NUR 425 PEDS EXAM 1 LICCIARDI ASU FALL 2026/2027 | PEDIATRIC NURSING
EXAM 1 STUDY GUIDE | NCLEX PRACTICE QUESTIONS & ANSWERS
ADHD medication indications and side effects - ✔✔Start at small initial doses
Monitor for side effects of appetite loss, abdominal pain, headaches, sleep disturbances (insomnia),
HTN, and decrease in growth velocity
Need close monitoring and follow up care my PCP
Avoid stimulants w/hx of tic-like behaviors, family hs of Tourette’s
Medications:
Methylphenidate hydrochloride (Ritalin)→ 1st drug of choice, must be older than 5 y/o
Lisdexamfetamine dimes late (Vyvanse)
Atomoxetine (Strattera)→ wt based dosing
TCAs and Clonidine ER→ dose depends on results and if child is having sleep disturbances
Upper Respiratory Meds and mechanism of action - ✔✔Mucolytics
Acetylcysteine (Acerote or Macays)
decreases thickness (viscosity) of mucous secretions
Tylenol OD
smells like rotten eggs
Expectorants
Guaifenesin (Mucinex)
reduce surface tension of secretions, thins thick mucous
Antitussives
Opioids: Codeine
Nonopioids: Dextromethorphan (Delsym), benzonatate (Tessalon)
suppress cough reflex in the brain
Sympathomimetics
Phenylephrine (Neo-synephrine)
mimics the SNS by activating alpha1 adrenergic receptors in the nose
vasoconstriction of blood vessles, causes nasal turbinate to shrink, opens nasal passage and relieves
nasal congestion
1st Gen/Sedating antihistamines
Diphenydramine (Benadryl) & Dramamine
sedating
H1 antagonist
2nd Gen/Nonsedating antihistamines
Cetirizine (Zyrtec), loratadine (Claratin), fexofenadine (Allegra), desloratadine (Clarinex)
antagonize histamine effects at H1 receptor sites without binding to or inactivating histamine
minimal anticholinergic affects
effects longer lasting so dosed once a day
, Compare the physiological differences between the very young and the older child in regard to
pharmacodynamics.
How does an infant's GI system affect medications? - ✔✔Absorption of feeding can be an issue, infants
eat more often than toddlers meaning they process food differently; frequent feedings/peristalsis can
interrupt the absorption of some medications (each age group absorbs medications differently)
Infants→ decreased gastric acid secretion, irregular gastric emptying, increased intestinal motility,
frequent feedings
limited binding of drugs to plasma protein due to low albumin, BB barrier not fully developed until 1st
year, infants total body water is 80% compared to adult of 50% (need higher doses of water soluble
meds)
enzymes in liver metabolize drugs are immature so drugs cannot be broken down
immature rental function requires smaller doses of drugs primarily excreted by the kidneys
Children→ gastric pH equal to adult by 2-3 ys
plasma protein levels at adult levels by age 1, skin and BB barrier more effective
decreased BMR after age 2, results in lowered effects of drugs
adults levels of renal function are reached by age 2
Identify the variations in medication administration between infants/children and adults.
Refer to Chapter 8 in ATI before class readings - ✔✔PO crushed up meds via syringe on side of mouth
for infants (best practice); stroke cheek afterwards to promote swallowing reflex
Most adults can swallow PO tablets/capsules
most IM injections in infants are given in vastus lateralis rather than deltoid like in adults
Medications in kiddos are weight based
Otic medications→ pull ear down and back for adults pull up and back; massage ear after to ensure
medication reaches canal
Rectal suppositories→ ½ to 1 inch and hold buttocks together for 5-10 mins; cut suppository lengthwise
if necessary
Eye drops in inner canthus when eyes are closed and then massage inner canthus to prevent medicine
from entering lacrimal ducts and going into nasal pharynx
Examine interventions to prevent falls in the pediatric population.
What factors place children at risks for falls? Review Humpty Dumpty tool criteria. - ✔✔Attachment to
IV lines/tubes
narcotics/analgesics
first time taking medication-unknown side effects
seizures, brain tumors, medications
developmental age not able to walk or skillful yet
disease process
assistive devices need
post-operative devices
hx of falls or neuromuscular defects
cribs with side rails down or child on daybed/couch left unattended
Humpty Dumpty→ age, gender, diagnosis, cognitive impairments, environmental factors, responses to
surgery/sedation/anesthesia, medication usage
minimum score is 7, being at risk is a score of 12 or above
EXAM 1 STUDY GUIDE | NCLEX PRACTICE QUESTIONS & ANSWERS
ADHD medication indications and side effects - ✔✔Start at small initial doses
Monitor for side effects of appetite loss, abdominal pain, headaches, sleep disturbances (insomnia),
HTN, and decrease in growth velocity
Need close monitoring and follow up care my PCP
Avoid stimulants w/hx of tic-like behaviors, family hs of Tourette’s
Medications:
Methylphenidate hydrochloride (Ritalin)→ 1st drug of choice, must be older than 5 y/o
Lisdexamfetamine dimes late (Vyvanse)
Atomoxetine (Strattera)→ wt based dosing
TCAs and Clonidine ER→ dose depends on results and if child is having sleep disturbances
Upper Respiratory Meds and mechanism of action - ✔✔Mucolytics
Acetylcysteine (Acerote or Macays)
decreases thickness (viscosity) of mucous secretions
Tylenol OD
smells like rotten eggs
Expectorants
Guaifenesin (Mucinex)
reduce surface tension of secretions, thins thick mucous
Antitussives
Opioids: Codeine
Nonopioids: Dextromethorphan (Delsym), benzonatate (Tessalon)
suppress cough reflex in the brain
Sympathomimetics
Phenylephrine (Neo-synephrine)
mimics the SNS by activating alpha1 adrenergic receptors in the nose
vasoconstriction of blood vessles, causes nasal turbinate to shrink, opens nasal passage and relieves
nasal congestion
1st Gen/Sedating antihistamines
Diphenydramine (Benadryl) & Dramamine
sedating
H1 antagonist
2nd Gen/Nonsedating antihistamines
Cetirizine (Zyrtec), loratadine (Claratin), fexofenadine (Allegra), desloratadine (Clarinex)
antagonize histamine effects at H1 receptor sites without binding to or inactivating histamine
minimal anticholinergic affects
effects longer lasting so dosed once a day
, Compare the physiological differences between the very young and the older child in regard to
pharmacodynamics.
How does an infant's GI system affect medications? - ✔✔Absorption of feeding can be an issue, infants
eat more often than toddlers meaning they process food differently; frequent feedings/peristalsis can
interrupt the absorption of some medications (each age group absorbs medications differently)
Infants→ decreased gastric acid secretion, irregular gastric emptying, increased intestinal motility,
frequent feedings
limited binding of drugs to plasma protein due to low albumin, BB barrier not fully developed until 1st
year, infants total body water is 80% compared to adult of 50% (need higher doses of water soluble
meds)
enzymes in liver metabolize drugs are immature so drugs cannot be broken down
immature rental function requires smaller doses of drugs primarily excreted by the kidneys
Children→ gastric pH equal to adult by 2-3 ys
plasma protein levels at adult levels by age 1, skin and BB barrier more effective
decreased BMR after age 2, results in lowered effects of drugs
adults levels of renal function are reached by age 2
Identify the variations in medication administration between infants/children and adults.
Refer to Chapter 8 in ATI before class readings - ✔✔PO crushed up meds via syringe on side of mouth
for infants (best practice); stroke cheek afterwards to promote swallowing reflex
Most adults can swallow PO tablets/capsules
most IM injections in infants are given in vastus lateralis rather than deltoid like in adults
Medications in kiddos are weight based
Otic medications→ pull ear down and back for adults pull up and back; massage ear after to ensure
medication reaches canal
Rectal suppositories→ ½ to 1 inch and hold buttocks together for 5-10 mins; cut suppository lengthwise
if necessary
Eye drops in inner canthus when eyes are closed and then massage inner canthus to prevent medicine
from entering lacrimal ducts and going into nasal pharynx
Examine interventions to prevent falls in the pediatric population.
What factors place children at risks for falls? Review Humpty Dumpty tool criteria. - ✔✔Attachment to
IV lines/tubes
narcotics/analgesics
first time taking medication-unknown side effects
seizures, brain tumors, medications
developmental age not able to walk or skillful yet
disease process
assistive devices need
post-operative devices
hx of falls or neuromuscular defects
cribs with side rails down or child on daybed/couch left unattended
Humpty Dumpty→ age, gender, diagnosis, cognitive impairments, environmental factors, responses to
surgery/sedation/anesthesia, medication usage
minimum score is 7, being at risk is a score of 12 or above
