A nurse is preparing to administer midazolam 0.2 mg/kg via IV bolus now. The client weighs 220 lb. How many mg 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.)

A. Dilute the medication with sterile water before injecting: Phenytoin should not be diluted before administration because it may cause precipitation or crystallization of the drug, leading to potential adverse effects such as tissue irritation or embolism.

B. Administer the medication over 1 min: Phenytoin should be administered slowly over 1 to 2 minutes to reduce the risk of adverse effects such as hypotension or cardiac arrhythmias. Rapid infusion can lead to cardiovascular collapse.

C. Slow the injection if the medication crystallizes: If the medication crystallizes, the nurse should stop the injection immediately and flush the IV line with normal saline. However, preventing crystallization by administering the medication slowly over the recommended time is preferable.

D. Follow the IV injection with sterile water: Following the IV injection with sterile water is not a standard practice for administering phenytoin. Instead, the nurse should follow institutional guidelines for flushing the IV line after medication administration, typically with normal saline.

A. A client received gentamicin intermittent IV bolus over 1 hr:

While gentamicin is typically administered as an intermittent IV bolus, the rate of administration over 1 hour is not necessarily inappropriate. However, the specific institutional protocol or medication administration guidelines should be followed. If the rate of administration deviates significantly from the standard protocol or manufacturer's recommendations, it may warrant further investigation but may not necessarily require an incident report.

B. A nurse used a 25-gauge 3-inch needle to administer a heparin injection:

Using a 25-gauge 3-inch needle for heparin injection is not standard practice and may not be the most appropriate needle size for subcutaneous administration. However, it does not necessarily indicate a need for an incident report unless it resulted in harm to the client. It may prompt further education or clarification regarding appropriate needle selection for subcutaneous injections.

C. A nurse injected Demerol IM into the vastus lateralis site of an adult:

While Demerol (meperidine) is typically administered intramuscularly, the choice of the vastus lateralis site for injection in an adult may not be the most common practice, but it is an acceptable site for IM injections. Unless there are specific contraindications or adverse outcomes related to the site selection, this finding may not require an incident report. However, it could prompt a review of injection site selection guidelines or further education.

D. A client received a crushed bupropion XL tablet mixed with applesauce:

This finding indicates a need for an incident report. Bupropion XL (extended-release) tablets should not be crushed or chewed, as this can lead to rapid release and absorption of the medication, potentially causing adverse effects or toxicity. Administering crushed extended-release tablets is a medication error that warrants an incident report to document the event, assess potential harm to the client, and implement corrective actions to prevent recurrence.