A nurse is caring for a client who is taking naproxen following an exacerbation of rheumatoid arthritis. Which of the following statements by the client requires further discussion by the nurse?

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:
Protecting the airway is the highest priority during a tonic-clonic seizure. Tonic-clonic seizures involve intense muscle contractions, which can lead to biting the tongue, aspiration of secretions, or even respiratory arrest if the airway is obstructed. Turning the client's head to the side helps to maintain a clear airway and prevent these complications.
It is essential to act quickly to prevent injury and ensure adequate oxygenation. Delaying airway management could have serious consequences.

Choice B rationale:
Checking motor strength is not a priority during the active phase of a seizure. It is more important to focus on protecting the airway and preventing injury.
Motor strength can be assessed after the seizure has subsided.

Choice C rationale:
Loosening clothing around the waist may be helpful to promote comfort and breathing, but it is not the first priority. It is more important to address the airway and prevent aspiration.

Choice D rationale:
Documenting the time the seizure began is important for accurate record-keeping and assessment of seizure patterns, but it is not the first priority in the immediate management of the seizure. Documentation can be done after the client's airway and safety are ensured.