A nurse is caring for a client who has a history of epilepsy and is taking phenytoin. The nurse notes that the client has swollen and bleeding gums. What is the most appropriate action for the nurse to take?

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.

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.