A nurse in a health care provider’s office is reviewing lab results and notes a phenytoin level was drawn.

Which level would the nurse consider as therapeutic documentation?

The client's symptoms of high fever, unstable blood pressure, increased confusion, and rigidity are consistent with neuroleptic malignant syndrome (NMS) ⁴. NMS is a rare but life-threatening reaction that can occur in response to neuroleptic or antipsychotic medication ⁴. In this case, the client was taking olanzapine and was recently prescribed chlorpromazine, both of which are antipsychotic medications that can cause NMS ⁴.
Option A is incorrect because accelerated dementia would not cause the sudden onset of these symptoms.
Option B is incorrect because an infection would not explain the sudden onset of these symptoms after starting a new medication.
Option C is incorrect because aspiration would not cause rigidity or unstable blood pressure.

A. Tolerance can develop over time and lead to the need for higher doses – This is correct because long-term use of clonazepam, like other benzodiazepines, can result in tolerance, potentially necessitating higher doses to achieve the same therapeutic effect.

B. Skip a dose if you need to drive – This is incorrect. Clients should be advised to take their medication as prescribed and consult their healthcare provider about driving, as clonazepam can impair coordination and reaction times.

C. Skip a dose if you plan to go out drinking with friends – This is incorrect. While it’s important to avoid alcohol when taking clonazepam due to the increased risk of sedation and respiratory depression, clients should not skip doses without consulting their healthcare provider.

D. Do not try to taper yourself off this medication without physician guidance – This is correct. Stopping clonazepam suddenly can lead to withdrawal symptoms and seizure recurrence, so any changes in medication should always be done under the guidance of a healthcare provider.