The nurse reviews laboratory results for a client with a traumatic brain injury prescribed phenytoin.
The nurse notes the phenytoin level is 32 mg/dL (normal range 10-20 mg/dL). Which findings should the nurse anticipate? Select all that apply.

Nystagmus.

Hypoglycemia.

Ataxia.

Vertigo.

High platelet level.

Answer and Explanation

Correct Answer : A,C,D

This case involves phenytoin toxicity resulting from a level exceeding the therapeutic range of 10 to 20 mg/dL. Knowledge of central nervous system effects, pharmacokinetics, and toxicological manifestations of anticonvulsants is necessary to identify appropriate neurological assessment findings.

Choice A rationale

Nystagmus, or involuntary eye movement, is a classic sign of phenytoin toxicity as levels rise above 20 mg/dL. It results from the drug's effect on the cerebellum and vestibular system, disrupting normal extraocular muscle coordination and balance.

Choice B rationale

Phenytoin typically causes hyperglycemia rather than hypoglycemia because it inhibits insulin secretion. A serum level of 32 mg/dL would not be expected to lower blood glucose; monitoring for elevated glucose levels is more appropriate in toxicity.

Choice C rationale

Ataxia involves uncoordinated muscle movements and gait instability, frequently occurring when phenytoin levels exceed therapeutic limits. The drug affects cerebellar function, leading to significant motor impairment and increasing the client's risk for falls and physical injury.

Choice D rationale

Vertigo or dizziness is a common central nervous system side effect of high phenytoin concentrations. As the drug reaches toxic levels like 32 mg/dL, it interferes with vestibular signaling, causing the sensation of spinning or loss of balance.

Choice E rationale

Phenytoin toxicity is more likely to cause blood dyscrasias like leukopenia or thrombocytopenia rather than a high platelet level. Normal platelet counts are 150,000 to 400,000 cells/mm; high levels are not a recognized manifestation of phenytoin overdose.

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Correct Answer is A

Explanation

This scenario requires understanding acid-base balance and renal pathophysiology. Acute kidney injury impairs the kidneys ability to excrete hydrogen ions and regenerate bicarbonate. Identifying metabolic acidosis with partial respiratory compensation is necessary based on the interpretation of arterial blood gas values.

Choice A rationale

Metabolic acidosis occurs in kidney injury due to decreased acid excretion. The pH is low at 7.26 (7.35 to 7.45) and bicarbonate is low at 14 (22 to 28), while the PaCO2 of 30 shows compensatory hyperventilation.

Choice B rationale

A pH of 7.26 indicates acidosis, but the normal bicarbonate level of 24 and elevated PaCO2 of 46 indicate respiratory acidosis. This occurs with hypoventilation and carbon dioxide retention rather than the metabolic issues seen in kidney failure.

Choice C rationale

The pH of 7.49 indicates alkalosis. A high bicarbonate of 30 with a normal PaCO2 of 40 represents uncompensated metabolic alkalosis. This is typical of excessive acid loss or base gain, which is opposite of kidney failure.

Choice D rationale

The pH of 7.49 and low PaCO2 of 30 suggest respiratory alkalosis. Bicarbonate is normal at 24. This state results from hyperventilation and excessive carbon dioxide loss, which does not characterize the pathophysiology of acute kidney injury.

Correct Answer is ["13376"]

Explanation

This scenario requires calculating fluid resuscitation requirements for a burn patient. Knowledge of the Parkland formula is necessary to determine the total volume of isotonic crystalloids required based on weight and the percentage of total body surface area burned.

Step 1 is 4 mL × 88 kg × 38 percent.

Step 2 is 352 × 38.

Step 3 is 13376 mL.

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The nurse reviews laboratory results for a client with a traumatic brain injury prescribed phenytoin. The nurse notes the phenytoin level is 32 mg/dL (normal range 10-20 mg/dL). Which findings should the nurse anticipate? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has acute kidney injury (AKI). Which of the following arterial blood gas values would the nurse expect this client to have?

Correct Answer is A

Explanation

An adult weighing 88 kg is brought to the emergency department after sustaining a thermal injury. Burns are partial and full thickness over 38 According to the Parkland formula, what would this client's fluid requirements be for the first 24 hours after injury?

Correct Answer is ["13376"]

Explanation

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The nurse reviews laboratory results for a client with a traumatic brain injury prescribed phenytoin.
The nurse notes the phenytoin level is 32 mg/dL (normal range 10-20 mg/dL). Which findings should the nurse anticipate? Select all that apply.