A nurse is preparing to administer phenytoin oral suspension to a client. Which of the following actions should the nurse take? (Refer to the medication label below.)

ALWAYS DISPENSE WITH MEDICATION GUIDE 8 fl oz (237 mL)

Phenytoin Oral Suspension, USP

125 mg per 5 mL

IMPORTANT SHAKE WELL BEFORE EACH USE NOT FOR PARENTERAL USE

THIS PRODUCT MUST BE SHAKEN WELL ESPECIALLY PRIOR TO INITIAL USE.

Each 5 mL contains 125 mg phenytoin, with a maximum alcohol content not greater than 0.6 percent.

Advice to Pharmacist and Patient-

A calibrated measuring device is recommended to measure and deliver the prescribed dose accurately. A household teaspoon or tablespoon is not an adequate device.

See package insert for complete prescribing information

Store at 20° to 25°C (68° to 77° F) see USP controlled room temperature. Protect from light. Do not freeze.

Keep this and all drugs out of the reach of children.

Shake the suspension well before each administration.

Dilute the suspension with 38 mL water prior to initial use.

Store the suspension in the refrigerator.

Discard the suspension 14 days after opening the bottle.

Answer and Explanation

The Correct Answer is A

A. Shake the suspension well before each administration.

The medication label specifically states, "IMPORTANT: SHAKE WELL BEFORE EACH USE," and "THIS PRODUCT MUST BE SHAKEN WELL ESPECIALLY PRIOR TO INITIAL USE." This indicates the necessity of shaking the suspension before administration to ensure proper mixing of the medication.

B. Dilute the suspension with 38 mL water prior to initial use.

There is no indication on the label to dilute the suspension with water. The label emphasizes shaking well before use, but dilution is not mentioned.

C. Store the suspension in the refrigerator.

The storage instructions on the label state, "Store at 20° to 25°C (68° to 77° F) see USP controlled room temperature." Refrigeration is not mentioned, and it is not recommended to deviate from the specified storage conditions.

D. Discard the suspension 14 days after opening the bottle.

The label does not provide specific information about the shelf life after opening. Therefore, it is essential to follow the specific instructions on the label or refer to the package insert for complete prescribing information regarding the expiration or discard date after opening. The information on the label does not specify a 14-day limit.

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Correct Answer is D

Explanation

A. "I might have trouble staying on a low-fat diet after my surgery."

- This statement reflects a concern about post-operative care and lifestyle adjustments. It's a valid concern but not a reason to delay the consent process or notify the provider. The client's ability to adhere to a low-fat diet can be addressed during pre-operative counseling or post-operative instructions.

B. "I can resume my normal activities in 1 to 2 weeks."

- This statement indicates an understanding of the post-operative recovery time frame, which is generally accurate for many laparoscopic cholecystectomy patients. This statement does not warrant delaying the consent process or notifying the provider.

C. "I will plan to be in the hospital for 24 hours following my surgery."

- This statement shows an understanding of the anticipated hospital stay after the surgery. It aligns with the typical length of hospitalization for a laparoscopic cholecystectomy. There is no need to delay the consent process or notify the provider based on this statement.

D. "I hope that removing my appendix will make me feel better."

- This statement raises a red flag as it indicates a misunderstanding or confusion about the procedure. A laparoscopic cholecystectomy involves removing the gallbladder, not the appendix. This misunderstanding could lead to the wrong procedure being performed. Therefore, it's crucial to delay obtaining the signature and notify the provider to clarify the intended surgery with the client.

Correct Answer is ["0.2"]

Explanation

To calculate the dosage of methotrexate for a client who has rheumatoid arthritis, the nurse needs to use the following formula:

D/H x Q = X, where D is the desired dose, H is the dose on hand, Q is the quantity of the solution, and X is the amount to administer.

In this case, D is 7.5 mg, H is 15 mg, and Q is 0.4 mL.

Plugging these values into the formula, we get: 7.5/15 x 0.4 = 0.2.

Therefore, the nurse should administer 0.2 mL of methotrexate subcutaneously for the client.

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Naxlex Comprehensive Predictor Exams

A nurse is preparing to witness a client sign a consent for a laparoscopic total cholecystectomy. The nurse should delay obtaining the signature and notify the provider if the client makes which of the following statements?

Correct Answer is D

Explanation

A nurse is preparing to administer methotrexate 7.5 mg subcutaneous for a client who has rheumatoid arthritis. Available is methotrexate 15 mg/0.4 mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["0.2"]

Explanation

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