Ch23: AEDs

A 15-year-old male client receiving phenytoin for treatment of epilepsy is being discharged from the hospital. What statement by Richard's mother leads you to believe she has understood your teaching related to his care and drug administration? "I will make sure he takes the medication on an empty stomach." "I will make sure he gets enough sleep." "I will make sure he has routine visits to the dentist." "I will weigh him daily."

"I will make sure he has routine visits to the dentist." Gingival hyperplasia, the overgrowth of gum tissue, is common in patients who take phenytoin. It is especially common in children.

During an in-service, the charge nurse explains to the licensed vocational nurse (LVN) that there are six categories of anticonvulsants with different mechanisms of action. The LVN demonstrates understanding of the action of the miscellaneous drug, gabapentin, by stating which of the following? "This drug is a gamma-aminobutyric acid (GABA) agonist." "This drug acts in the postsynapses in the motor cortex of the brain." "Gabapentin depresses the motor cortex." "Gabapentin elevates the seizure threshold."

"This drug is a gamma-aminobutyric acid (GABA) agonist." Gabapentin is a miscellaneous drug acting as a GABA agonist. Hydantoins stabilize the hyperexcitability postsynaptically in the motor cortex of the brain. Succinimides depress the motor cortex, thus raising the seizure threshold. Benzodiazepines elevate the seizure threshold by decreasing postsynaptic excitation.

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." "Take the drug 1 hour before or 2 hours after a meal to minimize stomach upset." "Try taking your pills at the same time as you eat some food." "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? "Yes, as long as your health care provider agrees and you take your medications regularly." "You likely won't be able to until your seizures are controlled by medication" "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" 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? 22 mcg/mL 12 mcg/mL 4 mcg/mL 30 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.

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 4 mcg/mL 6 mcg/mL 8 mcg/mL

2 mcg/mL 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? 15 µg/mL 18 µg/mL 10 µg/mL 27 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 The time frame depends on the child's body surface area 60 seconds 5 minutes

5 minutes IV phenobarbital has an onset of action of approximately 5 minutes.

An 18-year-old client has been taking phenytoin for the past 6 months for epileptic seizures. The client's phenytoin levels routinely fall within the therapeutic range. The client contacts the health care provider reporting nausea, headache, and diarrhea. What would be the most appropriate intervention based on the assessment of the client's symptoms and laboratory results? Advise the client to decrease the dose because the client is getting too much of the medication. Advise the client to double the dose for 24 hours because the client is experiencing the symptoms of drug withdrawal. Advise the client that these are normal reactions to the medication and he should continue the medication as ordered. Advise the client to have his blood redrawn today to ensure that it is not at a toxic level.

Advise the client to have his blood redrawn today to ensure that it is not at a toxic level. Clients may demonstrate adverse effects even if the serum level of phenytoin is "normal"; it is important to adjust the dose to the clinical response of the client, not the serum level.

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 Alcohol Antibiotics Antidiabetic medications Oral contraceptives

Analgesics Alcohol The concomitant use of anticonvulsants and analgesics or alcohol can result in increased CNS depressant effects.

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? Contact the provider to request a one-time supplementary dose Assess the client's renal function Anticipate a reduction in dosage Call an emergency code

Anticipate a reduction in 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 client has a history of seizures of which the client takes phenytoin on a regular basis. What should the nurse teach the client in order to ensure safety? Do not take garlic or ginger supplements Do not take OTC antacids Avoid brewer's yeast Avoid ginkgo supplements

Avoid ginkgo supplements Clients being treated with barbiturates or phenytoin should be advised not to use ginkgo, which could cause serious adverse effects. The nurse should collaborate with the care provider about other supplements and OTC medications, but antacids, ginger, garlic and brewer's yeast are not noted to be harmful.

The nurse is caring for an infant who has been diagnosed with secondary seizures. The nurse is aware of which possible causes of seizures that are classified as secondary? (Select all that apply.) Birth injury Inherited from mother Metabolic disorders Idiopathic Fever

Birth injury Metabolic disorders Fever Seizures are classified as idiopathic or secondary. In infants, secondary causes include metabolic disorders, birth injury, and fever.

A 25-year-old client takes ethosuximide for the treatment of absence seizures calls the clinic to report that she has developed a sore throat and a slight fever. The nurse will explain that she should come to the clinic to have what checked? Ethosuximide serum level Blood cell count Pulse and blood pressure Bleeding tendencies

Blood cell count If clients who take ethosuximide develop signs of infection such as a sore throat and fever, blood cell counts should be checked. Periodic urinalysis and liver function studies will help to identify any early complications that might occur from the drug therapy. The drug serum level, bleeding tendencies, and pulse and blood pressure are not used in early identification of infection.

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? Bone marrow depression Allergy to sulfonamides Bipolar disorder Diabetes

Bone marrow depression 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? Urticaria Ataxia CNS depression 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.

A client is diagnosed with trigeminal neuralgia. What antiepileptic agent may be used to treat this disorder? Ethosuximide Carbamazepine Phenytoin Fosphenytoin

Carbamazepine Carbamazepine is prescribed to treat trigeminal neuralgia. Neither phenytoin, fosphenytoin, nor ethosuximide is administered for trigeminal neuralgia.

Which would be most important to monitor in a client receiving ethosuximide? Nutritional status Electrocardiogram Weight Complete blood count

Complete blood count Although weight loss and anorexia may occur, ethosuximide is associated with bone marrow suppression, including potentially fatal pancytopenia, so it would be most important for the nurse to monitor the client's complete blood count. The drug is not associated with any cardiovascular effects that would necessitate an electrocardiogram.

A client in the clinic with a history of epilepsy has just tested positive for pregnancy. What is the nurse's next action? Discuss the most serious birth defects that may occur due to treating epilepsy during pregnancy. Advise the client to continue her current medication for epilepsy. Explain how to taper off her seizure medication as the risk for seizures decreases during pregnancy. Consult with the primary health care provider.

Consult with the primary health care provider. The nurse should first consult with the primary health care provider. Research suggests an association between (a) the use of anticonvulsants by pregnant women with epilepsy and (b) an increased incidence of birth defects. The use of anticonvulsants is not discontinued in pregnant women with a history of major seizures because of the danger of precipitating status epilepticus. However, when seizure activity poses no serious threat to the pregnant woman, the primary health care provider may consider discontinuing use of the drug during pregnancy.

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 Increases the chloride available to promote depolarization of the cells Decreases the calcium available to the cells responsible for electrical activity in the brain Increases the potassium available to the cell to reduce the repolarization of the cell

Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus Phenytoin (Dilantin) is the prototype drug that controls seizures by decreasing sodium influx into the cells. Sodium influx produces an action potential, which then causes the neurons to fire.

When describing the action of barbiturates and barbiturate-like agents in the control of seizures, what would the nurse include? Promotion of impulse conduction Stimulation of the cerebral cortex Maintenance of cerebellar function 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.

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? Raise the client's bed rails and maintain the client on bed rest Contact the care provider to communicate this result Perform a focused neurological assessment Document the fact that the nurse checked the client's phenytoin levels

Document the fact that the nurse checked the client's phenytoin levels The therapeutic range is 10 to 20 mcg/mL. Consequently, there is no action needed beyond documentation

Which factor should the clinician reassess when combination therapy is ineffective? Drug side effects The patient's age and gender Drug-drug interactions 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.

When combination therapy is ineffective, what needs to be reassessed? Whether the patient is truly having seizures Understanding of drug therapy regimen Drug-drug interactions Age and gender of patient

Drug-drug interactions Many of the AEDs have drug-drug interactions. Therefore, it is important to monitor for drug-drug interactions to arrange to adjust dosages appropriately if any drug is added or withdrawn from the drug regimen. The age and gender of the patient would not need to be reassessed and neither would whether or not the patient is truly having seizures.

A client has been prescribed carbamazepine for the prevention of seizures. What action should the nurse perform? Teach the client how to self-administer subcutaneous injections Educate the client about taking the medication at the first sign of impending seizure activity Establish intravenous access Educate the client about the need to take the pills as scheduled

Educate the client about the need to take the pills as scheduled Carbamazepine is administered orally on an ongoing basis. It is not an emergency treatment for seizure activity.

The community health nurse also assists the health care provider in the decision-making process for AED drug titration by performing which function? Counting the number of pills in the AED drug bottle to ensure compliance Administering the AED medication to the client Ensuring that the client makes the appointments for serum drug levels Monitoring the client for signs and symptoms of seizure activity during the monthly visit

Ensuring that the client makes the appointments for serum drug levels The community health nurse may assist the provider to titrate drug doses by ensuring that the client keeps appointments for serum drug level testing and follow-up care.

The most common form of epilepsy in children is characterized by what type of seizure? Akinetic seizure Febrile seizure Partial seizure Absence seizure

Febrile seizure Febrile seizures are the most common form of epilepsy in children. They are tonic-clonic seizures that occur with fever in the absence of other identifiable causes.

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 Complex seizures Atonic seizures Partial seizures

Generalized seizures Tonic-clonic seizures and myoclonic seizures are classified as generalized seizures. Partial seizures can be simple or complex. Complex seizures are partial seizures that involve impaired consciousness and variable unconscious repetitive actions, staring gaze, and hallucinations/delusions. Atonic seizures are a type of generalized seizure involving the loss of muscle tone where the person suddenly drops.

A client is receiving a hydantoin as treatment for tonic-clonic seizures. The nurse includes a discussion of what when teaching the client about this drug? Physical dependence Gingival hyperplasia Possible leukocytosis Withdrawal syndrome

Gingival hyperplasia Hydantoins may cause gingival hyperplasia, severe liver toxicity, and bone marrow suppression. Physical dependence and withdrawal syndrome are associated with benzodiazepines.

A 7-year-old child with epilepsy takes phenytoin for the control of seizures. What oral assessment does the nurse make related to a common side effect of the medication? Tooth decay Gingival hyperplasia Oral thrush Malalignment of teeth

Gingival hyperplasia A common side effect of phenytoin in children in gingival hyperplasia. Oral thrush is a side effect of antibiotics and not gingival hyperplasia. Malalignment of teeth and decay are caused by many various reasons but not generally are not a result of the phenytoin.

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? Make a referral to occupational therapy Monitor vital signs hourly while the client is awake Maintain the client on bed rest Implement falls precautions

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.

The nurse is formulating a care plan for a client with a seizure disorder. Which intervention would be an appropriate for the nurse to include? Informing the client and family that seizure control is not gained immediately Informing the client and family that excessive frustration is to be expected Informing the client and family that unrealistic expectations can occur Informing the client and family that seizure control is gained immediately

Informing the client and family that seizure control is not gained immediately The nurse should inform the client and family that seizure control is not gained immediately when drug therapy is started. The goal is to avoid unrealistic expectations and excessive frustration while drugs and dosages are being changed in an effort to determine the best regimen for the client.

When describing the action of zonisamide, which would the nurse include? Depression of motor nerve output Inhibition of sodium and calcium channels Decrease in conduction through nerve pathways Depression of the cerebral cortex

Inhibition of sodium and calcium channels Zonisamide inhibits voltage-sensitive sodium and calcium channels, thus stabilizing the nerve cell membranes and modulating calcium-dependent presynaptic release of excitatory neurotransmitters. Hydantoins decrease the conduction through nerve pathways. Barbiturates and barbiturate-like agents depress the cerebral cortex and motor nerve output.

A health care prescriber recently ordered a change in medication for a patient with a seizure disorder. Which action would the nurse take in evaluating the new drug's control of the seizure disorder? Interview and observe for evidence of underdosing or overdosing Check laboratory reports for evidence of hypernatremia Evaluate vital signs Interview and observe for adverse effects

Interview and observe for adverse effects Evaluation of the drug's effectiveness includes interviewing and observing for decrease in or absence of seizure activity; interviewing and observing for avoidance of adverse drug effects, especially those that impair safety; and, when available, checking laboratory reports of serum drug levels for therapeutic ranges or evidence of underdosing or overdosing.

A client who is receiving anticonvulsant therapy develops a serious skin reaction involving red wheals and blisters on the face, neck, and extremities. Which drug would the nurse likely expect the client to report being prescribed? Eslicarbazepine Phenytoin Lamotrigine Levetiracetam

Lamotrigine The client's skin reaction reflects Stevens-Johnson syndrome, which is associated with the use of lamotrigine. Eslicarbaxepine is used in the treatment of focal seizures. Phenytoin is used for tonic-clonic seizures, status epilepticus, and prophylactic seizure prevention. Levetiracetam is used for focal seizures, tonic-clonic seizures, bipolar disorder, and migraine headache.

A client has been prescribed valproic acid for the treatment of myoclonic seizures. When reviewing this client's latest laboratory results for signs of adverse effects, what results should the nurse prioritize? Liver enzymes White cell differential Electrolytes Creatinine clearance

Liver enzymes Valproic acid is associated with liver toxicity, more so than leukopenia, renal damage or electrolyte disturbances.

What should the nurse include as a possible adverse effect when teaching a client about phenytoin? Increased white blood cell count Physical dependence Liver toxicity Diarrhea

Liver toxicity Liver toxicity is a potential adverse effect of phenytoin. Constipation, not diarrhea, is an adverse effect of phenytoin. Bone marrow suppression and leukopenia would be adverse effects of phenytoin. Physical dependence is an adverse effect associated with the use of benzodiazepines and barbiturates.

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? Valproic acid Lorazepam Phenytoin Clorazepate Fosphenytoin

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.

A client is to receive ethotoin. The nurse would expect to administer this drug by which route? Intramuscular Rectal Oral Intravenous

Oral Ethotoin is administered orally.

A client is prescribed methsuximide. The nurse should expect to administer this drug by which route? Rectal Intramuscular Intravenous Oral

Oral Methsuximide is administered orally. Diazepam can be administered rectally. Diazepam or phenobarbital may be administered intramuscularly. Diazepam, fosphenytoin, phenytoin, valproic acid, and phenobarbital can be administered intravenously.

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? Generalized seizures Myoclonic seizures Partial seizures Tonic-clonic seizures

Partial seizures Seizures that do not impair consciousness but can involve the senses or motor ability are classified as partial seizures. Generalized seizures involve loss of consciousness during the seizure. Tonic-clonic seizures are a type of generalized seizure involving alternate contraction and relaxation of the muscles, loss of consciousness, and abnormal behavior. Myoclonic seizures involve sudden, forceful contractions of single or multiple groups of muscles.

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? Valproic acid Ethosuximide Lorazepam Phenytoin

Phenytoin 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? A sustained contraction of the skeletal muscles Loss of consciousness Abnormal posturing Rapid rhythmic and symmetric jerking movements

Rapid rhythmic and symmetric jerking movements 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.

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? Tell the client to ask for assistance when ambulating so as to prevent bruising. Document the findings and offer the client a soft-bristled toothbrush. Report the findings to the primary health care provider immediately. Notify the charge nurse about reporting suspected physical abuse.

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 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 sensory perception related to adverse drug effects Disturbed thought processes related to seizure activity Acute confusion related to seizure activity and drug effects Risk for injury related to seizure activity

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? Diarrhea Urinary frequency Slurred speech Constipation

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.

An adult client underwent diagnostic testing after experiencing an absence seizure for the first time. What aspect of this client's health history may result in impaired drug excretion? The client is morbidly obese The client takes a beta-blocker for the treatment of hypertension The client has a history of adhering poorly to prescribed treatment The client has recently been diagnosed with diabetic nephropathy

The client has recently been diagnosed with diabetic nephropathy Impaired renal function will reduce drug excretion. A lack of adherence must be addressed but this does not affect excretion. Similarly, obesity and the use of a beta-blocker will not inhibit excretion.

A client is prescribed topiramate. The nurse cautions the client to avoid the intake of alcohol for which reason? The client's risk for dependence is increased. The combination may lead to a hypertensive crisis. The client is at risk for increased CNS depression. A disulfiram-like reaction can occur.

The client is at risk for increased CNS depression. Combining alcohol with topiramate increases the client's risk for CNS depression. Topiramate combined with alcohol does not result in a disulfiram-like reaction. Drug dependency is not associated with the use of topiramate and alcohol. The combination of topiramate and alcohol is not associated with the development of a hypertensive crisis.

A nurse is to administer an anticonvulsant drug. The nurse understands that this drug is classified as an oxazolidinedione. Which drug would the nurse administer? Diazepam Gabapentin Levetiracetam Trimethadione

Trimethadione Trimethadione is classified as an oxazolidinedione. Diazepam is classified as a benzodiazepine. Gabapentin is classified as a miscellaneous anticonvulsant. Levetiracetam is classified as a miscellaneous anticonvulsant.

After teaching a group of students about anticonvulsant therapy, the instructor determines that the teaching was successful when the group identifies which drug as eliciting its effects by increasing levels of gamma-aminobutyric acid (GABA), which stabilizes cell membranes? Trimethadione Gabapentin Topiramate Valproic acid

Valproic acid Carboxylic acid derivatives like valproic acid elicit their effects by increasing levels of gamma-aminobutyric acid (GABA), which stabilizes cell membranes. Gabapentin is a GABA agonist. Topiramate blocks seizure activity rather than raising the threshold. Trimethadione decreases the repetitive synaptic transmissions of nerve impulses.

Which drug would the nurse expect to be ordered as the drug of choice for the treatment for myoclonic seizures? Zonisamide Clonazepam Diazepam Valproic acid

Valproic acid Valproic acid is considered the drug of choice for myoclonic seizures and a second choice drug for absence seizures. Clonazepam may be used for myoclonic seizures, but it is not considered the drug of choice. Diazepam and zonisamide are not used for treating myoclonic seizures.

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 age and gender of the client. When prescribing an AED, the health care provider takes into account the type of seizure the client is having. Different drugs work differently in different people. 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. Type of seizure is a major factor in drug selection. Age and gender are not factors that impact the choice of AED.

A client is experiencing absence seizures and has been prescribed a succinimide. What prescription is most likely? Dilantin Valium Depakene Zarontin

Zarontin Ethosuximide (Zarontin) is considered the drug of choice for treating absences seizures and is in the succinide family. The other listed drugs are not succinides.

In a person being treated for a diagnosed seizure disorder, what is the most common cause of status epilepticus? abusing drugs and/or alcohol experiencing a brain injury abruptly stopping the antiseizure medications hypoxia-inducing experience

abruptly stopping the antiseizure medications In a person taking medications for a diagnosed seizure disorder, the most common cause of status epilepticus is abruptly stopping AEDs. In other clients, regardless of whether they have a diagnosed seizure disorder, causes of status epilepticus include brain trauma or tumors, systemic or central nervous system (CNS) infections, alcohol withdrawal, and overdoses of drugs (e.g., cocaine, theophylline).

The nurse reviews the medical history of a client with a seizure disorder. For which reason should the nurse question giving the client zonisamide as prescribed? being treated for chronic sinusitis experiences absence seizures allergy to sulfa drugs diagnosed with fibromyalgia

allergy to sulfa drugs Zonisamide is a drug that modulates the inhibitory neurotransmitter GABA. It is a newer agent that stabilizes nerve cell membrane and modulates the release of excitatory neurotransmitters. Because is a sulfonamide, it should not be given to the client with an allergy to sulfa drugs. This medication has no effect on chronic sinusitis or fibromyalgia. It is used to treat absence seizures.

A client reports sensing an unusual smell just prior to experiencing a tonic-clonic seizure. What term is used to describe this event? spasm aura epilepsy spasticity

aura Tonic-clonic seizures are sometimes preceded by an aura—a brief warning, such as a flash of light or a specific sound or smell. None of the other options accurately describe this event.

A client with heart failure is diagnosed with a seizure disorder. Which medication would the nurse identify as contraindicated for this client? diazepam carbamazepine phenytoin valproic acid

carbamazepine Carbamazepine is indicated for treatment of generalized and focal seizures in addition to trigeminal neuralgia. Due to promotion of secretion of antidiuretic hormone, carbamazepine may cause edema, hypertension, and fluid overload, especially in clients with heart failure. Diazepam, phenytoin, and valproic acid are not contraindicated in the client with heart failure.

What is a common risk for epileptic seizures during late infancy to early childhood? malnutrition fever medication overdose learning disability

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. Learning disability, medication overdose, and malnutrition are not risk factors.

What is the primary medication prescribed to relieve pain associated with shingles? gabapentin morphine sulfate naproxen sodium meperidine

gabapentin 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.

The nurse is providing education for a client who has been prescribed phenytoin. What adverse reactions should the nurse discuss in the teaching? Select all that apply. lethargy increased seizure activity ataxia gingival hyperplasia nausea

lethargy ataxia gingival hyperplasia nausea The most common adverse effects of phenytoin affect the central nervous system (e.g., ataxia, drowsiness, lethargy) and gastrointestinal tract (e.g., nausea, vomiting). Gingival hyperplasia is an overgrowth of the gums related to long-term administration of phenytoin. Increased seizure activity would indicate an insufficient dose.

Which antiepileptic drug may be administered to a client with impaired liver function? levetiracetam oxcarbazepine carbamazepine fosphenytoin

levetiracetam 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.

What is the most common drug of choice prescribed for the treatment of seizure activity in adults? phenytoin gabapentin lorazepam diazepam

phenytoin The oldest and most widely used antiepileptic drug (AED), phenytoin is often the initial drug of choice, especially in adults. None of the remaining drugs are as widely prescribed.

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. respiratory depression. nervous breakdown. hearing impairment.

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.

What type of seizure activity is characterized by generalized tonic-clonic convulsions lasting for several minutes during which the client does not regain consciousness? motor febrile akinetic status epilepticus

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.