The nurse is caring for a child with spastic cerebral palsy. The child is 7 years old and 52lbs. The doctor has ordered 5mg of valium 4 times daily for muscle spasms. The drug book states the SDR for Valium is 0.1-0.8 mg/kg per dose. What is the safe dose range for this child?
5.2-41.6 mg per dose
118 mg per dose
2.4-18.9 mg per dose
2.4-5.2 mg per dose
The Correct Answer is C
Diazepam (Valium) is a benzodiazepine that enhances GABA-A receptor activity, producing skeletal muscle relaxation, anxiolysis, and anticonvulsant effects. In pediatric cerebral palsy, it is used to reduce spasticity by depressing central motor neuron excitability. Safe dosing is weight-based to prevent respiratory depression and excessive CNS sedation.
Rationale:
A. 5.2–41.6 mg per dose is excessively high for a 52 lb child and exceeds the recommended mg/kg dosing range, placing the child at risk of profound CNS depression, respiratory suppression, hypotonia, and potentially coma due to benzodiazepine toxicity.
B. 118 mg per dose is dangerously supratherapeutic and far beyond the safe pediatric range. This dose would likely cause severe respiratory depression, loss of protective airway reflexes, and deep sedation, making it clinically unsafe and incompatible with standard diazepam pediatric dosing.
C. 0.1–0.8 mg/kg per dose × 52 lb (≈ 23.6 kg) gives a safe range of approximately 2.4–18.9 mg per dose. This reflects the correct weight-based dosing calculation, ensuring therapeutic muscle relaxation while minimizing risk of oversedation and respiratory compromise in pediatric spasticity management.
D. 2.4–5.2 mg per dose underestimates the upper limit of the therapeutic dosing range for diazepam in spastic cerebral palsy. Although the lower boundary is correct, it restricts effective dosing, potentially resulting in inadequate spasm control in moderate to severe spasticity.
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Related Questions
Correct Answer is C
Explanation
Pediatric skeletal development depends on active epiphyseal growth plates where longitudinal bone growth occurs through endochondral ossification. Physeal cartilage, osteogenic activity, vascular supply, and chondrocyte proliferation determine growth integrity. Injury to this region disrupts alignment, growth potential, and may lead to limb length discrepancy or angular deformity depending on severity and timing.
Rationale:
A. Greenstick fractures occur in immature bone due to increased collagen content and reduced mineralization, producing incomplete cortical disruption. Although common in children, the periosteum remains intact, preserving growth plate function and typically not interfering with longitudinal bone development or epiphyseal activity.
B. Shaft fractures involve the diaphysis, which is primarily cortical bone responsible for structural support. These fractures heal through callus formation and remodeling without affecting the epiphyseal plate, therefore they rarely alter future bone growth or cause permanent growth disturbances.
C. Epiphyseal fractures directly involve the growth plate, which contains actively dividing chondrocytes essential for longitudinal growth. Damage can cause premature physeal closure, growth arrest, or asymmetric development leading to limb shortening or angular deformities, making it the most critical injury affecting pediatric skeletal growth.
D. Compound fractures involve bone penetrating through the skin barrier, increasing infection risk and soft tissue injury. However, unless the growth plate is involved, they do not inherently disrupt bone elongation or epiphyseal cartilage function and therefore have limited direct impact on skeletal growth potential
Correct Answer is B
Explanation
Oligoarticular juvenile idiopathic arthritis is a chronic autoimmune inflammatory disorder affecting children, characterized by persistent synovial inflammation limited to a small number of large joints. It commonly involves asymmetric joint disease with risk of uveitis due to immune-mediated ocular involvement.
Rationale:
A. Joint symptoms appearing only after strenuous activity suggest mechanical or overuse injury, not autoimmune inflammation. Juvenile idiopathic arthritis causes persistent synovitis with stiffness, particularly in the morning or after rest, rather than activity-triggered pain.
B. Oligoarticular juvenile idiopathic arthritis is defined by involvement of four or fewer joints, commonly large joints such as the knee or ankle. It is characterized by asymmetric swelling, stiffness, and chronic synovial inflammation due to autoimmune-mediated joint damage.
C. Daily high spiking fevers with a salmon-colored rash indicate systemic juvenile idiopathic arthritis (Still disease), not oligoarticular type. This subtype involves systemic inflammation with cytokine release causing fever patterns and evanescent rash during febrile episodes.
D. Involvement of five or more joints suggests polyarticular juvenile idiopathic arthritis, which typically affects small joints such as the hands and wrists. This subtype resembles adult rheumatoid arthritis and involves more widespread symmetric joint inflammation.
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