Unit 5 Pharm Chapter 23 Flashcards
What should the nurse include as a possible adverse effect when teaching a client about phenytoin?
A) Increased white blood cell count
B) Physical dependence
C) Liver toxicity
D) Diarrhea
C) Liver toxicity
Rationale:Liver toxicity is a potential adverse effect of phenytoin. Constipation, not diarrhea, is an adverse effect of phenytoin. Bone marrow suppression and leukopenia would be adverse effects of phenytoin. Physical dependence is an adverse effect associated with the use of benzodiazepines and barbiturates.
A client is receiving carbamazepine therapy, and the client’s latest serum level of the drug is 13 mcg/mL. What action is most appropriate?
A) Call an emergency code.
B) Contact the provider to request a one-time supplementary dose.
C) Anticipate a reduction is dosage.
D) Assess the client’s renal function.
C) Anticipate a reduction is dosage.
Rationale:A serum carbamazepine level of 13 mcg/mL is slightly over the therapeutic range of 4 to 12 mcg/mL, indicating need for a reduction in dosage. This is not an emergency, though it needs to be addressed. This result does not threaten the client’s renal function.
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?
A) Monitor vital signs hourly while the client is awake.
B) Maintain the client on bed rest.
C) Implement falls precautions.
D) Make a referral to occupational therapy.
C) Implement falls precautions.
Rationale: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.
A client with a history of seizures takes phenytoin on a regular basis. What should the nurse teach the client in order to ensure the client’s safety?
A) Avoid ginkgo supplements.
B) Avoid brewer’s yeast.
C) Do not take OTC antacids.
D) Do not take garlic or ginger supplements.
A) Avoid ginkgo supplements.
Rationale:Clients being treated with barbiturates or phenytoin should be advised not to use ginkgo, which could cause serious adverse effects. The nurse should collaborate with the care provider about other supplements and OTC medications, but antacids, ginger, garlic, and brewer’s yeast are not noted to be harmful.
A client has been prescribed carbamazepine for the prevention of seizures. What action should the nurse perform?
A) Educate the client about taking the medication at the first sign of impending seizure activity.
B) Teach the client how to self-administer subcutaneous injections.
C) Establish intravenous access.
D) Educate the client about the need to take the pills as scheduled.
D) Educate the client about the need to take the pills as scheduled.
Rationale:Carbamazepine is administered orally on an ongoing basis. It is not an emergency treatment for seizure activity.
The nurse is caring for a woman who has taken phenytoin for many years to control her seizures. The woman now wishes to become pregnant and asks the nurse what she should do. What is the nurse’s best response?
A) Women with a seizure disorder cannot get pregnant and you will need to look into other alternatives, such as adoption.
B) The risk to you and the fetus is greater when stopping the drug during pregnancy than the drug itself.
C) It is important to prevent seizures during pregnancy so the doctor will likely change you to combination therapy.
D) The drugs will be stopped until you get pregnant and then resumed when you enter your second trimester.
B) The risk to you and the fetus is greater when stopping the drug during pregnancy than the drug itself.
Rationale:The risk of taking a woman with a seizure disorder off of an antiepileptic drug that has stabilized her condition may be greater than the risk of the drug to the fetus. Discontinuing the drug could result in status epilepticus, which has a high risk of hypoxia for the mother and the fetus. Women with a seizure disorder can have children, but it takes careful planning to reduce risks to both the mother and the fetus. Combination therapy increases risk because the fetus is exposed to more drugs.
The nurse reviews the client’s order for phenytoin and would need to call the physician to question the order if what dosage was ordered?
A) 200 mg t.i.d.
B) 200 mg b.i.d.
C) 100 mg t.i.d.
D) 100 mg q.i.d.
A) 200 mg t.i.d.
Rationale:Maximum daily dosage is 400 mg, so an order for 200 mg t.i.d. would need to be questioned because it would deliver 600 mg per day. The other options are within acceptable range.
A child in status epilepticus has been prescribed phenobarbital 15 mg/kg IV to be administered over 15 minutes. The child weighs 24 kg, and the drug is added to a 50-mL minibag. At what rate, in mL/hour, should the nurse administer the drug?
_____________mL/hour
200ml/hr
Rationale:The dose and the child’s weight are not necessary for determining the rate of administration. The rate is calculated by volume alone: 50 mL over 15 minutes is equivalent to 200 mL over 60 minutes (using proportions, 15 minutes × 4 = 60 minutes; 50 ml × 4 = 200 mL).
An adult client underwent diagnostic testing after experiencing an absence seizure for the first time. What aspect of this client’s health history may result in impaired drug excretion?
A) The client has a history of adhering poorly to prescribed treatment.
B) The client is morbidly obese.
C) The client has recently been diagnosed with diabetic nephropathy.
D) The client takes a beta-blocker for the treatment of hypertension.
C) The client has recently been diagnosed with diabetic nephropathy.
Rationale:Impaired renal function will reduce drug excretion. A lack of adherence must be addressed, but this does not affect excretion. Similarly, obesity and the use of a beta-blocker will not inhibit excretion.
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?
A) Perform a focused neurologic assessment.
B) Contact the care provider to communicate this result.
C) Raise the client’s bed rails and maintain the client on bed rest.
D) Document the fact that the nurse checked the client’s phenytoin levels.
D) Document the fact that the nurse checked the client’s phenytoin levels.
Rationale:The therapeutic range is 10 to 20 mcg/mL. Consequently, there is no action needed beyond documentation.
Which nursing diagnosis would be most important for a nurse to include in the plan of care for a client who is receiving an antiseizure agent and experiencing common adverse effects?
A) Impaired skin integrity
B) Risk for injury
C) Ineffective coping
D) Risk for imbalanced fluid volume
B) Risk for injury
Rationale:The CNS depression that accompanies many antiseizure agents could lead to injury. Therefore, risk for injury and safety measures would be the priorities. Imbalanced fluid volume would be appropriate if the client was experiencing vomiting or diarrhea or showing signs of dehydration. Impaired skin integrity might be appropriate if the client developed a rash. Ineffective coping would be appropriate if the client was verbalizing difficulties with his condition or therapy.
The nurse is reviewing the newly admitted adult client’s prescription for carbamazepine. What prescription would reflect a safe dosage?
A) Carbamazepine 200 mg PO q6h
B) Carbamazepine 500 mg PO q8h
C) Carbamazepine 150 mg PO q8h
D) Carbamazepine 400 mg PO q6h
A) Carbamazepine 200 mg PO q6h
Rationale:Dosage for carbamazepine is 800 to 1,200 mg/d PO in divided doses q6–8h. A 200 mg q6h would administer 800 mg per day. The 400 mg q6h administers 1,600 mg, which would exceed normal dosage range. A 500 mg q8h would equal 1,500 mg, which exceeds dosage. Also, 150 mg q8h would deliver 450 mg per day, which is too low to meet the appropriate range.
By what routes might the nurse administer phenytoin? Select all that apply.
A) Oral
B) Intramuscular
C) Rectal
D) Intravenous
E) Subcutaneous
A) Oral
D) Intravenous
Rationale:Phenytoin can be given IV or PO. It would not be given subcutaneously, rectally, or intramuscularly.
The nurse is caring for a client suspected of having a seizure disorder. What test might be ordered for this client to test brain function?
A) Electrocardiogram
B) Electroencephalogram
C) Serum phenytoin level
D) Serum calcium levels
B) Electroencephalogram
Rationale:An electroencephalogram (EEG) would be ordered to test brain function because it shows the electrical functioning within brain tissue. An electrocardiogram (ECG) measures electrical activity in the heart. Serum phenytoin levels would indicate therapeutic levels of the antiepileptic drug, but they do not test brain function. Serum calcium levels have no relationship to brain function.
The nurse provides client teaching to the client taking phenytoin and instructs the client to avoid the use of what herbal therapies? Select all that apply.
A) St. John’s wort
B) Evening primrose
C) Ginkgo
D) Cinnamon
E) Black cohosh
B) Evening primrose
C) Ginkgo
Rationale:Clients being treated for epilepsy, no matter what drug taken, should be advised not to use the herb evening primrose because it increases the risk of having seizures. Clients being treated with barbiturates or phenytoin should be advised not to use ginkgo, which could cause serious adverse effects. There is no evidence of any ill effects from St. John’s wort, black cohosh, or cinnamon.
