PHARM - Neurological Medications

The nurse is caring for a child receiving carbamazepine who has a carbamazepine level drawn. Which result indicates a therapeutic level?

6 mcg/mL Rationale:When carbamazepine is administered, blood levels need to be drawn periodically to check for the child's absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. The therapeutic serum level for this medication is 4 to 12 mcg/mL.

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 Rationale:The antidote for acetaminophen is acetylcysteine. The normal therapeutic serum level of acetaminophen is 10 to 20 mcg/mL (100 to 200 mcmol/L). A toxic level is higher than 50 mcg/mL (500 mcmol/L), and levels higher than 100 mcg/mL (1000 mcmol/L) could indicate hepatotoxicity. Auranofin is a gold preparation that may be used to treat rheumatoid arthritis. Pentostatin and fludarabine are antineoplastic agents.

The nurse reviews the phenytoin level of a client who is taking phenytoin. The nurse notes that the plasma drug level is 9 mcg/mL. Which should the nurse anticipate to be prescribed for the client?

An increase in the present dosage Rationale:The dosing objective is to produce phenytoin levels between 10 and 20 mcg/mL. Levels below 10 mcg/mL are too low to control seizures. At levels greater than 20 mcg/mL, signs of toxicity begin to appear.

A client with narcolepsy has been prescribed a central nervous system (CNS) stimulant. The client complains to the nurse that he cannot sleep well anymore 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 time schedule?

At least 6 hours before bedtime Rationale:A central nervous system (CNS) stimulant acts by releasing norepinephrine from nerve endings. The client should take the medication at least 6 hours before going to bed at night to prevent disturbances with sleep. Taking the medication at the time frames indicated in options 1, 2, and 3 will prevent the client from sleeping because of the stimulant properties of the medication.

A client on the nursing unit has a prescription for a central nervous (CNS) stimulant orally daily. The nurse collaborates with the dietitian to limit the amount of which item on the client's dietary trays?

Caffeine Rationale:Caffeine is a stimulant and should be limited in the client taking a central nervous system (CNS) stimulant. The client should also be taught to limit caffeine intake as well.

The nurse should instruct the client taking atomoxetine to avoid foods containing which substance?

Caffeine Rationale:The action of atomoxetine is central nervous system (CNS) stimulation. Thus, the client should avoid other CNS stimulants, such as caffeine.

A client with a history of simple partial seizures is taking clorazepate, and asks the nurse if there is a risk of addiction. The nurse's response is based on which fact?

Clorazepate leads to physical and psychological dependence with prolonged high-dose therapy. Rationale:Clorazepate is classified as an anticonvulsant, antianxiety agent, and sedative-hypnotic. One of the concerns with clorazepate therapy is that the medication can lead to physical or psychological dependence with prolonged therapy at high doses. For this reason, the amount of medication that is readily available to the client at any one time is restricted.

A client is receiving phenytoin. Which findings would indicate that the client is experiencing side/adverse effects related to this medication? Select all that apply.

Constipation Bleeding gums Decreased white blood cells Decreased platelet count Rationale:Phenytoin causes blood dyscrasias, such as decreased platelet counts and decreased white blood cell counts; it contributes to constipation as well. Gingival hyperplasia can occur, causing gums to bleed easily. Ataxia is a side effect of benzodiazepines.

A client being seen in the clinic is taking phenytoin. The client's phenytoin blood level is within therapeutic range, and the client's seizures are controlled. Which data collected by the nurse would require primary health care provider notification and possible discontinuation of the medication?

Diffuse body rash Rationale:Stevens-Johnson syndrome is a rash indicating an allergy, and if this occurs the primary health care provider needs to be notified for consideration of medication discontinuation. Options 1, 2, and 3 are also side effects of the medication but may be reversed with medication dose alteration rather that medication discontinuation.

A client with Parkinson's disease has been prescribed benztropine. The nurse monitors for which gastrointestinal (GI) side effect of this medication?

Dry mouth Rationale:Common GI side effects of benztropine therapy include constipation and dry mouth. Other GI side effects include nausea and ileus. These effects are the result of the anticholinergic properties of the medication.

A client who recently began medication therapy with levodopa for Parkinson's disease complains of nausea. The nurse reminds the client to do which action to manage this problem?

Eat a snack before taking the medication. Rationale:Levodopa is a dopaminergic medication used to treat Parkinson's disease. The nurse should remind the client that a snack should be eaten before taking the medication to prevent the nausea.

The nurse is assisting in preparing a plan of care for a client with a diagnosis of cancer who is receiving morphine sulfate in an extended format by mouth. The nurse should include which priority nursing action in the plan of care for this client?

Encourage the client to cough and deep breathe. Rationale:Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep breathe to prevent complications related to the use of this medication.

The nurse is caring for a client receiving morphine sulfate intravenously for pain. Because morphine sulfate has been prescribed for this client, which nursing action should be included in the plan of care?

Encourage the client to cough and deep breathe. Rationale:Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep breathe to prevent pneumonia. The remaining options are not specifically associated with this medication.

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

Nausea and vomiting Rationale:Divalproex sodium is an anticonvulsant. The most frequent side effects of medication therapy are gastrointestinal (GI) disturbances such as nausea, vomiting, and indigestion. The items in the other options are not side effects.

A client is admitted to the hospital because of complaints of vomiting and abdominal pain. During data collection, the client tells the nurse that he is taking entacapone. Based on this finding, the nurse elicits information from the client regarding the presence of which condition?

Parkinson's disease Rationale:Entacapone is an antiparkinsonian agent used in conjunction with levodopa to improve the quality of life in clients with Parkinson's disease. It is not used to treat cardiovascular disorders.

The nurse is caring for a hospitalized child with a history of seizures who is receiving oral phenytoin sodium. Which should be included in the plan of care for this child?

Providing oral hygiene, especially care of the gums Rationale:Phenytoin sodium causes gum bleeding and hypertrophy; therefore, oral hygiene is important. Soft toothbrushes and gum massage should be instituted to reduce the risk of complications and prevent further trauma. Options 1 and 4 are incorrect because the intake and output, as well as heart rate, are not affected by this medication. Option 3 is incorrect because directions for administration of this medication include administering with food to minimize gastrointestinal upset.

Morphine sulfate is being administered to a client with cancer. The nurse is monitoring the client for signs of overdose related to this medication therapy. Which finding noted in the client should require the need to notify the registered nurse?

Respirations of 10 breaths per minute Rationale:Before an opioid is administered, respiratory rate, blood pressure, and pulse rate should be determined. The registered nurse is notified immediately if the respiratory rate is below 12 breaths per minute, if the blood pressure is significantly below the pretreatment value, or if the pulse rate is significantly above or below pretreatment value. The registered nurse would then contact the primary health care provider.

Ibuprofen is prescribed for a client. Which instruction should the nurse give the client about taking this medication?

Take with 8 oz of milk. Rationale:Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID). NSAIDs should be given with milk or food to prevent gastrointestinal irritation.

The nurse reviews the laboratory results of a client with trigeminal neuralgia who is being treated with carbamazepine 400 mg orally daily. The client's white blood cell (WBC) count is 3000 cells/mm3, blood urea nitrogen (BUN) is 15 mg/dL, sodium is 140 mEq/L, and uric acid is 5 ng/dL. Which laboratory result should the nurse report to the primary health care provider?

The WBC is low, indicating a blood dyscrasia. Rationale:Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects.

A client with a history of seizures is taking phenytoin for seizure control. The client arrives at the health care clinic, and a serum phenytoin drug level is drawn. The laboratory calls the nurse and reports a result of 10 mcg/mL. Which interpretation should the nurse make of this value?

The laboratory value is at the low end of therapeutic range. Rationale:The therapeutic serum drug level range for phenytoin is 10 to 20 mcg/L. A laboratory result of 10 mcg/mL is at the low end of therapeutic range.

The nurse is caring for a client who is taking phenytoin for control of seizures. During data collection, the nurse notes that the client is taking birth control pills. Which information should the nurse provide to the client?

The potential for decreased effectiveness of the birth control pills exists while taking phenytoin. Rationale:Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills.

The client is receiving meperidine hydrochloride for pain. Which signs/symptoms are side and adverse effects of this medication? Select all that apply.

Tremors Drowsiness Hypotension Rationale:Meperidine hydrochloride is an opioid analgesic. Side and adverse effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.

Meperidine has been prescribed for a client to treat pain. Which side and adverse effects should the nurse monitor for? Select all that apply.

Tremors Drowsiness Hypotension Rationale:Meperidine is an opioid analgesic. Side and adverse effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.

A client is receiving anticonvulsant therapy with phenytoin. The nurse plans to monitor the results of which laboratory tests closely? Select all that apply.

Urinalysis Serum calcium Alkaline phosphatase Complete blood cell count Rationale:The nurse would monitor the client's complete blood cell counts because hematological side effects of this therapy include aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia. Other values that warrant monitoring include serum calcium levels and the results of urinalysis, and hepatic and thyroid function tests. Serum sodium is not affected by phenytoin.

Entacapone is prescribed for a client with a diagnosis of Parkinson's disease. The nurse reinforces medication instructions to the client and instructs on which frequent side effect?

Urine discoloration to dark yellow or orange Rationale:Entacapone is an antiparkinsonian agent that is used in conjunction with levodopa to improve the quality of life in clients with Parkinson's disease. A frequent side effect is a urine discoloration to dark yellow or orange. Joint pains, muscle weakness and pruritus are not associated with the use of this medication.

The nurse employed in a primary health care provider's office is collecting data on a client who is taking ergotamine tartrate. The nurse evaluates the effectiveness of therapy by asking which question?

"Are the headaches relieved?" Rationale:Ergotamine tartrate is used to treat migraine or cluster headaches.

A client taking carbamazepine asks the nurse what to do if he misses one dose. Which response should the nurse give?

"Take the medication as long as it is not immediately before the next dose." Rationale:Carbamazepine is an anticonvulsant that should be taken around the clock, precisely as directed. If a dose is omitted, the client should take the dose as soon as it is remembered, as long as it is not immediately before the next dose. The medication should not be double dosed. If more than one dose is omitted, the client should call the primary health care provider.

A client taking phenytoin has a serum phenytoin level of 30 mcg/mL. The nurse would expect to note which signs and symptoms on data collection of the client? Select all that apply.

Ataxia (impaired coordination) Nausea Diplopia (double vision) Nystagmus (invol. eye movement) Rationale:The therapeutic serum range of phenytoin should be 10 to 20 mcg/mL. A level of 30 mcg/mL indicates toxicity. Central nervous system (CNS) depression, lethargy, ataxia, and nausea are all signs of phenytoin toxicity. Nystagmus and diplopia also occur. Phenytoin toxicity depresses the CNS, thus hyperactive reflexes would not be present. Tinnitus is not associated with phenytoin toxicity; rather, it is associated with acetylsalicylic acid toxicity.

A client with a closed head injury is receiving phenytoin, an anticonvulsant medication. Which would indicate that the client is experiencing side effects related to this medication? Select all that apply.

Constipation Bleeding Gums Hyperglycemia Decreased platelet count Rationale:Phenytoin causes blood dyscrasias, such as decreased platelet counts and decreased white blood cells counts; it contributes to constipation as well. Gingival hyperplasia can occur, causing gums to bleed easily, and blood glucose levels can be elevated when taking phenytoin. Sedation is a side effect of barbiturates, not phenytoin. Ataxia is a side effect of benzodiazepines.

Carbidopa-levodopa is prescribed for a client with Parkinson's disease, and the nurse monitors the client for adverse effects of the medication. Which sign/symptom indicates the client is experiencing an adverse effect?

Impaired voluntary movements Rationale:Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the temporary muscle weakness that lasts 1 minute to 1 hour, also known as the "on-off phenomenon") are frequent side effects of the medication.

The nurse is providing instructions to a client who is taking codeine sulfate for severe back pain. Which action does the nurse instruct the client to do?

Increase fluid intake. Rationale:Codeine sulfate can cause constipation. The client is instructed to increase fluid intake to prevent constipation. Options 2, 3, and 4 are incorrect because they do not address the side effects associated with the use of this medication. Although lightheadedness can occur with the use of this medication, all exercise is not avoided. It is important that the client ambulate frequently.

A client receiving morphine by the epidural route complains of itching. The nurse should anticipate which prescription to relieve the itching?

Low dose infusion of naloxone Rationale:Morphine can stimulate histamine release, leading to pruritus, with systemic administration. Pruritus occurs most frequently when opioids are administered via neuraxial (i.e., epidural, intrathecal) routes. Management of opioid-induced pruritus may include low-dose infusions of naloxone. The major categories of drugs used for symptomatic relief of chronic allergic disorders include Antihistamines, corticosteroids and antipruritic drugs are used for symptomatic relief of pruritus of chronic allergic disorders. Prednisone is a corticosteroid, methdialzine is an antipruritic medication and clemastine is an antihistamine.

The nurse has administered a dose of diazepam to a client. The nurse should take which most important action before leaving the client's room?

Per agency policy, put up the side rails on the bed. Rationale:Diazepam is a sedative-hypnotic with anticonvulsant and skeletal muscle relaxant properties. The nurse should institute safety measures before leaving the client's room to ensure that the client does not injure herself or himself. The most frequent side effects of this medication are dizziness, drowsiness, and lethargy. For this reason, the nurse puts the side rails up on the bed before leaving the room to prevent falls.

A registered nurse (RN) asks a licensed practical nurse (LPN) to obtain a vial of mannitol for administration to a client. The LPN notes that the vial contains a few small crystals. Based on this observation, which would the LPN expect the RN to do?

Place the vial in warm water until the crystals dissolve. Rationale:Crystals form in mannitol if the solution is cooled, but quickly dissolve if the container is placed in warm water, then cooled to body temperature before administration.

The parent of a client taking atomoxetine asks how the medication works to control attention deficit hyperactivity disorder (ADHD). The nurse's correct explanation is based on which fact?

The medication inhibits norepinephrine (NE) transport and reuptake. Rationale:Atomoxetine is a selective inhibitor of NE reuptake and hence causes NE to accumulate at synapses. Antidepressants work by selective serotonin reuptake inhibition. Increasing dopamine and decreasing acetylcholine are important in the treatment of Parkinson's disease.

The nurse is caring for 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

A client who was started on anticonvulsant therapy with clonazepam tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these symptoms and asks the nurse what to do. The nurse's response is based on which understanding of these symptoms?

These are expected effects during initial therapy and decrease or disappear with long-term use. Rationale:Drowsiness, unsteadiness, and clumsiness are expected effects of the medication during early therapy. They are dose related and usually diminish or disappear altogether with continued use of the medication. It does not indicate that a severe adverse reaction is occurring. It is also unrelated to interaction with another medication. The client is encouraged to take this medication with food to minimize gastrointestinal upset.

The nurse is reading the laboratory results for a client being treated with carbamazepine for prophylaxis of complex-partial seizures. The nurse interprets that which value is consistent with an adverse effect to this medication?

White blood cell count 3200 mm3 Rationale:Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia. Other adverse effects include cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects. A low white blood cell count would indicate an adverse effect. The values noted in options 1, 2, and 3 are normal values.

A client with myasthenia gravis is being discharged on pyridostigmine bromide. The nurse reinforces medication instructions with the client and makes which statement to the client?

"Take the medication before activities such as eating." Rationale:Pyridostigmine bromide is an anticholinesterase that is used to improve muscle strength in the client with myasthenia gravis. Taking the medication before activities such as eating helps lessen fatigue and dysphagia and improves muscle strength. The medication should be taken with food. Clients should avoid quinine, antacids, magnesium, and morphine sulfate and its derivatives because these medications can reverse the action of the pyridostigmine bromide and increase weakness. The medication should be taken regularly and on time to prevent fluctuating blood levels, which can cause weakness.

A client has a prescription for valproic acid orally once daily. How should the nurse plan to administer the medication?

Ensure that the medication is administered at the same time each day. Rationale: Valproic acid is an anticonvulsant, antimanic, and antimigraine medication. It may be administered with or without food. It should not be taken with an antacid or carbonated beverage because these products will affect medication absorption. The medication is administered at the same time each day to maintain therapeutic serum levels.

A 16-year-old child is brought to the emergency department by his mother with a complaint that the child just experienced a tonic-clonic seizure. On arrival in the emergency department no apparent seizures were occurring. The mother states that her son is taking medication for the seizure disorder. The nurse plans care, knowing that which medications are used for long-term control of tonic-clonic seizures? Select all that apply.

Gabapentin Ethosuximide Carbamazepine Rationale:Medications that are prescribed for long-term control of tonic-clonic seizures are gabapentin, ethosuximide, and carbamazepine. Diazepam is a medication that is prescribed to halt tonic-clonic episodes, and methylphenidate is a medication used to treat attention deficit hyperactivity disorder. Both of these medications are not suitable for long-term control of a seizure condition. Alprazolam is a medication used to treat anxiety.

The client with trigeminal neuralgia is being treated with carbamazepine. Which laboratory result indicates that the client is experiencing an adverse effect of the medication?

White blood cell count, 3000 mm3 (3 × 109/L) Rationale:Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbance, thrombophlebitis, dysrhythmia, and dermatological effects.

The client with myasthenia gravis becomes increasingly weak. The primary health care provider (PHCP) prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or increasing severity of the disease (myasthenic crisis). An injection of edrophonium is administered. Which change in condition indicates that the client is in cholinergic crisis?

A temporary worsening of the condition Rationale:An edrophonium injection makes the client experiencing cholinergic crisis temporarily worse. This is known as a negative test. An improvement of weakness would occur if the client were experiencing myasthenia gravis.

Carbamazepine is prescribed for a client with a diagnosis of psychomotor seizures. The nurse reviews the client's health history knowing that this medication is contraindicated if which disorder is present?

Liver disease Rationale:Carbamazepine is contraindicated in liver disease, and liver function tests are routinely prescribed for baseline purposes and are monitored during therapy. It is also contraindicated if the client has a history of blood dyscrasias. It is not contraindicated in the conditions noted in the incorrect options.

A client who was started on anticonvulsant therapy with clonazepam tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these manifestations and asks the nurse what to do. How should the nurse respond to the client's concerns?

"Clumsiness and unsteadiness are worse during initial therapy and decrease or disappear with long-term use." Rationale:Drowsiness, unsteadiness, and clumsiness are expected effects of the medication during early therapy. They are dose related and usually diminish or disappear altogether with continued use of the medication. It does not indicate that a severe side effect is occurring. It is also unrelated to interaction with another medication. The client is encouraged to take this medication with food to minimize gastrointestinal upset.

The nurse is caring for an older client with a diagnosis of myasthenia gravis and has reinforced self-care instructions. Which statement by the client indicates a need for further teaching?

"I can change the time of my medication on the mornings that I feel strong." Rationale:The client with myasthenia gravis should be taught that timing of anticholinesterase medication is critical. It is important to instruct the client to administer the medication on time to maintain a chemical balance at the neuromuscular junction. If not given on time, the client may become too weak to swallow.

The nurse is reinforcing instructions to an adolescent who has a history of seizures and is taking an anticonvulsant medication. Which statement indicates the client understands the instructions?

"I should not stop taking my medications even if my seizures go away." Rationale:The anticonvulsant medication should not be stopped even if there are no seizures. Adolescents can obtain a driver's license in most states when they have been seizure free for 1 year. Anticonvulsants cause acne and oily skin; therefore, a dermatologist may need to be consulted. If an anticonvulsant medication is missed, the primary health care provider should be notified.

A client with Parkinson's disease is beginning treatment with carbidopa/levodopa. Which statement made by the client indicates the need for further teaching?

"I should take my medication after a full meal." Rationale:Carbidopa/levodopa should be taken on an empty stomach with a full glass of water to enhance absorption. Because the medication can cause orthostatic hypotension, clients should be taught to change positions slowly. To ease the side effect of dry mouth, sugarless chewing gum, hard candy, and frequent mouth rinses are indicated. The side effect of sleep difficulty should be reported. In addition, the client is taught to avoid high-protein meals because it affects the effectiveness of the medication.

The nurse has reinforced instructions to a client with Parkinson's disease who is taking carbidopa/levodopa. Which statement by a client indicates the need for further teaching?

"I will eat lots of foods high in vitamin B6." Rationale:Foods high in vitamin B6 can counteract the effects of carbidopa/levodopa, so their intake should be limited.

Phenytoin, 100 mg orally three times daily, has been prescribed for a client for seizure control. The nurse reinforces instructions regarding the medication to the client. Which statement by the client indicates an understanding of the instructions?

"I will use a soft toothbrush to brush my teeth." Rationale:Phenytoin is an anticonvulsant. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client should not skip medication doses because this could precipitate a seizure. Capsules should not be chewed or broken, and they must be swallowed. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction because this indicates hematological toxicity.

Amantadine hydrochloride 100 mg orally twice daily has been prescribed for a client with Parkinson's disease, and the nurse teaches the client about the medication. Which statement by the client indicates a need for further teaching?

"I'll take this medication early in the morning and just before I go to bed." Rationale:Amantadine hydrochloride is an antiparkinson medication administered twice a day, but the last dose should not be administered near bedtime because it may cause insomnia in some clients.

The nurse is reinforcing instructions to the spouse of a client who is taking tacrine for the management of moderate dementia associated with Alzheimer's disease. The nurse should tell the spouse which information?

"If a change in the color of the stools occurs, notify the primary health care provider." Rationale:Tacrine may be administered between meals on an empty stomach, and if gastrointestinal upset occurs, it may be administered with meals. Flulike symptoms without fever and gastrointestinal symptoms are frequent side effects of the medication. The client or spouse should never be instructed to double the dose of any medication if it was missed, and the client and caregiver are instructed to notify the primary health care provider if nausea, vomiting, diarrhea, rash, jaundice, or changes in the color of the stool occur. This may be indicative of hepatitis.

The nurse is reinforcing instructions to an adolescent who is taking 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, I need to stop the medication." Rationale:The adolescent should not stop taking antiepileptic medications suddenly or without discussing it with a primary health care provider or nurse. Acne or oily skin may be a problem for the adolescent, and the adolescent is advised to call a primary health care provider for skin problems. Alcohol will lower the seizure threshold, and it is best to avoid the use of alcohol. Birth control pills may be less effective when the client is taking antiseizure medication.

The nurse is reinforcing instructions to a client taking phenytoin for seizure control. Which statement should the nurse make to the client regarding the administration of this medication?

"If you develop a sore throat, it is necessary to notify the primary health care provider." Rationale:Phenytoin is an anticonvulsant. Gingival hyperplasia, bleeding, and swelling and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client should not miss medication doses because this could precipitate a seizure. Capsules should not be chewed or broken, and they must be swallowed. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction because this indicates hematological toxicity.

The nurse is reinforcing instructions to the family of a client with Alzheimer's disease regarding tacrine. Which statement by the family would indicate an understanding of the side/adverse effects related to this medication?

"Increased urination may be an indication of an adverse effect." Rationale:Tacrine is a cholinergic agent. Frequent side effects of this medication include nausea, vomiting, diarrhea, dizziness, and headache. Overdose (adverse effects) will cause cholinergic crisis, including increased salivation, lacrimation, urination, defecation, bradycardia, hypotension, and increased muscle weakness. Fever is not an adverse effect, although if a fever occurs and persists this may be an indication of an unassociated infection and the primary health care provider should be notified. Constipation is not associated with this medication, and if constipation occurs, measures can be taken to relieve it. Difficulty voiding is not associated with the use of this medication. Although this symptom may warrant primary health care provider notification, it does not indicate the need to discontinue the medication.

The client is taking phenytoin for seizure control, and a blood sample for a serum drug level is drawn. Which laboratory finding indicates a therapeutic serum drug result?

15 mcg/mL (59.52 mcmol/L) Rationale:The therapeutic serum drug level range for phenytoin is 10 to 20 mcg/mL (39.68 to 79.36 mcmol/L).

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

2 to 3 weeks Rationale:Signs and symptoms of Parkinson's disease usually begin to resolve within 2 to 3 weeks of starting therapy, although in some clients marked improvement may not be seen for up to 6 months. Clients need to understand this concept to aid in compliance with medication therapy.

The nurse is caring for a client with myasthenia gravis who has received edrophonium intravenously to test for myasthenic crisis. The client asks the nurse how long the improvement in muscle strength will last. The nurse's response is based on the understanding that the duration is usually how many minutes?

30 Rationale:Edrophonium may be given to test for myasthenic crisis. If the client is in myasthenic crisis, muscle strength improves after administration of the medication and lasts for about 30 minutes.

A client with trigeminal neuralgia tells the nurse that acetaminophen is taken on a frequent daily basis for relief of generalized discomfort. The nurse reviews the client's laboratory results and determines that which indicates toxicity associated with the medication?

A direct bilirubin level of 2 mg/dL Rationale:In adults, overdose of acetaminophen causes liver damage. Option 3 is an indicator of liver function and is the only option that indicates an abnormal laboratory value applicable to liver dysfunction. The normal direct bilirubin is 0 to 0.4 mg/dL. The normal platelet count is 150,000 to 400,000 cells/mm3. The normal prothrombin time is 10 to 13 seconds. The normal sodium level is 135 to 145 mEq/L.

A client receiving therapy with carbidopa/levodopa is upset and tells the nurse that his urine has turned a darker color since he began to take the medication. The client wants to discontinue its use. In formulating a response to the client's concerns, how does the nurse interpret this development?

A harmless side effect of the medication Rationale:With carbidopa/levodopa therapy, a darkening of the urine or sweat may occur. The client should be reassured that this is a harmless effect of the medication, and its use should be continued.

A client taking phenytoin has a serum phenytoin level of 30 mcg/mL. The nurse should expect to note which signs and symptoms on data collection? Select all that apply.

Ataxia (impaired coordination) Nausea Restlessness Respiratory rate of 9 bpm Rationale:The therapeutic serum range of phenytoin should be 10 to 20 mcg/mL. Central nervous system (CNS) depression, restlessness, ataxia, and nausea are all signs of phenytoin toxicity. Phenytoin toxicity depresses the CNS; thus, hyperactive reflexes should not be present. Tinnitus is not associated with phenytoin toxicity; rather it is associated with acetylsalicylic acid (aspirin toxicity).

The client with myasthenia gravis is receiving pyridostigmine. The nurse monitors for signs and symptoms of cholinergic crisis caused by overdose of the medication. The nurse checks the medication supply to ensure that which medication is available for administration if a cholinergic crisis occurs?

Atropine sulfate Rationale:The antidote for cholinergic crisis is atropine sulfate. Acetylcysteine is the antidote for acetaminophen. Vitamin K is the antidote for warfarin and protamine sulfate is the antidote for heparin.

Neuroleptic malignant syndrome is suspected in a client who is taking chlorpromazine. Which medication should the nurse prepare in anticipation of the prescription to treat this adverse effect related to the use of chlorpromazine?

Bromocriptine Rationale:Bromocriptine is an antiparkinsonian prolactin inhibitor used in the treatment of neuroleptic malignant syndrome. Protamine sulfate is the antidote for heparin overdose. Vitamin K is the antidote for warfarin overdose. Enalapril maleate is an antihypertensive used in the treatment of hypertension.

A client with vascular headaches is taking ergotamine. Which client complaint should the nurse monitor?

Cool, numb fingers and toes Rationale:Ergotamine produces vasoconstriction, which suppresses vascular headaches when given at a therapeutic dose range. The nurse monitors for hypertension; cool, numb fingers and toes; muscle pain; and nausea and vomiting.

The client with myasthenia gravis is suspected of having cholinergic crisis. Which sign/symptom indicates this crisis is taking place?

Hypertension Rationale:Cholinergic crisis occurs as a result of an overdose of medication. Indications of cholinergic crisis include gastrointestinal disturbances, nausea, vomiting, diarrhea, abdominal cramps, increased salivation and tearing, miosis, hypertension, sweating, and increased bronchial secretions.

The nurse is assisting in the care of a client with Parkinson's disease who is receiving carbidopa/levodopa. The nurse plans to monitor the client for which adverse effect, which could appear with elevated serum levels of this medication?

Impaired voluntary movements Rationale:Dyskinesia and impaired voluntary movement may occur with high carbidopa/levodopa doses. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the temporary muscle weakness that lasts 1 minute to 1 hour, also known as "on-off phenomenon") are frequent side effects of the medication.

Mannitol is being administered to a client with increased intracranial pressure following a head injury. The nurse assisting in caring for the client knows that which indicates the therapeutic action of this medication?

Induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes Rationale:Mannitol is an osmotic diuretic that induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes. It is used to reduce intracranial pressure in the client with head trauma.

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

Instituting seizure precautions Rationale:Clonazepam is a benzodiazepine used as an anticonvulsant. During initial therapy and during periods of dosage adjustment, the nurse should initiate seizure precautions for the client.

A client has been given a prescription for chloral hydrate for short-term use. The nurse includes which nursing intervention in caring for this client?

Instruct the client to call for help to get out of bed. Rationale:Chloral hydrate is a sedative-hypnotic. This medication promotes sleep, and the client is at risk for falls due to sedative effects. The nurse should instruct the client to ask for assistance getting out of bed. It is not necessary to leave the room lights on; this would interfere with sleep. Awakening the client for vital sign measurement and neurological assessment is unnecessary and interferes with sleep as well.

A client is placed on hydrate sedative-hypnotic for short-term treatment. Which nursing action indicates an understanding of the major side effect of this medication?

Instructing the client to call for ambulation assistance Rationale:A sedative-hypnotic causes sedation and impairment of motor coordination; therefore, safety measures need to be implemented. The client is instructed to call for assistance with ambulation. Options 1 and 2 are not specifically associated with the use of this medication. Although option 4 is an appropriate nursing intervention, it is most important to instruct the client to call for assistance with ambulation.

The nurse is caring for a client with severe back pain, and codeine sulfate has been prescribed for the client. Which should the nurse include in the plan of care while the client is taking this medication?

Monitor bowel activity. Rationale:While the client is taking codeine sulfate, an opioid analgesic, the nurse should monitor vital signs and monitor for hypotension. The nurse should also increase fluid intake, palpate the bladder for urinary retention, auscultate bowel sounds, and monitor the pattern of daily bowel activity and stool consistency (codeine can cause constipation). The nurse should monitor respiratory status and initiate breathing and coughing exercises. In addition, the nurse monitors the effectiveness of the pain medication.

A licensed practical nurse (LPN) is assisting in the care of a pregnant teenaged client with preeclampsia receiving magnesium sulfate. The LPN plans to notify the registered nurse immediately if which sign of magnesium toxicity is noted?

Respiratory rate of 10 breaths per minute Rationale:Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of magnesium toxicity relate to central nervous system (CNS) depression and include respiratory depression, loss of deep tendon reflexes, sudden drop in fetal heart rate, and/or maternal heart rate and blood pressure. Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can develop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.

A client began taking amantadine approximately 2 weeks ago. A decrease in which should the nurse expect to see if the medication is having a therapeutic effect?

Rigidity and akinesia Rationale:Amantadine is an antiparkinson agent that potentiates the action of dopamine in the central nervous system. The expected effect of therapy is a decrease in akinesia and rigidity. Leukopenia, urinary retention, and hypotension are all adverse effects of the medication.

The nurse is caring for a client who has been prescribed gabapentin and is monitoring for adverse effects of the medication. Which finding indicates a potential adverse effect?

Slurred Speech Rationale:Gabapentin is classified as an anticonvulsant and antineuralgic and works by reducing seizure activity and neuropathic pain. Adverse effects include overdosage, which manifests as slurred speech, drowsiness, lethargy, and diarrhea. Tremors, dysarthria (difficulty speaking), and weight gain are side effects of this medication.

A client with epilepsy is taking the prescribed dose of phenytoin to control seizures. A phenytoin blood level is drawn, and the results reveal a level of 35 mcg/mL. Which symptom would be expected as a result of this laboratory result?

Slurred speech Rationale:The therapeutic phenytoin level is 10 to 20 mcg/mL. At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) appear. At a level higher than 30 mcg/mL, ataxia and slurred speech occur.

A primary health care provider initiates carbidopa/levodopa therapy for the client with Parkinson's disease. A few days after the client starts the medication, the client complains of nausea and vomiting. What should the nurse tell the client regarding how to avoid side effects when taking this combination medication?

Taking the medication with food will help prevent the nausea. Rationale:If carbidopa/levodopa is causing nausea and vomiting, the nurse would tell the client that taking the medication with food may decrease the nausea. Additionally, the client should be instructed not to take the medication with a high-protein meal because the high-protein will affect absorption. Antiemetics from the phenothiazine class should not be used because they block the therapeutic action of dopamine.

The nurse is assisting in caring for a pregnant client who is receiving intravenous magnesium sulfate for the management of preeclampsia and notes that the client's deep tendon reflexes are absent. On the basis of this data, the nurse reports the finding and makes which determination?

The client is experiencing magnesium toxicity. Rationale:Magnesium toxicity can occur as a result of magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression; loss of deep tendon reflexes; sudden decrease in fetal heart rate, maternal heart rate, or both; and sudden drop in blood pressure. Hyperreflexia indicates increased cerebral edema. An absence of reflexes indicates magnesium toxicity. The therapeutic serum level of magnesium for a client receiving magnesium sulfate ranges from 4 to 7.5 mEq/L (5 to 8 mg/dL).

Meperidine hydrochloride is prescribed for the client with pain. Which should the nurse monitor as a side effect of this medication?

Urinary retention Rationale:Meperidine hydrochloride is an opioid analgesic. Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

The nurse is assisting in preparing a plan of care for a client with renal colic receiving meperidine hydrochloride for pain. The nurse includes in the plan of care to monitor for which side effect of this medication?

Urinary retention Rationale:Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

A client is taking trihexyphenidyl for the treatment of Parkinson's disease. The nurse should monitor for which side effect of this medication?

Urinary retention Rationale:Trihexyphenidyl is an anticholinergic medication. Because of this, it can cause urinary hesitancy and retention, constipation, dry mouth, and decreased sweating as side effects.

The nurse is caring for a client who has been prescribed carbidopa/levodopa. The nurse should monitor the client for which side effects? Select all that apply.

Urinary retention Orthostatic hypotension Rationale:Monitor clients taking carbidopa/levodopa for orthostatic hypotension and urinary retention. Amantadine and pergolide may cause insomnia. Anticholinergics cause dry mouth and constipation.

The nurse has given medication instructions to a client beginning anticonvulsant therapy with carbamazepine. The nurse determines that the client understands the use of the medication if the client knows to perform which activity?

Use sunscreen when outside. Rationale:Carbamazepine acts by depressing synaptic transmission in the central nervous system (CNS). Because of this, the client should avoid driving or doing other activities that require mental alertness until the effect on the client is known. The client should use protective clothing and sunscreen to avoid photosensitivity reactions. The medication may cause dry mouth (not excessive salivation), 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 it could cause return of seizures or status epilepticus. Fever and sore throat should be reported to the primary health care provider (PHCP).