A nurse is caring for a client who has been prescribed phenytoin for seizure prevention. The nurse should monitor the client for which of the following adverse effects of phenytoin?
Gingival hyperplasia
Hypertension
Diarrhea
Tachycardia
The Correct Answer is A
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
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.
Correct Answer is A
Explanation
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.
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