The nurse is preparing to administer phenytoin to an 80-year-old ...

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The nurse is preparing to administer phenytoin to an 80-year-old patient and notes the following order: IVP phenytoin 50 mg. The nurse will perform which action?
 
  a. Administer the undiluted drug through a Y-tube over two minutes.
  b. Contact the provider to question the route and the dose.
  c. Dilute the drug in dextrose solution and infuse over 15 to 20 minutes.
  d. Request an order to administer the drug intramuscularly.

Question 2

A patient who takes phenytoin reports regular alcohol consumption. The nurse might expect a serum phenytoin level in this patient to be in which range?
 
  a. 5 to 10 mcg/mL
  b. 10 to 20 mcg/mL
  c. 20 to 30 mcg/mL
  d. 30 to 50 mcg/mL

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Answer to Question 1

ANS: A
Intravenous phenytoin should be administered undiluted through a 3-way stopcock or Y-tubing. In older patients it should be infused at a rate of 25 mcg/min. The dose and the route are appropriate. Phenytoin will precipitate in dextrose solution. Intramuscular injection is very irritating to tissues and is not used.

Answer to Question 2

ANS: A
Chronic ingestion of alcohol increases hydantoin metabolism, which would decrease serum drug levels. The therapeutic range is 10 to 20 mcg/mL, so a level lower than this may be expected in patients who consume alcohol regularly.

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TYSM

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