NUR 2144 Pharmacology II Chapter 23: Anti-seizure Agents
The nurse has been educating the client on the self-administration of phenytoin. Which statement made by the client demonstrates an understanding of the medication?
"I'll make sure to take the drug with food."
A 30-year-old female client is diagnosed with seizure disorder, and the provider is considering the use of carbamazepine. What assessment question best addresses the safety and effectiveness of the medication regimen?
"Is there any chance that you could be pregnant?"
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?
"It's safest if you avoid drinking alcohol while you're taking this drug."
During an in-service, the charge nurse explains to the licensed vocational nurse (LVN) that there are six categories of anticonvulsants with different mechanisms of action. The LVN demonstrates understanding of the action of the miscellaneous drug, gabapentin, by stating which of the following?
"This drug is a gamma-aminobutyric acid (GABA) agonist."
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?
"Try taking your pills at the same time as you eat some food."
The nurse is providing client teaching with a client who is newly diagnosed with epilepsy. The client asks, "Can I still drive to work?" What is the nurse's best response?
"You likely won't be able to until your seizures are controlled by medication"
A client who is receiving phenytoin has a serum drug level drawn. Which result would the nurse interpret as within the therapeutic range?
12 mcg/mL
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?
2 mcg/mL
The nurse has just begun administering phenobarbital intravenously to a child within status epilepticus. The nurse would expect this drug to begin working within which time frame?
5 minutes
A nurse who gives care on a neurological floor is working with several clients. Which client should the nurse prioritize for further assessment and possible interventions?
A client receiving pregabalin who is not responsive to verbal stimuli
The neurological nurse cares for several clients who have seizure disorders. Which client should the nurse monitor most closely for indications of drug dependence?
A client with a history of tonic-clonic seizures who takes phenobarbital
A client has been admitted to the emergency department and is experiencing tonic-clonic seizures. What intervention should the nurse prioritize?
Administration of phenytoin IV as prescribed
A nurse is caring for a patient who is going to take ethosuximide. During the nurse's initial assessment, the nurse learns that the patient's history includes hepatitis. Which laboratory test should be done before therapy is started?
Alanine aminotransferase (ALT)
The school nurse sees a child who has had an absence seizure. Which characteristics are typical of this type of seizure?
Alterations in consciousness that last seconds
A client is receiving carbamazepine therapy and the client's latest serum level of the drug is 13 mcg/mL. What action is most appropriate?
Anticipate a reduction in dosage
A client who has been taking medication for a seizure disorder is asking the nurse about getting pregnant. Why is pregnancy discouraged in women who are being treated for seizure disorders?
Antiepilepsy drugs are teratogenic.
A 25-year-old client takes ethosuximide for the treatment of absence seizures calls the clinic to report that she has developed a sore throat and a slight fever. The nurse will explain that she should come to the clinic to have what checked?
Blood cell count
A nurse is treating a patient who is receiving carbamazepine for a seizure disorder. The nurse knows that carbamazepine is contraindicated in patients with which diseases or disorders?
Bone marrow depression
The nurse is documenting the history of a client who is starting anticonvulsant therapy with carbamazepine. The nurse reviews the client's medical record for possible conditions contraindicating the drug's use. Which, if found, would lead the nurse to notify the primary health care provider?
Bone marrow depression
A patient with cortical focal seizures has been prescribed phenobarbital. What adverse reaction should the nurse monitor for in the patient?
CNS depression
Which would be most important to monitor in a client receiving ethosuximide?
Complete blood count
Which type of seizure would the nurse be least likely to include as a type of generalized seizure?
Complex seizures
The most common adverse effects associated with antiepileptic therapy reflect the depression of the CNS. In assessing a patient on antiepileptic therapy, the nurse would monitor the patient for which conditions?
Confusion GI depression
A client in the clinic with a history of epilepsy has just tested positive for pregnancy. What is the nurse's next action?
Consult with the primary health care provider.
A client is prescribed lamotrigine for control of partial seizures. What is the most important medication teaching information the nurse should emphasize from the plan of care?
Contact the health care provider immediately if rash appears.
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?
Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus
When describing the action of barbiturates and barbiturate-like agents in the control of seizures, what would the nurse include?
Depression of motor nerve output
What medication may be administered intravenously (IV) to assist in reducing status epilepticus seizure activity?
Diazepam
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
Which factor should the clinician reassess when combination therapy is ineffective?
Drug-drug interactions
A client has been prescribed carbamazepine for the prevention of seizures. What action should the nurse perform?
Educate the client about the need to take the pills as scheduled
The community health nurse also assists the health care provider in the decision-making process for AED drug titration by performing which function?
Ensuring that the client makes the appointments for serum drug levels
A child suffers from absence seizures. What is the drug of choice for absence seizures?
Ethosuximide
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?
Ethosuximide
The nurse instructs the parent of a young school-age child with a seizure disorder who takes an AED to be alert for what signs and symptoms?
Excessive sedation and interference with learning and social development
The nurse is caring for an 84-year-old client who is taking an AED and recognizes that this client is at increased risk for which condition?
Falls
When reviewing a journal article about seizure disorders, the nurse would expect to find tonic-clonic seizures and myoclonic seizures being classified as which type of seizures?
Generalized seizures
Which type of seizures involves a loss of consciousness?
Generalized seizures
A 7-year-old child with epilepsy takes phenytoin for the control of seizures. What oral assessment does the nurse make related to a common side effect of the medication?
Gingival hyperplasia
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?
Gingival hyperplasia
The nurse should be cautious and closely monitor clients receiving phenytoin (Dilantin) with which medical conditions? (Select all that apply.)
Hypotension Hepatic impairment
An older adult client has been prescribed an antiseizure medication and is experiencing central nervous system depression. What is the nurse's most appropriate action?
Implement falls precautions
The nurse is formulating a care plan for a client with a seizure disorder. Which intervention would be an appropriate for the nurse to include?
Informing the client and family that seizure control is not gained immediately
What best reflects the action of barbiturates when used to control seizures?
Inhibition of impulse conduction
When describing the action of zonisamide, which would the nurse include?
Inhibition of sodium and calcium channels
A health care prescriber recently ordered a change in medication for a patient with a seizure disorder. Which action would the nurse take in evaluating the new drug's control of the seizure disorder?
Interview and observe for adverse effects
Which agent would a nurse expect to administer intravenously for a partial seizure?
Levetiracetam
A client has been prescribed valproic acid for the treatment of myoclonic seizures. When reviewing this client's latest laboratory results for signs of adverse effects, what results should the nurse prioritize?
Liver enzymes
What should the nurse include as a possible adverse effect when teaching a client about phenytoin?
Liver toxicity
A client comes to the emergency department. The client is experiencing continuous seizure activity without any interruptions. Which anticonvulsant would the nurse anticipate that the primary health care provider would most likely prescribe initially?
Lorazepam
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 actions should the nurse take? Select all that apply.
Notify the primary care provider immediately Assess vital signs Document the skin assessment.
A nurse is caring for a patient prescribed phenobarbital for status epilepticus. What intervention should the nurse perform when the patient has been administered the drug?
Observe respirations frequently.
A client is prescribed methsuximide. The nurse should expect to administer this drug by which route?
Oral
A client is to receive ethotoin. The nurse would expect to administer this drug by which route?
Oral
After teaching a group of nursing students about seizures, the instructor determines that the teaching was successful when the group identifies seizures that do not impair consciousness but can involve the senses or motor ability as which type?
Partial seizures
A nurse is preparing to administer an anticonvulsant that produces its effects by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain. Which medication would the nurse administer?
Phenytoin
A 15-year-old is observed having a tonic-clonic seizure at school. Which behavior would allow the school nurse to recognize the clonic phase of the seizure?
Rapid rhythmic and symmetric jerking movements
A client is receiving lamotrigine as treatment for partial seizures. Which assessment finding would lead the nurse to stop the drug immediately?
Rash
The nurse is educating the client who has been started on Dilantin and its side effects. Which symptom would indicate a life-threatening condition and should be reported to the healthcare provider immediately?
Rash with itching
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?
Report the findings to the primary health care provider immediately.
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 Falls
Which nursing diagnosis would be most important for a nurse to include in the plan of care for a client who is receiving an antiseizure agent and experiencing common adverse effects?
Risk for injury
The nurse is participating in the care of a client in status epilepticus who is receiving phenobarbital IV. Which nursing diagnosis should the nurse prioritize during this client's current care?
Risk for injury related to seizure activity
The nurse is caring for a client who has taken hydantoins for several years. The nurse noted that the client has an unsteady gait, dizziness, nystagmus, acute confusion, a non-raised red rash on one arm, and has not been to the dentist for 2 years. Based upon the findings, what is the priority nursing diagnosis?
Risk for injury related to untoward effect of hydantoin
A client who is receiving an antiseizure agent reports feeling sleepy and tired and reports dizziness when standing up. Which intervention would the nurse most likely implement as the priority?
Safety precautions
A nurse is caring for a patient administered ethotoin. What are signs of toxicity for which the nurse should monitor the patient?
Slurred speech
A patient is prescribed daily doses of phenytoin for seizures. The nurse knows that a single dose should not be missed during the course of treatment. Which condition could result if a dose is missed?
Status epilepticus
The nurse is teaching a client who has been started on antiseizure medications. The nurse should inform the client that abrupt withdrawal from the medications can cause which problem?
Status epilepticus
A patient with partial seizures has been prescribed succinimides at a health care facility. The patient experiences GI upset after succinimides administration. What should the nurse instruct the patient to do?
Take the drug with food or milk.
A client is prescribed topiramate. The nurse cautions the client to avoid the intake of alcohol for which reason?
The client is at risk for increased CNS depression.
When teaching a group of students about epilepsy, which characteristic should the nurse include?
The most prevalent neurological disorder
A patient has been stabilized on phenytoin (Dilantin) for several years and has not experienced a grand mal seizure in more than 3 years. The patient decides to stop the drug because it no longer seems to be needed. In counseling, the nurse should include which points?
This drug needs to be slowly tapered to avoid potentially serious adverse effects. Stopping the drug suddenly could precipitate seizures because the nerves will be more sensitive.
A nurse is to administer an anticonvulsant drug. The nurse understands that this drug is classified as an oxazolidinedione. Which drug would the nurse administer?
Trimethadione
After teaching a group of students about anticonvulsant therapy, the instructor determines that the teaching was successful when the group identifies which drug as eliciting its effects by increasing levels of gamma-aminobutyric acid (GABA), which stabilizes cell membranes?
Valproic acid
Which drug would the nurse expect to be ordered as the drug of choice for the treatment for myoclonic seizures?
Valproic acid
Which instruction would the nurse encourage a patient receiving an antiepileptic drug to do?
Wear or carry a MedicAlert identification.
A client, newly diagnosed with a seizure disorder, asks the nurse why the client is receiving a specific drug. What would be the best answer by the nurse?
When prescribing an AED, the health care provider takes into account the type of seizure the client is having.
In a person being treated for a diagnosed seizure disorder, what is the most common cause of status epilepticus?
abruptly stopping the antiseizure medications
While speaking with a client, the nurse notes that the client stares off, unblinking. The nurse notes that after several prompts, the client blinks rapidly and then resumes normal conversation. This behavior is consistent with what type of seizure?
absence
Drugs that are commonly used to treat grand mal seizures include
barbiturates, benzodiazepines, and hydantoins.
One drug that is used alone in the treatment of partial seizures is
carbamazepine.
The drug of choice for the treatment of absence seizures is
ethosuximide.
What is a common risk for epileptic seizures during late infancy to early childhood?
fever
What is the primary medication prescribed to relieve pain associated with shingles?
gabapentin
Focal or partial seizures
involve only part of the brain.
A nurse is caring for a client with trigeminal neuralgia at a health care facility. The health care provider has prescribed carbamazepine. In which case is the use of carbamazepine contraindicated in clients with:
renal impairment.
The nurse is caring for a 26-year-old client with partial seizures and has been prescribed oxcarbazepine as monotherapy. It will be critical for the nurse to inform the client of which needed action?
since she is taking oral contraceptives, she will need to use an additional form of birth control.
The nurse is providing education to an adult client who has been prescribed lamotrigine for a seizure disorder. The nurse should inform the client that the medication must be stopped if what unexpected reaction develops?
skin rash
Treatment of epilepsy is directed at
stabilizing overexcited nerve membranes.
What type of seizure activity is characterized by generalized tonic-clonic convulsions lasting for several minutes during which the client does not regain consciousness?
status epilepticus
