight is 4200 grams. The order is for gentamicin 25mg/kg. The
label on the vial reads 150 mg/2cc. How many cc’s would the patient receive?
_________________cc
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18. The pediatric nurse is administering medication to a 4 year old. Which of the
following statements by the nurse indicates an understanding of the child’s
developmental level?
a.
“Your mom will help me hold your hands.”
b.
“Would you like orange or apple juice to drink after you take your medicine?”
c.
“You can make a poster of the schedule for all your medications.”
d.
“This booklet tells all about how this medicine works.”
19. When preparing to administer and oral medication to a child, it is best for the
nurse to:
a.
For infants, administer crushed pills mixed with honey to sweeten the taste.
b.
Place the pill in the posterior of the pharynx to assist a three year old in
swallowing.
c.
Do not crush enteric coated tablets.
d.
Mix the medication with a small amount of essential food or formula
to be sure the child receives all of the medication.
20. The nurse is administering an oral medication to Todd, a two-year-old boy. The
most appropriate action for the nurse to take when administering the medication
to:
a.
Follow previously established rituals and routines in medication administration.
b.
Do not allow Todd to touch any of the equipment.
c.
Tell Todd that the medication will be administered now, providing him with a
choice would be confusing to a child of this age.
d.
Have Todd’s caregivers leave the area when medications are being
administered.
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Answers
1. 46.9mg-60.3mg/day (safe dose), 80mg/day, not safe
2.
1.5 mg – 3mg/dose 3mg/dose (safe dose), x= 0.3cc
3.
1700 ml/24 hours
4.
19.44 ml/hour (19-20) ml
5.
0.4 ml
6.
0.4 ml
7.
20 ml
8.
0.3 ml
9.
1.5 ml
10. 2.6cc
11. 0.75cc
12. 1.8cc
13. 360 – 720mg/day, Yes, 4.5cc
14. 1250cc,52cc
15. 35,000 mcg
16. 54cc/hr
17. 1.4 cc
18. b
19. d
20. a
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Key Points & Developmental Considerations:
> Prepare a toddler for an event immediately prior to the event.
> Infants have a higher metabolic rate & less fat reserves than older children do.
Infants also have a higher intravascular fluid volume than older children do.
> Ampicillin and gentamycin are incompatible when mixed in the same IV tubing.
> Phenobarbital may adversely affect the central nervous system.
> No more than 1cc should be administered in one injection for patients less that 2
years of age.
> To prevent chemical phlebitis of the blood vessels, the concentration of potassium
chloride (KCL) should be <40mEq/liter.
> To administer ear drops;
1. In infants to 3 years of age - hold the pinna of the ear down and back
2. Always warm the drops prior to administration to prevent pain of the tympanic
membrane or vertigo.
> Prior to administering any medication via an NG tube, the nurse’s FIRST action should
always be to verify tube placement.
> Asthma patients (and their parents) receiving cromolyn (Intal) sodium must be
instructed to take their medication even when they are feeling well.
> Microdrip has a drop factor of 60gtt/ml.
> KCL can be safely added to IV fluids only after urinary output has been established.
> PRBC’s transfusions must be discontinued after an infusion period of 4 hours.
There is an increased risk of contamination if the infusion lasts longer.
> Rifampin can discolor body fluids red/orange.
> To prevent discomfort and potential injury resulting from blurred vision it is best to
administer ophthalmic ointments at naptime or prior to bedtime.
> Remember 1mg = 1000mcg
> Instructions to the parents of a child taking Benadryl over along time should include;
the child may be sleepy for the first few days, but this effect will lessen.
> Monitor apical pulse rate and rhythm prior to administering digoxin.
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Calculation Formulas
1. D/HxQ = X
Desired= the ordered dosage
Have: the available dosage strength
Quantity= the volume of the dosage strength
available X= unknown
2. Calculating Dosage Range
Calculate mg x kg
Decide if question asks dosage per day, or dose, or BID, etc.
3. 24 Hour IV Maintenance Fluid
100ml/kg for the first 10 kilograms
50m l/kg for second 10 kilograms
20ml/kg for each additional kilogram
Examples:
Patient weighs 25 kg
10kgx100ml= 1000ml
10 kg x 50ml= 500
ml 5 kg x 20ml = 100ml
Total= 1600ml/24hours
Patient weighs 17kg
10 kg x 100ml= 1000ml
7 kg x 50ml = 350ml
Total = 1350ml/24 hours
Patient weighs 8 kg
8 kg x 100ml =
Total = 800ml/24 hours
4. Calculating Dopamine Dosages
Change weight to kilograms.
Change mcg to mg.
Determine mg dosage per hour.
Determine how many ml/hr.
Recommended Pediatric Medication References:
Bindler RM, Howery LB: Pediatric Drugs and Nursing Implications, * 1996, Prentice Hall
Miller S, Fioravanti J: Pediatric Medications A handbook for Nurses, *1997, Mosby-Year
Book, Inc.
Taketomo C, Hodding J: Pediatric Dosage Handbook, *1998-1999, LEXI COMP, Inc.
Wolkenheim, Becki Jo: Pediatric Medication Administration, fourth edition, 1998.
Maxishare.
*Or the most current edition
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ADDITIONAL STUDY ON PEDIATRIC
MEDICATION ADMINISTRATION
Note: This supplemental skill sheet is provided to help focus your review of
pertinent information related to medication administration in the pediatric patient.
1. Recall the various routes of administration: oral, IM, IV, PCA, IO, subcutaneous,
sublingual, MDI, Optic, NG and Ophthalmic.
2. State the sites and nursing implications for IM, subcutaneous, NG, Optic, Ophthalmic, IO.
3. Identify general safety measures that relate to pediatric medication administration.
4. Apply knowledge of age-related factors that influence pediatric medication
administration.
5. Define principles of pain management.
6. Select the action, side effects, and nursing implications of the following drugs:
Amoxicillin
Ampicillin
Cefazolin
Ceftriaxone
Cefuroxime
Chloral Hydrate
Digoxin
Dilantin
Dilaudid
Erythromycin
Gentamycin
Keflex
Lasix
Lidocaine
Mannitol
Penicillin
Phenergan
Phenobarbital
Piperacillin
Potassium
Rifampin
Robitussin
Rocephin
Scopolamine
Solumedrol
Tylenol
Vancomycin
Zantac
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