The nurse is preparing to administer phenytoin to a patient who has a seizure disorder. The patient appears drowsy, and the nurse notes that the last random serum drug level was 18 mcg/mL. What action will the nurse take?

A. Administer the dose since the patient is not toxic. This is not the appropriate action. With a drowsy patient and a high serum phenytoin level, there is a concern for toxicity. Administering the next dose could worsen the toxicity. B. Contact the provider to discuss decreasing the phenytoin dose. While adjusting the dose may be a consideration, the immediate action should be to withhold the next dose and report the elevated level to the healthcare provider. The provider can then determine the appropriate course of action. C. Give the drug and monitor closely for adverse effects. Giving the drug without further intervention is not appropriate when there are signs of potential toxicity, such as drowsiness. Monitoring alone is not sufficient in this case. D. Report drug toxicity to the providers. This is the correct choice. With a drowsy patient and a serum phenytoin level of 18 mcg/mL, which is considered high, reporting the drug toxicity to the healthcare provider is the immediate and appropriate action. The provider can then determine the next steps, such as adjusting the dose or ordering additional tests.