Fall Semester 2026–2027 PED320 – Pediatric Pharmacology
Updated 2026 | 190+ Questions and Answers | PED320
Pediatric Pharmacology Comprehensive Study Guide, Practice
Exam, Exam Prep Test Bank, Pediatric Medication
Administration, Weight-Based Dosage Calculations, Drug
Classifications, Neonatal Pharmacology, Immunizations,
Pediatric Emergency Medications, Medication Safety, Adverse
Drug Reactions, Clinical Judgment, NCLEX-RN Review,
Detailed Rationales and Complete Revision Material
Question 1: A 4-year-old patient is prescribed an oral liquid medication that is
available as a 100 mg/5 mL suspension. The ordered dose is 40 mg. What is
the correct volume to administer?
A. 1 mL
B. 1.5 mL
C. 2 mL
D. 2.5 mL
CORRECT ANSWER: C. 2 mL
Rationale: The correct volume is calculated using the formula (Desired dose / Available
dose) x Volume. (40 mg / 100 mg) x 5 mL = 0.4 x 5 mL = 2 mL. Proper calculation is
critical in pediatrics to prevent dosing errors.
Question 2: Which physiological factor in neonates significantly alters drug
absorption after intramuscular administration compared to older children?
A. Higher muscle mass percentage
B. Increased peripheral perfusion
C. Reduced muscle blood flow
D. Faster gastric emptying
CORRECT ANSWER: C. Reduced muscle blood flow
Rationale: Neonates have reduced and variable muscle blood flow, which can lead to
erratic and slower absorption of IM drugs. This is due to their immature cardiovascular
system and lower cardiac output relative to body surface area.
Question 3: A pediatric patient with severe dehydration requires rapid fluid
resuscitation. Which intravenous solution is most appropriate for initial bolus
therapy in a child with hypovolemic shock?
A. 0.9% Sodium Chloride (Normal Saline)
B. 0.45% Sodium Chloride (Half Normal Saline)
C. 5% Dextrose in Water (D5W)
D. 3% Sodium Chloride (Hypertonic Saline)
CORRECT ANSWER: A. 0.9% Sodium Chloride (Normal Saline)
,Rationale: Normal saline (0.9% NaCl) is the preferred isotonic crystalloid for initial fluid
resuscitation in pediatric hypovolemic shock. D5W is hypotonic and distributes into
cells, and hypertonic saline is reserved for specific cases like intracranial hypertension.
Question 4: The prescription reads "Amoxicillin 250 mg/5 mL, take 1 tsp TID
for 10 days." How many milliliters will the patient consume in 24 hours?
A. 5 mL
B. 10 mL
C. 15 mL
D. 20 mL
CORRECT ANSWER: C. 15 mL
Rationale: 1 teaspoon (tsp) is equal to 5 mL. TID means three times a day. Therefore, the
total daily volume is 5 mL x 3 = 15 mL per 24-hour period. Dispensing requires
calculation of the total volume needed for the full course.
Question 5: A 10-month-old infant is prescribed Digoxin for heart failure.
Which adverse effect is most concerning and requires immediate monitoring
due to this drug's narrow therapeutic index?
A. Tachycardia
B. Bradycardia
C. Polyuria
D. Hyperglycemia
CORRECT ANSWER: B. Bradycardia
Rationale: Digoxin has a narrow therapeutic index. In infants, bradycardia and other
dysrhythmias are significant signs of digoxin toxicity. Heart rate must be counted for a
full minute before administration, and the drug is held if the rate is below a specific
threshold.
Question 6: When calculating a pediatric maintenance fluid rate, which
parameter is used in the Holliday-Segar method for a child weighing 15 kg?
A. 100 mL/kg/day for the first 10 kg
B. 50 mL/kg/day for the entire weight
C. A flat rate of 1500 mL/m²/day
D. 20 mL/kg/day for the first 10 kg
CORRECT ANSWER: A. 100 mL/kg/day for the first 10 kg
Rationale: The Holliday-Segar method uses weight-based calculations: 100 mL/kg/day
for the first 10 kg, 50 mL/kg/day for the next 10 kg, and 20 mL/kg/day for each kg
over 20 kg. This approximates metabolic expenditure.
Question 7: A child on phenytoin therapy develops nystagmus, ataxia, and
sedation. This clinical presentation is most indicative of:
,A. A therapeutic response
B. An anaphylactic reaction
C. Drug toxicity
D. A withdrawal syndrome
CORRECT ANSWER: C. Drug toxicity
Rationale: Nystagmus, ataxia, and sedation are classic signs of phenytoin toxicity.
Phenytoin has saturable metabolism, meaning small increases in dose can lead to large
increases in serum concentration and toxicity. Serum drug levels should be monitored.
Question 8: Which glucocorticoid is most commonly used for the chronic
management of asthma in children due to its high topical anti-inflammatory
activity and low systemic bioavailability when inhaled?
A. Prednisone
B. Dexamethasone
C. Fluticasone
D. Hydrocortisone
CORRECT ANSWER: C. Fluticasone
Rationale: Fluticasone is an inhaled corticosteroid (ICS) with high lipophilicity, allowing
it to stay in the lung tissue longer and have high topical potency. It has low oral
bioavailability, minimizing systemic side effects, making it ideal for chronic asthma
management.
Question 9: A neonate is receiving Gentamicin for suspected sepsis. The
provider orders a trough level to be drawn. What is the primary purpose of
monitoring the gentamicin trough level?
A. To ensure the peak level is high enough for efficacy
B. To assess for nephrotoxicity and ototoxicity risk
C. To determine the rate of drug distribution
D. To evaluate protein binding status
CORRECT ANSWER: B. To assess for nephrotoxicity and ototoxicity risk
Rationale: Aminoglycosides like gentamicin are concentration-dependent killers but
have a post-antibiotic effect. The trough level is monitored to prevent accumulation,
which is associated with nephrotoxicity and ototoxicity, ensuring levels are below the
toxic threshold before the next dose.
Question 10: According to standard pediatric dosing, what is the maximum
single dose of Acetaminophen for a 7-year-old child weighing 22 kg?
A. 150 mg
B. 220 mg
C. 325 mg
D. 500 mg
, CORRECT ANSWER: C. 325 mg
Rationale: The standard dose of acetaminophen is 10-15 mg/kg/dose. For a 22 kg child,
the maximum single dose would be 22 kg x 15 mg/kg = 330 mg. 325 mg is the closest
appropriate and standard tablet/capsule formulation available for a single dose, not
exceeding the calculated maximum.
Question 11: A 5-year-old is prescribed Cephalexin. The parent asks if they
can mix the medication with milk. What is the most appropriate response?
A. "Yes, any liquid is fine to mix it with."
B. "No, dairy products decrease the absorption of this specific antibiotic."
C. "It is best to avoid milk as it may alter the drug's stability or absorption."
D. "Yes, but it must be refrigerated after mixing."
CORRECT ANSWER: C. "It is best to avoid milk as it may alter the drug's
stability or absorption."
Rationale: Cephalexin is stable in milk, but general practice suggests using water to
avoid any potential binding or alteration of drug absorption. Consistency in
administration is important to ensure the full dose is ingested without interactions from
food components.
Question 12: Furosemide is administered to a child with congestive heart
failure. Which electrolyte imbalance is the most common adverse effect
associated with this loop diuretic?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
CORRECT ANSWER: B. Hypokalemia
Rationale: Furosemide inhibits the Na-K-2Cl cotransporter in the loop of Henle, leading
to increased excretion of potassium. Hypokalemia is the most common clinically
significant electrolyte imbalance caused by loop diuretics, necessitating monitoring and
often potassium supplementation.
Question 13: A pediatric patient is prescribed Amoxicillin-Clavulanate. The
clavulanate component is included to:
A. Enhance the taste of the suspension
B. Extend the half-life of amoxicillin
C. Inhibit beta-lactamase enzymes
D. Reduce the risk of diarrhea
CORRECT ANSWER: C. Inhibit beta-lactamase enzymes
Updated 2026 | 190+ Questions and Answers | PED320
Pediatric Pharmacology Comprehensive Study Guide, Practice
Exam, Exam Prep Test Bank, Pediatric Medication
Administration, Weight-Based Dosage Calculations, Drug
Classifications, Neonatal Pharmacology, Immunizations,
Pediatric Emergency Medications, Medication Safety, Adverse
Drug Reactions, Clinical Judgment, NCLEX-RN Review,
Detailed Rationales and Complete Revision Material
Question 1: A 4-year-old patient is prescribed an oral liquid medication that is
available as a 100 mg/5 mL suspension. The ordered dose is 40 mg. What is
the correct volume to administer?
A. 1 mL
B. 1.5 mL
C. 2 mL
D. 2.5 mL
CORRECT ANSWER: C. 2 mL
Rationale: The correct volume is calculated using the formula (Desired dose / Available
dose) x Volume. (40 mg / 100 mg) x 5 mL = 0.4 x 5 mL = 2 mL. Proper calculation is
critical in pediatrics to prevent dosing errors.
Question 2: Which physiological factor in neonates significantly alters drug
absorption after intramuscular administration compared to older children?
A. Higher muscle mass percentage
B. Increased peripheral perfusion
C. Reduced muscle blood flow
D. Faster gastric emptying
CORRECT ANSWER: C. Reduced muscle blood flow
Rationale: Neonates have reduced and variable muscle blood flow, which can lead to
erratic and slower absorption of IM drugs. This is due to their immature cardiovascular
system and lower cardiac output relative to body surface area.
Question 3: A pediatric patient with severe dehydration requires rapid fluid
resuscitation. Which intravenous solution is most appropriate for initial bolus
therapy in a child with hypovolemic shock?
A. 0.9% Sodium Chloride (Normal Saline)
B. 0.45% Sodium Chloride (Half Normal Saline)
C. 5% Dextrose in Water (D5W)
D. 3% Sodium Chloride (Hypertonic Saline)
CORRECT ANSWER: A. 0.9% Sodium Chloride (Normal Saline)
,Rationale: Normal saline (0.9% NaCl) is the preferred isotonic crystalloid for initial fluid
resuscitation in pediatric hypovolemic shock. D5W is hypotonic and distributes into
cells, and hypertonic saline is reserved for specific cases like intracranial hypertension.
Question 4: The prescription reads "Amoxicillin 250 mg/5 mL, take 1 tsp TID
for 10 days." How many milliliters will the patient consume in 24 hours?
A. 5 mL
B. 10 mL
C. 15 mL
D. 20 mL
CORRECT ANSWER: C. 15 mL
Rationale: 1 teaspoon (tsp) is equal to 5 mL. TID means three times a day. Therefore, the
total daily volume is 5 mL x 3 = 15 mL per 24-hour period. Dispensing requires
calculation of the total volume needed for the full course.
Question 5: A 10-month-old infant is prescribed Digoxin for heart failure.
Which adverse effect is most concerning and requires immediate monitoring
due to this drug's narrow therapeutic index?
A. Tachycardia
B. Bradycardia
C. Polyuria
D. Hyperglycemia
CORRECT ANSWER: B. Bradycardia
Rationale: Digoxin has a narrow therapeutic index. In infants, bradycardia and other
dysrhythmias are significant signs of digoxin toxicity. Heart rate must be counted for a
full minute before administration, and the drug is held if the rate is below a specific
threshold.
Question 6: When calculating a pediatric maintenance fluid rate, which
parameter is used in the Holliday-Segar method for a child weighing 15 kg?
A. 100 mL/kg/day for the first 10 kg
B. 50 mL/kg/day for the entire weight
C. A flat rate of 1500 mL/m²/day
D. 20 mL/kg/day for the first 10 kg
CORRECT ANSWER: A. 100 mL/kg/day for the first 10 kg
Rationale: The Holliday-Segar method uses weight-based calculations: 100 mL/kg/day
for the first 10 kg, 50 mL/kg/day for the next 10 kg, and 20 mL/kg/day for each kg
over 20 kg. This approximates metabolic expenditure.
Question 7: A child on phenytoin therapy develops nystagmus, ataxia, and
sedation. This clinical presentation is most indicative of:
,A. A therapeutic response
B. An anaphylactic reaction
C. Drug toxicity
D. A withdrawal syndrome
CORRECT ANSWER: C. Drug toxicity
Rationale: Nystagmus, ataxia, and sedation are classic signs of phenytoin toxicity.
Phenytoin has saturable metabolism, meaning small increases in dose can lead to large
increases in serum concentration and toxicity. Serum drug levels should be monitored.
Question 8: Which glucocorticoid is most commonly used for the chronic
management of asthma in children due to its high topical anti-inflammatory
activity and low systemic bioavailability when inhaled?
A. Prednisone
B. Dexamethasone
C. Fluticasone
D. Hydrocortisone
CORRECT ANSWER: C. Fluticasone
Rationale: Fluticasone is an inhaled corticosteroid (ICS) with high lipophilicity, allowing
it to stay in the lung tissue longer and have high topical potency. It has low oral
bioavailability, minimizing systemic side effects, making it ideal for chronic asthma
management.
Question 9: A neonate is receiving Gentamicin for suspected sepsis. The
provider orders a trough level to be drawn. What is the primary purpose of
monitoring the gentamicin trough level?
A. To ensure the peak level is high enough for efficacy
B. To assess for nephrotoxicity and ototoxicity risk
C. To determine the rate of drug distribution
D. To evaluate protein binding status
CORRECT ANSWER: B. To assess for nephrotoxicity and ototoxicity risk
Rationale: Aminoglycosides like gentamicin are concentration-dependent killers but
have a post-antibiotic effect. The trough level is monitored to prevent accumulation,
which is associated with nephrotoxicity and ototoxicity, ensuring levels are below the
toxic threshold before the next dose.
Question 10: According to standard pediatric dosing, what is the maximum
single dose of Acetaminophen for a 7-year-old child weighing 22 kg?
A. 150 mg
B. 220 mg
C. 325 mg
D. 500 mg
, CORRECT ANSWER: C. 325 mg
Rationale: The standard dose of acetaminophen is 10-15 mg/kg/dose. For a 22 kg child,
the maximum single dose would be 22 kg x 15 mg/kg = 330 mg. 325 mg is the closest
appropriate and standard tablet/capsule formulation available for a single dose, not
exceeding the calculated maximum.
Question 11: A 5-year-old is prescribed Cephalexin. The parent asks if they
can mix the medication with milk. What is the most appropriate response?
A. "Yes, any liquid is fine to mix it with."
B. "No, dairy products decrease the absorption of this specific antibiotic."
C. "It is best to avoid milk as it may alter the drug's stability or absorption."
D. "Yes, but it must be refrigerated after mixing."
CORRECT ANSWER: C. "It is best to avoid milk as it may alter the drug's
stability or absorption."
Rationale: Cephalexin is stable in milk, but general practice suggests using water to
avoid any potential binding or alteration of drug absorption. Consistency in
administration is important to ensure the full dose is ingested without interactions from
food components.
Question 12: Furosemide is administered to a child with congestive heart
failure. Which electrolyte imbalance is the most common adverse effect
associated with this loop diuretic?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
CORRECT ANSWER: B. Hypokalemia
Rationale: Furosemide inhibits the Na-K-2Cl cotransporter in the loop of Henle, leading
to increased excretion of potassium. Hypokalemia is the most common clinically
significant electrolyte imbalance caused by loop diuretics, necessitating monitoring and
often potassium supplementation.
Question 13: A pediatric patient is prescribed Amoxicillin-Clavulanate. The
clavulanate component is included to:
A. Enhance the taste of the suspension
B. Extend the half-life of amoxicillin
C. Inhibit beta-lactamase enzymes
D. Reduce the risk of diarrhea
CORRECT ANSWER: C. Inhibit beta-lactamase enzymes
