Author Question: The physician has prescribed phenytoin (Dilantin) for a patient with type 1 diabetes mellitus. What ... (Read 36 times)

charchew · **on:** Jul 23, 2018

The physician has prescribed phenytoin (Dilantin) for a patient with type 1 diabetes mellitus. What does the nurse include in the plan of care for this patient?

1. Plan to discuss with the physician the need to decrease the patient's insulin based on serum glucose levels.
2. Plan to discuss with the physician the need to increase the patient's insulin based on serum glucose levels.
3. Plan to assess the patient for petechiae, epistaxis, and hematuria.
4. Plan to institute safety precautions, as the patient is at risk for dizziness and ataxia.

Question 2

The patient is receiving phenobarbital (Luminal) for seizure control. The patient asks the nurse how this little pill can stop his seizures. What is the best response by the nurse?

1. Phenobarbital (Luminal) stops your seizures by decreasing the calcium in your brain which is responsible for the seizures.
2. Phenobarbital (Luminal) stops your seizures by increasing a chemical called glutamate that calms down the excitability in your brain.
3. Phenobarbital (Luminal) stops your seizures by decreasing the sodium in your brain which is responsible for the seizures.
4. Phenobarbital (Luminal) stops your seizures by increasing a chemical called GABA that calms down the excitability in your brain.

Ddddd · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

Correct Answer: 2
Rationale: Phenytoin (Dilantin) can increase serum glucose levels and the patient may need additional insulin. All patients receiving phenytoin (Dilantin) are at risk for dizziness and ataxia; this is not specific to the patient with type 1 diabetes mellitus. All patients receiving phenytoin (Dilantin) are at risk for petechiae, epistaxis, and hematuria; this is not specific to the patient with type 1 diabetes mellitus. Phenytoin (Dilantin) can increase serum glucose levels, not decrease them.

Answer to Question 2

Correct Answer: 4
Rationale: Phenobarbital (Luminal) acts biochemically in the brain by enhancing the action of the neurotransmitter GABA, which is responsible for suppressing abnormal neuronal discharges that can cause epilepsy. Glutamate is the primary excitatory neurotransmitter in the brain; enhancing this neurotransmitter will increase the likelihood of seizures. Hydantoins and phenytoin-like drugs, not phenobarbital (Luminal), suppress sodium influx. Succinimides, not phenobarbital (Luminal), suppress calcium influx.