A nurse is administering medications to a patient with a history of seizures and notices that the patient exhibits nystagmus, diplopia, and a serum phenytoin level of 25 mcg/mL
Upon further assessment, the nurse would anticipate which additional clinical finding? a. Other signs of phenytoin toxicity
b. Signs of an impending seizure
c. Stevens-Johnson syndrome
d. Gingival hyperplasia
A
A phenytoin plasma level above 20 mcg/mL may cause the patient to manifest nystagmus and diplopia, as well as other signs of toxicity. This level is toxic; the normal level is 10 to 20 mcg/mL.
Nystagmus and diplopia are not indications of an impending seizure.
No evidence suggests that Stevens-Johnson syndrome is a factor.
Gingival hyperplasia is not a result of toxicity, but rather an expected effect in about 20% of pa-tients given phenytoin.
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