Neuro-Meds Saunders Evolve

A client with a diagnosis of trigeminal neuralgia is started on a regimen of carbamazepine (Tegretol). The nurse provides instructions to the client about the side/adverse effects of the medication. Which client statement indicates an understanding of the side/adverse effects of the medication? 1. "I will report a fever or sore throat to my health care provider." 2. "I must brush my teeth frequently to avoid damage to my gums." 3. "If I notice ringing in my ears that doesn't stop, I'll seek medical attention." 4. "If I notice a pink color to my urine, I will stop the medication and call my health care provider (HCP)."

1 Rationale: Agranulocytosis is adverse effect of carbamazepine and places the client at risk for infection. If a fever or a sore throat develops, the HCP should be notified. Gum damage, ringing in the ears, and pink-colored urine are not effects associated with this medication.

Carbamazepine (Tegretol) has been prescribed for a client, and the client asks the nurse about the action of the medication. The nurse's response should incorporate which information as a primaryeffect of this medication? 1. Anticonvulsant effect 2. Prevention of cellular division 3. Decrease in intraocular pressure 4. Interference with DNA production

1 Rationale: Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. Options 2, 3, and 4 are not actions or effects of this medication.

The nurse has given instructions for taking codeine sulfate to a client with a severe headache. Which statement by the client indicates the teaching has been effective? 1. "I should increase fluid intake." 2. "I should maintain a low-fiber diet." 3. "I should avoid all exercise to prevent lightheadedness." 4. "I should avoid the use of stool softeners to prevent diarrhea."

1 Rationale: Codeine sulfate can cause constipation, so the client is instructed to increase fluid intake to prevent this occurrence. A high-fiber diet and stool softeners may be prescribed to prevent constipation. All exercise is not avoided.

A client experiencing spasticity as a result of spinal cord injury has a new prescription for dantrolene (Dantrium). Before administering the first dose, the nurse checks to see if which baseline study has been done? 1. Liver function studies 2. Renal function studies 3. Otoscopic examination 4. Blood glucose measurements

1 Rationale: Dantrolene is a skeletal muscle relaxant and can cause liver damage; therefore the nurse should monitor the results of liver function studies. They should be done before therapy starts and periodically throughout therapy. Dantrolene is discontinued if no relief of spasticity is achieved in 6 weeks. The incorrect options are not specifically related to the administration of this medication.

The nurse has the following prescription for a postcraniotomy client, "dexamethasone (Decadron) 4 mg by the intravenous (IV) route now." How does the nurse administer the medication? 1. IV push over 1 minute 2. IV push over 4 minutes 3. IV piggyback in 50 mL of normal saline over 10 minutes 4. IV piggyback in 50 mL of normal saline over 30 minutes

1 Rationale: Dexamethasone (Decadron) is an adrenocorticosteroid administered after craniotomy to control cerebral edema. It is given by IV push, and single doses are administered over 1 minute. Dexamethasone IV doses are changed to the oral route after 24 to 72 hours and are tapered until discontinued. Additionally, IV fluids are administered cautiously after craniotomy to prevent increased cerebral edema.

A client is receiving phenobarbital sodium (Luminal) for the treatment of a seizure disorder. Which finding on the nursing assessment would indicate that the client is experiencing a common side effect of this medication? 1. Drowsiness 2. Hypocalcemia 3. Blurred vision 4. Seizure activity

1 Rationale: Drowsiness is a common side effect of phenobarbital, which is a barbiturate and antiseizure medication. Hypocalcemia is a rare toxic reaction. Blurred vision is not an associated side effect of this medication. Seizure activity could occur from abrupt withdrawal of this medication therapy or as a toxic reaction. Test-Taking Strategy: Note the subject, common side effects of this medication. Focus on the word common in the question, and recall that this medication is a barbiturate and antiseizure medication.

A client is scheduled to begin medication therapy with valproic acid (Depakene). The nurse looks for the results of which laboratory test(s) before administering the first dose? 1. Liver function tests 2. Renal function tests 3. Pulmonary function test 4. Pancreatic enzyme studies

1 Rationale: Gastrointestinal effects from valproic acid (Depakene) are common and typically mild, but hepatotoxicity, although rare, is serious. To minimize the risk of fatal liver injury, liver function is evaluated before initiation of treatment and periodically thereafter. The other options are unrelated to the use of this medication.

A client with status epilepticus has been prescribed phenytoin (Dilantin) to be given by the intravenous (IV) route. The nurse administering the medication is careful not to exceed which recommended infusion rate? 1. 50 mg/min 2. 60 mg/min 3. 100 mg/min 4. 750 mg/min

1 Rationale: IV administration of phenytoin is performed slowly (no faster than 50 mg/min) because rapid administration can cause cardiovascular collapse. It should not be added to any existing IV infusion because this is likely to produce a precipitate in the solution. Solutions are highly alkaline and can cause local venous irritation. Test-Taking Strategy: Focus on the subject, infusion rate of phenytoin. Noting that the medication is to be administered by the IV route, select the choice that indicates the slowest route of administration. This will direct you to the correct option.

A client has a medication prescription for phenytoin (Dilantin) to be administered by the intravenous route. After drawing up the medication, the nurse notes the presence of precipitate in the syringe. Which action should the nurse take? 1. Discard the syringe and begin again. 2. Add sterile water to dissolve the precipitate. 3. Draw up an additional 1 mL of normal saline into the syringe. 4. Chart the medication as "not given," and write a note in the medical record.

1 Rationale: If the injectable solution is not clear or if precipitate is present, the medication should not be used and should be discarded. The nurse may have to call the pharmacy department to obtain another vial of the medication. Options 2, 3, and 4 are inaccurate actions.

Phenytoin (Dilantin), 100 mg to be given orally three times daily, has been prescribed to a client for seizure control. The home health nurse visits the client and provides instructions regarding the medication. Which statement, if made by the client, would indicate an understanding of the instructions? 1. "I will use a soft toothbrush to brush my teeth." 2. "It's okay to break the capsules to make it easier for me to swallow them." 3. "If I forget to take my medication, I can wait until the next dose and eliminate that dose." 4. "If my throat becomes sore, it's a normal effect of the medication, and it's nothing to be concerned about."

1 Rationale: Phenytoin is an anticonvulsant. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. Capsules should not be chewed or broken. The client should not skip medication doses because inadequate blood levels could precipitate a seizure. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction because such findings may indicate hematological toxicity.

The nurse has given medication instructions to a client beginning anticonvulsant therapy with carbamazepine (Tegretol). The nurse determines that the client understands the use of the medication if he or she makes which statement? 1. Use sunscreen when outdoors. 2. Drive a car as long as it is not at night. 3. Keep tissues handy because of excess salivation. 4. Discontinue the medication if fever or sore throat occurs.

1 Rationale: The client should use protective clothing and sunscreen to avoid photosensitivity reactions. Carbamazepine acts by depressing synaptic transmission in the central nervous system (CNS). Because of this, the client should avoid driving at any time or doing other activities that require mental alertness until the effect of the medication on the client is known. The medication may cause dry mouth, and he or she should be instructed to provide good oral hygiene and use sugarless candy or gum as needed. The medication should not be abruptly discontinued because this could lead to return of seizures or status epilepticus. Fever and sore throat (leukopenia) should be reported to the health care provider.

A client has a prescription for valproic acid (Depakene) 250 mg once daily. To maximize the client's safety, the nurse should plan to schedule the medication at what time? 1. At bedtime 2. With lunch 3. After breakfast 4. Before breakfast

1 Rationale: Valproic acid is an anticonvulsant that causes central nervous system (CNS) depression. For this reason, the side effects of the medication include sedation, dizziness, ataxia, and confusion. When the client is taking this medication as a single daily dose, administering it at bedtime negates the risk of injury from sedation and enhances client safety. The medication should be taken at the same time each day.

The client with a head injury is experiencing signs of increased intracranial pressure (ICP), and mannitol (Osmitrol) is prescribed. The nurse administering this medication expects which as an intended effects of this medication? Select all that apply. 1. Increased diuresis 2. Reduced intracranial pressure 3. Increased osmotic pressure of glomerular filtrate 4. Reduced tubular reabsorption of water and solutes 5. Reabsorption of sodium and water in the loop of Henle

1,2,3,4 Rationale: Mannitol is an osmotic diuretic that induces diuresis by raising the osmotic pressure of glomerular filtrate, there by inhibiting tubular reabsorption of water and solutes. It is used to reduce intracranial pressure in the client with head trauma. The incorrect option would cause fluid retention through reabsorption, thereby increasing the intracranial pressure.

The nurse is preparing an intravenous infusion of phenytoin (Dilantin) as prescribed by the health care provider for the client with seizures. Which solution should the nurse plan to use to dilute this medication? 1. Dextrose 5% 2. Normal saline solution 3. Lactated Ringer's solution 4. Dextrose 5% and half-normal saline (0.45%)

2

The nurse is caring for a client receiving mannitol (Osmitrol) via intravenous (IV) infusion. A vial is sent from the pharmacy, and in preparing the medication the nurse notes that the vial contains crystals. What is the most appropriate nursing action? 1. Discard the vial. 2. Place the vial in warm water. 3. Send the vial back to the pharmacy. 4. Shake the vial to dissolve the crystals.

2 Rationale: Crystals form in a mannitol solution if the solution is cooled, but they will quickly dissolve if the container is placed in warm water and then cooled to body temperature before administration. However, if crystals remain after the warming procedure, the medication should not be used and should be returned to the pharmacy. The nurse would not discard the medication. The medication is not initially returned to the pharmacy because it is not defective. Shaking the vial should not be done and will not dissolve the crystals. Test-Taking Strategy: Note the strategic words most appropriate.Knowledge regarding the administration of mannitol is required to answer this question. It is necessary to know that crystals may form in the mannitol solution and that the solution is placed in warm water to dissolve the crystals. Remember that not all medications should be placed in warm water if crystals are noted; however, with this medication, it is acceptable.

SCI not TBI Dexamethasone (Decadron) intravenously is prescribed for the client with cerebral edema. The nurse prepares the medication for administration and plans to perform which action? 1. Mix the medication in 1000 mL of 5% dextrose. 2. Prepare an undiluted direct injection of the medication. 3. Mix the medication in 100 mL of lactated Ringer's solution. 4. Dilute the medication in lactated Ringer's solution and administer as a direct injection.

2 Rationale: Dexamethasone may be given by direct intravenous injection or intravenous infusion. Dexamethasone may be mixed with 0.9% sodium chloride or 5% dextrose. If administered as an infusion, a minimum amount of diluting solution is needed.

A client who has been taking phenytoin (Dilantin) for seizure control has a serum phenytoin drug level of 8 mcg/mL. The nurse should make which interpretation about this value? 1. A toxic level 2. An inadequate drug level 3. The low end of therapeutic range 4. The high end of therapeutic range

2 Rationale: The therapeutic serum drug level range for phenytoin is 10 to 20 mcg/mL. A laboratory value of 8 mcg/mL is below the therapeutic range, indicating an inadequate drug level.

A client is taking phenytoin (Dilantin) for seizure control. A blood sample is drawn to determine the serum drug level, and the nurse reviews the results. Which would indicate a therapeutic serum drug range? 1. 5 to 10 mcg/mL 2. 10 to 20 mcg/mL 3. 20 to 30 mcg/mL 4. 30 to 40 mcg/mL

2 Rationale: The therapeutic serum drug level range for phenytoin is 10 to 20 mcg/mL; therefore the remaining options are incorrect.

The nurse has given medication instructions to a client receiving phenytoin (Dilantin). Which statement indicates that the client has an adequate understanding of the instructions? 1. "Alcohol is not contraindicated while taking this medication." 2. "Good oral hygiene is needed, including brushing and flossing." 3. "The medication dose may be self-adjusted, depending on side effects." 4. "The morning dose of the medication should be taken before a serum drug level is drawn."

2 Rationale: Typical anticonvulsant medication instructions include taking the prescribed daily dosage to keep the blood level of the drug constant and having a sample drawn for serum drug level determination before taking the morning dose. The client is taught not to stop the medication abruptly, to avoid alcohol, to check with a health care provider before taking over-the-counter medications, to avoid activities in which alertness and coordination are required until medication effects are known, to provide good oral hygiene, and to obtain regular dental care. The client should also wear a Medic-Alert bracelet.

A nurse is assisting in the care of a client being discharged on phenytoin (Dilantin), 100 mg three times daily, for seizure control. When providing client teaching about this medication, the nurse should be sure to include which points? Select all that apply. 1. Break the capsules so they are easier to swallow. 2. Use a soft toothbrush while taking this medication. 3. If a dose is missed, just wait until the next one is due. 4. Alcohol should be avoided while taking this medication. 5. The medication may turn the client's urine pink, red, or brown. 6. Sore throat is a common side effect of the medication and is nothing to worry about.

2,4,5 Rationale: Phenytoin is an anticonvulsant that can cause gingival hyperplasia, as well as bleeding, swelling, and tenderness of the gums. The client should use good oral hygiene, gum massage, and have regular dental checkups. Alcohol interferes with the absorption of phenytoin, so it should be avoided. Change in the color of the urine is a normal reaction. A sore throat, fever, glandular swelling, or any skin reaction indicates hematological toxicity and needs to be reported.

A nurse is transcribing a prescription for antibiotic therapy for a client with bacterial meningitis. The nurse understands that the medication that will be prescribed for the client will have which characteristic? 1. Metabolizes slowly 2. Acts within minutes to hours 3. Crosses the blood-brain barrier 4. Excretes readily and easily in the urine

3 Rationale: A key consideration in prescribing medications that will affect the brain is the ability of the medication to cross the blood-brain barrier. If the medication cannot pass into the brain, it will not be effective. The duration of action, onset, and excretion (options 1, 2, and 4) apply to most medications and most uses but are not specific to those needed to treat meningitis.

A nurse is reading the laboratory results for a client being treated with carbamazepine (Tegretol) for prophylaxis of complex partial seizures. When evaluating the client's laboratory data, the nurse determines that which value is consistent with an adverse effect of this medication? 1. Sodium level, 136 mEq/L 2. Platelet count, 350,000 cells/mm3 3. White blood cell count, 3200 cells/mm3 4. Blood urea nitrogen (BUN), 19 mg/dL

3 Rationale: Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia. Other adverse effects include cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects.

A client taking carbamazepine (Tegretol) asks the nurse what to do if a dose is inadvertently missed. The nurse responds that which action should be taken? 1. Withhold until the next scheduled dose. 2. Withhold and call the health care provider (HCP). 3. Take the dose as long as it is not close to the time for the next dose. 4. Withhold until the next scheduled dose, which should then be doubled.

3 Rationale: Carbamazepine is an anticonvulsant that should be taken around the clock, precisely as directed. If a dose is omitted, the client should take the dose as soon as it is remembered, as long as it is not close to the time that the next dose is due. The medication should not be double-dosed. If more than one dose is omitted, the client should call the HCP.

A client is having the dosage of clonazepam (Klonopin) adjusted. The nurse should plan to perform which action? 1. Weigh the client daily. 2. Monitor blood glucose levels. 3. Institute seizure precautions. 4. Observe for areas of ecchymosis.

3 Rationale: Clonazepam is a benzodiazepine that is used as an anticonvulsant. During initial therapy and during periods of dosage adjustment, the nurse should initiate seizure precautions for the client. Weight, glucose levels, and ecchymosis are unrelated to this medication.

A client who was started on anticonvulsant therapy with clonazepam (Klonopin) tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these manifestations and asks the nurse what to do. The nurse's response is based on which understanding? 1. These symptoms probably result from interaction with another medication. 2. These symptoms usually occur when the client takes the medication with food. 3. These symptoms are most severe during initial therapy and decrease or disappear with long-term use. 4. These symptoms indicate that the client is experiencing a severe adverse reaction to the medication.

3 Rationale: Clonazepam is classified as a benzodiazepine and is used as an anticonvulsant and antianxiety agent. Drowsiness, unsteadiness, and clumsiness are expected effects of the medication during early therapy. They are dose related and usually diminish or disappear altogether with continued use of the medication. They are unrelated to an interaction with another medication. The client is encouraged to take this medication with food to minimize gastrointestinal upset. These symptoms do not indicate that an adverse effect is occurring.

The nurse is preparing to give a postcraniotomy client medication for incisional pain. The family asks the nurse why the client is receiving codeine sulfate and not "something stronger." In formulating a response, the nurse incorporates which information about codeine sulfate? 1. Is one of the strongest opioid analgesics available 2. Cannot lead to physical or psychological dependence 3. Does not alter respirations or mask neurological signs as do other opioids 4. Does not cause gastrointestinal (GI) upset or constipation as do other opioids

3 Rationale: Codeine sulfate is an opioid analgesic used for clients after craniotomy. It often is combined with a nonopioid analgesic such as acetaminophen (Tylenol) for added effect. It does not alter the respiratory rate or mask neurological signs as do other opioids. Side effects of codeine sulfate include GI upset and constipation. Chronic use of the medication can lead to physical and psychological dependence.

Dantrolene sodium (Dantrium) has been administered to a client with a spinal cord injury. The nurse determines that the client is experiencing an adverse effect of the medication if which is noted? 1. Dizziness 2. Drowsiness 3. Abdominal pain 4. Lightheadedness

3 Rationale: Dantrium is hepatotoxic. The nurse observes for indications of liver dysfunction, which include jaundice, abdominal pain, and malaise. The nurse notifies the health care provider if these occur. The items in options 1, 2, and 4 are expected side effects due to the central nervous system (CNS)-depressant effects of the medication.

A nurse preparing to administer carbamazepine (Tegretol) notices each of the following items on the client's breakfast tray. Which item should be a cause for concern and should be removed from the tray? 1. Carton of milk 2. Scrambled eggs 3. Grapefruit juice 4. Toast with honey

3 Rationale: Grapefruit juice can increase peak and trough levels of carbamazepine by 40%. Accordingly, clients taking the medication should be advised to avoid grapefruit juice. The other foods can be taken with this medication.

The nurse is observing a new nursing graduate who is preparing an intermittent intravenous (IV) infusion of phenytoin (Dilantin) for a client with a diagnosis of seizures. Which solution used by the nursing graduate should indicate to the nurse an understanding of proper preparation of this medication? 1. 5% dextrose in water 2. Lactated Ringer's solution 3. 0.9% sodium chloride (normal saline) 4. 5% dextrose and 0.45% sodium chloride

3 Rationale: Intermittent IV infusion of phenytoin is administered by injection into a large vein, using normal saline solution. Dextrose solutions are avoided because the medication will precipitate in these solutions. Options 1, 2, and 4 identify incorrect solutions for IV administration with this medication.

The home health nurse visits a client who is taking phenytoin (Dilantin) for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan? 1. Pregnancy should be avoided while taking phenytoin. 2. The client may stop the medication if it is causing severe gastrointestinal effects. 3. There is the potential of decreased effectiveness of birth control pills while taking phenytoin. 4. There is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.

3 Rationale: Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, and 4 are inappropriate instructions.

The nurse is providing instructions to an adolescent prescribed phenytoin (Dilantin) for the control of seizures. Which statement by the adolescent indicates a need for further teaching regarding the medication? 1. "The medication may cause acne or oily skin." 2. "Drinking alcohol may affect the medication." 3. "If my gums become sore and swollen I need to stop the medication." 4. "Birth control pills may not be effective when I take this medication."

3 Rationale: The adolescent should not stop taking antiseizure medications suddenly or without discussing it with a health care provider (HCP) or nurse. Acne or oily skin may be a problem for the adolescent, and the adolescent is advised to call a health care provider (HCP) for skin problems. Alcohol will lower the seizure threshold, and it is best to avoid the use of alcohol. Birth control pills may be less effective when the client is taking antiseizure medication.

The nurse has a prescription to administer diazepam (Valium) 5 mg by the intravenous (IV) route to a client. The nurse should administer the medication over a period of at least how long? 1. 15 seconds 2. 30 seconds 3. 1 minute 4. 5 minutes

3 Rationale: The recommended rate of infusion of diazepam is to give each 5 mg of the medication over at least 1 minute. This will prevent adverse effects including apnea, bradycardia, hypotension, and possibly cardiac arrest. Focus on the subject, administering diazepam by the IV route. A majority of medications administered by the IV route to a client must be given over at least 1 minute. Because of this requirement, you could eliminate options 1 and 2 first as excessively brief. Regarding the remaining options, it is much more likely that it is given over 1 minute than 5 minutes.

After review of the client's laboratory values, the nurse notes that a phenytoin (Dilantin) level for a client receiving phenytoin (Dilantin) is 7 mcg/mL. The nurse makes which interpretation regarding this laboratory result? 1. The level is within the expected therapeutic range. 2. The level indicates the medication should be stopped. 3. The level is lower than the expected therapeutic range. 4. The level is higher than the expected therapeutic range.

3 Rationale: The target range for a therapeutic serum level of phenytoin is between 10 and 20 mcg/mL. Levels below 10 mcg/mL are too low to control seizures. At levels above 20 mcg/mL, signs of toxicity begin to appear. This client has a low serum level, and the dosage is likely to be increased.

A client is taking the prescribed dose of phenytoin (Dilantin) to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL. Which finding would be expected as a result of this laboratory result? 1. Hypotension 2. Tachycardia 3. Slurred speech 4. No abnormal finding

3 Rationale: The therapeutic phenytoin level is 10 to 20 mcg/mL. At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) occur. At a level higher than 30 mcg/mL, ataxia and slurred speech occur.

The nurse in the health care provider's office is reviewing the results of a client's phenytoin (Dilantin) level determination performed that morning. The nurse identifies that a therapeutic drug level has been achieved if which result is noted? 1. 3 mcg/mL 2. 8 mcg/mL 3. 15 mcg/mL 4. 24 mcg/mL

3 Rationale: The therapeutic range for serum phenytoin levels is 10 to 20 mcg/mL in clients with normal serum albumin levels and renal function. A level below this range indicates that the client is not receiving sufficient medication and is at risk for seizure activity. In this case, the medication dose should be adjusted upward. A level above this range indicates that the client is entering the toxic range and is at risk for toxic effects of the medication. In this case, the dose should be adjusted downward.

A client is scheduled to begin therapy with carbamazepine (Tegretol). The nurse should assess the results of which test(s) before administering the first dose of this medication to the client? 1. Liver function tests 2. Renal function tests 3. Pancreatic enzyme studies 4. Complete blood cell count

4 Rationale: Carbamazepine (Tegretol) can cause leukopenia, anemia, thrombocytopenia, and, very rarely, fatal aplastic anemia. To reduce the risk of serious hematological effects, a complete blood cell count should be done before treatment and periodically thereafter. This medication should be avoided in clients with preexisting hematological abnormalities. The client also is told to report the occurrence of fever, sore throat, pallor, weakness, infection, easy bruising, and petechiae. Options 1, 2, and 3 are not associated with the use of this medication. Test-Taking Strategy: Focus on the subject, laboratory studies related to this medication. Recalling that carbamazepine causes hematological effects will direct you to the correct option. To help answer questions similar to this one, remember thatcarbamazepine and complete blood count begin with C.

A nurse is collecting data from a client and notes that the client is taking carbamazepine (Tegretol). The nurse determines that this medication has been prescribed to treat which condition? 1. Glaucoma 2. Diabetes mellitus 3. Parkinson's disease 4. Trigeminal neuralgia

4 Rationale: Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. It is not used to treat any of the conditions noted in options 1, 2, or 3.

The health care provider (HCP) writes a prescription for carbamazepine (Tegretol) for a client who was admitted to the hospital. The nurse contacts the HCP to verify the prescription if which condition is noted in the assessment data? 1. Hypertension 2. Tonic-clonic seizures 3. Trigeminal neuralgia 4. Bone marrow depression

4 Rationale: Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. It is used to treat seizure disorders, trigeminal neuralgia, and diabetic neuropathy. The medication can cause blood dyscrasias as an adverse effect and is contraindicated if the client has a history of bone marrow depression or hypersensitivity to tricyclic antidepressants or concurrent use of monoamine oxidase inhibitors.

Carbamazepine (Tegretol) has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? 1. Lipase level 2. Amylase level 3. Ammonia level 4. Complete blood cell (CBC) count

4 Rationale: Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. The medication can cause blood dyscrasias as an adverse effect, and the client should have a CBC done before therapy and periodically during therapy. Additional laboratory tests that should be done include a serum iron determination, urinalysis, blood urea nitrogen determination, and a carbamazepine level. The tests identified in options 1, 2, and 3 are unnecessary.

A client who is taking phenytoin (Dilantin) for a seizure disorder is being admitted to the hospital because of an increase in seizure activity. The client reports severe vomiting for the last 24 hours and inability to take phenytoin during that time. The nurse anticipates that the health care provider will most likely prescribe which medication? 1. Phenobarbital (Luminal) 2. Clonazepam (Klonopin) 3. Valproic acid (Depakene) 4. Fosphenytoin sodium (Cerebyx)

4 Rationale: Fosphenytoin sodium is used for short-term parenteral (intravenous) infusion. A client who is not tolerating medications orally and has a seizure disorder would need an anticonvulsant administered by the parenteral route. Phenobarbital is an antiseizure medication that is given orally or parenterally. However, the medication of choice in this case would be fosphenytoin since its use if for short-term. Valproic acid and clonazepam usually are administered orally.

A nurse is speaking with a client taking phenytoin (Dilantin) for seizure control. The client states that she has started using birth control pills to prevent pregnancy. Which would be an important point for the nurse to emphasize to the client? 1. Oral contraceptives decrease the effectiveness of phenytoin. 2. Severe gastrointestinal side effects can occur when phenytoin and oral contraceptives are taken together. 3. There is an increased risk of thrombophlebitis when phenytoin and oral contraceptives are taken at the same time. 4. Phenytoin may decrease effectiveness of birth control pills, and additional measures should be taken to avoid pregnancy.

4 Rationale: Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. The nurse should tell the client to alert the health care provider about the use of birth control pills so that counseling may be provided about alternative birth control methods. The other options are incorrect.

A nurse is providing instructions to a client beginning medication therapy with divalproex sodium (Depakote) for treatment of absence seizures. The nurse instructs the client that which represents the most frequent side effect of this medication? 1. Tinnitus 2. Irritability 3. Blue vision 4. Nausea and vomiting

4 Rationale: The most frequent side effects of medication therapy with divalproex sodium (Depakote) are gastrointestinal (GI) disturbances, such as nausea, vomiting, and indigestion. The items in the other options are incorrect.

A client is receiving anticonvulsant therapy with phenytoin (Dilantin). To monitor for adverse effects of this medication, the nurse assesses the results of which laboratory test? 1. Serum sodium 2. Serum potassium 3. Blood urea nitrogen 4. Complete blood count (CBC)

4 Rationale: The nurse monitors the CBC because hematological effects of this therapy include aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia. Other test results that warrant monitoring include serum calcium levels, urinalysis, and hepatic and thyroid function tests. Electrolyte results and renal function tests are not a concern with this medication

A nurse is reviewing the results of a test on a sample drawn from a child who is receiving carbamazepine (Tegretol) for the control of seizures. The results indicate a serum carbamazepine level of 10 mcg/mL. The nurse analyzes the results and anticipates that the health care provider (HCP) will note which prescription? 1. Discontinuation of the medication 2. An increased dose of the medication 3. A decreased dose of the medication 4. Continuation of the presently prescribed dosage

4 Rationale: When carbamazepine (Tegretol) is administered, blood levels need to be tested periodically to check for the child's absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. Carbamazepine's therapeutic serum range is 3 to 14 mcg/mL. Therefore, the nurse anticipates that the HCP will continue the presently prescribed dosage.

The nurse is told that the result of a serum carbamazepine (Tegretol) level for a child who is receiving the medication for the control of seizures is 10 mcg/mL. Based on this laboratory result, the nurse anticipates that the health care provider (HCP) will document which prescription? 1. Discontinuation of the medication 2. A decrease of the dosage of the medication 3. An increase of the dosage of the medication 4. Continuation of the presently prescribed dosage

4 Rationale: When carbamazepine is administered, blood levels need to be monitored periodically to check for the child's absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. The therapeutic serum range of carbamazepine is 4 to 12 mcg/mL. The nurse would anticipate that the HCP will continue the presently prescribed dosage.

A client with trigeminal neuralgia is being treated with carbamazepine (Tegretol), 400 mg orally daily. Which value indicates that the client is experiencing an adverse effect to the medication? 1. Uric acid level, 5 mg/dL 2. Sodium level, 140 mEq/L 3. Blood urea nitrogen level, 15 mg/dL 4. White blood cell count, 3000 cells/mm3

4Rationale: Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia; cardiovascular disturbances including thrombophlebitis and dysrhythmias; and dermatological effects. The low white blood cell count reflects agranulocytosis. The laboratory values in options 1, 2, and 3 are normal values.

NO LONGER USE FOR ICP The nurse has a prescription to give dexamethasone (Decadron) by the intravenous (IV) route to a client with cerebral edema. How should the nurse prepare this medication? 1. Diluting the medication in 500 mL of 5% dextrose 2. Preparing an undiluted direct injection of the medication 3. Diluting the medication in 1 mL of lactated Ringer's solution for direct injection 4. Diluting the medication in 10% dextrose in water and administering it as a direct injection

Rationale: Dexamethasone may be given by direct IV injection or IV infusion. For IV infusion, it may be mixed with 50 to 100 mL of 0.9% sodium chloride or 5% dextrose in water. It is not mixed with lactated Ringer's solution or 10% dextrose in water.