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Difficulty: MediumPharmacological and Parenteral Therapies

A client with new-onset seizures is scheduled to receive a loading dose of intravenous (IV) phenytoin. The client currently has a continuous IV infusion of 5%5\% dextrose in water (D5W) running at 50 mL/hr50\text{ mL/hr} through a single peripheral IV catheter. Which action should the nurse take to administer the phenytoin safely?

  1. Stop the continuous D5W infusion and thoroughly flush the intravenous line with 0.9%0.9\% sodium chloride before and after giving the medication.Answer
  2. B
    Attach the phenytoin syringe directly to the lowest Y-site port while the D5W continues to infuse to ensure adequate dilution.
  3. C
    Calculate the push rate to deliver the entire loading dose over 30 to 60 seconds to rapidly achieve a therapeutic blood level.
  4. D
    Delegate the task of pausing the IV pump and flushing the line with saline to the unlicensed assistive personnel (UAP).

Answer

The nurse must stop the continuous D5W infusion and thoroughly flush the intravenous line with 0.9%0.9\% sodium chloride before and after giving the medication.
Phenytoin is chemically incompatible with dextrose-containing solutions and will rapidly precipitate if they mix in the intravenous line. To safely administer the medication through the same peripheral catheter, the nurse must pause the dextrose infusion and thoroughly flush the line with a compatible solution, such as normal saline (0.9%0.9\% sodium chloride), both before and after the phenytoin push to prevent crystal formation and maintain line patency.

Step-by-Step Solution

1
Identify the compatibility of the prescribed medication (phenytoin) with the currently infusing solution (5%5\% dextrose in water).
Recognize that phenytoin and dextrose are highly incompatible.
Mixing phenytoin with dextrose solutions causes immediate crystallization and precipitation in the IV tubing.
2
Determine the appropriate intervention to administer the medication through the single available peripheral line.
The continuous dextrose infusion must be paused.
The line must be cleared of all dextrose before the phenytoin can be safely introduced.
3
Select the correct flush solution to clear the line and maintain patency.
Select 0.9%0.9\% sodium chloride (normal saline) to flush before and after the medication push.
Normal saline is compatible with phenytoin and effectively clears the line of incompatible fluids while preventing venous irritation.

Key Concept

Intravenous medication compatibility and safe parenteral administration practices for phenytoin.
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Topics

Pharmacological and Parenteral Therapies

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