PrepU - Chapter 52: Drug Therapy for Seizure Disorders and Spasticity

A 50-year-old woman has begun taking baclofen to treat her recently diagnosed multiple sclerosis (MS). What teaching point should the nurse provide to the patient about her new drug regimen?

"Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply."

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."

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."

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

12 mcg/mL

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

12 mcg/mL

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

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

When reviewing the results of a patient's serum phenytoin level, which level would indicate toxicity?

22 mcg/mL

A patient presents to the emergency department with signs and symptoms of gabapentin overdose. Which of the following medications might be administered to treat gabapentin overdose?

Activiated charcoal

A patient in status epilepticus has been brought to the emergency department by emergency medical services. The nurse in the emergency department should anticipate which of the following treatment measures?

Administration of intravenous lorazepam

Which is an example of a skeletal muscle relaxant? -Baclofen (Lioresal) -Allopurinol (Zyloprim) -Alendronate (Fosamax) -Hydroxychloroquine (Plaquenil)

Baclofen (Lioresal)

A client has a new order for carbamazepine (Tegretol). Which condition is a contraindication to administration of carbamazine?

Bone marrow depression

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

CNS depression

The anatomy and physiology instructor is discussing what causes muscle contraction and relaxation. What element is part of the process that causes muscle contraction and relaxation?

Calcium

The drug of choice for the treatment of partial seizures is:

Carbamazepine (Tegretol)

An older client is to receive a centrally acting skeletal muscle relaxant. Which would the nurse expect to be prescribed?

Carisoprodol

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 with a history of malignant hyperthermia is scheduled for surgery. Which agent would the nurse most likely expect to administer?

Dantrolene

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 is the most important teaching point to emphasize from the plan of care when a client is prescribed a skeletal muscle relaxant?

Do not drive or operate machinery until individual drug effects are known.

A nurse administers carisoprodol to a patient for the treatment of an acute musculoskeletal condition. What adverse reaction of the administration of carisoprodol should the nurse monitor for in this patient?

Drowsiness

Which is the most common adverse reaction to carisoprodol (Soma) that the nurse should discuss with the patient?

Drowsiness

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

Drug-drug interactions

Tonic-clonic seizures and myoclonic seizures are classified as what type of seizures?

Generalized seizures

Which type of seizures involves a loss of consciousness?

Generalized seizures

Signs and symptoms of what would necessitate discontinuation of dantrolene therapy?

Hepatic dysfunction

Which would a nurse include when describing the action of dantrolene?

Interference with calcium release from the muscles

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

Intravenous

A patient, newly diagnosed with a seizure disorder, has been prescribed valproic acid. What is an adverse effect of valproic acid that the nurse should include in the medication teaching plan?

Liver toxicity

What would the nurse include as possible adverse effects when teaching a patient about phenytoin?

Liver toxicity

Status epilepticus is a life-threatening condition that needs immediate treatment. What is the drug of choice in treating status epilepticus?

Lorazepam

Which is the drug of choice in the treatment of status epilepticus, an emergency characterized continual seizure activity with no interruptions?

Lorazepam (Ativan)

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?

Measure regular serum plasma levels of the drug.

A client asks the nurse about the cause of idiopathic seizures. What is the nurse's best response?

No known cause

A client taking allopurinol exhibits an "itchy" skin rash on the neck and both arms. What is the nurse's top priority action?

Notify the health care provider.

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

Oral

A nurse is caring for a patient with trigeminal neuralgia at a health care facility. The physician has prescribed carbamazepine. In which case is the use of carbamazepine contraindicated?

Patients with renal impairment

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

Rash

A nurse should review a client's medical conditions prior to administering a cyclobenzaprine (Flexeril) as its use is contraindicated in clients with which of the following? Select all that apply: Recent myocardial infarction Diabetes Hepatic disease Hypertension Hyperthyroidism

Recent myocardial infarction Hyperthyroidism

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 man with a long history of absence seizures has been treated with ethosuximide for many years. The man is now in the process of moving to a long-term care facility and a nurse is creating a plan of care. The nurse understands the potential adverse effects of this drug and would consequently prioritize which nursing diagnoses?

Risk for Falls

A male patient who experienced a lower back injury while doing yard work has seen his range of motion decrease and his pain increase over the past several weeks. As a result, he has been prescribed cyclobenzaprine. What nursing diagnosis should the nurse prioritize in light of the patient's drug regimen?

Risk for Injury related to CNS depression

A client who is receiving an antiseizure agent reports feeling sleepy and tired and reports dizziness when standing up. Which intervention would the nurse most likely implement as the priority?

Safety precautions

A nurse is teaching a patient about phenytoin (Dilantin), his newly prescribed drug for a seizure disorder. Which will the nurse alert the patient to as a serious adverse effect of this drug?

Skin rash

A patient with severe spasticity sees their physician. The physician orders dantrolene. In what circumstances is the drug dantrolene contraindicated?

Spasticity that contributes to upright position, which would be lost if that spasticity were blocked

The nurse is providing patient education for a patient newly prescribed antiseizure medications. What would the nurse be sure to teach the patient that abrupt withdrawal of antiseizure agents may precipitate?

Status epilepticus

The nurse can determine that the client taking uric acid inhibitors is drinking enough fluids when which of the following occurs?

The daily urine output is about two liters.

The physician 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 close supervision is available for monitoring drug effects

A common cause of seizures for a client in late infancy to early childhood is:

fever

Adverse effects of dantrolene (Dantrium) include: -severe anemia. -potentially fatal hepatitis. -incoordination and hypotension. -hypoglycemia and hemolytic anemia.

potentially fatal hepatitis.

The nurse is caring for a 26-year-old woman with partial seizures. The nurse has been prescribed oxcarbazepine (Trileptal) as monotherapy. It will be critical for the nurse to inform the patient that:

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

The seizure type that is characterized by generalized tonic-clonic convulsions lasting for several minutes during which the client does not regain consciousness is known as:

status epilepticus.

A patient is taking ethosuximide (Zarontin) for absence seizures. The client reports GI upset associated with the drug. The nurse will encourage the patient to:

take the drug with food.

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

use another form of birth control, such as condoms.