This statement is incorrect because grapefruit juice does not interact with phenytoin and has no effect on its metabolism or blood levels¹. The patient does not need to avoid grapefruit juice while taking phenytoin, unless they are also taking another drug that is affected by grapefruit juice, such as some statins, calcium channel blockers, or cyclosporine²³.

The other statements by the patient are correct and indicate an understanding of the teaching.

- Choice A is correct because the patient should brush their teeth gently with a soft toothbrush to prevent gingival hyperplasia, which is an overgrowth of the gums that can occur with phenytoin use. The patient should also floss regularly and visit a dentist every 3 to 4 months.

- Choice B is correct because the patient should wear a medical alert bracelet that says they have epilepsy and are taking phenytoin. This can help emergency personnel to provide appropriate care and avoid drug interactions if the patient has a seizure or another medical problem.

- Choice C is correct because the patient should check their blood pressure regularly while taking phenytoin, as this drug can cause hypotension, especially when given intravenously or in high doses. The patient should also monitor their heart rate and rhythm, as phenytoin can cause bradycardia or arrhythmias.

The nurse should respond by saying, "You should report these symptoms to your doctor as they may indicate toxicity." This is the correct answer because dizziness and tiredness are common side effects of gabapentin, but they may also be signs of toxicity if they are severe or persistent¹². The nurse should also ask the patient about their dose and frequency of gabapentin, and check their blood levels if possible³. The nurse should advise the patient not to stop or change their dose of gabapentin without consulting their doctor, as this can cause withdrawal symptoms or seizures¹².

The other statements by the nurse are incorrect and indicate a need for further education.

- Saying, "You should stop taking the drug and ask your doctor for something else." is wrong because the nurse should not advise the patient to stop taking gabapentin abruptly, as this can cause withdrawal symptoms or seizures. The nurse should also not suggest alternative drugs without knowing the patient's medical history, allergies, or other medications¹².

- Saying, "You should increase your dose until you get relief from your pain." is wrong because the nurse should not advise the patient to increase their dose of gabapentin without consulting their doctor, as this can cause toxicity or adverse effects. The nurse should also not imply that gabapentin is ineffective for neuropathic pain, as it is one of the first-line drugs for this condition⁴.

- Saying, "You should continue taking the drug as prescribed and avoid driving or operating machinery." is partially correct, but not the best response. The nurse should advise the patient to continue taking gabapentin as prescribed and avoid driving or operating machinery until they know how the drug affects them, but they should also report their symptoms to their doctor as they may indicate toxicity¹².

D. Monitor the patient's respiratory rate and oxygen saturation during and after the drug administration.

The action that the nurse should take is choice D. Monitor the patient's respiratory rate and oxygen saturation during and after the drug administration. This is an important action because phenobarbital is a barbiturate that can cause respiratory depression, especially when given intravenously²³. The nurse should monitor the patient's respiratory rate and oxygen saturation and be prepared to provide respiratory support if needed²³.

The other actions by the nurse are incorrect and indicate a need for further education.

- Choice A is wrong because the nurse should not dilute the drug in normal saline solution, but rather in water for injection. Normal saline is not compatible with phenobarbital and can cause precipitation or crystallization of the drug¹². The nurse should dilute each 1 mL injection solution to 10 mL with water for injection before administration¹.

- Choice B is wrong because the nurse should not flush the IV line with dextrose solution before and after the drug administration, but rather with water for injection. Dextrose is not compatible with phenobarbital and can cause precipitation or crystallization of the drug¹². The nurse should flush the IV line with water for injection before and after administration to prevent drug interactions and ensure complete delivery of the medication¹.

- Choice C is wrong because the nurse should not give the drug by rapid IV push over 10 to 20 seconds, but rather slowly over at least 3 minutes. Rapid IV administration of phenobarbital can cause severe respiratory depression, apnea, laryngospasm, hypertension or vasodilation with hypotension²³. The maximum rate of injection is 30 mg/minute in children and 60 mg/minute in adults³.