A nurse is preparing to administer 800 mg of phenytoin via IV infusion to a client who is experiencing status epilepticus. Which of the following actions should the nurse take when administering the medication?
Administer the phenytoin infusion over 5 min.
Flush with 0.9% sodium chloride after administration.
Flush with 100 units/mL of heparin after administration.
Administer the phenytoin in 100 mL of D5W
The Correct Answer is B
Choice A rationale:
Phenytoin should be administered slowly to avoid adverse effects. Infusing 800 mg over 5 minutes is too rapid and can lead to cardiovascular complications.
Choice B rationale:
Rationale: After administering phenytoin via IV, it's important to flush the IV line with normal saline (0.9% sodium chloride) to ensure the medication is fully delivered to the client and to prevent any residual medication from precipitating in the IV line.
Choice C rationale:
Flushing with heparin is not standard practice for administering phenytoin.
Choice D rationale:
Phenytoin should be administered in normal saline, not in D5W (dextrose 5% in water), to avoid precipitation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
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Correct Answer is B
Explanation
Choice A rationale:
Waiting until school age to engage in social activities is not appropriate, as social interaction is important for a toddler's development.
Choice B rationale:
Interacting with the child according to their developmental age is important for fostering appropriate growth and development.
Choice C rationale:
Devoting more time to learning than playing may not be appropriate, as play is an essential component of early childhood development.
Choice D rationale:
Teaching several steps of a task at one time may be overwhelming for a toddler with a cognitive delay. Instructions should be simple and broken down into manageable steps.
Correct Answer is A
Explanation
Choice A rationale:
Inflammatory bowel disease, including Crohn's disease, can lead to decreased albumin levels due to malabsorption and inflammation.
Choice B rationale:
Increased erythrocyte sedimentation rate (ESR) is more likely in inflammatory conditions.
Choice C rationale:
Decreased hematocrit is more common due to potential blood loss.
Choice D rationale:
Decreased protein levels are expected due to inflammation and malabsorption.
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