A nurse is educating a client who has epilepsy and is planning to become pregnant about the risks of anticonvulsant therapy during pregnancy. Which of the following statements by the nurse is correct?

This means that the drug has leaked out of the vein and into the surrounding tissue, causing inflammation, pain, and tissue damage⁵⁶. Phenytoin is a known vesicant, which means it can cause severe skin reactions when extravasated⁵. The clinical manifestation of phenytoin extravasation is called purple glove syndrome (PGS), which is characterized by a purplish to black discoloration of the extremity followed by peripheral edema and pain distal to the site of infusion¹².

Choice A is wrong because the client is not having an allergic reaction to phenytoin. An allergic reaction would cause symptoms such as rash, itching, hives, swelling of the face or throat, difficulty breathing, or anaphylaxis⁷. The client's symptoms are localized to the hand and are consistent with extravasation, not allergy.

Choice B is wrong because the client is not developing purple glove syndrome. Purple glove syndrome is the name of the condition caused by phenytoin extravasation, not a separate entity¹². The client already has purple glove syndrome as a result of the extravasation.

Choice D is wrong because the client is not developing thrombophlebitis. Thrombophlebitis is inflammation of a vein caused by a blood clot, usually in the legs⁸⁹. Thrombophlebitis can cause symptoms such as

This is because anticonvulsants are essential for preventing seizures, which can be harmful for both the mother and the baby¹. Stopping or changing anticonvulsants without medical supervision can increase the risk of seizure recurrence or withdrawal symptoms¹. The doctor can monitor the blood levels of anticonvulsants and adjust the dose if needed, as well as prescribe folic acid supplements to reduce the risk of neural tube defects¹².

Choice A is wrong because advising the client to stop taking their anticonvulsants as soon as they find out that they are pregnant is not appropriate. As mentioned above, stopping anticonvulsants abruptly can cause seizures or withdrawal symptoms, which can be dangerous for both the mother and the baby¹. The client should not stop taking their anticonvulsants without consulting their doctor, who can weigh the benefits and risks of continuing or discontinuing the medication¹.

Choice C is wrong because advising the client to switch to a different type of anticonvulsant that is safer for their baby is not appropriate. There is no single anticonvulsant that is safe for all types of seizures and all stages of pregnancy². Some anticonvulsants may have a lower risk of teratogenicity than others, but they may also have different efficacy and side effects². The choice of anticonvulsant depends on several factors, such as the type and frequency of seizures, the previous response to medication, the presence of comorbidities, and the potential interactions with other drugs². The client should not switch to a different anticonvulsant without consulting their doctor, who can determine the best option for their individual case².

Choice D is wrong because advising the client to reduce their dose of anticonvulsants gradually until they deliver their baby is not appropriate. Reducing the dose of anticonvulsants can increase the risk of seizure recurrence, which can be harmful for both the mother and the baby¹. The dose of anticonvulsants should be based on the blood levels and clinical response of the client, not on a fixed schedule¹. The client should not reduce their dose of anticonvulsants without consulting their doctor, who can monitor their condition and adjust the dose if needed¹.