A nurse is caring for a client who reports difficulty breathing during the administration of an intermittent IV bolus of nafcillin. After stopping the infusion and notifying the provider, the nurse should anticipate a prescription for which of the following medications?

A. Tinnitus. Phenytoin is not commonly associated with tinnitus. Ototoxicity is more frequently linked to medications such as aminoglycoside antibiotics, loop diuretics, or high-dose aspirin. While phenytoin affects the nervous system, it does not typically cause ringing in the ears.

B. Bleeding gums. Gingival hyperplasia, characterized by swollen and bleeding gums, is a well-known adverse effect of phenytoin, especially with long-term use. It occurs due to an overgrowth of gum tissue and can be minimized with good oral hygiene and regular dental care. Clients should be advised to brush with a soft-bristled toothbrush and visit the dentist regularly.

C. Jaundice. Although phenytoin is metabolized by the liver, hepatotoxicity and jaundice are not common side effects. However, liver function should still be monitored, particularly in clients with pre-existing liver conditions or those taking other hepatotoxic medications.

D. Deep vein thrombosis. Phenytoin does not significantly increase the risk of deep vein thrombosis (DVT). While some anticonvulsants may affect coagulation factors, phenytoin is not known to cause hypercoagulability or clot formation. Clients at risk for DVT should be monitored for other contributing factors, such as immobility or genetic predisposition.

A. Lower the head of the client's bed. There is no need to lower the client’s head of the bed in response to receiving glipizide instead of guaifenesin. Glipizide is an oral antidiabetic medication used to lower blood glucose, while guaifenesin is an expectorant for respiratory conditions. Lowering the head of the bed does not address the potential effects of receiving the wrong medication.

B. Check the client for urinary retention. Glipizide does not cause urinary retention. Instead, it stimulates insulin release to lower blood sugar. If hypoglycemia occurs due to an unintentional dose of glipizide, symptoms such as sweating, dizziness, confusion, or tremors are more concerning than bladder dysfunction.

C. Offer the client a carbohydrate snack. Since glipizide lowers blood glucose levels, administering it instead of guaifenesin could result in hypoglycemia, particularly in a client who does not have diabetes. The nurse should monitor for signs of low blood sugar, such as shakiness, confusion, diaphoresis, and dizziness, and provide a fast-acting carbohydrate (e.g., juice, crackers, or glucose tablets) if symptoms develop.

D. Test the client’s deep-tendon reflexes. Glipizide does not affect neuromuscular function or deep-tendon reflexes. While severe hypoglycemia can cause altered mental status or seizures, routine reflex testing is not necessary for monitoring the effects of an incorrect glipizide administration.