PrepU chapter 23 Anti-seizure Agents
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." "It's important to take a dose as soon as possible if you feel a seizure is coming." "I'll explain the foods that you should avoid 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." 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.
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? "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." "Take the drug 1 hour before or 2 hours after a meal to minimize stomach upset." "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." 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 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" "Yes, as long as your health care provider agrees and you take your medications regularly." "You can drive as soon as therapeutic drug levels are established." "You'll need to use public transportation because a seizure could occur anytime."
"You likely won't be able to until your seizures are controlled by medication" Explanation: Clients newly diagnosed with epilepsy will not be able to drive. However, after the client's seizures are controlled (usually for 6 months to 2 years depending on state law), the client may be able to regain the ability to drive. This does not, however, mean that the client has to use public transportation. Serum drug levels are not the determining criterion.
A client who is receiving phenytoin has a serum drug level drawn. Which result would the nurse interpret as within the therapeutic range? 30 mcg/mL 4 mcg/mL 22 mcg/mL 12 mcg/mL
12 mcg/mL 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 patient is receiving carbamazepine therapy. Which serum drug level result would lead the nurse to suspect that the patient needs a decrease in dosage?
14 mcg/mL A serum carbamazepine level of 14 mcg/mL is over the therapeutic range of 4 to 12 mcg/mL, necessitating a reduction in dosage. A serum carbamazepine level of 6 mcg/mL is within the therapeutic range of 4 to 12 mcg/mL. No dosage reduction would be necessary. A serum carbamazepine level of 8 mcg/mL is within the therapeutic range of 4 to 12 mcg/mL. No dosage reduction would be necessary. A serum carbamazepine level of 12 mcg/mL is within the therapeutic range of 4 to 12 mcg/mL. No dosage reduction would be necessary.
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.
A client is receiving phenytoin. The nurse monitors the client's plasma drug level. Which level would alert the nurse to the possibility of toxicity? 10 µg/mL 27 µg/mL 15 µg/mL 18 µg/mL
27 µg/mL Phenytoin plasma levels between 10 and 20 µg/mL give optimal anticonvulsant effect. However, many clients achieve seizure control at lower serum concentration levels. Levels greater than 20 µg/mL are associated with toxicity.
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? 15 to 20 minutes 60 seconds 5 minutes The time frame depends on the child's body surface area
5 minutes Explanation: IV phenobarbital has an onset of action of approximately 5 minutes.
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 myoclonic seizures who takes valproic acid A client receiving IV phenytoin to prevent seizures post-neurosurgery A client receiving ethosuximide for the prevention of absence seizures A client with a history of tonic-clonic seizures who takes phenobarbital
A client with a history of tonic-clonic seizures who takes phenobarbital Barbiturates, such as phenobarbital, have an associated risk for dependence. This is not true of the other listed drugs.
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 receiving IV phenytoin to prevent seizures post-neurosurgery A client with a history of tonic-clonic seizures who takes phenobarbital A client with a history of myoclonic seizures who takes valproic acid A client receiving ethosuximide for the prevention of absence seizures
A client with a history of tonic-clonic seizures who takes phenobarbital Explanation: Barbiturates, such as phenobarbital, have an associated risk for dependence. This is not true of the other listed drugs. Reference:
A client has been admitted to the emergency department and is experiencing tonic-clonic seizures. What intervention should the nurse prioritize? Administration of gabapentin PO as prescribed Administration of phenytoin IV as prescribed Establishing a therapeutic relationship with the client Assessment of the client's renal and hepatic function
Administration of phenytoin IV as prescribed Explanation: Active seizure activity is an emergency and the client's immediate physiological needs supersede the importance of therapeutic relationship. Phenytoin IV is among the most common treatments for tonic-clonic seizures; gabapentin PO is not typically used for this purpose, and PO administration of any type is unsafe due to the risk for aspiration. Treatment would not be withheld pending assessment of renal and hepatic function.
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 Assessment of the client's renal and hepatic function Administration of gabapentin PO as prescribed Establishing a therapeutic relationship with the client
Administration of phenytoin IV as prescribed Explanation: Active seizure activity is an emergency and the client's immediate physiological needs supersede the importance of therapeutic relationship. Phenytoin IV is among the most common treatments for tonic-clonic seizures; gabapentin PO is not typically used for this purpose, and PO administration of any type is unsafe due to the risk for aspiration. Treatment would not be withheld pending assessment of renal and hepatic function.
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) Blood urea nitrogen (BUN) Blood glucose level Partial thromboplastin time (PTT)
Alanine aminotransferase (ALT)
A nurse should monitor a client closely for increased CNS depressant effects when an anticonvulsant is used concomitantly with which substances? (Select all that apply.) Analgesics Oral contraceptives Antidiabetic medications Antibiotics Alcohol
Analgesics Alcohol The concomitant use of anticonvulsants and analgesics or alcohol can result in increased CNS depressant effects. concomitant dong thoi, phu tuy
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 Contact the provider to request a one-time supplementary dose Assess the client's renal function Call an emergency code
Anticipate a reduction in dosage Explanation: A serum carbamazepine level of 13 mcg/mL is slightly over the therapeutic range of 4 to 12 mcg/mL, indicating need for a reduction in dosage. This not an emergency, though it needs to be addressed. This result does not threaten the client's renal function.
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? Call an emergency code Anticipate a reduction in dosage Assess the client's renal function Contact the provider to request a one-time supplementary dose
Anticipate a reduction is dosage A serum carbamazepine level of 13 mcg/mL is slightly over the therapeutic range of 4 to 12 mcg/mL, indicating need for a reduction in dosage. This not an emergency, though it needs to be addressed. This result does not threaten the client's renal function
A patient with a seizure disorder has had a recent change in medication ordered. In evaluating the new drug's control of the seizure disorder, what would the nurse do? Assess for increase in seizure activity Evaluate laboratory reports for hypernatremia Assess for adverse effects Evaluate vital signs
Assess for adverse effects Explanation: Evaluation: Interview and assess for decrease in or absence of seizure activity. Interview and assess for avoidance of adverse drug effects, especially those that impair safety. When available, check laboratory reports of serum drug levels for therapeutic ranges or evidence of underdosing or overdosing. The nurse would not assess vital signs, hypernatremia, or an increase in seizure activity when evaluating the body's response to the new AED.
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? Diabetes Bone marrow depression Bipolar disorder Allergy to sulfonamides
Bone marrow depression Explanation: Carbamazepine is contraindicated in patients with previous bone marrow depression.
A patient with cortical focal seizures has been prescribed phenobarbital. What adverse reaction should the nurse monitor for in the patient? Ataxia CNS depression Urticaria Gingival hyperplasia
CNS depression The nurse should monitor CNS depression in the patient undergoing phenobarbital treatment. Gingival hyperplasia is an adverse reaction in a patient administered ethotoins. Ataxia and urticaria are adverse reactions in patients undergoing anticonvulsant ethosuximide therapy. Reference:
The nurse has administered gabapentin to a client. Following administration, the nurse should assess the client for what possible adverse effect? Hypertension Tetany Central nervous system (CNS) depression Paradoxical seizures
Central nervous system (CNS) depression The most common adverse effects of gabapentin are associated with CNS depression and include dizziness, somnolence, insomnia, and ataxia. The drug has not been noted to cause tetany, hypertension, or paradoxical seizures.
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? Take this medication with food to prevent nausea and vomiting. Contact the health care provider immediately if rash appears. Seek assistance when walking if dizziness occurs. A mild headache may occur while taking this medication.
Contact the health care provider immediately if rash appears. GI upset, headache, rash, and dizziness are all adverse reactions of lamotrigine. The most important teaching point to emphasize is to notify the health care provider if a rash appears. A rash can develop into a Stevens-Johnson syndrome rash, a severe and potentially fatal rash.
When describing the action of barbiturates and barbiturate-like agents in the control of seizures, what would the nurse include? Maintenance of cerebellar function Stimulation of the cerebral cortex Promotion of impulse conduction Depression of motor nerve output
Depression of motor nerve output The barbiturates and barbiturate-like drugs depress motor nerve output, inhibit impulse conduction in the ascending reticular activating system (RAS), depress the cerebral cortex, and alter cerebellar function. They stabilize nerve membranes throughout the CNS directly by influencing ionic channels in the cell membrane, thereby decreasing excitability and hyperexcitability to stimulation.
When describing the action of zonisamide, which would the nurse include? Depression of motor nerve output Decrease in conduction through nerve pathways Inhibition of sodium and calcium channels Depression of the cerebral cortex
Depression of motor nerve output The barbiturates and barbiturate-like drugs depress motor nerve output, inhibit impulse conduction in the ascending reticular activating system (RAS), depress the cerebral cortex, and alter cerebellar function. They stabilize nerve membranes throughout the CNS directly by influencing ionic channels in the cell membrane, thereby decreasing excitability and hyperexcitability to stimulation.
For a client with a known heart block (conduction disorder), what medication is contraindicated? Theophylline Lithium Dilantin Valproic acid
Dilantin Explanation: Phenytoin, carbamazepine, ethosuximide, lamotrigine, topiramate, and zonisamide are contraindicated or must be used cautiously in clients with hepatic or renal impairment. Additional contraindications include phenytoin in clients with sinus bradycardia or heart block; carbamazepine in those with bone marrow depression (e.g., leukopenia, agranulocytosis); and tiagabine and valproic acid in people with liver disease.
A client has been prescribed carbamazepine for the prevention of seizures. What action should the nurse perform? Educate the client about taking the medication at the first sign of impending seizure activity Educate the client about the need to take the pills as scheduled Establish intravenous access Teach the client how to self-administer subcutaneous injections
Educate the client about the need to take the pills as scheduled Explanation: Carbamazepine is administered orally on an ongoing basis. It is not an emergency treatment for seizure activity.
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 Seizure activity Cardiac dysfunction Renal dysfunction
Falls:In older adults, decreased elimination by the liver and kidneys may lead to drug accumulation, with subsequent risks of dizziness, impaired coordination, and injuries due to falls.
Tonic-clonic seizures and myoclonic seizures are classified as what type of seizures?
Generalized seizures Tonic-clonic seizures and myoclonic seizures are classified generalized seizures.
Which type of seizures involves a loss of consciousness? Somatosensory seizures Partial seizures Motor seizures Generalized seizures
Generalized seizures Explanation: Generalized seizures involve a loss of consciousness.
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 Make a referral to occupational therapy Maintain the client on bed rest Monitor vital signs hourly while the client is awake
Implement falls precautions CNS depression creates a risk for falls, especially in older clients. There is no need to assess vital signs on an hourly basis, and the harm of bed rest exceeds the benefits. Occupational therapy has no direct relationship with treating CNS depression.
What best reflects the action of barbiturates when used to control seizures? Stimulation of the cerebral cortex Enhancement of cerebellar functioning Stimulation of motor nerve output Inhibition of impulse conduction
Inhibition of impulse conduction Explanation: Barbiturates inhibit impulse conduction in the ascending reticular activating system. Barbiturates depress the cerebral cortex, depress cerebellar functioning, and depress motor nerve output.
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? Fosphenytoin Valproic acid Lorazepam Phenytoin Clorazepate
Lorazepam Lorazepam (Ativan) is the drug of choice for this condition. However, because the effects of lorazepam last less than 1 hour, longer-lasting anticonvulsants such as phenytoin or fosphenytoin may be given to continue to control the seizure activity. Valproic acid is used to treat epilepsy, migraine headache, and mania. Clorazepate is used to treat focal seizures, anxiety disorders, and alcohol withdrawal.
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 Generalized seizures Tonic-clonic seizures
Partial seizures
A patient is admitted to the emergency department with severe recurrent convulsive seizures. What drug would the nurse expect to be ordered for use in emergency control of status epilepticus? A) Phenytoin (Dilantin) B) Diazepam (Valium) C) Phenobarbital (Luminal) D) Ethosuximide (Zarontin)
Phenobarbital is used for emergency control of status epilepticus. This barbiturate inhibits impulse conduction in the ascending reticular activating system (RAS), depresses the cerebral cortex, alters cerebellar function, and depresses motor nerve output. Phenobarbital stabilizes nerve membranes throughout the central nervous system (CNS) directly by influencing ionic channels in the cell membrane, thereby decreasing excitability and hyperexcitability to stimulation. By decreasing conduction through nerve pathways, it reduces the tonicclonic, muscular, and emotional responses to stimulation. Phenobarbital depresses conduction in the lower brainstem and the cerebral cortex and depresses motor conduction. Phenytoin is used to prevent status epilepticus but is not used to stop seizures after they have started; diazepam is used for short-term treatment of status epilepticus. Ethosuximide is used for absence 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? Lorazepam Phenytoin Valproic acid Ethosuximide
Phenytoin Explanation: Hydantoins like phenytoin elicit their effects by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain. Valproic acid increases the levels of GABA to help stabilize the membranes. Ethosuximide depresses the motor cortex, creating a higher threshold before the nerves react to the convulsive stimulus. Lorazepam elevates the seizure threshold by decreasing postsynaptic excitation.
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? Loss of consciousness A sustained contraction of the skeletal muscles Abnormal posturing Rapid rhythmic and symmetric jerking movements
Rapid rhythmic and symmetric jerking movements Explanation: The tonic phase of a tonic-clonic seizure involves sustained contraction of skeletal muscles, abnormal postures, and absence of respiration. The clonic phase of the seizure is characterized by rapid rhythmic and symmetric jerking movements of the body.
The nurse has taught a client who is receiving lamotrigine about possible adverse effects. The nurse determines that the client has understood the teaching when the client identifies a need to promptly report what adverse effect? Anorexia Signs of upper respiratory infection Rash Fatigue
Rash Lamotrigine has been associated with very serious to life-threatening rashes and the drug should be discontinued at the first sign of any rash. Anorexia is a common adverse GI effect. Fatigue is a common adverse CNS effect. Upper respiratory infection is an adverse effect of the drug, but it is not life threatening and does not need to be reported immediately.
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. Tell the client to ask for assistance when ambulating so as to prevent bruising. Notify the charge nurse about reporting suspected physical abuse. Document the findings and offer the client a soft-bristled toothbrush.
Report the findings to the primary health care provider immediately. 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 has administered gabapentin to a client. Following administration, the nurse should assess the client for what possible adverse effect? Paradoxical seizures Hypertension Tetany Central nervous system (CNS) depression
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.
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 Altered Urinary Elimination Risk for Impaired Gas Exchange Risk for Falls Risk for Impaired Skin Integrity
Risk for Falls 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.
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 Impaired skin integrity Ineffective coping Risk for imbalanced fluid volume
Risk for injury CNS depression that accompanies many antiseizure agents could lead to injury. Therefore risk for injury and safety measures would be the priorities. Imbalanced fluid volume would be appropriate if the client was experiencing vomiting or diarrhea or showing signs of dehydration. Impaired skin integrity might be appropriate if the client developed a rash. Ineffective coping would be appropriate if the client was verbalizing difficulties with his condition or therapy.
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? Disturbed thought processes related to seizure activity Risk for injury related to seizure activity Acute confusion related to seizure activity and drug effects Disturbed sensory perception related to adverse drug effects
Risk for injury related to seizure activity Seizures present an acute risk for injury which the nurse must prioritize when caring for the client. Cognitive and/or sensory disruptions are likely as well, but none of these presents such a high risk to the client's safety as the risk for injury.
A nurse is caring for a patient administered ethotoin. What are signs of toxicity for which the nurse should monitor the patient? Constipation Slurred speech Diarrhea Urinary frequency
Slurred speech The nurse should monitor the patient for slurred speech which is a sign of toxicity. Constipation, diarrhea, and urinary frequency are not signs of toxicity of ethotoin. Constipation and diarrhea are adverse reactions of barbiturates. Urinary frequency is an adverse reaction of succinimides.
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? Nystagmus Status epilepticus CNS depression Hypotension
Status epilepticus Status epilepticus may result from abrupt discontinuation of the drug, even when the anticonvulsant is being administered in small daily doses. Abrupt discontinuation of the drug does not cause CNS depression, hypotension, or nystagmus. CNS depression, hypotension, and nystagmus are adverse reactions of phenytoin.
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. Take the drugs before meals. Take the drug once only at bedtime.
Take the drug with food or milk. If the patient experiences GI upset after succinimides administration, the nurse should instruct the patient to take the drug with food or milk. The nurse need not instruct the patient to take the drug once only at bedtime, before meals, nor avoid taking fruit juice.
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? Different drugs are more effective in certain people than other drugs are. When prescribing an AED, the health care provider takes into account the type of seizure the client is having. When prescribing an AED, the health care provider takes into account the age and gender of the client. Different drugs work differently in different people.
When prescribing an AED, the health care provider takes into account the type of seizure the client is having. Type of seizure is a major factor in drug selection. Age and gender are not factors that impact the choice of AED.
which factor should the clinician reassess when combination therapy is ineffective? Drug side effects Drug-drug interactions The patient's age and gender The frequency of the seizures
drug-drug interactions If combination therapy is ineffective, the clinician may need to reassess the patient for type of seizure, medical conditions or drug-drug interactions that aggravate the seizure disorder or decrease the effectiveness of antiseizure drugs, and compliance with the prescribed drug therapy regimen.
What is a common risk for epileptic seizures during late infancy to early childhood? fever learning disability malnutrition medication overdose
fever 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.
What is the primary medication prescribed to relieve pain associated with shingles? morphine sulfate meperidine naproxen sodium gabapentin
gabapentin Explanation: Gabapentin is the first oral medication approved by the FDA for the management of postherpetic neuralgia. Meperidine and morphine sulfate will provide pain relief, but neither are effective in postherpetic neuralgia relief. Naproxen sodium will decrease inflammation but is not effective for postherpetic neuralgia relief.
Which antiepileptic drug may be administered to a client with impaired liver function? levetiracetam carbamazepine oxcarbazepine fosphenytoin
levetiracetam Explanation: Since levetiracetam is not primarily metabolized in the liver, it is the drug of choice for clients diagnosed with liver impairment. Oxcarbazepine, fosphenytoin, and carbamazepine are metabolized in the liver.
A client is prescribed methsuximide. The nurse should expect to administer this drug by which route?
oral
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: nervous breakdown. hearing impairment. renal impairment. respiratory depression.
renal impairment. The nurse should know that carbamazepine is contraindicated among clients with renal impairment. Carbamazepine is not contraindicated in those with nervous breakdown, hearing impairment, and respiratory depression.
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? the client should allow for periods of rest during the day. since she is taking oral contraceptives, she will need to use an additional form of birth control. GI problems are to be expected. she must have an eye exam at least every other month during oxcarbazepine therapy.
since she is taking oral contraceptives, she will need to use an additional form of birth control. Oxcarbazepine causes the circulating levels of oral contraceptives to decrease by up to half. The nurse should teach the client that she will need to use an additional form of birth control. Fatigue may be a concern, and the client should allow for rest periods during the day. Diplopia and abnormal vision can be adverse effects of the drug and eye exams should be part of the client's treatment regimen but they are not needed every other month. Informing the client that GI problems are common adverse effects is important but not as critical as preventing an unplanned pregnancy.
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? anorexia insomnia skin rash fever
skin rash Explanation: The FDA has issued a black box warning related to the potential development of serious dermatologic reactions. It should be discontinued at the first sign of skin rash in an adult. Insomnia, anorexia, and fever aren't known adverse effects, so the nurse wouldn't mention them in the teaching.
What type of seizure activity is characterized by generalized tonic-clonic convulsions lasting for several minutes during which the client does not regain consciousness? akinetic motor status epilepticus febrile
status epilepticus Status epilepticus is a life-threatening emergency characterized by generalized tonic-clonic convulsions lasting for several minutes or occurring at close intervals during which the client does not regain consciousness. None of the other options present with this described experience.
An adolescent taking oral contraceptives has been prescribed an anticonvulsant medication. The nurse should tell the client to do which? be aware that these two drugs will interact and increase seizure activity initially. use another form of birth control, such as condoms. watch for signs of hyperglycemia, such as increased thirst, hunger, and urination. stop driving due to the increased depressant effects and excessive drowsiness.
use another form of birth control, such as condoms. 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.
