A nurse is planning to administer phenytoin IV via intermittent bolus to a client who has a seizure disorder and is receiving a continuous IV infusion of dextrose 5% in water (D5W). Which of the following actions should the nurse plan to take?

Choice A rationale:

Administering phenytoin IV no faster than 100 mg/min is crucial to prevent adverse effects such as cardiovascular collapse or severe hypotension. Rapid administration of phenytoin can cause cardiac arrhythmias and should be avoided.

Choice B rationale:

Monitoring plasma phenytoin levels to establish the therapeutic range is a necessary action in managing the client's seizure disorder, but it does not pertain to the specific administration of phenytoin via intermittent bolus.

Choice C rationale:

Adding the medication to the existing IV solution is not appropriate for phenytoin administration. Phenytoin should be administered separately and not mixed with other IV solutions to maintain its stability and prevent interactions.

Choice D rationale:

Monitoring the client for hypertension is not directly related to the administration of phenytoin via intermittent bolus. Hypertension is not a common adverse effect of this medication. However, blood pressure should be monitored as part of routine care for any client on antiepileptic therapy.

Choice A rationale:
Increasing potassium consumption is unrelated to cephalexin, an antibiotic. It is not a necessary precaution or action to take while on this medication.
Choice B rationale:
Applying lotion to the skin to relieve itching is not related to cephalexin use. Itching is not a common side effect of this antibiotic, so the client's statement indicates a misunderstanding of the teaching.
Choice C rationale:
Avoiding sun exposure is essential while taking cephalexin because it is known to cause photosensitivity reactions. Sun exposure can lead to severe skin reactions, so the client's statement indicates an understanding of the teaching.
Choice D rationale:
Keeping the medication refrigerated is not necessary for cephalexin oral suspension. It should be stored at room temperature unless specified otherwise by the manufacturer. The client's statement suggests a misunderstanding of the medication storage instructions.