對於服用苯妥英（Phenytoin）控制癲癇的病人，下列哪些護理措施是適當的？（選所有適合的）
Which of the following interventions are appropriate for a client receiving phenytoin for seizure control? (Select all that apply.)
- APerform frequent oral hygiene to prevent gingival hyperplasia✓ 正解經常執行口腔衛生以預防牙齦增生
- BMonitor serum drug levels to ensure therapeutic range✓ 正解監測血清藥物濃度以確保治療範圍
- CEncourage the client to stop medication if seizures cease鼓勵病人在癲癇發作停止後停用藥物
- DAdvise the client to report a rash immediately✓ 正解建議病人立即報告皮疹
- EIncrease intake of folic acid-rich foods✓ 正解增加富含葉酸的食物的攝取
核心概念：抗癲癇藥物苯妥英（Phenytoin）的照護與監測。 為何正確答案對： A. 加強口腔衛生（Perform frequent oral hygiene）以預防牙齦增生（gingival hyperplasia）。Phenytoin 的常見副作用是牙齦增生，嚴格的口腔清潔能減緩此現象。 B. 監測血中藥物濃度（Monitor serum drug levels）。Phenytoin 具有狹窄的治療窗（narrow therapeutic index），血中濃度過高會增加毒性，過低則療效不彰。定期監測是確保療效與安全性的關鍵。 D. 病人出現皮疹（report a rash immediately）必須立即告知醫護人員。Phenytoin 可能引起嚴重的皮膚反應，如史蒂芬強森症候群（Stevens-Johnson syndrome, SJS）或毒性表皮溶解症（Toxic Epidermal Necrolysis, TEN），早期發現並停藥至關重要。 E. 補充葉酸（Increase intake of folic acid-rich foods）。Phenytoin 會干擾葉酸（folate）的吸收與代謝，長期使用者可能導致葉酸缺乏。建議補充葉酸，但需在醫師指示下進行。 為何其他選項錯： C. 癲癇發作停止後，不可自行停藥（stop medication if seizures cease）。癲癇是慢性疾病，需長期穩定控制，自行停藥可能導致癲癇復發或狀態癲癇（status epilepticus），後果嚴重。 臨床思路/安全優先：Phenytoin 雖是有效的抗癲癇藥物，但其副作用多且潛在嚴重。護理師的角色在於預防副作用、監測療效與毒性，並對病人進行衛教，使其了解藥物重要性與潛在風險。確保病人安全用藥、預防傷害是照護重點。
Core concept: care and monitoring of the antiepileptic medication phenytoin. Why the correct answers are right: A. Frequent oral hygiene to prevent gingival hyperplasia. Gingival hyperplasia is a common side effect of phenytoin, and rigorous oral cleaning can slow its development. B. Monitoring serum drug levels. Phenytoin has a narrow therapeutic index; excessive levels increase toxicity, while subtherapeutic levels reduce efficacy. Periodic monitoring is essential to ensure both effectiveness and safety. D. Patients must report any rash immediately. Phenytoin can produce severe cutaneous reactions such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN); early recognition and drug discontinuation are critical. E. Increase folic acid intake. Phenytoin interferes with the absorption and metabolism of folate, and long-term users may become folate-deficient. Folic acid supplementation is recommended but should be guided by the physician. Why the other option is wrong: C. The patient must not stop taking the medication on their own once seizures cease. Epilepsy is a chronic condition that requires sustained control; abrupt withdrawal can precipitate seizure recurrence or status epilepticus, with severe consequences. Clinical reasoning/safety priority: although phenytoin is an effective anticonvulsant, it has multiple side effects, some of which are potentially serious. The nurse's role is to prevent adverse effects, monitor efficacy and toxicity, and educate the patient about the importance of the drug and its potential risks. Ensuring safe medication use and preventing harm are the priorities of care.