Which action should the nurse take before administering the prescribed gabapentin regimen?

1 Give 300 mg three times daily because age does not affect gabapentin clearance.
2 Increase the dose to 600 mg three times daily to overcome reduced absorption.
3 Hold the dose and clarify a renal-adjusted regimen with the prescriber. ✓ Correct answer
4 Crush all scheduled doses together and administer them once each morning.

Explanation

Gabapentin requires dose adjustment in renal impairment. For creatinine clearance greater than 15 to 29 mL/min, the labeled total daily range is 200 to 700 mg given once daily; 300 mg three times daily is therefore inconsistent with the renal dosing table and should be clarified before administration.

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In-depth explanation

Quick answer
Hold and clarify the renal dose.

Why this is correct
Gabapentin clearance falls as renal function declines. The labeled regimen for creatinine clearance greater than 15 to 29 mL/min is a total of 200 to 700 mg once daily, while the order supplies 900 mg each day in three divided doses.

Easy analogy or mental picture
When the kidney exit narrows, the dosing traffic must slow down.

Memory hook
Gabapentin follows kidney function.

NCLEX decision rule
Compare renally cleared medication orders with the current renal dosing table before administration; clarify a mismatch rather than improvising a new schedule.

Why the other choices are wrong
The prescribed frequency is excessive for the stated renal function, dose escalation increases accumulation risk, and crushing doses together does not create a validated renal regimen.

References

1DailyMed: GabapentinRenal dose adjustment table for creatinine clearance 15 to 29 mL/min

Clinical scenario

Scenario 72-year-old male, postherpetic neuralgia. CKD stage 4 (eGFR 28 mL/min). Provider orders gabapentin 300 mg PO TID.

Key concepts

Renal dose adjustment — Reduction of drug dose based on eGFR or creatinine clearance; gabapentin requires this in CKD.
Gabapentinoid sedation — Dose-dependent CNS depression from gabapentin/pregabalin; magnified by renal accumulation in CKD.
Postherpetic neuralgia — Chronic neuropathic pain after herpes zoster; gabapentin and pregabalin are first-line agents.

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For study reference only. Always follow current clinical guidelines and your institution’s protocols.

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Which action should the nurse take before administering the prescribed gabapentin regimen?

In-depth explanation

Clinical scenario

Key concepts

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