A nurse is completing a focused assessment addressing a client's immune function. What should the nurse prioritize in the physical assessment?

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:
A high-purine diet is not recommended for clients with gout. Purines are substances found in certain foods, such as red meat, organ meats, seafood, and beer. When the body breaks down purines, it produces uric acid. Uric acid is a waste product that can build up in the blood and cause gout attacks.
Choice B rationale:
Aspirin is not typically recommended for clients with gout. In fact, aspirin can sometimes worsen gout symptoms by increasing uric acid levels in the blood.
Choice C rationale:
Limiting alcohol intake is a key part of the treatment regimen for gout. Alcohol can increase uric acid levels in the blood and trigger gout attacks.
Choice D rationale:
Limiting fluid intake is not recommended for clients with gout. In fact, it is important for clients with gout to stay well- hydrated to help flush uric acid out of the body.