Chapter 53: Drug Therapy for Seizure Disorders and Spasticity

A 43-year-old woman was diagnosed with multiple sclerosis 2 years ago and has experienced a recent exacerbation of her symptoms, including muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium). In light of this new addition to her drug regimen, what teaching point should the woman's nurse provide? "You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity." "We'll need to closely monitor your blood sugar levels for the next week." "This will likely relieve your muscle spasms but you'll probably develop a certain amount of dependence on the drug over time." "There's a small risk that you might experience some hallucinations in the first few days that you begin taking this drug."

"You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity." Explanation: Dantrolene causes weakness because of its generalized reduction of muscle contraction. It is not associated with drug dependence, hyperglycemia, hypoglycemia, or hallucinations.

A nurse is caring for a patient who is going to take ethosuximide. During the nurse's initial assessment, the nurse learns that the patient's history includes hepatitis. Which laboratory test should be done before therapy is started? Blood urea nitrogen (BUN) Alanine aminotransferase (ALT) Partial thromboplastin time (PTT) Blood glucose level

Alanine aminotransferase (ALT) Explanation: Because an adverse effect of ethosuximide can be liver function impairment, a baseline liver function study that includes the ALT should be done prior to starting ethosuximide. Baseline values will help the nurse determine if the drug is causing the abnormal values, and liver function studies will need to continue throughout the therapy. Blood glucose level would determine the glucose level in the blood. BUN would help determine urinary function. PTT is a test to assess the intrinsic system, which is the common pathway of clot formation in the blood. While these tests are important, they do not have a direct relationship to ethosuximide use.

A client in the clinic with a history of epilepsy has just tested positive for pregnancy. What is the nurse's next action? Consult with the primary health care provider. Discuss the most serious birth defects that may occur due to treating epilepsy during pregnancy. Explain how to taper off her seizure medication as the risk for seizures decreases during pregnancy. Advise the client to continue her current medication for epilepsy.

Consult with the primary health care provider. Explanation: The nurse should first consult with the primary health care provider. Research suggests an association between (a) the use of anticonvulsants by pregnant women with epilepsy and (b) an increased incidence of birth defects. The use of anticonvulsants is not discontinued in pregnant women with a history of major seizures because of the danger of precipitating status epilepticus. However, when seizure activity poses no serious threat to the pregnant woman, the primary health care provider may consider discontinuing use of the drug during pregnancy.

The nurse is caring for a 15-year-old male who was involved in a motor vehicle accident and, as a result, sustained a closed head injury. The health care provider ordered phenytoin prophylactically to prevent seizures. The nurse understands that phenytoin works by what mechanism? Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus Increases the chloride available to promote depolarization of the cells Increases the potassium available to the cell to reduce the repolarization of the cell Decreases the calcium available to the cells responsible for electrical activity in the brain

Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus Explanation: Phenytoin (Dilantin) is the prototype drug that controls seizures by decreasing sodium influx into the cells. Sodium influx produces an action potential, which then causes the neurons to fire.

What is the most important teaching from the plan of care, to emphasize, when a client is prescribed a skeletal muscle relaxant? Report increased muscle spasm to the health care provider immediately. Always take this medication with food to prevent nausea and vomiting. Do not drive or operate machinery until individual drug effects are known. Drink eight to 10 glasses of water daily to prevent constipation.

Do not drive or operate machinery until individual drug effects are known. Explanation: Drowsiness is the most common reaction seen with the use of skeletal muscle relaxants. The priority of care is safety; therefore, the most important teaching is to tell the client not to drive or operate machinery until the client knows how the drug affects him/her individually. Nausea and constipation may occur, but are not safety priorities. Increased muscle spasm may indicate the drug is not effective, but is not a high safety concern.

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? Complex seizures Atonic seizures Generalized seizures Partial seizures

Generalized seizures Explanation: Tonic-clonic seizures and myoclonic seizures are classified as generalized seizures. Partial seizures can be simple or complex. Complex seizures are partial seizures that involve impaired consciousness and variable unconscious repetitive actions, staring gaze, and hallucinations/delusions. Atonic seizures are a type of generalized seizure involving the loss of muscle tone where the person suddenly drops.

A client has received a prescription for baclofen. The home care nurse would schedule which laboratory tests to monitor this client? CBC and electrolytes Liver function tests Hemoglobin and hematocrit Cardiac function tests

Liver function tests Explanation: Baclofen is metabolized in the liver and excreted in urine. The client must be monitored for adverse effects on liver function.

A client comes to the emergency department. The client is experiencing continuous seizure activity without any interruptions. Which anticonvulsant would the nurse anticipate that the primary health care provider would most likely prescribe initially? Phenytoin Valproic acid Lorazepam Fosphenytoin Clorazepate

Lorazepam Explanation: Lorazepam (Ativan) is the drug of choice for this condition. However, because the effects of lorazepam last less than 1 hour, longer-lasting anticonvulsants such as phenytoin or fosphenytoin may be given to continue to control the seizure activity. Valproic acid is used to treat epilepsy, migraine headache, and mania. Clorazepate is used to treat focal seizures, anxiety disorders, and alcohol withdrawal.

A client asks the nurse about the cause of idiopathic seizures. What is the nurse's best response? Passed from parent to child No known cause Brain injury at birth High fever

No known cause Explanation: An idiopathic seizure has no known cause. Hereditary seizure disorders are passed from parent to child in their genetic makeup. Acquired seizure disorders have a known cause such as high fever. Brain injury at birth is an example of a cause for epilepsy.

After teaching a group of nursing students about seizures, the instructor determines that the teaching was successful when the group identifies seizures that do not impair consciousness but can involve the senses or motor ability as which type? Partial seizures Generalized seizures Tonic-clonic seizures Myoclonic seizures

Partial seizures Explanation: Seizures that do not impair consciousness but can involve the senses or motor ability are classified as partial seizures. Generalized seizures involve loss of consciousness during the seizure. Tonic-clonic seizures are a type of generalized seizure involving alternate contraction and relaxation of the muscles, loss of consciousness, and abnormal behavior. Myoclonic seizures involve sudden, forceful contractions of single or multiple groups of muscles.

The client, newly diagnosed with epilepsy, begins to show signs of seizure activity. What is the nurse's priority action? Obtain the client's vital signs as soon as possible. Attempt to calm the client. Protect the client's safety. Perform detailed documentation.

Protect the client's safety. Explanation: As in any nursing situation, safety is paramount. The client's safety is prioritized over documentation or gathering vital signs. Seizure activity cannot be influenced by calming a client.

A male client routinely takes baclofen as a skeletal muscle relaxant for a neuromuscular disorder. His last lab results indicate that he is experiencing renal insufficiency. Based on these data, what would the nurse expect the health care provider to do? Increase the dose Titer the dose Maintain the current dose Reduce the dose

Reduce the dose Explanation: The skeletal muscle relaxants should be used cautiously in clients with renal impairment. Dosage of baclofen must be reduced.

While taking the vital signs of a hospitalized client admitted for seizure control due to epilepsy, the nurse notices a bloody toothbrush on the client's bedside table and scattered bruising over the client's extremities. What is the nurse's best action? Tell the client to ask for assistance when ambulating so as to prevent bruising. Report the findings to the primary health care provider immediately. Document the findings and offer the client a soft-bristled toothbrush . Notify the charge nurse about reporting suspected physical abuse.

Report the findings to the primary health care provider immediately. Explanation: The client has a history of epilepsy and is likely taking anticonvulsants. Hematologic changes when taking anticonvulsants needs to be reported immediately to the health care provider. Such changes include bleeding gums and easy bruising. Abuse is not the likely cause of the client's bruising given the history of epilepsy. Telling the client to ask for assistance when ambulating and offering a soft toothbrush are appropriate, but the health care provider needs to be notified immediately about the hematologic changes.

The nurse is teaching a client about the medication they are receiving as treatment for gout. The nurse determines the session is successful when the client correctly chooses which instruction as most important? Taking drug on an empty stomach Using protection against sunlight Reporting any skin rash Wearing a brace to get out of bed

Reporting any skin rash Explanation: The nurse should instruct the client to report any skin rash. A rash should be monitored carefully because it may precede a serious adverse reaction, such as Stevens-Johnson syndrome. The nurse need not instruct the client to take the drug on an empty stomach, use protection against sunlight, or wear a brace to get out of bed. Clients with osteoporosis are asked to wear a brace to get out of bed. Clients taking medications for gout are asked to take it with food. These clients are also instructed to avoid driving or performing other hazardous tasks.

An older adult client experiencing seizures is prescribed diazepam. Which assessment should the nurse prioritize? Respiratory rate and depth Blood glucose levels Swallowing ability Speech quality

Respiratory rate and depth Explanation: Apnea and cardiac arrest can occur when diazepam is administered to older adults, very ill clients, and individuals with limited pulmonary reserve. Therefore, monitoring the client's respiratory rate and depth would be most important. If the client is prescribed diazepam and antidiabetic medications, there may be an increase in the blood glucose level. The nurse should test the client's swallowing ability by offering sips of water before giving the drug. If there is difficulty swallowing, hold the drug and contact the health care provider as soon as possible. Slurred speech is an adverse reaction of hydantoins. It is also a potential sign of toxicity; however, the most important would be to determine the respiratory status and if that is functioning within reasonable parameters, then address the toxicity issue, if present.

When reviewing a client's history, which condition would the nurse identify as contraindicating the use of a centrally acting skeletal muscle relaxant? Rheumatic disorder Depression Epilepsy Hypertension

Rheumatic disorder Explanation: Centrally acting skeletal muscle relaxants would be contraindicated for treatment of muscle spasms related to a rheumatic disorder. Epilepsy, depression, or hypertension would not necessitate cautious use.

Assessment of a client receiving anticonvulsant therapy reveals sore throat, chills, fever, gingival bleeding, and bruising. Which nursing diagnosis would the nurse most likely prioritize? Risk for impaired skin integrity Impaired oral mucous membranes Risk for injury Risk for infection

Risk for infection Explanation: The assessment findings suggest pancytopenia, so risk for infection would be most likely. Risk for impaired skin integrity would be appropriate if the client developed a rash. Impaired oral mucous membranes would be appropriate if the client was exhibiting signs of gingival hyperplasia. Risk for injury would be appropriate if the client was experiencing drowsiness, ataxia, and vision disturbances related to the drug therapy.

The nurse is caring for a client who has taken hydantoins for several years. The nurse noted that the client has an unsteady gait, dizziness, nystagmus, acute confusion, a non-raised red rash on one arm, and has not been to the dentist for 2 years. Based upon the findings, what is the priority nursing diagnosis? Risk for injury related to untoward effect of hydantoin Risk for impaired oral mucous membranes related to hydantoin therapy Risk for impaired skin integrity related to adverse reactions to hydantoin Risk for infection related to immunosuppression from hydantoin

Risk for injury related to untoward effect of hydantoin Explanation: The client is exhibiting symptoms of hydantoin toxicity, including ataxia, nystagmus, dizziness, and acute onset of confusion, which are untoward effects of the drug when the drug level is in toxic range and needs to be reported immediately. The dosage of hydantoin should also be held until further orders are received from the primary care provider. The symptoms can lead to the risk for injury, and constitute the highest priority nursing diagnosis. The rash is located on one arm, and usually a drug reaction results in a generalized rash, so impaired skin integrity needs further investigation as to what may be the etiology for the rash, but not as high of a priority as the drug toxicity reaction. Risk for an infection related to immunosuppression is a risk, but there are no symptoms suggesting an onset of an infection or history of an exposure to an infection. The risk for impaired oral mucous membranes is not as high of a priority since there are no symptoms of gingival hyperplasia noted. The client does need to be seen by the dentist at least every 6 months.

When does a client with spinal cord injury-associated spasticity require treatment for this condition? Safety, mobility, and activities of daily living are impaired. Orthopedic procedures are indicated. Ambulation is possible only with an assistive device. Pain is present in all affected extremities.

Safety, mobility, and activities of daily living are impaired. Explanation: In clients with spinal cord injury, spasticity requires treatment when it impairs safety, mobility, and the ability to perform activities of daily living (e.g., self-care in hygiene, eating, dressing, and work or recreational activities). The treatment should be implemented before the other options occur.

An 11 year-old client has been diagnosed with epilepsy and prescribed phenytoin 100 mg PO b.i.d. What statement by the client's parent suggests an accurate understanding of the client's medication regimen? "I will make sure my child takes the medication on an empty stomach." "I will stop the drug immediately if any side effects occur." "I will make sure my child has routine visits to the dentist." "I will weigh my child daily and feed them a high-calorie diet."

"I will make sure my child has routine visits to the dentist." Explanation: Gingival hyperplasia is common in clients, especially children, who take phenytoin, which makes regular dentist visits important to oral health. Taking the medication on a full stomach or with meals reduces gastrointestinal (GI) adverse effects. The mother should call the healthcare provider if adverse effects are noted and needs to understand the risks associated with abrupt withdrawal of the medication. Daily weight taking and high-calorie diets are not necessary during phenytoin administration.

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? "They are safe during pregnancy." "They are considered teratogenic." "They may interfere with conception." "They are contraindicated during the third trimester."

"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.

A client is receiving baclofen at 8 AM. The nurse would monitor the client for evidence of maximum effect at which time? 9 AM 10 AM 11 AM 12 PM

10 AM Explanation: Baclofen peaks in 2 hours after administration, so maximum effectiveness would be noted at this time, which in this case would be 10 AM.

A client who is receiving phenytoin has a serum drug level drawn. Which result would the nurse interpret as within the therapeutic range? 30 mcg/mL 12 mcg/mL 4 mcg/mL 22 mcg/mL

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.

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? 6 mcg/mL 4 mcg/mL 2 mcg/mL 8 mcg/mL

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.

A nurse is teaching a client with gout the importance of getting adequate fluids. The nurse determines the session is successful when the client correctly plans to drink at least how much fluid each day? 1000 mL 1500 mL 2000 mL 3000 mL

A client with gout is encouraged to drink at least 3000 mL of fluid per day to promote uric acid excretion.

A nurse administers a peripherally acting muscle relaxant to a patient with a spinal cord injury. Which of the following drugs does the nurse administer? A. dantrolene (Dantrium) B. baclofen (Lioresal) C. methocarbamol (Robaxin) D. diazepam (Valium)

A. dantrolene (Dantrium) (all skeletal muscle relaxants except dantrolene are centrally acting drugs)

When assessing a patient taking hydantoin therapy for seizure disorder, which indicates an adverse reaction to this therapy? A.Thrombocytopenia B.Leukocytosis C.Gingival atrophy D.Hypoglycemia

A.Thrombocytopenia (Severe side effects of hydantoins include thrombocytopenia, leukopenia, gingival hyperplasia, and hyperglycemia.)

Kate is experiencing status epilepticus. The prescriber orders IV diazepam. What special precautions need to be taken by a nurse to administer IV diazepam? Administer the drug very slowly, no faster than 5 mg/min. Administer the drug through an IV pump. Dilute the drug with 5 to 10 mL normal saline. Administer the drug in the small veins in the dorsum of the hand or the wrist.

Administer the drug very slowly, no faster than 5 mg/min. Explanation: Diazepam should be injected very slowly, no faster than 5 mg/min. Diazepam should not be mixed or diluted with other solutions or drugs, either in the syringe or in the intravenous bags of fluid. Since the small veins in the dorsum of the hand or the wrist should be avoided, diazepam can be administered through the IV infusion tubing as close to the insertion site into the vein as possible.

An 18-year-old client has been taking phenytoin for the past 6 months for epileptic seizures. The client's phenytoin levels routinely fall within the therapeutic range. The client contacts the health care provider reporting nausea, headache, and diarrhea. What would be the most appropriate intervention based on the assessment of the client's symptoms and laboratory results? Advise the client that these are normal reactions to the medication and he should continue the medication as ordered. Advise the client to have his blood redrawn today to ensure that it is not at a toxic level. Advise the client to decrease the dose because the client is getting too much of the medication. Advise the client to double the dose for 24 hours because the client is experiencing the symptoms of drug withdrawal.

Advise the client to have his blood redrawn today to ensure that it is not at a toxic level. Explanation: Clients may demonstrate adverse effects even if the serum level of phenytoin is "normal"; it is important to adjust the dose to the clinical response of the client, not the serum level.

Which would a nurse identify as increasing a client's risk for hepatic disease with dantrolene use? Male gender Age over 35 years Respiratory disease Infection

Age over 35 years Explanation: The risk for hepatocellular disease is increased in women and all clients over the age of 35 years. Respiratory disease could be exacerbated with the use of dantrolene. Acute infection would be a contraindication to the use of botulinum toxins.

A nurse would monitor a client closely for increased CNS depressant effects when a skeletal muscle relaxant is used concomitantly with which additional drug(s)? Select all that apply. Antihistamine Oral contraceptives Alcohol Opiates Antidiabetic medications

Antihistamine Alcohol Opiates The concomitant use of skeletal muscle relaxants and antihistamines, alcohol, opiates, or sedatives can result in increased CNS depressant effects. The use of a skeletal muscle relaxant and oral contraceptives may result in decreased effectiveness of the contraceptive. It is recommended that a barrier contraceptive be used to prevent transfer of the drug to the sperm and ensure effectiveness of the contraceptive. Skeletal muscle relaxants should be used cautiously by individuals using antidiabetic medication.

The nurse is working with a client who has been prescribed tizanidine for the treatment of muscle spasticity. When monitoring the client's risk for injury, what assessment should the nurse prioritize? assessment of bowel sounds and pattern of bowel movements assessment for headaches following peak blood levels Assessment of the client's creatinine clearance rate Assessment of the client's blood pressure following administration

Assessment of the client's blood pressure following administration Explanation: Tizanidine has been associated with hypotension, which could be a safety risk especially if the client is also taking an antihypertensive drug. Constipation and headaches are common adverse effects that do not pose as direct a safety risk. Creatinine levels are not normally affected, and these do not pose a safety risk.

Which instruction should the nurse specifically stress when administering drugs used for muscle spasm and cramping? Avoid alcohol or other CNS depressants. Take the drug with food. Stay upright for 30 minutes after taking the drugs. Take the drug with 6 to 8 oz of water

Avoid alcohol or other CNS depressants. Explanation: The nurse should instruct the patient to avoid alcohol or other CNS depressants when taking a drug for muscle spasms and cramping. The nurse should instruct patients taking drugs for osteoporosis to take them with 6 to 8 oz of water and to stay upright for 30 minutes after taking drugs. The nurse should instruct patients with gout to take drugs for treating gout with food.

Which medication would the nurse expect to administer if prescribed to achieve skeletal muscle relaxation? Baclofen Allopurinol Alendronate Hydroxychloroquine

Baclofen Baclofen is an example of a skeletal muscle relaxant. Allopurinol would be administered to treat gout. Alendronate would be administered to treat osteoporosis. Hydroxychloroquine would be used to treat rheumatoid arthritis.

A client presents in the emergency department with tonic-clonic seizure activity. What is the IV drug of choice for treatment to obtain rapid control of the seizure? Topiramate Valproic acid Zonegran Benzodiazepine

Benzodiazepine Explanation: An IV benzodiazepine (e.g., lorazepam 0.1 mg/kg at 2 mg/min) is the drug of choice for rapid control of tonic-clonic seizures.

After teaching a group of nursing students about the various drugs used to treat musculoskeletal conditions, the instructor determines that the teaching was successful when the students correctly choose which drug as being used to treat osteoporosis? DMARDs Bone resorption inhibitors Skeletal muscle relaxants Uric acid inhibitors

Bone resorption inhibitors Explanation: Bone resorption inhibitors are used to treat osteoporosis. Disease-modifying antirheumatic drugs (DMARDs) are used to treat rheumatoid arthritis. Uric acid inhibitors are used to treat gout. Skeletal muscle relaxants are used to alleviate muscle spasms and cramping.

A nurse administering valproic acid (Depakote) to a client should monitor the client for increased effects and toxicity of valproic acid (Depakote) when which of the following medications are initiated? Select all that apply: Metformin (Glucophage) Amitriptyline (Elavil) Cimetidine (Tagamet) Lisinopril (Prinvil) Ibuprofen (Motrin)

Cimetidine (Tagamet) Amitriptyline (Elavil) Explanation: A nurse administering valproic acid (Depakote) to a client should monitor the client for increased effects and toxicity of valproic acid (Depakote) when antibiotics, antifungals, tricyclic antidepressants (amitriptyline), and cimetidine are initiated.

Which would be most important to monitor in a client receiving ethosuximide? Weight Nutritional status Electrocardiogram Complete blood count

Complete blood count Explanation: Although weight loss and anorexia may occur, ethosuximide is associated with bone marrow suppression, including potentially fatal pancytopenia, so it would be most important for the nurse to monitor the client's complete blood count. The drug is not associated with any cardiovascular effects that would necessitate an electrocardiogram.

A nurse is assessing a client who has come to the emergency department reporting back spasms. The client states a history of opioid addiction and does not want to take any drug that "puts me at risk of becoming physically dependent." Which medication would the nurse question, if ordered? Methocarbamol (Robaxin) Orphenadrine (Norflex) Cyclobenzaprine (Flexeril) Metaxalone (Skelaxin)

Cyclobenzaprine (Flexeril) Explanation: The nurse would be concerned if the health care provider ordered cyclobenzaprine because long-term use of this drug may result in physical dependence. The other drugs listed are not associated with physical dependence.

A nurse administers baclofen (Lioresal) to a young man for a back injury. Which of the following interventions is most important related to the administration of baclofen? A. Assess heart rate B. Assess for edema C. Assess blood sugar D. Assess for increased spasticity

D. Assess for increased spasticity

A patient is being treated for intractable muscle spasticity with a peripherally acting spasmolytic. The nurse should anticipate administering which medication? Tizanidine Dantrolene Diazepam Cyclobenzaprine

Dantrolene Explanation: Dantrolene is a peripherally acting spasmolytic, while tizanidine, diazepam, and cyclobenzaprine are all centrally acting.

The community health nurse also assists the health care provider in the decision-making process for AED drug titration by performing which function? Counting the number of pills in the AED drug bottle to ensure compliance Administering the AED medication to the client Ensuring that the client makes the appointments for serum drug levels Monitoring the client for signs and symptoms of seizure activity during the monthly visit

Ensuring that the client makes the appointments for serum drug levels Explanation: The community health nurse may assist the provider to titrate drug doses by ensuring that the client keeps appointments for serum drug level testing and follow-up care

After teaching a class on drug classes used to treat seizures, the instructor determines that the teaching has been successful when the students identify which drug as most commonly used in the treatment of absence seizures? Mephobarbital Ethotoin Ethosuximide Primidone

Ethosuximide Explanation: Ethosuximide is most frequently used to treat absence seizures. Mephobarbital, ethotoin, and primidone are typically used for tonic-clonic seizures

Which type of seizures involves a loss of consciousness? Partial seizures Generalized seizures Somatosensory seizures Motor seizures

Generalized seizures Explanation: Generalized seizures involve a loss of consciousness.

Which would a nurse include when describing the action of dantrolene? Interference with calcium release from the muscles Inhibition of the release of acetylcholine Interference with the reflexes causing the spasm Inhibition of presynaptic motor neurons in central nervous system

Interference with calcium release from the muscles Explanation: Dantrolene interferes with the release of calcium from the muscle tubules, preventing the fibers from contracting. Botulinum toxins A and B bind directly to the receptor sites of motor nerve terminals and inhibit the release of acetylcholine. Centrally acting skeletal muscle relaxants interfere with the reflexes that are causing the muscle spasm. Tizanidine is thought to increase inhibition of presynaptic motor neurons in the CNS.

A client is receiving allopurinol. Which instruction would be most important for the nurse to include in the client's plan of care? Liberal fluid intake Moderate exercise Use of a brace or corset Avoidance of direct sunlight

Liberal fluid intake Explanation: When using uric acid inhibitors, such as allopurinol, the nurse should encourage liberal fluid intake and measure the client's intake and output. The client does not need to exercise or use braces or corsets; clients with osteoporosis may require a brace or corset when out of bed. The client need not avoid sunlight as uric acid inhibitors do not cause photosensitivity.

A nurse is caring for a patient with seizure disorders. The patient has been prescribed phenytoin. Which of the following ongoing assessment activities should a nurse perform during the treatment? Check for the patient's vital signs every three hours. Measure regular serum plasma levels of the drug. Measure the respiratory rate of the patient. Measure the pulse rate of the patient.

Measure regular serum plasma levels of the drug. Explanation: While caring for the patient on anticonvulsant treatment, the nurse should measure the regular serum plasma levels of the drug. The nurse need not check for the patient's vital signs every three hours, measure the respiratory rate of the patient, nor measure the pulse rate of the patient while caring for a patient on anticonvulsant treatment.

An older adult is prescribed a skeletal muscle relaxant for reports of neck pain. What is the top priority of care for the nurse to teach the family? Administer the medication with meals. Monitor the client before ambulating. Instruct on how to assess client's pain level. Give the medication at the same time each day.

Monitor the client before ambulating. Explanation: Safety is the top priority concern, because skeletal muscle relaxants can cause drowsiness. Administering the medication with meals can reduce GI distress but is not the top priority safety concern. Checking the client's pain level is important but not the top priority safety concern. Giving the medication at the same time each day may help the caregivers remember it, but is not the top priority safety concern.

A 40-year-old female client with myasthenia gravis has been prescribed dantrolene. The nurse has taught the client about the risks of liver toxicity associated with the medication and should teach the client to self-monitor for what early indications? Nausea and loss of appetite Weight gain and ankle edema Nosebleeds or bleeding gums Flank pain and abdominal distention

Nausea and loss of appetite Explanation: The prodrome associated with liver toxicity during dantrolene therapy includes nausea, anorexia and fatigue. It is not characterized by flank pain, weight gain, abdominal distention, edema or bleeding.

A client is to receive ethotoin. The nurse would expect to administer this drug by which route? Rectal Intramuscular Oral Intravenous

Oral Explanation: Ethotoin is administered orally.

A nurse is administering lorazepam to a client with status epilepticus. The nurse will be prepared to administer which additional drug to treat the status epilepticus for the next several hours? Ethosuximide Phenytoin Ethotoin Zonisamide

Phenytoin Explanation: Due to the short effects of lorazepam, a longer-acting anticonvulsant, such as phenytoin, is given to continue control of seizure activity. Ethotoin is a hydantoin that is used to treat tonic-clonic seizures. Ethosuximide is a succinimide that is used to treat focal seizures. Zonisamide is a nonspecified preparation and used to treat focal seizures as well.

The nurse is conducting an ongoing assessment on a client who was administered ethotoin. Which finding should the nurse prioritize? Constipation Slurred speech Diarrhea Urinary frequency

Slurred speech Explanation: The nurse should monitor the client for slurred speech, which is a sign of toxicity. Constipation, diarrhea, and urinary frequency are potential adverse reactions; however, these are not signs of ethotoin toxicity.

Which of the following drugs are approved for use in MS clients with severe spasticity? Metaxalone and Carisoprodol Dantrolene and Carisoprodol Tizanidine and Dantrolene Tizanidine and Baclofen

Tizanidine and Baclofen Explanation: Baclofen and tizanidine are approved for spasticity in people with MS. The two drugs are similarly effective, but tizanidine may cause fewer adverse effects.

A client is experiencing absence seizures and has been prescribed a succinimide. What prescription is most likely? Zarontin Depakene Dilantin Valium

Zarontin Explanation: Ethosuximide (Zarontin) is considered the drug of choice for treating absences seizures and is in the succinide family. The other listed drugs are not succinides.

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

aura Explanation: Tonic-clonic seizures are sometimes preceded by an aura—a brief warning, such as a flash of light or a specific sound or smell. None of the other options accurately describe this event.

A client with muscle spasticity has been prescribed baclofen. In order to promote the safe use of this medication, the nurse should encourage the client to: avoid eating grapefruit or drinking grapefruit juice until treatment is discontinued. increase fluid intake and self-monitor for decreased urine output . avoid drinking alcohol for the duration of treatment. increase intake of foods that are high in potassium.

avoid drinking alcohol for the duration of treatment. Explanation: The CNS depressant effects of baclofen can be dangerously exacerbated by alcohol, which should be avoided. Grapefruit is not contraindicated and there is no reason to increase potassium or fluid intake while taking baclofen

While most muscle relaxants drugs are central nervous system (CNS) depressants, which medication acts only on the muscle? tizanidine dantrolene metaxalone carisoprodol

dantrolene Explanation: Dantrolene is the only skeletal muscle relaxant that acts peripherally on the muscle itself; it inhibits the release of calcium in skeletal muscle cells, thereby decreasing the strength of muscle contraction.

A nurse is working with a 39-year-old client who is experiencing muscle spasms associated with multiple sclerosis. The client reports needing help with basic care The client's health care provider has prescribed baclofen (Lioresal). The nurse and the client agree that an appropriate goal related to helping to maintain self-worth would be to: experience relief of pain. experience improved motor function. increase self-care in activities of daily living. take medication independently.

increase self-care in activities of daily living. Explanation: All of the options are goals that the nurse would like the client to achieve. However, the goal related to self-worth would be to increase self-care in activities of daily living. Loss of ability to dress oneself puts the client at risk for decreased self-esteem and feelings of low self-worth.

The nurse is caring for an 84-year-old client in the acute care facility who was newly diagnosed with a seizure disorder. Before starting the client on an antiepileptic medication that will be continued after discharge, what laboratory studies should the nurse assess? Select all that apply. serum drug levels liver function studies renal function studies cardiovascular function studies central nervous system function studies

liver function studies renal function studies Baseline kidney and liver function tests should be done and results will guide dosing of the antiepileptic medication because clients with liver or kidney disease will require lower dosages of medication. Serum drug levels will not be drawn until after specific medications are started. Cardiovascular and central nervous system function studies are not indicated.

A client, newly diagnosed with a seizure disorder, has been prescribed valproic acid. When assessing for adverse effects, what assessment should the nurse prioritize? monitoring the client's liver enzyme levels assessing the client for signs of esophageal varices assessing the client's apical heart rate and rhythm performing musculoskeletal assessment

monitoring the client's liver enzyme levels Explanation: Valproic acid is associated with liver toxicity., so the nurse should periodically check the client's liver enzyme levels. Esophageal varices, cardiac damage and muscle weakness are not associated with valproic acid therapy.

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: renal impairment. nervous breakdown. respiratory depression. hearing impairment.

renal impairment. Explanation: The nurse should know that carbamazepine is contraindicated among clients with renal impairment. Carbamazepine is not contraindicated in those with nervous breakdown, hearing impairment, and respiratory depression.

A 26-year-old woman has been prescribed the suspension form of phenytoin. The nurse will inform the patient that she should check capillary blood glucose levels frequently. take the drug with food. shake the phenytoin suspension before pouring and measuring the dose. follow the drug with water.

shake the phenytoin suspension before pouring and measuring the dose. Explanation: Teaching the importance of shaking the suspension form of phenytoin thoroughly before pouring and measuring the dose is a safety issue. Shaking the suspension ensures that a proper concentration of drug is administered. Because there is no indication that the client is diabetic or has gastrointestinal stress, it is not necessary to frequently check her capillary blood glucose level, follow the drug with water, or take the drug with meals.

The nurse is providing education to an adult client who has been prescribed lamotrigine for a seizure disorder. The nurse should inform the client that the medication must be stopped if what unexpected reaction develops? anorexia insomnia skin rash fever

skin rash Explanation: The FDA has issued a black box warning related to the potential development of serious dermatologic reactions. It should be discontinued at the first sign of skin rash in an adult. Insomnia, anorexia, and fever aren't known adverse effects, so the nurse wouldn't mention them in the teachin

An adolescent taking oral contraceptives has been prescribed an anticonvulsant medication. The nurse should tell the client to do which? use another form of birth control, such as condoms. watch for signs of hyperglycemia, such as increased thirst, hunger, and urination. be aware that these two drugs will interact and increase seizure activity initially. stop driving due to the increased depressant effects and excessive drowsiness.

use another form of birth control, such as condoms. Explanation: Anticonvulsants and oral contraceptives interact, leading to decreased effectiveness of birth control. This can result in breakthrough bleeding or unintended pregnancy. Anticonvulsants and antidiabetic medications interact, resulting in increased blood glucose levels. Anticonvulsants and antiseizure medications taken together may increase seizure activity. Anticonvulsants interact with analgesics and alcohol, not oral contraceptives, to cause increased depressant effects.

A client is receiving phenytoin. The nurse monitors the client's plasma drug level. Which level would alert the nurse to the possibility of toxicity? 27 µg/mL 10 µg/mL 15 µg/mL 18 µg/mL

27 µg/mL Explanation: Phenytoin plasma levels between 10 and 20 µg/mL give optimal anticonvulsant effect. However, many clients achieve seizure control at lower serum concentration levels. Levels greater than 20 µg/mL are associated with toxicity.

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? Anticipate a reduction in dosage Call an emergency code Contact the provider to request a one-time supplementary dose Assess the client's renal function

Anticipate a reduction in dosage Explanation: 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 not an emergency, though it needs to be addressed. This result does not threaten the client's renal function.

Before administering a daily dose of phenytoin, it is most important for the nurse to A.maintain the patient on bed rest. B.check phenytoin levels. C.monitor intake and output. D.monitor renal function tests.

B.check phenytoin levels. (Checking the phenytoin level is most important because of the narrow therapeutic range of 10 to 20 mcg/mL. Maintaining bed rest and monitoring I&O and renal function tests are not necessary.)

A nurse administers carisoprodol to a client for the treatment of an acute musculoskeletal condition. The nurse would be alert for which adverse effect after administering the drug? Drowsiness Anxiety Constipation Insomnia

Drowsiness Explanation: The nurse should monitor for drowsiness in the client as the adverse reaction of carisoprodol administration. Depression is not an adverse reaction of carisoprodol administration. Insomnia and anxiety are adverse reactions associated with bisphosphonate drugs.

A client with spastic hypertonia resulting from cerebral palsy has not responded appreciably to oral baclofen. During the client's care conference, the nurse should anticipate a discussion about what possible treatment? Intrathecal baclofen infusion Cyclobenzaprine extended release Phenytoin IV infusion Phenobarbital IV intermittently

Intrathecal baclofen infusion Explanation: Baclofen is available by intrathecal administration for intractable spasticity. Oral cyclobenzaprine would not likely be used is a client has not responded to other oral centrally acting skeletal muscle relaxants. Phenytoin and phenobarbital treat seizure activity, not muscle spasticity.

A primary health care provider has prescribed phenytoin parenterally for a client experiencing seizures. The nurse prepares to administer this drug via which route? Intradermally Subcutaneously Intramuscularly Intravenously

Intravenously Explanation: Phenytoin can be administered orally and parenterally. If the drug is administered parenterally, the intravenous (IV) route is preferred over the intramuscular (IM) route because, with the IM route, erratic absorption of phenytoin causes pain and muscle damage at the injection site. The drug is not administered intradermally or subcutaneously.

A 40-year-old client with a diagnosis of fibromyalgia has been prescribed cyclobenzaprine (Flexeril) as an adjunct to her existing drug regimen. What nursing diagnosis should the nurse prioritize for the nursing care plan for this client? Diarrhea related to anticholinergic effects Altered Nutrition, Less than Body Requirements, related to appetite suppression Impaired Swallowing related to increased muscle tone Risk for Injury related to CNS depressant effects

Risk for Injury related to CNS depressant effects Explanation: The CNS depression that is associated with the use of cyclobenzaprine constitutes a risk for injury. The anticholinergic effects of the drug constitute a risk for constipation, not diarrhea. Nutrition and swallowing are not typically affected by the use of cyclobenzaprine.

The nurse is administering a bisphosphonate to a client with Paget's disease. Which finding on assessment should the nurse prioritize? Altered renal function Increased skin rashes Serum calcium levels Hematology function

Serum calcium levels Explanation: The nurse should monitor the serum levels of calcium before, during, and after bisphosphonate therapy, because bisphosphonates act primarily on the bone by inhibiting normal and abnormal bone resorption. These drugs are used cautiously in clients with renal function impairment but do not alter renal function. The nurse should monitor the client's renal function when allopurinol is administered and hematology function when methotrexate is administered.

A client has been experiencing increased muscle spasticity since being diagnosed with multiple sclerosis. What drug is most likely to meet this client's needs? orphenadrine metaxalone baclofen cyclobenzaprine

baclofen Explanation: Baclofen is used for treatment of muscle spasticity associated with neuromuscular diseases such as multiple sclerosis. Cyclobenzaprine, metaxalone, and orphenadrine are used for relief of discomfort associated with painful, acute musculoskeletal conditions.

A client has been diagnosed with cerebral palsy accompanied by muscle spasticity. The nurse should identify what causative factor of this client's symptoms? imbalances between neurotransmitter levels and the levels of enzymes that modulate their reuptake inherited defects of the peripheral nervous system irreversible injury to muscle tissue nerve damage within the central nervous system

nerve damage within the central nervous system Explanation: Muscle spasticity is the result of damage to neurons within the central nervous system (CNS) rather than injury to peripheral structures such as the musculoskeletal system. Serotonin is not involved in the process of muscle contraction and relaxation. The etiology of spasticity is not rooted in neurotransmitter disruptions, even though these may subsequently be affected.

A 44-year-old warehouse worker experienced a painful lower back injury that has not responded to treatment with nonsteroidal anti-inflammatory drugs. Consequently, the man's care provider is considering the short-term use of cyclobenzaprine (Flexeril). Which of the following assessment questions would inform the clinician's decision to prescribe this drug? "Are you taking antidepressant medications these days?" "Do you have a history of eczema or psoriasis?" "How would describe your activity level since your injury?" "Have you ever been told that you have an enlarged prostate gland?"

"Are you taking antidepressant medications these days?" Explanation: Because of its similarity to the TCAs, cyclobenzaprine is also contraindicated for use within 14 days of administration of monoamine oxidase inhibitors (MAOIs). Prostatic enlargement, skin disorders, and low activity level do not preclude the use of cyclobenzaprine.

A client with myasthenia gravis has been prescribed dantrolene for the treatment of muscle spasticity. What education should the nurse provide to the client? "You might experience some urinary frequency and urgency. Tell me promptly if it becomes problematic." "If you find you're losing your appetite, let me know so we can create a plan." "Most clients experience relief from their spasticity for 7 to 10 days following the injection." "The care team will follow you closely to ensure that you don't develop a dependence on this medication."

"You might experience some urinary frequency and urgency. Tell me promptly if it becomes problematic." Explanation: Dantrolene often causes urinary frequency and urgency. It is not linked with anorexia and is administered orally each day. Dantrolene is not associated with a high risk for dependence.

A 36-year-old man has been taking extended-release carbamazepine for 1 year. He is in the clinic every 3 months for follow-up visits, which include a drug blood level. Which of the following carbamazepine blood levels would indicate a potential risk for adverse effects? 2 mcg/mL 6 mcg/mL 10 mcg/mL 15 mcg/mL

15 mcg/mL Explanation: The therapeutic blood level for the drug ranges from 4 to 12 mcg/mL for an adult. A level of 15 mcg/mL is higher than the therapeutic level and could cause increased adverse effects or possible toxic effects.

A nurse is aware that baclofen (Lioresal) is a centrally-acting spasmolytic that has been demonstrated to be safe and effective in the treatment of numerous disorders of muscle spasm and spasticity. The nurse should question the order if baclofen is prescribed for which of the following patients? A 22-year-old man whose muscle spasticity is attributable to a spinal cord injury that he suffered while snowboarding. A 49-year-old woman whose recent motor disturbances have culminated in a diagnosis of multiple sclerosis. A 14-year-old boy who has a diagnosis of cerebral palsy and who has experienced a recent increase in muscle spasticity. A 70-year-old man whose Parkinson disease has worsened in recent months, resulting in decreased mobility and self-care.

A 70-year-old man whose Parkinson disease has worsened in recent months, resulting in decreased mobility and self-care. Explanation: Baclofen is useful in the treatment of spasticity and myoclonus resulting from disorders such as MS, cerebral palsy, and traumatic injury to the spinal cord. However, it is not useful in treating spasms that follow a CVA or stroke, or those that occur in Parkinson disease or Huntington chorea.

An older adult resident of a long-term care facility is experiencing muscle spasticity and has just been prescribed a centrally acting skeletal muscle relaxant. The client has comorbidities of early stage Alzheimer's disease and chronic obstructive pulmonary disease (COPD). What nursing action should the nurse prioritize for adding to the client's care plan? Falls prevention measures Seizure precautions Continuous pulse oximetry Deep breathing and coughing exercises

Falls prevention measures Explanation: The client's combination of CNS depression from the muscle relaxant and an underlying cognitive deficit creates a risk for falls. This combination is not associated with seizures and will not likely exacerbate the client's COPD; respiratory assessments and interventions would not likely need to be amended.

The nurse examines reviews the medical administration record and notes the medication lamotrigine needs to be administered. The client has developed a red scaly rash with fluid-filled blisters and purpuric areas all over the client's body. Which action(s) should the nurse take? Select all that apply. Notify the primary care provider immediately. Assess vital signs. Administer the dose of lamotrigine. Document the skin assessment. Cleanse affected areas with soap and water.

Notify the primary care provider immediately. Assess vital signs. Document the skin assessment.

A nurse is developing a plan of care for a client receiving anticonvulsant therapy and determines a nursing diagnosis of risk for injury is most appropriate. Which assessment finding(s) would support this nursing diagnosis? Select all that apply. Epistaxis Reports of blurred vision Reports of dizziness Photosensitivity Scaling red rash

Reports of blurred vision Reports of dizziness Photosensitivity

A client has been prescribed phenytoin for the treatment of seizures. How should the nurse most accurately determine whether the client has therapeutic levels of the medication? Review the client's laboratory blood work. Assess the client carefully for adverse effects. Monitor the client for seizure activity. Assess the client's cognitive status.

Review the client's laboratory blood work. Explanation: Measuring serum drug levels evaluates whether the therapeutic range of circulating drug can be found in the serum. It does not directly evaluate effectiveness of therapy, however, which can only be evaluated by determining whether the drug is having the desired effect of reducing number of seizures. Short-term absence of seizures does not necessarily indicate that drug is within therapeutic range.

A client with gout is prescribed pegloticase after not responding to the usual medications. Which nursing diagnosis would the nurse determine to be most appropriate in this case? Risk for injury Acute pain Impaired comfort: gastric distress Risk for allergic response

Risk for allergic response Explanation: When first-line treatments for gout are not successful, sometimes drugs that are more toxic may be prescribed, such as the pegloticase infusion. During the infusion the client is closely monitored for the development of adverse reactions, in particular anaphylaxis. Should an anaphylactic reaction occur, the infusion center staff members are prepared to start resuscitative measures as emergency personnel are notified. Risk for injury would be appropriate if the client is drowsy as well as pain and deformity may contribute to the risk of falling and suffering an injury. Acute pain is not a recognized nursing diagnosis for this medication. Impaired comfort: gastric discomfort may may be appropriate if the client experiences GI upset which is possible.

The nurse is participating in the care of a client in status epilepticus who is receiving phenobarbital IV. Which nursing diagnosis should the nurse prioritize during this client's current care? Risk for injury related to seizure activity Acute confusion related to seizure activity and drug effects Disturbed thought processes related to seizure activity Disturbed sensory perception related to adverse drug effects

Risk for injury related to seizure activity Explanation: Seizures present an acute risk for injury which the nurse must prioritize when caring for the client. Cognitive and/or sensory disruptions are likely as well, but none of these presents such a high risk to the client's safety as the risk for injury.

A client diagnosed with multiple sclerosis-induced spasticity asks why deep tissue massages do not relieve the associated pain. What facts about spasticity should be the basis of the nurse's response? Spasticity is caused by nerve damage in the brain and spinal cord, and it is a permanent condition. Spasticity is caused by skeletal muscle trauma and will improve only with time. Spasticity is caused by inflammation of the muscles; therefore, an anti-inflammatory drug would be more effective. Spasticity is caused by stimulation of "association areas" in the brain; therefore, only nerve blocks will be effective.

Spasticity is caused by nerve damage in the brain and spinal cord, and it is a permanent condition. Explanation: Spasticity is caused by nerve damage in the brain and spinal cord. It is a permanent condition that may be painful and disabling. None of the other options accurately provide information regarding the treatment of this condition.

A client with a spinal cord injury is experiencing increasing muscle spasticity and the care team is considering the use of dantrolene. The nurse should identify what possible contraindication to the safe and effective use of this medication? The client has hepatitis C The client is receiving a selective serotonin reuptake inhibitor for depression The client has a sacral pressure ulcer The client's injury took place less than three months ago

The client has hepatitis C Explanation: Dantrolene is associated with possible hepatocellular injury and a concurrent diagnosis of hepatitis C would require great caution, or may contraindicate the use of dantrolene. Pressure ulcers, use of SSRIs and recent injury do not contraindicate its use.

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? The client has recently been diagnosed with diabetic nephropathy The client takes a beta-blocker for the treatment of hypertension The client is morbidly obese The client has a history of adhering poorly to prescribed treatment

The client has recently been diagnosed with diabetic nephropathy Explanation: 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.

A client is prescribed topiramate. The nurse cautions the client to avoid the intake of alcohol for which reason? The client is at risk for increased CNS depression. A disulfiram-like reaction can occur. The client's risk for dependence is increased. The combination may lead to a hypertensive crisis.

The client is at risk for increased CNS depression. Explanation: Combining alcohol with topiramate increases the client's risk for CNS depression. Topiramate combined with alcohol does not result in a disulfiram-like reaction. Drug dependency is not associated with the use of topiramate and alcohol. The combination of topiramate and alcohol is not associated with the development of a hypertensive crisis.

A history of what medical condition would contraindicate the use of cyclobenzaprine for acute muscle spasms? cardiac arrhythmias diabetes mellitus transient ischemic attacks (TIA) chronic obstructive pulmonary disease (COPD)

cardiac arrhythmias Explanation: Contraindications to cyclobenzaprine include acute myocardial infarction, arrhythmia, heart block, conduction disturbances, heart failure, and hyperthyroidism. The other listed health problems do not contraindicate its use.

A client's seizure activity, which is isolated to facial and neck muscles, has been identified as being caused by one area of the client's brain. The nurse should anticipate the administration of what drug? carbamazepine gabapentin clorazepate felbamate

carbamazepine Explanation: Carbamazepine is often the drug of choice for treatment of partial seizures, which are described in this scenario. It has the ability to inhibit polysynaptic responses and to block sodium channels to prevent the formation of repetitive action potentials in the abnormal focus. Clorazepate is indicated for anxiety and alcohol withdrawal and used as adjunctive therapy for partial seizures. Felbamate has been associated with severe liver failure and aplastic anemia and is now reserved for those clients who do not respond to other therapies. Gabapentin is used as adjunctive therapy in the treatment of partial seizures and for the treatment of postherpetic neuralgia.

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? "Take the drug 1 hour before or 2 hours after a meal to minimize stomach upset." "Taking over-the-counter antacids before and after the dose helps for some clients." "Try taking your pills at the same time as you eat some food." "Contact your health care provider to see if there's an alternative drug that would work for you."

"Try taking your pills at the same time as you eat some food." If GI irritation occurs with ethosuximide or other anticonvulsants, the client should be encouraged to take the medication with food to reduce this adverse effect. Taking the drug 1 to 2 hours after meals would not reduce this effect. The nurse must be cautious when recommending the use of OTC medications. GI effects are unlikely to necessitate a change in medications.

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? 2 mcg/mL 4 mcg/mL 8 mcg/mL 6 mcg/mL

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.

The primary health care provider prescribes diazepam 10 mg IV to be administered to a client to control their seizures. The nurse would administer this drug over which time frame? 1 min 2 min 5 min 10 min

2 min Explanation: When used to control seizures, diazepam is administered IV pushed slowly as close as possible to the IV site, allowing at least 1 min for each 5 mg of drug. For a dosage of 10 mg, the nurse would administer the drug over 2 min.

A client in status epilepticus has been brought to the emergency department. The nurse should anticipate which treatment measures? Administration of intravenous lorazepam Administration of oral or sublingual phenytoin Administration of zonisamide (Zonegran) Administration of intravenous gabapentin

Administration of intravenous lorazepam Explanation: Although diazepam has been the traditional treatment for status epilepticus, research has shown that lorazepam is more effective than diazepam or phenytoin used alone for cessation of seizures and has an effective duration of up to 6 hours compared to 20 minutes for diazepam. Oral medications are not administered during status epilepticus and neither zonisamide nor gabapentin are used to treat this health crisis.

The perioperative nurse is caring for a client who requires an umbilical hernia repair but who has a known family history of malignant hyperthermia. The client has been prescribed dantrolene 2.5 mg/kg IV one hour before surgery. The client weighs 121 lbs. The nurse reconstitutes a single-use vial as per the manufacture's instructions, yielding a solution with a concentration of 50 mg/mL. How many mL of the reconstituted dantrolene solution should the nurse add to the client's bag of intravenous fluid? 6.87 mL 2.5 mL 6.05 mL 2.75 mL

2.75 mL Explanation: The client's weight in kilograms is 55 kg (121 lbs divided by 2.2). The ordered dose is 2.5 mg/kg and 55 kg x 2.5 mg = 137.5 mg. There are 50 mg in each mL of the reconstituted solution. Dividing the dose required (137.5 mg) by the dose available (50 mg/mL) yields 2.75 mL

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? Make a referral to occupational therapy Implement falls precautions Maintain the client on bed rest Monitor vital signs hourly while the client is awake

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.

A client has been admitted to the emergency department and is experiencing tonic-clonic seizures. What intervention should the nurse prioritize? Administration of phenytoin IV as prescribed Administration of gabapentin PO as prescribed Assessment of the client's renal and hepatic function Establishing a therapeutic relationship with the client

Administration of phenytoin IV as prescribed Explanation: Active seizure activity is an emergency and the client's immediate physiological needs supersede the importance of therapeutic relationship. Phenytoin IV is among the most common treatments for tonic-clonic seizures; gabapentin PO is not typically used for this purpose, and PO administration of any type is unsafe due to the risk for aspiration. Treatment would not be withheld pending assessment of renal and hepatic function.

A nurse who gives care on a neurological floor is working with several clients. Which client should the nurse prioritize for further assessment and possible interventions? A client receiving pregabalin who is not responsive to verbal stimuli A client being treated with phenobarbital whose blood pressure is 106/69 mmHg A client who will be discharged on carbamazepine and who requires education A client who is anxious about undergoing electroencephalography to investigate a recent absence seizure

A client receiving pregabalin who is not responsive to verbal stimuli Explanation: A client's decreased level of consciousness would be a priority for further assessment. It could be indicative of excessive CNS depression if the client is unable to be roused by voice. The client with a blood pressure of 106/69 may require further monitoring and possible interventions, but this blood pressure is not so low as to be considered an emergency. Addressing clients' learning needs and anxiety is also important, but less time dependent than a client who is not rousable.

A patient is taking carisoprodol (Soma) for back spasms related to an occupational injury. Which of the following is most important to teach the patient? A. to take the medication at 8:00 am, 2:00 pm, and 8:00 pm B. to know the signs and symptoms of an idiosyncratic reaction C. to take the medication between meals D. to stop the medication with the first sign of abdominal cramping

B. to know the signs and symptoms of an idiosyncratic reaction

What is the highest priority nursing diagnosis for a patient taking phenytoin? A.Anxiety B.Risk for falls C.Risk for constipation D.Deficient fluid volume

B.Risk for falls (The nursing diagnosis "Risk for falls" has the highest priority for a patient taking phenytoin because it may lead to side effects of dizziness, decreased coordination, and ataxia. Anxiety, constipation, and efficient fluid volume are not side effects of phenytoin, but depression and discoloration of urine are.)

The nurse is caring for a client who is being discharged home from the rehabilitation unit. Baclofen will be discontinued, and the client will begin taking carisoprodol as an outpatient. What is the nurse's primary consideration when discontinuing the client's baclofen? Baclofen must be tapered down over 1 to 2 weeks to prevent psychoses and hallucinations. The client will be prescribed alternate doses of baclofen and carisoprodol over 10 days to prevent symptoms of baclofen withdrawal. The client's dose of baclofen should be gradually withdrawn over 4 to 6 weeks to prevent rebound spasticity. Carisoprodol will be administered while continuing baclofen until the carisoprodol level is established.

Baclofen must be tapered down over 1 to 2 weeks to prevent psychoses and hallucinations. Explanation: If using baclofen, taper drug slowly over 1 to 2 weeks to prevent the development of psychoses and hallucinations. Giving both drugs at once would risk toxicity and serious adverse effects and would never be done. Four to 6 weeks is unnecessary for the transition.

A patient was discharged 3 days ago on phenytoin therapy for seizure disorder. The patient comes to the emergency department experiencing seizures. What will be of most value to determine the etiology of the returned seizures? A.A CT scan B.An EEG C.Serum phenytoin levels D.Serum electrolytes

C.Serum phenytoin levels (For dilantin therapy to be effective, a therapeutic serum range of 10 to 20 mcg/mL must be maintained. Subtherapeutic serum levels are a frequent cause of seizures for patients on dilantin therapy.)

A patient with cortical focal seizures has been prescribed phenobarbital. What adverse reaction should the nurse monitor for in the patient? Gingival hyperplasia Urticaria Ataxia CNS depression

CNS depression Explanation: The nurse should monitor CNS depression in the patient undergoing phenobarbital treatment. Gingival hyperplasia is an adverse reaction in a patient administered ethotoins. Ataxia and urticaria are adverse reactions in patients undergoing anticonvulsant ethosuximide therapy.

The client is taking cyclobenzaprine for muscle spasms secondary to an injury to the lumbar spine that occurred while lifting a motor at work. The client is being seen for a follow-up visit by the health care provider. The client reports dry mouth, blurred vision, and constipation. Why is the client having these side effects from cyclobenzaprine? Cyclobenzaprine has an effect at the neuromuscular junction Cyclobenzaprine acts in the peripheral nervous system Cyclobenzaprine produces an anticholinergic response Cyclobenzaprine is structurally similar to amitriptyline

Cyclobenzaprine produces an anticholinergic response Explanation: Cyclobenzaprine relieves muscle spasms through a central action, possibly at the level of the brain stem, with no direct action on the neuromuscular junction or the muscle involved. The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The most common adverse effects are drowsiness, dizziness, and dry mouth.

The nurse is administering phenytoin to a client who is also receiving a continuous nasogastric enteral feeding and is aware of what possible effect? Increasing absorption of the AED Decreasing the absorption of the AED Not affecting absorption of the AED Precipitating signs of overdosage

Decreasing the absorption of the AED Explanation: The use of continuous nasogastric enteral feedings may decrease the absorption of phenytoin administered through the same route, predisposing the client to the risk of seizure activity.

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? Document the fact that the nurse checked the client's phenytoin levels Raise the client's bed rails and maintain the client on bed rest Contact the care provider to communicate this result Perform a focused neurological assessment

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.

When developing a teaching plan for a client who is to receive carisoprodol, which sign or symptom would the nurse include as a common adverse reaction? Drowsiness Dyspnea Hypertension Tachycardia

Drowsiness Explanation: Drowsiness is the most common adverse reaction to skeletal muscle relaxants like carisoprodol that the nurse should discuss with the client. No correlation is found with skeletal muscle relaxants causing dyspnea. The Disease-modifying antirheumatic medication of leflunomide has the adverse reaction of hypertension. Tachycardia can be seen in the use of skeletal muscle relaxants but is not the most common and is seen in the use of dantrolene and diazepam.

A client has been prescribed carbamazepine for the prevention of seizures. What action should the nurse perform? Educate the client about the need to take the pills as scheduled Educate the client about taking the medication at the first sign of impending seizure activity Establish intravenous access Teach the client how to self-administer subcutaneous injections

Educate the client about the need to take the pills as scheduled Carbamazepine is administered orally on an ongoing basis. It is not an emergency treatment for seizure activity.

A client is receiving a hydantoin as treatment for tonic-clonic seizures. The nurse includes a discussion of what when teaching the client about this drug? Withdrawal syndrome Possible leukocytosis Physical dependence Gingival hyperplasia

Gingival hyperplasia Explanation: Hydantoins may cause gingival hyperplasia, severe liver toxicity, and bone marrow suppression. Physical dependence and withdrawal syndrome are associated with benzodiazepine

When describing the action of zonisamide, which would the nurse include? Depression of motor nerve output Decrease in conduction through nerve pathways Depression of the cerebral cortex Inhibition of sodium and calcium channels

Inhibition of sodium and calcium channels Explanation: Zonisamide inhibits voltage-sensitive sodium and calcium channels, thus stabilizing the nerve cell membranes and modulating calcium-dependent presynaptic release of excitatory neurotransmitters. Hydantoins decrease the conduction through nerve pathways. Barbiturates and barbiturate-like agents depress the cerebral cortex and motor nerve output.

The nurse is caring for a client whose current medication regimen includes baclofen 60 mg PO daily. What assessment should the nurse prioritize when assessing for therapeutic effects? Assessment for seizure activity Inspection for muscle spasticity and range of motion assessment Comparison of fine motor and gross motor skills Bilateral assessment of muscle strength

Inspection for muscle spasticity and range of motion assessment Explanation: Baclofen is prescribed to treat muscle spasticity and/or acute musculoskeletal discomfort. It is not an anticonvulsant and does not affect fine motor versus gross motor skills. An absence of spasticity may increase muscle strength but this is not the most direct effect of the medication.

An operating room nurse is assisting the anesthesiologist in the preparation of an intravenous dose of dantrolene. What emergent issue most likely prompted the need to give the patient dantrolene? Malignant hyperthermia Uncontrolled hypertension Myocardial ischemia Cerebrovascular accid

Malignant hyperthermia Explanation: IV dantrolene is the drug of choice, when accompanied by supportive measures, for acute treatment of malignant hyperthermia. The drug is not used in the treatment of emergent CVA, myocardial ischemia, or hypertension

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? Observe respirations frequently. Monitor blood glucose levels. Record fluid input and output. Monitor body temperature.

Observe respirations frequently. Explanation: When caring for a patient who has been administered phenobarbital, the nurse should observe respirations frequently. The nurse need not monitor blood glucose levels or body temperature. The nurse need not record fluid input and output. The nurse may need to observe blood glucose levels if the patient is being administered antidiabetic medications along with an anticonvulsant.

The nurse has administered anakinra to a client. Which assessment finding should the nurse prioritize? Constipation Abdominal pain Retinal changes Pancytopenia

Pancytopenia Explanation: Due to the immunosuppressive properties of DMARD drugs, pancytopenia is an adverse effect of anakinra, a DMARD, and the client should be monitored for it closely. Administration of anakinra may also cause headache and irritation at the injection site, but not constipation, abdominal pain, or retinal changes. Constipation is a potential adverse reaction to cyclobenzaprine. Retinal changes are potential adverse reactions to hydroxychloroquine. Pancytopenia is a potential adverse reaction to sulfasalazine, alendronate, ibandronate, risedronate, allopurinol, and colchicine.

A client with a spinal cord injury has developed central spasticity and the care provider wishes to administer a muscle relaxant intrathecally. What is the nurse's best action? Prepare to administer baclofen. Contact the care provider to question the treatment plan. Ensure that the client has patent venous access. Prepare to administer carisoprodol.

Prepare to administer baclofen. Explanation: Baclofen is available in oral and intrathecal forms and can be administered via a delivery pump for the treatment of central spasticity. Soma cannot be delivered in this manner and there is no obvious reason to question such an order. The client likely needs venous access for other fluids and medications, but it is not necessary for intrathecal administration.

A 77-year-old client is being admitted to a long-term care facility. The client has a history of absence seizures has been treated with ethosuximide for many years. While the nurse is creating a plan of care on the client, the nurse understands the potential adverse effects of this drug and would consequently prioritize which nursing diagnoses? Risk for Impaired Skin Integrity Risk for Impaired Gas Exchange Risk for Altered Urinary Elimination Risk for Falls

Risk for Falls Explanation: Common adverse effects of ethosuximide are drowsiness, dizziness, and lethargy- which potentiates the risk for fall in this client. Respiration, urinary function, and skin integrity are not normally affected by the use of ethosuximide.

The primary health care provider prescribes adalimumab. The nurse would prepare to administer this drug by which route? Orally Intramuscularly Subcutaneously Intravenously

Subcutaneously Explanation: Adalimumab, a DMARD, is administered by subcutaneous injection. Abatacept and infliximab are examples of DMARDs that are administered IV. Methotrexate, sulfasalazine, and leflunomide are examples of DMARDs that can be given orally.

A client has a new diagnosis of a seizure disorder. What aspect of this client's health status would contraindicate the use of carbamazepine? The client has an allergy to sulfonamides. The client is 17 years old. The client's most recent blood work reveals pancytopenia. The client has type 2 diabetes, controlled through diet.

The client's most recent blood work reveals pancytopenia. Explanation: Bone marrow suppression would be considered a contraindication to administration of carbamazepine therapy. Contraindications to the use of Tegretol do not include an allergy to sulfonamides, or diabetes. The drug could be safely administered to a 17 year-old client.

A client with a history of partial seizures has been taking lamotrigine for the past several days. The client calls the clinic and reports the development of a facial and torso rash to the nurse. What is the nurse's best action? Tell the client to take the medication with a high-fat food to minimize adverse effects. Rule out any shortness of breath and inform the client that this adverse effect will resolve with time. Recommend that the client take 50 mg diphenhydramine PO and check back tomorrow. Tell the client to take no further doses and come be assessed at the clinic immediately.

Tell the client to take no further doses and come be assessed at the clinic immediately . Explanation: The nurse should inform the client to discontinue the drug and return to the clinic. Rashes associated with the use of lamotrigine can be life-threatening. The client needs to return to the clinic to be evaluated and will need a change of medication. Recommending another medication is insufficient, and is also beyond the nurse's scope. High-fat foods are of no benefit.

A client's health care provider has prescribed baclofen in an effort to treat neuropathic cancer pain. What education should the nurse prioritize when teaching the client about this new medication? The importance of regularly scheduled liver function testing The need to maintain a diet that is high in iron and folic acid The importance of ensuring safety related to possible sedation The importance of maintaining a sterile central venous catheter

The importance of ensuring safety related to possible sedation Explanation: Baclofen carries a risk of CNS depression and a consequent threat to safety. The use of baclofen does not necessitate regular liver function testing or dietary changes. Baclofen is administered orally or intrathecally, not intravenously.

A nurse is to administer an anticonvulsant drug. The nurse understands that this drug is classified as an oxazolidinedione. Which drug would the nurse most likely be preparing to administer? Diazepam Trimethadione Gabapentin Levetiracetam

Trimethadione Explanation: Trimethadione is classified as an oxazolidinedione. Diazepam is classified as a benzodiazepine. Gabapentin is classified as a miscellaneous anticonvulsant. Levetiracetam is classified as a miscellaneous anticonvulsant.

The nurse is preparing to administer the next dose of methsuximide to a client experiencing partial seizures. The client remarks about hoping their stomach will do better this time. Which suggestion from the nurse will best assist this client when administering this next dose? Daily at bedtime Immediately before eating a meal With some food or milk First thing in the morning on arising

With some food or milk Explanation: If the client experiences GI upset after succinimide administration, the nurse should instruct the client to take the drug with food or milk. The nurse need not instruct the client to take the drug once only at bedtime, before meals, or immediately on arising in the morning.

The nurse is caring for four clients. Which client would have the highest risk for hepatotoxicity from dantrolene? a man who is taking a cardiac glycoside. a man who it taking an antipsychotic drug a woman who is on hormone replacement therapy a woman who is taking a loop diuretic

a woman who is on hormone replacement therapy Explanation: If dantrolene is combined with estrogen, the incidence of hepatocellular toxicity is increased. This combination should be avoided. Nothing indicates that clients taking a cardiac glycoside, an antipsychotic drug, and an antihypertensive would have serious adverse effects when combined with dantrolene therapy.

In a person being treated for a diagnosed seizure disorder, what is the most common cause of status epilepticus? abusing drugs and/or alcohol experiencing a brain injury abruptly stopping the antiseizure medications hypoxia-inducing experience

abruptly stopping the antiseizure medications Explanation: In a person taking medications for a diagnosed seizure disorder, the most common cause of status epilepticus is abruptly stopping AEDs. In other clients, regardless of whether they have a diagnosed seizure disorder, causes of status epilepticus include brain trauma or tumors, systemic or central nervous system (CNS) infections, alcohol withdrawal, and overdoses of drugs (e.g., cocaine, theophylline).

Which of the following places the pt at risk for toxicity following the administration of phenytoin? a) the pt skips a dose of phenytoin b) the pt takes a different brand of phenytoin c) the pt switches to a different antiepileptic agent d) the pt receives phenytoin in an enteral feeding

b) the pt takes a different brand of phenytoin

A 12 year old boy comes to the school nurse's office after falling during gym class. The nurse assesses the child and notes that he has bruising and petechiae over most of his legs, arms and torso. The child has a history of absence seizures that are treated with valproate. Based on the child's history, what would the nurse suspect? a) abuse b) leukemia c) adverse effect d) anemia

c) adverse effect (Valproic acid has an adverse effect of bleeding. The first sign of bleeding in this client is bruising and petechiae.)

The nurse is caring for a client who has a disorder of muscle contraction and relaxation. The nurse should prioritize the assessment of what laboratory value? magnesium chloride potassium calcium

calcium Explanation: Calcium is released from the sarcoplasmic reticulum, which leads to the binding of calcium with troponin-tropomyosin. This leads to contraction of the muscle fiber. The calcium pump then moves calcium back into the sarcoplasmic reticulum, which leads to relaxation of muscle fiber. Chloride, magnesium, and potassium are not involved in this proces

What is a common risk for epileptic seizures during late infancy to early childhood? medication overdose fever learning disability malnutrition

fever Explanation: Epilepsy can be classified as idiopathic or attributable to a secondary cause. Secondary causes in infancy include developmental defects, metabolic disease, or birth injury. Fever is a common cause during late infancy and early childhood, and inherited forms usually begin in childhood or adolescence. Learning disability, medication overdose, and malnutrition are not risk factors.

A 32-year-old female client is taking tizanidine (Zanaflex) for spasticity related to her multiple sclerosis. The nurse will inform the client and her husband that the adverse effect that poses the greatest safety risk to the client is: constipation. dry mouth. fatigue. hypotension.

hypotension. Explanation: Tizanidine (Zanaflex) has been associated with hypotension, which could be a safety risk, especially if the client is also taking an antihypertensive drug. Constipation, dry mouth, and fatigue are common adverse effects that do not pose a safety risk.

What type of seizure activity is characterized by generalized tonic-clonic convulsions lasting for several minutes during which the client does not regain consciousness? febrile akinetic motor status epilepticus

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. None of the other options present with this described experience.

A client with myoclonic seizures has been prescribed clonazepam as an adjunctive treatment by the neurologist. What teaching should the nurse prioritize when explaining this new drug regimen to the client? "You'll have to come to the hospital's outpatient clinic twice a week to have this administered intravenously." "We will need to monitor your blood sugar quite closely while you're taking this drug." "Make sure you don't stop taking this abruptly because that might bring on a seizure." "You might find that you'll feel somewhat agitated for the first few days that you take this drug."

"Make sure you don't stop taking this abruptly because that might bring on a seizure." Explanation: Tolerance to the antiseizure effects of clonazepam can occur within months. Abrupt withdrawal of the drug induces seizures, including status epilepticus. Clonazepam causes drowsiness, not agitation, and it is unnecessary to monitor blood sugar closely. Administration is oral, not intravenous.

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? "You can drive as soon as therapeutic drug levels are established." "Yes, as long as your health care provider agrees and you take your medications regularly." "You'll need to use public transportation because a seizure could occur anytime." "You likely won't be able to until your seizures are controlled by medication"

"You likely won't be able to until your seizures are controlled by medication" Explanation: Clients newly diagnosed with epilepsy will not be able to drive. However, after the client's seizures are controlled (usually for 6 months to 2 years depending on state law), the client may be able to regain the ability to drive. This does not, however, mean that the client has to use public transportation. Serum drug levels are not the determining criterion.

The nurse has completed a teaching with a client prescribed phenytoin daily for seizure activity. The nurse determines the session is successful after the client correctly chooses which potential adverse reaction that can occur if the client misses a dose of medication? CNS depression Hypotension Recurrence of seizures Nystagmus

Recurrence of seizures Explanation: Recurrence of seizure activity may result from abrupt discontinuation of the drug, even when the anticonvulsant is being administered in small daily doses. Abrupt discontinuation of the drug does not cause CNS depression, hypotension, or nystagmus. CNS depression, hypotension, and nystagmus are adverse reactions of phenytoin.

The neurological nurse cares for several clients who have seizure disorders. Which client should the nurse monitor most closely for indications of drug dependence? A client with a history of myoclonic seizures who takes valproic acid A client with a history of tonic-clonic seizures who takes phenobarbital A client receiving IV phenytoin to prevent seizures post-neurosurgery A client receiving ethosuximide for the prevention of absence seizures

A client with a history of tonic-clonic seizures who takes phenobarbital Explanation: Barbiturates, such as phenobarbital, have an associated risk for dependence. This is not true of the other listed drugs.

A client with a complex health history has developed severe spasticity. What aspect of the client's status would contraindicate the safe and effective use of dantrolene ? The client has a history of fatty liver disease. The client has type 2 diabetes and takes oral antihyperglycemics. The client has asthma and occasionally uses an inhaled corticosteroid. The client requires partial assistance with activities of daily living.

The client has a history of fatty liver disease. Explanation: Dantrolene is contraindicated in the presence of any known allergy to the drug. It is also contraindicated in the following conditions: spasticity that contributes to locomotion, upright position, or increased function, which would be lost if that spasticity was blocked; active hepatic disease (such as fatty liver disease), which might interfere with metabolism of the drug and because of known liver toxicity; and lactation because the drug may cross into breast milk and cause adverse effects in the infant. Diabetes, asthma and lack of independence do not contraindicate the use of dantrolene.

When reviewing the medical record of a client who is to receive dantrolene, which condition would alert the nurse to the need for close monitoring? The client has respiratory depression from opioid analgesia The client received a blood transfusion less than 24 hours ago The client is 67 years old The client has an infected surgical wound

The client has respiratory depression from opioid analgesia Clients with respiratory depression need to be monitored closely because the use of dantrolene can increase muscular weakness and exacerbate the respiratory depression. None of the other listed client factors would necessarily require increased monitoring.

A 60 year-old female client has multiple sclerosis accompanied by muscle spasticity. The client has responded well to dantrolene 200 mg PO daily in divided doses. What assessment finding should the nurse prioritize for communication to the client's provider? The client's most recent laboratory results show an upward trend in AST and ALT levels The client has gained 1.5 lbs. over the past 48 hours The client is reluctant to participate in physical therapy this morning, when she is normally highly motivated The client tells the nurse, "I'm struggling to come to grips with the fact that I'm never going to recover."

The client's most recent laboratory results show an upward trend in AST and ALT levels Explanation: An increase in liver enzyme levels could indicate the onset of hepatocellular damage, which is a high risk in female clients of this age. The provider must be made aware of this immediately. The client's lack of motivation and apparent despair should be addressed by the nurse, but may be able to be addressed independently by the nurse. As well, these issues are less time-dependent than a decrease in liver function. A weight gain of 1.5 lbs. over 48 hours is not outside the range of usual fluctuations in fluid balance.

A client is receiving hydroxychloroquine for a musculoskeletal disorder. Which adverse reactions are irreversible and needs to be reported immediately? Easy bruising Skin rash Fever Visual changes

Visual changes Explanation: The nurse needs to report visual changes in a client receiving hydroxychloroquine, because irreversible retinal damage may occur. Although easy bruising, skin rash, and fever are adverse reactions of the drug, they are not irreversible.

The health care provider orders short-term skeletal muscle relaxants for an 11-year-old client. The nurse is responsible for the family education plan and teaches the parents that the medications should be used only under which condition? When the client needs to be alert during pain management During school hours to increase alertness and management of spasms When close supervision is available for monitoring drug effects When the spasms cause uncontrolled pain

When close supervision is available for monitoring drug effects Explanation: For most of the skeletal muscle relaxants, safety and effectiveness for use in children 12 years of age and younger have not been established. The drugs should be used only when clearly indicated, for short periods, when close supervision is available for monitoring drug effects (especially sedation), and when mobility and alertness are not require

A client with a recent history of seizures has been prescribed carbamazepine. The nurse should recognize that this medication will achieve a therapeutic effect by what means? depressing conduction in the brainstem and cortex and slowing the reuptake of dopamine reducing electrical activity in the thalamus and hypothalamus altering the permeability of neuron cell membranes affecting gamma-aminobutyric acid (GABA) levels and blocking sodium channels

affecting gamma-aminobutyric acid (GABA) levels and blocking sodium channels Explanation: Carbamazepine affects GABA activity and inhibits sodium channels to stop action potentials. Succinimides reduce electrical activity. Acetazolamides reduce electrical activity and alter sodium and calcium channels. Barbiturates depress conduction in the brainstem and the cortex but do not affect dopamine reuptake.

General anesthetic has been administered to a surgical client and the client has begun to exhibit signs and symptoms of malignant hyperthermia. The operating room nurse should prepare to assist with the administration of: dantrolene. chlorzoxazone. orphenadrine. metaxalone.

dantrolene. Explanation: Indications for dantrolene include control of clinical spasticity resulting from upper motor neuron disorders; preoperatively to prevent or attenuate the development of malignant hyperthermia in susceptible clients; IV for management of fulminant malignant hyperthermia. The other drugs are not indicated for treatment of malignant hyperthermia.