A nurse is preparing to administer phenytoin 200 mg via a gastrostomy tube. Available is phenytoin oral suspension 125 mg/5 mL. How many mL should the nurse administer?
(Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Choice A reason: This choice is incorrect because insulin is not commonly given to all hospitalized clients. Insulin is a hormone that lowers blood sugar levels in the body. It is only given to clients who have diabetes or other conditions that cause high blood sugar, such as pancreatitis, sepsis, or steroid therapy. The nurse should explain the indication and purpose of insulin to the client and not make false or misleading statements.

Choice B reason: This choice is incorrect because the client did not likely develop diabetes prior to hospitalization, but are just now being diagnosed. Diabetes is a chronic condition where the body either does not produce enough insulin or does not use it properly, resulting in high blood sugar levels. Diabetes can be diagnosed by measuring the blood sugar levels, the hemoglobin A1c levels, or the oral glucose tolerance test. The nurse should not assume or imply that the client has diabetes without proper testing and confirmation.

Choice C reason: This choice is incorrect because the client did not develop type 1 diabetes and will not need insulin for the rest of their life. Type 1 diabetes is an autoimmune condition where the body destroys the insulin-producing cells in the pancreas, leading to a complete lack of insulin. Type 1 diabetes usually develops in childhood or adolescence, and requires lifelong insulin therapy. The nurse should not diagnose or predict the client's condition without evidence or authority.

Choice D reason: This choice is correct because glucocorticoid steroid medications can cause temporary hyperglycemia. Glucocorticoids are anti-inflammatory drugs that suppress the immune system and reduce inflammation. They are used to treat conditions such as multiple sclerosis, asthma, rheumatoid arthritis, and allergic reactions. However, they can also increase the blood sugar levels by stimulating the liver to produce more glucose and reducing the sensitivity of the cells to insulin. The nurse should inform the client that the insulin is needed to control the blood sugar levels while they are on steroid therapy, and that the insulin dose may be adjusted or discontinued when the steroids are tapered or stopped.

To calculate the dose of methylprednisolone sodium succinate that the nurse should administer, we can follow these steps:

Convert the client's weight from pounds to kilograms:

169 lb ÷ 2.2 = 76.82 kg (rounded to two decimal places)

Calculate the dose of methylprednisolone sodium succinate:

30 mg/kg × 76.82 kg = 2,304.6 mg

Determine the volume of methylprednisolone sodium succinate needed using the available concentration:

2,304.6 mg ÷ 125 mg/mL = 18.437 mL

Rounding to the nearest whole number, the nurse should administer 18 mL of methylprednisolone sodium succinate via intermittent IV bolus.