NU141- Chapter 23 Antiseizure Agents

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

"I will make sure he has routine visits to the dentist."

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

"I'll make sure to take the drug with food."

A 30-year-old female client is diagnosed with seizure disorder, and the provider is considering the use of carbamazepine. What assessment question best addresses the safety and effectiveness of the medication regimen?

"Is there any chance that you could be pregnant?"

A client has been diagnosed with partial seizures and has been prescribed carbamazepine. When providing health education about the safe and effective use of this medication, what should the nurse teach the client?

"It's safest if you avoid drinking alcohol while you're taking this drug."

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?

"Make sure you don't stop taking this abruptly because that might bring on a seizure."

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 considered teratogenic."

During an in-service, the charge nurse explains to the licensed vocational nurse (LVN) that there are six categories of anticonvulsants with different mechanisms of action. The LVN demonstrates understanding of the action of the miscellaneous drug, gabapentin, by stating which of the following?

"This drug is a gamma-aminobutyric acid (GABA) agonist."

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?

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

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

12 mcg/mL

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

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

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 tonic-clonic seizures who takes phenobarbital

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

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?

Alanine aminotransferase (ALT)

The school nurse sees a child who has had an absence seizure. Which characteristics are typical of this type of seizure?

Alterations in consciousness that last seconds

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 is dosage

A client who has been taking medication for a seizure disorder is asking the nurse about getting pregnant. Why is pregnancy discouraged in women who are being treated for seizure disorders?

Antiepilepsy drugs are teratogenic.

What explanation should the nurse provide for why pregnancy is discouraged in women who are being treated for seizure disorders?

Antiepilepsy drugs are teratogenic.

A patient with a seizure disorder has had a recent change in medication ordered. In evaluating the new drug's control of the seizure disorder, what would the nurse do?

Assess for adverse effects

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

Blood cell count

A nurse educating a client and their family about ethosuximide should tell them to notify the health care prescriber if which adverse reaction occurs? (Select all that apply.)

Blurred vision Joint pain Bruising

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

CNS depression

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

Central nervous system (CNS) depression

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.

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

Contact the health care provider immediately if rash appears.

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

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

Depression of motor nerve output

What medication may be administered intravenously (IV) to assist in reducing status epilepticus seizure activity?

Diazepam

For a client with a known heart block (conduction disorder), what medication is contraindicated?

Dilantin

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

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

Drug-drug interactions

Which factor should the clinician reassess when combination therapy is ineffective?

Drug-drug interactions

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

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?

Ethosuximide

The nurse instructs the parent of a young school-age child with a seizure disorder who takes an AED to be alert for what signs and symptoms?

Excessive sedation and interference with learning and social development

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

Falls

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?

Generalized seizures

Which type of seizures involves a loss of consciousness?

Generalized seizures

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?

Gingival hyperplasia

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?

Implement falls precautions

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

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

What best reflects the action of barbiturates when used to control seizures?

Inhibition of impulse conduction

When describing the action of zonisamide, which would the nurse include?

Inhibition of sodium and calcium channels

A health care prescriber recently ordered a change in medication for a patient with a seizure disorder. Which action would the nurse take in evaluating the new drug's control of the seizure disorder?

Interview and observe for adverse effects

Phenobarbital is ordered for a child with status epilepticus. The nurse would anticipate administering this drug by which route?

Intravenous

Which agent would a nurse expect to administer intravenously for a partial seizure?

Levetiracetam

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

Liver toxicity

A client comes to the emergency department experiencing status epilepticus. Which medication would the nurse expect to administer?

Lorazepam

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 actions should the nurse take? Select all that apply.

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

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.

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

Oral

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

Oral

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

A nurse is preparing to administer an anticonvulsant that produces its effects by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain. Which medication would the nurse be most likely to administer?

Phenytoin

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

Pregnancy Sinus bradycardia

A 15-year-old is observed having a tonic-clonic seizure at school. Which behavior would allow the school nurse to recognize the clonic phase of the seizure?

Rapid rhythmic and symmetric jerking movements

A client is receiving lamotrigine as treatment for partial seizures. Which assessment finding would lead the nurse to stop the drug immediately?

Rash

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

Rash

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?

Report the findings to the primary health care provider immediately.

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 Falls

Which nursing diagnosis would be most important for a nurse to include in the plan of care for a client who is receiving an antiseizure agent and experiencing common adverse effects?

Risk for injury

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

A nurse is caring for a patient administered ethotoin. What are signs of toxicity for which the nurse should monitor the patient?

Slurred speech

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

Status epilepticus

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

Status epilepticus

A patient with partial seizures has been prescribed succinimides at a health care facility. The patient experiences GI upset after succinimides administration. What should the nurse instruct the patient to do?

Take the drug with food or milk.

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 client has been admitted to the health care facility with myoclonic seizures. Once stabilized, the nurse should anticipate that the client will be prescribed what medication?

Valproic acid

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

Valproic acid

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

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

Drugs that are commonly used to treat grand mal seizures include a. barbiturates, benzodiazepines, and hydantoins. b. barbiturates, antihistamines, and local anesthetics. c. hydantoins, phenobarbital, and phensuximide. d. benzodiazepines, phensuximide, and valproic acid.

a. barbiturates, benzodiazepines, and hydantoins.

One drug that is used alone in the treatment of partial seizures is a. carbamazepine. b. topiramate. c. lamotrigine. d. gabapentin.

a. carbamazepine.

In a person being treated for a diagnosed seizure disorder, what is the most common cause of status epilepticus?

abruptly stopping the antiseizure medications

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

absence

Partial seizures

also called focal seizures; seizures involving one area of the brain that do not spread throughout the entire organ

While administering phenytoin, the nurse should observe the client what adverse reaction? Select all that apply.

ataxia nausea lethargy gingival hyperplasia

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

aura

A patient has been stabilized on phenytoin (Dilantin) for several years and has not experienced a grand mal seizure in more than 3 years. The patient decides to stop the drug because it no longer seems to be needed. In counseling, the nurse should include which points? a. The patient will always need this drug. b. This drug needs to be slowly tapered to avoid potentially serious adverse effects. c. The patient is probably correct, and the drug is not needed. d. The drug should not be stopped until appropriate blood tests are done. e. Stopping the drug suddenly could precipitate seizures because the nerves will be more sensitive. f. The patient's insurance company won't cover any problems that might occur if the drug is stopped without physician approval.

b. This drug needs to be slowly tapered to avoid potentially serious adverse effects. e. Stopping the drug suddenly could precipitate seizures because the nerves will be more sensitive.

Which instruction would the nurse encourage a patient receiving an antiepileptic drug to do? a. Give up his or her driver's license. b. Wear or carry a MedicAlert identification. c. Take antihistamines to help dry up secretions. d. Keep the diagnosis a secret to avoid prejudice.

b. Wear or carry a MedicAlert identification

Treatment of epilepsy is directed at a. blocking the transmission of nerve impulses into the brain. b. stabilizing overexcited nerve membranes. c. blocking peripheral nerve terminals. d. thickening the meninges to dampen brain electrical activity.

b. stabilizing overexcited nerve membranes

The most common adverse effects associated with antiepileptic therapy reflect the depression of the CNS. In assessing a patient on antiepileptic therapy, the nurse would monitor the patient for which conditions? a. Hypertension b. Insomnia c. Confusion d. GI depression e. Increased salivation f. Tachycardia

c. Confusion d. GI depression

When teaching a group of students about epilepsy, which characteristic should the nurse include? a. Always characterized by grand mal seizures b. Only a genetic problem c. The most prevalent neurological disorder d. The name given to one brain disorder

c. The most prevalent neurological disorder

Focal or partial seizures a. start at one point and spread quickly throughout the brain. b. are best treated with benzodiazepines. c. involve only part of the brain. d. are easily diagnosed and recognized.

c. involve only part of the brain.

Epilepsy

collection of various syndromes, all of which are characterized by seizures

Which type of seizure would the nurse be least likely to include as a type of generalized seizure? a. Petit mal seizures b. Febrile seizures c. Grand mal seizures d. Complex seizures

d. Complex seizures

The drug of choice for the treatment of absence seizures is a. valproic acid. b. methsuximide. c. phensuximide. d. ethosuximide.

d. ethosuximide

Antiepileptic

drug used to treat the abnormal and excessive energy bursts in the brain that are characteristic of epilepsy

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

fever

What is the primary medication prescribed to relieve pain associated with shingles?

gabapentin

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.

Generalized seizure

seizure that begins in one area of the brain and rapidly spreads throughout both hemispheres

The nurse is caring for a 26-year-old client with partial seizures and has been prescribed oxcarbazepine as monotherapy. It will be critical for the nurse to inform the client of which needed action?

since she is taking oral contraceptives, she will need to use an additional form of birth control.

Because of the black box warning for clients taking lamotrigine, the nurse should instruct a client to discontinue this medication immediately if he or she develops what unexpected reaction?

skin rashes

Status epilepticus

state in which seizures rapidly recur; most severe form of generalized seizure

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

status epilepticus

Seizure

sudden discharge of excessive electrical energy from nerve cells in the brain

Convulsion

tonic-clonic muscular reaction to excessive electrical energy arising from nerve cells in the brain

Tonic-clonic seizure

type of generalized seizure that is characterized by serious involuntary muscle contractions followed by relaxation appearing as an aggressive spasm in addition to a loss of consciousness, with exhaustion and little memory of the event on awakening; formerly known as a grand mal seizure

Absence seizure

type of generalized seizure that is characterized by sudden, temporary loss of consciousness, sometimes with staring or blinking for 3 to 5 seconds; formerly known as a petit mal seizure

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.