Deck 14: Antiepileptic Drugs

Question 1

Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these?

A) The safe and the toxic plasma levels of the drug are very close to each other.
B) The phenytoin has a low chance of being effective.
C) There is no difference between safe and toxic plasma levels.
D) A very small dosage can result in the desired therapeutic effect.

Answer 1

The safe and the toxic plasma levels of the drug are very close to each other.

Question 2

A 9-year-old child will be receiving carbamazepine (Tegretol) suspension, 200 mg twice daily. The medication is available in a strength of 100 mg/5 mL. Identify how many milliliters the nurse will give to the patient for each dose. _______

Answer 2

10 mL
100 mg:5 mL :: 200 mg:x mL
(100 × x) = (5 × 200); 100x = 1000; x = 10 mL

Question 3

The U.S. Food and Drug Administration has issued a warning for users of antiepileptic drugs. Based on this report, the nurse will monitor for which potential problems with this class of drugs?

A) Increased risk of suicidal thoughts and behaviors
B) Signs of bone marrow depression
C) Indications of drug addiction and dependency
D) Increased risk of cardiovascular events, such as strokes

Answer 3

Increased risk of suicidal thoughts and behaviors

Question 4

The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing?

A) Levetiracetam (Keppra)
B) Phenobarbital
C) Valproic acid (Depakote)
D) Gabapentin (Neurontin)

Question 5

When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction?

A) "Driving is allowed after 2 weeks of therapy."
B) "If seizures recur, take a double dose of the medication."
C) "Antacids can be taken with the AED to reduce gastrointestinal adverse effects."
D) "Take the drug at the same time every day."

Question 6

A patient has been taking an AED for several years as part of his treatment for focal seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a few days until she has a chance to go to the drugstore. What is the nurse's best response?

A) "He is taking another antiepileptic drug, so he can go without the medication for a week."
B) "Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away."
C) "He can temporarily increase the dosage of his other antiseizure medications until you get the refill."
D) "He can stop all medications because he has been treated for several years now."

Question 7

The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action is correct when administering this drug?

A) Give the dose as a fast intravenous (IV) bolus.
B) Mix the drug with normal saline, and give it as a slow IV push.
C) Mix the drug with dextrose (D5W), and give it as a slow IV push.
D) Mix the drug with any available solution as long as the administration rate is correct.

Question 8

The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient indicates that the patient has an adequate understanding of the instructions?

A) "I will need to take extra care of my teeth and gums while on this medication."
B) "I can go out for a beer while on this medication."
C) "I can skip doses if the side effects bother me."
D) "I will be able to stop taking this drug once the seizures stop."

Question 9

The nurse is monitoring a patient who has been taking carbamazepine (Tegretol) for 2 months. Which effects would indicate that autoinduction has started to occur?

A) The drug levels for carbamazepine are higher than expected.
B) The drug levels for carbamazepine are lower than expected.
C) The patient is experiencing fewer seizures.
D) The patient is experiencing toxic effects from the drug.

Question 10

A patient is taking gabapentin (Neurontin), and the nurse notes that there is no history of seizures on his medical record. What is the best possible rationale for this medication order?

A) The medication is used for the treatment of neuropathic pain.
B) The medication is helpful for the treatment of multiple sclerosis.
C) The medication is used to reduce the symptoms of Parkinson's disease.
D) The medical record is missing the correct information about the patient's history of seizures.

Question 11

A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition?

A) Diazepam (Valium)
B) Midazolam (Versed)
C) Valproic acid (Depakote)
D) Carbamazepine (Tegretol)

Question 12

A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin (Dilantin) therapy. He is to be NPO (consume nothing by mouth) for surgery in the morning. What will the nurse do about his morning dose of phenytoin?

A) Give the same dose intravenously.
B) Give the morning dose with a small sip of water.
C) Contact the prescriber for another dosage form of the medication.
D) Notify the operating room that the medication has been withheld.

Question 13

The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate?

A) AED therapy can be stopped when seizures are stopped.
B) AED therapy is usually lifelong.
C) Consistent dosing is the key to controlling seizures.
D) A dose may be skipped if the patient is experiencing adverse effects.
E) Abruptly stopping AEDs may cause rebound seizure activity.

Question 14

During a routine appointment, a patient with a history of seizures is found to have a phenytoin (Dilantin) level of 23 mcg/mL. What concern will the nurse have, if any?

A) The patient is at risk for seizures because the drug level is not at a therapeutic level.
B) The patient's seizures should be under control because this is a therapeutic drug level.
C) The patient's seizures should be under control if she is also taking a second antiepileptic drug.
D) The drug level is at a toxic level, and the dosage needs to be reduced.