A patient recently started on phenytoin (Dilantin) to control simple complex seizures is seen in the outpatient clinic. Which information obtained during his chart review and assessment will be of greatest concern?

Correct Answer: B

Rationale: The correct answer is B) The white blood cell count is 2300/mm³. This information is of greatest concern because it indicates a potential serious side effect of phenytoin, which is agranulocytosis. A low white blood cell count puts the patient at risk for infections and can be life-threatening. Monitoring the white blood cell count is essential when a patient is on phenytoin to detect this adverse effect early. Option A) The gums appear enlarged and inflamed, is a common side effect of phenytoin known as gingival hyperplasia. While it is important to address, it is not as immediately concerning as a low white blood cell count. Option C) Patient occasionally forgets to take the phenytoin until after lunch, is concerning for medication adherence but does not pose an immediate threat to the patient's health compared to a low white blood cell count. Option D) Patient wants to renew his driver's license in the next month, is not directly related to the patient's health status or the management of phenytoin. In an educational context, this question highlights the importance of monitoring for side effects and adverse reactions when administering medications like phenytoin. It emphasizes the critical role of assessing lab values and recognizing potential serious complications to ensure patient safety and well-being.

Correct Answer: D

Rationale: The correct answer is D) Destruction of nerve cells of the basal ganglia of the brain. In Parkinson's disease, there is a progressive degeneration of dopamine-producing neurons in the substantia nigra of the basal ganglia. This leads to a decrease in dopamine levels, which in turn causes the characteristic motor symptoms of Parkinson's disease such as tremors, rigidity, and bradykinesia. Option A is incorrect because Parkinson's disease is not characterized by multiple foci of nerve degeneration throughout the brain and spinal cord; it is more localized to the basal ganglia. Option B is incorrect because Parkinson's disease is not due to a decreased secretion of acetylcholine at myoneural junctions. It is primarily a result of dopamine deficiency. Option C is incorrect because although atrophy of voluntary muscles can occur as a consequence of decreased movement and muscle disuse in Parkinson's disease, it is not the primary pathophysiology of the disorder. Understanding the pathophysiology of Parkinson's disease is crucial for healthcare professionals as it informs the treatment strategies such as dopamine replacement therapies and deep brain stimulation. By knowing the specific areas of the brain affected, healthcare providers can better understand the motor symptoms experienced by patients and provide tailored care and support.

Correct Answer: A

Rationale: The correct answer is A) sudden, brief loss of sensory, motor, or visual function. This is crucial to document because a transient ischemic attack (TIA) is characterized by temporary disruption of blood flow to the brain, leading to temporary neurologic deficits. Documenting the specific symptoms experienced during the TIA episode is essential for accurate diagnosis and appropriate management. Option B) determining if he has any allergies is incorrect as it is not directly related to the diagnosis of TIA. Allergies are important to document in a medical history but not specifically relevant to a TIA. Option C) any history of neurologic disease is incorrect because the focus here is on documenting the specific symptoms experienced during the TIA episode, not a general history of neurologic diseases. Option D) his medication history, both prescribed and over-the-counter, is important in a comprehensive assessment but is not as essential as documenting the specific symptoms experienced during the TIA episode. In an educational context, understanding the importance of accurate documentation in a patient's history is critical for healthcare professionals to provide effective care and treatment. This question highlights the significance of recognizing key information needed to assess and manage a patient presenting with a TIA, emphasizing the importance of thorough history-taking in neurological assessments.

Correct Answer: B

Rationale: In this scenario, option B is the correct answer because it demonstrates the patient's understanding of the importance of monitoring for signs of complications post-discharge. Swelling and decreased temperature in the fingers of the left hand could indicate impaired circulation, requiring immediate medical attention. By mentioning elevation and prompt physician contact, the patient shows comprehension of self-care and when to seek professional help, reflecting effective teaching. Option A is incorrect because increasing pain in the arm should not be expected or ignored; persistent pain may indicate complications and should prompt immediate medical evaluation. Option C is incorrect as bleeding on the cast should not be circled but rather reported immediately to healthcare providers, as uncontrolled bleeding can lead to serious issues like infection or compromised healing. Option D is also incorrect as immobilizing the hand for a week without any mention of monitoring for complications or seeking medical advice could lead to potential issues such as stiffness or further complications. From an educational standpoint, this question highlights the importance of patient education in promoting post-discharge self-care and recognizing signs of complications. It emphasizes the significance of clear communication between healthcare providers and patients to ensure optimal outcomes and prevent adverse events. By assessing the patient's understanding through scenarios like this, healthcare professionals can gauge the effectiveness of their teaching and address any misconceptions or gaps in knowledge before discharge.

Correct Answer: A

Rationale: The correct answer is A) needs to exercise involved joints periodically. Joint stiffness can result from prolonged, static postures, such as reading for extended periods. Encouraging the patient to periodically move and exercise the involved joints can help alleviate stiffness and improve circulation. This is supported by the concept of maintaining joint mobility and preventing stiffness through movement. Option B) needs to take long walks twice a day is incorrect as it does not directly address the issue of joint stiffness related to prolonged reading. While walking can be beneficial for overall health, it may not specifically target the stiffness caused by reading. Option C) is a chronic complainer is a distractor and not related to the patient's reported joint stiffness. This option lacks relevance to the scenario presented. Option D) needs to rest involved joints for one hour at a time is incorrect because prolonged rest can actually contribute to joint stiffness. While rest is important, in this case, gentle movement and exercises are more appropriate to address the stiffness issue. In an educational context, understanding the importance of movement and exercise in maintaining joint health is crucial for healthcare providers. Encouraging patients to engage in regular physical activity can help prevent and manage joint stiffness, promoting overall well-being. It is essential to tailor recommendations to each individual's specific situation and activities to optimize health outcomes.