A nurse is reinforcing teaching a client who has a new prescription for phenytoin. The nurse should instruct the client to monitor and report which of the following adverse effects of this medication?

A. "Incorporate nonverbal cues in the conversation."

This is an appropriate response. Nonverbal cues, such as gestures, facial expressions, and body language, can help convey meaning and support comprehension for individuals with aphasia. Using visual aids or pointing to objects can also enhance communication.

B. "Ask multiple choice questions as part of the conversation."

While multiple choice questions can be helpful in some situations, they may not always be appropriate for individuals with aphasia. It's important to assess the client's specific communication needs and preferences. Open-ended questions and simple, direct language may be more effective for facilitating communication.

C. "Use a higher-pitched tone of voice when speaking."

Altering the tone of voice may not necessarily improve communication for individuals with aphasia. Instead, it's important to speak in a clear, natural tone at a moderate pace. Speaking too loudly or using a higher-pitched voice may be perceived as patronizing or condescending.

D. "Use simple child-like statements when speaking."

While it's important to use simple and clear language, using child-like statements may be inappropriate and demeaning to the client. Respectful communication that acknowledges the individual's intelligence and dignity is essential. Simplify language and sentences as needed, but avoid speaking down to the client.

A. Withhold the next dose and notify the physician:

Withholding the next dose of the cholinergic agent is the appropriate immediate action because the presence of inspiratory and expiratory wheezing bilaterally suggests bronchoconstriction or bronchospasm, which can be a serious adverse reaction to the medication. Notifying the physician promptly allows for further assessment and management of the patient's respiratory symptoms. The physician may need to adjust the medication regimen, order diagnostic tests, or provide treatment for bronchoconstriction.

B. Give the next dose:

Administering the next dose of the cholinergic agent could worsen the patient's respiratory symptoms and exacerbate bronchoconstriction. This action is contraindicated in the presence of wheezing, as it may further compromise the patient's respiratory function.

C. Assess heart rate:

While assessing heart rate is an important aspect of patient assessment, it is not the priority in this scenario. The priority is to address the respiratory distress and potential bronchoconstriction associated with the cholinergic agent. Wheezing is a respiratory symptom that suggests airway obstruction, and immediate intervention is necessary to ensure adequate oxygenation and ventilation.

D. Assess blood pressure:

Similarly, while assessing blood pressure is important in patient care, it is not the priority in this situation. The priority is to address the respiratory distress and potential bronchoconstriction associated with the cholinergic agent. Wheezing indicates respiratory compromise, and prompt action is required to prevent further respiratory deterioration.