護理師照護一位有癲癇病史且服用 Phenytoin 的病人。下列哪項評估為優先？
A nurse is caring for a client with a history of seizures who is prescribed phenytoin. Which assessment is priority?
- AAssess for skin rashes評估皮膚疹
- BCheck for urinary output檢查尿液排出量
- CMonitor for gingival hyperplasia監測牙齦增生
- DPerform a neurological assessment✓ 正解進行神經學評估
Phenytoin 為抗癲癇藥，臨床評估的優先順序應依「安全與治療效果」原則：D. 神經學評估涵蓋治療效果（癲癇控制狀況）與藥物毒性（共濟失調、眼震、嗜睡等中樞神經症狀），是首要評估。C. 皮疹（特別是 Stevens-Johnson syndrome）雖少見但致命，仍是必須監測但屬於發生時才優先處理的緊急事件。B. 牙齦增生雖常見但非急性風險，需長期口腔衛教而非優先評估。A. 排尿與此藥無直接關聯。
Phenytoin is an antiepileptic medication, and the priority of clinical assessment should follow the principle of "safety and therapeutic effect": D. Neurological assessment covers both therapeutic efficacy (seizure control) and drug toxicity (ataxia, nystagmus, drowsiness, and other central nervous system symptoms), and is the priority assessment. C. Skin rash (especially Stevens-Johnson syndrome), although rare, is potentially fatal and must be monitored, but it is an emergency to prioritize if it occurs. B. Gingival hyperplasia is common but not an acute risk; it requires long-term oral hygiene education rather than priority assessment. A. Urinary output is not directly related to this medication.
兩地牙醫與藥師衛教協作模式略有不同，但護理師對於抗癲癇藥物副作用的監測職責是一致的。