A Client with Seizures Pharm Questions

The client newly diagnosed with epilepsy is prescribed an anticonvulsant medication. Which information should the nurse tell the client? 1. The medication dosage will start low and gradually increase over a few weeks. 2. The dosage prescribed initially will be the dosage prescribed for the rest of your life. 3. The health-care provider will prescribe a loading dose and decrease dosage gradually. 4. The dose of medication will be adjusted monthly until a serum drug level is obtained.

1. Anticonvulsant dosages usually start low and gradually increase over a period of weeks until the serum drug level is within therapeutic range or the seizures stop.

The client with a seizure disorder who is taking carbamazepine (Tegretol) tells the clinic nurse, "I am taking evening primrose oil for my premenstrual cramps and it is really working." Which statement would be the nurse's best response? 1. "You should inform your health-care provider about taking this herb." 2. "It is very dangerous to take both the herb and Tegretol." 3. "Herbs are natural substances and I am glad it is helping your PMS." 4. "Are you sure you should be taking herbs along with Tegretol?"

1. Evening primrose oil may lower the seizure threshold, and the Tegretol dose may need to be modified. Therefore, the client should notify the health-care provider.

The client newly diagnosed with a seizure disorder also has Type 2 diabetes. The health-care provider prescribes phenytoin (Dilantin) for the client. Which intervention should the nurse implement? 1. Instruct the client to monitor his or her blood glucose more closely. 2. Explain that the Dilantin will not affect the client's antidiabetic medication. 3. Discuss the need to discontinue oral hypoglycemic medication and take insulin. 4. Call the health-care provider to discuss prescribing the Dilantin.

1. Serum glucose must be monitored more closely because phenytoin may inhibit insulin release, thus causing an increase in glucose level.

The client with a seizure disorder is prescribed the anticonvulsant fosphenytoin (Cerebyx). Which interventions should the nurse discuss with the client? Select all that apply. 1. Instruct the client to wear a MedicAlert bracelet and carry identification. 2. Tell the client to not self-medicate with over-the-counter medications. 3. Encourage the client to decrease drinking of any type of alcohol. 4. Discuss the importance of maintaining good oral hygiene. 5. Explain the importance of maintaining adequate nutritional intake.

1. The client should wear a MedicAlert bracelet and carry identification so that a health-care provider and others possibly providing care know that the client has a seizure disorder. 2. The client should not take any overthe-counter medications without first consulting with the HCP or pharmacist because many medications interact with Cerebyx. 5. Dilantin may cause anorexia, nausea, and vomiting; therefore, the client should maintain an adequate nutritional intake.

The female client diagnosed with epilepsy tells the nurse, "I am very scared to get pregnant since I am taking medication for my epilepsy." Which statement is the nurse's best response? 1. "You are scared because you take medication for your epilepsy." 2. "Many women with epilepsy give birth to normal infants." 3. "You should not get pregnant when you are taking anticonvulsants." 4. "Have you discussed your concerns with your health-care provider?"

2. Many anticonvulsant medications have teratogenic properties that increase the risk for fetal malformations, but many women with epilepsy give birth to normal infants. The nurse should provide the client with facts.

The nurse is preparing to administer phenytoin (Dilantin) intravenous push. The client has an IV of D5W 0.45 NS at 50 mL/hr. Which action should the nurse implement? 1. Administer the Dilantin undiluted over 5 minutes via the port closest to the client. 2. Dilute the medication with normal saline and administer over 2 minutes. 3. Flush tubing with normal saline (NS), administer diluted Dilantin, and then flush with NS. 4. Insert a saline lock in the other arm and administer the medication undiluted.

3. Dilantin should be diluted in a saline solution and the IV tubing should be flushed before and after administration because a dextrose solution will cause drug precipitation.

Which data should the nurse assess for the client with a seizure disorder who is taking valproate (Depakote)? 1. Creatinine and BUN. 2. White blood cell count. 3. Liver enzymes. 4. Red blood cell count.

3. Hepatotoxicity is one of the possible adverse reactions to Depakote; therefore, the liver enzymes should be monitored.

The client with a seizure disorder is prescribed the anticonvulsant phenytoin (Dilantin). Which statement indicates the client understands the medication teaching? 1. "If my urine turns a reddish-brown color, I should call my doctor." 2. "I should take my medication on an empty stomach." 3. "I will use a soft-bristled toothbrush to brush my teeth." 4. "I may get a sore throat when taking this medication."

3. The client should use a soft-bristled toothbrush to prevent gum irritation and bleeding. Gingival hyperplasia (overgrowth of gums) is a side effect of this medication.

The nurse is preparing to administer the following anticonvulsant medications. Which medication would the nurse question administering? 1. Carbamazepine (Tegretol) to the client who has a Tegretol serum level of 8 g/mL. 2. Clonazepam (Klonopin) to the client who has a Klonopin serum level of 60 ng/mL. 3. Phenytoin (Dilantin) to the client who has a Dilantin serum level of 26 g/mL. 4. Ethosuximide (Zarontin) to the client who has a Zarontin serum level of 45 g/mL.

3. The therapeutic serum level of Dilantin is 10-20 g/mL. Because the client's level is above that range, the nurse should question administering this medication.

The client is having status epilepticus and is prescribed intravenous diazepam (Valium). The client has an IV of D5W 75 mL/hr in the right arm and a saline lock in the left arm. Which intervention should the nurse implement? 1. Dilute the Valium and administer over 5 minutes via the existing IV. 2. Do not dilute the medication and administer at the port closest to the client. 3. Question the order because Valium cannot be administered with D5W. 4. Inject 3 mL of normal saline in the saline lock and administer Valium undiluted.

4. The nurse should administer the Valium undiluted through the saline lock.