Examkin

Question

Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is preparing to administer a prescribed dose of intravenous (IV) phenytoin to a client who is experiencing active seizure activity. The client has a single peripheral IV line with a continuous infusion of 5%5\% dextrose in water (D5W). Which of the following is the most appropriate action for the nurse to take?

  1. Stop the primary infusion and flush the IV line with 0.9%0.9\% sodium chloride before and after administering the medication.Answer
  2. B
    Administer the medication via slow IV push into the lowest Y-site port while the primary fluid is infusing.
  3. C
    Dilute the prescribed dose of the medication in a 50 mL50\text{ mL} bag of 5%5\% dextrose in water (D5W) and infuse it as a secondary piggyback.
  4. D
    Contact the healthcare provider to request an immediate order for a secondary IV access line.

Answer

The nurse should pause the primary 5%5\% dextrose in water (D5W) infusion and flush the IV line with 0.9%0.9\% sodium chloride before and after giving the phenytoin to prevent crystallization.
Phenytoin is highly incompatible with dextrose-containing solutions and will rapidly precipitate if mixed. To safely administer the medication through an existing IV line infusing 5%5\% dextrose in water (D5W), the nurse must pause the primary infusion and flush the line thoroughly with 0.9%0.9\% sodium chloride (normal saline) before and after the IV push.

Step-by-Step Solution

1
Identify the compatibility of the prescribed medication (phenytoin) with the continuous IV fluid (D5W).
Phenytoin is highly incompatible with all dextrose-containing solutions.
Mixing phenytoin with D5W causes the medication to immediately precipitate and form microcrystals in the IV tubing.
2
Determine the safest and most efficient method to administer the medication using the existing IV access.
The nurse must stop the primary D5W infusion and flush the line thoroughly with 0.9%0.9\% sodium chloride.
Flushing the line with normal saline clears the tubing of dextrose, creating a compatible environment for the phenytoin IV push without unnecessarily delaying treatment to start a new IV line.

Key Concept

Intravenous Medication Compatibility and Safe Administration
Estimated Time:1m 0s
Rate this question

Topics

Pharmacological and Parenteral Therapies

More questions from this topic