The correct answer is choice:

B. Instruct the client to use a soft toothbrush and floss gently. This is because phenytoin can cause gingival hyperplasia, which is an enlargement of the gums due to an increase in the number of cells or the size of the gingiva³. This condition can be prevented or minimized by maintaining good oral hygiene and avoiding trauma to the gums².

Choice A is wrong because advising the client to stop taking phenytoin and report to the doctor is not appropriate. Phenytoin is an anticonvulsant medication that is used to treat epileptic seizures, and stopping it abruptly can cause withdrawal symptoms or seizure recurrence¹. The client should not stop taking phenytoin without consulting their doctor, who may adjust the dose or switch to another medication if needed.

Choice C is wrong because administering an oral antiseptic rinse to the client is not effective for treating gingival hyperplasia. Oral antiseptic rinses are used to reduce plaque and bacteria in the mouth, but they do not address the underlying cause of gingival hyperplasia, which is a defect in collagen metabolism³. Oral antiseptic rinses may also have adverse effects such as staining the teeth, altering the taste, or causing mouth irritation².

Choice D is wrong because referring the client to a dentist for evaluation and treatment is not the most appropriate action for the nurse to take. Although a dentist can help diagnose and manage gingival hyperplasia, the nurse should first educate the client about the importance of oral hygiene and instruct them on how to care for their gums. The nurse should also monitor the client's condition and report any changes or complications to the doctor. A dentist referral may be indicated if the gingival hyperplasia is severe or does not respond to oral hygiene measures².

This statement indicates a need for further teaching because phenytoin and phenobarbital are not effective for treating absence seizures, which are a type of generalized onset seizure that cause brief lapses in awareness, such as blank staring¹. Phenytoin and phenobarbital are narrow-spectrum anticonvulsants that are mainly used for focal seizures, which begin in one area of the brain². Taking these medications for absence seizures may worsen the condition or cause adverse effects.

The other statements are correct and do not indicate a need for further teaching.

Choice A is correct because carbamazepine and valproic acid are both effective for treating partial seizures, which are a type of focal seizure that may or may not affect awareness².

Choice B is correct because phenobarbital and lamotrigine are both effective for treating generalized tonic-clonic seizures, which are a type of generalized onset seizure that cause muscle stiffness and jerking movements².

Choice D is correct because valproic acid and levetiracetam are both effective for treating myoclonic seizures, which are a type of generalized onset seizure that cause brief jerking movements². Choice E is correct because lamotrigine and topiramate are both effective for treating atonic seizures, which are a type of generalized onset seizure that cause sudden loss of muscle tone².

This means that the drug has leaked out of the vein and into the surrounding tissue, causing inflammation, pain, and tissue damage⁵⁶. Phenytoin is a known vesicant, which means it can cause severe skin reactions when extravasated⁵. The clinical manifestation of phenytoin extravasation is called purple glove syndrome (PGS), which is characterized by a purplish to black discoloration of the extremity followed by peripheral edema and pain distal to the site of infusion¹².

Choice A is wrong because the client is not having an allergic reaction to phenytoin. An allergic reaction would cause symptoms such as rash, itching, hives, swelling of the face or throat, difficulty breathing, or anaphylaxis⁷. The client's symptoms are localized to the hand and are consistent with extravasation, not allergy.

Choice B is wrong because the client is not developing purple glove syndrome. Purple glove syndrome is the name of the condition caused by phenytoin extravasation, not a separate entity¹². The client already has purple glove syndrome as a result of the extravasation.

Choice D is wrong because the client is not developing thrombophlebitis. Thrombophlebitis is inflammation of a vein caused by a blood clot, usually in the legs⁸⁹. Thrombophlebitis can cause symptoms such as

This is because anticonvulsants are essential for preventing seizures, which can be harmful for both the mother and the baby¹. Stopping or changing anticonvulsants without medical supervision can increase the risk of seizure recurrence or withdrawal symptoms¹. The doctor can monitor the blood levels of anticonvulsants and adjust the dose if needed, as well as prescribe folic acid supplements to reduce the risk of neural tube defects¹².

Choice A is wrong because advising the client to stop taking their anticonvulsants as soon as they find out that they are pregnant is not appropriate. As mentioned above, stopping anticonvulsants abruptly can cause seizures or withdrawal symptoms, which can be dangerous for both the mother and the baby¹. The client should not stop taking their anticonvulsants without consulting their doctor, who can weigh the benefits and risks of continuing or discontinuing the medication¹.

Choice C is wrong because advising the client to switch to a different type of anticonvulsant that is safer for their baby is not appropriate. There is no single anticonvulsant that is safe for all types of seizures and all stages of pregnancy². Some anticonvulsants may have a lower risk of teratogenicity than others, but they may also have different efficacy and side effects². The choice of anticonvulsant depends on several factors, such as the type and frequency of seizures, the previous response to medication, the presence of comorbidities, and the potential interactions with other drugs². The client should not switch to a different anticonvulsant without consulting their doctor, who can determine the best option for their individual case².

Choice D is wrong because advising the client to reduce their dose of anticonvulsants gradually until they deliver their baby is not appropriate. Reducing the dose of anticonvulsants can increase the risk of seizure recurrence, which can be harmful for both the mother and the baby¹. The dose of anticonvulsants should be based on the blood levels and clinical response of the client, not on a fixed schedule¹. The client should not reduce their dose of anticonvulsants without consulting their doctor, who can monitor their condition and adjust the dose if needed¹.

This is because documenting the seizure activity is important for assessing the type, frequency, and severity of seizures, as well as the response to treatment¹. The nurse should note the time of onset and termination of the seizure, the body parts involved, the level of consciousness, the presence of aura or prodrome, the type and pattern of movements, the eye deviation or blinking, the vocalization or breathing changes, the incontinence or salivation, and any postictal symptoms¹².

Choice A is wrong because administering oxygen via nasal cannula is not necessary for a client who has a simple focal seizure. A simple focal seizure is a type of seizure that affects only one part of the brain and does not impair awareness or consciousness³. The client may experience sensory, motor, autonomic, or psychic symptoms, but they do not have generalized convulsions or respiratory compromise³. Oxygen therapy is indicated for clients who have generalized tonic-clonic seizures or status epilepticus, which can cause hypoxia or apnea¹².

Choice C is wrong because inserting an oral airway to prevent tongue biting is not appropriate for a client who has a simple focal seizure. An oral airway is a device that is inserted into the mouth to keep the tongue from blocking the airway and to facilitate ventilation⁴. An oral airway should not be used for clients who are conscious or have a gag reflex, as it can cause injury, vomiting, or aspiration⁴. A client who has a simple focal seizure is fully alert and conscious and does not need an oral airway³. Tongue biting is rare in simple focal seizures and more common in generalized tonic-clonic seizures.

Choice D is wrong because restraining the client's limbs to prevent injury is not appropriate for a client who has a simple focal seizure. Restraining a client during a seizure can cause more harm than good, as it can increase agitation, prolong the seizure, or cause fractures or dislocations¹². A client who has a simple focal seizure may have involuntary movements of one part of the body, such as twitching or jerking of an arm or leg³. The nurse should not restrain these movements but rather protect the client from hitting any hard or sharp objects¹².

Nystagmus is a sign of phenytoin toxicity, which is caused by overdose, dosage changes, drug interactions, or physiological alterations. Nystagmus is a rapid, involuntary movement of the eyes, which can impair vision and balance. Nystagmus can occur at phenytoin levels above 20 mcg/mL¹².

Choice B is wrong because bradycardia, or slow heart rate, is not a common sign of phenytoin toxicity. Bradycardia can occur in rare cases of phenytoin overdose, especially if the drug is given intravenously too fast¹⁵. However, it is not a reliable indicator of phenytoin toxicity.

Choice C is wrong because hypertension, or high blood pressure, is not a sign of phenytoin toxicity. Hypertension can occur in some patients with seizures, but it is not related to phenytoin levels. Normal blood pressure ranges are less than 120/80 mm Hg for adults⁷⁹.

Choice D is wrong because hyperreflexia, or increased reflexes, is not a sign of phenytoin toxicity. Hyperreflexia can occur in some neurological disorders, such as multiple sclerosis or spinal cord injury, but it is not associated with phenytoin levels. Normal reflexes are graded from 0 to 4+, with 2+ being the average.

Corpus callosotomy is a surgical procedure that involves cutting the corpus callosum, the band of nerve fibers that connects the two hemispheres of the brain. This surgery aims to reduce the frequency and severity of generalized seizures, especially drop attacks, by preventing the spread of epileptic activity from one side of the brain to the other²³. After surgery, it is important to monitor the patient's neurologic status, including level of consciousness, pupillary response, motor function, and sensory function, to detect any complications or changes in seizure activity¹².

Choice B is wrong because prophylactic antibiotics are not routinely given before corpus callosotomy. Antibiotics may be used to treat infections that occur after surgery, such as meningitis or wound infection, but they are not indicated for prevention¹².

Choice C is wrong because instructing the patient to avoid coughing or sneezing after surgery is not a specific intervention for corpus callosotomy. Coughing or sneezing may increase intracranial pressure and cause discomfort, but they are not likely to affect the outcome of the surgery or cause complications¹².

Choice D is wrong because elevating the head of the bed to 45 degrees after surgery is not recommended for corpus callosotomy. Elevating the head of the bed may help reduce cerebral edema and improve venous drainage, but it may also increase the risk of bleeding or air embolism¹². The optimal position for the patient after corpus callosotomy is supine with the head in a neutral position¹².

An EEG is a test that records the electrical activity of your brain using electrodes attached to your scalp¹². The test is usually done while you are awake, but relaxed and still, for about 30 to 60 minutes¹. You may be asked to close your eyes, breathe deeply, or look at a flashing light during the test to see how your brain responds to different stimuli¹².

Choice A is wrong because the test will not be done while you are asleep. An EEG can be done while you are asleep in some cases, such as when you have sleep disorders or nocturnal seizures, but this is not the standard procedure¹². You may be asked to stay awake the night before the test if you need to have an EEG while you are asleep¹.

Choice C is wrong because the test will not be done while you are under general anesthesia. General anesthesia is not needed for an EEG, as it is a non-invasive and painless test¹². General anesthesia may interfere with the brain activity that the EEG is trying to measure³.

Choice D is wrong because the test will not be done while you are sedated. Sedation is not usually required for an EEG, as it is a simple and safe test¹². Sedation may also affect the brain activity that the EEG is trying to record³. Sedation may be used in some cases, such as when children are unable to stay still or cooperate during the test⁴.

Provocation refers to methods that may trigger or enhance epileptic activity in the brain, such as hyperventilation, photic stimulation, sleep deprivation, or cognitive tasks¹². Provocation can help diagnose photosensitive epilepsy, absence seizures, or other types of seizures that may not occur spontaneously during the EEG¹². However, provocation is not always necessary or feasible, depending on the patient's condition and the purpose of the EEG¹².

Video recording refers to capturing the patient's behavior and movements during the EEG, which can help correlate the clinical manifestations with the electrical activity of the brain³⁴. Video recording can help differentiate epileptic seizures from nonepileptic events, identify the type and onset of seizures, and evaluate the response to treatment³⁴. However, video recording is not always available or required, depending on the setting and the indication of the EEG³⁴.

Choice B is wrong because the EEG cannot be done with different electrode arrangements. The EEG electrode placement follows the International 10-20 system, which is a standardized method to describe and apply the location of scalp electrodes based on anatomical landmarks and proportional distances⁵⁶. The 10-20 system ensures consistency and reproducibility of EEG recordings across different centers and studies⁵⁶.

Choice C is wrong because the EEG cannot be done with contrast. Contrast is a substance that enhances the visibility of structures or fluids within the body in imaging tests, such as CT scan or MRI scan⁷⁸. Contrast is not used in EEG, as it is a non-invasive and painless test that measures electrical activity in the brain using electrodes attached to the scalp⁷⁸.

Choice D is wrong because the EEG is usually done without sedation. Sedation is not routinely required for EEG, as it is a simple and safe test that does not cause pain or discomfort⁷⁸. Sedation may also affect the electrical activity of the brain that the EEG is trying to measure⁹. Sedation may be used in some cases, such as when children are unable to stay still or cooperate during the test, or when sleep-deprived EEG is needed

This statement by the patient indicates a need for further teaching, as it is incorrect and shows a misunderstanding of the EEG procedure.

An EEG is a test that records the electrical activity of your brain using electrodes attached to your scalp . The test does not involve any injection of dye or contrast, as it is not an imaging test that requires enhancing the visibility of structures or fluids within the body . The test is non-invasive and painless, and does not expose you to any radiation or harmful substances .

Choice A is wrong because "I may need to hyperventilate during the test." This statement by the patient is correct and does not indicate a need for further teaching. Hyperventilation is a method of provocation that may be used during the EEG to trigger or enhance epileptic activity in the brain . Hyperventilation involves breathing deeply and rapidly for a few minutes, which can lower the carbon dioxide level in the blood and cause changes in the brain's electrical activity .

Choice B is wrong because "I may need to have flashing lights during the test." This statement by the patient is correct and does not indicate a need for further teaching. Photic stimulation is another method of provocation that may be used during the EEG to trigger or enhance epileptic activity in the brain . Photic stimulation involves exposing the patient to a flashing light of varying frequency and intensity, which can stimulate the visual cortex and cause changes in the brain's electrical activity .

Choice D is wrong because "I may need to have sleep deprivation before the test." This statement by the patient is correct and does not indicate a need for further teaching. Sleep deprivation is a condition that may be required before the EEG to increase the likelihood of detecting abnormal brain activity or seizures . Sleep deprivation involves staying awake for most or all of the night before the test, which can alter the brain's electrical activity and make it more sensitive to provocation methods .

This statement indicates a need for further teaching because sleep deprivation is not required for an MRI scan of the brain. Sleep deprivation is sometimes used for an electroencephalogram (EEG) test, which measures the electrical activity of the brain, but not for an MRI, which uses magnetic fields and radio waves to produce images of the brain.

Choice A is wrong because the patient may need to have an injection of dye or contrast during the test. This can help enhance the visibility of certain structures or abnormalities in the brain¹².

Choice B is wrong because the patient may need to have flashing lights during the test. This is part of a functional MRI (fMRI) of the brain, which can measure the metabolic changes in the brain when the patient performs certain tasks¹.

Choice D is wrong because it is similar to choice A. Contrast and dye are different terms for the same substance that can be injected during an MRI scan².

To prepare for an MRI scan of the brain, the patient should not eat or drink anything for four hours prior to the exam, and should not wear any metal objects, such as jewelry, hairpins, or eye makeup³⁴⁵. The patient should also inform the medical staff if they have any metal implants or devices in their body, such as pacemakers, artificial joints, or aneurysm clips¹⁴.

This instruction is incorrect and should not be provided to the patient, because an MRI scan of the brain does not measure the electrical activity of the brain or use electrodes. This is a description of an electroencephalogram (EEG) test, which is a different procedure¹².

Choice A is wrong because it is a correct instruction that the nurse can provide to the patient. The MRI can reveal structural abnormalities or lesions that may cause seizures, such as tumors, strokes, infections, or malformations¹².

Choice B is wrong because it is also a correct instruction that the nurse can provide to the patient. The MRI can detect abnormal patterns or discharges that indicate seizure activity, especially if it is a functional MRI (fMRI) that can measure the metabolic changes in the brain when the patient performs certain tasks¹².

Choice D is wrong because it is partly correct and partly incorrect. The MRI can be done in a clinic or hospital, depending on the purpose and duration of the test, but not at home¹³. MRI machines are large and expensive devices that require special facilities and trained staff to operate them¹.

The nurse should monitor the client for gingival hyperplasia, which is an overgrowth of the gums that can occur as an adverse effect of phenytoin¹². Gingival hyperplasia can cause bleeding, inflammation, and infection of the gums, and may interfere with chewing and oral hygiene¹². The nurse should advise the client to brush and floss their teeth regularly, and to see a dentist for regular check-ups and cleaning¹².

Choice B is wrong because hypertension, or high blood pressure, is not a common or serious adverse effect of phenytoin¹³. Phenytoin may actually lower blood pressure in some cases, especially when given intravenously¹⁴. The nurse should monitor the client's blood pressure before and during phenytoin therapy, and report any significant changes to the prescriber¹⁴.

Choice C is wrong because diarrhea is not a common or serious adverse effect of phenytoin¹³. Phenytoin may cause constipation in some people, which can be relieved by increasing fluid and fiber intake, and using laxatives if needed¹⁵. The nurse should ask the client about their bowel habits and provide appropriate interventions as needed¹⁵.

Choice D is wrong because tachycardia, or fast heart rate, is not a common or serious adverse effect of phenytoin¹³. Phenytoin may cause bradycardia, or slow heart rate, in some cases, especially when given intravenously or in high doses¹⁴. The nurse should monitor the client's heart rate and rhythm before and during phenytoin therapy, and report any significant changes to the prescriber¹⁴.

- **"I should stop taking these medications if I have a rash or fever."** This statement is incorrect and indicates a need for further teaching because the client should not stop taking anticonvulsant medications abruptly, as this can cause withdrawal symptoms and increase the risk of seizures¹². The client should contact their healthcare provider if they have a rash or fever, as these could be signs of an allergic reaction or infection, but they should not stop the medication without medical advice¹².

- **"I should have my blood levels checked regularly to make sure I am taking the right dose."** This statement is correct for some anticonvulsant medications, such as phenytoin, carbamazepine, and valproate, but not for others, such as levetiracetam, lamotrigine, and gabapentin¹³. The client should ask their healthcare provider which medications require blood level monitoring and how often they need to have it done¹³.

The other statements by the client are correct and do not indicate a need for further teaching:

- **"I should avoid drinking alcohol while taking these medications."** This statement is correct because alcohol can interact with anticonvulsant medications and increase their side effects, such as drowsiness, dizziness, and impaired coordination¹². Alcohol can also lower the seizure threshold and trigger seizures in some people¹².

- **"I should take these medications at the same time every day."** This statement is correct because taking anticonvulsant medications at the same time every day helps maintain a steady level of the drug in the blood and prevent seizures¹². The client should follow the prescribed schedule and dosage of their medication and not miss or skip any doses¹².

- **"I should not drive or operate heavy machinery until I know how these medications affect me."** This statement is correct because anticonvulsant medications can cause side effects that impair the client's ability to drive or operate heavy machinery, such as blurred vision, confusion, fatigue, and poor

The correct answer is choice

A. "It blocks sodium channels in your brain cells, which reduces their excitability and prevents seizures."

The nurse should say: "Carbamazepine works by blocking sodium channels in your brain cells, which reduces their excitability and prevents seizures." This is the most accurate and simple explanation of the mechanism of action of carbamazepine⁴.

The other choices are incorrect and should not be said by the nurse:

- **"It enhances the activity of GABA in your brain, which inhibits the transmission of nerve impulses and prevents seizures."** This is not how carbamazepine works. This is a description of the mechanism of action of some other anticonvulsants, such as benzodiazepines and barbiturates¹².

- **"It modulates the activity of NMDA receptors in your brain, which reduces the influx of calcium and prevents seizures."** This is not how carbamazepine works. This is a description of the mechanism of action of some other anticonvulsants, such as felbamate and topiramate¹².

- **"It facilitates the opening of potassium channels in your brain cells, which stabilizes their membrane potential and prevents seizures."** This is not how carbamazepine works. This is a description of the mechanism of action of some other anticonvulsants, such as ezogabine and retigabine¹².

Valproic acid can interact with warfarin and increase the risk of bleeding by inhibiting the metabolism of warfarin and displacing it from plasma protein binding sites¹. The nurse should monitor the client's international normalized ratio (INR) and prothrombin time (PT) and adjust the warfarin dose accordingly.

Choice B. Metformin is wrong because valproic acid does not have a significant interaction with metformin. Metformin is an oral antidiabetic drug that lowers blood glucose levels by decreasing hepatic glucose production and increasing insulin sensitivity².

Choice C. Ibuprofen is wrong because valproic acid does not have a significant interaction with ibuprofen. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation, pain, and fever by inhibiting cyclooxygenase enzymes².

Choice D. Levothyroxine is wrong because valproic acid does not have a significant interaction with levothyroxine. Levothyroxine is a synthetic thyroid hormone that replaces the deficient endogenous hormone in hypothyroidism².

Choice A is correct because diazepam is a benzodiazepine that can cause respiratory depression, especially when given intravenously. The nurse should monitor the client's respiratory rate and oxygen saturation and be prepared to provide respiratory support if needed²⁴.

- Choice B is correct because diazepam should be diluted with normal saline or dextrose 5% in water before administration to prevent venous irritation and thrombophlebitis. The concentration of diazepam should not exceed 5 mg/mL²⁴.

- Choice C is correct because diazepam should be injected slowly over at least 3 minutes to avoid adverse effects such as hypotension, bradycardia, cardiac arrest, or apnea. The maximum rate of injection is 5 mg/min²⁴.

- Choice D is correct because diazepam is incompatible with many other drugs and solutions, and can precipitate or adsorb to plastic tubing. The nurse should flush the IV line with normal saline before and after administration to prevent drug interactions and ensure complete delivery of the medication²⁴.

- Choice E is wrong because repeating the dose of diazepam every 15 minutes until seizure activity stops is not recommended. Diazepam has a short duration of action and can accumulate in the body with repeated doses, increasing the risk of toxicity and respiratory depression. If seizures persist after the initial dose of diazepam, the nurse should start emergency IV antiepileptic drug therapy with levetiracetam, sodium valproate, or phenytoin³⁶.

Phenytoin is an anticonvulsant that works by stabilizing the neuronal membrane and preventing the spread of seizure activity¹. The therapeutic range of phenytoin is **10-20 mcg/mL**²³⁴⁵. A serum phenytoin level of **25 mcg/mL** is above the therapeutic range and indicates toxicity. The nurse should hold the next dose and notify the provider to prevent further adverse effects, such as nystagmus, ataxia, confusion, and coma¹.

Choice A. Administer the next dose as scheduled is wrong because it would increase the risk of phenytoin toxicity and worsen the client's condition.

Choice C. Increase the next dose by 25% is wrong because it would also increase the risk of phenytoin toxicity and worsen the client's condition.

Choice D. Decrease the next dose by 25% is wrong because it may not be enough to lower the phenytoin level to the therapeutic range. The nurse should consult with the provider before making any dose adjustments.

Carbamazepine is an anticonvulsant that works by stabilizing the neuronal membrane and preventing the spread of seizure activity¹. One of the common side effects of carbamazepine is drowsiness or dizziness, which may affect your ability to drive or operate machinery. You should avoid alcohol and other sedatives while taking this medication, and be careful when getting up from a lying or sitting position².

Choice B. You should avoid grapefruit juice while taking this medication is also correct. Grapefruit juice can interact with carbamazepine and increase its blood levels, which may increase the risk of toxicity and adverse effects. You should avoid drinking grapefruit juice or eating grapefruit while taking this medication, unless your doctor tells you otherwise³⁴.

Choice C. You should have your blood pressure checked regularly while taking this medication is wrong because carbamazepine does not affect blood pressure significantly. However, you should have your blood counts checked regularly while taking this medication, as carbamazepine can cause serious blood disorders such as aplastic anemia and agranulocytosis. You should also have your liver function tests and thyroid function tests monitored periodically, as carbamazepine can cause liver damage and thyroid abnormalities².

Choice D. You should report any signs of bleeding or bruising to your provider is also correct. Carbamazepine can interact with warfarin and other anticoagulants and increase the risk of bleeding by inhibiting the metabolism of warfarin and displacing it from plasma protein binding sites⁵. You should report any signs of bleeding or bruising to your provider, and have your INR and PT checked regularly if you are taking warfarin or other anticoagulants with carbamazepine.

Choice E. You should use a reliable form of contraception while taking this medication is also correct. Carbamazepine can reduce the effectiveness of hormonal contraceptives such as the pill, the implant, the patch, the vaginal ring, and the emergency contraceptive pill by inducing the liver enzyme CYP450, which breaks down estrogen and progesterone faster. This could put you at risk of an unplanned pregnancy. You should use a reliable form of non-hormonal contraception such as condoms or an intrauterine device (IUD) while taking this medication, unless your doctor advises you otherwise²⁶.

Valproic acid is an anticonvulsant that is used to treat absence seizures, which are brief episodes of staring or blanking out. Valproic acid is believed to increase the concentration of gamma-aminobutyric acid (GABA) in the brain, which is a neurotransmitter that reduces the excitability of neurons and prevents seizures¹².

Choice A is wrong because valproic acid does not inhibit the breakdown of a neurotransmitter, but rather increases its availability. The neurotransmitter that is inhibited by valproic acid is not known to prevent seizures, but rather to cause them. This neurotransmitter is glutamate, which is the main excitatory neurotransmitter in the brain³.

Choice C is wrong because valproic acid does not block sodium channels that trigger seizures, but rather calcium channels that are involved in neuronal signaling. Blocking sodium channels is the mechanism of action of another class of anticonvulsants, such as phenytoin and carbamazepine⁴.

Choice D is wrong because valproic acid does not suppress calcium influx that causes seizures, but rather inhibits calcium channels that regulate calcium influx. Suppressing calcium influx is the mechanism of action of another anticonvulsant, ethosuximide, which is also used to treat absence seizures⁵.

Phenobarbital is a barbiturate that can cause physical and psychological dependence with chronic use, meaning that the body and the mind become accustomed to the drug and need it to function normally. Dependence can lead to withdrawal symptoms when the drug is stopped or reduced, such as insomnia, nausea, tremors, and dizziness⁹. Dependence can also increase the risk of overdose, tolerance, and addiction¹³.

Choice A is wrong because these are not common side effects of phenobarbital, but signs of dependence. Common side effects of phenobarbital may include drowsiness, lack of energy, dizziness, or spinning sensation².

Choice B is wrong because these are not signs of toxicity, but signs of dependence. Toxicity occurs when the drug reaches a level in the body that causes harmful effects, such as respiratory depression, hypotension, coma, or death⁵. Signs of toxicity may include slow or shallow breathing, weak pulse, cold or clammy skin, little or no urination, pinpoint pupils, feeling cold, or fainting².

Choice C is wrong because these are not symptoms of withdrawal, but signs of dependence. Withdrawal occurs when the drug is stopped or reduced after a period of regular use, causing the body and the mind to react to the absence of the drug. Withdrawal symptoms may include anxiety, restlessness, irritability, agitation, confusion, hallucinations, seizures, or delirium⁹. Increasing the dose of phenobarbital can worsen the dependence and increase the risk of adverse effects.

The nurse should monitor the client for gingival hyperplasia, which is an overgrowth of the gums, as an adverse effect of phenytoin. Gingival hyperplasia can cause bleeding, inflammation, and infection of the gums, and may interfere with chewing and oral hygiene¹². The nurse should advise the client to brush and floss their teeth regularly, use a soft toothbrush, and visit a dentist every 3 to 4 months²³.

Choice A is wrong because hypertension is not an adverse effect of phenytoin. Phenytoin can cause hypotension, especially when given intravenously at a high rate or in large doses⁴⁵. The nurse should monitor the client's blood pressure and heart rate and inject the medication slowly over at least 3 minutes⁵.

Choice C is wrong because diarrhea is not an adverse effect of phenytoin. Phenytoin can cause constipation, especially in elderly clients or those with reduced mobility . The nurse should encourage the client to drink plenty of fluids, eat high-fiber foods, and exercise regularly to prevent constipation.

Choice D is wrong because tachycardia is not an adverse effect of phenytoin. Phenytoin can cause bradycardia, especially when given intravenously at a high rate or in large doses⁴⁵. The nurse should monitor the client's heart rate and rhythm and inject the medication slowly over at least 3 minutes⁵.

You may develop a rash or itching. The nurse should inform the client that this drug may cause a rash or itching, which can be a sign of a serious allergic reaction or a rare but life-threatening skin condition called Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN)¹². The nurse should instruct the client to stop taking the drug and seek medical attention immediately if they develop a rash, hives, blisters, peeling skin, fever, or swollen lymph nodes²³.

Choice A is wrong because blurred vision or drowsiness are not adverse effects of carbamazepine, but rather common side effects that usually go away with time or dose adjustment¹². The nurse should advise the client to avoid driving or operating machinery until they know how the drug affects them, and to report any persistent or severe vision problems to their doctor²³.

Choice C is wrong because difficulty urinating or constipation are not adverse effects of carbamazepine, but rather rare side effects that may indicate urinary retention or bowel obstruction¹⁴. The nurse should encourage the client to drink plenty of fluids, eat high-fiber foods, and exercise regularly to prevent these problems, and to report any difficulty passing urine or stool to their doctor³⁴.

Choice D is wrong because nausea or vomiting are not adverse effects of carbamazepine, but rather common side effects that can be minimized by taking the drug with food or milk¹². The nurse should advise the client to eat small, frequent meals and avoid spicy or fatty foo

The nurse should evaluate the response of the client who is receiving gabapentin (Neurontin) for neuropathic pain by measuring the frequency and intensity of pain using a valid and reliable pain scale, such as the numeric rating scale or the visual analog scale¹². The nurse should also ask the client about their satisfaction with pain relief and their functional status²³. The main goal of gabapentin therapy is to reduce pain by at least 50% or to a tolerable level⁴⁵.

Choice B is wrong because increased range of motion and mobility are not outcomes that the nurse should assess the client for when receiving gabapentin for neuropathic pain. Gabapentin is not indicated for musculoskeletal pain or inflammatory pain, and does not have anti-inflammatory or muscle relaxant properties⁶. Gabapentin may improve mobility indirectly by reducing pain, but this is not a direct outcome of the drug.

Choice C is wrong because improved mood and sleep quality are not outcomes that the nurse should assess the client for when receiving gabapentin for neuropathic pain. Gabapentin is not indicated for depression or insomnia, and does not have antidepressant or sedative properties⁶. Gabapentin may improve mood and sleep indirectly by reducing pain, but this is not a direct outcome of the drug.

Choice D is wrong because decreased inflammation and swelling are not outcomes that the nurse should assess the client for when receiving gabapentin for neuropathic pain. Gabapentin is not indicated for inflammatory pain or edema, and does not have anti-inflammatory or diuretic properties⁶. Gabapentin may reduce swelling indirectly by reducing pain, but this is not a direct outcome of the drug.

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.

The nurse can use seizure scales or questionnaires to measure the impact and burden of seizures on the patient and the caregiver. Seizure scales or questionnaires are tools that assess the frequency, duration, severity, and type of seizures, as well as the quality of life, mood, cognition, and functioning of the patient and the caregiver¹². Some examples of seizure scales or questionnaires are the National Hospital Seizure Severity Scale, the Liverpool Seizure Severity Scale, the Quality of Life in Epilepsy Inventory, and the Epilepsy and Learning Disabilities Quality of Life Scale¹².

Choice B is wrong because EEG is not a tool to measure the impact and burden of seizures on the patient and the caregiver. EEG is a diagnostic test that records the electrical activity of the brain and can detect abnormal patterns that indicate seizures or epilepsy³. EEG can help confirm the diagnosis, classify the type of seizures, identify the seizure focus, and guide the treatment of epilepsy³. However, EEG cannot measure the subjective aspects of seizure burden, such as quality of life, mood, cognition, or functioning.

Choice C is wrong because serum drug levels are not a tool to measure the impact and burden of seizures on the patient and the caregiver. Serum drug levels are laboratory tests that measure the concentration of anticonvulsant drugs in the blood and can help monitor the effectiveness and toxicity of these drugs. Serum drug levels can help adjust the dose, avoid drug interactions, and prevent breakthrough seizures or adverse effects. However, serum drug levels cannot measure the subjective aspects of seizure burden, such as quality of life, mood, cognition, or functioning.

Choice D is wrong because the quality of life scales or questionnaires is not a tool to measure the impact and burden of seizures on the patient and the caregiver. Quality of life scales or questionnaires are tools that assess the physical, psychological, social, and spiritual aspects of well-being and satisfaction with life. Quality of life scales or questionnaires can help evaluate the outcomes and effectiveness of epilepsy treatment. However, quality-of-life scales or questionnaires cannot measure the objective aspects of seizure burden, such as frequency, duration, severity, or type of seizures.

- Choice A is correct because the patient should report any rash, fever, or swollen lymph nodes to the prescriber immediately. These can be signs of a serious allergic reaction or a rare but life-threatening skin condition called Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN)¹². The patient should stop taking the drug and seek medical attention immediately if they develop these symptoms²³.

- Choice C is correct because the patient should use a reliable form of contraception while taking this medication. Lamotrigine can reduce the effectiveness of oral contraceptives and increase the risk of pregnancy¹². Lamotrigine can also cause birth defects or fetal harm if taken during pregnancy¹². The patient should consult their prescriber about the best method of contraception for them and inform them if they become pregnant or plan to become pregnant while taking lamotrigine²³.

- Choice D is correct because the patient should avoid exposure to sunlight and use sunscreen and protective clothing. Lamotrigine can increase the sensitivity of the skin to sunlight and cause sunburn or rash¹². The patient should limit their time in the sun and protect their skin from sun damage²³.

- Choice B is wrong because the patient does not need to take the medication with food to prevent gastrointestinal upset. Lamotrigine can be taken with or without food, depending on the patient's preference¹². Taking the medication with food may delay its absorption, but does not affect its bioavailability or efficacy⁴. The patient may experience some mild gastrointestinal side effects, such as nausea, vomiting, or diarrhea, but these usually go away with time or dose adjustment¹².

- Choice E is wrong because the patient does not need to avoid drinking alcohol or using illicit drugs while taking this medication. Lamotrigine does not have a significant interaction with alcohol or illicit drugs and does not affect the central nervous system as much as other anticonvulsants. However, the patient should still drink alcohol moderately and avoid using illicit drugs for their general health and well-being.

This is an appropriate action because absence seizures involve brief, sudden lapses of consciousness that last for a few seconds¹²³. The patient may stare blankly into space, stop talking, or stop moving during the seizure¹²³. The nurse should protect the patient from injury by guiding them to a safe place, such as a chair or a bed, and staying with them until they regain awareness¹²³. The nurse should also observe and document the time, duration, and type of seizure¹²³.

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

- Choice A is wrong because calling for help and preparing to administer rescue medication is not necessary for absence seizures. Absence seizures are usually harmless and do not cause physical injury or complications¹²³. They do not require emergency treatment or rescue medication, unless they occur in clusters or last longer than 15 seconds¹²³.

- Choice C is wrong because shaking the patient and asking them if they are okay is not helpful for absence seizures. Shaking the patient may startle them or cause injury, and asking them questions may confuse them or increase their anxiety¹²³. The patient is not aware of their surroundings or able to respond during the seizure¹²³. The nurse should avoid touching or talking to the patient unnecessarily during the seizure¹²³.

- Choice D is wrong because documenting the time, duration, and type of seizure in the patient's chart is not the best action. Documenting the seizure is important, but it should not be done before ensuring the patient's safety and comfort¹²³. The nurse should document the seizure after it ends and after checking the patient's vital signs and level of consciousness¹²³.

large muscle mass. This is the correct action because phenytoin (Dilantin) is a poorly soluble drug that can cause tissue irritation, necrosis, and abscess formation when given intramuscularly¹³. The nurse should use a large-bore needle (at least 21 gauge) and inject the drug slowly into a large muscle mass, such as the gluteus maximus or the vastus lateralis, to minimize these complications¹³. The nurse should also avoid injecting more than 5 mL of solution per site and rotate the injection sites¹³.

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

- Choice B is wrong because the nurse should not use a small-bore needle and inject the drug rapidly into a small muscle mass. This can increase the risk of tissue damage, pain, and infection due to the high pH and low solubility of phenytoin¹³. The nurse should use a large-bore needle and inject the drug slowly into a large muscle mass to reduce these risks¹³.

- Choice C is wrong because the nurse should not mix the drug with lidocaine or procaine to reduce pain and tissue irritation. These are local anesthetics that can interfere with the absorption and efficacy of phenytoin¹². The nurse should not mix phenytoin with any other drugs or solutions, as it is incompatible with many of them and can cause precipitation or crystallization¹².

- Choice D is wrong because the nurse should not massage the injection site after administration to enhance absorption. This can cause tissue damage, pain, and infection due to the high pH and low solubility of phenytoin¹³. The nurse should avoid touching or rubbing the injection site after administration to prevent these complications¹³.

This statement indicates that the patient understands that carbamazepine can cause a serious skin reaction called Stevens-Johnson syndrome, which requires immediate medical attention. The other statements are incorrect for the following reasons:

- A. "I will need to have my blood levels checked every week". This statement is incorrect because carbamazepine levels do not need to be checked every week, but rather every few months or as directed by the doctor.

- B. "I will drink grapefruit juice every morning with my medication". This statement is incorrect because grapefruit juice can increase the blood levels of carbamazepine and cause toxicity. The patient should avoid drinking grapefruit juice while taking this medication.

- D. "I will take my medication with food or milk". This statement is incorrect because carbamazepine should be taken on an empty stomach, at least one hour before or two hours after meals, to ensure optimal absorption. Taking it with food or milk can reduce its effectiveness.

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.