NUR 316 | Chapter #23: Antiseizure Agents PrepU
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
A 15-year-old male client receiving phenytoin for treatment of epilepsy is being discharged from the hospital. What statement by Richard's mother leads you to believe she has understood your teaching related to his care and drug administration?
"I will make sure he has routine visits to the dentist."
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."
During an in-service, the charge nurse explains to the licensed vocational nurse (LVN) that there are six categories of anticonvulsants with different mechanisms of action. The LVN demonstrates understanding of the action of the miscellaneous drug, gabapentin, by stating which of the following?
"This drug is a gamma-aminobutyric acid (GABA) agonist."
A client who is receiving phenytoin has a serum drug level drawn. Which result would the nurse interpret as within the therapeutic range?
12 mcg/mL
The nurse has just begun administering phenobarbital intravenously to a child within status epilepticus. The nurse would expect this drug to begin working within which time frame?
5 minutes
In a person taking medications for a diagnosed seizure disorder, the most common cause of status epilepticus is:
Abruptly stopping the antiseizure medications.
A male client has been taking phenytoin (Dilantin) for the past 6 months for epileptic seizures. His Dilantin levels routinely fall within the therapeutic range. He contacts the physician's office reporting nausea, headache, and diarrhea. What would be the most appropriate intervention based on the assessment of the client's symptoms and laboratory results?
Advise the client to have his blood redrawn today to ensure that he is not at a toxic level.
A nurse is caring for a patient who is going to take ethosuximide (Zarontin). During the nurse's initial assessment, the nurse learns that the patient's history includes hepatitis. Which laboratory test should be done before therapy is started?
Alanine aminotransferase (ALT)
A nurse should monitor a client closely for increased CNS depressant effects when an anticonvulsant is used concomitantly with which substances? (Select all that apply.)
Analgesics Alcohol
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?
Anticipate a reduction is dosage
A female patient who takes ethosuximide for the treatment of absence seizures calls the clinic to report that she has developed a sore throat and a slight fever. The nurse will explain that she should come to the clinic to have what checked?
Blood cell count
A nurse is treating a patient who is receiving carbamazepine for a seizure disorder. The nurse knows that carbamazepine is contraindicated in patients with which diseases or disorders?
Bone marrow depression
The nurse is documenting the history of a patient who is to be initiated in carbamazepine therapy. In which condition is carbamazepine contraindicated?
Bone marrow depression
While administering phenytoin, the nurse should observe the client for symptoms of which adverse reaction?
Bradycardia
A patient with cortical focal seizures has been prescribed phenobarbital. What adverse reaction should the nurse monitor for in the patient?
CNS depression
A client comes to the clinic for a follow-up visit. The client is prescribed lamotrigine for seizure control. The nurse suspects that the client may be experiencing Stevens-Johnson syndrome based on which of the following? Select all that apply.
Complaints of muscle pain Lesions on the mucous membranes Blisters on the face and neck
Which would be most important to monitor in a client receiving ethosuximide?
Complete blood count
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 is prescribed lamotrigine (Lamictal) for control of partial seizures. What is the most important medication teaching information the nurse should emphasize from the plan of care?
Contact the health care provider immediately if rash appears.
The nurse is caring for a 15-year-old male who was involved in a motor vehicle accident and, as a result, sustained a closed head injury. The physician ordered phenytoin prophylactically to prevent seizures. The nurse understands that phenytoin works by what mechanism?
Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus
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
For a client with a known heart block (conduction disorder), what medication is contraindicated?
Dilantin
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?
Document the fact that the nurse checked the client's phenytoin levels
A client has been prescribed carbamazepine for the prevention of seizures. What action should the nurse perform?
Educate the client about the need to take the pills as scheduled
A child has been presented for care because he has episodes where he pauses what he is doing for a few seconds, is unresponsive, and then continues on with his activity. The nurse should anticipate the administration of what medication?
Ethosuximide
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?
Ethosuximide
A child suffers from absence seizures. What is the drug of choice for absence seizures?
Ethosuximide (Zarontin)
The nurse instructs the parent of a young school-age child with a seizure disorder who takes an AED to be alert for what signs and symptoms?
Excessive sedation and interference with learning and social development
The nurse is caring for an 84-year-old client who is taking an AED and recognizes that this client is at increased risk for which condition?
Falls
A common cause of seizures for a client in late infancy to early childhood is:
Fever
Which type of seizures involves a loss of consciousness?
Generalized seizures
A client is receiving a hydantoin as treatment for tonic-clonic seizures. The nurse includes a discussion of what when teaching the client about this drug?
Gingival hyperplasia
Phenobarbital is ordered for a child with status epilepticus. The nurse would anticipate administering this drug by which route?
IV
What best reflects the action of barbiturates when used to control seizures?
Inhibition of impulse conduction
When describing the action of zonisamide, which would the nurse include?
Inhibition of sodium and calcium channels
A physician recently ordered a change in medication for a patient with a seizure disorder. Which action would the nurse take in evaluating the new drug's control of the seizure disorder?
Interview and observe for adverse effects
A patient with impaired liver function is suffering from a seizure disorder, which is noted to consist of partial seizures. Which medication is administered to a patient with impaired liver function?
Levetiracetam (Keppra)
A client has been prescribed valproic acid for the treatment of myoclonic seizures. When reviewing this client's latest laboratory results for signs of adverse effects, what results should the nurse prioritize?
Liver enzymes
What should the nurse include as a possible adverse effect when teaching a client about phenytoin?
Liver toxicity
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 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 prescribed methsuximide. The nurse should expect to administer this drug by which route?
Oral
A client is to receive ethotoin. The nurse would expect to administer this drug by which route?
Oral
A patient has been diagnosed with a brain tumor, which has caused partial seizure activity. The patient is being treated with the newest antiepileptic medication. Which medication is administered as monotherapy to diminish or eliminate seizures?
Oxcarbazepine (Trileptal)
Simple seizures, motor seizures, and somatosensory seizures are classified as what type of seizure?
Partial seizures
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
Which anticonvulsant elicits its effects by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain?
Phenytoin (Dilantin)
Which anticonvulsants exert their effect by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain? (Select all that apply.)
Phenytoin (Dilantin) Ethotoin (Peganone)
The nurse is reviewing the medical record of a client with partial seizures who is prescribed drug therapy. The nurse would question the order for what if the nurse finds that the client has a history of alcohol abuse?
Pregabalin
A 15-year-old is observed having a tonic-clonic seizure at school. Which behavior would allow the school nurse to recognize the clonic phase of the seizure?
Rapid rhythmic and symmetric jerking movements
A client is receiving lamotrigine as treatment for partial seizures. Which assessment finding would lead the nurse to stop the drug immediately?
Rash
The nurse has taught a client who is receiving lamotrigine about possible adverse effects. The nurse determines that the client has understood the teaching when the client identifies a need to promptly report what adverse effect?
Rash
Dilantin has several side effects. When teaching the patient about these side effects, which symptom would indicate a life-threatening condition and should be reported to the health care provider immediately?
Rash with itching
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
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 FDA has issued a BLACK BOX WARNING for clients taking lamotrigine (Lamictal), instructing them to discontinue the medication immediately if they develop:
Skin rashes
A patient is prescribed daily doses of phenytoin for seizures. The nurse knows that a single dose should not be missed during the course of treatment. Which condition could result if a dose is missed?
Status epilepticus
The nurse is planning patient education for a patient on antiseizure medications. The nurse should inform the patient that abrupt withdrawal from the medications can precipitate which problem?
Status epilepticus
A patient with partial seizures has been prescribed succinimides at a health care facility. The patient experiences GI upset after succinimides administration. What should the nurse instruct the patient to do?
Take the drug with food or milk
A client reports gastrointestinal (GI) upset when taking phenytoin (Dilantin). The nurse should tell the client to:
Take the medication with meals.
A client is prescribed topiramate. The nurse cautions the client to avoid the intake of alcohol for which reason?
The client is at risk for increased CNS depression.
A client has been admitted to the health care facility with myoclonic seizures. Once stabilized, the nurse should anticipate that the client will be prescribed what medication?
Valproic acid
Which drug would the nurse expect to be ordered as the drug of choice for the treatment for myoclonic seizures?
Valproic acid
Which anticonvulsant elicits its effects by increasing levels of gamma-aminobutyric acid (GABA), which stabilizes cell membranes?
Valproic acid (Depakote)
A client is experiencing absence seizures and has been prescribed a succinide. What prescription is most likely?
Zarontin
While speaking with a client, the nurse notes that the client stares off, unblinking. The nurse notes that after several prompts, the client blinks rapidly and then resumes normal conversation. The type of seizure demonstrated by this client is a(n):
absence seizure.
A patient has a history of tonic-clonic seizures that have been successfully treated with phenytoin (Dilantin) for several years. Phenytoin achieves a therapeutic effect by:
decreasing the influx of sodium into neurons.
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.
