Chapter 53 Drugs for Seizure Prep U

A male client works in an auto assembly line. His health care provider orders a skeletal muscle relaxant for short-term back spasms. Which instruction would be part of the nurse's education plan for this client?

"Do not take the medication when working with machinery."

A nurse is teaching a client about musculoskeletal medication that has been prescribed. The client needs further teaching about the medication when making which statements?

"I take my medicine with three to four beers each evening."

A 50-year-old woman has begun taking baclofen to treat her recently diagnosed multiple sclerosis (MS). What teaching point should the nurse provide to the patient about her new drug regimen?

"Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply."

A 56-year-old woman with a diagnosis of multiple sclerosis has begun taking dantrolene. What client teaching should the nurse provide?

"Make sure to see your health care provider promptly if you develop yellowish skin or eyes."

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 female client's seizure disorder has been successfully controlled by AEDs for years. She and her husband decide that it is time to start a family. She asks the nurse if it is safe for the fetus for her to continue her AEDs as prescribed. What is the nurse's best response?

"They are considered teratogenic."

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?

"Try taking your pills at the same time as you eat some food."

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 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

The perioperative nurse is caring for a client who requires an umbilical hernia repair but who has a known family history of malignant hyperthermia. The client has been prescribed dantrolene 2.5 mg/kg IV one hour before surgery. The client weighs 121 lbs. The nurse reconstitutes a single-use vial as per the manufacture's instructions, yielding a solution with a concentration of 50 mg/mL. How many mL of the reconstituted dantrolene solution should the nurse add to the client's bag of intravenous fluid?

2.75 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 pregabalin who is not responsive to verbal stimuli

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 has been admitted to the emergency department and is experiencing tonic-clonic seizures. What intervention should the nurse prioritize?

Administration of phenytoin IV as prescribed

A nurse is assessing a client who has come to the emergency department reporting back spasms. The client states a history of opioid addiction and does not want to take any drug that "puts me at risk of becoming physically dependent." Which medication would the nurse question, if ordered?

Cyclobenzaprine (Flexeril)

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

The nurse is administering phenytoin to a client who is also receiving a continuous nasogastric enteral feeding and is aware of what possible effect?

Decreasing the absorption of the AED

A nurse has admitted two patients to the unit and is are developing care plans for both of them. One of the patients is having a pump placed to deliver intrathecal baclofen. The other patient will be receiving dantrolene as a muscle relaxant. What nursing diagnosis would be appropriate for both care plans?

Deficient knowledge regarding drug therapy

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

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

The community health nurse also assists the health care provider in the decision-making process for AED drug titration by performing which function?

Ensuring that the client makes the appointments for serum drug levels

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

Signs and symptoms of what would necessitate discontinuation of dantrolene therapy?

Hepatic dysfunction

When describing the action of zonisamide, which would the nurse include?

Inhibition of sodium and calcium channels

Which agent would a nurse expect to administer intravenously for a partial seizure?

Levetiracetam

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

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.)

Metabolic disorders Birth injury Fever

A client asks the nurse about the cause of idiopathic seizures. What is the nurse's best response?

No known cause

A client is taking allopurinol for gout. The client exhibits an "itchy" skin rash on the neck and both arms. What is the nurse's top priority action?

Notify the healthcare provider.

A nurse is caring for a patient prescribed phenobarbital for status epilepticus. What intervention should the nurse perform when the patient has been administered the drug?

Observe respirations frequently.

Simple seizures, motor seizures, and somatosensory seizures are classified as what type of seizure?

Partial seizures

The nurse should closely monitor clients receiving which of the following anticonvulsants for gingival hyperplasia? Select all that apply:

Phenytoin (Dilantin) Ethosuximide (Zarontin)

The client, newly diagnosed with epilepsy, begins to show signs of seizure activity. What is the nurse's priority action?

Protect the client's safety.

A nurse should review a client's medical conditions prior to administering a cyclobenzaprine (Flexeril) as its use is contraindicated in clients with which of the following? Select all that apply:

Recent myocardial infarction Hyperthyroidism

A male client routinely takes baclofen as a skeletal muscle relaxant for a neuromuscular disorder. His last lab results indicate that he is experiencing renal insufficiency. Based on these data, what would the nurse expect the health care provider to do?

Reduce the dose

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 40-year-old client with a diagnosis of fibromyalgia has been prescribed cyclobenzaprine (Flexeril) as an adjunct to her existing drug regimen. What nursing diagnosis should the nurse prioritize for the nursing care plan for this client?

Risk for Injury related to CNS depressant effects

A 29-year-old client who experienced a lower back injury has seen his range of motion decrease and his pain increase over the past several weeks. As a result, he has been prescribed cyclobenzaprine. What nursing diagnosis should the nurse prioritize in light of the client's drug regimen?

Risk for Injury related to CNS depression

Which nursing diagnosis would be most important for a nurse to include in the plan of care for a client who is receiving an antiseizure agent and experiencing common adverse effects?

Risk for injury

A client with a history of partial seizures has been taking lamotrigine 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 is prescribed topiramate. The nurse cautions the client to avoid the intake of alcohol for which reason?

The client is at risk for increased CNS depression.

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.

Which client should the nurse identify as having an absence seizure?

a client whose alterations in consciousness last a few seconds

In a person being treated for a diagnosed seizure disorder, what is the most common cause of status epilepticus?

abruptly stopping the antiseizure medications

While speaking with a client, the nurse notes that the client stares off, unblinking. The nurse notes that after several prompts, the client blinks rapidly and then resumes normal conversation. This behavior is consistent with what type of seizure?

absence

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

A client has been administered phenobarbital during seizure activity. When assessing for adverse effects after resolution of the seizure, what assessment should the nurse prioritize?

assessment of orientation

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

aura

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.

Which medication would the nurse expect to administer if prescribed to achieve skeletal muscle relaxation?

baclofen

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

A client's seizure activity, which is isolated to facial and neck muscles, has been identified as being caused by one area of the client's brain. The nurse should anticipate the administration of what drug?

carbamazepine

A surgical client has developed malignant hyperthermia. Which medication can be used to treat this health emergency?

dantrolene

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.

The nurse is giving discharge instructions to a client who just had Botox A injections around their eyes. The nurse should caution the client about what potential adverse effects? Select all that apply.

development of respiratory infections flu-like symptoms droopy eyelids

What is a common risk for epileptic seizures during late infancy to early childhood?

fever

A client is brought in to the emergency department by ambulance in status epilepticus. What drug would best halt this client's seizure activity?

fosphenytoin

A nurse is working with a 39-year-old client who is experiencing muscle spasms associated with multiple sclerosis. The client reports needing help with basic care The client's health care provider has prescribed baclofen (Lioresal). The nurse and the client agree that an appropriate goal related to helping to maintain self-worth would be to:

increase self-care in activities of daily living.

A client has received a prescription for baclofen. The home care nurse would schedule which laboratory tests to monitor this client?

liver function tests

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

oral

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 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

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 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 26-year-old woman has been prescribed the suspension form of phenytoin. The nurse will inform the patient that she should

shake the phenytoin suspension before pouring and measuring the dose.

The nurse is providing education to an adult client who has been prescribed lamotrigine for a seizure disorder. The nurse should inform the client that the medication must be stopped if what unexpected reaction develops?

skin rash

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