A nurse is preparing to administer amphotericin B lipid complex via intermittent IV bolus to a client who has infective endocarditis. Which of the following actions should the nurse take?

Topiramate is a broad-spectrum anticonvulsantused for seizure control and migraine prophylaxis. It modulates voltage-gated sodium channels and enhances GABAergictransmission. For patients with dysphagia, the "sprinkle" formulation allows for oral administration without requiring the client to swallow a whole, large capsule shell.

Rationale:

A.Mixing the contents to be taken over several hours is incorrect because the entire dose must be consumed immediately to ensure therapeutic serum levels. Delayed consumption can lead to subtherapeutic dosing and an increased risk of breakthrough seizures. The nurse must supervise the administration to confirm that the full 25 mg dose is ingested in a single sitting.

B.Mixing the contents of the capsule in a spoonful of soft food, such as applesauce or pudding, is the recommended method for clients with difficulty swallowing. This technique ensures the medication is safely transported past the oropharynx without the risk of aspiration or choking. It is important that the food is not chewed, as the medication particles have a bitter taste.

C.Placing the contents on the tongue to dissolve is inappropriate for topiramate capsules. The medication is not formulated as an orally disintegrating tablet (ODT) and will not dissolve efficiently in the mouth. Furthermore, the taste of the undiluted medication is highly unpleasant and can cause mucosal irritation, leading to poor patient compliance and distress during administration.

D.Chewing the capsule or its contents is contraindicated because it can destroy the intended release profile and cause an immediate, unpleasant taste. Topiramate particles should be swallowed whole to avoid irritation of the mouth and throat. Chewing also increases the risk of the medication getting stuck in dental crevices, preventing the full dose from reaching the stomach for absorption.

Total parenteral nutritioncontains high concentrations of glucose, which stimulates the pancreas to secrete significant amounts of insulin. Abrupt cessation of this hypertonic solution can lead to a rapid drop in blood glucose levels, resulting in rebound hypoglycemia. Maintaining a consistent dextrose source is critical until the next TPN bag is prepared.

Rationale:

A.Dextrose 10% in water (D10W) is the appropriate fluid to administer because it provides enough glucose to prevent rebound hypoglycemia when TPN is unavailable. The patient's pancreas is primed to release high levels of insulin in response to the TPN; without a continued dextrose source, the patient's blood sugar will plummet. D10W serves as a temporary bridge to maintain glycemic stability.

B.0.9% sodium chloride is an isotonic solution that provides volume and electrolytes but contains no glucose. Administering this fluid alone would fail to prevent the severe hypoglycemia that occurs when the high-glucose TPN infusion is suddenly stopped. While it is useful for many clinical situations, it is inappropriate as a substitute for TPN in a patient requiring glucose maintenance.

C.0.45% sodium chloride is a hypotonic solution used for cellular dehydration and does not contain the calories or sugar necessary to counteract the patient's high insulin levels. Using this solution when TPN runs out would leave the patient vulnerable to symptomatic hypoglycemia and potential neurological complications. It is an inadequate substitute for the high dextrose concentration required by the patient's current metabolic state.

D.Lactated Ringer's is a balanced crystalloid solution used for fluid resuscitation and electrolyte replacement, but it contains negligible amounts of carbohydrate. It cannot maintain the blood glucose levels of a patient who has been receiving hypertonic TPN. The nurse must prioritize a dextrose-containing solution to avoid the life-threatening consequences of a sudden cessation of parenteral nutrition support.