A client with a creatinine clearance of 24 mL/min has a new gabapentin order for 600 mg by mouth three times daily. Which action should the nurse take first?
1Administer the first dose as ordered, then reassess sedation and gait after three days of therapy.
2Hold the dose and clarify a renal-adjusted regimen with the prescriber and pharmacist.✓ Correct answer
3Change the schedule to 600 mg once daily and document the nurse-directed renal adjustment.
4Administer the medication with an antacid and increase oral fluids to prevent renal accumulation.
Explanation
Gabapentin dosing must be reduced in renal impairment. For creatinine clearance greater than 15 to 29 mL/min, the labeled total daily range is 200 to 700 mg, so 600 mg three times daily requires clarification.
Quick answer Hold and clarify the gabapentin regimen because the ordered total daily dose does not match the renal dosing range.
Why this is correct DailyMed recommends 200 to 700 mg total per day when creatinine clearance is greater than 15 to 29 mL/min. The order totals 1,800 mg per day, so the nurse should not administer it before authorized adjustment.
Easy analogy or mental picture Renal clearance is a narrow exit. When the exit slows, the same incoming schedule can create a medication traffic jam.
Memory hook CrCl 15 to 29: verify a reduced gabapentin total daily dose.
NCLEX decision rule Compare renally cleared medication orders with current creatinine clearance before the first dose. Hold and clarify a mismatch; do not independently invent a replacement schedule.
Why the other choices are wrong Administering first exposes the client to an excessive regimen. Changing it to once daily without an order is unauthorized, and an antacid does not correct renal accumulation.
References
1DailyMed: GabapentinDosage adjustment by creatinine clearance
Renal-dose checkVerify the current creatinine clearance, formulation, total daily dose, interval, indication, and prescriber-approved adjustment.