A nurse is caring for a client who has just begun therapy with alprazolam to treat anxiety. The nurse should monitor the client for which of the following adverse effects of this medication?

A. Hold the injection if seizure activity is present:

This is incorrect. Phenytoin is an antiepileptic medication used to prevent seizures. If a client with a seizure disorder is experiencing seizure activity, it is essential to administer phenytoin promptly to help control and prevent further seizures.

B. Administer the medication at 100 mg/min:

This is incorrect. Phenytoin should be administered at a rate no faster than 50 mg/min to reduce the risk of adverse effects such as hypotension, arrhythmias, and cardiovascular collapse. Rapid infusion can cause adverse reactions such as hypotension, bradycardia, and cardiac arrhythmias.

C. Dilute the medication with dextrose 5% in water:

This is incorrect. Phenytoin should not be diluted with dextrose-containing solutions, as it can cause precipitation and result in clogging of the IV line. It is typically administered undiluted or diluted with normal saline solution.

D. Administer a saline solution after injection:

This is the correct action. After administering phenytoin IV, it is recommended to flush the IV line with normal saline solution to ensure that the medication is fully delivered and to prevent any remaining medication from precipitating in the IV line, which could lead to occlusion.

A. "Gradually decrease the dose once tolerance to the effect is reached." - Gradually decreasing the dose may help mitigate daytime sedation, but it's not the most appropriate initial response. Additionally, it should be done under the guidance of a healthcare provider.

B. "Take most of the daily dose at bedtime." - This response is appropriate because diphenhydramine commonly causes drowsiness, and taking most of the dose at bedtime can help minimize daytime sedation.

C. "Take the medication with meals." - Taking diphenhydramine with meals may reduce the risk of gastrointestinal upset but is unlikely to significantly decrease daytime sedation.

D. "Distribute the doses evenly throughout the day." - This approach may not effectively minimize daytime sedation because diphenhydramine's sedative effects are prolonged and may persist throughout the day if taken at regular intervals. Taking most of the dose at bedtime is a more practical strategy.