Question 1

A patient with a seizure disorder is admitted to the hospital and has a partial convulsive episode shortly after arriving on the unit. The patient has been taking phenytoin [Dilantin] 100 mg three times daily and oxcarbazepine [Trileptal] 300 mg twice daily for several years. The patient's phenytoin level is 8.6 mcg/mL,and the oxcarbazepine level is 22 mcg/mL. The nurse contacts the provider to report these levels and the seizure. What will the nurse expect the provider to order?

A) A decreased dose of oxcarbazepine
B) Extended-release phenytoin
C) An increased dose of phenytoin
D) Once-daily dosing of oxcarbazepine

An increased dose of phenytoin

Accepted Answer

This patient's phenytoin level is low; the therapeutic range is 10 to 20 mcg/mL. An increase in the phenytoin dose is necessary. The oxcarbazepine level is within the normal range of 3 to 40 mcg/mL,so changing the dose is not necessary. Extended-release phenytoin is absorbed more slowly and would not increase this patient's serum phenytoin level. The dosing of oxcarbazepine does not need to be changed.

Question 2

A nurse is assessing a patient who becomes motionless and seems to stare at the wall and then experiences about 60 seconds of lip smacking and hand wringing. What should the nurse do?&#10;A) Ask the patient about a history of absence seizures.&#10;B) Contact the provider to report symptoms of a complex partial seizure.&#10;C) Notify the provider that the patient has had a grand mal seizure.&#10;D) Request an order for intravenous diazepam [Valium] to treat status epilepticus.

Accepted Answer

This patient showed signs of a complex partial seizure,characterized by impaired consciousness beginning with a period of motionlessness with a fixed gaze,followed by a period of automatism. The entire episode generally lasts 45 to 90 seconds. Absence seizures are characterized by loss of consciousness for a brief period (about 10 to 30 seconds)and may involve mild,symmetric motor activity or no motor signs. A grand mal seizure is characterized by jaw clenching and rigidity followed by alternating muscle relaxation and contraction and then periods of cyanosis,all with a loss of consciousness. Status epilepticus is a seizure that persists for 30 minutes or longer.

Question 3

A nurse is discussing partial versus generalized seizures with a group of nursing students. Which statement by a student indicates understanding of the teaching?&#10;A) &#34;Febrile seizures are a type of generalized tonic-clonic seizure.&#34;&#10;B) &#34;Generalized seizures are characterized by convulsive activity.&#34;&#10;C) &#34;Partial seizures do not last as long as generalized seizures.&#34;&#10;D) &#34;Patients having partial seizures do not lose consciousness.&#34;

Accepted Answer

Febrile seizures typically manifest as a tonic-clonic seizure of short duration and are a type of generalized seizure. Generalized seizures may be convulsive or nonconvulsive. Partial seizures may last longer than some types of generalized seizures. Patients with complex partial seizures and secondarily generalized seizures,which are types of partial seizures,may lose consciousness.

Question 4

A 20-kg child has been taking valproic acid [Depakote] for 1 week to treat a seizure disorder. The child is receiving 200 mg PO twice daily. The child's parents report no improvement in seizure activity. The nurse will anticipate that the provider will order which change in this child's drug regimen?

A) Adding another seizure medication to supplement the valproic acid
B) Changing to phenytoin [Dilantin] since the valproic acid is not effective
C) Increasing the dose of valproic acid to 300 mg PO twice daily
D) Increasing the dose of valproic acid to 200 mg three times daily

Accepted Answer

Valproic acid is given initially at a dose of 5 to 15 mg/kg/day,administered in two divided doses. This child is receiving 400 mg/day,which is 10 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/day each week until optimal levels are achieved up to a maximum dose of 60 mg/kg/day. At this point,adding another AED or changing to another AED is not recommended. Increasing the dose to three times daily is not recommended.

Question 5

A nurse provides teaching for a patient with a newly diagnosed partial complex seizure disorder who is about to begin therapy with antiepileptic drugs (AEDs). Which statement by the patient indicates understanding of the teaching?

A) "Even with an accurate diagnosis of my seizures, it may be difficult to find an effective drug."
B) "I will soon know that the drugs are effective by being seizure free for several months."
C) "Serious side effects may occur, and if they do, I should stop taking the medication."
D) "When drug levels are maintained at therapeutic levels, I can expect to be seizure free."

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Accepted Answer

Even with an accurate diagnosis of seizures,many patients have to try more than one AED to find a drug that is effective and well tolerated. Unless patients are being treated for absence seizures,which occur frequently,monitoring of the clinical outcome is not sufficient for determining effectiveness,because patients with convulsive seizures often have long seizure-free periods. Serious side effects may occur,but withdrawing a drug precipitously can induce seizures. Not all patients have seizure control with therapeutic drug levels,because not all medications work for all patients.

Question 6

A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What will the nurse do?

A) Ask the patient to complete a seizure frequency chart for the past few weeks.
B) Contact the provider to request an order for serum drug levels.
C) Reinforce the need to take the medications as prescribed.
D) Request an order to increase the dose of the antiepileptic drug.

Accepted Answer

If medication therapy is not effective,it is important to measure serum drug levels of the medication to determine whether therapeutic levels have been reached and to help monitor patient compliance. Patients should be asked at the beginning of therapy to keep a seizure frequency chart to help deepen their involvement in therapy; asking for historical information is not helpful. Until it is determined that the patient is not complying,the nurse should not reinforce the need to take the medication. Until the drug level is known,increasing the dose is not indicated.

Question 7

A child is diagnosed with absence seizures,and the prescriber orders ethosuximide [Zarontin]. When teaching the child's parents about dosage adjustments for this drug,the nurse will stress the importance of:

A) frequent serum drug level monitoring.
B) learning as much as possible about the disorder and its treatment.
C) recording the number of seizures the child has each day.
D) reporting dizziness and drowsiness to the provider.

Accepted Answer

Measurements of plasma drug levels are less important than observation of seizure activity for determining effective dosages for absence seizures,because this type of seizure is characterized by as many as several hundred occurrences a day. Keeping a chart of seizure activity is the best way to monitor drug effectiveness when treating absence seizures. Frequent drug level monitoring is important when side effects occur to ensure that drug toxicity is not occurring. Learning about the disorder is an important part of adherence. Dizziness and drowsiness are common side effects that diminish with continued use.

Question 8

A patient who is taking oral contraceptives begins taking valproic acid [Depakote] for seizures. After a week of therapy with valproic acid,the patient tells the nurse that she is experiencing nausea. What will the nurse do?

A) Ask the patient if she is taking the valproic acid with food, because taking the drug on an empty stomach can cause gastrointestinal side effects.
B) Contact the provider to request an order for a blood ammonia level, because hyperammonemia can occur with valproic acid therapy.
C) Suggest that the patient perform a home pregnancy test, because valproic acid can reduce the efficacy of oral contraceptives.
D) Suspect that hepatotoxicity has occurred, because this is a common adverse effect of valproic acid.

Accepted Answer

Gastrointestinal effects,including nausea,vomiting,and indigestion,are common with valproic acid and can be minimized by taking the drug with food or using an enteric-coated product. Hyperammonemia can occur when valproic acid is combined with topiramate. Signs of pregnancy usually do not occur within a week,so this is less likely. Hepatotoxicity is a rare adverse effect.

Question 9

A nurse counsels a patient who is to begin taking phenytoin [Dilantin] for epilepsy. Which statement by the patient indicates understanding of the teaching?&#10;A) &#34;I should brush and floss my teeth regularly.&#34;&#10;B) &#34;Once therapeutic blood levels are reached, they are easy to maintain.&#34;&#10;C) &#34;I can consume alcohol in moderation while taking this drug.&#34;&#10;D) &#34;Rashes are a common side effect but are not serious.&#34;

Accepted Answer

Gingival hyperplasia occurs in about 20% of patients who take phenytoin. It can be minimized with good oral hygiene,so patients should be encouraged to brush and floss regularly. Because small fluctuations in phenytoin levels can affect response,maintaining therapeutic levels is not easy. Patients should be cautioned against consuming alcohol while taking phenytoin. Rashes can be serious and should be reported immediately.

Question 10

A child who receives valproic acid [Depakote] begins taking lamotrigine [Lamictal] because of an increase in the number of seizures. The nurse will observe this child closely for which symptom?&#10;A) Angioedema&#10;B) Hypohidrosis&#10;C) Rash&#10;D) Psychosis

Accepted Answer

Lamotrigine can cause life-threatening rashes,such as Stevens-Johnson syndrome and toxic epidermal necrolysis,and this risk increases with concurrent use of valproic acid. Angioedema is an adverse effect associated with pregabalin. Hypohidrosis and psychosis are associated with topiramate.

Question 11

A nurse is providing teaching to a patient newly diagnosed with partial seizures who will begin taking oxcarbazepine [Trileptal]. The patient also takes furosemide [Lasix] and digoxin [Lanoxin]. Which statement by the patient indicates understanding of the teaching?

A) "I may need to increase my dose of Trileptal while taking these medications."
B) "I may develop a rash and itching, but these are not considered serious."
C) "I should report any nausea, drowsiness, and headache to my provider."
D) "I should use salt substitutes instead of real salt while taking these drugs."

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Accepted Answer

The answer of A nurse is providing teaching to a...

Question 12

A patient who has been taking phenobarbital for epilepsy begins taking valproic acid [Depakote] as adjunct therapy. The nurse notes that the patient is very drowsy. What will the nurse do?&#10;A) Explain to the patient that tolerance to sedation eventually will develop.&#10;B) Notify the prescriber, and request an order to reduce the dose of phenobarbital.&#10;C) Notify the prescriber of the need to increase the dose of valproic acid.&#10;D) Request an order for liver function tests to monitor for hepatotoxicity.

Accepted Answer

The answer of A patient who has been taking phenobarbital...

Question 13

A patient has begun taking phenobarbital after experiencing several seizures and is currently receiving 60 mg PO twice daily. After two weeks of therapy,the patient has a serum drug level of 30 mcg/mL and reports feeling drowsy much of the day. What will the nurse tell this patient?

A) "I will contact your provider to discuss changing your dosing to once daily to minimize the drowsiness."
B) "The drug level is low and you may need a higher dose, but taking it three times daily will reduce the drowsiness."
C) "This side effect is expected and should decrease over time. You should avoid driving in the meantime."
D) "Your lab work shows a higher than normal level of the drug and your provider will probably lower your dose."

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Accepted Answer

The answer of A patient has begun taking phenobarbital after...

Question 14

A patient shows loss of consciousness,jaw clenching,contraction and relaxation of muscle groups,and periods of cyanosis. The nurse correctly identifies this as which type of seizure?&#10;A) Tonic-clonic&#10;B) Petit mal&#10;C) Myoclonic&#10;D) Atonic

Accepted Answer

The answer of A patient shows loss of consciousness,jaw clenching,contraction...

Question 15

A patient who has a seizure disorder is admitted to the hospital after an increase in seizure frequency,and the prescriber orders carbamazepine [Tegretol] 100 mg twice daily to be added to the patient's medication regimen. The nurse reviewing the patient's medical history notes that the patient is already taking lamotrigine [Lamictal] 375 mg twice daily. The nurse will contact the provider to discuss which action?

A) Reducing the carbamazepine dose to 50 mg twice daily
B) Reducing the lamotrigine dose to 225 mg twice daily
C) Increasing the carbamazepine dose to 200 mg twice daily
D) Increasing the lamotrigine dose to 500 mg twice daily

Accepted Answer

The answer of A patient who has a seizure disorder...

Question 16

A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient?&#10;A) She may need to increase her dose of phenytoin while taking oral contraceptives.&#10;B) She should consider a different form of birth control while taking phenytoin.&#10;C) She should remain on oral contraceptives, because phenytoin causes birth defects.&#10;D) She should stop taking oral contraceptives, because they reduce the effectiveness of phenytoin.

Accepted Answer

The answer of A patient is to begin taking phenytoin...

Question 17

A patient with a form of epilepsy that may have spontaneous remission has been taking an AED for a year. The patient reports being seizure free for 6 months and asks the nurse when the drug can be discontinued. What will the nurse tell the patient?

A) AEDs must be taken for life to maintain remission.
B) Another AED will be substituted for the current AED.
C) The provider will withdraw the drug over a 6- to 12-week period.
D) The patient should stop taking the AED now and restart the drug if seizures recur.

Accepted Answer

The answer of A patient with a form of epilepsy...

Deck 24: Drugs for Epilepsy