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Difficulty: MediumPharmacological and Parenteral Therapies

A client is prescribed an intravenous (IV) dose of phenytoin for seizure management. The client has a single peripheral IV access site with a continuous primary infusion of 5%5\% dextrose in water (D5W). Which action should the nurse take to safely administer the phenytoin?

  1. Stop the primary D5W infusion and flush the IV line with 0.9%0.9\% sodium chloride before and after administering the medication.Answer
  2. B
    Connect the phenytoin as a secondary piggyback and administer it concurrently with the active D5W infusion.
  3. C
    Pause the primary D5W infusion, administer the phenytoin, and immediately resume the primary infusion without flushing.
  4. D
    Rapidly administer the phenytoin via IV push over 3030 seconds to ensure a quick therapeutic response.

Answer

The nurse must stop the primary D5W infusion and flush the IV line with 0.9%0.9\% sodium chloride both before and after administering the phenytoin.
Phenytoin is physically incompatible with dextrose-containing solutions, such as D5W, and will precipitate (form solid crystals) if they mix. Because the client has only one IV access site, the safest and only correct method is to stop the D5W infusion and thoroughly flush the IV tubing with 0.9%0.9\% sodium chloride (normal saline) before administering the phenytoin. After the medication is fully administered, the line must be flushed again with normal saline before the D5W infusion can be safely resumed.

Step-by-Step Solution

1
Assess the compatibility of the prescribed IV medication (phenytoin) with the current continuous IV fluid (D5W).
Identify that phenytoin is incompatible with all dextrose-containing solutions.
Mixing phenytoin with D5W causes rapid precipitation and crystallization in the IV tubing.
2
Determine the necessary intervention to safely administer the medication through the single existing IV line.
Plan to temporarily stop the primary continuous infusion and clear the line of any incompatible fluid.
The line must be completely free of dextrose before the phenytoin is introduced.
3
Select the correct flushing solution and proper sequence.
Flush the line with 0.9%0.9\% sodium chloride, administer the phenytoin at the correct safe rate, and flush again with 0.9%0.9\% sodium chloride.
0.9%0.9\% sodium chloride is the only standard IV fluid compatible with phenytoin.

Key Concept

Intravenous medication compatibility and safe administration practices for phenytoin.
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Topics

Pharmacological and Parenteral Therapies

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