A home health nurse teaches a client who has been discharged after an ischemic stroke about lifestyle modifications to prevent future strokes.
Which statement by the client indicates that further education is needed?

This case involves phenytoin toxicity resulting from a level exceeding the therapeutic range of 10 to 20 mg/dL. Knowledge of central nervous system effects, pharmacokinetics, and toxicological manifestations of anticonvulsants is necessary to identify appropriate neurological assessment findings.

Choice A rationale

Nystagmus, or involuntary eye movement, is a classic sign of phenytoin toxicity as levels rise above 20 mg/dL. It results from the drug's effect on the cerebellum and vestibular system, disrupting normal extraocular muscle coordination and balance.

Choice B rationale

Phenytoin typically causes hyperglycemia rather than hypoglycemia because it inhibits insulin secretion. A serum level of 32 mg/dL would not be expected to lower blood glucose; monitoring for elevated glucose levels is more appropriate in toxicity.

Choice C rationale

Ataxia involves uncoordinated muscle movements and gait instability, frequently occurring when phenytoin levels exceed therapeutic limits. The drug affects cerebellar function, leading to significant motor impairment and increasing the client's risk for falls and physical injury.

Choice D rationale

Vertigo or dizziness is a common central nervous system side effect of high phenytoin concentrations. As the drug reaches toxic levels like 32 mg/dL, it interferes with vestibular signaling, causing the sensation of spinning or loss of balance.

Choice E rationale

Phenytoin toxicity is more likely to cause blood dyscrasias like leukopenia or thrombocytopenia rather than a high platelet level. Normal platelet counts are 150,000 to 400,000 cells/mm; high levels are not a recognized manifestation of phenytoin overdose.

This clinical scenario focuses on postoperative care for split-thickness skin grafts and integumentary rehabilitation. Knowledge of tissue fragility, ultraviolet radiation sensitivity, and wound healing phases is required to prevent graft failure, hyperpigmentation, and secondary injury during the remodeling phase.

Choice A rationale

Newly grafted skin lacks melanocytes and the protective epidermal barrier, making it highly susceptible to ultraviolet damage. Direct sunlight can cause severe sunburn and permanent hyperpigmentation. Protection ensures long-term graft viability and prevents tissue degradation.

Choice B rationale

Physical therapy is vital to prevent contractures and maintain range of motion in burned limbs. While necessary for functional recovery, it is not the immediate priority over preventing physical damage to the fragile graft site from environmental factors.

Choice C rationale

Cosmetic camouflage helps manage the psychological impact of scarring and skin discoloration. While important for holistic recovery and body image, it is a psychosocial intervention that ranks lower than physiological protection of the surgical graft site.

Choice D rationale

Burn recovery requires a high-protein, high-calorie diet to support tissue synthesis and positive nitrogen balance. A low-protein diet would be contraindicated as it impairs collagen formation and delays wound healing in recovering burn patients.