The nurse receives telephone messages from the following 4 clients. Which client should the nurse call back first?

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Phenytoin is an anticonvulsant prescribed for the treatment of seizures. Clients should never abruptly stop taking the medication due to the possibility of seizure reoccurrence and status epilepticus. An exception is the development of a rash, which may indicate Stevens-Johnson syndrome (SJS). SJS is a rare but potentially life-threatening hypersensitivity reaction. SJS often starts with flu-like symptoms and a painful, purple or red rash to the skin or mucous membranes that may resemble a third-degree burn (Option C). Immediate discontinuation of the triggering agent and notification of the health care provider is necessary to prevent rapid progression and multiple organ failure. (Option A) Gingival hyperplasia (ie, swollen, bleeding gums) is common with cyclosporine and phenytoin. Clients should be instructed on proper dental hygiene. (Option B) Photosensitivity reactions are common with tetracycline antibiotics and sulfa drugs. Clients should wear protective clothing and sunscreen when outdoors. This client requires treatment for sunburn, but the condition is not life-threatening. (Option D) Orthostatic hypotension is a common side effect of antihypertensives, antipsychotics, antidepressants, diuretics, narcotics, and vasodilator medications. Sildenafil (Viagra) and tadalafil (Cialis), commonly used to treat erectile dysfunction, can cause vasodilation and orthostatic hypotension. Clients should move slowly and carefully when changing to a standing position to decrease the risk for falls. Educational objective: Clients taking phenytoin should discontinue the medication immediately if a rash develops and notify the health care provider. The rash may indicate Stevens-Johnson syndrome, a potentially life-threatening hypersensitivity reaction.

The Nurse Receives Telephone Messages from the Following 4 Clients