Question 1

The nurse is teaching a class for clients who have been recently diagnosed with epilepsy. The nurse determines that learning has occurred when the clients make which statements? Select all that apply.

Accepted Answer

These statements demonstrate an understanding of the potential causes of epilepsy, including cases where the cause is unknown (B), the association with cerebral vascular accidents (C), and the possibility of a head injury as a cause (D). Statement A is incorrect, as there is no established link between eating disorders and development of epilepsy. Statement E is also incorrect, as stress levels are not a confirmed cause of epilepsy.

Question 2

The client is receiving Phenobarbital (Nembutal) for control of seizures. The client tells the nurse she plans to become pregnant. What is the best response of the nurse?

Accepted Answer

Phenobarbital is a Category D drug, meaning there is evidence of fetal risk but potential benefits may outweigh risks in certain situations. However, it is contraindicated in pregnancy unless there is no alternative treatment available. The nurse should advise the client to speak with her doctor about safer medication options for controlling seizures during pregnancy.

Question 3

The client is receiving phenobarbital (Nembutal) for seizure control. The client asks the nurse how this little pill can stop his seizures. What is the best response by the nurse?

Accepted Answer

Phenobarbital (Nembutal) stops seizures by increasing the activity of a chemical called GABA (gamma-aminobutyric acid) in the brain. GABA is an inhibitory neurotransmitter that decreases neuronal excitability and helps prevent seizures.

Question 4

The physician has ordered intravenous phenytoin (Dilantin). The client is also receiving 5% dextrose in water (D5W) intravenously (IV). What will the nurse plan to do before administering this medication? Select all that apply.

Accepted Answer

A) Stevens-Johnson Syndrome is a potential adverse effect of phenytoin but it is not necessary to monitor for it before administering the medication.
B) Phenytoin must be given through an IV line with a filter to prevent the infusion of any particulate matter that can cause tissue damage, thrombophlebitis or emboli.
C) Before administering the medication, it is essential to flush the IV line with saline to prevent the medication from precipitating in the tubing or syringe.
D) Phenytoin can cause local tissue damage and extravasation when given through a small or fragile vein. Therefore, it is important to use a large vein for the infusion to avoid severe local tissue damage.
E) Hypertension is not a known adverse effect of phenytoin, and it is not necessary to monitor for it before administering the medication.

Question 5

The client tells the nurse that she has been taking phenytoin (Dilantin) for two years now and is still having too many side effects. She wants to stop taking it. What is the best response by the nurse?

Accepted Answer

The nurse should advise the client not to stop taking phenytoin (Dilantin) abruptly, as this can increase the risk of withdrawal seizures. It is important for the client to work with their healthcare provider to gradually decrease the medication under supervision. The other answer choices are not appropriate as they do not address the potential consequences of abruptly stopping the medication.

Question 6

The physician has prescribed phenytoin (Dilantin) for a client with diabetes mellitus, type 1. What does the nurse include in the plan of care for this client?

Accepted Answer

Phenytoin can increase blood glucose levels, so the nurse should discuss with the physician the potential need to increase the client's insulin dosage to maintain proper glucose control.

Question 7

The nurse has been conducting medication education for a client with epilepsy. What is the best outcome for this client?

Accepted Answer

The best outcome for a client with epilepsy who is receiving medication education is for the client to recognize the need to continue antiseizure medication indefinitely. Epilepsy is a chronic condition that requires ongoing management, and discontinuing medication without medical supervision can lead to seizures and other complications. While some clients may require adjustments or changes in their medication regimen over time, the need for ongoing treatment is a key message that should be conveyed in medication education. Choices A and D are not relevant to most clients with epilepsy, and choice B only applies to a subset of clients who have been seizure-free for a specified period of time.

Question 8

The client is receiving valproic acid (Depakene) for treatment of seizures. The client has also been taking a daily 81 mg aspirin tablet prophylactically for a cardiac condition. What would the nurse be most likely to observe?

Accepted Answer

Valproic acid and aspirin both have anticoagulant effects and can increase the risk of bleeding. The nurse should monitor the client for signs of bleeding such as bleeding gums and bruising of the skin. Steven-Johnson Syndrome is a severe allergic reaction to medication and is not a side effect of valproic acid or aspirin. Increased seizure activity, migraines, and irritability are not likely to be caused by this combination of medications.

Question 9

The client says to the nurse "My doctor said I have epilepsy and need to take medicine for those seizures I had. Do I really need medicine?" What is the best response by the nurse?

Accepted Answer

Epilepsy is a chronic condition characterized by recurrent seizures, and medication is often required on a continuous basis to control these seizures. Unlike some conditions that might be cured or significantly improved through dietary changes alone (such as certain cases mentioned in option C), epilepsy typically requires ongoing medication management to maintain seizure control. Options A and B are incorrect; epilepsy is not cured by medication (it's managed), and it is not the same as a mental illness, nor are the medications necessarily similar.

Question 10

The client has epilepsy and receives phenytoin (Dilantin). The client has been seizure -free, and asks the nurse why he still needs blood tests when he is not having seizures. What is the best response by the nurse?

Accepted Answer

Phenytoin (Dilantin) has a narrow range between a therapeutic dose and a toxic dose. Blood tests are necessary to monitor the client's phenytoin levels in order to ensure that the dose is therapeutic and not toxic.

Question 11

The young child has absence seizures. The physician has prescribed valproic acid (Depakene) syrup. The nurse has completed medication education with the child's mother and determines that learning has occurred when the mother makes which statement?

Accepted Answer

Valproic acid should not be mixed with carbonated beverages as it can cause stomach upset and decrease the effectiveness of the medication. It is important to take valproic acid with food to decrease stomach upset and should not be taken on an empty stomach. Clonazepam is not typically prescribed for sleep in children and should not be given with valproic acid without consulting a physician. Aspirin should not be given to children without consulting a physician first, as it increases the risk of Reye's syndrome.

Question 12

The elderly client is taking phenobarbital (Nembutal) for seizure control. What is most important for the nurse to assess in the client?

Accepted Answer

Phenobarbital is primarily metabolized by the liver and excreted through the kidneys, so hepatic and renal function need to be assessed periodically in clients taking this medication. Monitoring fluid intake, nutritional status, and electrolyte balance is also important, but not as high a priority as assessing hepatic and renal function.

Question 13

A parent says to the nurse "The doctor prescribed ethosuximide (Zarontin) for my child, who has absence seizures. What does this mean?" What is the best response by the nurse?"

Accepted Answer

The best response would be to provide information about the specific type of seizure the child is having and explain that ethosuximide is an appropriate medication for this type of seizure. Options A and B provide inaccurate or unhelpful information, and option C questions the doctor's prescription without providing any useful information.

Question 14

The physician has ordered intravenous (IV) diazepam (Valium) for the client in status epilepticus. During administration, which assessment by the nurse is most important?

Accepted Answer

When administering IV diazepam for status epilepticus, the most important assessment by the nurse is monitoring the client's respirations due to the potential for respiratory depression as a side effect of the medication. The nurse should assess respirations every 5 to 15 minutes to ensure adequate oxygenation and prevent potential complications. While levels of consciousness, pulse, and blood pressure should also be monitored, the priority assessment during diazepam administration is respiratory rate and effort.

Question 15

The physician has ordered intravenous (IV) phenytoin (Dilantin). The nurse does not read the drug label and administers the medication intramuscularly (IM). What is the most likely response in the client?

Accepted Answer

IV phenytoin is not meant to be given IM as it can cause local tissue damage following extravasation. This is because it is a vesicant drug that can cause severe irritation and tissue damage if it leaks into the surrounding tissue. Purple gluteus syndrome is not a known adverse reaction to phenytoin. A marked decrease in glucose levels is also not a known adverse reaction to phenytoin. It is important for healthcare providers to read the drug label and ensure that the medication is administered in the correct route to prevent harm to the patient.

Quiz 15: Drugs for Seizures