PrepU Chapter 53
The nurse is caring for an 84-year-old client who was newly diagnosed with a seizure disorder. Before starting the client on an antiepileptic medication what laboratory studies should the nurse assess? Select all that apply.
Liver function studies Renal function studies
A client has been diagnosed with multiple sclerosis and experiences spasticity in several muscle groups. The client is prescribed a medication that will act peripherally on the muscles themselves. For what drug should the nurse provide educational information to the client?
dantrolene
What is a common risk for epileptic seizures during late infancy to early childhood?
fever
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.
A patient with cortical focal seizures has been prescribed phenobarbital. What adverse reaction should the nurse monitor for in the patient?
CNS depression
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
When developing a teaching plan for a client who is to receive carisoprodol, which sign or symptom would the nurse include as the most common adverse reaction?
Drowsiness
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
Signs and symptoms of what would necessitate discontinuation of dantrolene therapy?
Hepatic dysfunction
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?
"The combination of baclofen and alcohol could depress your nervous system to a dangerous level."
A client who is experiencing lower back pain has been prescribed cyclobenzapine. The nurse should provide what health education in order to ensure safe and effective treatment?
"This will likely make you drowsy, so don't take it before doing anything that would require alertness."
A client has been prescribed cyclobenzaprine for the treatment of muscle spasticity due to injury. The client asks if it is safe to take ibuprofen while taking cyclobenzaprine. What should the nurse teach the client?
"Check with your care provider, but it's likely not a problem."
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
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?
15 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
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 pregablin who is not responsive to verbal stimuli
Which client should the nurse identify as having an absence seizure?
A client whose alterations in consciousness last a few seconds
A client in status epilepticus has been brought to the emergency department. The nurse should anticipate which treatment measures?
Administration of intravenous lorazepam
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 is dosage
After administering a centrally acting skeletal muscle relaxant, what other independent nursing measures might the nurse implement to relieve pain and reduce spasm?
Application of heat to the affected region
Which instruction should the nurse specifically stress when administering drugs used for muscle spasm and cramping?
Avoid alcohol or other CNS depressants.
The nurse is caring for a client who is being discharged home from the rehabilitation unit. Baclofen will be discontinued and the client will begin taking carisoprodol as an outpatient. What is the nurse's primary consideration when discontinuing the client's baclofen?
Baclofen must be tapered down over one to two weeks to prevent psychoses and hallucinations
The nurse is caring for a 4-year-old child with a seizure disorder. The child requires an antiseizure agent. What principle should guide the care team's medication management?
Children often require a larger mg/kg dose than an adult.
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.
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 produces an anticholinergic response
A client with a history of malignant hyperthermia is scheduled for surgery. Which agent would the nurse most likely expect to administer?
Dantrolene
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
For a client with a known heart block (conduction disorder), what medication is contraindicated?
Dilantin
The client is taking baclofen (Lioresal). What would be the most important safety instruction for the nurse to give to this client?
Discontinue the use of alcohol.
While writing a care plan for a client newly diagnosed with generalized seizures, the nurse might appropriately choose what nursing diagnosis?
Disturbed thought processes related to central nervous system effects
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
A nurse administers carisoprodol to a client for the treatment of an acute musculoskeletal condition. The nurse would be alert for which adverse effect after administering the drug?
Drowsiness
When combination therapy is ineffective, what needs to be reassessed?
Drug-drug interactions
A child has been presented for care because he has episodes where he pauses what he is doing for a few seconds, is unresponsive, and then continues on with his activity. The nurse should anticipate the administration of what medication?
Ethosuximide
T/F: Muscle spasticity is the result of damage to peripheral structures rather than to injured neurons.
False
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
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 caring for a client whose current medication regimen includes baclofen 60 mg PO daily. What assessment should the nurse nurse prioritize when assessing for therapeutic effects?
Inspection for muscle spasticity and range of motion assessment
A client comes to the emergency department experiencing status epilepticus. Which medication would the nurse expect to administer?
Lorazepam
Status epilepticus is a life-threatening condition that needs immediate treatment. What is the drug of choice in treating status epilepticus?
Lorazepam
An operating room nurse is assisting the anesthesiologist in the preparation of an intravenous dose of dantrolene. What emergent issue most likely prompted the need to give the patient dantrolene?
Malignant hyperthermia
A client, newly diagnosed with a seizure disorder, has been prescribed valproic acid. When assessing for adverse effects, what assessment should the nurse prioritize?
Monitoring the client's liver enzyme levels
A client asks the nurse about the cause of idiopathic seizures. What is the nurse's best response?
No known cause
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?
Rash
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 providing client education for a client newly prescribed a hydantoin antiseizure medication. The nurse has taught the client about the need to taper down the dose of the drug slowly when the provider decides it should be discontinued. What benefit of tapering should the nurse describe?
Reduced risk of status epilepticus
A nurse is caring for a patient who is receiving cyclobenzaprine. Which of is the action of the drug on the patient?
Reduction of muscle spasm
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?
Review the client's laboratory blood work
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 with a history of partial seizures has been taking lamotrigine (Lamictal) for the past several days. The client calls the clinic and reports the development of a facial and torso rash to the nurse. What is the nurse's best action?
Tell the client to take no further doses and come be assessed at the clinic immediately
A client with a spinal cord injury is experiencing increasing muscle spasticity and the care team is considering the use of dantrolene. The nurse should identify what possible contraindication to the safe and effective use of this medication?
The client has hepatitis C
A nurse is to administer an anticonvulsant drug. The nurse understands that this drug is classified as an oxazolidinedione. Which drug would the nurse most likely be preparing to administer?
Trimethadione
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
A 32-year-old female client is taking tizanidine (Zanaflex) for spasticity related to her multiple sclerosis. The nurse will inform the client and her husband that the adverse effect that poses the greatest safety risk to the client is:
hypotension.
One week ago, a client began taking ethosuximide (Zarontin) 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 43-year-old woman was diagnosed with multiple sclerosis 2 years ago and has experienced a recent exacerbation of her symptoms, including muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium). In light of this new addition to her drug regimen, what teaching point should the woman's nurse provide?
"You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity."
A client has received a prescription for baclofen. The home care nurse would schedule which laboratory tests to monitor this client?
Liver function tests
What should the nurse include as a possible adverse effect when teaching a client about phenytoin?
Liver toxicity
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 drinking alcohol for the duration of treatment.
General anesthetic has been administered to a surgical client and the client has begun to exhibit signs and symptoms of malignant hyperthermia. The operating room nurse should prepare to assist with the administration of:
dantrolene