Ch 53: Drug Therapy for Seizure Disorders and Spasticity

c) 2.75 mL Pg. 1067 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.

1. 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? a) 6.87 mL b) 6.05 mL c) 2.75 mL d) 2.5 mL

b) "Are you on hormone replacement therapy?" Pg. 1070 The combination of dantrolene and estrogen creates an unacceptable risk for hepatotoxicity. For this reason, concurrent use of dantrolene and hormone therapy would be unsafe. The age at which the client began menopause and any history of fibromyalgia or hysterectomy would be much less relevant to the safety and effectiveness of dantrolene.

10. The nurse is caring for a 59 year-old female client who was diagnosed with multiple sclerosis two years ago. In recent weeks, the client has developed increasing muscle spasticity and the care team is considering the use of dantrolene. What assessment question should the nurse prioritize? a) "At what age did you begin menopause?" b) "Are you on hormone replacement therapy?" c) "Have you ever been treated for fibromyalgia?" d) "Have you had a hysterectomy?"

a) When close supervision is available for monitoring drug effects Pg. 1067 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 required.

11. 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? a) When close supervision is available for monitoring drug effects b) When the spasms cause uncontrolled pain c) When the client needs to be alert during pain management d) During school hours to increase alertness and management of spasms

a) Reduce the dose Pg. 1069 The skeletal muscle relaxants should be used cautiously in clients with renal impairment. Dosage of baclofen must be reduced.

12. 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? a) Reduce the dose b) Titer the dose c) Increase the dose d) Maintain the current dose

b) Risk for injury related to CNS depression Pg. 1071 The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The drug is not noted to impact the patient's ability to swallow, cough, or function sexually.

13. A 29-year-old client who experienced a lower back injury 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 client's drug regimen? a) Risk for sexual dysfunction related to endocrine changes b) Risk for injury related to CNS depression c) Risk for ineffective airway clearance related to increased secretions and decreased lung function d) Risk for impaired swallowing related to adverse neuromuscular effects

b) "Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply" Pg. 1069 Abrupt discontinuation of baclofen should be avoided, as it may result in severe side effects such as confusion, seizures, exacerbations of severe spasticity, hallucinations, and other psychiatric disorders. Baclofen is not available over the counter and is prescribed on a scheduled basis, rather than in response to acute symptoms. It is not necessary to stop taking other drugs prior to or during treatment with baclofen.

14. 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? a) "Even though baclofen is a drug that's available over the counter, it still has the potential to cause serious adverse effects if taken incorrectly" b) "Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply" c) "You'll likely have to stop taking your other medications for a week to ten days before starting to take baclofen" d) "It's best to avoid taking a dose of baclofen unless your spasticity becomes impossible to manage"

d) Safety, mobility, and activities of daily living are impaired Pg. 1038 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.

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

a) Ethosuximide Pg. 1053 Ethosuximide is most frequently used to treat absence seizures. Mephobarbital, ethotoin, and primidone are typically used for tonic-clonic seizures.

16. 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? a) Ethosuximide b) Primidone c) Ethotoin d) Mephobarbital

d) Dantrolene Pg. 1066 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.

17. While most muscle relaxants drugs are central nervous system (CNS) depressants, which medication acts only on the muscle? a) Tizanidine b) Carisoprodol c) Metaxalone d) Dantrolene

c) Rotate sites when administering the injections Pg. The nurse should teach the client about rotating subcutaneous injection sites. The deltoid is a muscle, not a subcutaneous injection site. Pulling the skin to the side describes the Z-track method used with intramuscular injections. Aspirating is not recommended with subcutaneous injections.

18. A client has been prescribed a subcutaneous medication to treat rheumatoid arthritis (RA). The nurse should teach the client to do which? a) Pull the skin to the side when injecting to prevent skin irritation b) Aspirate the syringe before injecting the medication c) Rotate sites when administering the injections d) Pinch the skin over the deltoid before injection

d) Use another form of birth control, such as condoms Pg. 1060 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.

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

b) Risk for falls Pg. 1058 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.

2. 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? a) Risk for impaired gas exchange b) Risk for falls c) Risk for altered urinary elimination d) Risk for impaired skin integrity

c) Cyclobenzaprine produces an anticholinergic response Pg. 1071 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.

20. 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? a) Cyclobenzaprine is structurally similar to amitriptyline b) Cyclobenzaprine acts in the peripheral nervous system c) Cyclobenzaprine produces an anticholinergic response d) Cyclobenzaprine has an effect at the neuromuscular junction

b) "Make sure you don't stop taking this abruptly because that might bring on a seizure" Pg. 1045 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.

21. 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? a) "We will need to monitor your blood sugar quite closely while you're taking this drug" b) "Make sure you don't stop taking this abruptly because that might bring on a seizure" c) "You might find that you'll feel somewhat agitated for the first few days that you take this drug" d) "You'll have to come to the hospital's outpatient clinic twice a week to have this administered intravenously"

200 mL/hr Pg. 1042 The dose and the child's weight are not necessary for determining the rate of administration. The rate is calculated by volume alone: 50 mL over 15 minutes is equivalent to 200 mL over 60 minutes (using proportions, 15 minutes X 4 = 60 minutes; 50 ml X 4 = 200 mL).

22. A child in status epilepticus has been prescribed phenobarbital 15 mg/kg IV to be administered over 15 minutes. The child weighs 24 kg and the drug is added to a 50 mL minibag. At what rate, in mL/hour, should the nurse administer the drug?

d) Tell the client to take no further doses and come be assessed at the clinic immediately Pg. 1061 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.

23. 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? a) Rule out any shortness of breath and inform the client that this adverse effect will resolve with time b) Recommend that the client take 50 mg diphenhydramine PO and check back tomorrow c) Tell the client to take the medication with a high-fat food to minimize adverse effects d) Tell the client to take no further doses and come be assessed at the clinic immediately

d) 2 mcg/mL Pg. 1051 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.

24. 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? a) 8 mcg/mL b) 4 mcg/mL c) 6 mcg/mL d) 2 mcg/mL

a) Depression of motor nerve output Pg. 1040 The barbiturates and barbiturate-like drugs depress motor nerve output, inhibit impulse conduction in the ascending reticular activating system (RAS), depress the cerebral cortex, and alter cerebellar function. They stabilize nerve membranes throughout the CNS directly by influencing ionic channels in the cell membrane, thereby decreasing excitability and hyperexcitability to stimulation.

25. When describing the action of barbiturates and barbiturate-like agents in the control of seizures, what would the nurse include? a) Depression of motor nerve output b) Stimulation of the cerebral cortex c) Maintenance of cerebellar function d) Promotion of impulse conduction

b) Malignant hyperthermia Pg. 1070 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.

26. 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? a) Myocardial ischemia b) Malignant hyperthermia c) Uncontrolled hypertension d) Cerebrovascular accident

a) Liver function tests Pg. 1069 Baclofen is metabolized in the liver and excreted in urine. The client must be monitored for adverse effects on liver function.

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

c) Observe respirations frequently Pg. 1042 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.

28. 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? a) Monitor body temperature b) Record fluid input and output c) Observe respirations frequently d) Monitor blood glucose levels

c) Contact the health care provider immediately if rash appears Pg. 1061 GI upset, headache, rash, and dizziness are all adverse reactions of lamotrigine. The most important teaching point to emphasize is to notify the health care provider if a rash appears. A rash can develop into a Stevens-Johnson syndrome rash, a severe and potentially fatal rash.

29. 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? a) Take this medication with food to prevent nausea and vomiting b) A mild headache may occur while taking this medication c) Contact the health care provider immediately if rash appears d) Seek assistance when walking if dizziness occurs

a) "They are considered teratogenic" Pg. 1059 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.

3. 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? a) "They are considered teratogenic" b) "They may interfere with conception" c) "They are contraindicated during the third trimester" d) "They are safe during pregnancy"

c) Review the client's laboratory blood work Pg. 1049 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.

30. 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? a) Monitor the client for seizure activity b) Assess the client's cognitive status c) Review the client's laboratory blood work d) Assess the client carefully for adverse effects

b) Hepatic dysfunction Pg. 1070 Dantrolene therapy must be discontinued at any sign of liver dysfunction. Intermittent GI upset, visual disturbances, and urinary retention are associated adverse effects of the drug and, although problematic, do not necessitate discontinuing the drug.

31. Signs and symptoms of what would necessitate discontinuation of dantrolene therapy? a) Urinary retention b) Hepatic dysfunction c) Intermittent gastrointestinal upset d) Visual disturbances

d) When prescribing an AED, the health care provider takes into account the type of seizure the client is having Pg. 1039 Type of seizure is a major factor in drug selection. Age and gender are not factors that impact the choice of AED.

32. 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? a) Different drugs work differently in different people b) When prescribing an AED, the health care provider takes into account the age and gender of the client c) Different drugs are more effective in certain people than other drugs are d) When prescribing an AED, the health care provider takes into account the type of seizure the client is having

d) Activated charcoal Pg. 1060 There are no specific antidotes for antiseizure drugs, and treatment for overdose is symptomatic and supportive. Gastric lavage and activated charcoal may be indicated to prevent absorption of additional drug.

33. 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? a) Flumazenil b) Phenobarbital c) Lorazepam d) Activated charcoal

c) Decreasing the absorption of the AED Pg. 1050 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.

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

c) Age d) Type of epilepsy e) Culture and ethnicity Pg. 1038 The drug of choice for any given situation depends on the type of epilepsy, client age, specific client characteristics such as cultural variations, and client tolerance for associated adverse effects as opposed to preferred adverse effect. Gender and cognition do not play a role in determining drug of choice.

35. The nurse is working with the interdisciplinary team to plan the care of a client newly diagnosed with epilepsy. What factors should the team consider when determining the drug of choice for the client? Select all that apply. a) Gender b) Cognitive status c) Age d) Type of epilepsy e) Culture and ethnicity

c) Implement falls precautions Pg. 1071 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.

36. 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? a) Maintain the client on bed rest b) Make a referral to occupational therapy c) Implement falls precautions d) Monitor vital signs hourly while the client is awake

d) Rash Pg. 1061 Lamotrigine has been associated with very serious to life-threatening rashes, and the drug should be discontinued at the first sign of any rash. Somnolence and confusion are typical CNS effects; anorexia is a common gastrointestinal effect.

37. A client is receiving lamotrigine as treatment for partial seizures. Which assessment finding would lead the nurse to stop the drug immediately? a) Somnolence b) Confusion c) Anorexia d) Rash

c) Carbamazepine Pg. 1045 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.

38. 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? a) Felbamate b) Gabapentin c) Carbamazepine d) Clorazepate

b) Abruptly stopping the antiseizure medications Pg. 1039 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).

39. In a person being treated for a diagnosed seizure disorder, what is the most common cause of status epilepticus? a) Experiencing a brain injury b) Abruptly stopping the antiseizure medications c) Hypoxia-inducing experience c) Abusing drugs and/or alcohol

b) Avoid drinking alcohol for the duration of treatment Pg. 1069 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.

4. 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: a) Increase fluid intake and self-monitor for decreased urine output b) Avoid drinking alcohol for the duration of treatment c) Increase intake of foods that are high in potassium d) Avoid eating grapefruit or drinking grapefruit juice until treatment is discontinued

b) Drowsiness Pg. 1066 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.

40. 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? a) Hypertension b) Drowsiness c) Tachycardia d) Dyspnea

c) Monitoring the client's liver enzyme levels Pg. 1060 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.

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

b) Nerve damage in the brain and spinal cord, and it is a permanent condition Pg. 1038 Spasticity is caused by nerve damage in the brain and spinal cord. It is a permanent condition that may be painful and disabling.

42. A client with multiple sclerosis asks the nurse to explain why deep tissue massages do not relieve spasticity. The nurse should explain that spasticity is caused by: a) Inflammation of the muscles; therefore, NSAIDs may be effective b) Nerve damage in the brain and spinal cord, and it is a permanent condition c) Skeletal muscle trauma and will improve in time d) Stimulation of "association areas" in the brain; therefore, only nerve blocks will be effective

c) Inspection for muscle spasticity and range of motion assessment Pg. 1069 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.

43. 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? a) Assessment for seizure activity b) Bilateral assessment of muscle strength c) Inspection for muscle spasticity and range of motion assessment d) Comparison of fine motor and gross motor skills

c) Anticipate a reduction in dosage Pg. 1051 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.

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

a) Document the fact that the nurse checked the client's phenytoin levels Pg. 1049 The therapeutic range is 10 to 20 mcg/mL. Consequently, there is no action needed beyond documentation.

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

a) Dantrolene Pg. 1070 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.

46. 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: a) Dantrolene b) Metaxalone c) Orphenadrine d) Chlorzoxazone

b) The client has respiratory depression from opioid analgesia Pg. 1070 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.

47. 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? a) The client received a blood transfusion less than 24 hours ago b) The client has respiratory depression from opioid analgesia c) The client is 67 years old d) The client has an infected surgical wound

a) Document the skin assessment d) Notify the primary care provider immediately e) Assess vital signs Pg. 1061 The nurse observes that the client is exhibiting a severe hypersensitivity rash that is potentially fatal, called Stevens-Johnsons Syndrome, and must notify the health care provider (HCP) immediately, and hold the dose of lamotrigine awaiting orders from the PCP. The nurse should assess vital signs for signs and symptoms of infection, which may occur from bacteria entering large areas of compromised skin. The nurse should document the skin assessment and the actions taken, including holding the drug and calling the primary care provider immediately. The nurse should not cleanse the skin with soap and water because the soap will dry out the skin leading to further breakdown.

48. 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. a) Document the skin assessment b) Cleanse affected areas with soap and water c) Administer the dose of lamotrigine d) Notify the primary care provider immediately e) Assess vital signs

a) "Try taking your pills at the same time as you eat some food" Pg. 1058 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.

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

a) Notify the healthcare provider Pg. 1050 A rash while taking allopurinol should be reported to the healthcare provider, because it may precede a serious adverse reaction known as Stevens-Johnson syndrome. Applying a lotion may relieve itching, but notifying the healthcare provider is top priority as a safety precaution. Trimming the fingernails can help prevent further skin damage from scratching, but the healthcare provider needs to be notified as well.

6. A client is taking allopurinol for gout. The client exhibits an "itchy" skin rash on the neck and both arms. What is the nurse's top priority action? a) Notify the healthcare provider b) Document the finding as a common side effect c) Recommend the client trim fingernails d) Apply a moisturizing lotion

b) "It's safest if you avoid drinking alcohol while you're taking this drug" Pg. 1052 Use of alcohol during treatment with carbamazepine is contraindicated due to the potential for CNS depression. Carbamazepine is taken on an ongoing basis to prevent partial seizures; it is not a treatment for impending seizure activity. It is administered orally, not by injection, and it does not necessitate significant dietary changes.

7. 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? a) "I'll be showing you how to safely self-inject this drug" b) "It's safest if you avoid drinking alcohol while you're taking this drug" c) "I'll explain the foods that you should avoid while you're taking this drug" d) "It's important to take a dose as soon as possible if you feel a seizure is coming"

b) Fever Pg. 1039 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.

8. What is a common risk for epileptic seizures during late infancy to early childhood? a) Medication overdose b) Fever c) Malnutrition d) Learning disability

a) Protect the client's safety Pg. 1073 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.

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