The client has epilepsy and is prescribed phenytoin (Dilantin). The client has been seizure free and asks the nurse why he still needs blood tests when he is not having seizures. Which response by the nurse is the most appropriate?
1. "Dilantin can cause blood thinning in some people."
2. "There is a narrow range between a helpful dose of this medication and a dose that could make you feel sicker."
3. "Dilantin tends to lower blood levels of potassium."
4. "This medication can cause a severe skin reaction called Steven–Johnson syndrome if doses are too high."
Correct Answer: 2
Rationale 1: Phenytoin (Dilantin) is not an anticoagulant and does not cause thinning of the blood.
Rationale 2: Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose; blood levels must be monitored to ensure a therapeutic level and to prevent toxicity.
Rationale 3: There is no evidence that phenytoin (Dilantin) causes potassium depletion.
Rationale 4: Stevens–Johnson syndrome is a severe skin reaction that can be an adverse outcome with phenytoin (Dilantin), but it is monitored by skin assessment, not blood tests.
Global Rationale: Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose; blood levels must be monitored to ensure a therapeutic level and to prevent toxicity. It is not an anticoagulant and does not cause thinning of the blood. There is no evidence that phenytoin (Dilantin) causes potassium depletion. Stevens–Johnson syndrome is a severe skin reaction that can be an adverse outcome with phenytoin (Dilantin), but it is monitored by skin assessment, not blood tests.
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