A nurse in a clinic is caring for a client.
Click to highlight the findings that require immediate follow-up as contraindications to the prescribed prescription. To deselect a finding click on the finding again.
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Client is a vegetarian and takes a multivitamin daily
Client reports having three to four alcoholic beverages a couple times per week
Last menstrual period was 3 months ago
Client takes diazepam as needed for anxiety
Temperature 36.4° C (97.6° F)
Respiratory rate 16/min
Blood pressure 100/74mm Hg
Oxygen saturation 99% on room air
S1 S2 auscultated
Client has full range of motion and is able to maintain flexion against resistance in all four extremities
Last bowel movement was 3 days ago.
The Correct Answer is ["A","B","C","D"]
- Client reports having three to four alcoholic beverages a couple times per week. Phenytoin metabolism is significantly affected by alcohol consumption. Chronic alcohol use increases phenytoin clearance, leading to subtherapeutic drug levels and seizure breakthrough. Conversely, acute alcohol intake inhibits phenytoin metabolism, increasing the risk of toxicity. The client should be counseled to avoid alcohol while on phenytoin therapy.
- Client takes diazepam as needed for anxiety. Diazepam is a CNS depressant that interacts with phenytoin, increasing sedation and the risk of respiratory depression. Both medications can cause drowsiness, dizziness, and impaired coordination, raising the risk of falls and injury. The provider should assess whether diazepam should be discontinued or adjusted when initiating phenytoin therapy.
- Last menstrual period was 3 months ago. Phenytoin is Pregnancy Category D, meaning it poses a significant teratogenic risk, including fetal hydantoin syndrome. The missed menstrual period suggests a possible pregnancy, which must be evaluated before starting phenytoin. A pregnancy test should be performed, and alternative antiseizure medications may need to be considered if pregnancy is confirmed.
- Client is a vegetarian and takes a multivitamin daily. Phenytoin interferes with the absorption of folic acid and vitamin D, both of which are crucial for bone health and red blood cell production. Vegetarians are already at higher risk for folate and vitamin B12 deficiency, making supplementation essential. However, multivitamins containing calcium, magnesium, or iron can decrease phenytoin absorption, reducing its effectiveness. The provider should review the multivitamin’s composition and adjust dosing schedules to prevent interactions.
- Temperature 36.4°C (97.6°F), oral. The client’s temperature is within normal range and does not indicate infection or systemic concerns that would affect phenytoin therapy.
- Heart rate 75/min, Respiratory rate 16/min, Blood pressure 100/74 mm Hg, Oxygen saturation 99% on room air.
All vital signs are stable and do not indicate hemodynamic instability, respiratory depression, or cardiovascular issues that would contraindicate phenytoin administration. - Skin color is consistent with genetic background. No rashes or lesions. The client has varicose veins. There are no signs of drug hypersensitivity reactions or dermatologic conditions that would require stopping phenytoin therapy.
- S1 S2 auscultated. No murmurs. All peripheral pulses 2+. Lung sounds clear bilaterally.
There are no cardiopulmonary concerns that would indicate contraindications to phenytoin. - Abdomen soft, nontender. Normoactive bowel sounds in all 4 quadrants. Last bowel movement was 3 days ago. Voids four to five times a day. Urine is clear, yellow, and odorless. Mild constipation is noted, but this is not a contraindication for phenytoin. The client should be encouraged to increase fiber and fluid intake to prevent worsening constipation, which can sometimes be a side effect of phenytoin.
- Alert and oriented to person, place, and time. Client has full range of motion and is able to maintain flexion against resistance in all four extremities. There are no neurological deficits requiring immediate intervention, and the client's baseline mental status is intact.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","D","E","F","G"]
Explanation
- Shortness of breath. The client is experiencing respiratory distress, which could indicate a severe allergic reaction (anaphylaxis). Immediate intervention is needed to prevent airway compromise and respiratory failure.
- Intercostal retractions. Retractions occur when breathing is labored, suggesting airway obstruction or bronchoconstriction. This is a sign of worsening respiratory distress, requiring urgent medical attention.
- Wheezing auscultated throughout lung fields. Wheezing suggests bronchospasm, which is common in anaphylaxis and asthma attacks. The presence of diffuse wheezing indicates that the airways are narrowing, making breathing more difficult.
- Diffuse, raised rash present on trunk. A new-onset rash following antibiotic administration raises suspicion for anaphylaxis or a severe allergic reaction. Immediate treatment with antihistamines and corticosteroids may be required.
- Respiratory rate 30/min. The increased respiratory rate indicates that the client is compensating for airway constriction and hypoxia. This is an early warning sign of impending respiratory failure if not treated promptly.
- Blood pressure 90/55 mmHg. The drop in blood pressure suggests anaphylactic shock, where vasodilation and fluid leakage from capillaries lead to hypotension. Immediate administration of epinephrine is necessary to prevent cardiovascular collapse.
- Oxygen saturation 91% on room air. A decrease in oxygen saturation indicates impaired gas exchange, likely due to airway swelling and bronchospasm. Supplemental oxygen therapy should be provided to prevent further desaturation.
Correct Answer is A
Explanation
A. Drowsiness. Dimenhydrinate is an antihistamine that works by blocking histamine and acetylcholine receptors in the brain to prevent nausea and vomiting. A common adverse effect is drowsiness due to its sedative properties, which can impair alertness and coordination. Clients should be advised to avoid activities requiring mental alertness, such as driving, until they understand how the medication affects them.
B. Hypertension. Dimenhydrinate does not typically cause hypertension. Instead, it may lead to mild hypotension due to its sedative and anticholinergic effects. Clients with pre-existing hypertension should still monitor their blood pressure, but significant increases are uncommon.
C. Polyuria. Increased urination is not associated with dimenhydrinate use. Antihistamines, including dimenhydrinate, have anticholinergic properties, which can lead to urinary retention rather than increased urine output. Clients experiencing difficulty urinating should report this to their healthcare provider.
D. Dependent edema. Dimenhydrinate does not cause fluid retention or edema. Medications that contribute to edema typically involve hormonal, cardiovascular, or kidney-related effects, which are not mechanisms of dimenhydrinate. If a client develops unexplained edema, other underlying conditions should be investigated.
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