The physician orders Dilantin oral suspension 80 mg po three times a day for seizures. The medication is supplied in 125 mg/5 mL. How many milliliters will the nurse administer?

Choice A rationale: Hypothyroidism, or an underactive thyroid gland, in infants is often congenital and characterized by insufficient thyroid hormone production. Thyroid hormones are crucial for metabolic rate regulation and neurologic development. Insufficient levels lead to a slowed metabolism, causing symptoms like lethargy and excessive sleep. Snoring can be a sign of macroglossia, or an enlarged tongue, which is also associated with congenital hypothyroidism.
Choice B rationale: Hyperthyroidism, or an overactive thyroid gland, is characterized by the overproduction of thyroid hormones, leading to an increased metabolic rate. This condition would manifest in an infant with symptoms that are the opposite of those described, such as irritability, sleeplessness, and an increased appetite, not lethargy or excessive sleep. These symptoms reflect a hypermetabolic state.
Choice C rationale: Type 2 diabetes mellitus is a metabolic disorder characterized by insulin resistance and hyperglycemia. While it can cause lethargy and excessive sleepiness, it is extremely rare in infants and is not associated with snoring or an enlarged tongue. The primary symptoms in this age group are more likely to be related to fluid balance and glucose control.
Choice D rationale: Tay-Sachs disease is a rare, fatal, neurodegenerative genetic disorder. It results from the absence of a vital enzyme, hexosaminidase A, which leads to the buildup of gangliosides in the brain. Symptoms typically appear around 6 months of age and include a startle response, loss of motor skills, and an exaggerated response to noise, not lethargy or snoring.

Choice A rationale: Thyroid hormone absorption is enhanced when taken on an empty stomach, typically in the morning approximately 30-60 minutes before breakfast. Food, particularly calcium, iron, and soy, can chelate with the medication and reduce its bioavailability, leading to inadequate therapeutic levels. This timing ensures consistent and maximal drug absorption, preventing erratic serum hormone levels and optimizing symptom control.
Choice B rationale: Taking thyroid medication with a meal, such as lunch, significantly impedes its absorption. The presence of food in the gastrointestinal tract, especially high-fiber foods, binds to the synthetic hormone, reducing the amount available for systemic circulation. This can lead to sub-therapeutic levels, resulting in persistent hypothyroid symptoms like fatigue, weight gain, and cold intolerance.
Choice C rationale: Administering thyroid replacement therapy with the evening meal is not recommended due to reduced absorption efficacy. The stomach's pH and motility are altered by food consumption, which can interfere with the dissolution and absorption of the drug. Consistent poor absorption can necessitate dosage increases, complicating medication management and potentially leading to adverse effects.
Choice D rationale: Taking thyroid medication at bedtime is generally discouraged because it can cause insomnia and interfere with sleep patterns. The increase in metabolic rate induced by the hormone can make it difficult for some individuals to fall asleep. Additionally, absorption may still be compromised if the individual has recently eaten, as gastric emptying is slower during sleep.