A clinic nurse is performing a physical assessment on a client who has systemic lupus erythematosus (SLE). Which of the following findings should the nurse expect?

Rationale for Choice A:
Phenytoin is an anticonvulsant medication used to control seizures. It is typically a long-term medication, and abruptly stopping it can lead to breakthrough seizures or worsen existing seizures.
This statement indicates that the client may not understand the importance of taking phenytoin consistently and the potential consequences of discontinuing it without consulting their doctor.

Rationale for Choice B:
Making an appointment with a dentist is important for all individuals, including those with seizure disorders. There is no specific concern related to phenytoin and dental care that would necessitate further teaching in this context.

Rationale for Choice C:
It is important for clients to understand that switching brands of phenytoin might affect its effectiveness due to slight variations in formulation. However, simply stating awareness of this fact does not necessarily indicate a need for further teaching, as the nurse can assess the client's understanding through further questioning.

Rationale for Choice D:
Notifying a doctor before taking any new medications is crucial for individuals with seizures, as some medications can interact with phenytoin and increase the risk of seizures. This statement demonstrates the client's understanding of an important safety precaution.
Therefore, Choice A is the only statement that suggests a potential lack of understanding about the long-term nature of phenytoin treatment and the dangers of discontinuing it without medical supervision. This highlights the need for further education to ensure the client's safety and adherence to the prescribed medication regimen.

Choice A rationale:
Holding the client's arms and legs from moving during a seizure can actually cause injury to the client or the nurse. The forceful muscle contractions that occur during a seizure can cause bones to break or joints to dislocate. Additionally, trying to restrain the client can increase their agitation and make the seizure worse.

Choice B rationale:
Placing the client back in bed during a seizure is not safe. The client could fall out of bed and injure themselves. It is also important to allow the client to have space to move freely during the seizure to prevent injury.

Choice C rationale:

Placing the client on their side is the safest position for a client who is having a seizure. This position helps to protect the airway and prevent aspiration. It also allows any fluids or secretions to drain out of the mouth, which can help prevent choking.

Choice D rationale:
Inserting a tongue blade into the client's mouth during a seizure is not recommended. It is a common misconception that people can swallow their tongue during a seizure. This is not possible. Inserting a tongue blade can actually cause more harm than good. It can break teeth, damage the mouth, or even block the airway.