REVIEW PHRM Chapter 18 Drugs Used for Seizure Disorders

18. The nurse is preparing to administer zonisamide (Zonegran) to a newly admitted patient with the diagnosis of adult partial seizures. The nurse should hold this medication if the patient has which sign(s) or symptom(s)? (Select all that apply.) a. Skin rash b. Urinary frequency c. Drowsiness d. Allergy to Bactrim e. Pruritus

ADE

20. The nurse witnesses a patient with a seizure disorder as he suddenly has spasms of his arms and legs, falling to the floor. He is initially unconscious and is quite groggy as he wakes up. Which type of seizure being demonstrated by this patient will be documented by the nurse? a. Tonic-clonic seizure b. Atonic seizure c. Focal simple motor seizure d. Absence seizure

A

19. A patient on anticonvulsant therapy confides to the nurse at an outpatient clinic that she suspects she may be pregnant. The nurse should encourage the patient to take which action(s)? (Select all that apply.) a. Consult an obstetrician. b. Discontinue medications. c. Carry an identification card. d. Provide a list of seizure medications. e. Consider oral contraception.

ACD

10. What dose is within the acceptable range for administering IV phenytoin (Dilantin) to a patient with a seizure disorder? a. 5 mg/min b. 30 mg/min c. 60 mg/min d. 100 mg/min

B

13. The nurse is providing education to a patient recently prescribed pregabalin (Lyrica). Which statement by the patient indicates a need for further instruction? a. "I may feel tired at first, but this should improve with continued use." b. "Once my pain improves, I will stop taking this medication." c. "Taking sleeping aids will increase the sedative effect of this medication." d. "This drug may affect my mental alertness, so I need to be careful around machinery."

B

8. Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity? a. Oculogyric crisis b. Nystagmus c. Strabismus d. Amblyopia

B

15. What is included in the nursing management of the patient with generalized tonic-clonic seizure activity? (Select all that apply.) a. Restraining the patient's arms to avoid further injury b. Placing padding around or under the patient's head c. Attempting to insert a tongue depressor into the patient's mouth d. Positioning the patient on the side once the relaxation stage is entered to allow oral secretions to drain e. Requesting additional assistance and/or necessary equipment in case the patient does not begin breathing spontaneously when the seizure is over

BDE

11. The nurse is providing discharge teaching to a patient prescribed phenytoin (Dilantin) for management of a seizure disorder. Which patient statement indicates a need for further teaching? a. "I need to avoid or limit caffeine intake." b. "I will check with the pharmacist before taking over-the-counter medication." c. "If I develop enlarged gums, I will stop taking the medication." d. "It is important for me to take my medicine at the same time daily."

C

14. The pediatric nurse is caring for a patient diagnosed with refractory seizures. The physician orders a ketogenic diet. When the child receives his food tray, the nurse should remove any food containing high levels of a. fat. b. salt. c. carbohydrates. d. vitamin K.

C

26. The nurse caring for a patient recently diagnosed with epilepsy remembered that the patient listed sulfa as an allergy. Which antiepileptic would the nurse recognize as being classified as a sulfonamide? a. Valproic acid (Depakene) b. Topiramate (Topamax) c. Zonisamide (Zonegran) d. Levetiracetam (Keppra)

C

12. Which premedication assessment by the nurse is most important prior to the initiation of carbamazepine (Tegretol) therapy? a. Determine patient's ancestry. b. Monitor blood pressure (BP) lying, sitting, and standing. c. Auscultate lung sounds. d. Obtain smoking history.

A

7. Which medication is used to control seizures or prevent migraine headaches? a. Topiramate (Topamax) b. Zonisamide (Zonegran) c. Valproic acid (Depakene) d. Tiagabine (Gabitril)

A

1. Which condition is associated with hydantoin therapy? a. Postictal state b. Atonia c. Seizure threshold reduction d. Gingival hyperplasia

D

3. What is a guideline for the nurse when administering phenytoin (Dilantin) intravenously? a. Deliver rapidly. b. Monitor for signs of tachycardia. c. Assess for hypertensive crisis. d. Administer without mixing with other medications.

D

25. The nurse was monitoring a patient recently started on pregabalin (Lyrica) for peripheral neuropathy for any adverse effects and notified the healthcare provider after the patient made which statement? a. "I keep having blurred vision, especially in the morning." b. "I have not noticed any significant change in my pain." c. "I find myself needing to take a nap after breakfast, I'm so sleepy." d. "I have a better appetite now since I have been started on this drug."

B

9. What information would be most important for the nurse to provide to a patient when teaching about the adverse effects of succinimide therapy? a. Nausea, vomiting, and indigestion are common during the initiation of therapy. b. Avoid taking the medication with food or milk to minimize adverse effects. c. Sedation, drowsiness, and dizziness tend to worsen with continued therapy. d. Reducing the dosage of medication will relieve symptoms of nausea.

A

22. When caring for a patient with epilepsy who was hospitalized and was recovering from a seizure, what are the expected assessments/interventions by the nurse during the postictal time? (Select all that apply.) a. Place oxygen and suction equipment at the bedside. b. Determine whether any bodily harm occurred during the seizure. c. Evaluate the degree of weakness, speech pattern changes, and memory loss. d. Turn the patient on his or her side to allow secretions to drain out of the mouth. e. Encourage oral hygiene and ask the patient to brush his or her teeth.

ABCD

24. From the following medications ordered by the healthcare provider for patients with known seizure disorders, the nurse knows which medications are for the seizures? (Select all that apply.) a. Levetiracetam (Keppra) 500 mg PO b. Carbamazepine (Tegretol) 200 mg PO c. Terbinafine (Lamisil) 250 mg PO d. Gabapentin (Neurontin) 300 mg PO e. Phenytoin (Dilantin) 100 mg PO

ABDE

17. Patients taking phenytoin (Dilantin) for control of seizures must be aware of the risk for which adverse effect(s)? (Select all that apply.) a. Blood dyscrasias b. Hyperglycemia c. Urinary retention d. Gingival hyperplasia e. Insomnia f. Sedation

ABDF

21. An infant is brought to the emergency department with observable twitching of the extremities and a temperature of 104.2°F as reported by his parents. The nurse will take which of the following actions? (Select all that apply.) a. Take the infant's vital signs. b. Leave the infant and mother for a brief time to allow privacy. c. Assess the infant's airway. d. Restrain the infant and swaddle in blankets. e. Protect the infant from injury.

ACE

16. The health care provider orders diazepam (Valium) 10 mg IV stat for a patient who was admitted with status epilepticus. What important nursing interventions(s) associated with administration of this medication IV should the nurse perform? (Select all that apply.) a. Apply a cardiac monitor to the patient to assess for continuous heart rate, if not already done. b. Administer the prescribed dosage over 1 minute. c. Mix diazepam in a primary IV solution to avoid overdosing. d. Continuously assess the patient's airway. e. Obtain the correct dose (10 mg) and administer over slow IV push.

ADE

2. The nurse is preparing discharge instructions for a patient with a history of diabetes who has just been diagnosed with seizure disorder. The patient has been prescribed hydantoin therapy. What will the patient most likely experience? a. Hunger b. Hyperglycemia c. Diarrhea d. Pupil dilation

B

23. The patient asked the nurse what to expect when taking the antiepileptic lamotrigine (Lamictal). What are appropriate responses by the nurse? (Select all that apply.) a. "As soon as you are started on lamotrigine, you can expect a decrease in the frequency of your seizures." b. "You will need frequent laboratory tests to check for the drug level so the dose can be adjusted." c. "Common side effects from this drug are nausea and gastrointestinal upset; this will decrease if you take the drug with food and as your body gets used to it." d. "You may feel drowsy or dizzy at first; these symptoms tend to disappear with continued therapy." e. "The drug dosage will need to be increased over several weeks before we get to the maintenance dose."

CDE

6. Which response by the nurse is accurate when a patient who has been on lamotrigine (Lamictal) for seizure control reports a skin rash and urticaria? a. Reassure the patient that this is a common adverse effect of the medication and not to worry. b. Instruct the patient to discontinue use of the drug immediately. c. Instruct the patient to decrease the dosage of the medication until the rash disappears. d. Advise the patient that this adverse effect usually resolves but should be reported to the health care provider.

D

4. For which condition may carbamazepine (Tegretol) be used? a. Tardive dyskinesia b. Psychotic episodes c. Trigeminal neuralgia pain d. Sedation

C

5. What is the drug of choice when treating a generalized tonic-clonic seizure? a. Diazepam (Valium) b. Haloperidol (Haldol) c. Valproic acid (Depakene) d. Risperidone (Risperdal)

C