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Zorluk: Çok zorPharmacological Therapies

A practical nurse (PN) is caring for an adult client who is receiving continuous enteral nutrition via a nasogastric (NG) tube. The client is scheduled to receive 300 mg300\text{ mg} of phenytoin. The pharmacy dispenses phenytoin oral suspension 125 mg/5 mL125\text{ mg}/5\text{ mL}. The client's morning laboratory results show a serum phenytoin level of 26 mcg/mL26\text{ mcg/mL}. During the morning assessment, the client exhibits involuntary, rapid eye movements and a noticeably unsteady gait when transferring to the chair. Which of the following actions should the PN take? Select all that apply.

  1. Withhold the scheduled dose of the phenytoin oral suspension.Cevap
  2. Report the neurological assessment findings and laboratory results to the registered nurse (RN).Cevap
  3. Implement strict fall precautions due to the client's current neurological status.Cevap
  4. D
    Administer 24 mL24\text{ mL} of the medication after temporarily pausing the continuous enteral feeding.
  5. E
    Accept a telephone order from the healthcare provider to initiate an intravenous (IV) push central nervous system depressant.
  6. F
    Verify the client's identity by asking the assistive personnel (AP) in the room to confirm the client's name prior to any interventions.

Cevap

The practical nurse should withhold the dose of phenytoin, report the findings to the RN, and implement fall precautions.
The therapeutic serum level for phenytoin is 10 to 20 mcg/mL. A level of 26 mcg/mL is toxic and correlates directly with the client's clinical presentation of nystagmus (involuntary eye movements) and ataxia (unsteady gait). The practical nurse must prioritize safety by withholding the scheduled dose to prevent worsening toxicity, immediately reporting both the clinical findings and the critical laboratory value to the registered nurse, and initiating fall precautions to protect the neurologically impaired client.

Adım Adım Çözüm

1
Analyze the laboratory value.
The serum phenytoin level is 26 mcg/mL26\text{ mcg/mL}, which exceeds the normal therapeutic range of 10−20 mcg/mL10-20\text{ mcg/mL}.
Recognizing a toxic drug level is the first step in prioritizing medication safety.
2
Correlate the physical assessment findings with the medication profile.
Involuntary eye movements (nystagmus) and an unsteady gait (ataxia) are classic, direct manifestations of central nervous system toxicity from elevated phenytoin levels.
Connecting physiological symptoms to pharmacological effects determines whether a drug should be administered or withheld.
3
Determine the appropriate interventions within the practical nurse scope of practice.
The nurse must withhold the toxic medication, protect the client from physical harm (fall precautions), and communicate the critical data to the supervising RN.
Safe nursing practice requires recognizing out-of-scope tasks (like IV push meds) and prioritizing immediate patient safety and chain-of-command reporting.
4
Evaluate the mathematical calculation presented in the distractors.
Using the formula (Desired / Have) * Volume: (300 mg/125 mg)×5 mL=12 mL(300\text{ mg} / 125\text{ mg}) \times 5\text{ mL} = 12\text{ mL}. The distractor offering 24 mL24\text{ mL} is mathematically incorrect.
Identifying calculation errors prevents dangerous overdosing, reinforcing standard medication administration rights.

Anahtar Kavram

Phenytoin Toxicity and Practical Nurse Scope of Practice
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Konular

Pharmacological Therapies

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