Chapter 53: Drug Therapy for Seizure Disorders and Spasticity
A client has been diagnosed with partial seizures and has been prescribed carbamazepine. When providing health education about the safe and effective use of this medication, what should the nurse teach the client? "I'll explain the foods that you should avoid while you're taking this drug." "It's important to take a dose as soon as possible if you feel a seizure is coming." "It's safest if you avoid drinking alcohol while you're taking this drug." "I'll be showing you how to safely self-inject this drug."
"It's safest if you avoid drinking alcohol while you're taking this drug." Explanation: Use of alcohol during treatment with carbamazepine is contraindicated due to the potential for CNS depression. Carbamazepine is taken on an ongoing basis to prevent partial seizures; it is not a treatment for impending seizure activity. It is administered orally, not by injection, and it does not necessitate significant dietary changes.
A client has been diagnosed with partial seizures and has been prescribed carbamazepine. When providing health education about the safe and effective use of this medication, what should the nurse teach the client? · "I'll be showing you how to safely self-inject this drug." · "It's important to take a dose as soon as possible if you feel a seizure is coming." · "It's safest if you avoid drinking alcohol while you're taking this drug." · "I'll explain the foods that you should avoid while you're taking this drug."
"It's safest if you avoid drinking alcohol while you're taking this drug." Explanation: Use of alcohol during treatment with carbamazepine is contraindicated due to the potential for CNS depression. Carbamazepine is taken on an ongoing basis to prevent partial seizures; it is not a treatment for impending seizure activity. It is administered orally, not by injection, and it does not necessitate significant dietary changes.
A 56-year-old woman with a diagnosis of multiple sclerosis has begun taking dantrolene. What client teaching should the nurse provide? "You'll find that your muscles will get progressively stronger over the next several weeks." "Make sure to see your health care provider promptly if you develop yellowish skin or eyes." "You'll have to come to the hospital daily to be administered this drug." "Take an over-the-counter laxative so that you don't get constipated."
"Make sure to see your health care provider promptly if you develop yellowish skin or eyes." Explanation: Dantrolene carries a significant risk of hepatitis; signs and symptoms must be reported promptly. It typically causes diarrhea, not constipation, and muscle weakness, not increases in strength. Dantrolene may be administered on an outpatient basis.
A client has been prescribed baclofen and will be taking the drug on an outpatient basis. The client asks the nurse if it is still okay to drink wine with meals or end the day with a "nightcap." What is the nurse's best response? · "You're not permitted to drink alcohol while you're taking baclofen." · "If you combine baclofen and alcohol you could suffer a severe allergic-type reaction." · "It's best to keep your alcohol intake to a low level when you're taking muscle relaxants." · "The combination of baclofen and alcohol could depress your nervous system to a dangerous level."
"The combination of baclofen and alcohol could depress your nervous system to a dangerous level." Explanation: The nurse should explain the rationale for avoiding alcohol while taking baclofen. The nurse should ideally promote abstinence rather than low intake. The nurse should avoid giving a prohibition without explaining. This combination does not result in an allergic reaction.
One week ago, a client began taking ethosuximide 500 mg/day PO for the treatment of absence seizures. The client reports gastrointestinal (GI) upset after taking with the drug. What health education should the nurse provide? "Take the drug 1 hour before or 2 hours after a meal to minimize stomach upset." "Contact your health care provider to see if there's an alternative drug that would work for you." "Try taking your pills at the same time as you eat some food." "Taking over-the-counter antacids before and after the dose helps for some clients."
"Try taking your pills at the same time as you eat some food." Explanation: If GI irritation occurs with ethosuximide or other anticonvulsants, the client should be encouraged to take the medication with food to reduce this adverse effect. Taking the drug 1 to 2 hours after meals would not reduce this effect. The nurse must be cautious when recommending the use of OTC medications. GI effects are unlikely to necessitate a change in medications
A client is receiving baclofen at 8 AM. The nurse would monitor the client for evidence of maximum effect at which time? 12 PM 11 AM 9 AM 10 AM
10 AM Explanation: Baclofen peaks in 2 hours after administration, so maximum effectiveness would be noted at this time, which in this case would be 10 AM.
A client who is receiving phenytoin has a serum drug level drawn. Which result would the nurse interpret as within the therapeutic range? 4 mcg/mL 30 mcg/mL 22 mcg/mL 12 mcg/mL
12 mcg/mL Explanation: The therapeutic serum phenytoin levels range from 10 to 20 mcg/mL. Thus, a level of 12 mcg/mL would fall within this range
A 36-year-old man has been taking extended-release carbamazepine for 1 year. He is in the clinic every 3 months for follow-up visits, which include a drug blood level. Which of the following carbamazepine blood levels would indicate a potential risk for adverse effects? 2 mcg/mL 6 mcg/mL 15 mcg/mL 10 mcg/mL
15 mcg/mL Explanation: The therapeutic blood level for the drug ranges from 4 to 12 mcg/mL for an adult. A level of 15 mcg/mL is higher than the therapeutic level and could cause increased adverse effects or possible toxic effects.
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? 6 mcg/mL 2 mcg/mL 4 mcg/mL 8 mcg/mL
2 mcg/mL Explanation: Therapeutic serum carbamazepine levels range from 4 to 12 mcg/mL. Therefore, a level under 4 mcg/mL would suggest that the drug has not reached therapeutic levels, so the dosage may need to be increased
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? · 6 mcg/mL · 4 mcg/mL · 8 mcg/mL · 2 mcg/mL
2 mcg/mL Explanation: Therapeutic serum carbamazepine levels range from 4 to 12 mcg/mL. Therefore, a level under 4 mcg/mL would suggest that the drug has not reached therapeutic levels, so the dosage may need to be increased.
The primary health care provider prescribes diazepam 10 mg IV to be administered to a client to control their seizures. The nurse would administer this drug over which time frame? 10 min 2 min 1 min 5 min
2 min Explanation: When used to control seizures, diazepam is administered IV pushed slowly as close as possible to the IV site, allowing at least 1 min for each 5 mg of drug. For a dosage of 10 mg, the nurse would administer the drug over 2 min
A nurse is aware that baclofen (Lioresal) is a centrally-acting spasmolytic that has been demonstrated to be safe and effective in the treatment of numerous disorders of muscle spasm and spasticity. The nurse should question the order if baclofen is prescribed for which of the following patients? A 49-year-old woman whose recent motor disturbances have culminated in a diagnosis of multiple sclerosis. A 70-year-old man whose Parkinson disease has worsened in recent months, resulting in decreased mobility and self-care. A 14-year-old boy who has a diagnosis of cerebral palsy and who has experienced a recent increase in muscle spasticity. A 22-year-old man whose muscle spasticity is attributable to a spinal cord injury that he suffered while snowboarding.
A 70-year-old man whose Parkinson disease has worsened in recent months, resulting in decreased mobility and self-care. Baclofen is useful in the treatment of spasticity and myoclonus resulting from disorders such as MS, cerebral palsy, and traumatic injury to the spinal cord. However, it is not useful in treating spasms that follow a CVA or stroke, or those that occur in Parkinson disease or Huntington chorea.
A client in status epilepticus has been brought to the emergency department. The nurse should anticipate which treatment measures? Administration of zonisamide (Zonegran) Administration of intravenous gabapentin Administration of oral or sublingual phenytoin Administration of intravenous lorazepam
Administration of intravenous lorazepam Explanation: Although diazepam has been the traditional treatment for status epilepticus, research has shown that lorazepam is more effective than diazepam or phenytoin used alone for cessation of seizures and has an effective duration of up to 6 hours compared to 20 minutes for diazepam. Oral medications are not administered during status epilepticus and neither zonisamide nor gabapentin are used to treat this health crisis
The nurse is preparing to administer an antiepileptic to a client who is experiencing seizures. The nurse will include documentation of which factor(s) before administering the medication? Select all that apply. Any recent infections Dietary habits Seizure frequency Description of seizures Average length of seizures
Any recent infections Dietary habits Seizure frequency Description of seizures Average length of seizures Explanation: The nurse's general assessment of seizure activity should include the following: description of seizures, seizure frequency, average length of seizures, description of aura, description of the degree of impairment, and description of what appears to bring on the seizure. Any recent infections and the client's dietary habits would be included in the general assessment; however, they would not be necessary before administering the antiepileptic
A nurse is preparing to administer methotrexate to a client. The nurse determines close monitoring is warranted if the client is also administered which drug(s)? Select all that apply. Diclofenac Sulfamethoxazole/trimethoprim Cephalexin Ibuprofen Aspirin
Aspirin sulfamethoxazole/trimethoprim Ibuprofen Diclofenac Explanation: The nurse should closely monitor the client for methotrexate toxicity when methotrexate is given with aspirin, sulfa antibiotics, and NSAIDs. Cephalosporins should be used cautiously with probenecid as it can increase the serum level of anti-infective.
The nurse examines reviews the medical administration record and notes the medication lamotrigine needs to be administered. The client has developed a red scaly rash with fluid-filled blisters and purpuric areas all over the client's body. Which action(s) should the nurse take? Select all that apply. Assess vital signs. Notify the primary care provider immediately. Cleanse affected areas with soap and water. Administer the dose of lamotrigine. Document the skin assessment.
Assess vital signs. Notify the primary care provider immediately. Document the skin assessment. Explanation: The nurse observes that the client is exhibiting a severe hypersensitivity rash that is potentially fatal, called Stevens-Johnsons Syndrome, and must notify the health care provider (HCP) immediately, and hold the dose of lamotrigine awaiting orders from the PCP. The nurse should assess vital signs for signs and symptoms of infection, which may occur from bacteria entering large areas of compromised skin. The nurse should document the skin assessment and the actions taken, including holding the drug and calling the primary care provider immediately. The nurse should not cleanse the skin with soap and water because the soap will dry out the skin leading to further breakdown.
Which instruction should the nurse specifically stress when administering drugs used for muscle spasm and cramping? · Avoid alcohol or other CNS depressants. · Take the drug with 6 to 8 oz of water. · Stay upright for 30 minutes after taking the drugs. · Take the drug with food.
Avoid alcohol or other CNS depressants. Explanation: The nurse should instruct the patient to avoid alcohol or other CNS depressants when taking a drug for muscle spasms and cramping. The nurse should instruct patients taking drugs for osteoporosis to take them with 6 to 8 oz of water and to stay upright for 30 minutes after taking drugs. The nurse should instruct patients with gout to take drugs for treating gout with food.
The nurse is caring for a 4-year-old child diagnosed with a seizure disorder requiring an antiseizure agent. What principle should guide the care team's medication management? Children often receive adult doses because excess medication is readily excreted in children. Benzodiazepines are the only approved antiseizure drugs for children. Children often require a larger milligram per kilogram dose than an adult. Electroconvulsive therapy is considered safer and more effective than drug therapy.
Children often require a larger milligram per kilogram dose than an adult. Explanation: Older children (2 months to 6 years of age) absorb and metabolize many of these drugs more quickly than adults and require a larger dosage per kilogram to maintain therapeutic levels. This does not, however, mean they receive the same actual dose as an adult. There are multiple drug options for treating childhood seizures. Electroconvulsive therapy is not indicated
The client is taking cyclobenzaprine for muscle spasms secondary to an injury to the lumbar spine that occurred while lifting a motor at work. The client is being seen for a follow-up visit by the health care provider. The client reports dry mouth, blurred vision, and constipation. Why is the client having these side effects from cyclobenzaprine? Cyclobenzaprine acts in the peripheral nervous system Cyclobenzaprine is structurally similar to amitriptyline Cyclobenzaprine produces an anticholinergic response Cyclobenzaprine has an effect at the neuromuscular junction
Cyclobenzaprine produces an anticholinergic response Explanation: Cyclobenzaprine relieves muscle spasms through a central action, possibly at the level of the brain stem, with no direct action on the neuromuscular junction or the muscle involved. The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The most common adverse effects are drowsiness, dizziness, and dry mouth.
A client with a history of malignant hyperthermia is scheduled for surgery. Which agent would the nurse most likely expect to administer? Dantrolene Botulinum toxin type B Methocarbamol Baclofen
Dantrolene Explanation: Dantrolene is the drug that would be used as prevention and treatment of malignant hyperthermia
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 health care provider ordered phenytoin prophylactically to prevent seizures. The nurse understands that phenytoin works by what mechanism? Increases the potassium available to the cell to reduce the repolarization of the cell Increases the chloride available to promote depolarization of the cells Decreases the calcium available to the cells responsible for electrical activity in the brain Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus
Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus Explanation: Phenytoin (Dilantin) is the prototype drug that controls seizures by decreasing sodium influx into the cells. Sodium influx produces an action potential, which then causes the neurons to fire.
What is the most important teaching from the plan of care, to emphasize, when a client is prescribed a skeletal muscle relaxant? Always take this medication with food to prevent nausea and vomiting. Do not drive or operate machinery until individual drug effects are known. Drink eight to 10 glasses of water daily to prevent constipation. Report increased muscle spasm to the health care provider immediately.
Do not drive or operate machinery until individual drug effects are known. Explanation: Drowsiness is the most common reaction seen with the use of skeletal muscle relaxants. The priority of care is safety; therefore, the most important teaching is to tell the client not to drive or operate machinery until the client knows how the drug affects him/her individually. Nausea and constipation may occur, but are not safety priorities. Increased muscle spasm may indicate the drug is not effective, but is not a high safety concern.
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 Contact the care provider to communicate this result Perform a focused neurological assessment Raise the client's bed rails and maintain the client on bed rest
Document the fact that the nurse checked the client's phenytoin levels Explanation: The therapeutic range is 10 to 20 mcg/mL. Consequently, there is no action needed beyond documentation
When developing a teaching plan for a client who is to receive carisoprodol, which sign or symptom would the nurse include as a common adverse reaction? · Drowsiness · Tachycardia · Dyspnea · Hypertension
Drowsiness Explanation: Drowsiness is the most common adverse reaction to skeletal muscle relaxants like carisoprodol that the nurse should discuss with the client. No correlation is found with skeletal muscle relaxants causing dyspnea. The Disease-modifying antirheumatic medication of leflunomide has the adverse reaction of hypertension. Tachycardia can be seen in the use of skeletal muscle relaxants but is not the most common and is seen in the use of dantrolene and diazepam.
When combination therapy is ineffective, what needs to be reassessed? Understanding of drug therapy regimen Drug-drug interactions Age and gender of patient Whether the patient is truly having seizures
Drug-drug interactions Explanation: Many of the AEDs have drug-drug interactions. Therefore, it is important to monitor for drug-drug interactions to arrange to adjust dosages appropriately if any drug is added or withdrawn from the drug regimen. The age and gender of the patient would not need to be reassessed and neither would whether or not the patient is truly having seizures
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? · Primidone · Mephobarbital · Ethosuximide · Ethotoin
Ethosuximide Explanation: Ethosuximide is most frequently used to treat absence seizures. Mephobarbital, ethotoin, and primidone are typically used for tonic-clonic seizures.
The nurse is examining a client's mouth to assess for potential adverse effects related to the long term use of which medication(s)? Select all that apply. Felbamate Valproic acid Carbamazepine Ethotoin Phenytoin
Ethotoin Phenytoin Gingival hyperplasia, although it can occur with any anticonvulsant, is commonly associated with long-term hydantoin therapy such as with phenytoin or ethotoin. Potential adverse effects of carbamazepine and felbamate include pancytopenia. Valproic acid is associated with an increased risk for pancreatitis.
Which type of seizures involves a loss of consciousness? · Generalized seizures · Somatosensory seizures · Partial seizures · Motor seizures
Generalized seizures Explanation: Generalized seizures involve a loss of consciousness.
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? Physical dependence Possible leukocytosis Gingival hyperplasia Withdrawal syndrome
Gingival hyperplasia Explanation: Hydantoins may cause gingival hyperplasia, severe liver toxicity, and bone marrow suppression. Physical dependence and withdrawal syndrome are associated with benzodiazepines.
The nurse is caring for a client whose current medication regimen includes baclofen 60 mg PO daily. What assessment should the nurse prioritize when assessing for therapeutic effects? Comparison of fine motor and gross motor skills Bilateral assessment of muscle strength Assessment for seizure activity Inspection for muscle spasticity and range of motion assessment
Inspection for muscle spasticity and range of motion assessment Explanation: Baclofen is prescribed to treat muscle spasticity and/or acute musculoskeletal discomfort. It is not an anticonvulsant and does not affect fine motor versus gross motor skills. An absence of spasticity may increase muscle strength but this is not the most direct effect of the medication.
A client has received a prescription for baclofen. The home care nurse would schedule which laboratory tests to monitor this client? CBC and electrolytes Cardiac function tests Liver function tests Hemoglobin and hematocrit
Liver function tests Explanation: Baclofen is metabolized in the liver and excreted in urine. The client must be monitored for adverse effects on liver function.
A client asks the nurse about the cause of idiopathic seizures. What is the nurse's bestresponse? · Passed from parent to child · High fever · No known cause · Brain injury at birth
No known cause Explanation: An idiopathic seizure has no known cause. Hereditary seizure disorders are passed from parent to child in their genetic makeup. Acquired seizure disorders have a known cause such as high fever. Brain injury at birth is an example of a cause for epilepsy.
A client is taking allopurinol for gout. The client exhibits an "itchy" skin rash on the neck and both arms. What is the nurse's top priority action? Notify the healthcare provider. Apply a moisturizing lotion. Document the finding as a common side effect. Recommend the client trim fingernails.
Notify the healthcare provider. Explanation: A rash while taking allopurinol should be reported to the healthcare provider, because it may precede a serious adverse reaction known as Stevens-Johnson syndrome. Applying a lotion may relieve itching, but notifying the healthcare provider is top priority as a safety precaution. Trimming the fingernails can help prevent further skin damage from scratching, but the healthcare provider needs to be notified as well
A client is to receive ethotoin. The nurse would expect to administer this drug by which route? Intramuscular Oral Intravenous Rectal
Oral Explanation: Ethotoin is administered orally.
A client is to receive ethotoin. The nurse would expect to administer this drug by which route? · Intramuscular · Intravenous · Oral · Rectal
Oral Explanation: Ethotoin is administered orally.
The nurse has administered anakinra to a client. Which assessment finding should the nurse prioritize? Constipation Abdominal pain Pancytopenia Retinal changes
Pancytopenia Explanation: Due to the immunosuppressive properties of DMARD drugs, pancytopenia is an adverse effect of anakinra, a DMARD, and the client should be monitored for it closely. Administration of anakinra may also cause headache and irritation at the injection site, but not constipation, abdominal pain, or retinal changes. Constipation is a potential adverse reaction to cyclobenzaprine. Retinal changes are potential adverse reactions to hydroxychloroquine. Pancytopenia is a potential adverse reaction to sulfasalazine, alendronate, ibandronate, risedronate, allopurinol, and colchicine
A nurse is administering lorazepam to a client with status epilepticus. The nurse will be prepared to administer which additional drug to treat the status epilepticus for the next several hours? Zonisamide Phenytoin Ethotoin Ethosuximide
Phenytoin Explanation: Due to the short effects of lorazepam, a longer-acting anticonvulsant, such as phenytoin, is given to continue control of seizure activity. Ethotoin is a hydantoin that is used to treat tonic-clonic seizures. Ethosuximide is a succinimide that is used to treat focal seizures. Zonisamide is a nonspecified preparation and used to treat focal seizures as well
A nurse is administering lorazepam to a client with status epilepticus. The nurse will be prepared to administer which additional drug to treat the status epilepticus for the next several hours? Ethosuximide Zonisamide Phenytoin Ethotoin
Phenytoin Explanation: Due to the short effects of lorazepam, a longer-acting anticonvulsant, such as phenytoin, is given to continue control of seizure activity. Ethotoin is a hydantoin that is used to treat tonic-clonic seizures. Ethosuximide is a succinimide that is used to treat focal seizures. Zonisamide is a nonspecified preparation and used to treat focal seizures as well.
The client, newly diagnosed with epilepsy, begins to show signs of seizure activity. What is the nurse's priority action? · Attempt to calm the client. · Protect the client's safety. · Obtain the client's vital signs as soon as possible. · Perform detailed documentation
Protect the client's safety. Explanation: As in any nursing situation, safety is paramount. The client's safety is prioritized over documentation or gathering vital signs. Seizure activity cannot be influenced by calming a client.
A client is receiving lamotrigine as treatment for partial seizures. Which assessment finding would lead the nurse to stop the drug immediately? Anorexia Rash Confusion Somnolence
Rash Explanation: Lamotrigine has been associated with very serious to life-threatening rashes, and the drug should be discontinued at the first sign of any rash. Somnolence and confusion are typical CNS effects; anorexia is a common gastrointestinal effect.
The nurse is preparing to administer cyclobenzaprine to a client. The nurse should question this order if which disorder(s) is noted in the past history? Select all that apply. Hepatic disease Diabetes Recent myocardial infarction Hyperthyroidism Hypertension
Recent myocardial infarction Hyperthyroidism The use of cyclobenzaprine is contraindicated in clients with a recent myocardial infarction, cardiac conduction disorders, hyperthyroidism, and known hypersensitivity to the drug and within 14 days of the administration of an MAOI. Individuals with diabetes should use DMARDS cautiously. Hepatic disease is a contraindication for clients to be administered oral dantrolene and colchicine. Hypertension is a potential adverse reaction to leflunomide.
While taking the vital signs of a hospitalized client admitted for seizure control due to epilepsy, the nurse notices a bloody toothbrush on the client's bedside table and scattered bruising over the client's extremities. What is the nurse's best action? · Tell the client to ask for assistance when ambulating so as to prevent bruising. · Notify the charge nurse about reporting suspected physical abuse. · Report the findings to the primary health care provider immediately. · Document the findings and offer the client a soft-bristled toothbrush.
Report the findings to the primary health care provider immediately. Explanation: The client has a history of epilepsy and is likely taking anticonvulsants. Hematologic changes when taking anticonvulsants needs to be reported immediately to the health care provider. Such changes include bleeding gums and easy bruising. Abuse is not the likely cause of the client's bruising given the history of epilepsy. Telling the client to ask for assistance when ambulating and offering a soft toothbrush are appropriate, but the health care provider needs to be notified immediately about the hematologic changes.
The nurse is teaching a client about the medication they are receiving as treatment for gout. The nurse determines the session is successful when the client correctly chooses which instruction as most important? Taking drug on an empty stomach Wearing a brace to get out of bed Using protection against sunlight Reporting any skin rash
Reporting any skin rash Explanation: The nurse should instruct the client to report any skin rash. A rash should be monitored carefully because it may precede a serious adverse reaction, such as Stevens-Johnson syndrome. The nurse need not instruct the client to take the drug on an empty stomach, use protection against sunlight, or wear a brace to get out of bed. Clients with osteoporosis are asked to wear a brace to get out of bed. Clients taking medications for gout are asked to take it with food. These clients are also instructed to avoid driving or performing other hazardous tasks
An older adult client experiencing seizures is prescribed diazepam. Which assessment should the nurse prioritize? Respiratory rate and depth Speech quality Blood glucose levels Swallowing ability
Respiratory rate and depth Explanation: Apnea and cardiac arrest can occur when diazepam is administered to older adults, very ill clients, and individuals with limited pulmonary reserve. Therefore, monitoring the client's respiratory rate and depth would be most important. If the client is prescribed diazepam and antidiabetic medications, there may be an increase in the blood glucose level. The nurse should test the client's swallowing ability by offering sips of water before giving the drug. If there is difficulty swallowing, hold the drug and contact the health care provider as soon as possible. Slurred speech is an adverse reaction of hydantoins. It is also a potential sign of toxicity; however, the most important would be to determine the respiratory status and if that is functioning within reasonable parameters, then address the toxicity issue, if present
A client has been prescribed phenytoin for the treatment of seizures. How should the nurse most accurately determine whether the client has therapeutic levels of the medication? Monitor the client for seizure activity. Review the client's laboratory blood work. Assess the client's cognitive status. Assess the client carefully for adverse effects.
Review the client's laboratory blood work. Explanation: Measuring serum drug levels evaluates whether the therapeutic range of circulating drug can be found in the serum. It does not directly evaluate effectiveness of therapy, however, which can only be evaluated by determining whether the drug is having the desired effect of reducing number of seizures. Short-term absence of seizures does not necessarily indicate that drug is within therapeutic range
A 77-year-old client is being admitted to a long-term care facility. The client has a history of absence seizures has been treated with ethosuximide for many years. While the nurse is creating a plan of care on the client, the nurse understands the potential adverse effects of this drug and would consequently prioritize which nursing diagnoses? Risk for Impaired Skin Integrity Risk for Impaired Gas Exchange Risk for Falls Risk for Altered Urinary Elimination
Risk for Falls Explanation: Common adverse effects of ethosuximide are drowsiness, dizziness, and lethargy- which potentiates the risk for fall in this client. Respiration, urinary function, and skin integrity are not normally affected by the use of ethosuximide
A 29-year-old client who experienced a lower back injury has seen his range of motion decrease and his pain increase over the past several weeks. As a result, he has been prescribed cyclobenzaprine. What nursing diagnosis should the nurse prioritize in light of the client's drug regimen? · Risk for Injury related to CNS depression · Risk for Ineffective Airway Clearance related to increased secretions and decreased lung function · Risk for Sexual Dysfunction related to endocrine changes · Risk for Impaired Swallowing related to adverse neuromuscular effects
Risk for Injury related to CNS depression Explanation: The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The drug is not noted to impact the patient's ability to swallow, cough, or function sexually.
A client has been prescribed a subcutaneous medication to treat rheumatoid arthritis (RA). The nurse should teach the client to do which? · Pinch the skin over the deltoid before injection. · Pull the skin to the side when injecting to prevent skin irritation. · Aspirate the syringe before injecting the medication. · Rotate sites when administering the injections.
Rotate sites when administering the injections. Explanation: The nurse should teach the client about rotating subcutaneous injection sites. The deltoid is a muscle, not a subcutaneous injection site. Pulling the skin to the side describes the Z-track method used with intramuscular injections. Aspirating is not recommended with subcutaneous injections
The nurse is administering a bisphosphonate to a client with Paget's disease. Which finding on assessment should the nurse prioritize? Increased skin rashes Serum calcium levels Hematology function Altered renal function
Serum calcium levels Explanation: The nurse should monitor the serum levels of calcium before, during, and after bisphosphonate therapy, because bisphosphonates act primarily on the bone by inhibiting normal and abnormal bone resorption. These drugs are used cautiously in clients with renal function impairment but do not alter renal function. The nurse should monitor the client's renal function when allopurinol is administered and hematology function when methotrexate is administered.
The primary health care provider prescribes adalimumab. The nurse would prepare to administer this drug by which route? · Orally · Intramuscularly · Intravenously · Subcutaneously
Subcutaneously Explanation: Adalimumab, a DMARD, is administered by subcutaneous injection. Abatacept and infliximab are examples of DMARDs that are administered IV. Methotrexate, sulfasalazine, and leflunomide are examples of DMARDs that can be given orally.
Which of the following drugs are approved for use in MS clients with severe spasticity? Dantrolene and Carisoprodol Tizanidine and Dantrolene Tizanidine and Baclofen Metaxalone and Carisoprodol
Tizanidine and Baclofen Explanation: Baclofen and tizanidine are approved for spasticity in people with MS. The two drugs are similarly effective, but tizanidine may cause fewer adverse effects
One week ago, a client began taking ethosuximide 500 mg/day PO for the treatment of absence seizures. The client reports gastrointestinal (GI) upset after taking with the drug. What health education should the nurse provide? · "Taking over-the-counter antacids before and after the dose helps for some clients." · "Take the drug 1 hour before or 2 hours after a meal to minimize stomach upset." · "Contact your health care provider to see if there's an alternative drug that would work for you." · "Try taking your pills at the same time as you eat some food."
Try taking your pills at the same time as you eat some food." Explanation: If GI irritation occurs with ethosuximide or other anticonvulsants, the client should be encouraged to take the medication with food to reduce this adverse effect. Taking the drug 1 to 2 hours after meals would not reduce this effect. The nurse must be cautious when recommending the use of OTC medications. GI effects are unlikely to necessitate a change in medications.
The health care provider orders short-term skeletal muscle relaxants for an 11-year-old client. The nurse is responsible for the family education plan and teaches the parents that the medications should be used only under which condition? When the client needs to be alert during pain management When the spasms cause uncontrolled pain When close supervision is available for monitoring drug effects During school hours to increase alertness and management of spasms
When close supervision is available for monitoring drug effects Explanation: For most of the skeletal muscle relaxants, safety and effectiveness for use in children 12 years of age and younger have not been established. The drugs should be used only when clearly indicated, for short periods, when close supervision is available for monitoring drug effects (especially sedation), and when mobility and alertness are not required
The nurse is preparing to administer the next dose of methsuximide to a client experiencing partial seizures. The client remarks about hoping their stomach will do better this time. Which suggestion from the nurse will best assist this client when administering this next dose? Immediately before eating a meal Daily at bedtime With some food or milk First thing in the morning on arising
With some food or milk Explanation: If the client experiences GI upset after succinimide administration, the nurse should instruct the client to take the drug with food or milk. The nurse need not instruct the client to take the drug once only at bedtime, before meals, or immediately on arising in the morning.
In a person being treated for a diagnosed seizure disorder, what is the most common cause of status epilepticus? abusing drugs and/or alcohol abruptly stopping the antiseizure medications hypoxia-inducing experience experiencing a brain injury
abruptly stopping the antiseizure medications Explanation: In a person taking medications for a diagnosed seizure disorder, the most common cause of status epilepticus is abruptly stopping AEDs. In other clients, regardless of whether they have a diagnosed seizure disorder, causes of status epilepticus include brain trauma or tumors, systemic or central nervous system (CNS) infections, alcohol withdrawal, and overdoses of drugs (e.g., cocaine, theophylline)
A client reports sensing an unusual smell just prior to experiencing a tonic-clonic seizure. What term is used to describe this event? aura spasm epilepsy spasticity
aura Explanation: Tonic-clonic seizures are sometimes preceded by an aura—a brief warning, such as a flash of light or a specific sound or smell. None of the other options accurately describe this event.
A client reports sensing an unusual smell just prior to experiencing a tonic-clonic seizure. What term is used to describe this event? · spasticity · epilepsy · spasm · aura
aura Explanation: Tonic-clonic seizures are sometimes preceded by an aura—a brief warning, such as a flash of light or a specific sound or smell. None of the other options accurately describe this event.
A client with muscle spasticity has been prescribed baclofen. In order to promote the safe use of this medication, the nurse should encourage the client to: · avoid eating grapefruit or drinking grapefruit juice until treatment is discontinued. · avoid drinking alcohol for the duration of treatment. · increase intake of foods that are high in potassium. · increase fluid intake and self-monitor for decreased urine output.
avoid drinking alcohol for the duration of treatment. Explanation: The CNS depressant effects of baclofen can be dangerously exacerbated by alcohol, which should be avoided. Grapefruit is not contraindicated and there is no reason to increase potassium or fluid intake while taking baclofen.
The nurse is caring for a client who has a disorder of muscle contraction and relaxation. The nurse should prioritize the assessment of what laboratory value? · calcium · magnesium · chloride · potassium
calcium Explanation: Calcium is released from the sarcoplasmic reticulum, which leads to the binding of calcium with troponin-tropomyosin. This leads to contraction of the muscle fiber. The calcium pump then moves calcium back into the sarcoplasmic reticulum, which leads to relaxation of muscle fiber. Chloride, magnesium, and potassium are not involved in this process
A client's seizure activity, which is isolated to facial and neck muscles, has been identified as being caused by one area of the client's brain. The nurse should anticipate the administration of what drug? clorazepate carbamazepine felbamate gabapentin
carbamazepine Explanation: Carbamazepine is often the drug of choice for treatment of partial seizures, which are described in this scenario. It has the ability to inhibit polysynaptic responses and to block sodium channels to prevent the formation of repetitive action potentials in the abnormal focus. Clorazepate is indicated for anxiety and alcohol withdrawal and used as adjunctive therapy for partial seizures. Felbamate has been associated with severe liver failure and aplastic anemia and is now reserved for those clients who do not respond to other therapies. Gabapentin is used as adjunctive therapy in the treatment of partial seizures and for the treatment of postherpetic neuralgia
client's seizure activity, which is isolated to facial and neck muscles, has been identified as being caused by one area of the client's brain. The nurse should anticipate the administration of what drug? · clorazepate · felbamate · gabapentin · carbamazepine
carbamazepine Explanation: Carbamazepine is often the drug of choice for treatment of partial seizures, which are described in this scenario. It has the ability to inhibit polysynaptic responses and to block sodium channels to prevent the formation of repetitive action potentials in the abnormal focus. Clorazepate is indicated for anxiety and alcohol withdrawal and used as adjunctive therapy for partial seizures. Felbamate has been associated with severe liver failure and aplastic anemia and is now reserved for those clients who do not respond to other therapies. Gabapentin is used as adjunctive therapy in the treatment of partial seizures and for the treatment of postherpetic neuralgia.
A surgical client has developed malignant hyperthermia. Which medication can be used to treat this health emergency? methocarbamol dantrolene carisoprodol metaxalone
dantrolene Explanation: Dantrolene acts directly on skeletal muscle to inhibit muscle contraction. It is used to relieve spasticity in neurologic disorders (e.g., MS, spinal cord injury) and to prevent or treat malignant hyperthermia, a rare but life-threatening complication of anesthesia characterized by hypercarbia, metabolic acidosis, skeletal muscle rigidity, fever, and cyanosis. None of the other medications are prescribed for this emergency.
What is a common risk for epileptic seizures during late infancy to early childhood? fever malnutrition learning disability medication overdose
fever Explanation: Epilepsy can be classified as idiopathic or attributable to a secondary cause. Secondary causes in infancy include developmental defects, metabolic disease, or birth injury. Fever is a common cause during late infancy and early childhood, and inherited forms usually begin in childhood or adolescence. Learning disability, medication overdose, and malnutrition are not risk factors.
What is a common risk for epileptic seizures during late infancy to early childhood? · malnutrition · fever · learning disability · medication overdose
fever Explanation: Epilepsy can be classified as idiopathic or attributable to a secondary cause. Secondary causes in infancy include developmental defects, metabolic disease, or birth injury. Fever is a common cause during late infancy and early childhood, and inherited forms usually begin in childhood or adolescence. Learning disability, medication overdose, and malnutrition are not risk factors.
A nurse is working with a 39-year-old client who is experiencing muscle spasms associated with multiple sclerosis. The client reports needing help with basic care The client's health care provider has prescribed baclofen (Lioresal). The nurse and the client agree that an appropriate goal related to helping to maintain self-worth would be to: increase self-care in activities of daily living. experience relief of pain. experience improved motor function. take medication independently.
increase self-care in activities of daily living. Explanation: All of the options are goals that the nurse would like the client to achieve. However, the goal related to self-worth would be to increase self-care in activities of daily living. Loss of ability to dress oneself puts the client at risk for decreased self-esteem and feelings of low self-worth
When caring for a client taking dantrolene, for what adverse effects should the nurse monitor the client? Select all that apply. bradycardia jaundice urinary retention fatigue drowsiness
jaundice fatigue drowsiness Explanation: Adverse effects of dantrolene include drowsiness, dizziness, weakness, fatigue, diarrhea, hepatitis, myalgia, tachycardia, transient blood pressure changes, rash, and urinary frequency. Hepatitis and other forms of liver damage could be indicated by the development of jaundice. Adverse effects of dantrolene do not include bradycardia or urinary retention
An adolescent taking oral contraceptives has been prescribed an anticonvulsant medication. The nurse should tell the client to do which? stop driving due to the increased depressant effects and excessive drowsiness. watch for signs of hyperglycemia, such as increased thirst, hunger, and urination. use another form of birth control, such as condoms. be aware that these two drugs will interact and increase seizure activity initially
use another form of birth control, such as condoms. Explanation: Anticonvulsants and oral contraceptives interact, leading to decreased effectiveness of birth control. This can result in breakthrough bleeding or unintended pregnancy. Anticonvulsants and antidiabetic medications interact, resulting in increased blood glucose levels. Anticonvulsants and antiseizure medications taken together may increase seizure activity. Anticonvulsants interact with analgesics and alcohol, not oral contraceptives, to cause increased depressant effects
An adolescent taking oral contraceptives has been prescribed an anticonvulsant medication. The nurse should tell the client to do which? watch for signs of hyperglycemia, such as increased thirst, hunger, and urination. stop driving due to the increased depressant effects and excessive drowsiness. be aware that these two drugs will interact and increase seizure activity initially. use another form of birth control, such as condoms.
use another form of birth control, such as condoms. Explanation: Anticonvulsants and oral contraceptives interact, leading to decreased effectiveness of birth control. This can result in breakthrough bleeding or unintended pregnancy. Anticonvulsants and antidiabetic medications interact, resulting in increased blood glucose levels. Anticonvulsants and antiseizure medications taken together may increase seizure activity. Anticonvulsants interact with analgesics and alcohol, not oral contraceptives, to cause increased depressant effects.
