A nurse is reinforcing teaching with a female client who is taking phenytoin. Which of the following statements should the nurse include in the teaching?

"You should expect to have blood work every 6 months while taking this medication."

*You can safely take this medication if you become pregnant."

"You might experience swollen gums while taking this medication."

"You can skip a dose of this medication if you are nauseated."

Answer and Explanation

The Correct Answer is C

A) "You should expect to have blood work every 6 months while taking this medication.": While it is important for clients on phenytoin to have regular blood work, especially to monitor drug levels and assess for potential side effects (e.g., liver function, complete blood count), the frequency of blood work is typically more frequent than every 6 months. Blood work is often performed at least every 3-6 months, or more frequently if there are concerns about phenytoin levels or side effects. Therefore, this statement is not accurate.

B) "You can safely take this medication if you become pregnant.": Phenytoin is classified as a Category D medication in pregnancy, meaning it has been shown to cause potential harm to the fetus. It is not considered safe during pregnancy, and women who are pregnant or planning to become pregnant should discuss alternative medications with their healthcare provider.

C) "You might experience swollen gums while taking this medication.": Gingival hyperplasia (swelling of the gums) is a common side effect of phenytoin. Clients taking this medication should be aware of this potential side effect and should be instructed on proper oral hygiene and regular dental checkups to help minimize this risk. This statement is accurate and should be included in the teaching.

D) "You can skip a dose of this medication if you are nauseated.": It is important not to skip doses of phenytoin, as maintaining therapeutic levels of the drug is crucial for its effectiveness in preventing seizures. If a client experiences nausea or difficulty taking the medication, they should contact their healthcare provider for guidance rather than skipping doses. Skipping doses could lead to breakthrough seizures.

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Correct Answer is B

Explanation

A) Place the client in Sims' position for catheter insertion: Sims' position (side-lying position) is not typically used for central venous catheter insertion. The client is usually placed in a supine or Trendelenburg position to help facilitate insertion and decrease the risk of air embolism during the procedure.

B) Prepare the client for a chest x-ray to verify catheter placement: After the insertion of a central venous catheter, a chest x-ray is routinely performed to verify the correct placement of the catheter in the superior vena cava or right atrium. This is essential to ensure the catheter is properly positioned and to check for complications like pneumothorax or inadvertent placement in the lung.

C) Use clean technique when changing the catheter dressing: When changing the dressing for a central venous catheter, sterile technique is required, not clean technique. Sterile technique minimizes the risk of infection, which is a major concern when caring for central venous access devices.

D) Verify the amount of TPN solution the client is receiving every 4 hr: While it is important to monitor the amount of TPN being infused and assess for complications, verifying the exact amount every 4 hours is not a standard procedure. Typically, TPN is managed and adjusted by the healthcare provider based on lab results, weight, and clinical status, but constant monitoring of the solution is not required.

A. I do not need to sign a consent form before this procedure B. I will feel a warming sensation after the injection of the dye C. I should limit my fluid intake for 2 days after the procedure D. I can have a meal up to 2 hours before the procedure

Correct Answer is B

Explanation

A) "I do not need to sign a consent form before this procedure": This statement is incorrect. Most procedures involving intravenous (IV) dye or contrast require the client to sign a consent form. This is because the procedure involves the use of a contrast agent that could have potential risks or side effects, and the client needs to be informed and give consent for its use.

B) "I will feel a warming sensation after the injection of the dye": This statement is correct. It is common for patients to experience a warming or flushing sensation after the injection of IV contrast dye. This feeling is typically temporary and a normal response to the dye being introduced into the bloodstream. The nurse should reassure the client about this sensation.

C) "I should limit my fluid intake for 2 days after the procedure": This statement is incorrect. In most cases, clients are encouraged to increase their fluid intake after procedures involving IV contrast to help flush the dye from their system and prevent any potential kidney complications. Limiting fluid intake is generally not recommended unless otherwise instructed by the healthcare provider.

D) "I can have a meal up to 2 hours before the procedure": This statement is incorrect in many cases, especially if the procedure involves sedation or anesthesia. Typically, clients are instructed to fast for a period (usually 4–6 hours) before procedures involving contrast dye, particularly if anesthesia or sedation is used. Eating too soon before the procedure can increase the risk of aspiration or other complications. It’s important to follow specific instructions from the healthcare provider.

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A nurse is reinforcing teaching with a female client who is taking phenytoin. Which of the following statements should the nurse include in the teaching?

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