Pharm (Ch. 13)

d (Rationale: Most antiseizure medications are Safety Category D, which mean that these medications may cause harm to the fetus but may provide benefit to the mother in a life-threatening situation. Category A (option 1) medications are lowest risk to the woman and fetus. Category B (option 2) medications have not shown a confirmed risk to fetus or woman. Category C (option 3) medications have shown a risk to fetus but no studies have been performed in women.)

1. A young woman with a diagnosed seizure disorder asks the nurse about getting pregnant. In planning her response, the nurse knows that most antiseizure medications fall under which pregnancy category? a. A b. B c. C d. D

epilepsy

disorder of the CNS characterized by seizures and/or convulsions

partial seizures

seizures that start on one side of the brain and travel a short distance before stopping

generalized seizures

seizures that travel throughout the entire brain on both sides

seizures

symptom of epilepsy charcterized by abnormal neuronal discharges within the brain

a b d (Rationale: Taking more phenobarbital than prescribed can cause severe respiratory depression, coma, and death. Confusion (option 3) is not one the adverse effects of phenobarbital.)

A nurse is teaching a patient the importance of taking her antiseizure medication, phenobarbital (Luminal), every day at the same time. She informs the patient not to take more of this medication than prescribed because this antiseizure drug may cause: (Select all that apply.) a. severe respiratory depression b. coma c. confusion d. death

a (Rationale: Diazepam (Valium), a benzodiazepine, is the drug of choice in helping to terminate status epilepticus when given via the parenteral route. Its effects occur within minutes and can last for about 20 minutes. Clorazepate (option 3) and clonazepam (option 4), also benzodiazepines, are used to treat partial seizures and absence seizures (respectively). Gabapentin (option 2), a newer GABA related drug, is typically used to treat partial seizures.)

A patient who has had repeated tonic-clonic seizures is admitted into the hospital. He has had a history of status epilepticus. In preparation for the possibility that status epilepticus may happen again, the nurse will have what drug available to terminate this serious type of seizure? a. Diazepam (Valium) b. Gabapentin (Neurontin) c. Clorazepate (Tranxene) d. Clonazepam (Klonopin)

a (Rationale: Taking ethosuximide with phenytoin may cause an elevation in serum levels of phenytoin, causing phenytoin toxicity. An elevation in serum levels of phenytoin will not occur if taken with the barbituate, phenobarbital (option 1). Usually, phenytoin-like drugs such as carbamazepine (option 2) and valproic acid (option 3), would not be given with phenytoin because their actions are similar.)

The nurse checks a patient's phenytoin serum levels because, in addition to taking phenytoin, the patient is also taking: a. ethosuximide (Zarontin). b. phenobarbital (Luminal). c. carbamazepine (Tegretol, Oxtellar XR). d. valproic acid (Depakene).

d (Rationale: Taking ethosuximide (Zarontin) may cause depression. Urinary dysfunction (option 1), gingival hyperplasia, (option 2), and tremors (option 3) are not typically associated with ethosuximide.)

The nurse collects data on a patient taking ethosuximide (Zarontin) for which of the following possible adverse effects? a. Urinary dysfunction b. Gingival hyperplasia c. Tremors d. Depression

b (Rationale: Alternating contractions and relaxation of the muscles occur during the clonic phase of a generalized, tonic-clonic seizure. "Absence" (option 1) refers to a type of seizure that lasts only a few seconds with the patient appearing as if he/she is "daydreaming". "Febrile" (option 3) refers to a type of seizure that usually lasts no more than a couple of minutes and occurs with a rapid rise of temperature during an illness. "Myoclonic" (option 4) refers to a type of seizure that is characterized by large, jerking body movements.)

The nurse is reviewing a patient's chart and reads that the patient experienced a generalized seizure involving alternating contractions and relaxation of the muscles. The nurse knows that this phase of the seizure is called the _______ phase. a. absence b. clonic c. febrile d. myoclonic

c (Rationale: Phenytoin (Dilantin) can cause gingival hyperplasia. Valproic acid (option 1), Carbamazepine (option 2) and primidone (option 4) are not associated with gingival hyperplasia.)

The nurse monitors for the occurrence of gingival hyperplasia for the patient who is taking what antiseizure medication? a. Valproic acid (Depakene) b. Carbamazepine (Tegretol, Oxtellar XR) c. Phenytoin (Dilantin) d. Primidone (Mysoline)

c (Rationale: One of the most common adverse effects of newer hydantoin-related, antiseizure drugs is drowiness. Other adverse effects include dizziness and blurred vision. The newer hydantoin-related drugs are not known to cause GI upset (option 1), spasms (option 2) or dry mouth (option 4).)

The nurse teaches the patient that one of the most common adverse effects of newer antiseizure drugs is: a. GI upset. b. spasms. c. drowsiness. d. dry mouth.

d (Rationale: Antiseizure medications are used to control seizure activity. Patients may take other medications along with the antiseizure medications for overall disease or adverse effects control. Antiseizure medications are not used for curative purposes therefore, the nurse cannot guarantee patients that they will be seizure free within any specific time frame or that they can be cured (options 1, 2 & 3).)

The patient on antiseizure medication wants to know how long he must take his medication before he is cured. The nurse's best response would be: a. "You should be totally seizure free in 1 to 3 weeks." b. "We may need to add additional medications before you are cured." c. "It may take up to 3 years before you are cured." d. "The goal of therapy is to control seizure activity."

c (Rationale: Levels of antiseizure medications in the blood are analyzed to ensure that therapeutic levels are achieved or maintained (getting enough but not too much), helping healthcare providers to determine correct dosages for their patients. In addition, knowing levels allows the healthcare provider to monitor the effects that other medications, or even foods, can have on the amount of medication available and/or utilized by the patient. Dilantin does not cause blood disorders (option 1). The patient could ask the doctor, but the nurse should be able to understand and respond to this question (option 2). The primary way to determine the presence of adverse effects is usually by the patient's report and a physical assessment. Various diagnostic tests such as drug levels allow the healthcare provider to determine the patient's risk for developing some adverse effects (option 4). )

The patient on phenytoin (Dilantin) asks why he must have his labs checked. The nurse's best response would be: a. "Dilantin can cause blood disorders." b. "You will need to ask your doctor." c. "We are checking to make sure you are getting enough but not too much medication." d. "We must see if you are developing any adverse effects of the medication."

staticus epilepticus

condition characterized by repeated seizures

pre-eclampsia

condition where hypertension develops because of pregnancy or recent pregnancy. Hypertension is accompanied by proteinuria and/or edema

eclampsia

condition whereby seizures and/or a coma develop in a client with pre-eclampsia

action potential

the change in electrical activity across the plasma membrane of a muscle or nerve cell due to changes in membrane permeability

convulsions

uncontrolled muscle contractions or spasms that occur in the face, torso, arms, or legs