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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Bradycardia
Bradycardia is not a common side effect of diphenoxylate with atropine. Atropine, which is included in the combination, has anticholinergic effects that can lead to an increased heart rate (tachycardia), not bradycardia.
B. Fluid retention
Fluid retention is not a common side effect of diphenoxylate with atropine. In fact, the medication is used to treat severe diarrhea, and the goal is to decrease fluid loss associated with diarrhea rather than causing fluid retention.
C. Nervousness and tremors
Nervousness and tremors are not common side effects of diphenoxylate with atropine. Atropine's anticholinergic effects may cause nervousness, but these effects are generally not prominent at therapeutic doses.
D. Respiratory depression
This is the correct choice. Respiratory depression is a potential side effect of diphenoxylate with atropine, particularly if the medication is misused or taken in excessive amounts. Atropine is included in the combination to discourage misuse, as it can cause unpleasant anticholinergic effects.
Correct Answer is A
Explanation
A. The importance of consuming adequate amounts of water
When instructing a patient who will take psyllium (Metamucil) to treat constipation, it is crucial to emphasize the importance of consuming adequate amounts of water. Psyllium is a bulk-forming laxative that works by absorbing water in the intestines, forming a gel-like mass that helps soften stools and promote bowel movements. Without sufficient water intake, psyllium may cause an obstruction or worsen constipation.
B. The need to monitor for systemic side effects.
Psyllium is generally well-tolerated and is not associated with significant systemic side effects. The primary consideration is ensuring proper hydration.
C. The onset of action of 30-60 minutes after administration.
Psyllium is not a fast-acting laxative. It usually takes a longer time to produce its effects, and patients should not expect an immediate response within 30-60 minutes.
D. The need to use the dry form of psyllium to prevent cramping.
Using the dry form of psyllium is not recommended, as it may increase the risk of choking or swallowing difficulties. It is typically recommended to mix psyllium with a sufficient amount of water or other liquids to prevent cramping and ensure proper absorption.
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