Quick answerHold and clarify the gabapentin regimen because the ordered total daily dose does not match the renal dosing range.
Why this is correctDailyMed 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 pictureRenal clearance is a narrow exit. When the exit slows, the same incoming schedule can create a medication traffic jam.
Memory hookCrCl 15 to 29: verify a reduced gabapentin total daily dose.NCLEX decision ruleCompare 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 wrongAdministering 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