Pharm 3 Final Exam- Chapter 18: Drugs Used for Seizure Disorders

Which drug used in the treatment of seizures requires careful monitoring of renal function? 1. Lamotrigine 2. Primidone 3. Carbamazepine 4. Valproic acid

3. Carbamazepine

An intravenous (IV) bolus of phenytoin (Dilantin) is administered with the patient under electrocardiographic (ECG) monitoring. Which risk factor should the nurse be prepared to assess? 1) Bradycardia 2) Myocardial infarction 3) Atrial fibrillation 4) Bundle branch block

1) Bradycardia

Which drug used in the treatment of seizures requires careful monitoring of renal function? 1) Carbamazepine (Tegretol) 2) Lamotrigine (Lamictal) 3) Valproic acid (Depakene) 4) Primidone (Mysoline)

1) Carbamazepine (Tegretol)

Which measurement is the best indicator of how well an antiseizure medication is working? 1) Serum drug levels 2) Liver enzymes 3) Frequency and duration of seizures 4) Urinary output

3) Frequency and duration of seizures

Which factor should be considered during data collection when evaluating the effectiveness of succinimides? 1) Presence or absence of muscle spasms 2) Patient's sleep pattern 3) Occurrence of petit mal seizures 4) Large bowel function

3) Occurrence of petit mal seizures

Which patient should not be prescribed carbamazepine (Tegretol)? 1) Patient with new onset of seizures 2) Patient with diabetes mellitus 3) Patient with chronic hepatitis B 4) Patient with an ulcer

3) Patient with chronic hepatitis B

The pediatric nurse is caring for a patient diagnosed with refractory seizures. The physician orders a ketogenic diet. When the child receives his food tray, the nurse should remove any food containing high levels of: a. fat. b. salt. c. carbohydrates. d. vitamin K.

c. carbohydrates.

Which premedication assessment by the nurse is most important prior to the initiation of carbamazepine (Tegretol) therapy? a. Determine patient's ancestry. b. Monitor blood pressure (BP) lying, sitting, and standing. c. Auscultate lung sounds. d. Obtain smoking history.

a. Determine patient's ancestry.

What information would be most important for the nurse to provide to a patient when teaching about the adverse effects of succinimide therapy? a. Nausea, vomiting, and indigestion are common during the initiation of therapy. b. Avoid taking the medication with food or milk to minimize adverse effects. c. Sedation, drowsiness, and dizziness tend to worsen with continued therapy. d. Reducing the dosage of medication will relieve symptoms of nausea.

a. Nausea, vomiting, and indigestion are common during the initiation of therapy.

The nurse is preparing to administer zonisamide (Zonegran) to a newly admitted patient with the diagnosis of adult partial seizures. The nurse should hold this medication if the patient has which sign(s) or symptom(s)? ( Select all that apply. ) a. Skin rash b. Urinary frequency c. Drowsiness d. Allergy to Bactrim e. Pruritus

a. Skin rash d. Allergy to Bactrim e. Pruritus

Which medication is used to control seizures or prevent migraine headaches? a. Topiramate (Topamax) b. Zonisamide (Zonegran) c. Valproic acid (Depakene) d. Tiagabine (Gabitril)

a. Topiramate (Topamax)

The nurse is providing education to a patient recently prescribed pregabalin (Lyrica). Which statement by the patient indicates a need for further instruction? a. "I may feel tired at first, but this should improve with continued use." b. "Once my pain improves, I will stop taking this medication." c. "Taking sleeping aids will increase the sedative effect of this medication." d. "This drug may affect my mental alertness, so I need to be careful around machinery."

b. "Once my pain improves, I will stop taking this medication."

What dose is within the acceptable range for administering IV phenytoin (Dilantin) to a patient with a seizure disorder? a. 5 mg/min b. 30 mg/min c. 60 mg/min d. 100 mg/min

b. 30 mg/min

Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity? a. Oculogyric crisis b. Nystagmus c. Strabismus d. Amblyopia

b. Nystagmus

What is included in the nursing management of the patient with generalized tonic clonic seizure activity? ( Select all that apply. ) a. Restraining the patient's arms to avoid further injury b. Placing padding around or under the patient's head c. Attempting to insert a tongue depressor into the patient's mouth d. Positioning the patient on the side once the relaxation stage is entered to allow oral secretions to drain e. Requesting additional assistance and/or necessary equipment in case the patient does not begin breathing spontaneously when the seizure is over

b. Placing padding around or under the patient's head d. Positioning the patient on the side once the relaxation stage is entered to allow oral secretions to drain e. Requesting additional assistance and/or necessary equipment in case the patient does not begin breathing spontaneously when the seizure is over

he nurse is providing discharge teaching to a patient prescribed phenytoin (Dilantin) for management of a seizure disorder. Which patient statement indicates a need for further teaching? a. "I need to avoid or limit caffeine intake." b. "I will check with the pharmacist before taking over the counter medication." c. "If I develop enlarged gums, I will stop taking the medication." d. "It is important for me to take my medicine at the same time daily."

c. "If I develop enlarged gums, I will stop taking the medication."

For which condition may carbamazepine (Tegretol) be used? a. Tardive dyskinesia b. Psychotic episodes c. Trigeminal neuralgia pain d. Sedation

c. Trigeminal neuralgia pain

What is a guideline for the nurse when administering phenytoin (Dilantin) intravenously? a. Deliver rapidly. b. Monitor for signs of tachycardia. c. Assess for hypertensive crisis. d. Administer without mixing with other medications.

d. Administer without mixing with other medications.

Which response by the nurse is accurate when a patient who has been on lamotrigine ( Lamictal) for seizure control reports a skin rash and urticaria? a. Reassure the patient that this is a common adverse effect of the medication and not to worry. b. Instruct the patient to discontinue use of the drug immediately. c. Instruct the patient to decrease the dosage of the medication until the rash disappears. d. Advise the patient that this adverse effect usually resolves but should be reported to the health care provider.

d. Advise the patient that this adverse effect usually resolves but should be reported to the health care provider.

Which condition is associated with hydantoin therapy? a. Postictal state b. Atonia c. Seizure threshold reduction d. Gingival hyperplasia

d. Gingival hyperplasia

The nurse is preparing discharge instructions for a patient with a history of diabetes who has just been diagnosed with seizure disorder. The patient has been prescribed hydantoin therapy. What will the patient most likely experience? a. Hunger b. Hyperglycemia c. Diarrhea d. Pupil dilation

b. Hyperglycemia

Patients taking phenytoin (Dilantin) for control of seizures must be aware of the risk for which adverse effect(s)? ( Select all that apply. ) a. Blood dyscrasias b. Hyperglycemia c. Urinary retention d. Gingival hyperplasia e. Insomnia f. Sedation

a. Blood dyscrasias b. Hyperglycemia d. Gingival hyperplasia f. Sedation

The health care provider orders diazepam (Valium) 10 mg IV stat for a patient who was admitted with status epilepticus. What important nursing interventions(s) associated with administration of this medication IV should the nurse perform? ( Select all that apply. ) a. Apply a cardiac monitor to the patient to assess for continuous heart rate, if not already done. b. Administer the prescribed dosage over 1 minute. c. Mix diazepam in a primary IV solution to avoid overdosing. d. Continuously assess the patient's airway. e. Obtain the correct dose (10 mg) and administer over slow IV push.

a. Apply a cardiac monitor to the patient to assess for continuous heart rate, if not already done. d. Continuously assess the patient's airway. e. Obtain the correct dose (10 mg) and administer over slow IV push.

A patient on anticonvulsant therapy confides to the nurse at an outpatient clinic that she suspects she may be pregnant. The nurse should encourage the patient to take which action(s)? ( Select all that apply. ) a. Consult an obstetrician. b. Discontinue medications. c. Carry an identification card. d. Provide a list of seizure medications. e. Consider oral contraception.

a. Consult an obstetrician. c. Carry an identification card. d. Provide a list of seizure medications.

A patient taking phenytoin (Dilantin) and isoniazid reports feeling lethargic. Nystagmus is noted on physical examination. Which problem does this information suggest to the nurse? 1) Phenytoin toxicity 2) Abrupt discontinuation of isoniazid 3) Tubercular reactivation 4) Liver damage

1) Phenytoin toxicity

Which laboratory result would be the priority for the nurse monitoring a patient taking zonisamide? 1. Complete blood count (CBC) 2. Blood pressure 3. Deep tendon reflexes 4. Cardiac dysrhythmias

1. Complete blood count (CBC)

The health care provider has prescribed carbamazepine for seizure control in a patient also taking warfarin. Which nursing interventions would prevent complications related to concurrent use of these drugs? Select all that apply. 1. Monitor the patient's prothrombin time. 2. Monitor the patient for signs of continued infection. 3. Advise the patient to avoid using estrogen-containing contraceptives. 4. Request that the health care provider increase the dosage of warfarin. 5. Monitor the patient's daily weight, lung sounds, and accumulation of edema.

1. Monitor the patient's prothrombin time. 4. Request that the health care provider increase the dosage of warfarin.

Which conditions may occur as a result of an overdose of phenytoin? Select all that apply. 1. Nystagmus 2. Memory loss 3. Nephrotoxicity 4. Hyperglycemia 5. Aseptic meningitis

1. Nystagmus 4. Hyperglycemia

Which drug would a nurse administer to a 2-year-old child who has seizures associated with Lennox-Gastaut syndrome? 1. Topiramate 2. Gabapentin 3. Methsuximide 4. Carbamazepine

1. Topiramate

A patient taking phenytoin (Dilantin) has started attending college and reports frequently drinking alcohol with friends. What does the nurse monitor for in this patient? 1) Hyperglycemia 2) Increased seizure activity 3) Hypertension 4) Clinical manifestations of phenytoin toxicity

2) Increased seizure activity

A patient who is taking an estrogen-containing contraceptive is prescribed oxcarbazepine for seizure control. Which instruction would the nurse provide to prevent complications? 1. "Follow good oral hygiene." 2. "Use another form of birth control." 3. "Do not smoke cigarettes while taking this medication." 4. "Drink six to eight 8-ounce glasses of water daily while taking the medication."

2. "Use another form of birth control."

Which anticonvulsants are used to prevent migraine headaches in adults? Select all that apply. 1. Pregabalin 2. Topiramate 3. Gabapentin 4. Valproic acid 5. Carbamazepine

2. Topiramate 4. Valproic acid

What does the nurse monitor in a patient taking zonisamide (Zonegran)? 1) Blood pressure 2) Cardiac dysrhythmias 3) Complete blood count (CBC) 4) Deep tendon reflexes

3) Complete blood count (CBC)

Which anticonvulsant drug increases the risk of congenital anomalies such as cleft lip or cleft palate? 1. Tiagabine 2. Zonisamide 3. Topiramate 4. Valproic acid

3. Topiramate

A patient prescribed anticonvulsant therapy reports abdominal pain, nausea, vomiting, and anorexia, and laboratory data show elevated bilirubin and alkaline phosphatase levels. Which medication does the nurse anticipate to find in the patient's prescription? 1. Primidone 2. Zonisamide 3. Valproic acid 4. Oxcarbazepine

3. Valproic acid

A patient with diabetes is started on phenytoin (Dilantin) for partial seizures. What does the nurse closely monitor in this individual? 1) Weight loss 2) Hypoglycemia 3) Blood pressure 4) Hyperglycemia

4) Hyperglycemia

Which antiepileptic drug is effective for almost all forms of seizures? 1) Phenobarbital (Luminal) 2) Carbamazepine (Tegretol) 3) Phenytoin (Dilantin) 4) Valproic acid (Depakene)

4) Valproic acid (Depakene)

A patient has been started on lamotrigine (Lamictal). How does the nurse instruct this patient to take the medication to decrease the incidence of gastric irritation? 1) One hour before meals or 2 hours after meals 2) At bedtime 3) Between meals with a glass of orange juice 4) With milk or food

4) With milk or food

An intravenous (IV) bolus of phenytoin is administered with the patient being monitored by electrocardiogram (ECG) because of the risk of which occurrence? 1. Myocardial infarction 2. Bundle branch block 3. Atrial fibrillation 4. Bradycardia

4. Bradycardia

Which anticonvulsant is used to treat pain associated with trigeminal neuralgia? 1. Pregabalin 2. Lamotrigine 3. Gabapentin 4. Carbamazepine

4. Carbamazepine

What is the drug of choice when treating a generalized tonic clonic seizure? a. Diazepam (Valium) b. Haloperidol (Haldol) c. Valproic acid (Depakene) d. Risperidone (Risperdal)

c. Valproic acid (Depakene)