# A nurse is preparing to administer IV phenytoin for status epilepticus. Which preparation and administration practice is essential for safety?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391738&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A nurse is preparing to administer IV phenytoin for status epilepticus. Which preparation and administration practice is essential for safety?

## Option

1. Mix in normal saline only, infuse at no more than 50 mg/min through a large vein with continuous ECG monitoring **✔ Correct answer**
2. Administer undiluted as an IV push over 2 minutes, using a peripheral line with intermittent blood pressure checks
3. Mix in dextrose 5% in water and infuse at 100 mg/min through a small peripheral vein with pulse oximetry monitoring
4. Infuse concurrently through a Y-site with maintenance IV fluids containing potassium chloride to maintain line patency

**Correct answer: 1**

## Explanation

Correct (2): IV phenytoin precipitates in dextrose-containing fluids — must use normal saline only. Max rate: 50 mg/min (25 mg/min in elderly/cardiac disease) to avoid hypotension, bradycardia, and arrhythmias. Continuous ECG and BP monitoring required. Use a large vein to minimize purple glove syndrome (extravasation → soft tissue ischemia). (1) D5W causes precipitation; 100 mg/min is dangerous. (3) Bolus push causes cardiac arrest. (4) Y-site KCl coadministration risks precipitation.

## In-depth explanation

Memory Tip Phenytoin IV = "Saline, Slow, Strong-vein, Strip (ECG)." Fosphenytoin is the safer alternative — water-soluble, faster infusion permitted, less local injury.

## Clinical scenario

Scenario 38-year-old in status epilepticus; provider orders phenytoin 1000 mg IV loading dose. The client has a dedicated 18-gauge antecubital IV.

## Key concepts

- **Purple glove syndrome** — Limb ischemia and discoloration from phenytoin extravasation; treat by stopping infusion and elevating the limb.
- **Fosphenytoin** — Water-soluble phenytoin prodrug; safer for IV/IM, allows faster infusion rate (150 mg PE/min).
- **Status epilepticus** — Continuous seizure activity >5 minutes or recurrent seizures without recovery; medical emergency requiring rapid anticonvulsant load.

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