Deck 15: Drugs for Seizures

Question 1

The patient has epilepsy and receives phenytoin (Dilantin). The patient 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?

A) "Because phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose."
B) "Because phenytoin (Dilantin) can cause blood-thinning in some patients."
C) "Because phenytoin (Dilantin) can cause Stevens-Johnson syndrome, which will show up in the blood tests."
D) "Because phenytoin (Dilantin) can deplete your system of potassium."

Answer 1

"Because phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose."

Question 2

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

A) "Excessive stress levels cause disruptions in how the brain receives oxygen, leading to epilepsy."
B) "Epilepsy may be caused by a head injury."
C) "Eating disorders, like anorexia nervosa, increase the risk for developing epilepsy."
D) "A stroke, or brain attack, could increase the risk for developing epilepsy."
E) "With some cases of epilepsy, the cause is never determined."

Answer 2

"Epilepsy may be caused by a head injury."
"A stroke, or brain attack, could increase the risk for developing epilepsy."
"With some cases of epilepsy, the cause is never determined."

Question 3

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?

A) "I should not mix this with carbonated beverages."
B) "If my child gets a headache from this, I can administer a baby aspirin."
C) "I can still give the clonazepam (Klonopin) prescribed by the psychiatrist for sleep."
D) "I can give this on a full stomach or an empty stomach."

Answer 3

"I should not mix this with carbonated beverages."

Question 4

The patient tells the nurse that she has been taking phenytoin (Dilantin) for 2 years now and is still having too many side effects. She wants to stop taking it. What is the best response by the nurse?

A) "Please do not stop the medication abruptly, as you will have withdrawal seizures."
B) "Side effects are a problem, but they are not as bad as the seizures you were having."
C) "This is the best medication for you; we can add another medication to decrease side effects."
D) "You have probably been on the medication long enough; I'll let your doctor know you are stopping it."

Question 5

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

A) Plan to discuss with the physician the need to decrease the patient's insulin based on serum glucose levels.
B) Plan to discuss with the physician the need to increase the patient's insulin based on serum glucose levels.
C) Plan to assess the patient for petechiae, epistaxis, and hematuria.
D) Plan to institute safety precautions, as the patient is at risk for dizziness and ataxia.

Question 6

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?

A) "Absence seizures are basically the same kind of seizures as grand mal, but they are less frequent."
B) "Your daughter's seizures manifest as a staring into space for a few seconds. Ethosuximide (Zarontin) is a good medication for this type of seizure."
C) "Explaining the types of seizure activity is complicated. Have you spoken to your doctor about it?"
D) "Are you sure your doctor prescribed ethosuximide (Zarontin)? Phenobarbital (Luminal) is used much more frequently with children."

Question 7

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

A) "Your medication dose will need to be decreased during your pregnancy."
B) "Please talk to your doctor; this drug is contraindicated in pregnancy."
C) "Your medication dose will need to be increased during your pregnancy."
D) "Please talk to your doctor; you will need a safer drug like valproic acid (Depakene)."

Question 8

A person who stops talking mid-sentence and has a blank stare for 5 seconds would most likely be experiencing

A) a simple partial seizure.
B) status epilepticus.
C) a petit mal seizure.
D) a drop attack.

Question 9

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

A) Assessing respirations
B) Assessing level of consciousness
C) Assessing pulse for bradycardia
D) Assessing blood pressure for hypertension

Question 10

A parent states, "The doctors all say that my son's problem is epilepsy, but I don't think that is correct. I have never seen him jerk or thrash." What nursing response is indicated?

A) "The episodes of jerking and thrashing are called convulsions."
B) "Seizures take many forms."
C) "Your son may have seizures, but not epilepsy."
D) "Seizures can be a sign that epilepsy is present."
E) "If there is no physical movement, epilepsy is ruled out."

Question 11

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 patient?

A) Local tissue damage following extravasation will most likely occur.
B) A phenomenon known as purple gluteus syndrome will most likely occur.
C) A marked decrease in serum glucose levels will most likely occur.
D) Nothing adverse, the medication may be administered intravenously (IV) or intramuscularly (IM).

Question 12

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

A) An increase in seizure activity
B) Stevens-Johnson syndrome
C) Migraine headaches and generalized irritability
D) Bleeding from the gums and bruising of the skin

Question 13

An older adult patient is taking phenobarbital (Luminal) for seizure control. What is most important for the nurse to assess in the patient?

A) Fluid intake
B) Electrolyte balance
C) Respiratory function
D) Nutritional status

Question 14

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

A) Use a large vein for the infusion.
B) Use an intravenous (IV) line with a filter.
C) Flush the intravenous (IV) line with saline.
D) Monitor the patient for hypertension.
E) Monitor the patient for Stevens-Johnson syndrome.

Question 15

Which of the following adverse effects would most likely be associated with the use of phenytoin (Dilantin)?

A) Vitamin B deficiency
B) Leg edema
C) Bleeding
D) Hypoglycemia

Question 16

The patient 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?

A) "Having epilepsy is the same as having a mental illness; the medications are very similar."
B) "You will need medicine for a little while to cure the seizures."
C) "You might not need medicine; you may be controlled by a ketogenic diet."
D) "Yes, you need to take medication on a continual basis to control the seizures."

Question 17

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

A) "Phenobarbital (Luminal) stops your seizures by decreasing the calcium in your brain, which is responsible for the seizures."
B) "Phenobarbital (Luminal) stops your seizures by increasing a chemical called glutamate that calms down the excitability in your brain."
C) "Phenobarbital (Luminal) stops your seizures by decreasing the sodium in your brain, which is responsible for the seizures."
D) "Phenobarbital (Luminal) stops your seizures by increasing a chemical called GABA that calms down the excitability in your brain."

Question 18

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

A) The patient will recognize that the antiseizure medication must be continued indefinitely.
B) The patient will recognize the need to be on a tyramine-free diet while on antiseizure medications.
C) The patient will recognize the need to be on a ketogenic diet in combination with antiseizure medications.
D) The patient will recognize the need to be on antiseizure medication for 1 year after the last seizure.

Question 19

Identify the correct statement regarding seizures.

A) Convulsions are a symptom of the underlying seizure disorder.
B) Seizures can be caused by bacterial infections of the nervous system.
C) Epilepsy is an acute disorder characterized by non-convulsive seizures.
D) All seizures are convulsions, but not all convulsions are seizures.

Question 20

A low-income patient without insurance has been prescribed several different medications over several months for seizure control without any improvement. The patient indicates she has not experienced any adverse effects. At this point the nurse should

A) recommend nontypical drug use.
B) inform the patient that it might take years for the medications to work.
C) assess for medication compliance.
D) advise the patient to double the current dose.

Question 21

A mother phones the clinic and tells the nurse, "My 5-year-old son had a febrile seizure this morning." She adds that this is the child's first seizure experience. The nurse responds by asking the mother to bring the child in to be seen today. What other information should the nurse offer?

A) "Febrile seizures are uncommon in boys."
B) "High temperatures generally induce seizures."
C) "Five-year-olds are too old for febrile seizures."
D) "Febrile seizures occur in up to 2% of children."
E) "Seizure medications are usually not necessary for febrile seizures."

Question 22

The nurse would be especially cautious to avoid extravasation of which drug that is commonly administered intravenously?

A) Phenobarbital (Luminal)
B) Phenytoin (Dilantin)
C) Ethosuximide (Zarontin)
D) Clonazepam (Klonopin)

Question 23

The patient who is prescribed valproic acid (Depakene) for seizure control would like to have a baby. Which statements should the nurse include in a discussion with this patient?

A) "Since your epilepsy may flare up during pregnancy, your doctor will likely have you take a second antiepileptic medication."
B) "Thankfully, most modern antiepileptic medications will not interfere with you getting pregnant."
C) "Your current antiepileptic medication should not be used when you are pregnant."
D) "Folic acid supplementation is important for you."
E) "You should consider adopting a baby instead since there are so many problems associated with epilepsy and pregnancy."

Question 24

A patient has been prescribed to follow a ketogenic diet to supplement pharmacotherapy for a seizure disorder. The nurse would support the inclusion of which types of food in menu selection?

A) Foods high in fat
B) Salty foods
C) Foods high in vitamin K
D) Low protein foods
E) Low carbohydrate foods

Question 25

The nurse is planning education sessions for a patient regarding use of a newly prescribed antiepileptic drug (AED). Which topics should be included in this session?

A) The patient should take the medication at the same time every day.
B) If the patient forgets a dose of medication, wait until the next dose is due and take both doses together.
C) The patient should take an additional dose of medication upon experiencing a seizure aura.
D) If the patient experiences side effects of the medication, the patient should skip the next dose to see if the side effects lessen.
E) The patient should avoid using dietary supplements containing kava when on this medication.

Question 26

The parents of an infant with recurrent seizures are interested in starting amino acid therapy for their child. The father says, "After all, amino acids are natural; it couldn't hurt to give this a try." The nurse should consider which complications of this therapy when formulating a response?

A) Allergic reactions to the product
B) Cardiac changes such as palpitations
C) Neurological effects such as dizziness and lack of coordination
D) Gastrointestinal effects such as decreased weight gain
E) Failure to thrive.

Question 27

A patient had a tonic-clonic seizure. Which findings does the nurse evaluate as indicating the patient is in a postictal state?

A) The patient is incontinent of urine.
B) The patient is in a deep sleep.
C) The patient is confused as to place and time.
D) The patient reports an odd taste in his mouth.
E) The patient is attempting to remove his hospital gown.

Question 28

The nurse has completed education to the parents of a child newly diagnosed with tonic-clonic seizures. Which comments made by the parents would the nurse evaluate as indicating need for further education?

A) "Some of the times when I thought he was ignoring me may have actually been seizure activity."
B) "He just needs to focus more to prevent these attacks."
C) "I know he will outgrow these seizures with time."
D) "I hope we can help our son identify his seizure aura."
E) "We will watch for the development of status epilepticus."

Question 29

A drug that is used to treat petit mal seizures but not tonic-clonic seizures and works by decreasing neuronal activity in the motor cortex is

A) diazepam (Valium).
B) valproic acid (Depakote).
C) phenytoin (Dilantin).
D) ethosuximide (Zarontin).

Question 30

The nurse is talking with a patient who was just prescribed ethosuximide (Zarontin). Which patient statement should the nurse immediately discuss with the patient's health care provider?

A) "Did I mention that I used to take phenobarbital for my seizures?"
B) "I forgot to tell the doctor that I am allergic to penicillin."
C) "I take ginkgo to help improve my memory."
D) "My husband and I plan to have a baby in a couple of years."
E) "My husband and I are leading a 20-mile bicycle tour next weekend for the company we have just started."