Patients taking phenytoin (Dilantin) for control of seizures must be aware of which adverse effect(s)? (Select all that apply.)

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.

The client consumes three different types of fluids during the day: milk, juice, and soup. The amount of each fluid is measured in different units: cups, ounces, and bowls. To record the client's intake in milliliters (mL), we need to convert these units using the following conversion factors:

- 1 cup = 240 mL

- 1 ounce = 30 mL

- 1 bowl = 150 mL

Using these conversion factors, we can calculate the client's intake in mL as follows:

- Milk: 1 cup x 240 mL/cup = 240 mL

- Juice: 4 oz. x 30 mL/oz. = 120 mL

- Soup: 6 oz. x 30 mL/oz. = 180 mL

The total intake in mL is the sum of these three values:

- Total intake = 240 mL + 120 mL + 180 mL = 540 mL

Therefore, the client's intake in mL is 540 mL.