PREP U- Antiseizure chap 23

The school nurse sees a child who has had an absence seizure. Which characteristics are typical of this type of seizure? Alterations in consciousness that last seconds Automatic and repetitive movements Abnormal movements and bizarre behavior Sustained contraction of skeletal muscle

Alterations in consciousness that last seconds Explanation: Absence seizures are characterized by abrupt alterations in consciousness that last only a few seconds.

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

While administering phenytoin, the nurse should observe the client for symptoms of which adverse reaction? Nausea Bradycardia Lethargy Increasing seizure activity

Bradycardia Explanation: Phenytoin is well absorbed. It commonly produces adverse effects such as ataxia (impaired muscular coordination such as a staggering gait when trying to walk), confusion, dizziness, and drowsiness. It can also cause serious or life-threatening adverse effects, such as cardiac dysrhythmias, bone marrow depression, or pancreatitis.

A client taking which of the anticonvulsants should be monitored closely for hematologic changes? (Select all that apply.) Carbamazepine (Tegretol) Phenytoin (Dilantin) Valproic acid (Depakote) Felbamate (Felbatol) Zonisamide (Zonegran)

Carbamazepine (Tegretol) Felbamate (Felbatol) Explanation: A client taking carbamazepine (Tegretol) or felbamate (Felbatol) should be monitored closely for hematological changes.

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 Explanation: 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.

Which type of seizures involves a loss of consciousness? Generalized seizures Partial seizures Somatosensory seizures Motor seizures

Generalized seizures Explanation: Generalized seizures involve a loss of consciousness.

A nurse is caring for a patient administered ethotoin. What are signs of toxicity for which the nurse should monitor the patient?

Slurred speech Explanation: 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. Reference:

The nurse is documenting the history of a patient who is to be initiated in carbamazepine therapy. In which condition is carbamazepine contraindicated?

bone marrow depression

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. The type of seizure demonstrated by this client is a(n): myoclonic seizure. tonic seizure. absence seizure. complex motor seizure with rapid resolution.

absence seizure. Explanation: A type of generalized seizure is the absence seizure, characterized by abrupt alterations in consciousness that last only a few seconds. Other types of generalized seizures include the myoclonic type (contraction of a muscle or group of muscles) and the akinetic type (absence of movement). Some people are subject to mixed seizures.

A client comes to the clinic for a follow-up visit. The client is prescribed lamotrigine for seizure control. The nurse suspects that the client may be experiencing Stevens-Johnson syndrome based on which of the following? Select all that apply. Complaints of muscle pain Lesions on the mucous membranes Blisters on the face and neck Recurrence of seizure activity Dizziness

Complaints of muscle pain Lesions on the mucous membranes Blisters on the face and neck Explanation: Stevens-Johnson syndrome (SJS) is manifested by fever, cough, muscular aches and pains, headache, and lesions of the skin, mucous membranes, and eyes; the lesions appear as red wheals or blisters, often starting on the face, in the mouth, or on the lips, neck, and extremities. Recurrence of seizure activity and dizziness are not associated with this condition.

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

Consult with the primary health care provider. Explanation: 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 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 Contact the care provider to communicate this result Raise the client's bed rails and maintain the client on bed rest Perform a focused neurological assessment

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

The nurse should be cautious and closely monitor clients receiving phenytoin (Dilantin) with which medical conditions? (Select all that apply.) Hyperthyroidism Hypotension Diabetes Asthma Hepatic impairment

Hypotension Hepatic impairment Explanation: Phenytoin (Dilantin) is used cautiously in clients with hypotension, severe myocardial insufficiency, and hepatic impairment.

Which intervention would be an appropriate part of a plan of care for a patient with a seizure disorder? Informing the patient and family that unrealistic expectations can occur Informing the patient and family that seizure control is not gained immediately Informing the patient and family that seizure control is gained immediately Informing the patient and family that excessive frustration is to be expected

Informing the patient and family that seizure control is not gained immediately Explanation: The nurse should inform the patient 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 patient.

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

Inhibition of sodium and calcium channels Explanation: 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.

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.) Idiopathic Metabolic disorders Birth injury Inherited from mother Fever

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

Which anticonvulsant elicits its effects by depressing the motor cortex and creating a higher threshold before nerves react to the convulsive stimuli? Methsuximide (Celontin) Phenobarbital (Luminal) Clonazepam (Klonopin) Trimethadione (Tridione)

Methsuximide (Celontin) Explanation: Succinimides like methsuximide (Celontin) elicits their effects by depressing the motor cortex and creating a higher threshold before nerves react to the convulsive stimuli

A nurse is caring for a patient with trigeminal neuralgia at a health care facility. The physician has prescribed carbamazepine. In which case is the use of carbamazepine contraindicated?

Patients with renal impairment Explanation: The nurse should know that carbamazepine is contraindicated among patients with renal impairment. The carbamazepine drug is not contraindicated in patients with nervous breakdown, hearing impairment, and respiratory depression.

A nurse should review a client's medical conditions prior to administering a phenytoin (Dilantin) because its use is contraindicated in some clients. In what clients would its use be contraindicated? (Select all that apply.) Pregnancy Sinus bradycardia Hepatic disease Diabetes Atrial fibrillation

Pregnancy Sinus bradycardia Explanation: The use of phenytoin is contraindicated in clients with known hypersensitivity to the drug, clients with sinus bradycardia, sinoatrial block, Adam-Stokes syndrome, and second- and third-degree atrioventricular block, pregnancy, and lactation.

A female client reports that her seizure was preceded by a brief warning, which she describes as an unusual smell. This is known as a(n): aura. partial seizure. motor seizure. absence seizure.

aura. Explanation: Tonic-clonic seizures are sometimes preceded by an aura—a brief warning, such as a flash of light or a specific sound or smell.