Final answer:
The nurse should examine the oral cavity as the next step following the report of an elevated phenytoin level, indicative of potential toxicity. This is essential for assessing cranial nerve function and signs of infection related to drug toxicity.
Step-by-step explanation:
The nurse should examine the oral cavity as the next action after finding a phenytoin level of 32 mcg/mL. This assessment is part of a comprehensive neurological exam, which is critical when monitoring a patient who takes medication for seizure prevention. A phenytoin level of 32 mcg/mL indicates potential toxicity, as the therapeutic range is generally between 10 to 20 mcg/mL. It's important for health care professionals to assess for signs of toxicity, which can include nystagmus, ataxia, slurred speech, and altered mental status. The inspection of the oral cavity can reveal signs of infection or assess cranial nerve functions that might be impaired due to elevated drug levels.
Moreover, the neurological exam enables health care professionals to rapidly assess a patient's neurological functions using various techniques, such as testing muscular strength, sensory response, and checking reflexes. An exam of the patient's oral cavity may reveal neural dysfunction due to phenytoin toxicity. The nurse's examination can contribute to a prompt diagnosis and management of the side effects or overdose associated with high levels of phenytoin.