Chapter 31-agents affecting seizures/epilepsy Flashcards Preview

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Flashcards in Chapter 31-agents affecting seizures/epilepsy Deck (32)
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1
Q

A client is prescribed fosphenytoin sodium. The nurse prepares to administer this by which route?

A

intravenous

2
Q

When teaching a client and his family about anticonvulsant therapy, the nurse should include which of the following?

A

Clients need routine serum blood levels of the drug drawn.

3
Q

The nurse recognizes a generalized tonic-clonic seizure when the client exhibits what characteristics?

A

rigidity with muscle jerks, temporal apnea, possible loss of bowel and bladder control

4
Q

A client is experiencing status epilepticus. The nurse should:

A

ensure a patent airway and protect the client’s head and body from injury.

5
Q

When obtaining a client history, the nurse learns that the client exercises regularly and is an avid sports fan. He is currently under a great deal of both personal and professional stress, and this is causing him to desire to snack frequently. Which of these factors would pose the greatest risk for decreasing the client’s seizure threshold?

A

stress- (psychosociophysiologic) can lower the seizure threshold.

6
Q

When teaching a client prescribed phenytoin about a common adverse effect of this drug, the nurse should instruct the client to:

A

practice good oral hygiene.-Gingival hyperplasia is an adverse effect of phenytoin and occurs most often in children.

7
Q

Folic acid supplements are often given when phenytoin therapy is started. The reason for this is to:

A

prevent the development of anemia.- Phenytoin can cause folic acid deficiency anemia.

8
Q

A client who is npo is prescribed IV phenytoin. When preparing the equipment to administer this dose, the nurse should:

A

hang an IV bag of 0.9% normal saline and prime the IV tubing.

9
Q

Which of the following anticonvulsants is indicated for the treatment of trigeminal neuralgia?

A

carbamazepine

10
Q

The client expresses concern about the drowsiness she experienced when beginning phenytoin therapy. The nurse should instruct her that this adverse effect:

A

improves after taking the drug for a while.

11
Q

Clients who experience intractable seizures may require surgical intervention if:

A

seizures consistently originate in just one part of the brain.
This is one of three major criteria for surgical intervention.

12
Q

The nurse would prepare to administer this medication to treat or prevent seizures during neurosurgery.

A

fosphenytoin sodium-is the drug of choice, because it is rapidly converted to phenytoin and does not cause the high irritability associated with parenteral phenytoin.

13
Q

An adult client having been treated for 3 months with phenytoin is admitted to the nursing unit with mental status changes, irritability, and agitation. When evaluating the client’s laboratory results, which of the following indicates to the nurse the cause of the client’s current status?

A

phenytoin level of 30 mcg/mL- These are manifestations of phenytoin toxicity, and this is a toxic phenytoin level.

14
Q

The nurse is caring for a client who has been on chronic therapy with valproic acid. The nurse assesses which of the following for this client?

A

liver function tests-Hepatotoxicity is a concern for the client on long-term valproic acid therapy.

15
Q

Clients taking carbamazepine should have which test monitored routinely?

A

complete blood count- Hematological impairment, including leukopenia and thrombocytopenia, are associated with carbamazepine therapy.

16
Q

A nurse is teaching a client taking carbamazepine about what action he should take related to his serum drug level. Which of the following would indicate client understanding of the instruction for a serum carbamazepine level of 11 mcg/L?

A

“I will plan to take my next dose as usual.”- The normal level for carbamazepine is 4 to 12 mcg/mL, so his level is normal and he should plan to continue his medication at its present dose.

17
Q

When preparing to administer fosphenytoin sodium to an adult, the nurse understands that too-rapid intravenous administration of fosphenytoin sodium can cause:

A

a pulse rate less than 60.-It can cause bradycardia.

18
Q

During the client’s annual physical examination, the significant other states that the client will “just stop in the middle of a sentence and stare off into space for about 15 seconds fluttering his eyes. When he stops staring, he just continues what he was saying. I asked him what he was thinking when he was staring and he does not remember anything about this episode. It has happened about a dozen times in the last couple of months.” What is happening with him? The nurse recognizes this behavior as characteristic of

A

an absence seizure.

19
Q

A client is prescribed IV phenytoin 300 mg. The nurse will administer this IV bolus over:

A

6 minutes-300 mg divided by 50 mg/min = 6 minutes.

20
Q

When administering IV bolus phenytoin to an infant, the nurse must use:

A

a central venous access

21
Q

A neonate weighing 7.5 pounds is experiencing seizures secondary to maternal drug use during pregnancy and is prescribed IV phenytoin, which cannot exceed 3 mg/kg/minute. The safe dose for this neonate is:

A

10 mg/min.- 7.5 divided by 2.2 = 3.4 kg; multiplied by 3 mg/min = 10.2, which rounds to 10 mg/min

22
Q

The nurse is caring for an adult client receiving continuous enteral feedings who is prescribed phenytoin per nasogastric tube. The nurse should:

A

discontinue the enteral feeding 90 minutes before and after administering the phenytoin.

23
Q

The nurse should monitor the client taking carbamazepine for:

A

fever and sore throat.

-: Carbamazepine can cause hematological abnormalities, including leukopenia and thrombocytopenia.

24
Q

A client is prescribed valproic acid for seizure control. The client’s current serum level of valproic acid is 130 mcg/mL. The nurse should:

A

notify the health care provider immediately.

25
Q

An 8-year-old child is prescribed oxcarbazepine. The child weighs 66 pounds, and the safe recommended dosage range for oxcarbazepine is 8–10 mg/kg. What is the safe dosage range for this child?

A

240–300 mg - 66 pounds divided by 2.2 = 30 kg; multiplied by 8 = 240 mg; 30 kg multiplied by 10 = 300 mg.

26
Q

A client is prescribed tiagabine. The nurse understands that this drug works by:

A

increasing the inhibitory neurotransmitter GABA.

27
Q

A client is prescribed lamotrigine. The nurse understands that this agent is used in combination with other anticonvulsant agents to treat:

A

partial seizures in adults.-This is a primary use for lamotrigine in combination with valproic acid.

28
Q

The client receiving rufinamide would be monitored for all of the following adverse effects EXCEPT:

A

leukocytosis- Rufinamide can cause leukopenia, not leukocytosis.

29
Q

Which of the following statements by the nurse recruit indicates a misunderstanding about the medication Topamax?

A

“The client should be instructed to decrease fluid intake during the medication regimen.”

30
Q

The factor(s) most influencing the choice of anticonvulsants to prescribe for the client include which of the following? Select all that apply.

A

c. type of seizure experienced by client

d. adverse effects of the drug

31
Q

The client receiving continuous enteral feedings is prescribed phenytoin per gastric tube. The nurse recognizes the spouse’s understanding of the instructions when the spouse does which of the following? Select all that apply.

A

a. stops the enteral feeding 2 hours prior to administering phenytoin
b. flushes the gastric tube with water before and after administering phenytoin
d. restarts the enteral feeding 2 hours following phenytoin administration

32
Q

When administering fosphenytoin sodium to a client experiencing status epilepticus the nurse knows if he administers the drug at a rate greater than 150 mg/min, it could result in which of the following? Select all that apply.

A

a. bradycardia
b. ventricular fibrillation
d. cardiac arrest