A nurse is collecting data from a client who reports nausea and has vomited clear emesis. Which of the following medications should the nurse administer?

A. Add the medications to the enteral feeding bag. Medications should not be mixed with enteral feeding formula as this can alter drug absorption, cause tube clogging, or result in medication interactions. Each medication should be administered separately to ensure proper effectiveness.

B. Check for gastric residual 15 min after administering the medications. Gastric residual volume (GRV) should be checked before medication administration to assess delayed gastric emptying. Checking it after administration is unnecessary and may disrupt medication absorption without clinical benefit.

C. Keep the client's head elevated 15° while administering the medications. The head of the bed should be elevated at least 30–45 degrees, not 15 degrees, to reduce aspiration risk and promote medication passage. Insufficient elevation increases the likelihood of regurgitation and aspiration pneumonia.

D. Flush the tube with 30 ml of water between each medication. Flushing with 30 mL of water between medications prevents tube clogging and ensures each drug is properly delivered. It also minimizes drug interactions by preventing medications from mixing within the tube.

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.