Review Questions CH 15

NCLEX-RN

® Review Questions CH 15 1.An 8-year-old boy is evaluated and diagnosed with absence seizures. He is started on ethosuximide (Zarontin). Which information should the nurse provide the parents?

1.After-school sports activities will need to be stopped because they will increase the risk of seizures.

2.Monitor height and weight to assess that growth is progressing normally.

3.Fractures may occur, so increase the amount of vitamin D and calcium-rich foods in the diet.

4.Avoid dehydration with activities and increase fluid intake.

Answer: 2

Rationale: Because adverse drug effects such as nausea, anorexia, or abdominal pain may occur with ethosuximide (Zarontin), the parents should monitor the child’s height and weight to assess whether nutritional intake is sufficient for normal growth and development. Options 1, 3, and 4 are incorrect. Physical activity does not increase the risk of seizure activity or need to be curtailed, and the drug does not affect bone growth or require extra vitamin D or calcium in the diet. Dehydration is a condition to be avoided in all clients, although increasing fluid intake is not necessary related to the use of ethosuximide.

2.The nurse is providing education for a 12-year-old client with partial seizures currently prescribed valproic acid (Depakene). The nurse will teach the client and the parents to immediately report which symptom?

1.Increasing or severe abdominal pain 2.Decreased or foul taste in the mouth 3.Pruritus and dry skin 4.Bone and joint pain

Answer: 1

Rationale: Valproic acid may cause a life-threatening pancreatitis and any severe or increasing abdominal pain should be reported immediately. Options 2, 3, and 4 are incorrect. The drug is not known to cause dysgeusia (altered sense of taste) or effects on

bones or joints. Although pruritus is an adverse effect associated with valproic acid, it may be managed with simple therapies, and unless it progresses to a more serious rash, it does not need to be reported immediately.

3.The nurse is caring for a 72-year-old client taking gabapentin (Neurontin) for a seizure disorder. Because of this client’s age, the nurse would establish which nursing diagnosis related to the drug’s common adverse effects?

1.Risk for Deficient Fluid Volume 2.Risk for Impaired Verbal Communication 3.Risk for Constipation 4.Risk for Falls

Answer: 4

Rationale: Common adverse effects to gabapentin (Neurontin) include CNS depression including dizziness and drowsiness. Because of this client’s age, these effects may increase the risk of falls. Options 1, 2, and 3 are incorrect. The drug is not known to cause dehydration (fluid volume deficit) or constipation or impair the ability to communicate.

4.A client has been taking phenytoin (Dilantin) for control of generalized seizures, tonic– clonic type. The client is admitted to the medical unit with symptoms of nystagmus, confusion, and ataxia. What change in the phenytoin dosage does the nurse anticipate will be made based on these symptoms?

1.The dosage will be increased.

2.The dosage will be decreased.

3.The dosage will remain unchanged; these are symptoms unrelated to the phenytoin.

4.The dosage will remain unchanged but an additional antiseizure medication may be added.

Answer: 2

Rationale: Nystagmus, confusion, and ataxia may occur with phenytoin, particularly with higher dosages. The dosage is likely to be decreased. Options 1, 3, and 4 are incorrect.The dosage would not remain the same or be increased because these are adverse effects of phenytoin that are related to overdosage.

5.Teaching for a client receiving carbamazepine (Tegretol) should include instructions that the client should immediately report which symptom?

1.Leg cramping 2.Blurred vision 3.Lethargy 4.Blister-like rash

Answer: 4

Rationale: Carbamazepine (Tegretol) is associated with Stevens–Johnson Syndrome (SJS) and exfoliative dermatitis. A blister-like skin rash may indicate that these conditions are developing. Options 1, 2, and 3 are incorrect. Blurred vision, leg cramping, and drowsiness or lethargy are adverse effects of carbamazepine but do not require immediate reporting and may diminish over time.

6.Which of the following medications may be used to treat partial seizures? (Select all that apply.) 1.Phenytoin (Dilantin) 2.Valproic acid (Depakene) 3.Diazepam (Valium) 4.Carbamazepine (Tegretol) 5.Ethosuximide (Zarontin)

Answer: 1, 2, 4

Rationale: The phenytoin-like drugs including phenytoin (Dilantin), valproic acid (Depakene), and carbamazepine (Tegretol) are used to treat partial seizures. Options 3 and 5 are incorrect. Diazepam (Valium) is a benzodiazepine that is used to treat tonic– clonic seizures and status epilepticus. Ethosuximide (Zarontin) is used in the control of generalized seizures such as absence seizures.

NCLEX-RN

® Review Questions CH 29

1.A client with type 1 diabetes on insulin therapy reports that he takes propranolol (Inderal) for his hypertension. The nurse will teach the client to check glucose levels more frequently because of what concern?

1.The propranolol can produce insulin resistance.

2.The two drugs used together will increase the risk of ketoacidosis.

3.Propranolol will increase insulin requirements by antagonizing the effects at the receptors.

4.The propranolol may mask symptoms of hypoglycemia.

Answer: 4

Rationale: Beta blockers such as propranolol decrease the body’s adrenergic “fight-or- flight” responses and may diminish or mask the symptoms and signals of hypoglycemia that a client with diabetes normally perceives as blood glucose drops. Options 1, 2, and 3 are incorrect. Beta blockers may inhibit glycogenolysis, resulting in hypoglycemia, and have no effect on the development of insulin resistance.

2.When monitoring for therapeutic effect of any antidysrhythmic drug, the nurse would be sure to assess which essential parameter?

1.Pulse 2.Blood pressure 3.Drug level 4.Hourly urine output

Answer: 1

Rationale: In the absence of ECG monitoring, the nurse would assess the pulse for rate, regularity, quality, and volume, noting any changes. The nurse should also teach the client to monitor the pulse for rate and regularity, before sending the client home. Options 2, 3, and 4 are incorrect. The nurse is monitoring for the therapeutic effects of antidysrhythmic therapy. Although blood pressure and drug level may also be monitored, they do not evaluate the therapeutic effects of the drug. Urine output may change related to the type of drug given and any effects on cardiac output, but frequent output monitoring is not indicated in routine antidysrhythmic therapy and will not assess for therapeutic drug effects.