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B. Instruct the client to use a soft toothbrush and floss gently. This is because phenytoin can cause gingival hyperplasia, which is an enlargement of the gums due to an increase in the number of cells or the size of the gingiva³. This condition can be prevented or minimized by maintaining good oral hygiene and avoiding trauma to the gums².

Choice C is wrong because administering an oral antiseptic rinse to the client is not effective for treating gingival hyperplasia. Oral antiseptic rinses are used to reduce plaque and bacteria in the mouth, but they do not address the underlying cause of gingival hyperplasia, which is a defect in collagen metabolism³. Oral antiseptic rinses may also have adverse effects such as staining the teeth, altering the taste, or causing mouth irritation².

Choice D is wrong because referring the client to a dentist for evaluation and treatment is not the most appropriate action for the nurse to take. Although a dentist can help diagnose and manage gingival hyperplasia, the nurse should first educate the client about the importance of oral hygiene and instruct them on how to care for their gums. The nurse should also monitor the client's condition and report any changes or complications to the doctor. A dentist referral may be indicated if the gingival hyperplasia is severe or does not respond to oral hygiene measures².

Choice A is wrong because the client is not having an allergic reaction to phenytoin. An allergic reaction would cause symptoms such as rash, itching, hives, swelling of the face or throat, difficulty breathing, or anaphylaxis⁷. The client's symptoms are localized to the hand and are consistent with extravasation, not allergy.

Choice B is wrong because the client is not developing purple glove syndrome. Purple glove syndrome is the name of the condition caused by phenytoin extravasation, not a separate entity¹². The client already has purple glove syndrome as a result of the extravasation.

Choice D is wrong because the client is not developing thrombophlebitis. Thrombophlebitis is inflammation of a vein caused by a blood clot, usually in the legs⁸⁹. Thrombophlebitis can cause symptoms such as

Choice A is wrong because advising the client to stop taking warfarin and switch to aspirin is not appropriate. Warfarin is an anticoagulant that prevents blood clots from forming or growing, while aspirin is an antiplatelet that prevents platelets from sticking together and forming clots³. Warfarin and aspirin have different mechanisms of action and indications, and they are not interchangeable. The client should not stop taking warfarin without consulting their doctor, as this may increase the risk of stroke or other thromboembolic events due to atrial fibrillation³.

Choice C is wrong because administering vitamin K to the client as an antidote is not necessary. Vitamin K is used to reverse the effects of warfarin in cases of severe bleeding or overdose⁴. The client does not have any signs of bleeding or overdose, and giving vitamin K may lower the INR too much and reduce the effectiveness of warfarin⁴. Vitamin K should only be given under the supervision of a doctor and with careful monitoring of INR⁴.

Choice D is wrong because informing the client that there is no interaction between valproic acid and warfarin is false. As mentioned above, valproic acid and warfarin have a clinically significant interaction that can affect the INR and bleeding risk of the client¹². The client should be aware of this interaction and take precautions to prevent adverse outcomes.

Choice A is wrong because advising the client to stop taking their anticonvulsants as soon as they find out that they are pregnant is not appropriate. As mentioned above, stopping anticonvulsants abruptly can cause seizures or withdrawal symptoms, which can be dangerous for both the mother and the baby¹. The client should not stop taking their anticonvulsants without consulting their doctor, who can weigh the benefits and risks of continuing or discontinuing the medication¹.

Choice C is wrong because advising the client to switch to a different type of anticonvulsant that is safer for their baby is not appropriate. There is no single anticonvulsant that is safe for all types of seizures and all stages of pregnancy². Some anticonvulsants may have a lower risk of teratogenicity than others, but they may also have different efficacy and side effects². The choice of anticonvulsant depends on several factors, such as the type and frequency of seizures, the previous response to medication, the presence of comorbidities, and the potential interactions with other drugs². The client should not switch to a different anticonvulsant without consulting their doctor, who can determine the best option for their individual case².

Choice D is wrong because advising the client to reduce their dose of anticonvulsants gradually until they deliver their baby is not appropriate. Reducing the dose of anticonvulsants can increase the risk of seizure recurrence, which can be harmful for both the mother and the baby¹. The dose of anticonvulsants should be based on the blood levels and clinical response of the client, not on a fixed schedule¹. The client should not reduce their dose of anticonvulsants without consulting their doctor, who can monitor their condition and adjust the dose if needed¹.