A 17-year-old client is taking phenytoin (Dilantin) for the treatment of seizures. Phenytoin blood level reveals to be 25 mcg/ml. Which of the following symptoms would be expected as a result of the laboratory result?

Correct Answer: D

Rationale: Phenytoin is an antiepileptic medication that is used to treat seizures. It has a narrow therapeutic range, and a blood level of 25 mcg/ml is considered to be high. At this level, patients are at risk for developing symptoms of phenytoin toxicity. Nystagmus, which is an involuntary rapid eye movement, is a common symptom of phenytoin toxicity. Other symptoms of phenytoin toxicity may include ataxia, diplopia, slurred speech, confusion, and drowsiness. It is important to monitor phenytoin blood levels regularly to avoid toxicity and adjust the dose accordingly.

Correct Answer: A

Rationale: The patient's new tremors, ambulation issues, and gait disturbance during hospitalization for hyponatremia suggest a drug-related cause. Haloperidol, an antipsychotic, is known for extrapyramidal symptoms (EPS)-tremors, rigidity, and gait problems-making iatrogenic the correct answer. Infection lacks supporting fever or systemic signs. Neoplastic process is unlikely without prior hints. Viral encephalitis would involve fever, altered mentation beyond agitation, and CSF findings, none present. Haloperidol's dopamine D2 blockade in the nigrostriatal pathway induces EPS, especially in older patients, aligning with the timeline and symptoms. This iatrogenic effect is a common adverse reaction, distinguishing it from unrelated pathologies in this context.

Correct Answer: D

Rationale: Phenytoin is an antiepileptic medication that is used to treat seizures. It has a narrow therapeutic range, and a blood level of 25 mcg/ml is considered to be high. At this level, patients are at risk for developing symptoms of phenytoin toxicity. Nystagmus, which is an involuntary rapid eye movement, is a common symptom of phenytoin toxicity. Other symptoms of phenytoin toxicity may include ataxia, diplopia, slurred speech, confusion, and drowsiness. It is important to monitor phenytoin blood levels regularly to avoid toxicity and adjust the dose accordingly.

Correct Answer: C

Rationale: Salicylamide is less effective than aspirin but may be used in patients allergic to aspirin. It is a derivative of salicylic acid and acts as an analgesic and antipyretic, but it lacks the anti-inflammatory properties of aspirin. Sodium salicylate and acetylsalicylic acid (aspirin) are more effective than salicylamide. Methyl salicylate is mainly used as a topical analgesic. Diflunisal is a salicylate derivative that is more potent and has a longer duration of action compared to aspirin, so it is not a suitable alternative for patients allergic to aspirin.

Correct Answer: B

Rationale: Sertraline, an SSRI, carries a black box warning for increased suicidal risk, particularly early in treatment, as it can paradoxically worsen mood or detachment in some patients. The spouse's report of moodiness and disconnection suggests possible suicidal ideation or adverse effects, necessitating urgent in-person assessment to evaluate safety and adjust treatment. Giving diphenhydramine is inappropriate, as it addresses neither depression nor the drug's effects and could mask symptoms. Holding medication without assessment risks untreated depression or withdrawal effects. Doubling the dose could exacerbate the issue, increasing risk. The nurse's priority is patient safety, requiring immediate evaluation by a professional, making choice B the most responsible and evidence-based response.