Mod 15- Antiseizure Agents

Question 1

A patient with cortical focal seizures has been prescribed phenobarbital. What adverse reaction should the nurse monitor for in the patient?

Answer 1

CNS depression

Question 2

A client is prescribed methsuximide. The nurse should expect to administer this drug by which route?

Answer 2

Oral

Question 3

One week ago, a client began taking ethosuximide 500 mg/day PO for the treatment of absence seizures. The client reports gastrointestinal (GI) upset after taking with the drug. What health education should the nurse provide?

Answer 3

“Try taking your pills at the same time as you eat some food.”

Question 4

The nurse has been educating the client on the self-administration of phenytoin. Which statement made by the client demonstrates an understanding of the medication?

Answer 4

“I’ll make sure to take the drug with food.”

Question 5

The nurse is providing client teaching with a client who is newly diagnosed with epilepsy. The client asks, “Can I still drive to work?” What is the nurse’s best response?

Answer 5

“You likely won’t be able to until your seizures are controlled by medication”

Question 6

When describing the action of barbiturates and barbiturate-like agents in the control of seizures, what would the nurse include?

Answer 6

Depression of motor nerve output

Question 7

The nurse is formulating a care plan for a client with a seizure disorder. Which intervention would be an appropriate for the nurse to include?

Answer 7

Informing the client and family that seizure control is not gained immediately

Question 8

When reviewing a journal article about seizure disorders, the nurse would expect to find tonic–clonic seizures and myoclonic seizures being classified as which type of seizures?

Answer 8

Generalized seizures

Question 9

An adolescent taking oral contraceptives has been prescribed an anticonvulsant medication. The nurse should tell the client to do which?

Answer 9

use another form of birth control, such as condoms.

Question 10

A nurse is caring for a patient prescribed phenobarbital for status epilepticus. What intervention should the nurse perform when the patient has been administered the drug?

Answer 10

Observe respirations frequently.

Question 11

A client reports sensing an unusual smell just prior to experiencing a tonic–clonic seizure. What term is used to describe this event?

Answer 11

aura
Tonic–clonic seizures are sometimes preceded by an aura—a brief warning, such as a flash of light or a specific sound or smell.

Question 12

The nurse is teaching a client who has been started on antiseizure medications. The nurse should inform the client that abrupt withdrawal from the medications can cause which problem?

Answer 12

Status epilepticus
Explanation:
In clients receiving drug treatment for seizure disorders, the most common cause of status epilepticus is abruptly stopping antiseizure drugs.

Question 13

After teaching a group of students about anticonvulsant therapy, the instructor determines that the teaching was successful when the group identifies which drug as eliciting its effects by increasing levels of gamma-aminobutyric acid (GABA), which stabilizes cell membranes?

Answer 13

Valproic acid

Question 14

A nurse should review a client’s medical conditions prior to administering a phenytoin (Dilantin) because its use is contraindicated in some clients. In what clients would its use be contraindicated? (Select all that apply.)

Answer 14

Pregnancy
Sinus bradycardia
Explanation:
The use of phenytoin is contraindicated in clients with known hypersensitivity to the drug, clients with sinus bradycardia, sinoatrial block, Adam-Stokes syndrome, and second- and third-degree atrioventricular block, pregnancy, and lactation.

Question 15

A female client’s seizure disorder has been successfully controlled by AEDs for years. She and her husband decide that it is time to start a family. She asks the nurse if it is safe for the fetus for her to continue her AEDs as prescribed. What is the nurse’s best response?

Answer 15

“They are considered teratogenic.”
Explanation:
Sexually active adolescent girls and women of childbearing potential who require an AED must be evaluated and monitored very closely, because all of the AEDs are considered teratogenic. In general, infants exposed to one AED have a significantly higher risk of birth defects than those who are not exposed, and infants exposed to two or more AEDs have a significantly higher risk than those exposed to one AED.

Question 16

While speaking with a client, the nurse notes that the client stares off, unblinking. The nurse notes that after several prompts, the client blinks rapidly and then resumes normal conversation. This behavior is consistent with what type of seizure?

Answer 16

absence

Question 17

The nurse is reviewing the results of a hospital client’s serum phenytoin level, which has just become available. The results indicate that the client’s phenytoin level is 17.5 mcg/mL. What is the nurse’s best action?

Answer 17

Document the fact that the nurse checked the client’s phenytoin levels
Explanation:
The therapeutic range is 10 to 20 mcg/mL. Consequently, there is no action needed beyond documentation.

Question 18

The nurse has taught a client who is receiving lamotrigine about possible adverse effects. The nurse determines that the client has understood the teaching when the client identifies a need to promptly report what adverse effect?

Answer 18

Rash
Explanation:
Lamotrigine has been associated with very serious to life-threatening rashes and the drug should be discontinued at the first sign of any rash.

Question 19

When combination therapy is ineffective, what needs to be reassessed?

Answer 19

Drug–drug interactions

Question 20

A client, newly diagnosed with a seizure disorder, asks the nurse why the client is receiving a specific drug. What would be the best answer by the nurse?

Answer 20

When prescribing an AED, the health care provider takes into account the type of seizure the client is having.

Question 21

Simple seizures, motor seizures, and somatosensory seizures are classified as what type of seizure?

Answer 21

Partial seizures

Question 22

A 15-year-old male client receiving phenytoin for treatment of epilepsy is being discharged from the hospital. What statement by Richard’s mother leads you to believe she has understood your teaching related to his care and drug administration?

Answer 22

“I will make sure he has routine visits to the dentist.”
Explanation:
Gingival hyperplasia, the overgrowth of gum tissue, is common in patients who take phenytoin. It is especially common in children.

Question 23

A client who is receiving phenytoin has a serum drug level drawn. Which result would the nurse interpret as within the therapeutic range?

Answer 23

12 mcg/mL
Explanation:
The therapeutic serum phenytoin levels range from 10 to 20 mcg/mL. Thus, a level of 12 mcg/mL would fall within this range.

Question 24

A client is prescribed lamotrigine for control of partial seizures. What is the most important medication teaching information the nurse should emphasize from the plan of care?

Answer 24

Contact the health care provider immediately if rash appears

Question 25

A 25-year-old client takes ethosuximide for the treatment of absence seizures calls the clinic to report that she has developed a sore throat and a slight fever. The nurse will explain that she should come to the clinic to have what checked?

Answer 25

Blood cell count
Explanation:
If clients who take ethosuximide develop signs of infection such as a sore throat and fever, blood cell counts should be checked

Question 26

The nurse has administered gabapentin to a client. Following administration, the nurse should assess the client for what possible adverse effect?

Answer 26

Central nervous system (CNS) depression
Explanation:
The most common adverse effects of gabapentin are associated with CNS depression and include dizziness, somnolence, insomnia, and ataxia

Question 27

The nurse is caring for an 84-year-old client who is taking an AED and recognizes that this client is at increased risk for which condition?

Answer 27

Falls
Explanation:
In older adults, decreased elimination by the liver and kidneys may lead to drug accumulation, with subsequent risks of dizziness, impaired coordination, and injuries due to falls.

Question 28

What type of seizure activity is characterized by generalized tonic–clonic convulsions lasting for several minutes during which the client does not regain consciousness?

Answer 28

status epilepticus
Explanation:
Status epilepticus is a life-threatening emergency characterized by generalized tonic–clonic convulsions lasting for several minutes or occurring at close intervals during which the client does not regain consciousness

Question 29

What is a common risk for epileptic seizures during late infancy to early childhood?

Answer 29

fever

Question 30

A nurse is caring for a client with trigeminal neuralgia at a health care facility. The health care provider has prescribed carbamazepine. In which case is the use of carbamazepine contraindicated in clients with:

Answer 30

renal impairment.
Explanation:
The nurse should know that carbamazepine is contraindicated among clients with renal impairment.

Question 31

The nurse is monitoring the serum carbamazepine level of a client. Which result would lead the nurse to notify the prescriber that the client most likely needs an increased dosage?

Answer 31

2 mcg/mL
Explanation:
Therapeutic serum carbamazepine levels range from 4 to 12 mcg/mL. Therefore, a level under 4 mcg/mL would suggest that the drug has not reached therapeutic levels, so the dosage may need to be increased.

Question 32

An older adult client has been prescribed an antiseizure medication and is experiencing central nervous system depression. What is the nurse’s most appropriate action?

Answer 32

Implement falls precautions
Explanation:
CNS depression creates a risk for falls, especially in older clients. There is no need to assess vital signs on an hourly basis and the harm of bed rest exceeds the benefits. Occupational therapy has no direct relationship with treating CNS depression.

Question 33

Which type of seizures involves a loss of consciousness?

Answer 33

Generalized seizures

Question 34

What should the nurse include as a possible adverse effect when teaching a client about phenytoin?

Answer 34

Liver toxicity

Question 35

A patient is prescribed daily doses of phenytoin for seizures. The nurse knows that a single dose should not be missed during the course of treatment. Which condition could result if a dose is missed?

Answer 35

Status epilepticus
Explanation:
Status epilepticus may result from abrupt discontinuation of the drug, even when the anticonvulsant is being administered in small daily doses.