A pediatric nurse is caring for a toddler who weighs 16 \text{ kg} and is receiving treatm… — NCLEX-RN

A pediatric nurse is caring for a toddler who weighs $16 \text{ kg}$ and is receiving treatment for bacterial meningitis. The client's current temperature is $38.9^\circ\text{C}$ ( $102^\circ\text{F}$ ), heart rate is $135 \text{ bpm}$ , and respiratory rate is $28 \text{ breaths/min}$ . The client has a single-lumen peripheral intravenous (IV) catheter. The healthcare provider prescribes ampicillin $500 \text{ mg}$ IV and gentamicin $2.5 \text{ mg/kg}$ IV. Both intermittent medications are scheduled to be administered at 09:00. The pharmacy supplies gentamicin in a multiple-dose vial labeled $20 \text{ mg/mL}$ . Which of the following is the most appropriate action by the nurse?

A
Draw up $0.2 \text{ mL}$ of gentamicin from the vial. Flush the IV line with $0.9\% \text{ sodium chloride}$ , administer the gentamicin, and then administer the ampicillin.
Draw up $2 \text{ mL}$ of gentamicin from the vial. Administer the ampicillin infusion first, thoroughly flush the IV line with $0.9\% \text{ sodium chloride}$ , and then administer the gentamicin infusion.Answer
C
Draw up $4.4 \text{ mL}$ of gentamicin from the vial. Administer the ampicillin infusion first, thoroughly flush the IV line with $0.9\% \text{ sodium chloride}$ , and then administer the gentamicin infusion.
D
Draw up $2 \text{ mL}$ of gentamicin from the vial and infuse it via the Y-site concurrently with the ampicillin to ensure both medications are delivered on time.

Answer

Draw up

2 \text{ mL}

of gentamicin from the vial. Administer the ampicillin infusion first, thoroughly flush the IV line with

0.9\% \text{ sodium chloride}

, and then administer the gentamicin infusion.

The correct action involves first calculating the accurate dose:

16 \text{ kg} \times 2.5 \text{ mg/kg} = 40 \text{ mg}

. Next, calculating the required volume:

40 \text{ mg} \div 20 \text{ mg/mL} = 2 \text{ mL}

. Because penicillins (like ampicillin) and aminoglycosides (like gentamicin) are physically incompatible and can chemically inactivate each other, they must not be mixed in the same IV line. For a client with a single-lumen catheter, the nurse must administer the medications sequentially and thoroughly flush the line with a compatible solution, such as

0.9\% \text{ sodium chloride}

, between the infusions.

Step-by-Step Solution

Calculate the required dose of gentamicin using the client's weight in kilograms.

16 \text{ kg} \times 2.5 \text{ mg/kg} = 40 \text{ mg}

of gentamicin.

Pediatric medication dosing is strictly weight-based and must be calculated accurately before administration to prevent toxicity or underdosing.

Calculate the volume of gentamicin needed from the supplied vial.

40 \text{ mg} \div 20 \text{ mg/mL} = 2 \text{ mL}

To ensure the exact required physical volume is drawn from the vial for the intermittent infusion.

Evaluate the IV compatibility of the prescribed medications.

Ampicillin (a penicillin) and gentamicin (an aminoglycoside) are physically incompatible and chemically inactivate each other if mixed.

Medications scheduled for the same time must be checked for Y-site compatibility to prevent crystallization, precipitation, or loss of therapeutic efficacy.

Determine the correct administration sequence for a single-lumen IV line.

Administer the medications sequentially, thoroughly flushing the IV line with

0.9\% \text{ sodium chloride}

between the infusions.

When incompatible medications are scheduled concurrently for a client with a single IV access, they must be given one after the other with adequate flushing to ensure the drugs never mix in the tubing.

Key Concept

Pediatric Weight-Based Dosage Calculation and IV Medication Compatibility

Estimated Time:2m 0s

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Key Concept

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