The nurse is caring for a 4-month-old child who is on a water ...

[BrownTown3]

The nurse is caring for a 4-month-old child who is on a water soluble medication for seizures. The child's mother voices concern that the dosage seems too much for the child's age and would like the dosage verified.
 
  What actions will the nurse take? (Select all that apply.)
  a. Verify dosage requirements in the Physicians' Desk Reference (PDR) in mg/kg.
  b. Compare the water composition requirements of adults and children.
  c. Evaluate lean body mass and total fat content in adults and infants.
  d. Chart refused per mother on the MAR and do not administer.
  e. Compare transportation in the circulation of plasma bound proteins between adults and children.

Question 2

For which reason(s) is/are elderly patients at increased risk for drug interactions and toxicity? (Select all that apply.)
 
  a. They have a higher incidence of malnourishment.
  b. Their renal function is enhanced.
  c. They have increased use of multiple medications.
  d. Hepatic function is reduced.
  e. There are often issues with swallowing.

[tsternbergh47]

Answer to Question 1

ANS: A, B
The PDR lists the recommended dosages for all age groups. Because dilution may vary among age groups, the water concentration should be verified prior to administration. As we age, lean body mass and total body water decrease while total fat content increases; however, this drug is not fat soluble. The nurse is responsible for administering the medication as ordered after verifying that it is correct; the mother is asking for verification, not refusal of administration. Drugs that are relatively insoluble are transported in the circulation by being bound to plasma proteins; however, this drug is water soluble.

Answer to Question 2

ANS: A, C, D
Older adult patients have an increased incidence of malnourishment, are often on multiple medications, and have reduced hepatic function, all of which put them at increased risk for drug interactions and toxicity. Renal function diminishes in the elderly as a result of decreased renal blood flow, reduced cardiac output, loss of glomeruli, and diminished tubular function and concentrating ability. Older adults have swallowing difficulties, leading to compliance issues, but taking drugs less often would not result in toxicity.

[BrownTown3]

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