Question 1

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?

Accepted Answer

Intravenous phenytoin should be administered undiluted through a 3-way stopcock or Y-tubing.In older patients it should be infused at a rate of 25 mcg/min.The dose and the route are appropriate.Phenytoin will precipitate in dextrose solution.Intramuscular injection is very irritating to tissues and is not used.

Question 2

A patient will begin taking the antiepileptic drug ethosuximide (Zarontin)and asks the nurse whether to take the drug with or without food.The nurse will counsel the patient to take this medication

Accepted Answer

Gastric irritation is common with ethosuximide,so patients should be counseled to take it with food.It is given twice daily.

Question 3

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.What action will the nurse take?

Accepted Answer

This patient's carbamazepine level is high.When taken with grapefruit juice,an interaction may occur that causes toxicity.The nurse should question the patient about food and fluid preferences.The therapeutic level is 5 to 12 mcg/mL.This is a toxic level,not subtherapeutic.

Question 4

A parent expresses concern that a 5-year-old child may develop epilepsy because the child experienced a febrile seizure at age 18 months.What will the nurse tell this parent?

Accepted Answer

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

Question 5

The nurse provides teaching for a patient who will begin taking phenytoin.Which statement by the patient indicates understanding of the teaching?

Accepted Answer

Phenytoin will cause reddish-brown colored urine.Patients should be counseled to report a rash to the provider because it could be a serious adverse reaction.Bleeding gums are common,but patients should never stop taking anticonvulsants abruptly,or they may develop seizures.Changes in blood glucose may occur but do not necessarily result in diabetes.

Question 6

A patient is diagnosed with epilepsy and asks the nurse what may have caused this condition.The nurse explains that epilepsy is most often

Accepted Answer

Of all seizure cases,75% are primary,or idiopathic,with no known cause.The remaining are secondary and may be related to head trauma,stroke,or anoxic events.

Question 7

The nurse is providing teaching to the parents 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?

Accepted Answer

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.

Question 8

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 the nurse to be concerned?

Accepted Answer

Valproic acid can elevate liver enzymes.Patients with a history of liver disease should be monitored closely while taking this drug.

Question 9

A parent of a child who has been taking valproic acid (Depakote)for several years calls the clinic to report a recent recurrence of seizures and states that the child is having three or four seizures per week.The nurse will perform which action first?

Accepted Answer

Questions pertaining to medication adherence are a no-cost,non-invasive way of troubleshooting cause of decreased drug effect.The serum drug level will be assessed next.Children may need changes in doses as they grow.The child is not in status epilepticus so does not need to go to the emergency department.The dose will not be increased until the serum drug level is known.

Question 10

The nurse is caring for a patient who has a seizure disorder.The nurse notes that the patient has reddened gums that bleed when oral care is given.The nurse recognizes this finding as

Accepted Answer

Hydantoins commonly cause gingival hyperplasia,which causes overgrowth of reddened gum tissue that bleeds easily.It is not a sign of a drug interaction (there is no known interaction between phenytoin and aspirin)or a symptom of hepatotoxicity.It does not indicate a lack of self-care.

Question 11

The nurse is preparing to administer phenytoin (Dilantin)to a patient who has a seizure disorder.The patient appears drowsy,and the nurse notes that the last random serum drug level was 18 mcg/mL.What action will the nurse take?

Accepted Answer

Drowsiness is a common side effect of phenytoin and is not cause for alarm.The patient's drug level is normal,since 10 to 20 mcg/mL is the therapeutic range.The nurse should administer the dose.It is not necessary to decrease the dose or monitor the patient more closely than usual.

Question 12

An intubated child is brought to the emergency department while having a seizure that has been progressing for 20 minutes.Which drug will the nurse anticipate administering to this patient first?

Accepted Answer

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

Question 13

A patient who has epilepsy will begin an anticonvulsant medication.The patient asks the nurse how long the medication will be necessary.How will the nurse respond?

Accepted Answer

Anticonvulsants are given to prevent seizures and are usually taken throughout the patient's lifetime.Stopping the medication will lead to recurrence of seizures in most patients.Some patients may attempt to stop taking the medications after 3 to 5 years of no seizure activity.Anticonvulsants are not given as needed.

Question 14

A 25-year-old female patient will begin taking phenytoin for epilepsy.The patient tells the nurse she is taking oral contraceptives (OCPs).Which response will the nurse give?

Accepted Answer

Female patients who take oral contraceptives and anticonvulsants should be advised to use a backup method of contraception because of reduced effectiveness of OCPs.Patients should be cautioned to consult with a provider if considering pregnancy because of the teratogenic effects of anticonvulsants.Patients should not stop taking OCPs and do not need to take precautions against stroke.

Question 15

A woman who is pregnant is taking an anticonvulsant medication to treat a seizure disorder.The nurse will ensure that the patient takes which dietary supplement toward the end of her pregnancy?

Accepted Answer

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 the last week to 10 days of their pregnancies.

Question 16

A patient who takes phenytoin reports regular alcohol consumption.The nurse might expect a serum phenytoin level in this patient to be in which range?

Accepted Answer

Chronic ingestion of alcohol increases hydantoin metabolism,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 patients who consume alcohol regularly.

Question 17

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?

Accepted Answer

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.Phenobarbital is typically used because possible teratogenic effects are less pronounced.Teratogenicity increases with multiple anticonvulsants.

Question 18

A patient has recently begun taking phenytoin (Dilantin)for a seizure disorder.The nurse notes a reddish-brown color to the patient's urine.Which action will the nurse take?

Accepted Answer

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.

Question 19

The nurse is caring for a patient who has been diagnosed with petit mal seizures.The nurse will anticipate teaching this patient about which antiepileptic medication?

Accepted Answer

Ethosuximide is used to treat petit mal seizures.The other drugs are not used to treat petit mal seizures.

Question 20

The nurse is preparing to assist with blood collection on a newly admitted patient who has been taking phenytoin for several years.The provider has ordered a complete blood count and liver function tests.Which other blood test will the nurse discuss with the provider?

Accepted Answer

Patients who have taken hydantoins for long periods might have an elevated blood sugar that results from the drug inhibiting the release of inulin.The nurse should discuss this test with the provider.

Quiz 19: Antiseizure Drugs

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?

A patient will begin taking the antiepileptic drug ethosuximide (Zarontin) and asks the nurse whether to take the drug with or without food.The nurse will counsel the patient to take this medication

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.What action will the nurse take?

A parent expresses concern that a 5-year-old child may develop epilepsy because the child experienced a febrile seizure at age 18 months.What will the nurse tell this parent?

The nurse provides teaching for a patient who will begin taking phenytoin.Which statement by the patient indicates understanding of the teaching?

A patient is diagnosed with epilepsy and asks the nurse what may have caused this condition.The nurse explains that epilepsy is most often

The nurse is providing teaching to the parents 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?

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 the nurse to be concerned?

A parent of a child who has been taking valproic acid (Depakote) for several years calls the clinic to report a recent recurrence of seizures and states that the child is having three or four seizures per week.The nurse will perform which action first?