Pediatric pharmacology and medication administration represent critical competencies for nurses pursuing Certified Pediatric Nurse (CPN) certification, as medication errors in children can have devastating consequences due to their unique physiological characteristics and developmental needs. Unlike adult patients, pediatric patients require weight-based dosing calculations, age-appropriate administration techniques, and careful consideration of developmental stages that affect cooperation and understanding. The margin for error in pediatric medication administration is significantly smaller than in adult care, making precise calculation skills and knowledge of safe dose ranges absolutely essential for preventing adverse events. Nurses must master the principles of pharmacokinetics and pharmacodynamics as they apply to infants, children, and adolescents, understanding how factors such as immature organ systems, body composition differences, and metabolic variations affect drug absorption, distribution, metabolism, and excretion. Additionally, pediatric nurses must be skilled in various administration routes and techniques, from calculating appropriate dosages for oral suspensions to safely administering intravenous medications using microdrip infusion sets. The ability to assess for adverse effects, recognize signs of toxicity, and implement appropriate interventions is paramount, particularly with high-alert medications such as opioids, cardiac medications, and chemotherapeutic agents. Family education plays a crucial role in pediatric pharmacology, as parents and caregivers often continue medication administration at home and must understand proper techniques, storage requirements, and signs of adverse reactions. Developmentally appropriate communication and administration strategies are essential for gaining cooperation from pediatric patients while maintaining safety and therapeutic effectiveness. Understanding medication safety principles, including the use of standardized concentrations, independent double-checks, and smart pump technology, helps prevent the medication errors that remain a leading cause of preventable harm in pediatric healthcare settings. This practice question set focuses on essential pharmacology concepts that CPN candidates must master to ensure safe, effective medication administration across the pediatric age spectrum. These questions address calculation skills, administration techniques, safety principles, and clinical decision-making scenarios that reflect real-world pediatric nursing practice and are commonly tested on the CPN certification examination.
Practice Questions
Question 1
A nurse is preparing to administer acetaminophen to a 6-month-old infant weighing 7.5 kg. The recommended dose is 10-15 mg/kg every 4-6 hours. What is the maximum safe single dose for this infant?
A) 75 mg
B) 100 mg
C) 112.5 mg
D) 150 mg
Correct Answer: C) 112.5 mg
Explanation: Using the maximum recommended dose of 15 mg/kg: 7.5 kg × 15 mg/kg = 112.5 mg. This calculation ensures safe dosing while providing adequate pain relief or fever reduction. Doses exceeding this amount could lead to hepatotoxicity, especially with repeated administration.
Question 2
When administering intramuscular injections to a 4-year-old child, which site is most appropriate?
A) Dorsogluteal muscle
B) Deltoid muscle
C) Vastus lateralis muscle
D) Ventrogluteal muscle
Correct Answer: C) Vastus lateralis muscle
Explanation: The vastus lateralis is the preferred site for IM injections in children under 7 years of age because it is well-developed, has few major nerves and blood vessels, and is easily accessible. The dorsogluteal site should be avoided in children due to risk of sciatic nerve injury. The ventrogluteal site can be used but requires proper landmark identification.
Question 3
A pediatric nurse is teaching parents about administering oral antibiotics at home. Which instruction is most important to emphasize?
A) Mix the medication with the child’s favorite juice
B) Complete the entire prescribed course even if symptoms improve
C) Double the dose if one is missed
D) Store all medications in the refrigerator
Correct Answer: B) Complete the entire prescribed course even if symptoms improve
Explanation: Completing the full antibiotic course is essential to prevent antibiotic resistance and ensure complete eradication of the infection. Stopping antibiotics early can lead to recurrence and development of resistant bacteria. Medications should not be mixed with large amounts of food or drink, missed doses should not be doubled, and storage requirements vary by medication.
Question 4
A nurse is preparing to administer digoxin to a 2-year-old with congenital heart disease. The child’s apical pulse is 88 beats per minute. What is the appropriate nursing action?
A) Administer the medication as ordered
B) Withhold the medication and notify the provider
C) Administer half the prescribed dose
D) Recheck the pulse in 30 minutes
Correct Answer: B) Withhold the medication and notify the provider
Explanation: Digoxin should be withheld if the apical pulse is below 90-110 bpm in infants and young children (below 70 bpm in older children). A pulse of 88 bpm in a 2-year-old is below the safe threshold and may indicate digoxin toxicity or bradycardia. The provider must be notified before administration.
Question 5
Which route of medication administration has the fastest onset of action in pediatric patients?
A) Oral
B) Intramuscular
C) Subcutaneous
D) Intravenous
Correct Answer: D) Intravenous
Explanation: Intravenous administration provides the most rapid onset of action because the medication enters directly into the bloodstream, bypassing absorption barriers. This is particularly important in emergency situations or when immediate therapeutic effects are needed. Oral medications must be absorbed through the GI tract, while IM and subcutaneous routes require absorption from tissue.
Question 6
A nurse is calculating the safe dose range for amoxicillin for a child weighing 20 kg. The recommended dose is 20-40 mg/kg/day divided into three doses. What is the safe single dose range?
A) 100-200 mg
B) 133-267 mg
C) 200-400 mg
D) 400-800 mg
Correct Answer: B) 133-267 mg
Explanation: First calculate daily dose: 20 kg × 20 mg/kg = 400 mg (minimum) and 20 kg × 40 mg/kg = 800 mg (maximum). Then divide by 3 doses: 400 ÷ 3 = 133 mg and 800 ÷ 3 = 267 mg. This ensures each dose falls within the safe therapeutic range.
Question 7
When administering eye drops to a 5-year-old child, where should the nurse instill the medication?
A) Directly onto the cornea
B) Into the inner canthus
C) Into the lower conjunctival sac
D) Into the upper conjunctival sac
Correct Answer: C) Into the lower conjunctival sac
Explanation: Eye drops should be instilled into the lower conjunctival sac to prevent injury to the cornea and ensure proper distribution of the medication. The child should look upward, and gentle pressure should be applied to the inner canthus after instillation to prevent systemic absorption and promote local effect.
Question 8
A 10-year-old child with asthma is prescribed a metered-dose inhaler (MDI). What is the most important teaching point for proper technique?
A) Breathe in quickly and forcefully
B) Hold breath for 10 seconds after inhalation
C) Take multiple puffs in rapid succession
D) Exhale into the inhaler before use
Correct Answer: B) Hold breath for 10 seconds after inhalation
Explanation: Holding the breath for 10 seconds after inhalation allows the medication to deposit in the airways and maximizes therapeutic effect. The child should breathe in slowly and deeply (not quickly), wait 1 minute between puffs if multiple doses are prescribed, and exhale away from the inhaler before use.
Question 9
A nurse is preparing to administer an IV medication to an infant. Which consideration is most important for pediatric IV medication administration?
A) Using a microdrip infusion set
B) Administering medications as rapidly as possible
C) Diluting all medications in 50 mL of fluid
D) Avoiding the use of infusion pumps
Correct Answer: A) Using a microdrip infusion set
Explanation: Microdrip infusion sets (60 drops/mL) provide precise control of fluid and medication delivery in infants and small children, preventing fluid overload. Medications should be administered slowly per protocol, dilution volumes should be appropriate for the child’s size and fluid status, and infusion pumps are essential for accuracy and safety.
Question 10
A child is receiving morphine for post-operative pain management. Which assessment finding requires immediate intervention?
A) Respiratory rate of 10 breaths per minute
B) Pain score of 4 on a 0-10 scale
C) Drowsiness after administration
D) Request for additional pain medication
Correct Answer: A) Respiratory rate of 10 breaths per minute
Explanation: Respiratory depression is the most serious adverse effect of opioid administration. A respiratory rate of 10 breaths per minute is significantly below normal for any pediatric age group and indicates potential opioid toxicity requiring immediate intervention, including possible naloxone administration. Mild drowsiness is expected, but respiratory depression is life-threatening.
Question 11
When administering oral medications to a toddler who refuses to cooperate, what is the best nursing approach?
A) Hold the child’s nose to force swallowing
B) Mix the medication with a large bottle of formula
C) Offer choices such as which cup to use
D) Tell the child the medication is candy
Correct Answer: C) Offer choices such as which cup to use
Explanation: Offering limited choices gives the toddler a sense of control while ensuring medication administration. This developmentally appropriate approach respects autonomy and reduces resistance. Never hold a child’s nose (aspiration risk), mix medication with essential foods (may cause food aversion), or deceive children about medications (damages trust).
Question 12
A nurse is teaching parents about the use of a rectal suppository for their 18-month-old child. What is the correct insertion depth?
A) 1 inch
B) 2 inches
C) 3 inches
D) Until it cannot be felt
Correct Answer: A) 1 inch
Explanation: For infants and toddlers, rectal suppositories should be inserted approximately 1 inch (2.5 cm) to ensure proper placement beyond the internal sphincter while avoiding injury to the rectal mucosa. Deeper insertion is not necessary and may cause trauma. The buttocks should be held together for several minutes to prevent expulsion.
Question 13
A 7-year-old child with diabetes is learning to self-administer insulin. Which injection site should be rotated to prevent lipodystrophy?
A) Use the same site for consistency
B) Rotate within the same anatomical area
C) Alternate between different anatomical areas
D) Use only the abdomen for all injections
Correct Answer: C) Alternate between different anatomical areas
Explanation: Rotating injection sites between different anatomical areas (abdomen, thighs, arms, buttocks) prevents lipodystrophy (abnormal fat distribution) and ensures consistent insulin absorption. Sites should be at least 1 inch apart, and systematic rotation helps maintain tissue integrity and optimal medication absorption.
Question 14
A nurse is preparing to administer a medication with a narrow therapeutic index to a pediatric patient. What does this mean?
A) The medication has few side effects
B) There is a small margin between therapeutic and toxic doses
C) The medication can be given at any time
D) The medication is safe for all age groups
Correct Answer: B) There is a small margin between therapeutic and toxic doses
Explanation: A narrow therapeutic index means there is a small difference between the dose that produces therapeutic effects and the dose that causes toxicity. Medications like digoxin, theophylline, and phenytoin require careful dosing, frequent monitoring, and precise calculation to prevent adverse effects while maintaining efficacy.
Question 15
When administering medications to pediatric patients, which principle is most important for ensuring safety?
A) Always round doses up to the nearest whole number
B) Use the child’s age to calculate all medication doses
C) Double-check calculations with another nurse
D) Administer medications at the same time as adults
Correct Answer: C) Double-check calculations with another nurse
Explanation: Independent double-checking of pediatric medication calculations by two nurses is a critical safety practice that prevents dosing errors. Pediatric doses are weight-based and require precise calculations; even small errors can have serious consequences. Doses should not be arbitrarily rounded, age alone is insufficient for dosing, and pediatric medication timing may differ from adult schedules.