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This action is necessary to prevent the formation of precipitates in the IV line, which can cause thrombophlebitis or embolism. The other actions are incorrect for the following reasons:

This action is necessary to prevent the formation of precipitates in the IV line, which can cause thrombophlebitis or embolism. The other actions are incorrect for the following reasons:

This action is necessary to prevent the formation of precipitates in the IV line, which can cause thrombophlebitis or embolism. The other actions are incorrect for the following reasons:

This statement is incorrect because ibuprofen may interact with lamotrigine and increase the risk of side effects such as dizziness, drowsiness, confusion, and difficulty concentrating¹². A clinical study found that common interactions between lamotrigine and ibuprofen include gait disturbance among females and insomnia among males². The patient should avoid taking ibuprofen while on lamotrigine and consult their doctor for alternative pain relief options. The other statements are correct for the following reasons:

This statement is incorrect because ibuprofen may interact with lamotrigine and increase the risk of side effects such as dizziness, drowsiness, confusion, and difficulty concentrating¹². A clinical study found that common interactions between lamotrigine and ibuprofen include gait disturbance among females and insomnia among males². The patient should avoid taking ibuprofen while on lamotrigine and consult their doctor for alternative pain relief options. The other statements are correct for the following reasons:

This statement is incorrect because ibuprofen may interact with lamotrigine and increase the risk of side effects such as dizziness, drowsiness, confusion, and difficulty concentrating¹². A clinical study found that common interactions between lamotrigine and ibuprofen include gait disturbance among females and insomnia among males². The patient should avoid taking ibuprofen while on lamotrigine and consult their doctor for alternative pain relief options. The other statements are correct for the following reasons:

This instruction is important because valproic acid can cause nausea, vomiting, stomach pain, and diarrhea as common side effects³⁴. Taking the medication with food can help reduce these gastrointestinal symptoms and improve the patient's tolerance and adherence to the treatment. The other choices are incorrect for the following reasons:

This instruction is important because valproic acid can cause nausea, vomiting, stomach pain, and diarrhea as common side effects³⁴. Taking the medication with food can help reduce these gastrointestinal symptoms and improve the patient's tolerance and adherence to the treatment. The other choices are incorrect for the following reasons:

This instruction is important because valproic acid can cause nausea, vomiting, stomach pain, and diarrhea as common side effects³⁴. Taking the medication with food can help reduce these gastrointestinal symptoms and improve the patient's tolerance and adherence to the treatment. The other choices are incorrect for the following reasons:

This action takes priority because the patient's head is at risk of hitting the bed, the side rails, or other objects during a seizure, which can cause trauma, bleeding, or brain damage . The nurse should place a soft pad or pillow under the patient's head and move any sharp or hard objects away from the bed. The other choices are incorrect for the following reasons:

This action takes priority because the patient's head is at risk of hitting the bed, the side rails, or other objects during a seizure, which can cause trauma, bleeding, or brain damage . The nurse should place a soft pad or pillow under the patient's head and move any sharp or hard objects away from the bed. The other choices are incorrect for the following reasons:

This action takes priority because the patient's head is at risk of hitting the bed, the side rails, or other objects during a seizure, which can cause trauma, bleeding, or brain damage . The nurse should place a soft pad or pillow under the patient's head and move any sharp or hard objects away from the bed. The other choices are incorrect for the following reasons:

This statement accurately describes the action of amantadine, which is a medication that has both antiviral and antiparkinsonian effects. The mechanism of action of amantadine in the treatment of parkinsonism is not fully understood, but it may involve increasing dopamine release in the brain, stimulating norepinephrine response, or activating dopaminergic receptors¹². The other choices are incorrect for the following reasons:

This statement accurately describes the action of amantadine, which is a medication that has both antiviral and antiparkinsonian effects. The mechanism of action of amantadine in the treatment of parkinsonism is not fully understood, but it may involve increasing dopamine release in the brain, stimulating norepinephrine response, or activating dopaminergic receptors¹². The other choices are incorrect for the following reasons:

This statement accurately describes the action of amantadine, which is a medication that has both antiviral and antiparkinsonian effects. The mechanism of action of amantadine in the treatment of parkinsonism is not fully understood, but it may involve increasing dopamine release in the brain, stimulating norepinephrine response, or activating dopaminergic receptors¹². The other choices are incorrect for the following reasons

This statement indicates that the client understands that lamotrigine can cause a serious adverse reaction called aseptic meningitis, which is an inflammation of the membranes that cover the brain and spinal cord. Aseptic meningitis can cause symptoms such as fever, headache, stiff neck, sore throat, nausea, vomiting, and sensitivity to light¹². The client should report any signs of aseptic meningitis to their provider immediately, as it may require discontinuation of lamotrigine and medical attention¹². The other statements are incorrect for the following reasons:

This statement indicates that the client understands that lamotrigine can cause a serious adverse reaction called aseptic meningitis, which is an inflammation of the membranes that cover the brain and spinal cord. Aseptic meningitis can cause symptoms such as fever, headache, stiff neck, sore throat, nausea, vomiting, and sensitivity to light¹². The client should report any signs of aseptic meningitis to their provider immediately, as it may require discontinuation of lamotrigine and medical attention¹². The other statements are incorrect for the following reasons:

This statement indicates that the client understands that lamotrigine can cause a serious adverse reaction called aseptic meningitis, which is an inflammation of the membranes that cover the brain and spinal cord. Aseptic meningitis can cause symptoms such as fever, headache, stiff neck, sore throat, nausea, vomiting, and sensitivity to light¹². The client should report any signs of aseptic meningitis to their provider immediately, as it may require discontinuation of lamotrigine and medical attention¹². The other statements are incorrect for the following reasons:

This instruction is important because gabapentin can cause drowsiness, dizziness, or blurred vision as common side effects¹². These effects can impair the client's ability to drive safely and increase the risk of accidents or injuries. The client should avoid driving or operating machinery until they know how gabapentin affects them and their doctor says it is safe to do so¹². The other instructions are incorrect for the following reasons:

This instruction is important because gabapentin can cause drowsiness, dizziness, or blurred vision as common side effects¹². These effects can impair the client's ability to drive safely and increase the risk of accidents or injuries. The client should avoid driving or operating machinery until they know how gabapentin affects them and their doctor says it is safe to do so¹². The other instructions are incorrect for the following reasons:

This instruction is important because gabapentin can cause drowsiness, dizziness, or blurred vision as common side effects¹². These effects can impair the client's ability to drive safely and increase the risk of accidents or injuries. The client should avoid driving or operating machinery until they know how gabapentin affects them and their doctor says it is safe to do so¹². The other instructions are incorrect for the following reasons:

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.

Choice A is wrong because applying warm compresses and slowing the infusion rate may not prevent or reverse the damage caused by phenytoin infiltration. In fact, it may worsen the condition by increasing the blood flow to the affected area and prolonging the exposure to the drug².

Choice C is wrong because requesting an order for intravenous fosphenytoin instead of phenytoin may not be appropriate or necessary at this point. Fosphenytoin is a prodrug of phenytoin that has some advantages over phenytoin, such as better solubility, faster infusion rate, and fewer cardiovascular complications⁷. However, it is not indicated for the treatment of purple glove syndrome or phenytoin infiltration. Moreover, fosphenytoin may still cause some adverse effects, such as hypotension, pruritus, rash, and paresthesia⁶. Therefore, the nurse should focus on managing the current situation rather than switching to another drug.

Choice D is wrong because stopping the infusion temporarily and administering an antihistamine may not be effective or sufficient for treating phenytoin infiltration. Purple glove syndrome is not an allergic reaction, but a local tissue injury caused by phenytoin crystallization². Therefore, an antihistamine may not have any benefit for this condition. Stopping the infusion temporarily may not prevent further damage to the tissue or blood vessels. The nurse should discontinue the IV line completely and notify the provider as soon as possible.

Choice B is wrong because hyperglycemia is not a common or serious adverse effect of phenobarbital. Phenobarbital does not affect blood glucose levels directly, but it may interfere with the metabolism of some oral antidiabetic drugs, such as sulfonylureas. Therefore, patients who take both phenobarbital and antidiabetic drugs may need to adjust their doses or monitor their blood glucose more frequently.

Choice C is wrong because hypertension is not a common or serious adverse effect of phenobarbital. Phenobarbital may cause hypotension or orthostatic hypotension in some patients, especially when given intravenously or in high doses². The nurse should monitor the patient's blood pressure and heart rate, and avoid sudden changes in position³.

Choice D is wrong because insomnia is not a common or serious adverse effect of phenobarbital. Phenobarbital is a barbiturate that has sedative and hypnotic properties. It may cause drowsiness, dizziness, lethargy, and impaired cognition in some patients². The nurse should advise the patient to avoid driving or operating machinery while taking phenobarbital and to avoid alcohol and other CNS depressants³.

Choice A is wrong because blurred vision is not a common side effect of ethosuximide. Ethosuximide is not known to affect vision or eye health¹.

Choice B is wrong because gingival hyperplasia is not a common side effect of ethosuximide. Ethosuximide is not known to cause overgrowth of the gums or dental problems¹. Gingival hyperplasia is more commonly associated with other anticonvulsants, such as phenytoin (Dilantin)².

Choice D is wrong because constipation is not a common side effect of ethosuximide. Ethosuximide may cause gastrointestinal side effects, such as nausea, vomiting, stomach pain, and loss of appetite, but not constipation¹³. Constipation is more commonly associated with other anticonvulsants, such as carbamazepine (Tegretol)⁴.

Choice A is wrong because the client should not stop taking phenytoin without consulting the provider. Stopping phenytoin suddenly can increase the risk of seizures or status epilepticus, which is a life-threatening condition¹. If the client wants to switch to another anticonvulsant medication, the provider should advise on how to do so safely and gradually¹.

Choice B is wrong because the client should not reduce the dose of phenytoin without consulting the provider. Reducing the dose of phenytoin can lower the blood level of the medication and make it less effective in controlling seizures¹. The provider should monitor the blood level of phenytoin and adjust the dose accordingly¹.

Choice D is wrong because the client should not take ibuprofen (Motrin) or aspirin (Ecotrin) to relieve the inflammation and pain in the gums. These medications are nonsteroidal anti-inflammatory drugs (NSAIDs) that can interact with phenytoin and increase its blood level and side effects². They can also increase the risk of bleeding, especially in people with low platelet count or clotting problems². The client should consult the provider before taking any other medications with phenytoin¹.

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.