Question

A nurse is preparing to administer phenytoin via intermittent IV bolus to a client who is having a tonic-clonic seizure caused by epilepsy. Which of the following factors should the nurse consider when administering IV phenytoin?

1) Mix the phenytoin with 5% dextrose solution
2) Discard phenytoin if precipitate occurs when refrigerated
3) Administer phenytoin at a rate no greater than 50 mg/min
4) Monitor for hypertension while infusing the phenytoin

Answer 1

When administering phenytoin intravenously, it should not be mixed with dextrose, should be discarded if precipitate forms, administered at a rate no greater than 50 mg/min, and the patient should be monitored for hypotension, not hypertension.

Step-by-step explanation:

When administering phenytoin via intermittent IV bolus to a client experiencing a tonic-clonic seizure, there are several important considerations. Firstly, phenytoin should not be mixed with 5% dextrose solution as it may cause precipitation. Instead, it should be prepared in normal saline. Secondly, if a precipitate does form, for instance, due to refrigeration, the phenytoin should indeed be discarded as this indicates instability of the solution. Administering a cloudy or precipitated solution could cause harm. Thirdly, phenytoin should be administered carefully, at a rate no greater than 50 mg/min, to prevent cardiotoxicity, such as arrhythmias and hypotension.

Lastly, while it is necessary to monitor for cardiac issues, monitoring for hypertension is less relevant as hypotension is a more common concern during phenytoin administration. The nurse should monitor the patient for signs of hypotension and bradycardia instead.