A nurse in a clinic is caring for a client. Exhibits Click to highlight the findings that require immediate follow-up as contraindications to the prescribed prescription. To deselect a finding click on the finding again. Body System Findings Vital Signs/General History Temperature 35.4 °C (97.6 °F), oral Heart rate 75/min Respiratory rate 16/min Blood pressure 100/74 mmHg Oxygen saturation 99% on room air Client is a vegetarian and takes a multivitamin daily Client reports having three to four alcoholic beverages a couple times per week. Integumentary Skin color is consistent with genetic background. No rashes or lesions. The client has varicose veins. Cardiovascular/Respiratory S1S2 auscultated. No murmurs. All peripheral pulses 2+. Lung sounds clear bilaterally. Gastrointestinal/Genitourinary Abdomen soft, nontender. Normoactive bowel sounds in all 4 quadrants. Last bowel movement was 3 days ago. Voids four to five times a day. Urine is clear, yellow, and odorless. Last menstrual period was 3 months ago. Neurologic/Musculoskeletal Alert and oriented to person, place, and time. Client takes diazepam as needed for anxiety. Client has full range of motion and is able to maintain flexion against resistance in all four extremities.

Client reports having three to four alcoholic beverages a couple times per week: Alcohol can interact with phenytoin, either enhancing its effects or reducing its efficacy. Chronic alcohol use can induce liver enzymes, altering phenytoin metabolism and potentially leading to subtherapeutic or toxic levels. Client takes diazepam as needed for anxiety: Diazepam and phenytoin can interact, increasing the sedative effects and potentially leading to central nervous system depression. Monitoring is essential when these drugs are coadministered. Last menstrual period was 3 months ago: This finding may indicate a possible pregnancy, which is critical because phenytoin is teratogenic and classified as a Pregnancy Category D drug. Immediate follow-up is required to rule out pregnancy before starting phenytoin therapy. Temperature 35.4°C (97.6°F), oral: This is slightly lower than the normal range and does not require immediate follow-up. Blood pressure 100/74 mmHg: This is within the expected range and does not contraindicate phenytoin use. Client is a vegetarian and takes a multivitamin daily: A vegetarian diet is not a contraindication, though it may necessitate monitoring for folic acid levels since phenytoin can deplete folate. Client has varicose veins: Varicose veins do not affect phenytoin use or metabolism. Last bowel movement was 3 days ago: While mild constipation should be noted, it does not contraindicate phenytoin use.