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Reporting an abnormal phenytoin level of 18 mcg/mL would not be necessary, as this level falls within the therapeutic range of 10–20 mcg/mL. Reporting would only be indicated if levels were below 10 (risk of seizures) or above 20 (risk of toxicity).

Encouraging vigorous tooth brushing is not appropriate because phenytoin is associated with gingival hyperplasia. Patients should instead be taught gentle oral hygiene with a soft-bristled toothbrush and regular dental visits to minimize gum irritation and overgrowth.

Stopping the drug immediately when urine turns pinkish-red or reddish-brown is not appropriate because this is a harmless side effect of phenytoin. Discontinuation should never be sudden, as it may precipitate status epilepticus. Patients should be reassured that urine discoloration is expected and benign.

“I must shake the oral suspension very well before pouring it in the dose cup.” This reflects proper knowledge. Phenytoin suspension must be shaken to ensure even distribution of the drug because it can settle, leading to inaccurate dosing if not mixed.

“I cannot drink alcoholic beverages when taking phenytoin.” This statement is appropriate because alcohol can alter phenytoin levels, either raising toxicity risk with acute intake or lowering seizure control with chronic use. Avoiding alcohol is an important safety precaution.

“I will need to get periodic dental checkups.” This is accurate since phenytoin commonly causes gingival hyperplasia, and regular dental visits combined with good oral hygiene help reduce complications.

Psychosis is not a common adverse effect of phenytoin. While phenytoin can cause confusion or mood changes at toxic levels, psychosis is not typically associated with its use.

Hypertension is not linked to phenytoin therapy. If anything, phenytoin toxicity may cause hypotension, particularly when administered intravenously too rapidly.

Gum erosion is not a known adverse effect of phenytoin. Instead, the drug is associated with gingival hyperplasia, or overgrowth of gum tissue, not erosion or breakdown.

After-school sports activities will need to be stopped is not true. Ethosuximide helps control seizures so that children can continue a normal lifestyle, including participation in sports, once seizures are well managed. Physical activity does not increase seizure risk.

Fractures may occur, so increase the amount of vitamin D and calcium-rich foods in the diet is more relevant to long-term therapy with enzyme-inducing anticonvulsants such as phenytoin, carbamazepine, or phenobarbital, which can affect bone metabolism. Ethosuximide is not typically associated with osteoporosis or fracture risk.

Avoid dehydration with activities and increase fluid intake is not a key teaching point for ethosuximide. While maintaining hydration is always healthy, ethosuximide does not cause significant dehydration or renal effects that require special fluid precautions.

Increasing the dosage would be unsafe since the patient is already experiencing toxicity. Higher doses would worsen CNS depression and put the client at risk of life-threatening complications.

Leaving the dosage unchanged and considering these symptoms unrelated would be inappropriate because the symptoms strongly match phenytoin toxicity and cannot be ignored.

Keeping the dosage the same and adding another antiseizure medication is not correct at this stage. The priority is to address toxicity by lowering the dose, not by adding additional medications.