A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?

Phenytoin is an anticonvulsant medication that is used to prevent and treat seizures. It works by stabilizing the electrical activity of the brain and reducing the spread of abnormal impulses. Phenytoin is usually taken for life or until the seizures are controlled by other means, such as surgery or diet. The client should not stop taking phenytoin without consulting their doctor, as this can cause withdrawal symptoms or increase the risk of seizures.

The other options are correct and indicate that the client understands the discharge teaching because:

1. "I have made an appointment to see my dentist next week." This statement is correct because phenytoin can cause gingival hyperplasia, which is an overgrowth of gum tissue that can lead to bleeding, infection, or difficulty chewing. The client should practice good oral hygiene and see their dentist regularly to prevent or treat this condition.

1. "I will notify my doctor before taking any other medications." This statement is correct because phenytoin can interact with many other medications, such as antibiotics, anticoagulants, oral contraceptives, or antacids. These interactions can affect the blood levels and effectiveness of phenytoin or the other medications, causing adverse effects or reduced seizure control. The client should inform their doctor of any other medications they are taking or planning to take, including over-the-counter, herbal, or dietary supplements.
2. "I know that I cannot switch brands of this medication." This statement is correct because different brands of phenytoin may have different formulations or bioavailability, which can affect the absorption and metabolism of the drug. Switching brands can cause changes in the blood levels and effectiveness of phenytoin, leading to toxicity or reduced seizure control. The client should always use the same brand of phenytoin and check with their pharmacist if they notice any changes in the appearance or labeling of their medication.

Rationale for A:

A small hematoma at the catheter insertion site is common after cardiac catheterization due to the puncture of blood vessels. The nurse should inform the client that this may occur but reassure them that it typically resolves on its own.

Rationale for B:

The dressing usually remains intact for 24 to 48 hours post-procedure to prevent infection and promote healing. The client should be instructed to keep the dressing clean and dry until the healthcare provider gives specific instructions.

Rationale for C: Clients are usually advised to avoid strenuous activities and exercise for several days after the procedure, not to resume regular exercise the next day.

Rationale for D: Pain medication may be necessary to manage discomfort post-procedure, and the nurse should encourage the client to take pain relief as needed.