Neuro-drugs

The nurse has completed discharge teaching for a client prescribed carbamazepine. Which statement by the client indicates that education about the main effect of the medication was effective?

"This medication has an anticonvulsant effect."

A hospitalized client has a prescription for dextroamphetamine daily. The unit nurse collaborates with the dietitian to limit the amount of which item on the client's dietary trays?

Caffeine

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for side and adverse effects of the medication. Which finding indicates that the client is experiencing an adverse effect?

Impaired voluntary movements

A client with myasthenia gravis has difficulty chewing and has received a prescription for pyridostigmine. The nurse should check to see that the client takes the medication at what time?

30 minutes before meals

A client is having the dosage of clonazepam adjusted. The nurse should plan to perform which action?

Institute seizure precautions. (Rationale:Clonazepam is a benzodiazepine that is used as an anticonvulsant. During initial therapy and during periods of dosage adjustment, the nurse should initiate seizure precautions for the client. Weight, glucose levels, and ecchymosis are unrelated to this medication.)

A client experiencing spasticity as a result of spinal cord injury has a new prescription for dantrolene. Before administering the first dose, the nurse checks to see if which baseline study has been done?

Liver function studies

Dexamethasone intravenously is prescribed for the client with cerebral edema. The nurse prepares the medication for administration and plans to perform which action?

Administer by direct injection

Carbamazepine has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication?

Complete blood cell (CBC) count

A client is scheduled to begin therapy with carbamazepine. The nurse should assess the results of which test(s) before administering the first dose of this medication to the client?

Complete blood cell count

The nurse should question a prescription for which medication in the client concurrently receiving tramadol?

Monoamine oxidase inhibitors (MAOIs)

The nurse is caring for a client in the emergency department who has been diagnosed with Bell's palsy. The client has been taking acetaminophen, and acetaminophen overdose is suspected. Which antidote should the nurse prepare for administration if prescribed?

Acetylcysteine

The nurse is caring for a client diagnosed with bacterial meningitis. Which clinical manifestation should the nurse monitor for, indicating increased intracranial pressure?

Altered mental status

The nurse is assisting in the care of a client who is being evaluated for possible myasthenia gravis. The health care provider gives a test dose of edrophonium. Evaluation of the results indicates that the test is positive. Which would be the expected response noted by the nurse?

An increase in muscle strength within 1 to 3 minutes

The home health nurse visits a client who is taking phenytoin for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan?

There is the potential of decreased effectiveness of birth control pills while taking phenytoin. (Rationale:Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, and 4 are inappropriate instructions. Pregnancy does not need to be "avoided" while taking phenytoin; however, because phenytoin may cause some risk to the fetus (Pregnancy Category D medication), consultation with the health care provider should be done if pregnancy is considered. Telling a client that there is an increased risk of thrombophlebitis is incorrect and inappropriate and could cause anxiety in the client. A client should not be instructed to stop antiseizure medication.)

The nurse is told that the result of a serum carbamazepine level for a client who is receiving the medication for the control of seizures is 13 mcg/mL (55.03 mmol/L). Based on this laboratory result, the nurse anticipates that the health care provider (HCP) will document which prescription?

A decrease of the dosage of the medication

The nurse is administering medications to a client with trigeminal neuralgia. The nurse expects that which medication will be prescribed for pain relief?

Carbamazepine and gabapentin

The nurse is caring for a client with an exacerbation of multiple sclerosis. Which medication(s) will the nurse expect to be prescribed to hasten recovery from the exacerbation?

Methylprednisolone and cyclophosphamide intravenously

A client with a diagnosis of trigeminal neuralgia is started on a regimen of carbamazepine. The nurse provides instructions to the client about the side and adverse effects of the medication. Which client statement indicates an understanding of the side and adverse effects of the medication?

"I will report a fever or sore throat to my health care provider." (Rationale:Agranulocytosis is an adverse effect of carbamazepine and places the client at risk for infection. If a fever or a sore throat develops, the health care provider should be notified. Gum damage, ringing in the ears, and pink-colored urine are not effects associated with this medication.)

A client receiving therapy with carbidopa/levodopa is upset and tells the home health nurse that his urine has turned a darker color since he started taking this medication. The client wants to discontinue its use. In formulating a response to the client's concerns, the nurse interprets that this change is indicative of which condition?

A harmless side effect of the medication

A client is suspected of having myasthenia gravis. Edrophonium is administered intravenously to determine the diagnosis. Which indicates that the client may have myasthenia gravis?

An increase in muscle strength within 30 to 60 seconds following administration of the medication

The health care provider (HCP) writes a prescription for carbamazepine for a client who was admitted to the hospital. The nurse contacts the HCP to verify the prescription if which condition is noted in the assessment data?

Bone marrow depression

A client taking carbamazepine asks the nurse what to do if a dose is inadvertently missed. The nurse responds that which action should be taken?

Take the dose as long as it is not close to the time for the next dose.

The nurse is caring for a client with myasthenia gravis who has received edrophonium by the intravenous route to test for myasthenic crisis. The client asks the nurse how long the improvement in muscle strength will last. Which response should the nurse make to the client?

"It will last for 4 to 5 minutes." (Rationale:Edrophonium commonly is given to test for myasthenic crisis. If the client is in myasthenic crisis, muscle strength improves after administration of the medication. Within 30 to 60 seconds, most myasthenic clients show a marked improvement in muscle tone that lasts for 4 to 5 minutes.)

The nurse teaches the wife of a client who is receiving levodopa/carbidopa to avoid pyridoxine medications. Which statement by the wife indicates an understanding of the instructions?

"Vitamin B6 reverses the effectiveness of the medication, meaning a higher dose is needed."

A client is experiencing impotence after taking guanfacine. The client states, "I would sooner have a stroke than keep living with the effects of this medication." What is the most appropriate response by the nurse?

"You are concerned about the effects of your medication."

The nurse is observing a new nursing graduate who is preparing an intermittent intravenous (IV) infusion of phenytoin for a client with a diagnosis of seizures. Which solution used by the nursing graduate should indicate to the nurse an understanding of proper preparation of this medication?

0.9% sodium chloride (Rationale:Intermittent IV infusion of phenytoin is administered by injection into a large vein, using normal saline solution. Dextrose solutions are avoided because the medication will precipitate in these solutions. Therefore, the options containing dextrose identify incorrect solutions for IV administration with this medication. In addition, lactated Ringer's solution contains electrolytes that can interfere with phenytoin administration)

A client with myasthenia gravis has become increasingly weaker. The health care provider prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or an increasing severity of the disease (myasthenic crisis). An injection of edrophonium is administered. Which finding would indicate that the client is in cholinergic crisis?

A temporary worsening of the condition (Rationale:An edrophonium injection makes the client in cholinergic crisis temporarily worse. An improvement in the weakness indicates myasthenia crisis. Muscle spasms are not associated with this test.)

A client with trigeminal neuralgia tells the nurse that acetaminophen is taken daily for the relief of generalized discomfort. Which laboratory value would indicate toxicity associated with the medication?

Direct bilirubin level of 2 mg/dL (34 mcmol/L)

A client who is taking phenytoin for a seizure disorder is being admitted to the hospital because of an increase in seizure activity. The client reports severe vomiting for the last 24 hours and an inability to take phenytoin during that time. The nurse anticipates that the health care provider will most likely prescribe which medication?

Fosphenytoin sodium

A client has a prescription for valproic acid. To maximize the client's safety, the nurse should plan to monitor for which potential complications of this medication? Select all that apply.

Pancreatitis Hepatotoxicity (Rationale:Valproic acid is an anticonvulsant that causes central nervous system depression. Although rare, this medication has caused pancreatitis and hepatoxicity. The nurse should monitor for these complications. The other complications noted in the options are not specifically associated with this medication.)

The nurse is caring for a client receiving mannitol via intravenous (IV) infusion. A vial is sent from the pharmacy, and in preparing the medication the nurse notes that the vial contains crystals. What is the most appropriate nursing action?

Place the vial in warm water. (Rationale:Crystals form in a mannitol solution if the solution is cooled, but they will quickly dissolve if the container is placed in warm water and then cooled to body temperature before administration. However, if crystals remain after the warming procedure, the medication should not be used and should be returned to the pharmacy. The nurse would not discard the medication. The medication is not initially returned to the pharmacy because it is not defective. Shaking the vial should not be done and will not dissolve the crystals.)

A client is taking the prescribed dose of phenytoin to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL (140 mcmol/L). Which finding would be expected as a result of this laboratory result?

Slurred speech

A client has been prescribed dextroamphetamine. The client complains to the nurse that the client cannot sleep well at night and does not want to take the medication any longer. Before making any specific comment, the nurse plans to investigate whether the client takes the medication at which proper time schedule?

At least 6 hours before bedtime

The nurse is assisting in the care of a client with myasthenia gravis who is receiving pyridostigmine. Which medication should the nurse plan to have readily available should the client develop cholinergic crisis because of excessive medication dosage?

Atropine sulfate

A client is receiving phenytoin. To monitor for side and adverse effects of this medication, the nurse assesses the results of which laboratory test?

Complete blood count (CBC) (Rationale:Phenytoin is an anticonvulsant used to treat seizure disorders. The nurse monitors the CBC because hematological effects of this therapy include aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia. Other test results that warrant monitoring include serum calcium levels, urinalysis, and hepatic and thyroid function tests. Electrolyte results and renal function tests are not a concern with this medication)

A client has been prescribed codeine sulfate. The nurse has given the client instructions for its use. The nurse concludes that the client understands the instructions if the client verbalizes to self-assess for which side effect?

Constipation

A client is taking benztropine mesylate orally daily. In monitoring this client for medication side effects, the nurse should plan to focus the assessment on which item?

Voiding pattern

On admission the client tells the nurse that sumatriptan is prescribed. Based on this information, which question should the nurse ask the client?

"Have you had migraine headaches?"

Benztropine mesylate is prescribed for a client. What statement by the client indicates that the client needs further teaching about the medication?

"I will sit in the sun for an hour a day to enhance medication effectiveness."

Phenytoin 100 mg to be given orally 3 times daily has been prescribed to a client. The home health nurse visits the client and provides instructions regarding the medication. Which statement, if made by the client, would indicate an understanding of the instructions?

"I will use a soft toothbrush to brush my teeth."

The nurse is providing instructions to an adolescent prescribed phenytoin for the control of seizures. Which statement by the adolescent indicates a need for further teaching regarding the medication?

"If my gums become sore and swollen, I need to stop the medication."

A client with status epilepticus has been prescribed phenytoin to be given by the intravenous (IV) route. The nurse administering the medication is careful not to exceed which recommended infusion rate?

50 mg/min

A client is taking clorazepate. The client asks the nurse if there is a risk of addiction with this medication. Which information should the nurse provide?

It leads to physical and psychological dependence with prolonged high-dose therapy.

The nurse is providing instructions to a client beginning medication therapy with divalproex sodium for treatment of absence seizures. The nurse instructs the client that which represents the most frequent side or adverse effect of this medication?

Nausea and vomiting

The nurse is preparing an intravenous (IV) infusion of phenytoin as prescribed by the health care provider for the client with seizures. Which solution should the nurse plan to use to dilute this medication?

Normal saline solution

The nurse is preparing to ambulate a client with Parkinson's disease who has recently been started on levodopa/carbidopa. Before performing this activity with the client, the nurse should include which most important assessment in the client's plan of care?

Postural (orthostatic) vital signs

A client has received a dose of dimenhydrinate. The nurse evaluates the effect of the medication by noting whether the client obtained relief from what symptom?

Nausea and vomiting

After review of the client's laboratory values, the nurse notes that a phenytoin level for a client receiving phenytoin is 7 mcg/mL (27.78 mmol/L). The nurse makes which interpretation regarding this laboratory result?

The level is lower than the expected therapeutic range.

A home care nurse visits a client at home. Clonazepam has been prescribed for the client, and the nurse teaches the client about the medication. Which client statement indicates that further teaching is necessary?

"If I experience slurred speech, this problem will disappear in about 8 weeks."

The nurse in the health care provider's office is reviewing the results of a client's phenytoin level determination performed that morning. The nurse identifies that a therapeutic medication level has been achieved if which result is noted?

15 mcg/mL (59.52 mmol/L)

A client began taking amantadine approximately 2 weeks ago. The client reports to the clinic for a follow-up evaluation. The nurse determines that the client is experiencing a side or adverse effect related to the use of this medication if which is noted?

Client complaints of urinary retention

A client has been prescribed cyclobenzaprine for the treatment of painful muscle spasms accompanying a herniated intervertebral disk. The nurse should withhold the medication and question the prescription if the client has a concurrent prescription for which medication?

Tranylcypromine (Rationale:The client should not receive cyclobenzaprine if the client has taken monoamine oxidase inhibitors such as tranylcypromine or phenelzine within the last 14 days. Otherwise, the client could experience hyperpyretic crisis, seizures, and possibly death. The medications in the remaining options are not contraindicated.)

The nurse in a long-term care facility is reviewing the health care provider's (HCP's) prescriptions on an assigned client. The nurse notes that the HCP prescribed ropinirole hydrochloride. The nurse determines that this medication has been prescribed to treat which condition in the client?

Parkinsonian syndrome

The client with a head injury is experiencing signs of increased intracranial pressure (ICP), and mannitol is prescribed. The nurse administering this medication expects which as intended effects of this medication? Select all that apply.

Reduced ICP Increased diuresis Increased osmotic pressure of glomerular filtrate Reduced tubular reabsorption of water and solutes

A client with trigeminal neuralgia is being treated with carbamazepine, 400 mg orally daily. Which value indicates that the client is experiencing an adverse effect to the medication?

White blood cell count, 3000 mm3 (3.0 × 109/L)

A client with myasthenia gravis who is taking neostigmine is experiencing frequent exacerbations of myasthenic crisis and cholinergic crisis. The nurse teaches the client that it is most important that this medication be taken in which manner?

On time (Rationale:The client should take neostigmine exactly on time. Taking the medication early or late could result in myasthenic or cholinergic crisis. Taking the medication on time is especially important for the client with dysphagia because the client may not be able to swallow the medication if it is given late. These clients are taught to set an alarm clock to remind them of dosage times. The medication should be administered with food or milk to minimize side and adverse effects. The client should never skip or double up on missed doses or titrate the dose, depending on symptoms. The client needs to take the medication exactly as prescribed.)

The nurse has given medication instructions to a client beginning carbamazepine. The nurse determines that the client understands the use of the medication if he makes which statement?

"I will use sunscreen when outdoors." (Rationale:Carbamazepine is an anticonvulsant. The client should use protective clothing and sunscreen to avoid photosensitivity reactions. Carbamazepine acts by depressing synaptic transmission in the central nervous system (CNS). Because of this, the client should avoid driving at any time or doing other activities that require mental alertness until the effect of the medication on the client is known. The medication may cause dry mouth, and the client should be instructed to provide good oral hygiene and use sugarless candy or gum as needed. The medication should not be abruptly discontinued because this could lead to return of seizures or status epilepticus. Fever and sore throat (leukopenia) should be reported to the health care provider.)

The nurse has given medication instructions to a client receiving phenytoin. Which statement indicates that the client has an adequate understanding of the instructions?

"Good oral hygiene is needed, including brushing and flossing."

A client has been started on zolpidem. After instructing the client in how to obtain the maximal effect of zolpidem, the nurse determines that the client demonstrates understanding of correct administration of the medication by which statement?

"I need to swallow the medication whole with a full glass of water."

The nurse is collecting data from a client and notes that the client is taking carbamazepine. The nurse determines that this medication has been prescribed to treat which condition?

Trigeminal neuralgia

A client with Parkinson's disease has begun therapy with levodopa/carbidopa. The nurse determines that the client understands the action of the medication if he or she verbalizes that results may not be apparent for how long?

2 to 3 weeks

A client is receiving phenobarbital sodium. Which finding on the nursing assessment would indicate that the client is experiencing a common side or adverse effect of this medication?

Drowsiness

The nurse preparing to administer carbamazepine notices a number of items on the client's breakfast tray. Which item should be a cause for concern and should be removed from the tray?

Grapefruit juice

The nurse has a prescription to give dexamethasone by the intravenous (IV) route to a client with cerebral edema. How should the nurse prepare this medication?

Preparing an undiluted direct injection of the medication

The nurse is caring for a client with chronic back pain. Codeine has been prescribed for the client. Specific to this medication, which intervention should the nurse include in the plan of care while the client is taking this medication?

Monitor bowel activity.

The nurse has a prescription to administer phenytoin 100 mg mixed in 5% dextrose in water by the intravenous (IV) route to a client. After reading this prescription, which action should the nurse take?

Contact the health care provider (HCP) to question the prescription.

A client with vascular headaches is taking ergotamine. The home health nurse should periodically assess him or her for which finding?

Cool, numb fingers and toes

A client is taking trihexyphenidyl hydrochloride. The nurse should assess for which side or adverse effect of this medication?

Urinary retention

The nurse has a prescription to administer diazepam 5 mg by the intravenous (IV) route to a client. The nurse should administer the medication over a period of at least how long?

1 minute