NCLEX Chapter 19 Questions - Antiseizure Drugs

NCLEX Chapter 19 Questions - Antiseizure Drugs Leave the first rating Students also studied Terms in this set (20) Save NCLEX Review Questions Chapter 2...21 terms emily222_Preview

CH. 14: Anti epileptic Drugs NCLEX

22 terms bshanesyPreview Antibiotics NCLEX Practice Questio...67 terms LeMoyneFreeman Preview Anticon 10 terms kar A patient is diagnosed with epilepsy and asks the nurse what may have caused this condition.The nurse explains that epilepsy is most often

• caused by head trauma.
• of unknown origin.
• linked to a stroke.
• related to brain anoxia.
• Of unknown origin

Of all seizure cases, 75% are considered to be primary, or idiopathic, with no known cause.the remaining are secondary and may be related to head trauma, stroke, or anoxia.A patient who has epilepsy will begin an anticonvulsant medication. the patient asks the nurse how long themedication will be necessary. How will the nurse respond?

• "The medication may be necessary for a lifetime."
• "The medication will be given until you are seizure

free."

• "You will need to take themedication for 3 to 5 years."
• "You will take themedication as needed for seizure

activity."

• "The medication may be necessary for a lifetime."

Anticonvulsants are given to prevent seizures and are usually taken throughout thepatient's lifetime. Stopping themedication can lead to recurrence of seizures in many patients. Some patients may attempt to stop taking themedications after 3 to 5 years of no seizure activity.Anticonvulsants are not given as needed.The nurse is providing teaching to theparents of a 5-year- old child who will begin taking phenytoin (Dilantin). What information will the nurse include when teaching these parents about their child's medication?

• "Drug interactions are uncommon with phenytoin."
• "There are very few side effects associated with this

drug."

• "The therapeutic range of phenytoin is between 15 and

45 mcg/mL."

• "Your child may need a higher dose than is usually used

in adults."

• "Your child may need a higher dose than is usually used in adults."

Drug dosage for phenytoin is age related, and children, who have a rapid metabolism, may need higher doses than those used for newborns and adults. Phenytoin has many drug interactions and many side effects. the therapeutic range is 10 to 20 mcg/mL.

The nurse is caring for a patient who has a seizure disorder being treated with phenytoin.thenurse notes that thepatient has reddened gums that bleed when brushing. thenurse recognizes this finding as

• an adverse effect of thephenytoin.
• likely due to a drug interaction with aspirin.
• a symptom of hepatotoxicity.
• a sign of poor self-care.
• An adverse effect of the phenytoin

Phenytoin commonly causes gingival hyperplasia, which causes overgrowth of reddened gum tissue that bleeds easily. It is not a sign of a drug interaction or a symptom of hepatotoxicity. It does not indicate a lack of self-care.The nurse is preparing to administer phenytoin (Dilantin) to a patient who has a seizure disorder.thenurse notes that thelast random serum drug level was 18 mcg/mL. What action will the nurse take?

• Administer the dose since the patient's labs do not

indicate toxic phenytoin levels.

• Contact the provider to discuss decreasing the

phenytoin dose.

• Contact theprovider and discuss increasing

thephenytoin dose.

• Report drug toxicity to the providers.
• Administer the dose since the patient's labs do not indicate toxic phenytoin

levels.The patient's drug level is considered within the desired therapeutic range of 10 to 20 mcg/mL.thenurse should administer thedose as written. It is not necessary to decrease thedose or increase the dose based on this serum level.The nurse is preparing to administer phenytoin to an 80- year-old patient and notes the following

order: IVP phenytoin 50 mg. the nurse will perform which

action?

• Administer through a PICC over 2 minutes.
• Contact theprovider to question theroute and thedose.
• Dilute thedrug in dextrose solution and infuse over 15

to 20 minutes.

• Request an order to administer the drug

intramuscularly.

• Administer through a PICC over 2 minutes.

It is recommended that phenytoin be administered by direct injection into a large vein via a central line or PICC. In older patients it should be infused at a rate of 25 mcg/min.thedose and theroute are appropriate. Phenytoin will precipitate in dextrose solution.Intramuscular injection is very irritating to tissues and is not used.The nurse is preparing to assist with blood collection on a newly admitted patient who has been taking phenytoin for several years. theprovider has ordered a complete blood count and liver function tests. Which other blood test will the nurse discuss with the provider?

• Blood glucose
• Coagulation studies
• Renal function tests
• Serum electrolytes
• Blood glucose

Patients who have taken hydantoins for long periods might have an elevated blood sugar that results from thedrug inhibiting therelease of inulin. thenurse should discuss this test with the provider.

A patient who takes phenytoin reports recently starting to take antacids for new-onset dyspepsia.thepatient previously had a phenytoin level in thenormal therapeutic range. thenurse might expect a serum phenytoin level in this patient to be in which range?

• 5 to 10 mcg/mL
• 10 to 20 mcg/mL
• 20 to 30 mcg/mL
• 30 to 50 mcg/mL
• 5 to 10 mcg/mL

Antacids can decrease the effects of phenytoin by inhibiting its absorption, which would decrease serum drug levels. The therapeutic range is 10 to 20 mcg/mL, so a level lower than this may be expected in a patient who started antacids while on phenytoin.A patient has recently begun taking phenytoin (Dilantin) for a seizure disorder. thenurse notes a reddish-brown color to thepatient's urine. Which action will thenurse take?

• Ask theprovider to order a serum drug level.
• Reassure the patient that this is a harmless side effect.
• Report possible thrombocytopenia to theprovider.
• Request an order for a urinalysis and creatinine

clearance.

• Reassure the patient that this is a harmless side effect.

Reddish-brown urine is a harmless side effect of phenytoin. The nurse should reassure the patient.It is not necessary to order a serum drug level or renal function studies. It is not a symptom of thrombocytopenia.A female patient who takes phenytoin for epilepsy becomes pregnant. The nurse will notify the patient's provider and will anticipate that the provider will take which action?

• Add valproic acid (Depakote) for improved seizure

control.

• Discontinue thephenytoin and discuss alternative

options to manage her epilepsy.

• Closely monitor this patient's serum phenytoin levels.
• Discontinue all anticonvulsant medications.
• Discontinue the phenytoin and discuss alternative options to manage her

epilepsy.Phenytoin has serious teratogenic effects, so women who are pregnant should not take it.Valproic acid is known to cause major congenital malformations in infants in 4% to 8% of women who take the drug; it should be avoided also. Teratogenicity increases with multiple anticonvulsants.The nurse is caring for a patient who has been diagnosed with absence seizures. thenurse will anticipate teaching this patient about which antiepileptic medication?

• Carbamazepine (Tegretol)
• Ethosuximide (Zarontin)
• Phenobarbital (Luminal)
• Phenytoin (Dilantin)
• Ethosuximide (Zarontin)

Ethosuximide, which belongs to the succinimide drug group, is used to treat absence seizures.The other drugs are not used to treat absence seizures.An intubated child is brought to the emergency department while having a seizure that has been progressing for 20 minutes. Which drug will thenurse anticipate administering to this patient first?

• Diazepam (Valium)
• Phenobarbital (Luminal)
• Phenytoin (Dilantin)
• Valproic acid (Depakote)
• Diazepam (Valium)

Diazepam is given to patients in status epilepticus and is administered IV. thedrug has a short- term effect; other antiseizure drugs, such as phenytoin or phenobarbital, must be given during or immediately after administration of diazepam. theother anticonvulsant medications do not have a rapid onset and are not used for emergencies.

A patient will begin taking theantiepileptic drug ethosuximide (Zarontin). Ethosuximide works by which of thefollowing mechanisms?

• Suppressing sodium influx
• Increasing GABA activity
• Decreasing GABA activity
• Suppressing calcium influx
• Suppressing calcium influx

Ethosuximide works by suppressing calcium influx. Other seizure medications work by suppressing sodium influx and increasing GABA activity. Decreasing GABA activity would increase seizure activity.A patient has recently begun taking carbamazepine (Tegretol) as an adjunct medication to treat refractory seizures. The patient has a serum carbamazepine level of 18 mcg/mL. Which of the following would be the most appropriate next step?

• Ask the patient about usual dietary preferences.
• Reassure the patient that this is a therapeutic drug

level.

• Report a subtherapeutic drug dose to the provider.
• Discontinue the carbamazepine.
• Ask the patient about usual dietary preferences.

This patient's carbamazepine level is high. When taken with grapefruit juice, an interaction may occur that results in toxic levels of carbamazepine. thenurse should question thepatient about food and fluid preferences. thetherapeutic level is 4 to 12 mcg/mL. This is a toxic level, not subtherapeutic. It would not be appropriate to discontinue therapy at this time.The nurse is performing a health history on a patient who is ordered to begin therapy with valproic acid (Depakote) to treat epilepsy. Which aspect of the patient's medical history will cause thenurse to be concerned?

• Chronic obstructive pulmonary disease
• Gastrointestinal disease
• Liver disease
• Renal disease
• Liver disease

Valproic acid can elevate liver enzymes and contribute to hepatotoxicity. Patients with a history of liver disease should use valproic acid with caution and receive appropriate liver monitoring.A woman who is pregnant is taking an anticonvulsant medication to treat a seizure disorder.thenurse will ensure that thepatient takes which dietary supplement toward theend of her pregnancy?

• Vitamin D
• Iron
• Vitamin C
• Vitamin K
• Vitamin K

Anticonvulsants act as inhibitors of vitamin K and can contribute to hemorrhage in infants shortly after birth. Women taking these drugs should receive vitamin K within thelast week to 10 days of their pregnancies.A parent expresses concern that a 5-year-old child may develop epilepsy because thechild experienced a febrile seizure at age 18 months. What will thenurse tell this parent?

• "A child who has had a febrile seizure is considered to

have epilepsy."

• "A small percentage of children who have febrile

seizures develop epilepsy."

• "I recommend discussing prophylactic anticonvulsant

drugs with theprovider."

• "Treat fevers aggressively with aspirin and NSAIDs to

prevent seizures."

• "A small percentage of children who have febrile seizures develop epilepsy."

Epilepsy develops in approximately 2.5% of children who have one or more febrile seizures. One febrile seizure does not always result in epilepsy. Prophylactic anticonvulsants are given to high- risk patients. Children should not receive aspirin for fever because of therisk of Reye's syndrome.