This action is necessary to prevent the formation of precipitates in the IV line, which can cause thrombophlebitis or embolism. The other actions are incorrect for the following reasons:

- A. "Flush the IV line with normal saline before and after giving phenytoin". This action is correct, but not sufficient to prevent precipitation. Phenytoin is incompatible with many IV solutions and drugs, so it should be given in a separate line or flushed thoroughly with normal saline before and after administration.

- B. "Mix phenytoin with dextrose solution in a syringe". This action is incorrect because phenytoin is incompatible with dextrose solution and will form a precipitate. Phenytoin should only be diluted with normal saline.

- C. "Give phenytoin as a bolus over 1 minute". This action is incorrect because phenytoin should be given slowly, at a rate of no more than 50 mg/min, to avoid hypotension and cardiac arrhythmias.

This statement is incorrect because ibuprofen may interact with lamotrigine and increase the risk of side effects such as dizziness, drowsiness, confusion, and difficulty concentrating¹². A clinical study found that common interactions between lamotrigine and ibuprofen include gait disturbance among females and insomnia among males². The patient should avoid taking ibuprofen while on lamotrigine and consult their doctor for alternative pain relief options. The other statements are correct for the following reasons:

- A. "I will wear sunscreen and protective clothing when I go outside". This statement is correct because lamotrigine can make the skin more sensitive to sunlight and increase the risk of sunburns and rashes. The patient should protect their skin from sun exposure while taking this medication.

- C. "I will report any changes in my vision or mood to my doctor". This statement is correct because lamotrigine can cause vision problems such as blurred vision, double vision, or eye irritation, as well as mood changes such as depression, anxiety, or suicidal thoughts. The patient should monitor their vision and mood and report any changes to their doctor promptly.

- D. "I will not stop taking my medication abruptly". This statement is correct because stopping lamotrigine suddenly can cause withdrawal symptoms such as seizures, headaches, nausea, or insomnia. The patient should follow their doctor's instructions on how to taper off the medication gradually if they need to stop taking it.

This instruction is important because valproic acid can cause nausea, vomiting, stomach pain, and diarrhea as common side effects³⁴. Taking the medication with food can help reduce these gastrointestinal symptoms and improve the patient's tolerance and adherence to the treatment. The other choices are incorrect for the following reasons:

- B. "Avoid driving until the medication level is therapeutic". This instruction is unnecessary because valproic acid does not impair driving performance or increase the risk of accidents¹. The patient can drive safely as long as they do not experience drowsiness, dizziness, or blurred vision from the medication.

- C. "Drink at least 3 L of fluid per day". This instruction is excessive because valproic acid does not cause dehydration or fluid loss¹. The patient should drink enough fluids to stay hydrated, but not more than their normal intake.

- D. "Report any bruising or bleeding to the provider". This instruction is irrelevant because valproic acid does not affect blood clotting or increase the risk of bleeding¹. The patient should report any bruising or bleeding to the provider only if they have other conditions or medications that may cause these problems.

This action takes priority because the patient's head is at risk of hitting the bed, the side rails, or other objects during a seizure, which can cause trauma, bleeding, or brain damage . The nurse should place a soft pad or pillow under the patient's head and move any sharp or hard objects away from the bed. The other choices are incorrect for the following reasons:

- A. "Loosening restrictive clothing". This action is helpful but not urgent because restrictive clothing can interfere with breathing or circulation during a seizure, but it is not a life-threatening issue . The nurse can loosen the patient's clothing after protecting their head and ensuring their airway is clear.

- B. "Restraining the client's limbs". This action is harmful and contraindicated because restraining the patient's limbs can cause injury, pain, or fractures during a seizure, as well as increase their anxiety and agitation . The nurse should never restrain a patient who is having a seizure, but rather let them move freely and safely.

- C. "Removing pillows and raising side rails". This action is unnecessary and potentially dangerous because removing pillows can expose the patient's head to injury, and raising side rails can trap the patient's limbs or body between them during a seizure . The nurse should keep pillows under the patient's head and lower the side rails if possible.

This statement accurately describes the action of amantadine, which is a medication that has both antiviral and antiparkinsonian effects. The mechanism of action of amantadine in the treatment of parkinsonism is not fully understood, but it may involve increasing dopamine release in the brain, stimulating norepinephrine response, or activating dopaminergic receptors¹². The other choices are incorrect for the following reasons:

- B. "Dopamine in the central nervous system is decreased". This statement is incorrect because amantadine does not decrease dopamine levels, but rather enhances them. Decreasing dopamine levels would worsen the symptoms of parkinsonism, which are caused by a deficiency of dopamine in the basal ganglia.

- C. "Acetylcholine in the central nervous system is increased". This statement is incorrect because amantadine does not affect acetylcholine levels or activity. Acetylcholine is another neurotransmitter that is involved in the regulation of movement and cognition. Increasing acetylcholine levels would have anticholinergic effects, such as dry mouth, blurred vision, constipation, and confusion.

- D. "Acetylcholine in the central nervous system is decreased". This statement is incorrect because amantadine does not affect acetylcholine levels or activity. Decreasing acetylcholine levels would have cholinergic effects, such as salivation, lacrimation, urination, and diarrhea.

This statement indicates that the client understands that lamotrigine can cause a serious adverse reaction called aseptic meningitis, which is an inflammation of the membranes that cover the brain and spinal cord. Aseptic meningitis can cause symptoms such as fever, headache, stiff neck, sore throat, nausea, vomiting, and sensitivity to light¹². The client should report any signs of aseptic meningitis to their provider immediately, as it may require discontinuation of lamotrigine and medical attention¹². The other statements are incorrect for the following reasons:

- A. "Blurred vision". This statement is incorrect because blurred vision is a common and usually mild side effect of lamotrigine that does not require reporting to the provider unless it is severe or persistent¹². Blurred vision may improve over time as the client adjusts to the medication¹².

- B. "Headache". This statement is incorrect because headache is a common and usually mild side effect of lamotrigine that does not require reporting to the provider unless it is severe or persistent¹². Headache may improve over time as the client adjusts to the medication¹².

- D. "Nausea". This statement is incorrect because nausea is a common and usually mild side effect of lamotrigine that does not require reporting to the provider unless it is severe or persistent¹². Nausea may improve over time as the client adjusts to the medication¹².

This instruction is important because gabapentin can cause drowsiness, dizziness, or blurred vision as common side effects¹². These effects can impair the client's ability to drive safely and increase the risk of accidents or injuries. The client should avoid driving or operating machinery until they know how gabapentin affects them and their doctor says it is safe to do so¹². The other instructions are incorrect for the following reasons:

- A. "Take this medication with food or milk to prevent gastric irritation". This instruction is unnecessary because gabapentin does not cause gastric irritation or ulcers as a side effect¹². The client can take gabapentin with or without food, depending on their preference and tolerance¹².

- C. "Increase your intake of fluids and fiber to prevent constipation". This instruction is irrelevant because gabapentin does not cause constipation as a side effect¹². The client should maintain a normal intake of fluids and fiber to promote bowel health, but not specifically because of gabapentin use¹².

- D. "Discontinue this medication gradually to prevent withdrawal symptoms". This instruction is incorrect because gabapentin does not cause withdrawal symptoms or physical dependence as a side effect¹². However, the client should not stop taking gabapentin suddenly or without their doctor's advice, as this can increase the risk of seizures or other complications¹².

This is because phenytoin, a medication used to control seizures, may cause gingival hyperplasia or overgrowth of the gums¹. This can lead to tenderness, swelling, or bleeding of the gums. The condition is more common in patients taking phenytoin, cyclosporine, or calcium channel blockers¹. The etiology of phenytoin-induced gingival enlargement is likely due to the direct effects of the drug and its metabolites on the gingival fibroblasts¹. Patients can benefit from controlling the inflammatory component through an appropriate oral hygiene program¹. Referral to a general dentist or periodontist is appropriate for management¹.

Choice A is wrong because flossing his teeth regularly may not prevent or reduce the gingival overgrowth caused by phenytoin. Flossing may also aggravate the bleeding of the gums.

Choice B is wrong because serum drug levels may not correlate with the extent of gingival overgrowth. Some studies do not support the concept that the dose, duration, and plasma levels of phenytoin affect the severity of gingival enlargement².

Choice C is wrong because this is not a harmless side effect of phenytoin. Gingival overgrowth may interfere with speech, mastication, tooth eruption and aesthetics². It may also increase the risk of periodontal disease and infection³.

This is because phenytoin, a medication used to treat seizures, can cause a rare but serious side effect called “purple glove syndrome” when administered intravenously². This condition is characterized by worsening limb edema and discoloration that may result from the crystallization of phenytoin within the blood². It can lead to skin necrosis and limb ischemia, requiring amputation in severe cases². Therefore, the nurse should stop the infusion immediately, remove the IV line, and report the adverse reaction to the provider. The patient may need surgical intervention or other treatments to prevent further complications².

Choice A is wrong because applying warm compresses and slowing the infusion rate may not prevent or reverse the damage caused by phenytoin infiltration. In fact, it may worsen the condition by increasing the blood flow to the affected area and prolonging the exposure to the drug².

Choice C is wrong because requesting an order for intravenous fosphenytoin instead of phenytoin may not be appropriate or necessary at this point. Fosphenytoin is a prodrug of phenytoin that has some advantages over phenytoin, such as better solubility, faster infusion rate, and fewer cardiovascular complications⁷. However, it is not indicated for the treatment of purple glove syndrome or phenytoin infiltration. Moreover, fosphenytoin may still cause some adverse effects, such as hypotension, pruritus, rash, and paresthesia⁶. Therefore, the nurse should focus on managing the current situation rather than switching to another drug.

Choice D is wrong because stopping the infusion temporarily and administering an antihistamine may not be effective or sufficient for treating phenytoin infiltration. Purple glove syndrome is not an allergic reaction, but a local tissue injury caused by phenytoin crystallization². Therefore, an antihistamine may not have any benefit for this condition. Stopping the infusion temporarily may not prevent further damage to the tissue or blood vessels. The nurse should discontinue the IV line completely and notify the provider as soon as possible.

This is because phenobarbital, a medication used to treat seizures, can cause serious side effects on the respiratory system, such as weak or shallow breathing, apnea, respiratory arrest, and death². Respiratory depression is more likely to occur in patients who are elderly, debilitated, or have underlying lung disease². The nurse should monitor the patient's respiratory rate, oxygen saturation, and level of consciousness, and be prepared to administer oxygen or mechanical ventilation if needed³.

Choice B is wrong because hyperglycemia is not a common or serious adverse effect of phenobarbital. Phenobarbital does not affect blood glucose levels directly, but it may interfere with the metabolism of some oral antidiabetic drugs, such as sulfonylureas. Therefore, patients who take both phenobarbital and antidiabetic drugs may need to adjust their doses or monitor their blood glucose more frequently.

Choice C is wrong because hypertension is not a common or serious adverse effect of phenobarbital. Phenobarbital may cause hypotension or orthostatic hypotension in some patients, especially when given intravenously or in high doses². The nurse should monitor the patient's blood pressure and heart rate, and avoid sudden changes in position³.

Choice D is wrong because insomnia is not a common or serious adverse effect of phenobarbital. Phenobarbital is a barbiturate that has sedative and hypnotic properties. It may cause drowsiness, dizziness, lethargy, and impaired cognition in some patients². The nurse should advise the patient to avoid driving or operating machinery while taking phenobarbital, and to avoid alcohol and other CNS depressants³.

Skin rash is an adverse effect of ethosuximide (Zarontin) that should be reported to the provider¹. Ethosuximide can cause allergic reactions, such as hives, itching, and skin rash, in some people¹. A skin rash may indicate a serious condition, such as Stevens-Johnson syndrome or toxic epidermal necrolysis, which can be life-threatening¹.

Choice A is wrong because blurred vision is not a common side effect of ethosuximide. Ethosuximide is not known to affect vision or eye health¹.

Choice B is wrong because gingival hyperplasia is not a common side effect of ethosuximide. Ethosuximide is not known to cause overgrowth of the gums or dental problems¹. Gingival hyperplasia is more commonly associated with other anticonvulsants, such as phenytoin (Dilantin)².

Choice D is wrong because constipation is not a common side effect of ethosuximide. Ethosuximide may cause gastrointestinal side effects, such as nausea, vomiting, stomach pain, and loss of appetite, but not constipation¹³. Constipation is more commonly associated with other anticonvulsants, such as carbamazepine (Tegretol)⁴.

Phenytoin (Dilantin) can cause overgrowth of gum tissue, also known as gingival hyperplasia, in some people¹. This can lead to swelling, bleeding, and infection of the gums¹. Good oral hygiene, such as brushing, flossing, and using mouthwash, can help prevent or reduce gum problems¹. The client should also see the dentist regularly for check-ups and cleaning¹.

Choice A is wrong because the client should not stop taking phenytoin without consulting the provider. Stopping phenytoin suddenly can increase the risk of seizures or status epilepticus, which is a life-threatening condition¹. If the client wants to switch to another anticonvulsant medication, the provider should advise on how to do so safely and gradually¹.

Choice B is wrong because the client should not reduce the dose of phenytoin without consulting the provider. Reducing the dose of phenytoin can lower the blood level of the medication and make it less effective in controlling seizures¹. The provider should monitor the blood level of phenytoin and adjust the dose accordingly¹.

Choice D is wrong because the client should not take ibuprofen (Motrin) or aspirin (Ecotrin) to relieve the inflammation and pain in the gums. These medications are nonsteroidal anti-inflammatory drugs (NSAIDs) that can interact with phenytoin and increase its blood level and side effects². They can also increase the risk of bleeding, especially in people with low platelet count or clotting problems². The client should consult the provider before taking any other medications with phenytoin¹.

Phenytoin (Dilantin) can cause cosmetic side effects, such as coarse facial features, hirsutism, and acne, in some people¹²³. These side effects can affect the client's self-esteem, social interactions, and emotional well-being¹. The nurse should assess the client's perception of his or her appearance and provide support and education to cope with the changes¹.

Choice A is wrong because risk for infection related to immunosuppression is not a relevant nursing diagnosis for this client. Phenytoin can cause blood dyscrasias, such as leukopenia and thrombocytopenia, in some people¹²³. However, these side effects are not related to immunosuppression and do not increase the risk of infection¹. The nurse should monitor the client's blood counts and report any signs of bleeding or anemia to the provider¹.

Choice C is wrong because impaired skin integrity related to hypersensitivity reaction is not a relevant nursing diagnosis for this client. Phenytoin can cause allergic reactions, such as rash, fever, lymphadenopathy, and hepatitis, in some people¹²³. However, these side effects are not related to impaired skin integrity and do not cause skin breakdown or ulceration¹. The nurse should discontinue the medication and report any signs of hypersensitivity reaction to the provider¹.

Choice D is wrong because deficient knowledge related to self-care and medication management is not a relevant nursing diagnosis for this client. Phenytoin requires careful monitoring and education to ensure therapeutic and safe use¹²³. However, this nursing diagnosis does not address the client's specific concern about the cosmetic side effects of phenytoin¹. The nurse should provide information and counseling about the benefits and risks of phenytoin therapy and discuss alternative options with the provider if needed¹.