Chapter 31-agents affecting seizures/epilepsy

Question 1

A client is prescribed fosphenytoin sodium. The nurse prepares to administer this by which route?

Answer 1

intravenous

Question 2

When teaching a client and his family about anticonvulsant therapy, the nurse should include which of the following?

Answer 2

Clients need routine serum blood levels of the drug drawn.

Question 3

The nurse recognizes a generalized tonic-clonic seizure when the client exhibits what characteristics?

Answer 3

rigidity with muscle jerks, temporal apnea, possible loss of bowel and bladder control

Question 4

A client is experiencing status epilepticus. The nurse should:

Answer 4

ensure a patent airway and protect the client’s head and body from injury.

Question 5

When obtaining a client history, the nurse learns that the client exercises regularly and is an avid sports fan. He is currently under a great deal of both personal and professional stress, and this is causing him to desire to snack frequently. Which of these factors would pose the greatest risk for decreasing the client’s seizure threshold?

Answer 5

stress- (psychosociophysiologic) can lower the seizure threshold.

Question 6

When teaching a client prescribed phenytoin about a common adverse effect of this drug, the nurse should instruct the client to:

Answer 6

practice good oral hygiene.-Gingival hyperplasia is an adverse effect of phenytoin and occurs most often in children.

Question 7

Folic acid supplements are often given when phenytoin therapy is started. The reason for this is to:

Answer 7

prevent the development of anemia.- Phenytoin can cause folic acid deficiency anemia.

Question 8

A client who is npo is prescribed IV phenytoin. When preparing the equipment to administer this dose, the nurse should:

Answer 8

hang an IV bag of 0.9% normal saline and prime the IV tubing.

Question 9

Which of the following anticonvulsants is indicated for the treatment of trigeminal neuralgia?

Answer 9

carbamazepine

Question 10

The client expresses concern about the drowsiness she experienced when beginning phenytoin therapy. The nurse should instruct her that this adverse effect:

Answer 10

improves after taking the drug for a while.

Question 11

Clients who experience intractable seizures may require surgical intervention if:

Answer 11

seizures consistently originate in just one part of the brain.
This is one of three major criteria for surgical intervention.

Question 12

The nurse would prepare to administer this medication to treat or prevent seizures during neurosurgery.

Answer 12

fosphenytoin sodium-is the drug of choice, because it is rapidly converted to phenytoin and does not cause the high irritability associated with parenteral phenytoin.

Question 13

An adult client having been treated for 3 months with phenytoin is admitted to the nursing unit with mental status changes, irritability, and agitation. When evaluating the client’s laboratory results, which of the following indicates to the nurse the cause of the client’s current status?

Answer 13

phenytoin level of 30 mcg/mL- These are manifestations of phenytoin toxicity, and this is a toxic phenytoin level.

Question 14

The nurse is caring for a client who has been on chronic therapy with valproic acid. The nurse assesses which of the following for this client?

Answer 14

liver function tests-Hepatotoxicity is a concern for the client on long-term valproic acid therapy.

Question 15

Clients taking carbamazepine should have which test monitored routinely?

Answer 15

complete blood count- Hematological impairment, including leukopenia and thrombocytopenia, are associated with carbamazepine therapy.

Question 16

A nurse is teaching a client taking carbamazepine about what action he should take related to his serum drug level. Which of the following would indicate client understanding of the instruction for a serum carbamazepine level of 11 mcg/L?

Answer 16

“I will plan to take my next dose as usual.”- The normal level for carbamazepine is 4 to 12 mcg/mL, so his level is normal and he should plan to continue his medication at its present dose.

Question 17

When preparing to administer fosphenytoin sodium to an adult, the nurse understands that too-rapid intravenous administration of fosphenytoin sodium can cause:

Answer 17

a pulse rate less than 60.-It can cause bradycardia.

Question 18

During the client’s annual physical examination, the significant other states that the client will “just stop in the middle of a sentence and stare off into space for about 15 seconds fluttering his eyes. When he stops staring, he just continues what he was saying. I asked him what he was thinking when he was staring and he does not remember anything about this episode. It has happened about a dozen times in the last couple of months.” What is happening with him? The nurse recognizes this behavior as characteristic of

Answer 18

an absence seizure.

Question 19

A client is prescribed IV phenytoin 300 mg. The nurse will administer this IV bolus over:

Answer 19

6 minutes-300 mg divided by 50 mg/min = 6 minutes.

Question 20

When administering IV bolus phenytoin to an infant, the nurse must use:

Answer 20

a central venous access

Question 21

A neonate weighing 7.5 pounds is experiencing seizures secondary to maternal drug use during pregnancy and is prescribed IV phenytoin, which cannot exceed 3 mg/kg/minute. The safe dose for this neonate is:

Answer 21

10 mg/min.- 7.5 divided by 2.2 = 3.4 kg; multiplied by 3 mg/min = 10.2, which rounds to 10 mg/min

Question 22

The nurse is caring for an adult client receiving continuous enteral feedings who is prescribed phenytoin per nasogastric tube. The nurse should:

Answer 22

discontinue the enteral feeding 90 minutes before and after administering the phenytoin.

Question 23

The nurse should monitor the client taking carbamazepine for:

Answer 23

fever and sore throat.

-: Carbamazepine can cause hematological abnormalities, including leukopenia and thrombocytopenia.

Question 24

A client is prescribed valproic acid for seizure control. The client’s current serum level of valproic acid is 130 mcg/mL. The nurse should:

Answer 24

notify the health care provider immediately.

Question 25

An 8-year-old child is prescribed oxcarbazepine. The child weighs 66 pounds, and the safe recommended dosage range for oxcarbazepine is 8–10 mg/kg. What is the safe dosage range for this child?

Answer 25

240–300 mg - 66 pounds divided by 2.2 = 30 kg; multiplied by 8 = 240 mg; 30 kg multiplied by 10 = 300 mg.

Question 26

A client is prescribed tiagabine. The nurse understands that this drug works by:

Answer 26

increasing the inhibitory neurotransmitter GABA.

Question 27

A client is prescribed lamotrigine. The nurse understands that this agent is used in combination with other anticonvulsant agents to treat:

Answer 27

partial seizures in adults.-This is a primary use for lamotrigine in combination with valproic acid.

Question 28

The client receiving rufinamide would be monitored for all of the following adverse effects EXCEPT:

Answer 28

leukocytosis- Rufinamide can cause leukopenia, not leukocytosis.

Question 29

Which of the following statements by the nurse recruit indicates a misunderstanding about the medication Topamax?

Answer 29

“The client should be instructed to decrease fluid intake during the medication regimen.”

Question 30

The factor(s) most influencing the choice of anticonvulsants to prescribe for the client include which of the following? Select all that apply.

Answer 30

c. type of seizure experienced by client

d. adverse effects of the drug

Question 31

The client receiving continuous enteral feedings is prescribed phenytoin per gastric tube. The nurse recognizes the spouse’s understanding of the instructions when the spouse does which of the following? Select all that apply.

Answer 31

a. stops the enteral feeding 2 hours prior to administering phenytoin
b. flushes the gastric tube with water before and after administering phenytoin
d. restarts the enteral feeding 2 hours following phenytoin administration

Question 32

When administering fosphenytoin sodium to a client experiencing status epilepticus the nurse knows if he administers the drug at a rate greater than 150 mg/min, it could result in which of the following? Select all that apply.

Answer 32

a. bradycardia
b. ventricular fibrillation
d. cardiac arrest