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Difficulty: Very hardPharmacological Therapies

A practical nurse (PN) is preparing to administer morning medications to a client who is receiving continuous enteral nutrition via a nasogastric (NG) tube. The client's medication administration record includes phenytoin oral suspension, an extended-release metoprolol tablet, and a PRN sublingual nitroglycerin tablet for chest pain. Which of the following actions should the PN take? Select all that apply.

  1. Stop the continuous enteral feeding for 1 to 2 hours before and after administering the phenytoin oral suspension.Answer
  2. B
    Crush the extended-release metoprolol tablet and dissolve it in 30 mL of warm water before administration.
  3. Flush the nasogastric tube with 15 to 30 mL of water before and after administering each medication.Answer
  4. D
    Administer the sublingual nitroglycerin directly into the nasogastric tube if the client experiences acute chest pain.
  5. E
    Delegate the administration of the phenytoin oral suspension to the unlicensed assistive personnel (UAP).
  6. Verify the client's identity using two unique identifiers, such as name and date of birth, prior to medication administration.Answer

Answer

The correct actions are: stopping the continuous enteral feeding for 1 to 2 hours before and after administering the phenytoin, flushing the nasogastric tube with 15 to 30 mL of water before and after each medication, and verifying the client's identity using two unique identifiers.
The correct actions ensure medication efficacy and client safety. Enteral nutritional formulas bind to phenytoin, significantly decreasing its absorption; therefore, the feeding must be paused 1 to 2 hours before and after administration. Flushing the nasogastric tube with 15 to 30 mL of water before and after each medication maintains tube patency and ensures the full dose reaches the stomach. Verifying the client using two unique identifiers is a mandatory safety standard prior to any medication administration.

Step-by-Step Solution

1
Analyze the prescribed medications and the client's current administration route.
The client has a nasogastric tube with continuous feeding. Medications ordered are phenytoin suspension, extended-release metoprolol, and sublingual nitroglycerin.
Identifying the route and specific medication formulations is the first step in ensuring safe administration practices.
2
Evaluate the interaction between phenytoin and continuous enteral nutrition.
The enteral feeding must be stopped 1 to 2 hours before and after administering the phenytoin.
Nutritional formulas bind strongly to phenytoin in the gastrointestinal tract, severely reducing its absorption and therapeutic effect.
3
Assess the formulation of the remaining medications against NG tube protocols.
The extended-release metoprolol cannot be crushed, and the sublingual nitroglycerin must be given under the tongue, not via the NG tube.
Crushing extended-release medications causes toxic dose dumping. Sublingual medications require mucosal absorption to bypass liver metabolism.
4
Apply general medication safety and PN scope of practice principles.
The tube must be flushed properly, the client's identity must be verified using two identifiers, and administration cannot be delegated to a UAP.
These are fundamental nursing standards for safety, infection control, and legal delegation.

Key Concept

Safe Medication Administration via Enteral Tubes
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Topics

Pharmacological Therapies

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