A nurse is assessing a client who has schizophrenia and has been on long-term treatment with chlorpromazine. He notes the client is experiencing some involuntary movements of the tongue and face. The nurse should suspect the client has developed which of the following adverse effects?

A. Hold the injection if seizure activity is present:

This is incorrect. Phenytoin is an antiepileptic medication used to prevent seizures. If a client with a seizure disorder is experiencing seizure activity, it is essential to administer phenytoin promptly to help control and prevent further seizures.

B. Administer the medication at 100 mg/min:

This is incorrect. Phenytoin should be administered at a rate no faster than 50 mg/min to reduce the risk of adverse effects such as hypotension, arrhythmias, and cardiovascular collapse. Rapid infusion can cause adverse reactions such as hypotension, bradycardia, and cardiac arrhythmias.

C. Dilute the medication with dextrose 5% in water:

This is incorrect. Phenytoin should not be diluted with dextrose-containing solutions, as it can cause precipitation and result in clogging of the IV line. It is typically administered undiluted or diluted with normal saline solution.

D. Administer a saline solution after injection:

This is the correct action. After administering phenytoin IV, it is recommended to flush the IV line with normal saline solution to ensure that the medication is fully delivered and to prevent any remaining medication from precipitating in the IV line, which could lead to occlusion.

B. Shake the container vigorously:

This is the correct action. Phenytoin suspension tends to settle over time, leading to non-uniform distribution of the medication in the suspension. Therefore, shaking the container vigorously before administering each dose ensures proper dispersion of the medication and helps maintain consistent drug concentration, thus promoting therapeutic efficacy.

A. Check the child's blood pressure:

Checking the child's blood pressure is not directly related to the administration of phenytoin suspension. Monitoring blood pressure may be indicated in certain clinical situations or with certain medications, but it is not specifically required before administering phenytoin suspension.

C. Be sure the child has not eaten within the hour:

While it's important to consider food-drug interactions with certain medications, such as those affected by food intake, there are no specific dietary restrictions associated with phenytoin suspension administration. Therefore, checking whether the child has eaten within the hour is not a necessary step before administering phenytoin suspension.

D. Perform mouth care:

Performing mouth care is not directly related to the administration of phenytoin suspension. However, oral hygiene is important for overall health, especially in children who may have difficulty performing adequate mouth care independently. While mouth care should be encouraged, it is not specifically required before administering phenytoin suspension.