The nurse reviews a prescription for phenytoin 1,000 mg IV to infuse over 10 minutes for an adult with status epilepticus. Which action should the nurse take?
1Administer the dose through a peripheral vein while checking the pulse every 10 minutes
2Dilute the medication in dextrose and infuse it through the current IV tubing
3Replace the IV prescription with an intramuscular dose to reduce cardiac effects
4Hold the dose, clarify the infusion rate, and prepare continuous cardiac monitoring✓ Correct answer
Explanation
The prescribed rate is 100 mg/min, which exceeds the adult maximum of 50 mg/min and increases hypotension and dysrhythmia risk. The nurse should clarify the rate and use continuous ECG and blood pressure monitoring.
Quick answer Hold the prescription and clarify the infusion rate before administration. Phenytoin 1,000 mg over 10 minutes equals 100 mg/min, exceeding the adult maximum of 50 mg/min.
Why this is correct Rapid IV phenytoin can cause severe hypotension and cardiac dysrhythmias. Adult administration should not exceed 50 mg/min, and continuous ECG, blood pressure, and respiratory monitoring are essential during and after the infusion.
Easy analogy or mental picture Think of IV phenytoin as traffic entering a narrow cardiac toll lane. Sending the dose too quickly can overwhelm the lane and destabilize circulation; the picture explains rate safety but does not replace patient-specific dosing or monitoring.
Memory hook Calculate the rate before the dose moves: if IV phenytoin exceeds 50 mg/min in an adult, stop and clarify.
NCLEX decision rule When a high-alert IV medication includes a dose and time, calculate the actual rate before administration. If the rate exceeds the labeled limit, hold the dose, clarify the prescription, and prepare the required physiologic monitoring.
Why the other choices are wrong Intermittent pulse checks do not replace continuous monitoring. Phenytoin is not diluted in dextrose because precipitation can occur, and intramuscular administration has erratic absorption and local tissue risks rather than providing a safe substitute.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
FDA: Dilantin Injection Prescribing InformationU.S. Food and Drug Administration