A patient with epilepsy has a morning Phenytoin level of 7 mcg/mL. What should the nurse do?

• A. Initiate seizure precautions
• B. Assess the patient for a rash
• C. Hold the next dose of Phenytoin
• D. Continue to monitor the patient

Answer: (A)

Subtherapeutic phenytoin levels mean seizure control may be inadequate, so the priority is to keep the patient safe in case a seizure occurs. A morning level of 7 mcg/mL falls below the usual therapeutic range (around 10–20 mcg/mL), signaling an increased risk of breakthrough seizures. Implementing seizure precautions right away helps protect the patient from injury until the clinician adjusts the dose to bring levels back into range.

Assessing for a rash is important with phenytoin because of potential hypersensitivity, but it doesn’t address the immediate risk created by a low drug level. Holding the next dose would further lower the level and isn’t appropriate here. Simply continuing to monitor without taking safety precautions leaves the patient exposed to seizures.