A nurse monitors a client with a phenytoin level of 32 mg/dL. Which symptoms should the nurse watch for?

A phenytoin level of 32 mg/dL is significantly above the therapeutic range, which typically falls between 10 to 20 mg/dL. Elevated levels of phenytoin can lead to various side effects, primarily affecting the central nervous system. Ataxia, which refers to a lack of voluntary coordination of muscle movements, is a common symptom associated with phenytoin toxicity. The body may struggle to coordinate movements due to impaired neural function, leading to an unsteady gait and difficulty with tasks requiring fine motor skills.

While confusion can occur with high levels of phenytoin, the overt and more pronounced symptom of ataxia makes it primary to monitor in this scenario. Similarly, tonic-clonic seizures are the very reason for prescribing phenytoin, making this option less relevant in the context of toxicity symptoms. Urinary incontinence may happen in various clinical situations, but it is not specifically tied to phenytoin toxicity either. Therefore, the most critical symptom to watch for in a client with a phenytoin level this high is the risk of ataxia.