Chapter 56: Neurological Medications

Phenytoin, 100 mg orally three times daily, has been prescribed for a client for seizure control. The nurse reinforces instructions regarding the medication to the client. Which statement by the client indicates an understanding of the instructions? 1. "I will use a soft toothbrush to brush my teeth." 2. "It's all right to break the capsules to make it easier for me to swallow them." 3. "If I forget to take my medication, I can wait until the next dose and eliminate that dose." 4. "If my throat becomes sore, it's a normal effect of the medication and it's nothing to be concerned about."

1 Rationale: Phenytoin is an antiseizure medication. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client would not skip medication doses because this could precipitate a seizure. Capsules should not be chewed or broken. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction because this indicates hematological toxicity. Test-Taking Strategy: Focus on the subject, an understanding of the instructions. Eliminate option 3 because the client needs to be encouraged to take medications on time. Also, eliminate option 4 because the client needs to report these symptoms to the primary health care provider. From the remaining options, recalling that capsules should not be broken will direct you to option 1.

Ibuprofen is prescribed for a client. Which instruction would the nurse give the client about taking this medication? 1. Take with 8 oz of milk. 2. Take in the morning after arising. 3. Take 60 minutes before breakfast. 4. Take at bedtime on an empty stomach.

1 Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs would be given with milk or food to prevent gastrointestinal irritation. Options 2, 3, and 4 are incorrect. Test-Taking Strategy: Note that options 2, 3, and 4 are comparable or alike. Each of these options indicates administering the medication without food. Remember, NSAIDs can cause gastric irritation.

The client is taking phenytoin for seizure control, and a blood sample for a serum drug level is drawn. Which laboratory finding indicates a therapeutic serum drug result? 1. 5 mcg/mL 2. 15 mcg/mL 3. 25 mcg/mL 4. 30 mcg/mL

2 Rationale: The therapeutic serum drug level range for phenytoin is 10 to 20 mcg/mL. Therefore, options 1, 3, and 4 are incorrect. Test-Taking Strategy: Knowledge regarding the subject, the therapeutic serum range of phenytoin, is required to answer the question. A helpful hint may be to remember that the theophylline therapeutic range and the acetaminophen therapeutic range are similar to the phenytoin therapeutic range. Remembering this may assist you when answering questions related to any of these three medications.

The client is receiving meperidine hydrochloride for pain. Which signs/symptoms are side and adverse effects of this medication? Select all that apply. 1. Diarrhea 2. Tremors 3. Drowsiness 4. Hypotension 5. Urinary frequency 6. Increased respiratory rate

2, 3, 4 Rationale: Meperidine hydrochloride is an opioid analgesic. Side and adverse effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors. Test-Taking Strategy: Focus on the subject, side and adverse effects of meperidine hydrochloride. Recalling that this medication is an opioid analgesic and recalling the effects of an opioid analgesic will assist in identifying the side and adverse effects.

The client with trigeminal neuralgia is being treated with carbamazepine. Which laboratory result indicates that the client is experiencing an adverse effect of the medication? 1. Sodium level, 140 mEq/L 2. Uric acid level, 5.0 mg/dL 3. White blood cell count, 3000 mm3 4. Blood urea nitrogen (BUN) level, 15 mg/dL

3 Rationale: Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbance, thrombophlebitis, dysrhythmia, and dermatological effects. Options 1, 2, and 4 identify normal laboratory values. Test-Taking Strategy: Focus on the subject, the medication and normal laboratory values, to answer this question. If you are familiar with normal laboratory values, you will note that the only option that indicates an abnormal value is option 3.

The nurse is caring for a client who is taking phenytoin for control of seizures. During data collection, the nurse notes that the client is taking birth control pills. Which information would the nurse provide to the client? 1. Pregnancy would be avoided while taking phenytoin. 2. The client may stop taking the phenytoin if it is causing severe gastrointestinal effects. 3. The potential for decreased effectiveness of the birth control pills exists while taking phenytoin. 4. The increased risk of thrombophlebitis exists while taking phenytoin and birth control pills together.

3 Rationale: Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, are 4 are not accurate. Test-Taking Strategy: Recall knowledge of the subject, medication interactions between phenytoin and birth control pills. Option 4 is not an appropriate statement because it would cause anxiety in the client. A client would not be instructed to stop anticonvulsant medication. Pregnancy does not need to be "avoided."

The client with myasthenia gravis is receiving pyridostigmine. The nurse monitors for signs/symptoms of cholinergic crisis caused by overdose of the medication. The nurse checks the medication supply to ensure that which medication is available for administration if a cholinergic crisis occurs? 1. Vitamin K 2. Acetylcysteine 3. Atropine sulfate 4. Protamine sulfate

3 Rationale: The antidote for cholinergic crisis is atropine sulfate. Acetylcysteine is the antidote for acetaminophen. Vitamin K is the antidote for warfarin, and protamine sulfate is the antidote for heparin. Test-Taking Strategy: Knowledge regarding the subject, antidotes for various medications, is needed to answer this question. Remember that atropine sulfate is the antidote for cholinergic crisis.

The client with myasthenia gravis is suspected of having cholinergic crisis. Which sign/symptom indicates this crisis is taking place? 1. Ataxia 2. Mouth sores 3. Hypothermia 4. Hypertension

4 Rationale: Cholinergic crisis occurs as a result of an overdose of medication. Indications of cholinergic crisis include gastrointestinal disturbances, nausea, vomiting, diarrhea, abdominal cramps, increased salivation and tearing, miosis, hypertension, sweating, and increased bronchial secretions. Test-Taking Strategy: Note the subject, cholinergic crisis, and recall the signs/symptoms of cholinergic crisis, including hypertension. Note that mouth sores represent a condition that takes time to occur and is not an immediate sign of a crisis.

Carbidopa-levodopa is prescribed for a client with Parkinson's disease, and the nurse monitors the client for adverse effects of the medication. Which sign/symptom indicates the client is experiencing an adverse effect? 1. Pruritus 2. Tachycardia 3. Hypertension 4. Impaired voluntary movements

4 Rationale: Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the temporary muscle weakness that lasts 1 minute to 1 hour, also known as the "on-off phenomenon") are frequent side effects of the medication. Test-Taking Strategy: Focus on the subject, signs/symptoms of adverse effects associated with carbidopa and levodopa. Options 2 and 3 are cardiac-related options, so these options can be eliminated first as comparable or alike, and not related to the subject. Note that the question asks for an adverse effect; therefore, select option 4 over option 1 as the correct answer.