A nurse is caring for a client who is taking lamotrigine for partial seizures. The nurse should instruct the client to report which of the following signs of a serious adverse reaction to lamotrigine?¹

This instruction is important because gabapentin can cause drowsiness, dizziness, or blurred vision as common side effects¹². These effects can impair the client's ability to drive safely and increase the risk of accidents or injuries. The client should avoid driving or operating machinery until they know how gabapentin affects them and their doctor says it is safe to do so¹². The other instructions are incorrect for the following reasons:

- A. "Take this medication with food or milk to prevent gastric irritation". This instruction is unnecessary because gabapentin does not cause gastric irritation or ulcers as a side effect¹². The client can take gabapentin with or without food, depending on their preference and tolerance¹².

- C. "Increase your intake of fluids and fiber to prevent constipation". This instruction is irrelevant because gabapentin does not cause constipation as a side effect¹². The client should maintain a normal intake of fluids and fiber to promote bowel health, but not specifically because of gabapentin use¹².

- D. "Discontinue this medication gradually to prevent withdrawal symptoms". This instruction is incorrect because gabapentin does not cause withdrawal symptoms or physical dependence as a side effect¹². However, the client should not stop taking gabapentin suddenly or without their doctor's advice, as this can increase the risk of seizures or other complications¹².

This action takes priority because the patient's head is at risk of hitting the bed, the side rails, or other objects during a seizure, which can cause trauma, bleeding, or brain damage . The nurse should place a soft pad or pillow under the patient's head and move any sharp or hard objects away from the bed. The other choices are incorrect for the following reasons:

- A. "Loosening restrictive clothing". This action is helpful but not urgent because restrictive clothing can interfere with breathing or circulation during a seizure, but it is not a life-threatening issue . The nurse can loosen the patient's clothing after protecting their head and ensuring their airway is clear.

- B. "Restraining the client's limbs". This action is harmful and contraindicated because restraining the patient's limbs can cause injury, pain, or fractures during a seizure, as well as increase their anxiety and agitation . The nurse should never restrain a patient who is having a seizure, but rather let them move freely and safely.

- C. "Removing pillows and raising side rails". This action is unnecessary and potentially dangerous because removing pillows can expose the patient's head to injury, and raising side rails can trap the patient's limbs or body between them during a seizure . The nurse should keep pillows under the patient's head and lower the side rails if possible.