The nurse is preparing to administer phenytoin to a patient who has a seizure disorder. The patient appears drowsy, and the nurse notes that the last random serum drug level was 18 mcg/mL. What action will the nurse take?

Administer the dose since the patient is not toxic

Contact the provider to discuss decreasing the phenytoin dose

Give the drug and monitor closely for adverse effects

Report drug toxicity to the providers

Answer and Explanation

The Correct Answer is D

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.

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Correct Answer is B

Explanation

A. Butorphanol

Butorphanol is a mixed opioid agonist-antagonist. It has both agonist and antagonist properties at opioid receptors. While it can be used for pain management, it is not commonly used for opioid overdose reversal.

B. Naloxone

Naloxone is an opioid receptor antagonist and is the drug of choice for reversing opioid overdose, including morphine overdose. It works by competitively binding to opioid receptors, blocking the effects of opioids.

C. Flumazenil

Flumazenil is a selective antagonist for benzodiazepines. It is used to reverse the effects of benzodiazepine overdose but does not have an effect on opioid overdose.

D. Pentazocine

Pentazocine is a mixed opioid agonist-antagonist. Like butorphanol, it has both agonist and antagonist properties at opioid receptors. It is used for pain management but is not commonly used for opioid overdose reversal.

A. "Continue taking OCPS because phenytoin is not safe during pregnancy." B. "You should use a backup method of contraception along with OCPs." C. "You should stop taking OCPs because of drug-drug interactions with phenytoin." D. "You should take low-dose aspirin while taking these medications to reduce your risk of stroke."

Correct Answer is B

Explanation

A. "Continue taking OCPS because phenytoin is not safe during pregnancy."

This statement is not accurate. While it's essential to address pregnancy risk, phenytoin can reduce the effectiveness of oral contraceptives. Women on phenytoin are often advised to use additional contraceptive measures.

B. "You should use a backup method of contraception along with OCPs."

This is the correct response. Phenytoin can accelerate the metabolism of oral contraceptives, potentially reducing their effectiveness. Using a backup method, such as condoms, is recommended to ensure adequate contraception.

C. "You should stop taking OCPs because of drug-drug interactions with phenytoin."

This advice is generally not recommended without consulting the healthcare provider. Abruptly stopping OCPs without an alternative form of contraception can increase the risk of unintended pregnancy.

D. "You should take low-dose aspirin while taking these medications to reduce your risk of stroke."

This statement is not relevant to the situation described. Low-dose aspirin is not typically recommended for contraception, and its use in this context does not address the potential interaction between phenytoin and oral contraceptives.

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The nurse is preparing to administer phenytoin to a patient who has a seizure disorder. The patient appears drowsy, and the nurse notes that the last random serum drug level was 18 mcg/mL. What action will the nurse take?

Nursing Test Bank

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