Pharm 2 test 2 (CH 18)
An intravenous (IV) bolus of phenytoin (Dilantin) is administered with the patient under electrocardiographic (ECG) monitoring because of the risk of which occurrence?
Bradycardia
A patient taking phenytoin (Dilantin) and isoniazid reports feeling lethargic. Nystagmus is noted on physical examination. What problem does this information suggest to the nurse?
Phenytoin toxicity
Which antiepileptic drug is effective for almost all forms of seizures?
Valproic acid (Depakene)
Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity? a. Oculogyric crisis b. Nystagmus c. Strabismus d. Amblyopia
ANS: B
A patient has been started on lamotrigine (Lamictal). How does the nurse instruct this patient to take the medication to decrease the incidence of gastric irritation?
With milk or food
In which patient is carbamazepine (Tegretol) contraindicated?
Patient with chronic hepatitis B
The patient asked the nurse what to expect when taking the antiepileptic lamotrigine (Lamictal). The nurse should respond: (Select all that apply.) 1. "Once you are started on lamotrigine, you can expect a decrease in the frequency of your seizures." 2. "You will need frequent laboratory tests to check for the drug level so the dose can be adjusted." 3. "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." 4. "You may feel drowsy or dizzy at first; these symptoms tend to disappear with continued therapy." 5. "The drug dosage will need to be increased over several weeks before we get to the maintenance dose."
ANS: 1, 3, 4, 5
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
ANS: A, B, D, F
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.
ANS: A, C, D
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
ANS: A, D, E
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
ANS: B
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.
ANS: B
What is included in the nursing management of the patient with generalized tonic clonic seizure activity? (Select all that apply.) a. Restraining the patients arms to avoid further injury b. Placing padding around or under the patients head c. Attempting to insert a tongue depressor into the patients 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
ANS: B, D, E
For which condition may carbamazepine (Tegretol) be used? a. Tardive dyskinesia b. Psychotic episodes c. Trigeminal neuralgia pain d. Sedation
ANS: C
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.
ANS: C
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.
ANS: D
Which condition is associated with hydantoin therapy? a. Postictal state b. Atonia c. Seizure threshold reduction d. Gingival hyperplasia
ANS: D
Which drug used in the treatment of seizures requires careful monitoring of renal function?
Carbamazepine (Tegretol)
What does the nurse monitor in a patient taking zonisamide (Zonegran)?
Complete blood count (CBC)
Which measurement is the best indicator of how well an antiseizure medication is working?
Frequency and duration of seizures
A patient with diabetes is started on phenytoin (Dilantin) for partial seizures. What does the nurse closely monitor in this individual?
Hyperglycemia
When evaluating the effectiveness of succinimides, for which factor does the nurse collect data?
Occurrence of petit mal seizures
From the following medications ordered by the healthcare provider for patients with known seizure disorders, the nurse knows these medications are for the seizures: (Select all that apply.) 1. levetiracetam (Keppra) 500 mg PO 2. carbamazepine (Tegretol) 200 mg PO 3. terbinafine (Lamisil) 250 mg PO 4. gabapentin (Neurontin) 300 mg PO 5. phenytoin (Dilantin) 100 mg PO
ANS: 1, 2, 4, 5
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 stated 1. "I keep having blurred vision, especially in the morning." 2. "I have not noticed any significant change in my pain." 3. "I find myself needing to take a nap after breakfast. I'm so sleepy." 4. "I have a better appetite now since I have been started on this."
ANS: 2
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.
ANS: A
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)
ANS: C
A patient taking phenytoin (Dilantin) has started attending college and reports frequently drinking alcohol with friends. What does the nurse monitor for in this patient?
Increased seizure activity
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. This type of seizure demonstrated by this patient will be documented by the nurse as 1. tonic-clonic seizure. 2. atonic seizure. 3. partial simple motor seizure. 4. absence seizure.
ANS: 1
Which medication is used to control seizures or prevent migraine headaches? a. Topiramate (Topamax) b. Zonisamide (Zonegran) c. Valproic acid (Depakene) d. Tiagabine (Gabitril)
ANS: A
Which premedication assessment by the nurse is most important prior to the initiation of carbamazepine (Tegretol) therapy? a. Determine patients ancestry. b. Monitor blood pressure (BP) lying, sitting, and standing. c. Auscultate lung sounds. d. Obtain smoking history.
ANS: A
When caring for a patient with epilepsy who was hospitalized and was recovering from a seizure, the expected assessments/interventions by the nurse during postictal time include: (Select all that apply.) 1. place oxygen and suction equipment at the bedside. 2. determine whether any bodily harm occurred during the seizure. 3. evaluate the degree of weakness, speech pattern changes, and memory loss. 4. turn the patient on his or her side to allow secretions to drain out of the mouth. 5. encourage oral hygiene and ask the patient to brush his or her teeth.
ANS: 1, 2, 3, 4
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 the following actions: (Select all that apply.) 1. take the infant's vital signs. 2. leave the infant and mother for a brief time to allow privacy. 3. assess the infant's airway. 4. restrain the infant and swaddle in blankets. 5. protect the patient from injury.
ANS: 1, 3, 5
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 patients airway. e. Obtain the correct dose (10 mg) and administer over slow IV push.
ANS: A, D, E
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
ANS: B
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.
ANS: C