Certified Pediatric Emergency Nurse (CPEN) Practice Exam

Which pediatric emergency medication requires specific exception handling by being administered rapidly?

1. Dopamine

2. Adenosine

3. Nitroprusside

4. Atropine

The correct answer is: Adenosine

Adenosine is a medication that is particularly important in the context of pediatric emergencies, especially for the management of certain types of supraventricular tachycardia (SVT). This medication acts rapidly to terminate reentrant and atrial flutter tachycardias by temporarily interrupting conduction through the atrioventricular (AV) node. The reason adenosine requires rapid administration is due to its very short half-life, which limits its duration of action and effectiveness. If adenosine is not administered quickly, it may not reach the heart at the right moment to induce the desired therapeutic effect, and the potential for restoring a normal rhythm decreases significantly. The standard administration practice involves using a rapid IV push followed by a saline flush to ensure the medication reaches the systemic circulation swiftly. In contrast, dopamine, nitroprusside, and atropine do not necessitate the same immediate administration due to their pharmacokinetics. Dopamine has a more gradual onset and can be titrated based on the patient’s response. Nitroprusside requires careful dosing and monitoring but is not given as a rapid bolus. Atropine can be administered relatively quickly but is used more in cases of bradycardia rather than acute rhythm