Nokea
When reviewing the client's medical record, the nurse understands that which of the following if found would contraindicate administering phenytoin (Dilantin) to a client? Select all that apply.
- A. Pregnancy
- B. Sinus bradycardia
- C. Hepatic disease
- D. Diabetes
- E. Atrial fibrillation
Correct Answer: A,B
Rationale: The use of phenytoin is contraindicated in clients with known hypersensitivity to the drug, sinus bradycardia, sinoatrial block, Adam-Stokes syndrome, and second- and third-degree atrioventricular block and in clients who are pregnant or lactating.
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A nurse at a health care center has been asked to prepare a teaching plan for a client on oxazolidinedione therapy. Which of the following points should the nurse include?
- A. Avoiding exposure to ultraviolet light
- B. Taking the drug 2 hours after a meal
- C. Taking the drug with milk
- D. Avoiding carbonated drinks during therapy
Correct Answer: A
Rationale: The nurse should suggest avoiding exposure to ultraviolet light in the teaching plan of the client on oxazolidinedione therapy because of the risk for photosensitivity. The nurse need not include taking the drug 2 hours after a meal, taking the drug with milk, or avoiding carbonated drinks.
After teaching a client and family about prescribed phenytoin therapy, the nurse determines that the teaching was successful when they identify that which of the following should be reported to the primary health care provider as possibly indicating toxicity? Select all that apply.
- A. Ataxia
- B. Nystagmus
- C. Slurred speech
- D. Lethargy
- E. Diplopia
Correct Answer: A,C,D
Rationale: Signs suggesting phenytoin toxicity that need to be reported include slurred speech, ataxia, lethargy, dizziness, nausea, and vomiting.
A primary health care provider prescribes phenytoin to be administered parenterally to a client with a seizure disorder. The nurse prepares the drug to be given by which method?
- A. Intradermally
- B. Subcutaneously
- C. Intramuscularly
- D. Intravenously
Correct Answer: D
Rationale: Phenytoin can be administered orally and parenterally. If the drug is administered parenterally, the intravenous (IV) route is preferred over the intramuscular (IM) route, because with the IM route erratic absorption of phenytoin causes pain and muscle damage at the injection site. The drug is not administered intradermally or subcutaneously.
The nurse is assessing a client for gingival hyperplasia based on the understanding that this adverse reaction is commonly associated with long-term administration of which of the following? Select all that apply.
- A. Carbamazepine (Tegretol)
- B. Phenytoin (Dilantin)
- C. Valproic acid (Depakote)
- D. Felbamate (Felbatol)
- E. Ethotoin (Peganone)
Correct Answer: B,E
Rationale: Gingival hyperplasia, although it can occur with any anticonvulsant, is commonly associated with long-term hydantoin therapy such as with phenytoin or ethotoin.
A nurse is preparing to administer phenytoin to a client. The nurse understands the need to administer this drug cautiously if the client has a history of which of the following? Select all that apply.
- A. Hyperthyroidism
- B. Hypotension
- C. Diabetes
- D. Asthma
- E. Hepatic impairment
Correct Answer: B,E
Rationale: Phenytoin (Dilantin) is used cautiously in clients with hypotension, severe myocardial insufficiency, and hepatic impairment.