Difficulty: Medium
Average Score: 68%
Full-length
The nurse is caring for a client with epilepsy who is to receive phenytoin sodium (Dilantin) 100mg IV push. The client has an IV of D51/2NS infusing at 100 mL/hr. When administering the Dilantin, which is the appropriate initial nursing action?
Correct answer
C
Rationale
Flushing the IV with normal saline ensures compatibility, as Dilantin is incompatible with D5W. An ambu bag (A) is precautionary, a 16 g catheter (B) is unnecessary, and promethazine (D) is not indicated.