What action should the nurse take if a client's phenytoin level is elevated at 32 mcg/mL?

When a client's phenytoin level is elevated at 32 mcg/mL, it indicates that the drug concentration in the bloodstream is higher than the therapeutic range, which is typically between 10 to 20 mcg/mL for phenytoin. Elevated levels of phenytoin can lead to toxicity, resulting in symptoms such as confusion, dizziness, ataxia, and even more severe neurological effects.

In this case, decreasing the daily dose of phenytoin is the appropriate action to take. By reducing the dosage, the nurse aims to bring the drug concentration back into the therapeutic range, thereby preventing the risk of toxicity and ensuring the client’s safety.

Continuing phenytoin as prescribed would maintain the elevated level, potentially exacerbating the situation. Increasing the dose would further increase the serum concentration, which is inappropriate in the context of an already elevated level. Simply repeating the serum phenytoin level in 2 hours without taking further action would not address the immediate concern of toxicity and would delay necessary interventions. Therefore, decreasing the phenytoin daily dose addresses the critical issue of elevated drug levels and protects the client from potential adverse effects associated with toxicity.