Question

The nurse is preparing to administer newly prescribed intravenous phenytoin to a client. When reviewing the client's medical record, which prescription should the nurse question?

Continuous infusion of dextrose 5% in 0.9% saline

NPH insulin 40 units before meals

Labetalol 100 mg orally twice per day

Ketorolac 15 mg IV push as needed for pain

Answer 1

The nurse should question the prescription of dextrose 5% in 0.9% saline with intravenous phenytoin due to compatibility issues. Insulin injections actually help to decrease blood glucose levels. Other medications like labetalol and ketorolac are not directly related to phenytoin administration but should still be considered for potential interactions.

Step-by-step explanation:

The nurse should question the continuous infusion of dextrose 5% in 0.9% saline when preparing to administer intravenous phenytoin. Phenytoin is not compatible with dextrose solutions as it can precipitate, potentially leading to a blockage in the IV line or harm to the patient. Instead, phenytoin should be administered with normal saline. Compatibility with other medications and solutions is an important consideration when administering IV medications. Both normal saline and lactated Ringer's solution are isotonic, which is important to prevent osmotic imbalances when giving IV fluids. When considering drug administration, factors such as dosing, timing, side effects, drug interactions, and patient condition must be considered.

Regarding the student's question about intravenous prescriptions, insulin injections do not increase blood glucose levels before a meal; rather, they help facilitate the uptake of glucose by the cells to lower blood glucose levels. Labetalol is a blood pressure medication and ketorolac is a pain reliever; these do not directly interfere with phenytoin administration. However, it's always important to consider potential drug interactions.