Chapter 29: Antiepileptics
The nurse has been educating the client on the self-administration of phenytoin. Which statement made by the client demonstrates an understanding of the medication? "I'll only take the drug when I feel an impending seizure." "I'll reduce my dose if I remain seizure free." "I'll make sure to take the drug with food." "I'll stop taking the drug if I don't have a seizure for 8 weeks."
"I'll make sure to take the drug with food."
A client has been diagnosed with partial seizures and has been prescribed carbamazepine. When providing health education about the safe and effective use of this medication, what should the nurse teach the client? "It's important to take a dose as soon as possible if you feel a seizure is coming." "I'll be showing you how to safely self-inject this drug." "I'll explain the foods that you should avoid while you're taking this drug." "It's safest if you avoid drinking alcohol while you're taking this drug."
"It's safest if you avoid drinking alcohol while you're taking this drug."
A client with myoclonic seizures has been prescribed clonazepam as an adjunctive treatment by the neurologist. What teaching should the nurse prioritize when explaining this new drug regimen to the client? "You might find that you'll feel somewhat agitated for the first few days that you take this drug." "Make sure you don't stop taking this abruptly because that might bring on a seizure." "You'll have to come to the hospital's outpatient clinic twice a week to have this administered intravenously." "We will need to monitor your blood sugar quite closely while you're taking this drug."
"Make sure you don't stop taking this abruptly because that might bring on a seizure."
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 acts in the postsynapses in the motor cortex of the brain." "Gabapentin elevates the seizure threshold." "Gabapentin depresses the motor cortex." "This drug is a gamma-aminobutyric acid (GABA) agonist."
"This drug is a gamma-aminobutyric acid (GABA) agonist."
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? "Take the drug 1 hour before or 2 hours after a meal to minimize stomach upset." "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." "Contact your health care provider to see if there's an alternative drug that would work for you."
"Try taking your pills at the same time as you eat some food."
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? "You likely won't be able to until your seizures are controlled by medication" "Yes, as long as your health care provider agrees and you take your medications regularly." "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"
The neurological nurse cares for several clients who have seizure disorders. Which client should the nurse monitor most closely for indications of drug dependence? A client receiving IV phenytoin to prevent seizures post-neurosurgery A client with a history of tonic-clonic seizures who takes phenobarbital A client receiving ethosuximide for the prevention of absence seizures Aclient with a history of myoclonic seizures who takes valproic acid
A client with a history of tonic-clonic seizures who takes phenobarbital
Kate is experiencing status epilepticus. The prescriber orders IV diazepam. What special precautions need to be taken by a nurse to administer IV diazepam? Administer the drug very slowly, no faster than 5 mg/min. Administer the drug through an IV pump. Dilute the drug with 5 to 10 mL normal saline. Administer the drug in the small veins in the dorsum of the hand or the wrist.
Administer the drug very slowly, no faster than 5 mg/min.
A client in status epilepticus has been brought to the emergency department. The nurse should anticipate which treatment measures? Administration of oral or sublingual phenytoin Administration of intravenous lorazepam Administration of zonisamide (Zonegran) Administration of intravenous gabapentin
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 gabapentin PO as prescribed Assessment of the client's renal and hepatic function Establishing a therapeutic relationship with the client Administration of phenytoin IV as prescribed
Administration of phenytoin IV as prescribed
x 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 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 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 to have his blood redrawn today to ensure that it is not at a toxic level.
What explanation should the nurse provide for why pregnancy is discouraged in women who are being treated for seizure disorders? Seizure disorders are genetic. Seizure disorders are familial. Antiepilepsy drugs decrease fertility. Antiepilepsy drugs are teratogenic.
Antiepilepsy drugs are teratogenic.
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 Bleeding tendencies Blood cell count Pulse and blood pressure
Blood cell count
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? Bipolar disorder Allergy to sulfonamides Bone marrow depression Diabetes
Bone marrow depression
The nurse has administered gabapentin to a client. Following administration, the nurse should assess the client for what possible adverse effect? Tetany Hypertension Paradoxical seizures Central nervous system (CNS) depression
Central nervous system (CNS) depression
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.
A client is prescribed lamotrigine for control of partial seizures. What is the most important medication teaching information the nurse should emphasize from the plan of care? Take this medication with food to prevent nausea and vomiting. A mild headache may occur while taking this medication. Contact the health care provider immediately if rash appears. Seek assistance when walking if dizziness occurs.
Contact the health care provider immediately if rash appears.
What medication may be administered intravenously (IV) to assist in reducing status epilepticus seizure activity? Ethosuximide Insulin Meperidine Diazepam
Diazepam
A nurse is caring for a patient who has been prescribed miscellaneous anticonvulsants containing valproic acid. What method of drug administration should the nurse inform the patient about? Take the drug in small and frequent doses Dissolve the tablet in a glass of water to take the drug Do not chew but swallow the whole tablet to avoid irritation Take the drug orally with meals to avoid an adverse reaction
Do not chew but swallow the whole tablet to avoid irritation
The nurse evaluates the client's latest serum phenytoin level which is revealed to be 16 mcg/mL. What is the nurse's best action? Contact the provider to discuss the need for a supplementary dose of phenytoin. Document the fact that the client's phenytoin level is therapeutic. Promptly establish seizure precautions. Contact the provider to discuss withholding the next scheduled dose.
Document the fact that the client's phenytoin level is therapeutic.
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
A client has been prescribed carbamazepine for the prevention of seizures. What action should the nurse perform? Educate the client about the need to take the pills as scheduled Educate the client about taking the medication at the first sign of impending seizure activity Establish intravenous access Teach the client how to self-administer subcutaneous injections
Educate the client about the need to take the pills as scheduled
Which type of seizures involves a loss of consciousness? Generalized seizures Partial seizures Somatosensory seizures Motor seizures
Generalized seizures
The nurse is preparing to administer phenytoin (Dilantin) to a client. The nurse should notify the healthcare provider before administration based on which assessment finding? Negative qualitative HCG test result. Blood pressure reading of 130/80 mmHg. Heart rate 50 beats per minute on cardiac monitor. Hepatic function tests within normal parameters.
Heart rate 50 beats per minute on cardiac monitor.
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? Implement falls precautions Monitor vital signs hourly while the client is awake Maintain the client on bed rest Make a referral to occupational therapy
Implement falls precautions
Concomitant administration of fluconazole (Diflucan) and phenytoin (Dilantin) can result in which of the following? (Choose one) Increased levels of phenytoin (Dilantin) Decreased levels of phenytoin (Dilantin) Increased levels of fluconazole (Diflucan) Decreased levels of fluconazole (Diflucan)
Increased levels of phenytoin (Dilantin)
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 unrealistic expectations can occur Informing the client and family that seizure control is not gained immediately Informing the client and family that seizure control is gained immediately Informing the client and family that excessive frustration is to be expected
Informing the client and family that seizure control is not gained immediately
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? Evaluate vital signs Check laboratory reports for evidence of hypernatremia Interview and observe for adverse effects Interview and observe for evidence of underdosing or overdosing
Interview and observe for adverse effects
What should the nurse include as a possible adverse effect when teaching a client about phenytoin? Liver toxicity Diarrhea Increased white blood cell count Physical dependence
Liver toxicity
A client is experiencing status epilepticus. Which medication should the nurse prepare to administer? Lorazepam (Ativan) Diazepam (Valium) Valproic acid (Depakote) Clonazepam (Klonopin)
Lorazepam (Ativan)
The nurse is part of a team caring for a client in status epilepticus. What will the pharmacologic portion of the treatment consist of? Lorazepam given by mouth. Lorazepam given intravenously. Diazepam given by mouth. Diazepam given by intramuscular injection.
Lorazepam given intravenously.
A client asks the nurse about the cause of idiopathic seizures. What is the nurse's best response? High fever No known cause Passed from parent to child Brain injury at birth
No known cause
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? Partial seizures Generalized seizures Tonic-clonic seizures Myoclonic seizures
Partial seizures
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 Tonic-clonic seizures Partial seizures Myoclonic seizures
Partial seizures
The nurse is caring for a client receiving ethotoin to control seizure activity. When reviewing the client's laboratory results, the nurse learns that the client's serum ethotoin level is 67 mcg/mL. What is the nurse's best action? Administer naloxone as prescribed. Report this finding to the provider and monitor closely for seizure activity. Report this to the provider and monitor for signs of toxicity. Document the fact that the client's ethotoin levels are therapeutic.
Report this to the provider and monitor for signs of toxicity.
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? Acute confusion related to seizure activity and drug effects Disturbed thought processes related to seizure activity Risk for injury related to seizure activity Disturbed sensory perception related to adverse drug effects
Risk for injury related to seizure activity
The client has a seizure that causes rhythmic twitching of the left hand for 90 seconds with no loss of consciousness and then stops. The nurse notes this same action repeated many times throughout the day and documents this as what type of seizure? myoclonic seizure Jacksonian seizure psychomotor seizure simple partial seizure
Simple partial seizure
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? Rule out any shortness of breath and inform the client that this adverse effect will resolve with time. Recommend that the client take 50 mg diphenhydramine PO and check back tomorrow. Tell the client to take the medication with a high-fat food to minimize adverse effects. Tell the client to take no further doses and come be assessed at the clinic immediately
Tell the client to take no further doses and come be assessed at the clinic immediately
A client has a new diagnosis of a seizure disorder. What aspect of this client's health status would contraindicate the use of carbamazepine? The client's most recent blood work reveals pancytopenia. The client has type 2 diabetes, controlled through diet. The client has an allergy to sulfonamides. The client is 17 years old.
The client's most recent blood work reveals pancytopenia.
A nurse is to administer an anticonvulsant drug. The nurse understands that this drug is classified as an oxazolidinedione. Which drug would the nurse most likely be preparing to administer? Trimethadione Diazepam Gabapentin Levetiracetam
Trimethadione
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? Valproic acid Gabapentin Topiramate Trimethadione
Valproic acid
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? 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 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.
When prescribing an AED, the health care provider takes into account the type of seizure the client is having.
x A client with a recent history of seizures has been prescribed carbamazepine. The nurse should recognize that this medication will achieve a therapeutic effect by what means? reducing electrical activity in the thalamus and hypothalamus altering the permeability of neuron cell membranes affecting gamma-aminobutyric acid (GABA) levels and blocking sodium channels depressing conduction in the brainstem and cortex and slowing the reuptake of dopamine
affecting gamma-aminobutyric acid (GABA) levels and blocking sodium channels
A client reports sensing an unusual smell just prior to experiencing a tonic-clonic seizure. What term is used to describe this event? aura spasm spasticity epilepsy
aura
A 21 year-old client is distraught about the implications of a recent diagnosis of seizure activity. When addressing this client's most likely psychosocial needs, what topic should the nurse address? consequences of quitting college loss of libido and sexual performance client's loss of their driver's license consequences of needing bed rest during stressful times
client's loss of their driver's license
he nurse is at the bedside when a client experiences a seizure. What data should be collected during assessment after the seizure is over? Select all that apply. Client's name Client's last food intake Client's ability to identify a familiar item Client's ability to touch own ear Client's reported location
client's name Client's ability to identify a familiar item Client's ability to touch own ear Client's reported location
What is a common risk for epileptic seizures during late infancy to early childhood? learning disability fever medication overdose malnutrition
fever
A client comes to the emergency department experiencing status epilepticus. Which medication would the nurse expect to administer? Lorazepam Levetiracetam Trimethadione Methsuximide
lorazepam
A client, newly diagnosed with a seizure disorder, has been prescribed valproic acid. When assessing for adverse effects, what assessment should the nurse prioritize? assessing the client for signs of esophageal varices monitoring the client's liver enzyme levels assessing the client's apical heart rate and rhythm performing musculoskeletal assessment
monitoring the client's liver enzyme levels
A client, newly diagnosed with a seizure disorder, has been prescribed valproic acid. When assessing for adverse effects, what assessment should the nurse prioritize? assessing the client for signs of esophageal varices assessing the client's apical heart rate and rhythm performing musculoskeletal assessment monitoring the client's liver enzyme levels
monitoring the client's liver enzyme levels
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? shorter duration of absence seizures reduced risk of cardiac arrhythmias improved blood pressure stability reduced risk of status epilepticus
reduced risk of status epilepticus
A 26-year-old woman has been prescribed the suspension form of phenytoin. The nurse will inform the patient that she should check capillary blood glucose levels frequently. take the drug with food. shake the phenytoin suspension before pouring and measuring the dose. follow the drug with water.
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? insomnia skin rash anorexia fever
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? akinetic motor status epilepticus febrile
status epilepticus
