The client was admitted to the medical floor. Upon arrival, the client was assessed: He is difficult to arouse but follows commands. He has a peripheral IV which is infusing normal saline at 145 mL/hr. No redness or edema at the site. Breath sounds are clear and equal bilaterally. He appears pink and well-perfused.

The client had a tonic-clonic seizure that lasted for 3 minutes and 5 seconds. The client became apneic during the seizure and the oxygen saturation dropped to 48%. The client was manually ventilated at 100% oxygen and padding was placed around the vent for safety. After the seizure, the client was turned to his left for recovery.

The physician comes to the bedside following the seizure and prescribes phenytoin. The PN administers the phenytoin as prescribed.

What are the possible toxic effects of phenytoin that the PN should closely monitor the client for after administration?

Select all that apply

C. Regularly selects salty snacks to eat in the evening: Consuming excessive amounts of sodium (found in salty snacks) can increase blood pressure and contribute to the development of hypertension.
E. Chews tobacco while playing baseball every weekend: Tobacco use, including chewing tobacco, is associated with an increased risk of hypertension and other cardiovascular diseases.

The other choices are incorrect because they do not directly contribute to an increased risk of hypertension:
A. Drinks a protein supplement for breakfast every day: Consuming a protein supplement for breakfast does not necessarily increase the risk of hypertension. However, it is important to note that some protein supplements may contain added sodium, which can contribute to hypertension if consumed in excessive amounts.
B. Eats eight ounces of nonfat yogurt for lunch daily: Eating nonfat yogurt is generally considered a healthy food choice. However, unless the yogurt is high in added sodium, it would not significantly increase the risk of hypertension.
D. Walks briskly for two miles every day after work: Regular exercise, such as brisk walking, is generally beneficial for cardiovascular health and can help lower blood pressure. It is unlikely to increase the risk of hypertension.

Worsening perineal pain after medication could indicate inadequate pain relief or a potential complication such as infection or hematoma. It is important to reassess the client to determine the cause of the increased pain and take appropriate action before transferring to the postpartum unit.
The other scenarios described in the options may also require attention, but they do not indicate an immediate need for reassessment before transfer:
B. A primigravida who passed a small clot when she sat up on the edge of the bed: Passing small clots is a normal part of the postpartum period, and it may not necessarily require immediate reassessment. However, the PN should monitor for any excessive or large clots and report any concerning findings.
C. A multigravida whose peri-pad is 1⁄2 saturated with lochia rubra after one hour: Lochia rubra is the normal discharge following childbirth, and some saturation of the peri-pad is expected.
However, the PN should continue to monitor the amount and consistency of the lochia and report any significant changes.
D. A multigravida complaining of strong afterbirth pains when breastfeeding: Afterbirth pains, also known as uterine cramps, are common during breastfeeding as the uterus contracts. While discomfort is expected, strong afterbirth pains should be assessed for severity and managed appropriately. The PN should provide comfort measures and assess if the pain is within the expected range or if it requires further evaluation.