Test 4 (Chapter 15)

The patient has epilepsy and receives phenytoin (Dilantin). The patient has been seizure-free, and asks the nurse why he still needs blood tests when he is not having seizures. What is the best response by the nurse?

"Because phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose."

An older adult patient is taking phenobarbital (Luminal) for seizure control. What is most important for the nurse to assess in the patient?

Respiratory function

Identify the correct statement regarding seizures.

Seizures can be caused by bacterial infections of the nervous system.

The physician has ordered intravenous phenytoin (Dilantin). The patient is also receiving 5% dextrose in water (D5W) intravenously (IV). What will the nurse plan to do before administering this medication?

Use a large vein for the infusion. Use an intravenous (IV) line with a filter. Flush the intravenous (IV) line with saline.

The patient who is prescribed valproic acid (Depakene) for seizure control would like to have a baby. Which statements should the nurse include in a discussion with this patient?

Your current antiepileptic medication should not be used when you are pregnant." "Folic acid supplementation is important for you."

A person who stops talking mid-sentence and has a blank stare for 5 seconds would most likely be experiencing

a petit mal seizure.

The nurse is teaching a class for patients who have been recently diagnosed with epilepsy. The nurse determines that learning has occurred when the patients make which statements?

"Epilepsy may be caused by a head injury." "A stroke, or brain attack, could increase the risk for developing epilepsy." "With some cases of epilepsy, the cause is never determined."

A mother phones the clinic and tells the nurse, "My 5-year-old son had a febrile seizure this morning." She adds that this is the child's first seizure experience. The nurse responds by asking the mother to bring the child in to be seen today. What other information should the nurse offer?

"Febrile seizures occur in up to 2% of children." -"Seizure medications are usually not necessary for febrile seizures."

The young child has absence seizures. The physician has prescribed valproic acid (Depakene) syrup. The nurse has completed medication education with the child's mother and determines that learning has occurred when the mother makes which statement?

"I should not mix this with carbonated beverages."

The patient is receiving phenobarbital (Luminal) for seizure control. The patient asks the nurse how this little pill can stop his seizures. What is the best response by the nurse?

"Phenobarbital (Luminal) stops your seizures by increasing a chemical called GABA that calms down the excitability in your brain."

The patient tells the nurse that she has been taking phenytoin (Dilantin) for 2 years now and is still having too many side effects. She wants to stop taking it. What is the best response by the nurse?

"Please do not stop the medication abruptly, as you will have withdrawal seizures."

The patient is receiving Phenobarbital (Luminal) for control of seizures. The patient tells the nurse she plans to become pregnant. What is the best response of the nurse?

"Please talk to your doctor; this drug is contraindicated in pregnancy."

The nurse has completed education to the parents of a child newly diagnosed with tonic-clonic seizures. Which comments made by the parents would the nurse evaluate as indicating need for further education?

"Some of the times when I thought he was ignoring me may have actually been seizure activity." "He just needs to focus more to prevent these attacks." "I know he will outgrow these seizures with time."

A parent states, "The doctors all say that my son's problem is epilepsy, but I don't think that is correct. I have never seen him jerk or thrash." What nursing response is indicated?

"The episodes of jerking and thrashing are called convulsions." "Seizures take many forms." "Seizures can be a sign that epilepsy is present."

The patient says to the nurse, "My doctor said I have epilepsy and need to take medicine for those seizures I had. Do I really need medicine?" What is the best response by the nurse?

"Yes, you need to take medication on a continual basis to control the seizures."

A parent says to the nurse, "The doctor prescribed ethosuximide (Zarontin) for my child, who has absence seizures. What does this mean?" What is the best response by the nurse?

"Your daughter's seizures manifest as a staring into space for a few seconds. Ethosuximide (Zarontin) is a good medication for this type of seizure."

The nurse would be especially cautious to avoid extravasation of which drug that is commonly administered intravenously?

Phenytoin (Dilantin)

The nurse is planning education sessions for a patient regarding use of a newly prescribed antiepileptic drug (AED). Which topics should be included in this session?

-The patient should take the medication at the same time every day. -The patient should avoid using dietary supplements containing kava when on this medication.

The parents of an infant with recurrent seizures are interested in starting amino acid therapy for their child. The father says, "After all, amino acids are natural; it couldn't hurt to give this a try." The nurse should consider which complications of this therapy when formulating a response?

1. Allergic reactions to the product 2. Cardiac changes such as palpitations 3. Neurological effects such as dizziness and lack of coordination

The physician has ordered intravenous (IV) diazepam (Valium) for the patient in status epilepticus. During administration, which assessment by the nurse is most important?

Assessing respirations

Which of the following adverse effects would most likely be associated with the use of phenytoin (Dilantin)?

Bleeding

The patient is receiving valproic acid (Depakene) for treatment of seizures. The patient has also been taking a daily 81 mg aspirin tablet prophylactically for a cardiac condition. What would the nurse be most likely to observe?

Bleeding from the gums and bruising of the skin

The physician has prescribed phenytoin (Dilantin) for a patient with type 1 diabetes mellitus. What does the nurse include in the plan of care for this patient?

Plan to discuss with the physician the need to increase the patient's insulin based on serum glucose levels.

A patient has been prescribed to follow a ketogenic diet to supplement pharmacotherapy for a seizure disorder. The nurse would support the inclusion of which types of food in menu selection?

Foods high in fat Low protein foods Low carbohydrate foods

The nurse is talking with a patient who was just prescribed ethosuximide (Zarontin). Which patient statement should the nurse immediately discuss with the patient's health care provider?

I take ginkgo to help improve my memory. ""My husband and I are leading a 20-mile bicycle tour next weekend for the company we have just started

The physician has ordered intravenous (IV) phenytoin (Dilantin). The nurse does not read the drug label and administers the medication intramuscularly (IM). What is the most likely response in the patient?

Local tissue damage following extravasation will most likely occur.

A patient had a tonic-clonic seizure. Which findings does the nurse evaluate as indicating the patient is in a postictal state?

The patient is in a deep sleep. The patient is confused as to place and time.

The nurse has been conducting medication education for a patient with epilepsy. What is the best outcome for this patient?

The patient will recognize that the antiseizure medication must be continued indefinitely.

A low-income patient without insurance has been prescribed several different medications over several months for seizure control without any improvement. The patient indicates she has not experienced any adverse effects. At this point the nurse should

assess for medication compliance.

A drug that is used to treat petit mal seizures but not tonic-clonic seizures and works by decreasing neuronal activity in the motor cortex is

ethosuximide (Zarontin).