MCQ Quiz: Pediatric Patient Care

Pediatric patient care is a specialized area of pharmacy that requires a deep understanding that children are not simply small adults. Their physiology, pharmacokinetics, and developmental stages present unique challenges in medication therapy management. The Pharm.D. curriculum dedicates significant time to this special population, covering everything from common ambulatory conditions like otitis media to the complexities of cystic fibrosis, congenital heart disease, and neonatal intensive care. A pharmacist’s role is critical in ensuring medication safety through accurate weight-based dosing, selecting appropriate formulations, and providing effective counseling to both children and their caregivers. This quiz will test your knowledge on the key principles of pediatric pharmacotherapy and patient care.

1. A key principle of pediatric pharmacotherapy is that medication dosing is almost always based on:

• a) The patient’s age.
• b) The patient’s height.
• c) A standard adult dose.
• d) The patient’s weight (mg/kg) or body surface area (BSA).

Answer: d) The patient’s weight (mg/kg) or body surface area (BSA).

2. Which of the following is a significant pharmacokinetic difference in neonates compared to adults?

• a) Increased renal clearance of drugs.
• b) Mature and fully active hepatic enzyme systems.
• c) Higher percentage of total body water, which can increase the volume of distribution for hydrophilic drugs.
• d) Lower gastric pH.

Answer: c) Higher percentage of total body water, which can increase the volume of distribution for hydrophilic drugs.

3. When counseling a parent on how to administer a liquid medication to an infant, the best advice is to use:

• a) A household teaspoon.
• b) An oral syringe and administer the liquid into the side of the cheek.
• c) The medication bottle cap.
• d) A tablespoon.

Answer: b) An oral syringe and administer the liquid into the side of the cheek.

4. A 6-month-old infant presents with acute otitis media. According to treatment guidelines, what is the first-line antibiotic choice?

• a) Doxycycline
• b) Ciprofloxacin
• c) High-dose amoxicillin
• d) Levofloxacin

Answer: c) High-dose amoxicillin

5. A pharmacist receives a prescription for tetracycline for a 7-year-old child. The pharmacist should be concerned because tetracyclines can cause:

• a) Severe hypertension in children.
• b) Permanent discoloration of teeth and affect bone development in children under 8.
• c) An increased risk of Reye’s syndrome.
• d) Rapid weight gain.

Answer: b) Permanent discoloration of teeth and affect bone development in children under 8.

6. The use of the preservative benzyl alcohol in neonatal IV preparations should be avoided due to the risk of:

• a) “Gray baby syndrome”
• b) “Gasping syndrome”
• c) “Red man syndrome”
• d) Stevens-Johnson syndrome

Answer: b) “Gasping syndrome”

7. A child with asthma is prescribed a fluticasone metered-dose inhaler (MDI). To ensure optimal drug delivery to the lungs, it should be administered with:

• a) A nebulizer.
• b) A spacer or valved holding chamber.
• c) A peak flow meter.
• d) A glass of water.

Answer: b) A spacer or valved holding chamber.

8. Pancreatic enzyme replacement therapy (PERT) for a child with cystic fibrosis should be administered:

• a) Once daily at bedtime.
• b) 30 minutes after each meal.
• c) With the first bite of all meals and snacks.
• d) Only when the child experiences steatorrhea.

Answer: c) With the first bite of all meals and snacks.

9. A child is diagnosed with Type 1 Diabetes Mellitus. The primary goal of insulin therapy is to:

• a) Cure the diabetes.
• b) Mimic physiologic insulin secretion to maintain euglycemia and prevent long-term complications.
• c) Allow the child to eat unlimited amounts of sugar.
• d) Be used only when blood sugar is very high.

Answer: b) Mimic physiologic insulin secretion to maintain euglycemia and prevent long-term complications.

10. Which medication is generally avoided for fever or pain in children and adolescents due to its association with Reye’s syndrome?

• a) Acetaminophen
• b) Ibuprofen
• c) Aspirin
• d) Naproxen

Answer: c) Aspirin

11. A key strategy to prevent medication errors in pediatric patients is:

• a) Using standard adult doses for all children.
• b) Avoiding the use of oral syringes for liquid medications.
• c) Implementing a system of independent double-checks for high-risk medication calculations.
• d) Discouraging parents from asking questions.

Answer: c) Implementing a system of independent double-checks for high-risk medication calculations.

12. When selecting an antiepileptic drug (AED) for a pediatric patient, a key consideration is:

• a) The medication’s potential effect on cognition, learning, and behavior.
• b) Choosing the most sedating option available.
• c) The availability of the drug in a once-yearly injection.
• d) The color of the tablet.

Answer: a) The medication’s potential effect on cognition, learning, and behavior.

13. A premature infant has a patent ductus arteriosus (PDA). Which medication can be used to facilitate its closure?

• a) Alprostadil
• b) Furosemide
• c) Indomethacin or ibuprofen
• d) Sildenafil

Answer: c) Indomethacin or ibuprofen

14. The skills lab module on pediatric patient care is designed to help students become competent in:

• a) Performing surgery on children.
• b) Recommending appropriate medication choices and doses tailored to pediatric populations.
• c) Interpreting pediatric EEGs.
• d) Managing a pediatric hospital ward.

Answer: b) Recommending appropriate medication choices and doses tailored to pediatric populations.

15. A parent asks for an over-the-counter cough and cold product for their 3-year-old child. The pharmacist should advise that:

• a) These products are highly effective and safe for all children.
• b) These products are generally not recommended for children under 4-6 years of age due to a lack of efficacy and risk of side effects.
• c) A double dose should be used for faster relief.
• d) Any product is fine to use.

Answer: b) These products are generally not recommended for children under 4-6 years of age due to a lack of efficacy and risk of side effects.

16. Which of the following is a primary lifestyle intervention for managing pediatric obesity?

• a) A very-low-calorie diet of 500 kcal/day.
• b) A combination of healthy dietary changes, increased physical activity, and family involvement.
• c) Bariatric surgery as a first-line option.
• d) Prescription weight-loss medications used for adults.

Answer: b) A combination of healthy dietary changes, increased physical activity, and family involvement.

17. What is the most common chronic disease of childhood?

• a) Cancer
• b) Asthma
• c) Diabetes
• d) Hypertension

Answer: b) Asthma

18. Dornase alfa (Pulmozyme®) is an inhaled medication used in cystic fibrosis to:

• a) Kill bacteria in the lungs.
• b) Correct the underlying CFTR protein defect.
• c) Decrease the viscosity of sputum by breaking down extracellular DNA.
• d) Improve pancreatic function.

Answer: c) Decrease the viscosity of sputum by breaking down extracellular DNA.

19. A 5-year-old child weighing 20 kg is prescribed amoxicillin 90 mg/kg/day divided into two doses for AOM. What is the correct single dose?

• a) 450 mg
• b) 900 mg
• c) 1800 mg
• d) 200 mg

Answer: b) 900 mg

20. A key counseling point for a child taking stimulant medication for ADHD is:

• a) The medication should be taken right before bedtime.
• b) The medication can cause appetite suppression, so it should be given with or after a meal.
• c) The medication will cause significant weight gain.
• d) The medication can be stopped and started at any time without a problem.

Answer: b) The medication can cause appetite suppression, so it should be given with or after a meal.

21. In a pediatric patient, percutaneous (topical) drug absorption is generally increased compared to adults because:

• a) Their skin is thicker.
• b) They have a smaller body surface area to weight ratio.
• c) They have a larger body surface area to weight ratio and a thinner stratum corneum.
• d) They sweat less than adults.

Answer: c) They have a larger body surface area to weight ratio and a thinner stratum corneum.

22. Which of the following is a common sign of digoxin toxicity in an infant?

• a) Hyperactivity and insomnia.
• b) Increased appetite.
• c) Vomiting, poor feeding, and bradycardia.
• d) A high fever and rash.

Answer: c) Vomiting, poor feeding, and bradycardia.

23. The Hib vaccine protects children against:

• a) Hepatitis B
• b) Influenza type A
• c) Haemophilus influenzae type b, a cause of meningitis and epiglottitis.
• d) Human Papillomavirus.

Answer: c) Haemophilus influenzae type b, a cause of meningitis and epiglottitis.

24. A pharmacist receives a prescription for ceftriaxone for a 2-week-old neonate with jaundice. The pharmacist should:

• a) Dispense the medication as written.
• b) Contact the prescriber to recommend an alternative like cefotaxime, as ceftriaxone can displace bilirubin from albumin.
• c) Tell the parent that jaundice is a normal side effect.
• d) Double the dose to treat the jaundice.

Answer: b) Contact the prescriber to recommend an alternative like cefotaxime, as ceftriaxone can displace bilirubin from albumin.

25. When a medication is not available in a suitable liquid formulation for a child, the pharmacist may need to perform:

• a) Therapeutic drug monitoring.
• b) Extemporaneous compounding.
• c) A vaccination.
• d) A point-of-care test.

Answer: b) Extemporaneous compounding.

26. A 10-year-old child is diagnosed with an uncomplicated UTI. Which of the following would be an appropriate oral antibiotic?

• a) Vancomycin
• b) Meropenem
• c) Cefalexin or TMP-SMX
• d) Daptomycin

Answer: c) Cefalexin or TMP-SMX

27. Which of the following is a “red flag” symptom in a child with fever that warrants immediate medical evaluation?

• a) A temperature of 100.5°F
• b) Irritability and a stiff neck.
• c) A mild cough.
• d) Decreased appetite.

Answer: b) Irritability and a stiff neck.

28. Palivizumab (Synagis) is a monoclonal antibody used to prevent serious lower respiratory tract disease caused by what virus in high-risk infants?

• a) Influenza
• b) Rotavirus
• c) Respiratory Syncytial Virus (RSV)
• d) Varicella

Answer: c) Respiratory Syncytial Virus (RSV)

29. What is a primary consideration when managing pain in pediatric patients?

• a) Children do not feel pain as intensely as adults.
• b) Opioids should never be used in children.
• c) Using a validated pain scale appropriate for the child’s age and developmental level is crucial for assessment.
• d) Acetaminophen is ineffective in children.

Answer: c) Using a validated pain scale appropriate for the child’s age and developmental level is crucial for assessment.

30. The use of fluoroquinolones in children is generally limited due to concerns about:

• a) Hepatotoxicity
• b) Cardiotoxicity
• c) Adverse effects on cartilage and joint development (arthropathy).
• d) Ototoxicity

Answer: c) Adverse effects on cartilage and joint development (arthropathy).

31. Family-centered care, a key principle in pediatrics, involves:

• a) Making all decisions for the family.
• b) Treating the family as partners in the child’s care and decision-making process.
• c) Limiting the family’s access to the child’s medical information.
• d) Focusing only on the child’s physical health.

Answer: b) Treating the family as partners in the child’s care and decision-making process.

32. A child receiving chemotherapy is at high risk for febrile neutropenia. The parent should be counseled to:

• a) Treat any fever at home with ibuprofen.
• b) Consider any fever a medical emergency and contact their oncologist immediately.
• c) Wait 24 hours before reporting a fever.
• d) Administer an extra dose of chemotherapy.

Answer: b) Consider any fever a medical emergency and contact their oncologist immediately.

33. The most appropriate way to prepare an immediate-release tablet for administration via a feeding tube is to:

• a) Administer the tablet whole.
• b) Crush the tablet to a fine powder and mix it with water.
• c) Dissolve the tablet in juice.
• d) This cannot be done.

Answer: b) Crush the tablet to a fine powder and mix it with water.

34. The “5 Rights” of Medication Administration are especially critical in pediatrics. They are the Right Patient, Right Drug, Right Dose, Right Route, and Right:

• a) Price
• b) Time
• c) Pharmacy
• d) Prescriber

Answer: b) Time

35. A key difference in managing pediatric epilepsy compared to adult epilepsy is:

• a) The types of seizures that occur can be age-specific (e.g., infantile spasms).
• b) The impact of AEDs on growth and development must be considered.
• c) Formulations (e.g., liquids, chewable tablets) are a major factor in drug selection.
• d) All of the above.

Answer: d) All of the above.

36. When compounding a pediatric oral suspension from a tablet, what is a crucial piece of information for the pharmacist to find?

• a) The color of the tablet.
• b) The manufacturer of the tablet.
• c) Stability data for the specific compounded formulation (a beyond-use date).
• d) The cost of the ingredients.

Answer: c) Stability data for the specific compounded formulation (a beyond-use date).

37. Which of the following is a common congenital heart defect seen in children?

• a) Myocardial infarction
• b) Ventricular Septal Defect (VSD)
• c) Atrial fibrillation
• d) Heart failure

Answer: b) Ventricular Septal Defect (VSD)

38. A child with Type 1 Diabetes and their family should be educated on managing:

• a) Hypoglycemia
• b) Hyperglycemia
• c) “Sick day” rules
• d) All of the above

Answer: d) All of the above.

39. A pharmacist’s role in the care of a child with cystic fibrosis includes:

• a) Ensuring correct use and timing of pancreatic enzymes.
• b) Educating on the proper use and cleaning of nebulizers for inhaled medications.
• c) Monitoring for drug interactions with CFTR modulators.
• d) All of the above.

Answer: d) All of the above.

40. Why are promethazine and codeine-containing cough syrups generally not recommended in young children?

• a) They are ineffective.
• b) They can cause severe respiratory depression.
• c) They are too expensive.
• d) They have a pleasant taste.

Answer: b) They can cause severe respiratory depression.

41. The preferred site for an intramuscular (IM) injection in an infant is the:

• a) Deltoid muscle
• b) Dorsogluteal muscle
• c) Anterolateral thigh (vastus lateralis muscle)
• d) Abdomen

Answer: c) Anterolateral thigh (vastus lateralis muscle)

42. A significant barrier to medication adherence in adolescent patients is:

• a) The desire for autonomy and potential peer pressure.
• b) The inability to swallow tablets.
• c) A lack of understanding of their disease.
• d) The cost of medication, as they rarely have jobs.

Answer: a) The desire for autonomy and potential peer pressure.

43. The ketogenic diet, used for refractory epilepsy in children, is a:

• a) High-protein, low-carbohydrate diet.
• b) High-carbohydrate, low-fat diet.
• c) High-fat, adequate-protein, low-carbohydrate diet.
• d) Liquid-only diet.

Answer: c) High-fat, adequate-protein, low-carbohydrate diet.

44. A pharmacist assessing a pediatric patient should always consider their _________ stage in addition to their chronological age.

• a) Financial
• b) Social
• c) Developmental
• d) Educational

Answer: c) Developmental

45. Which of the following resources is specifically focused on pediatric drug dosing and information?

• a) The AGS Beers Criteria®
• b) The Harriet Lane Handbook or the Lexicomp Pediatric & Neonatal Dosage Handbook
• c) The Orange Book
• d) The Red Book

Answer: b) The Harriet Lane Handbook or the Lexicomp Pediatric & Neonatal Dosage Handbook

46. A child taking an inhaled corticosteroid should be counseled to do what after each use to prevent oral thrush?

• a) Rinse their mouth with water and spit.
• b) Drink a glass of milk.
• c) Brush their teeth with extra toothpaste.
• d) Nothing is needed.

Answer: a) Rinse their mouth with water and spit.

47. Off-label medication use is common in pediatrics because:

• a) Pharmacists prefer to use drugs off-label.
• b) Many drugs lack FDA approval for use in children due to a historical lack of pediatric clinical trials.
• c) Off-label use is always safer.
• d) It is a way to use cheaper medications.

Answer: b) Many drugs lack FDA approval for use in children due to a historical lack of pediatric clinical trials.

48. For a pediatric patient, medication reconciliation at hospital discharge is crucial to:

• a) Ensure the family receives the correct prescriptions and understands any changes from the home regimen.
• b) Bill the insurance company correctly.
• c) Increase the length of the hospital stay.
• d) Prescribe new medications.

Answer: a) Ensure the family receives the correct prescriptions and understands any changes from the home regimen.

49. A 2-year-old is prescribed an antibiotic suspension. The parent reports the child refuses to take it due to the taste. A pharmacist could suggest:

• a) Telling the parent to force the child to take it.
• b) Discontinuing the antibiotic.
• c) Contacting the prescriber to see if another medication is appropriate, or asking the compounding pharmacy if a flavor can be added.
• d) Mixing the medication in a full bottle of milk or juice.

Answer: c) Contacting the prescriber to see if another medication is appropriate, or asking the compounding pharmacy if a flavor can be added.

50. The ultimate goal of pediatric patient care for a pharmacist is to:

• a) Act as the primary care provider for all children.
• b) Ensure the safe and effective use of medications, tailored to the unique needs of each child.
• c) Only dispense medications and not provide counseling.
• d) Minimize the number of vaccines a child receives.

Answer: b) Ensure the safe and effective use of medications, tailored to the unique needs of each child.