A client with hypertension currently takes two and a half tablets of bisoprolol per day, each containing 100 mg. The new order is 500 mg of bisoprolol per day.
What instruction should be given to this client for the effective management of hypertension?

To answer this question, we need to understand the principles of pediatric dosage calculations and the factors that affect them. Pediatric dosages are usually calculated based on the child's weight or body surface area, and sometimes adjusted for age, organ function, or disease severity¹. However, not all medications that are used in adults are safe or effective in children. Some medications may have different pharmacokinetics, pharmacodynamics, adverse effects, or interactions in children than in adults².

Therefore, it is important to check the drug insert or label for any contraindications, warnings, or precautions for pediatric use before prescribing or administering a medication to a child. If the drug insert states that the medication is not for pediatric use, it means that the medication has not been tested or approved for use in children, or that it has been shown to be harmful or ineffective in children. In this case, a pediatric dose calculated from an adult dose should be avoided, as it may result in serious toxicity or therapeutic failure. The healthcare provider should consult a pediatric specialist, a pharmacist, or a reliable drug reference for alternative medications or dosing recommendations.

The other options are not correct because they do not necessarily warrant avoiding a pediatric dose calculated from an adult dose.

Option a. If the drug insert does not specify a pediatric dose, it means that there is insufficient data or evidence to support a specific pediatric dose, but it does not mean that the medication is contraindicated or unsafe in children. The healthcare provider should use clinical judgment and available resources to determine the appropriate dose for the child³.

Option b. If the child has an elevated temperature that has not responded to treatment, it means that the child may have an infection or inflammation that may affect the absorption, distribution, metabolism, or excretion of some medications. The healthcare provider should monitor the child's condition and adjust the dose accordingly, but it does not mean that the medication should be avoided altogether⁴.

Option c. If the child has gained or lost weight in the past month, it means that the child's weight may have changed significantly since the last dose calculation. The healthcare provider should weigh the child and recalculate the dose based on the current weight, but it does not mean that the medication should be avoided altogether.

To find the milliliters per hour, you need to calculate the following:

- The patient's weight in kilograms
- The dose of Principen in milligrams
- The infusion rate in milliliters per hour using the formula: Infusion rate (mL/h) = (Total volume (mL) x Flow factor (gt/mL)) / Time (min) x 60 min/h

First, convert the patient's weight from pounds to kilograms by dividing by 2.2:

22 lb / 2.2 = 10 kg

Next, multiply the patient's weight by the dose of Principen per kilogram to get the total dose in milligrams:

10 kg x 25 mg/kg = 250 mg

Then, use the formula for infusion rate to find how many milliliters per hour the IV pump should deliver:

Infusion rate (mL/h) = (Total volume (mL) x Flow factor (gt/mL)) / Time (min) x 60 min/h

Since the medication is prepared in 50 mL of solution and the infusion time is 30 minutes, plug in these values into the formula:

Infusion rate (mL/h) = (50 mL x 1 gt/mL) / 30 min x 60 min/h

Simplify and solve for the infusion rate:

Infusion rate (mL/h) = 100 mL/h

Therefore, the nurse should administer **100 mL/h** to infuse Principen 250 mg over 30 minutes.