Phenytoin has a narrow therapeutic index.
The nurse recognizes that this characteristic indicates which of these?

Choice A rationale:

Phenytoin is an anticonvulsant drug used in the prophylaxis and control of various types of seizures. It has a narrow therapeutic index, which means that the safe and toxic plasma levels of the drug are very close to each other. This characteristic makes the dosing of phenytoin challenging, as even small deviations from the recommended therapeutic range can lead to suboptimal treatment or adverse effects. Therapeutic effect without clinical signs of toxicity occurs more often with serum total concentrations between 10 and 20 mcg/mL34. Therefore, clinicians are advised to initiate therapeutic drug monitoring in patients who require phenytoin.

Choice B rationale:

The statement that phenytoin has a low chance of being effective is incorrect. Phenytoin is a widely used and effective anticonvulsant. It works by slowing down impulses in the brain that cause seizures. It is used to control seizures but does not treat all types of seizures. The effectiveness of phenytoin is not determined by its narrow therapeutic index but by its pharmacological action in the brain.

Choice C rationale:

The assertion that there is no difference between safe and toxic plasma levels of phenytoin is incorrect. There is indeed a difference between the safe (therapeutic) and toxic levels of phenytoin. The therapeutic range for phenytoin is typically between 10 and 20 mcg/mL34. Levels above this range can lead to toxicity, while levels below this range may not provide the desired therapeutic effect.

Choice D rationale:

The statement that a very small dosage of phenytoin can result in the desired therapeutic effect is not entirely accurate. While it’s true that phenytoin is effective in controlling seizures, the dosage required to achieve this effect is not necessarily “very small”. The usual adult dose for seizures is 100 mg orally 3 times a day. The dosage may need to be adjusted based on individual patient factors and response to therapy. Therefore, it’s not accurate to generalize that a “very small” dosage will result in the desired therapeutic effect for all patients.

Choice A rationale:

Bounding peripheral pulses are not typically associated with diabetes insipidus. Diabetes insipidus is a condition characterized by excessive thirst and excretion of large amounts of severely dilute urine.

Choice B rationale:

Moist mucous membranes are not a common finding in diabetes insipidus. In fact, due to excessive urination, patients may experience dehydration which can lead to dry mucous membranes.

Choice C rationale:

Bradycardia, or a slower than normal heart rate, is not a typical symptom of diabetes insipidus. The condition does not directly affect the heart rate.

Choice D rationale:

Decreased urine specific gravity is a key finding in diabetes insipidus. The condition causes an imbalance of water in the body, leading to the production of large amounts of dilute (or low specific gravity) urine.

Please note that these rationales are based on general knowledge about diabetes insipidus and the specific symptoms mentioned in the choices. For a more detailed understanding, it’s recommended to refer to medical textbooks or consult with healthcare professionals.