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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is preparing to administer a prescribed intravenous dose of phenytoin to a client with a seizure disorder. The pharmacy delivers the medication labeled as 'phenytoin 300 mg in 50 mL of 5% dextrose in water (D5W)'. The client has a continuous intravenous (IV) infusion of 0.9% sodium chloride running at 50 mL/hr. Which action should the nurse take?

  1. Withhold the medication and contact the pharmacy to request that the phenytoin be prepared in 0.9% sodium chloride.Answer
  2. B
    Stop the continuous 0.9% sodium chloride infusion, administer the medication, and then flush the line with 5% dextrose in water.
  3. C
    Calculate the pump rate to administer the medication as supplied over a duration of 3 minutes.
  4. D
    Delay the administration of the phenytoin until the client completes a routine neurological assessment and morning hygiene.

Answer

Withhold the medication and contact the pharmacy to request that the phenytoin be prepared in 0.9% sodium chloride.
Phenytoin is highly incompatible with dextrose solutions and will form a solid precipitate if mixed with 5% dextrose in water (D5W). The nurse must recognize this pharmacological incompatibility and intervene by withholding the medication and having the pharmacy prepare it in 0.9% sodium chloride (normal saline), which is the only compatible intravenous diluent for phenytoin.

Step-by-Step Solution

1
Analyze the prescribed medication and the supplied diluent.
The pharmacy supplied phenytoin mixed in 5% dextrose in water (D5W).
Verifying the correct medication, dose, and diluent is a critical safety step before administration.
2
Evaluate the compatibility of the medication with the supplied diluent.
Phenytoin is highly incompatible with any dextrose-containing solutions.
Mixing phenytoin with dextrose causes the medication to form a solid precipitate, which can cause a potentially fatal embolus if administered.
3
Determine the appropriate nursing intervention to ensure client safety.
The nurse must withhold the incorrectly mixed medication and obtain phenytoin prepared in 0.9% sodium chloride.
Normal saline (0.9% sodium chloride) is the only compatible intravenous fluid for phenytoin administration.

Key Concept

Phenytoin Compatibility and Safe Intravenous Administration
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Topics

Pharmacological and Parenteral Therapies

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