# 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?

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> language: en  
> subject: Medication Administration  
> category: PPT

## Question

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?

## Option

1. Administer the first dose and reassess after three days.
2. Hold the dose and clarify a renal-adjusted regimen with the prescriber and pharmacist. **✔ Correct answer**
3. Give 600 mg once daily without obtaining a new order.
4. Administer the medication with an antacid to reduce accumulation.

**Correct answer: 2**

## 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.

## In-depth explanation

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

## Clinical scenario

Renal-dose check
Verify the current creatinine clearance, formulation, total daily dose, interval, indication, and prescriber-approved adjustment.

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