Nurse Exam 3: Module 15
The nurse has provided education for a client diagnosed with epilepsy. Which statement made by the client indicates an understanding of the information? "Excessive stress levels cause disruptions in how the brain receives oxygen, leading to epilepsy." "Epilepsy may be caused by a head injury." "Eating disorders, like anorexia nervosa, increase the risk for developing epilepsy." "A stroke, or brain attack, could increase the risk for developing epilepsy." "With some cases of epilepsy, the cause is never determined."
"Epilepsy may be caused by a head injury." "A stroke, or brain attack, could increase the risk for developing epilepsy." "With some cases of epilepsy, the cause is never determined." Rationale: Epilepsy is a disorder where seizures occur on a chronic basis. Head trauma is a known cause of seizures. In some cases, the exact etiology may not be identified. Changes in cerebral perfusion such as hypotension; strokes, or brain attacks; and shock may be causes of seizures. There is no known correlation with anorexia nervosa and the development of epilepsy. Excessive levels of stress cannot disrupt cerebral oxygen to the extent that epilepsy would occur.
The nurse has provided the education to the parent of a young child prescribed valproic acid (Depakene) syrup. Which statement made by the parent indicates an understanding of the teaching? "If my child gets a headache from this, I can administer a baby aspirin." "I can still give the clonazepam (Klonopin) prescribed by the psychiatrist for sleep." "I should not mix this with carbonated beverages." "I can give this on a full stomach or an empty stomach."
"I should not mix this with carbonated beverages." Rationale: Mixing valproic acid (Depakene) syrup with carbonated beverages will trigger immediate release of the drug, which causes severe mouth and throat irritation. Valproic acid (Depakene) is a gastrointestinal (GI) irritant and should be given with food. Aspirin can increase valproic acid (Depakene) toxicity, and aspirin should not be given to children because of Reye syndrome. Clonazepam (Klonopin) given with valproic acid (Depakene) can induce absence seizures.
A client with epilepsy who has been seizure free and prescribed phenytoin (Dilantin) asks the nurse why he or she needs to still have blood testing. Which response should the nurse provide the client? "Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose." "Phenytoin (Dilantin) can cause blood-thinning in some patients." "Phenytoin (Dilantin) can cause Stevens-Johnson syndrome, which can be detected through blood testing." "Phenytoin (Dilantin) can deplete your system of potassium."
"Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose." Rationale: Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose; blood levels must be monitored to ensure a therapeutic level and to prevent toxicity. There isn't any evidence to support that phenytoin (Dilantin) causes potassium depletion. Stevens-Johnson syndrome is a severe skin reaction that can be an adverse outcome with phenytoin (Dilantin), but it is monitored by skin assessment, not blood tests. Phenytoin (Dilantin) is not an anticoagulant and does not cause thinning of the blood.
A client with type I diabetes mellitus has been prescribed phenytoin (Dilantin). Based on the client's medical history, which should the nurse anticipate to be included in the treatment plan? Monitor coagulation studies. A decrease in the patient's insulin. An increase the patient's insulin. Implement fall precautions.
An increase the patient's insulin. Rationale: Phenytoin (Dilantin) can increase serum glucose levels resulting in the need for additional insulin. Diabetes does not place the client at risk for coagulation disorders or falls. Phenytoin increases the risk for bleeding as well as dizziness and ataxia.
For which adverse effect should the nurse monitor a client prescribed phenytoin (Dilantin)? Hypoglycemia Leg edema Bleeding Vitamin B deficiency
Bleeding Rationale: Dilantin affects the metabolism of vitamin K, which can lead to blood dyscrasias. Hyperglycemia is more common than hypoglycemia, and leg edema is not generally experienced as an adverse effect. Vitamin B deficiency is not the most common complication.
The client receiving valproic acid (Depakene) for treatment of seizures has been taking 81 mg aspirin daily. For which should the nurse monitor the client? Increased seizure activity. Bruising of the skin. Migraine headaches. Stevens-Johnson syndrome.
Bruising of the skin. Rationale: Valproic acid (Depakene) can prolong bleeding time; concomitant aspirin use can cause severe bleeding. Valproic acid (Depakene) and aspirin do not increase the risk of seizure activity. Valproic acid (Depakene) and aspirin use are not associated with migraine headaches. Valproic acid (Depakene) can prolong bleeding time; concomitant aspirin use can cause severe bleeding.
The nurse is preparing to review the records for a client with petit mal seizures. Which prescription should the nurse anticipate the client has been prescribed? Ethosuximide (Zarontin) Carbamazepine (Tegretol) Phenytoin (Dilantin) Diazepam (Valium)
Ethosuximide (Zarontin) Rationale: Succinimides like ethosuximide are indicated for petit mal seizures but not for tonic-clonic seizures. Diazepam, and Dilantin, can be effective for tonic-clonic seizures.
A client has been prescribed ketogenic diet to supplement pharmacotherapy for a seizure disorder. Which food items should the nurse encourage the client to consume? Foods high in fat Salty foods Foods high in vitamin K Low protein foods Low carbohydrate foods
Foods high in fat Low protein foods Low carbohydrate foods Rationale: The ketogenic diet is high in fat and low in protein and carbohydrates. Foods high in salt or vitamin K are not specifically included in the recommended foods to be consumed.
The nurse is providing education to a parent of a 5-year-old that experienced a febrile seizure. Which information should the nurse include? Seizure medications are usually prescribed for febrile seizures. High temperatures rarely induce seizures in children. After a febrile seizure the child returns to consciousness slowly. A five-year-old is too old for febrile seizures.
High temperatures rarely induce seizures in children. Rationale: Many children experience high temperatures without experiencing seizures. After a febrile seizure the child returns to consciousness rapidly. Febrile seizures usually occur between 3 months and 5 years of age. The best course of action for febrile seizures is prevention by using acetaminophen to prevent onset of fever.
The nurse is preparing to administer phenytoin (Dilantin). Which route should the nurse anticipate to administer the prescription? Central venous catheter Intramuscular Subcutaneous Intravenously
Intravenously Rationale: Phenytoin is administered intravenously. Phenytoin is not administered intramuscularly or subcutaneously. The prescription is a soft-tissue irritant that causes local tissue damage following extravasation. Phenytoin should not be administered through a central venous catheter.
The nurse observes a client that stops talking mid-sentence and has a blank stare for 5 seconds. Which should the nurse suspect has occurred? Petit mal seizure Simple partial seizure Drop attack Status epilepticus
Petit mal seizure Rationale: The symptoms presented indicate a general (absence) or petit mal seizure. Simple partial seizures manifest in olfactory, auditory, or visual hallucinations; intense emotions; or twitching of arms, legs, and face. Status epilepticus is continuous seizure activity, which can lead to coma or death. Drop attacks are manifested by falling or stumbling for no reason. These attacks typically last a few seconds.
The educator is discussing the adverse effects of prescriptions used to treat seizure disorders. Which prescription should educator refer to when discussing the risk for extravasation? Clonazepam (Klonopin) Phenytoin (Dilantin) Ethosuximide (Zarontin) Phenobarbital (Luminal)
Phenytoin (Dilantin) Rationale: Dilantin is frequently administered intravenously due to slow and variable absorption rates when given orally. Dilantin results in serious soft tissue damage if extravasation occurs. Phenobarbital is primarily administered orally and is infrequently administered intravenously. Zarontin and Klonopin are oral medications.
The nurse has administered intravenous (IV) diazepam (Valium) for the client in status epilepticus. Which initial assessment should the nurse perform? Heart rate Respirations Blood pressure Level of consciousness
Respirations Rationale: Respiratory depression is common when diazepam is given intravenously (IV). Assessing the respirations is the most important. Assessing the level of consciousness, heart rate, and blood pressure are important, but not the most important. Although tachycardia is an effect of intravenous diazepam (Valium), it is not the most important assessment. Although hypotension is an effect of intravenous diazepam (Valium), it is not the most important assessment.
An older adult is prescribed phenobarbital (Luminal) for seizure control. Which assessment should the nurse recognize is the most important? Fluid intake Electrolyte balance Nutritional status Respiratory function
Respiratory function Rationale: Older adults are at risk for cumulative effects of barbiturates due to diminished hepatic and renal function. Central nervous system (CNS) depression can lead to suppression of respiratory function. Nutritional status is important with older adults but is not the primary concern. Fluid intake is often decreased in older adults but is not a side effect of barbiturates. Barbiturates do not affect electrolyte balance.
The nurse is preparing to assess a client that had a tonic-clonic seizure. Which assessment findings should the nurse anticipate? Incontinence of urine. The client is in a deep sleep. Confusion in relation to place and time. The client reports of an odd taste in the mouth. The client attempting to remove their hospital gown.
The client is in a deep sleep. Confusion in relation to place and time. Rationale: Deep sleep after the seizure is a finding associated with the postictal state. Clients who are in the postictal state may be confused and disoriented. Incontinence of bowel or bladder is common during a tonic-clonic seizure but is not indicative of a postictal state. An odd taste, specific odor or noise, or other sensory change known as an aura often occurs prior to a seizure. During complex partial seizures, clients sometimes fumble with or attempt to remove clothing.
The nurse is preparing to educate a client on prescribed antiepileptic drug (AED). Which information should the nurse include in the teaching? The prescription should be taken at the same time every day. When a dose of the prescription is missed take both doses together when the next does is due. Take an additional dose of the prescription if experiencing a seizure aura. When experiencing side effects skip the next dose of the prescription. Avoid the use of dietary supplements containing kava while taking the prescription.
The prescription should be taken at the same time every day. Avoid the use of dietary supplements containing kava while taking the prescription. Rationale: Stable blood levels of prescription are important in the control of seizure activity; therefore, the prescription should be taken at the same time daily. Kava interferes with many AEDs, often adding to their sedative effects. The client should take a missed dose of the prescription as soon as they remember. Two doses of the prescription should not be taken at the same time or close together. Oral prescriptions are not delivered rapidly to the system, so taking an additional dose of the prescription when an aura occurs is not effective in controlling the impending seizure. The client should never abruptly discontinue or skip doses of the prescription.
The healthcare provider has prescribed intravenous phenytoin (Dilantin) IV piggyback. The client is currently receiving 5% dextrose in water (D5W) intravenously (IV). Which action should the nurse take? Use a large vein for the infusion. Use an intravenous (IV) line with a filter. Flush the intravenous (IV) line with saline. Monitor the patient for hypertension. Monitor the patient for Stevens-Johnson syndrome.
Use an intravenous (IV) line with a filter. Flush the intravenous (IV) line with saline. Rationale: Intravenous lines of 5% dextrose in water (D5W) must be flushed with saline, as traces of dextrose can cause microscopic precipitate formations that become emboli, if infused. An intravenous filter will trap any precipitate that occurs. Phenytoin (Dilantin) is a soft-tissue irritant that will cause local tissue damage if extravasation occurs, so a large vein must be used for infusion. Patients receiving phenytoin (Dilantin) are at risk for hypotension, not hypertension. Stevens-Johnson syndrome is a side effect of phenytoin (Dilantin), but occurs over the course of several days.
The nurse is providing information about seizures to a client. Which statement should the nurse include in the discussion? "Convulsions are a symptom of the underlying seizure disorder." "Bacterial infections can cause seizures." "All seizures involve convulsions." "Epilepsy is an acute disorder characterized by nonconvulsive seizures."
"Bacterial infections can cause seizures." Rationale: Seizures can be caused by bacterial infections of the nervous system. Convulsions are a type of seizure, and seizures are a symptom of an underlying disorder. Epilepsy is generally chronic and can present with convulsive seizures. Not all seizures involve convulsions.
A client has been prescribed several different prescriptions for seizure control without any improvement. Which initial question should the nurse ask the client? "Have you thought about taking a nontypical prescription?" "Do you drink alcohol?" "Do you take your medication as prescribed?" "Have you noticed any decrease in the amount of seizures you have?"
"Do you take your medication as prescribed?" Rationale: Compliance with the prescription should be initially assessed for a patient that has that has not had an improvement in seizure control after taking several different prescriptions for seizure control. Another drug might be indicated, but compliance should be assessed first. There is no indication there is an improvement in seizure control. Alcohol does not increase the risk of seizures for a patient prescribed an antileptic.
The nurse has provided education for a client prescribed ethosuximide (Zarontin). For which information offered by the client should the nurse notify the healthcare provider? "Did I mention that I used to take phenobarbital for my seizures?" "I forgot to tell the doctor that I am allergic to penicillin." "I take ginkgo to help improve my memory." "My husband and I plan to have a baby in a couple of years." "My husband and I are leading a 20-mile bicycle tour next weekend for the company we have just started."
"I take ginkgo to help improve my memory." "My husband and I are leading a 20-mile bicycle tour next weekend for the company we have just started." Rationale: Ginkgo may reduce the therapeutic effects of ethosuximide (Zarontin). The most common adverse effects of ethosuximide (Zarontin) include dizziness, ataxia, and fatigue. These side effects place the client at risk for injury while cycling. There is no indication that previous phenobarbital use is problematic with the use of ethosuximide (Zarontin). There is no indication of cross sensitivity with penicillin. Ethosuximide (Zarontin) is Pregnancy Category C.
The nurse has provided a client education on the pharmacologic management of epilepsy. Which statement made by the client indicates an understanding of the treatment? "I understand that I will take an antiseizure prescription indefinitely." "I will remain on an antiseizure prescription for 1 year after my last seizure." "I will avoid foods with tyramine while taking my antiseizure prescription." "I will be on a ketogenic diet combined with an antiseizure prescription."
"I understand that I will take an antiseizure prescription indefinitely." Rationale: Once seizures have been controlled, clients are continued indefinitely on the antiseizure drug. A ketogenic diet is indicated when seizures cannot be controlled through pharmacotherapy or when there are unacceptable side effects to the medications. A tyramine-free diet is indicated for patients receiving monoamine oxidase inhibitor medications. It is unknown how long antiseizure drugs will be necessary, but many clients require a life-time regimen.
A client taking phenobarbital (Luminal) for seizure control asks the nurse how the prescription can control seizures. Which response should the nurse provide the client? Phenobarbital (Luminal) stops seizures by decreasing the calcium in the brain, which is responsible for the seizures." "Phenobarbital (Luminal) stops seizures by increasing a chemical called GABA that calms down the excitability in the brain." "Phenobarbital (Luminal) stops seizures by increasing a chemical called glutamate that calms down the excitability in the brain." "Phenobarbital (Luminal) stops seizures by decreasing the sodium in brain, which is responsible for the seizures."
"Phenobarbital (Luminal) stops seizures by increasing a chemical called GABA that calms down the excitability in the brain." Rationale: Phenobarbital (Luminal) acts biochemically in the brain by enhancing the action of the neurotransmitter GABA, which is responsible for suppressing abnormal neuronal discharges that can cause epilepsy. Glutamate is the primary excitatory neurotransmitter in the brain; enhancing this neurotransmitter will increase the likelihood of seizures. Hydantoins and phenytoin-like drugs, not phenobarbital (Luminal), suppress sodium influx. Succinimides, not phenobarbital (Luminal), suppress calcium influx.
A client that has been taking phenytoin (Dilantin) tells the nurse they want to stop taking the medication due to the side effects. Which response should the nurse provide the client? "Another prescription can be added to decrease the side effects." "Side effects are a problem, but they are not as bad as the seizures you were having." "Your seizures have been controlled so I will let your healthcare provider know that you no longer will be taking the prescription." "Please do not stop the prescription abruptly, as you will have withdrawal seizures."
"Please do not stop the prescription abruptly, as you will have withdrawal seizures." Rationale: Seizures are likely to occur with abrupt withdrawal of antiseizure prescription. The prescription must be withdrawn over a period of 6 to 12 weeks. Telling a client that prescription side effects are not as bad as seizures is an inappropriate and nontherapeutic response that does not address the client's concerns. There is no other prescription that can be added to decrease the side effects associated with phenytoin. It is not within the nurse's scope of practice to determine if a client has been taking a medication long enough. The client must be informed of the consequences of abruptly stopping the medication.
A client with epilepsy prescribed Phenobarbital (Luminal) tells the nurse she is planning a pregnancy. Which statement should the nurse provide the client? "Please talk to your doctor; this drug is contraindicated in pregnancy." "Please talk to your doctor; you will need a safer drug like valproic acid (Depakene)." "Your medication dose will need to be decreased during your pregnancy." "Your medication dose will need to be increased during your pregnancy."
"Please talk to your doctor; this drug is contraindicated in pregnancy." Rationale: Phenobarbital (Luminal) falls under Pregnancy Category D and is contraindicated in pregnancy. The medication does not need to be increased; it might need to be stopped. The medication does not need to be decreased; it might need to be stopped. Valproic acid (Depakene) is also a Pregnancy Category D drug and is contraindicated during pregnancy.
The nurse has completed the education for the parents of a child with tonic-clonic seizures. Which statements made by the parents indicate further education is needed? "Some of the times when I thought he was ignoring me may have actually been seizure activity." "He just needs to focus more to prevent these attacks." "I know he will outgrow these seizures with time." "I hope we can help our son identify his seizure aura." "We will watch for the development of status epilepticus."
"Some of the times when I thought he was ignoring me may have actually been seizure activity." "He just needs to focus more to prevent these attacks." "I know he will outgrow these seizures with time." Rationale: Behavior that manifests as the child ignoring outside stimuli is most likely absence seizure, which is different from tonic-clonic seizure. The client who suffers seizure disorder cannot prevent seizure occurrence by focusing harder. The patient with tonic-clonic seizure disorder is less likely to outgrow them than the patient with absence seizure disorder. Many clients experience an aura prior to the tonic-clonic phase. Identifying the aura can provide time for the patient to move to a safe area, notify another person of the impending seizure, and to prepare. Status epilepticus is a medical emergency that may occur in the client who suffers with tonic-clonic seizure disorder.
A parent states, "The doctors all say that my son's problem is epilepsy, but I don't think that is correct. I have never seen him jerk or thrash." Which information should the nurse include in a response to the parent? "The episodes of jerking and thrashing are called convulsions." "Seizures take many forms." "Your son may have seizures, but not epilepsy." "Seizures can be a sign that epilepsy is present." "If there is no physical movement, epilepsy is ruled out."
"The episodes of jerking and thrashing are called convulsions." "Seizures take many forms." "Seizures can be a sign that epilepsy is present." Rationale: Convulsions are the involuntary, violent spasms of the large skeletal muscles of the face, neck, arms, and legs. It is important to provide this parent with correct terminology. There are many types of seizures. Epilepsy is any disorder that is characterized by recurrent seizures. It is inappropriate to lead the parent to believe that the diagnosis is incorrect. The nurse does not have all the necessary information. Many seizures do not include physical movement, yet the patient still is diagnosed with epilepsy.
A client asks the nurse about the characteristics of absence seizures. Which explanation should the nurse provide the client? "Absence seizures are basically the same kind of seizures as grand mal, but they are less frequent." "This type of seizure is similar to drop attacks." "Absence seizures are characterized by twitching of the arms and legs." "This type of seizure manifests is characterized by staring into space for a few seconds."
"This type of seizure manifests is characterized by staring into space for a few seconds." Rationale: Absence seizures, formerly known as petit mal, last a few seconds and are characterized by staring into space. Grand mal, or tonic-clonic, seizures are different from absence or petit mal seizures; they are different forms of epilepsy. Simple partial seizures are characterized by twitching of the arms and legs. Drop attacks or atonic seizures last a few seconds and are characterized by stumbling or falling for no reason.
The nurse is obtaining a history from a client that experienced an atonic seizure. Which information is the most important for the nurse to obtain? "What method of birth control do you use?" "Do you have a history of infertility?" "Are your periods regular?" "Have you ever been pregnant?"
"What method of birth control do you use?" Rationale: Atonic seizures can be treated with barbiturates such as phenobarbital. Barbiturates decrease the effectiveness of oral contraceptives and additional forms of contraception should be used. Obtaining a menstrual cycle history is important, but not the most important. Assessing a client for infertility is important information to obtain, but not the most important. Assessing a client's history of pregnancy is important information to obtain, but not the most important.
A client diagnosed with epilepsy ask the nurse why he or she will have to take a prescription. Which response should the nurse provide the client? "You will need to take a prescription on a continual basis to control the seizures." "The prescription will decrease the intensity of the seizures." "You will need a prescription for a little while to cure the seizures." "You might not need prescription; the epilepsy may be controlled with a ketogenic diet."
"You will need to take a prescription on a continual basis to control the seizures." Rationale: Epilepsy is a condition for which seizures may occur on a chronic basis. Once seizures are controlled, clients will continue indefinitely on the antiseizure prescription. The prescription is intended to prevent seizure activity. Epilepsy and associated seizures are not curable with medications. The ketogenic diet is used when seizures cannot be controlled through pharmacotherapy or when there are unacceptable side effects to the prescriptions.
A client prescribed valproic acid (Depakene) for seizure control is planning a pregnancy. Which statements should the nurse include in a discussion with the client? Since your epilepsy may be exacerbated by a pregnancy, your healthcare provider will most likely prescribe a second antiepileptic prescription." "Thankfully, the current generation of antiepileptic prescriptions will not interfere with you getting pregnant." "Your current antiepileptic prescription should not be used when you are pregnant." "Folic acid supplementation is important for you." "You should consider adopting a baby instead since there are so many problems associated with epilepsy and pregnancy."
"Your current antiepileptic prescription should not be used when you are pregnant." "Folic acid supplementation is important for you." Rationale: Valproic acid (Depakene) is Pregnancy Category D. Folic acid supplementation is important for all women who are, or wish to become, pregnant. This is especially true of women who are epileptic because many antiepileptic prescriptions cause folic acid deficiency. Due to the increased side effects of the antiepileptic prescriptions, single drug therapy is the goal for pregnant clients. Women who have epilepsy have a reduced fertility rate, and some do not ovulate. Women who have epilepsy have a reduced fertility rate, and some do not ovulate. Women who are epileptic can conceive and deliver healthy babies. The nurse should not discourage this client, but should provide information to the client and then support the patient's choice.