A nurse is teaching a client measures to help relieve sleeplessness. Which would be the highest priority teaching point during the instructional session?

A. Administer the dose since the patient is not toxic.

This is not the appropriate action. With a drowsy patient and a high serum phenytoin level, there is a concern for toxicity. Administering the next dose could worsen the toxicity.

B. Contact the provider to discuss decreasing the phenytoin dose.

While adjusting the dose may be a consideration, the immediate action should be to withhold the next dose and report the elevated level to the healthcare provider. The provider can then determine the appropriate course of action.

C. Give the drug and monitor closely for adverse effects.

Giving the drug without further intervention is not appropriate when there are signs of potential toxicity, such as drowsiness. Monitoring alone is not sufficient in this case.

D. Report drug toxicity to the providers.

This is the correct choice. With a drowsy patient and a serum phenytoin level of 18 mcg/mL, which is considered high, reporting the drug toxicity to the healthcare provider is the immediate and appropriate action. The provider can then determine the next steps, such as adjusting the dose or ordering additional tests.

A. The patient's understanding of the medication:

While it's important for the patient to understand their medication, assessing their understanding is typically done through patient education and counseling. This assessment is vital for promoting adherence and safe medication practices but is not the primary consideration immediately before administration.

B. The patient's ability to swallow:

This is the correct answer. Assessing the patient's ability to swallow is crucial before administering oral medications to ensure that the patient can safely and effectively take the prescribed medication without the risk of aspiration or choking.

C. The patient's allergies:

Assessing the patient's allergies is an essential step in medication administration, but it is generally part of the overall medication safety process. It may not be the primary assessment immediately before administering an oral medication, but it is a crucial consideration.

D. The eyesight:

The patient's eyesight is not typically a primary assessment before administering oral medications. While visual impairments can affect a patient's ability to read medication labels or instructions, it is not the immediate concern when assessing readiness for oral medication administration.