A patient who has been taking phenytoin for several years comes to the clinic for a follow-up visit and tells the nurse that he has been experiencing gum tenderness and bleeding when he brushes his teeth. The nurse will perform which action?

Ask whether he has been flossing his teeth regularly.

Notify the provider and request an order for serum drug levels.

Reassure him that this is a harmless side effect of phenytoin.

Suggest that he use a soft-bristled toothbrush and massage his gums.¹

Answer and Explanation

The Correct Answer is D

This is because phenytoin, a medication used to control seizures, may cause gingival hyperplasia or overgrowth of the gums¹. This can lead to tenderness, swelling, or bleeding of the gums. The condition is more common in patients taking phenytoin, cyclosporine, or calcium channel blockers¹. The etiology of phenytoin-induced gingival enlargement is likely due to the direct effects of the drug and its metabolites on the gingival fibroblasts¹. Patients can benefit from controlling the inflammatory component through an appropriate oral hygiene program¹. Referral to a general dentist or periodontist is appropriate for management¹.

Choice A is wrong because flossing his teeth regularly may not prevent or reduce the gingival overgrowth caused by phenytoin. Flossing may also aggravate the bleeding of the gums.

Choice B is wrong because serum drug levels may not correlate with the extent of gingival overgrowth. Some studies do not support the concept that the dose, duration, and plasma levels of phenytoin affect the severity of gingival enlargement².

Choice C is wrong because this is not a harmless side effect of phenytoin. Gingival overgrowth may interfere with speech, mastication, tooth eruption and aesthetics². It may also increase the risk of periodontal disease and infection³.

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Correct Answer is B

No explanation

A. Risk for infection related to immunosuppression B. Disturbed body image related to phenytoin-induced changes C. Impaired skin integrity related to hypersensitivity reaction D. Deficient knowledge related to self-care and medication management

Correct Answer is B

Explanation

Phenytoin (Dilantin) can cause cosmetic side effects, such as coarse facial features, hirsutism, and acne, in some people¹²³. These side effects can affect the client's self-esteem, social interactions, and emotional well-being¹. The nurse should assess the client's perception of his or her appearance and provide support and education to cope with the changes¹.

Choice A is wrong because risk for infection related to immunosuppression is not a relevant nursing diagnosis for this client. Phenytoin can cause blood dyscrasias, such as leukopenia and thrombocytopenia, in some people¹²³. However, these side effects are not related to immunosuppression and do not increase the risk of infection¹. The nurse should monitor the client's blood counts and report any signs of bleeding or anemia to the provider¹.

Choice C is wrong because impaired skin integrity related to hypersensitivity reaction is not a relevant nursing diagnosis for this client. Phenytoin can cause allergic reactions, such as rash, fever, lymphadenopathy, and hepatitis, in some people¹²³. However, these side effects are not related to impaired skin integrity and do not cause skin breakdown or ulceration¹. The nurse should discontinue the medication and report any signs of hypersensitivity reaction to the provider¹.

Choice D is wrong because deficient knowledge related to self-care and medication management is not a relevant nursing diagnosis for this client. Phenytoin requires careful monitoring and education to ensure therapeutic and safe use¹²³. However, this nursing diagnosis does not address the client's specific concern about the cosmetic side effects of phenytoin¹. The nurse should provide information and counseling about the benefits and risks of phenytoin therapy and discuss alternative options with the provider if needed¹.

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A patient who has been taking phenytoin for several years comes to the clinic for a follow-up visit and tells the nurse that he has been experiencing gum tenderness and bleeding when he brushes his teeth. The nurse will perform which action?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The healthcare provider prescribes captopril (Capoten) 37.5 mg. The medication is available in 25 mg tablets. What should the nurse administer?

Correct Answer is B

The nurse is preparing to give medications to a client who has been receiving long-term therapy with phenytoin (Dilantin). The nurse notes that the client has coarse facial features, hirsutism, and acne. What is the most appropriate nursing diagnosis for this client?

Correct Answer is B

Explanation

A nurse is providing discharge teaching to a client who has a new prescription for valproic acid to treat seizures. Which of the following instructions should the nurse include in the teaching?¹

A nurse is preparing to administer intravenous phenytoin (Dilantin) to a patient who has status epilepticus. Which of the following actions should the nurse take?

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

A nurse is teaching a client who has a new prescription for gabapentin for partial seizures. Which of the following instructions should the nurse include in the teaching?

A client is prescribed ethosuximide (Zarontin) for absence seizures. The nurse should instruct the client to report which adverse effect?¹

A nurse is reviewing discharge instructions with a patient who has epilepsy and has been prescribed lamotrigine (Lamictal). Which of the following statements by the patient indicates a need for further teaching?

A patient who has been taking phenytoin for several years comes to the clinic for a follow-up visit and tells the nurse that he has been experiencing gum tenderness and bleeding when he brushes his teeth. The nurse will perform which action?

The nurse is caring for a client who has been taking phenytoin (Dilantin) for several years to control tonic-clonic seizures. The client tells the nurse that he wants to stop taking the medication because it makes his gums swell and bleed. What is the most appropriate response by the nurse?