Chapter 23 Anti-seizure Agents prepU (GRADED A) Questions and Answers REF, Karch, A. M., Focus on Nursing Pharmacology, 8th ed | Download To Score An A

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Chapter 23: Anti-seizure Agents Question 1 See full question34s Report this Question A client is prescribed topiramate. The nurse cautions the client to avoid the intake of alcohol for which rea... son? You Selected: The client is at risk for increased CNS depression. Correct response: The client is at risk for increased CNS depression. Explanation: Combining alcohol with topiramate increases the client's risk for CNS depression. Topiramate combined with alcohol does not result in a disulfiram-like reaction. Drug dependency is not associated with the use of topiramate and alcohol. The combination of topiramate and alcohol is not associated with the development of a hypertensive crisis. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Adverse Effects, p. 408. Chapter 23: Anti-seizure Agents - Page 408 Add a Note Question 2 See full question31s Report this Question When reviewing a journal article about seizure disorders, the nurse would expect to find tonic–clonic seizures and myoclonic seizures being classified as which type of seizures? You Selected: Generalized seizures Correct response: Generalized seizures Explanation: Tonic–clonic seizures and myoclonic seizures are classified as generalized seizures. Partial seizures can be simple or complex. Complex seizures are partial seizures that involve impaired consciousness and variable unconscious repetitive actions, staring gaze, and hallucinations/delusions. Atonic seizures are a type of generalized seizure involving the loss of muscle tone where the person suddenly drops. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Generalized Seizures, p. 394. Chapter 23: Anti-seizure Agents - Page 394 Add a Note Question 3 See full question27s Report this Question Which anticonvulsant elicits its effects by depressing the motor cortex and creating a higher threshold before nerves react to the convulsive stimuli? You Selected: Methsuximide (Celontin) Correct response: 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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Therapeutic Actions and Indications, p. 400. Chapter 23: Anti-seizure Agents - Page 400 Add a Note Question 4 See full question18s Report this Question A patient with partial seizures has been prescribed succinimides at a health care facility. The patient experiences GI upset after succinimides administration. What should the nurse instruct the patient to do? You Selected: Take the drug with food or milk. Correct response: Take the drug with food or milk. Explanation: If the patient experiences GI upset after succinimides administration, the nurse should instruct the patient to take the drug with food or milk. The nurse need not instruct the patient to take the drug once only at bedtime, before meals, nor avoid taking fruit juice. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Therapeutic Actions and Indications, p. 400. Chapter 23: Anti-seizure Agents - Page 400 Add a Note Question 5 See full question13s Report this Question A client who has been taking valproic acid (sodium valproate) for a seizure disorder is asking the nurse about getting pregnant. Why is pregnancy discouraged in women who are being treated for seizure disorders? You Selected: Antiepilepsy drugs are teratogenic Correct response: Antiepilepsy drugs are teratogenic Explanation: Antiepileptic drugs must be used cautiously during pregnancy because they are teratogenic in animals. Seizure disorders are not genetic. Seizure disorders are not familial. Antiepilepsy medications do not decrease fertility. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Adverse Effects, p. 401. Chapter 23: Anti-seizure Agents - Page 401 Add a Note Question 6 See full question30s Report this Question 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? You Selected: Informing the client and family that seizure control is not gained immediately Correct response: Informing the client and family that seizure control is not gained immediately Explanation: The nurse should inform the client 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 client. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Contraindications and Cautions, p. 396. Chapter 23: Anti-seizure Agents - Page 396 Add a Note Question 7 See full question15s Report this Question Which factor should the clinician reassess when combination therapy is ineffective? You Selected: Drug-drug interactions Correct response: Drug-drug interactions Explanation: If combination therapy is ineffective, the clinician may need to reassess the patient for type of seizure, medical conditions or drug–drug interactions that aggravate the seizure disorder or decrease the effectiveness of antiseizure drugs, and compliance with the prescribed drug therapy regimen. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents. Add a Note Question 8 See full question22s Report this Question The nurse is monitoring the serum carbamazepine level of a client. Which result would lead the nurse to notify the prescriber that the client most likely needs an increased dosage? You Selected: 2 mcg/mL Correct response: 2 mcg/mL Explanation: Therapeutic serum carbamazepine levels range from 4 to 12 mcg/mL. Therefore, a level under 4 mcg/mL would suggest that the drug has not reached therapeutic levels, so the dosage may need to be increased. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Table 23.3 Drugs in Focus: Drugs for Treating Partial Seizures, p. 406. Chapter 23: Anti-seizure Agents - Page 406 Add a Note Question 9 See full question20s Report this Question A client is to receive ethotoin. The nurse would expect to administer this drug by which route? You Selected: Oral Correct response: Oral Explanation: Ethotoin is administered orally. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Pharmacokinetics, p. 396. Chapter 23: Anti-seizure Agents - Page 396 Add a Note Question 10 See full question58s Report this Question A 30-year-old female client is diagnosed with seizure disorder, and the provider is considering the use of carbamazepine. What assessment question best addresses the safety and effectiveness of the medication regimen? You Selected: "Is there any chance that you could be pregnant?" Correct response: "Is there any chance that you could be pregnant?" Explanation: Carbamazepine is contraindicated during pregnancy. A female client of this age should be assessed for pregnancy prior to starting to take the drug. The client's history of hepatitis vaccinations does not have a major bearing on treatment. Visual changes are unlikely and there are not known optic conditions that contraindicate use. It is appropriate to assess the client's ability to pay but this does not directly relate to client safety. Question 1 See full question1m 24s Report this Question In a person being treated for a diagnosed seizure disorder, what is the most common cause of status epilepticus? You Selected: abruptly stopping the antiseizure medications Correct response: abruptly stopping the antiseizure medications Explanation: In a person taking medications for a diagnosed seizure disorder, the most common cause of status epilepticus is abruptly stopping AEDs. In other clients, regardless of whether they have a diagnosed seizure disorder, causes of status epilepticus include brain trauma or tumors, systemic or central nervous system (CNS) infections, alcohol withdrawal, and overdoses of drugs (e.g., cocaine, theophylline). Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Contraindications and Cautions, p. 396. Chapter 23: Anti-seizure Agents - Page 396 Add a Note Question 2 See full question20s Report this Question A patient with cortical focal seizures has been prescribed phenobarbital. What adverse reaction should the nurse monitor for in the patient? You Selected: CNS depression Correct response: CNS depression Explanation: The nurse should monitor CNS depression in the patient undergoing phenobarbital treatment. Gingival hyperplasia is an adverse reaction in a patient administered ethotoins. Ataxia and urticaria are adverse reactions in patients undergoing anticonvulsant ethosuximide therapy. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Adverse Effects, p. 398. Chapter 23: Anti-seizure Agents - Page 398 Add a Note Question 3 See full question14s Report this Question A nurse is caring for a client with trigeminal neuralgia at a health care facility. The health care provider has prescribed carbamazepine. In which case is the use of carbamazepine contraindicated in clients with: You Selected: renal impairment. Correct response: renal impairment. Explanation: The nurse should know that carbamazepine is contraindicated among clients with renal impairment. Carbamazepine is not contraindicated in those with nervous breakdown, hearing impairment, and respiratory depression. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Adverse Effects, p. 408. Chapter 23: Anti-seizure Agents - Page 408 Add a Note Question 4 See full question39s Report this Question A client prescribed phenytoin for a seizure disorder has recently run out of medication and has not obtained a refill. What is the client at risk for developing? You Selected: status epilepticus Correct response: status epilepticus Explanation: In a person taking medications for a diagnosed seizure disorder, the most common cause of status epilepticus is abruptly stopping AEDs. Abruptly stopping phenytoin will not cause hypotension, migraine headaches, or depression. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Contraindications and Cautions, p. 396. Chapter 23: Anti-seizure Agents - Page 396 Add a Note Question 5 See full question16s Report this Question A female client’s seizure disorder has been successfully controlled by AEDs for years. She and her husband decide that it is time to start a family. She asks the nurse if it is safe for the fetus for her to continue her AEDs as prescribed. What is the nurse’s best response? You Selected: “They are considered teratogenic.” Correct response: “They are considered teratogenic.” Explanation: Sexually active adolescent girls and women of childbearing potential who require an AED must be evaluated and monitored very closely, because all of the AEDs are considered teratogenic. In general, infants exposed to one AED have a significantly higher risk of birth defects than those who are not exposed, and infants exposed to two or more AEDs have a significantly higher risk than those exposed to one AED. Question 1 See full question56s Report this Question What is a common risk for epileptic seizures during late infancy to early childhood? You Selected: fever Correct response: fever Explanation: Epilepsy can be classified as idiopathic or attributable to a secondary cause. Secondary causes in infancy include developmental defects, metabolic disease, or birth injury. Fever is a common cause during late infancy and early childhood, and inherited forms usually begin in childhood or adolescence. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Partial Seizures, p. 395. Chapter 23: Anti-seizure Agents - Page 395 Add a Note Question 2 See full question47s Report this Question What best reflects the action of barbiturates when used to control seizures? You Selected: Inhibition of impulse conduction Correct response: Inhibition of impulse conduction Explanation: Barbiturates inhibit impulse conduction in the ascending reticular activating system. Barbiturates depress the cerebral cortex, depress cerebellar functioning, and depress motor nerve output. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, barbiturates, p. 398. Chapter 23: Anti-seizure Agents - Page 398 Add a Note Question 3 See full question1m Report this Question Which nursing diagnosis would be most important for a nurse to include in the plan of care for a client who is receiving an antiseizure agent and experiencing common adverse effects? You Selected: Risk for injury Correct response: Risk for injury Explanation: CNS depression that accompanies many antiseizure agents could lead to injury. Therefore risk for injury and safety measures would be the priorities. Imbalanced fluid volume would be appropriate if the client was experiencing vomiting or diarrhea or showing signs of dehydration. Impaired skin integrity might be appropriate if the client developed a rash. Ineffective coping would be appropriate if the client was verbalizing difficulties with his condition or therapy. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, ANTISEIZURE AGENTS, p. 394. Chapter 23: Anti-seizure Agents - Page 394 Add a Note Question 4 See full question1m 35s Report this Question The nurse in the newborn nursery is caring for a newborn who has exhibited seizure activity and is prepared to administer what drug of choice? You Selected: IM phenobarbital Correct response: IM phenobarbital Explanation: Oral drugs are absorbed slowly and inefficiently in newborns. If an antiseizure drug is necessary during the first 7 to 10 days of life, IM phenobarbital is effective. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Box 23.2 Focus on Drug Therapy across the Lifespan, p. 394. Chapter 23: Anti-seizure Agents - Page 394 Add a Note Question 5 See full question34s Report this Question The nurse instructs the parent of a young school-age child with a seizure disorder who takes an AED to be alert for what signs and symptoms? You Selected: Excessive sedation and interference with learning and social development Correct response: Excessive sedation and interference with learning and social development Explanation: AEDs must be used cautiously to avoid excessive sedation and interference with learning and social development. Question 1 See full question1m 39s Report this Question While administering phenytoin, the nurse should observe the client for symptoms of which adverse reaction? You Selected: Bradycardia Correct response: 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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Adverse Effects, p. 399. Chapter 23: Anti-seizure Agents - Page 399 Add a Note Question 2 See full question30s Report this Question The nurse has taught a client who is receiving lamotrigine about possible adverse effects. The nurse determines that the client has understood the teaching when the client identifies a need to promptly report what adverse effect? You Selected: Rash Correct response: Rash Explanation: Lamotrigine has been associated with very serious to life-threatening rashes and the drug should be discontinued at the first sign of any rash. Anorexia is a common adverse GI effect. Fatigue is a common adverse CNS effect. Upper respiratory infection is an adverse effect of the drug, but it is not life threatening and does not need to be reported immediately. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Adverse Effects, p. 408. Chapter 23: Anti-seizure Agents - Page 408 Add a Note Question 3 See full question17s Report this Question Which type of seizures involves a loss of consciousness? You Selected: Generalized seizures Correct response: Generalized seizures Explanation: Generalized seizures involve a loss of consciousness. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Generalized Seizures, p. 394. Chapter 23: Anti-seizure Agents - Page 394 Add a Note Question 4 See full question22s Report this Question A client comes to the emergency department experiencing status epilepticus. Which medication would the nurse expect to administer? You Selected: Lorazepam Correct response: Lorazepam Explanation: Lorazepam is the drug of choice in the treatment of status epilepticus, an emergency characterized by continual seizure activity with no interruptions. Levetiracetam in an anticonvulsant is used as adjunctive therapy to treat partial onset seizures as well as tonic–clonic seizures. Trimethadione is used to treat epilepsy. Methsuximide is used for focal seizures. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Lorazepam, p. 394. Chapter 23: Anti-seizure Agents - Page 394 Add a Note Question 5 See full question15s Report this Question A patient is prescribed daily doses of phenytoin for seizures. The nurse knows that a single dose should not be missed during the course of treatment. Which condition could result if a dose is missed? You Selected: Status epilepticus Correct response: Status epilepticus Explanation: Status epilepticus may result from abrupt discontinuation of the drug, even when the anticonvulsant is being administered in small daily doses. Abrupt discontinuation of the drug does not cause CNS depression, hypotension, or nystagmus. CNS depression, hypotension, and nystagmus are adverse reactions of phenytoin. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Contraindications and Cautions, p. 396. Chapter 23: Anti-seizure Agents - Page 396 Add a Note Question 6 See full question19s Report this Question A nurse is caring for a patient prescribed phenobarbital for status epilepticus. What intervention should the nurse perform when the patient has been administered the drug? You Selected: Observe respirations frequently. Correct response: Observe respirations frequently. Explanation: When caring for a patient who has been administered phenobarbital, the nurse should observe respirations frequently. The nurse need not monitor blood glucose levels or body temperature. The nurse need not record fluid input and output. The nurse may need to observe blood glucose levels if the patient is being administered antidiabetic medications along with an anticonvulsant. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Pharmacokinetics, p. 399. Chapter 23: Anti-seizure Agents - Page 399 Add a Note Question 7 See full question14s Report this Question The nurse is caring for a 26-year-old client with partial seizures and has been prescribed oxcarbazepine as monotherapy. It will be critical for the nurse to inform the client of which needed action? You Selected: since she is taking oral contraceptives, she will need to use an additional form of birth control. Correct response: since she is taking oral contraceptives, she will need to use an additional form of birth control. Explanation: Oxcarbazepine causes the circulating levels of oral contraceptives to decrease by up to half. The nurse should teach the client that she will need to use an additional form of birth control. Fatigue may be a concern, and the client should allow for rest periods during the day. Diplopia and abnormal vision can be adverse effects of the drug and eye exams should be part of the client's treatment regimen but they are not needed every other month. Informing the client that GI problems are common adverse effects is important but not as critical as preventing an unplanned pregnancy. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Therapeutic Actions and Indications, p. 405. Chapter 23: Anti-seizure Agents - Page 405 Add a Note Question 8 See full question9s Report this Question A client is receiving a hydantoin as treatment for tonic-clonic seizures. The nurse includes a discussion of what when teaching the client about this drug? You Selected: Gingival hyperplasia Correct response: Gingival hyperplasia Explanation: Hydantoins may cause gingival hyperplasia, severe liver toxicity, and bone marrow suppression. Physical dependence and withdrawal syndrome are associated with benzodiazepines. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Adverse Effects, p. 398. Chapter 23: Anti-seizure Agents - Page 398 Add a Note Question 9 See full question13s Report this Question A client is receiving lamotrigine as treatment for partial seizures. Which assessment finding would lead the nurse to stop the drug immediately? You Selected: Rash Correct response: Rash Explanation: Lamotrigine has been associated with very serious to life-threatening rashes, and the drug should be discontinued at the first sign of any rash. Somnolence and confusion are typical CNS effects; anorexia is a common gastrointestinal effect. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Adverse Effects, p. 408. Chapter 23: Anti-seizure Agents - Page 408 Add a Note Question 10 See full question24s Report this Question 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? You Selected: Implement falls precautions Correct response: Implement falls precautions Explanation: CNS depression creates a risk for falls, especially in older clients. There is no need to assess vital signs on an hourly basis and the harm of bed rest exceeds the benefits. Occupational therapy has no direct relationship with treating CNS depression. uestion 1 See full question37s Report this Question 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? You Selected: Document the fact that the nurse checked the client’s phenytoin levels Correct response: 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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, phenytoin levels, p. 396. Chapter 23: Anti-seizure Agents - Page 396 Add a Note Question 2 See full question11s Report this Question A client is receiving carbamazepine therapy and the client’s latest serum level of the drug is 13 mcg/mL. What action is most appropriate? You Selected: Anticipate a reduction is dosage Correct response: Anticipate a reduction is dosage Explanation: A serum carbamazepine level of 13 mcg/mL is slightly over the therapeutic range of 4 to 12 mcg/mL, indicating need for a reduction in dosage. This not an emergency, though it needs to be addressed. This result does not threaten the client’s renal function. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Clinically Important Drug–Drug Interactions, p. 408. Chapter 23: Anti-seizure Agents - Page 408 Add a Note Question 3 See full question22s Report this Question A client is experiencing absence seizures and has been prescribed a succinide. What prescription is most likely? You Selected: Zarontin Correct response: Zarontin Explanation: Ethosuximide (Zarontin) is considered the drug of choice for treating absences seizures and is in the succinide family. The other listed drugs are not succinides. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Succinimides, p. 400. Chapter 23: Anti-seizure Agents - Page 400 Add a Note Question 4 See full question46s Report this Question A client has been prescribed carbamazepine for the prevention of seizures. What action should the nurse perform? You Selected: Educate the client about the need to ake the pills as scheduled Correct response: Educate the client about the need to ake the pills as scheduled Explanation: Carbamazepine is administered orally on an ongoing basis. It is not an emergency treatment for seizure activity. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Therapeutic Actions and Indications, p. 405. Chapter 23: Anti-seizure Agents - Page 405 Add a Note Question 5 See full question35s Report this Question When reviewing a journal article about seizure disorders, the nurse would expect to find tonic–clonic seizures and myoclonic seizures being classified as which type of seizures? You Selected: Partial seizures Correct response: Generalized seizures Explanation: Tonic–clonic seizures and myoclonic seizures are classified as generalized seizures. Partial seizures can be simple or complex. Complex seizures are partial seizures that involve impaired consciousness and variable unconscious repetitive actions, staring gaze, and hallucinations/delusions. Atonic seizures are a type of generalized seizure involving the loss of muscle tone where the person suddenly drops. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Generalized Seizures, p. 394. Chapter 23: Anti-seizure Agents - Page 394 Add a Note Question 6 See full question11s Report this Question A client in the clinic with a history of epilepsy has just tested positive for pregnancy. What is the nurse’s next action? You Selected: Consult with the primary health care provider. Correct response: 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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Clinically Important Drug–Drug Interactions, p. 400. Chapter 23: Anti-seizure Agents - Page 400 Add a Note Question 7 See full question18s Report this Question While taking the vital signs of a hospitalized client admitted for seizure control due to epilepsy, the nurse notices a bloody toothbrush on the client’s bedside table and scattered bruising over the client’s extremities. What is the nurse’s best action? You Selected: Report the findings to the primary health care provider immediately. Correct response: Report the findings to the primary health care provider immediately. Explanation: The client has a history of epilepsy and is likely taking anticonvulsants. Hematologic changes when taking anticonvulsants needs to be reported immediately to the health care provider. Such changes include bleeding gums and easy bruising. Abuse is not the likely cause of the client’s bruising given the history of epilepsy. Telling the client to ask for assistance when ambulating and offering a soft toothbrush are appropriate, but the health care provider needs to be notified immediately about the hematologic changes. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, p. 393. Chapter 23: Anti-seizure Agents - Page 393 Add a Note Question 8 See full question11s Report this Question 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? You Selected: Contact the health care provider immediately if rash appears. Correct response: Contact the health care provider immediately if rash appears. Explanation: GI upset, headache, rash, and dizziness are all adverse reactions of lamotrigine. The most important teaching point to emphasize is to notify the health care provider if a rash appears. A rash can develop into a Stevens-Johnson syndrome rash, a severe and potentially fatal rash. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Adverse Effects, p. 408. Chapter 23: Anti-seizure Agents - Page 408 Add a Note Question 9 See full question15s Report this Question When describing the action of barbiturates and barbiturate-like agents in the control of seizures, what would the nurse include? You Selected: Depression of motor nerve output Correct response: Depression of motor nerve output Explanation: The barbiturates and barbiturate-like drugs depress motor nerve output, inhibit impulse conduction in the ascending reticular activating system (RAS), depress the cerebral cortex, and alter cerebellar function. They stabilize nerve membranes throughout the CNS directly by influencing ionic channels in the cell membrane, thereby decreasing excitability and hyperexcitability to stimulation. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Therapeutic Actions and Indications, pp. 398-399. Chapter 23: Anti-seizure Agents - Page 398-399 Add a Note Question 10 See full question20s Report this Question A client is to receive ethotoin. The nurse would expect to administer this drug by which route? You Selected: Oral Correct response: Oral Explanation: Ethotoin is administered orally. Question 1 See full question11s Report this Question The nurse has just begun administering phenobarbital intravenously to a child within status epilepticus. The nurse would expect this drug to begin working within which time frame? You Selected: 5 minutes Correct response: 5 minutes Explanation: IV phenobarbital has an onset of action of approximately 5 minutes. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Pharmacokinetics, p. 399. Chapter 23: Anti-seizure Agents - Page 399 Add a Note Question 2 See full question22s Report this Question A patient with cortical focal seizures has been prescribed phenobarbital. What adverse reaction should the nurse monitor for in the patient? You Selected: CNS depression Correct response: CNS depression Explanation: The nurse should monitor CNS depression in the patient undergoing phenobarbital treatment. Gingival hyperplasia is an adverse reaction in a patient administered ethotoins. Ataxia and urticaria are adverse reactions in patients undergoing anticonvulsant ethosuximide therapy. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Adverse Effects, p. 398. Chapter 23: Anti-seizure Agents - Page 398 Add a Note Question 3 See full question12s Report this Question A nurse is caring for a patient who is going to take ethosuximide. During the nurse's initial assessment, the nurse learns that the patient's history includes hepatitis. Which laboratory test should be done before therapy is started? You Selected: Alanine aminotransferase (ALT) Correct response: Alanine aminotransferase (ALT) Explanation: Because an adverse effect of ethosuximide can be liver function impairment, a baseline liver function study that includes the ALT should be done prior to starting ethosuximide. Baseline values will help the nurse determine if the drug is causing the abnormal values, and liver function studies will need to continue throughout the therapy. Blood glucose level would determine the glucose level in the blood. BUN would help determine urinary function. PTT is a test to assess the intrinsic system, which is the common pathway of clot formation in the blood. While these tests are important, they do not have a direct relationship to ethosuximide use. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Therapeutic Actions and Indications, p. 400. Chapter 23: Anti-seizure Agents - Page 400 Add a Note Question 4 See full question25s Report this Question The nurse is caring for a 15-year-old male who was involved in a motor vehicle accident and, as a result, sustained a closed head injury. The health care provider ordered phenytoin prophylactically to prevent seizures. The nurse understands that phenytoin works by what mechanism? You Selected: Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus Correct response: Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus Explanation: Phenytoin (Dilantin) is the prototype drug that controls seizures by decreasing sodium influx into the cells. Sodium influx produces an action potential, which then causes the neurons to fire. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Pharmacokinetics, p. 396. Chapter 23: Anti-seizure Agents - Page 396 Add a Note Question 5 See full question12s Report this Question 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? You Selected: Bone marrow depression Correct response: Bone marrow depression Explanation: Carbamazepine is contraindicated in patients with previous bone marrow depression. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Pharmacokinetics, p. 407. Chapter 23: Anti-seizure Agents - Page 407 Add a Note Question 6 See full question20s Report this Question An adolescent taking oral contraceptives has been prescribed an anticonvulsant medication. The nurse should tell the client to do which? You Selected: use another form of birth control, such as condoms. Correct response: use another form of birth control, such as condoms. Explanation: Anticonvulsants and oral contraceptives interact, leading to decreased effectiveness of birth control. This can result in breakthrough bleeding or unintended pregnancy. Anticonvulsants and antidiabetic medications interact, resulting in increased blood glucose levels. Anticonvulsants and antiseizure medications taken together may increase seizure activity. Anticonvulsants interact with analgesics and alcohol, not oral contraceptives, to cause increased depressant effects. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, p. 393. Chapter 23: Anti-seizure Agents - Page 393 Add a Note Question 7 See full question47s Report this Question A client has been admitted to the emergency department and is experiencing tonic-clonic seizures. What intervention should the nurse prioritize? You Selected: Administration of phenytoin IV as prescribed Correct response: Administration of phenytoin IV as prescribed Explanation: Active seizure activity is an emergency and the client's immediate physiological needs supersede the importance of therapeutic relationship. Phenytoin IV is among the most common treatments for tonic- clonic seizures; gabapentin PO is not typically used for this purpose, and PO administration of any type is unsafe due to the risk for aspiration. Treatment would not be withheld pending assessment of renal and hepatic function. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Hydantoins, p. 396. Chapter 23: Anti-seizure Agents - Page 396 Add a Note Question 8 See full question22s Report this Question A nurse who gives care on a neurological floor is working with several clients. Which client should the nurse prioritize for further assessment and possible interventions? You Selected: A client receiving pregabalin who is not responsive to verbal stimuli Correct response: A client receiving pregabalin who is not responsive to verbal stimuli Explanation: A client's decreased level of consciousness would be a priority for further assessment. It could be indicative of excessive CNS depression if the client is unable to be roused by voice. The client with a blood pressure of 106/69 may require further monitoring and possible interventions, but this blood pressure is not so low as to be considered an emergency. Addressing clients' learning needs and anxiety is also important, but less time dependent than a client who is not rousable. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Drugs for Treating Partial Seizures, p. 408. Chapter 23: Anti-seizure Agents - Page 408 Add a Note Question 9 See full question25s Report this Question The nurse examines reviews the medical administration record and notes the medication lamotrigine needs to be administered. The client has developed a red scaly rash with fluid filled blisters and purpuric areas all over the client’s body. Which actions should the nurse take? Select all that apply. You Selected: Document the skin assessment. Notify the primary care provider immediately. Assess vital signs. Correct response: Notify the primary care provider immediately. Assess vital signs. Document the skin assessment. Explanation: The nurse observes that the client is exhibiting a severe hypersensitivity rash that is potentially fatal, called Stevens-Johnsons Syndrome, and must notify the health care provider (HCP) immediately, and hold the dose of lamotrigine awaiting orders from the PCP. The nurse should assess vital signs for signs and symptoms of infection, which may occur from bacteria entering large areas of compromised skin. The nurse should document the skin assessment and the actions taken, including holding the drug and calling the primary care provider immediately. The nurse should not cleanse the skin with soap and water because the soap will dry out the skin leading to further breakdown. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Adverse Effects, p. 408. Chapter 23: Anti-seizure Agents - Page 408 Add a Note Question 10 See full question25s Report this Question After administering gabapentin, the nurse should assess the client for what possible adverse effect? You Selected: central nervous system (CNS) depression Correct response: central nervous system (CNS) depression Explanation: The most common adverse effects of gabapentin are associated with CNS depression and include dizziness, somnolence, insomnia, and ataxia. The drug has not been noted to cause tetany, hypersensitivity reactions, or paradoxical seizures. Question 1 See full question18s Report this Question 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. This behavior is consistent with what type of seizure? You Selected: absence Correct response: absence Explanation: A type of generalized seizure is the absence seizure, characterized by abrupt alterations in consciousness that last only a few seconds. Generalized seizures (tonic–clonic or major motor seizure) involve sustained contraction of skeletal muscles; abnormal postures, such as opisthotonos; and absence of respiration, during which the person becomes cyanotic. The clonic phase is characterized by rapid rhythmic and symmetric jerking movements of the body. Tonic–clonic seizures are sometimes preceded by an aura. Other types of generalized seizures include the myoclonic type (contraction of a muscle or group of muscles) and the akinetic type (absence of movement). Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Absence seizures, p. 395. Chapter 23: Anti-seizure Agents - Page 395 Add a Note Question 2 See full question12s Report this Question Because of the black box warning for clients taking lamotrigine, the nurse should instruct a client to discontinue this medication immediately if he or she develops what unexpected reaction? You Selected: skin rashes Correct response: skin rashes Explanation: Adverse effects of lamotrigine include dizziness, drowsiness, headache, ataxia, blurred or double vision, nausea and vomiting, and weakness. The FDA has issued a black box warning related to the potential development of serious dermatological reactions. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Adverse Effects, p. 408. Chapter 23: Anti-seizure Agents - Page 408 Add a Note Question 3 See full question13s Report this Question A nurse is preparing to administer an anticonvulsant that produces its effects by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain. Which medication would the nurse be most likely to administer? You Selected: Phenytoin Correct response: Phenytoin Explanation: Hydantoins like phenytoin elicit their effects by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain. Valproic acid increases the levels of GABA to help stabilize the membranes. Ethosuximide depresses the motor cortex, creating a higher threshold before the nerves react to the convulsive stimulus. Lorazepam elevates the seizure threshold by decreasing postsynaptic excitation. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Contraindications and Cautions, p. 396. Chapter 23: Anti-seizure Agents - Page 396 Add a Note Question 4 See full question21s Report this Question 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? You Selected: Interview and observe for adverse effects Correct response: Interview and observe for adverse effects Explanation: Evaluation of the drug's effectiveness includes interviewing and observing for decrease in or absence of seizure activity; interviewing and observing for avoidance of adverse drug effects, especially those that impair safety; and, when available, checking laboratory reports of serum drug levels for therapeutic ranges or evidence of underdosing or overdosing. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Contraindications and Cautions, p. 396. Chapter 23: Anti-seizure Agents - Page 396 Add a Note Question 5 See full question11s Report this Question The nurse is caring for an 84-year-old client who is taking an AED and recognizes that this client is at increased risk for which condition? You Selected: Falls Correct response: Falls Explanation: In older adults, decreased elimination by the liver and kidneys may lead to drug accumulation, with subsequent risks of dizziness, impaired coordination, and injuries due to falls. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Nursing Considerations for Patients Receiving Drugs to Treat Partial Seizures, p. 409. Chapter 23: Anti-seizure Agents - Page 409 Add a Note Question 6 See full question38s Report this Question 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? You Selected: Risk for injury related to seizure activity Correct response: Risk for injury related to seizure activity Explanation: Seizures present an acute risk for injury which the nurse must prioritize when caring for the client. Cognitive and/or sensory disruptions are likely as well, but none of these presents such a high risk to the client's safety as the risk for injury. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Nursing Considerations for Patients Receiving Drugs for Treating Generalized Seizures, p. 402. Chapter 23: Anti-seizure Agents - Page 402 Add a Note Question 7 See full question21s Report this Question The neurological nurse cares for several clients who have seizure disorders. Which client should the nurse monitor most closely for indications of drug dependence? You Selected: A client with a history of tonic-clonic seizures who takes phenobarbital Correct response: A client with a history of tonic-clonic seizures who takes phenobarbital Explanation: Barbiturates, such as phenobarbital, have an associated risk for dependence. This is not true of the other listed drugs. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Adverse Effects, p. 399. Chapter 23: Anti-seizure Agents - Page 399 Add a Note Question 8 See full question27s Report this Question 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? You Selected: Partial seizures Correct response: Partial seizures Explanation: Seizures that do not impair consciousness but can involve the senses or motor ability are classified as partial seizures. Generalized seizures involve loss of consciousness during the seizure. Tonic–clonic seizures are a type of generalized seizure involving alternate contraction and relaxation of the muscles, loss of consciousness, and abnormal behavior. Myoclonic seizures involve sudden, forceful contractions of single or multiple groups of muscles. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Partial seizures, p. 395. Chapter 23: Anti-seizure Agents - Page 395 Add a Note Question 9 See full question28s Report this Question 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? You Selected: “I'll make sure to take the drug with food.” Correct response: “I'll make sure to take the drug with food.” Explanation: Phenytoin should be taken with food to reduce the chance of stomach upset. It should be taken on a regular basis and not only when a seizure occurs. The client should not arbitrarily reduce the dose of phenytoin. Abrupt cessation can cause seizures. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Pharmacokinetics, p. 396. Chapter 23: Anti-seizure Agents - Page 396 Add a Note Question 10 See full question52s Report this Question A 7-year-old child with epilepsy takes phenytoin for the control of seizures. What oral assessment does the nurse make related to a common side effect of the medication? You Selected: Gingival hyperplasia Correct response: Gingival hyperplasia Explanation: A common side effect of phenytoin in children in gingival hyperplasia. Oral thrush is a side effect of antibiotics and not gingival hyperplasia. Malalignment of teeth and decay are caused by many various reasons but not generally are not a result of the phenytoin. Question 1 See full question26s Report this Question 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? You Selected: Valproic acid Correct response: Valproic acid Explanation: Carboxylic acid derivatives like valproic acid elicit their effects by increasing levels of gamma- aminobutyric acid (GABA), which stabilizes cell membranes. Gabapentin is a GABA agonist. Topiramate blocks seizure activity rather than raising the threshold. Trimethadione decreases the repetitive synaptic transmissions of nerve impulses. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Adverse Effects, p. 401. Chapter 23: Anti-seizure Agents - Page 401 Add a Note Question 2 See full question31s Report this Question A child suffers from absence seizures. What is the drug of choice for absence seizures? You Selected: Ethosuximide Correct response: Ethosuximide Explanation: Ethosuximide is the drug of choice for absence seizures. Phenytoin is not recommended for absence seizures. Carbamazepine is not the drug of choice for absence seizures. Fosphenytoin is not recommended for absence seizures. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Pharmacokinetics, p. 400. Chapter 23: Anti-seizure Agents - Page 400 Add a Note Question 3 See full question1m 13s Report this Question A 15-year-old is observed having a tonic-clonic seizure at school. Which behavior would allow the school nurse to recognize the clonic phase of the seizure? You Selected: Rapid rhythmic and symmetric jerking movements Correct response: Rapid rhythmic and symmetric jerking movements Explanation: The tonic phase of a tonic-clonic seizure involves sustained contraction of skeletal muscles, abnormal postures, and absence of respiration. The clonic phase of the seizure is characterized by rapid rhythmic and symmetric jerking movements of the body. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Generalized Seizures, p. 395. Chapter 23: Anti-seizure Agents - Page 395 Add a Note Question 4 See full question1m 23s Report this Question Which agent would a nurse expect to administer intravenously for a partial seizure? You Selected: Levetiracetam Correct response: Levetiracetam Explanation: Levetiracetam is available for oral or intravenous use. Carbamazepine, gabapentin, and felbamate are administered orally. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Pharmacokinetics, p. 407. Chapter 23: Anti-seizure Agents - Page 407 Add a Note Question 5 See full question1m 36s Report this Question After teaching a class on drug classes used to treat seizures, the instructor determines that the teaching has been successful when the students identify which drug as most commonly used in the treatment of absence seizures? You Selected: Ethosuximide Correct response: Ethosuximide Explanation: Ethosuximide is most frequently used to treat absence seizures. Mephobarbital, ethotoin, and primidone are typically used for tonic-clonic seizures. Question 1 See full question33s Report this Question A child has been presented for care because he has episodes where he pauses what he is doing for a few seconds, is unresponsive, and then continues on with his activity. The nurse should anticipate the administration of what medication? You Selected: Ethosuximide Correct response: Ethosuximide Explanation: Ethosuximide is the drug of choice for absence seizures, which is this child’s most likely diagnosis. The other listed drugs are less likely to be used for this purpose. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Therapeutic Actions and Indications, p. 400. Chapter 23: Anti-seizure Agents - Page 400 Add a Note Question 2 See full question51s Report this Question A client is diagnosed with trigeminal neuralgia. What antiepileptic agent may be used to treat this disorder? You Selected: carbamazepine Correct response: carbamazepine Explanation: Carbamazepine is prescribed to treat trigeminal neuralgia. Neither phenytoin, fosphenytoin, nor ethosuximide is administered for trigeminal neuralgia. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Therapeutic Actions and Indications, p. 405. Chapter 23: Anti-seizure Agents - Page 405 Add a Note Question 3 See full question1m 8s Report this Question 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? You Selected: Advise the client to have his blood redrawn today to ensure that it is not at a toxic level. Correct response: Advise the client to have his blood redrawn today to ensure that it is not at a toxic level. Explanation: Clients may demonstrate adverse effects even if the serum level of phenytoin is "normal"; it is important to adjust the dose to the clinical response of the client, not the serum level. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Clinically Important Drug–Drug Interactions, p. 398. Chapter 23: Anti-seizure Agents - Page 398 Add a Note Question 4 See full question23s Report this Question 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? You Selected: “This drug is a gamma-aminobutyric acid (GABA) agonist.” Correct response: “This drug is a gamma-aminobutyric acid (GABA) agonist.” Explanation: Gabapentin is a miscellaneous drug acting as a GABA agonist. Hydantoins stabilize the hyperexcitability postsynaptically in the motor cortex of the brain. Succinimides depress the motor cortex, thus raising the seizure threshold. Benzodiazepines elevate the seizure threshold by decreasing postsynaptic excitation. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 23: Anti-seizure Agents, Drugs for Treating Generalized Seizures, p. 396. Chapter 23: Anti-seizure Agents - Page 396 Add a Note Question 5 See full question39s Report this Question A client who is receiving phenytoin has a serum drug level drawn. Which result would the nurse interpret as within the therapeutic range? You Selected: 12 mcg/mL Correct response: 12 mcg/mL Explanation: The therapeutic serum phenytoin levels range from 10 to 20 mcg/mL. Thus, a level of 12 mcg/mL would fall within this range. [Show More]

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