Ch. 14 Antiepilectic Drugs (Exam 1)

A patient in a long-term care facility has a new order for carbamazepine (Tegretol) for seizure management. The nurse is correct when recognizing auto-induction as which response?

A. Toxic levels of carbamazepine (Tegretol)

B. Lower than expected drug levels

C. Gingival hyperplasia

D. Cessation of seizure activity

B. Lower than expected drug levels

The nurse is assessing the current medication list of a newly admitted patient. The drug gabapentin (Neurontin) is listed, but the patient states that he does not have any problems with seizures. What does the nurse suspect?

A. The patient is unaware of his own disease history.

B. The patient has been taking his wife's medication by mistake.

C. The patient may be taking this drug for neuropathic pain.

D. The patient is reluctant to admit to having a seizure disorder.

C. The patient may be taking this drug for neuropathic pain.

Before a patient is to receive phenytoin (Dilantin), the nurse practitioner orders lab work. Which lab result is of greatest concern?

A. High white blood cell count

B. Low serum albumin levels

C. Low platelet levels

D. High hemoglobin levels

B. Low serum albumin levels

A patient with unstable epilepsy is receiving IV doses of phenytoin (Dilantin). The latest drug level is 12 mcg/mL. Which administration technique will the nurse use?

A. Administer the drug by rapid IV push

B. Infuse slowly, not exceeding 50 mg/min

C. Mix the medication with dextrose solution

D. Administer via continuous infusion

B. Infuse slowly, not exceeding 50 mg/min

Which information will the nurse provide to the patient who is receiving antiepileptic drug therapy?

A. If you feel sleepy when taking the drug, decrease the dose by half

B. Take the drug on an empty stomach

C. Call your health care provider if you experience a sore throat or fever

D. Patients with epilepsy are not able to hold a job and work, so you should apply for benefits

C. Call your health care provider if you experience a sore throat or fever

Through which mechanism of action do antiseizure drugs work?

A. They decrease the inhibitory neurotransmitter system in the brain called the gamma-aminobutyric acid (GABA) system.

B. They increase calcium influx in the brain, causing a decrease in electrical current flow.

C. They stabilize nerve cell membranes and suppress the abnormal electrical impulses in the cerebral cortex.

D. They bind to opioid receptors, and molecular signaling activates the receptors to mediate certain actions.

C. They stabilize nerve cell membranes and suppress the abnormal electrical impulses in the cerebral cortex.

Through which action does phenytoin exert its effects?

A. By eliminating the underlying causes of seizure disorders

B. By increasing the action of gamma-aminobutyric acid (GABA), which inhibits neurotransmitters throughout the brain

C. By suppressing sodium influx and prolonging the channel inactivation to prevent neuron firing

D. By suppressing the calcium influx to prevent the electric current generated by the calcium ions to the T-type calcium channel

C. By suppressing sodium influx and prolonging the channel inactivation to prevent neuron firing

Through which mechanisms can antiseizure drugs decrease seizure activities?

A. Diminishing calcium influx

B. Suppressing sodium influx

C. Increasing sodium channel activation

D. Increasing the action of gamma-aminobutyric acid (GABA)

E. Increasing the calcium ion current through the T-type channel

A. Diminishing calcium influx

B. Suppressing sodium influx

D. Increasing the action of gamma-aminobutyric acid (GABA)

After Mr. Briggs recovers from the postictal state, the nurse provides phenytoin education. Which statement indicates Mr. Briggs understands the phenytoin education?

A. "I need to avoid drinking alcohol."

B. "I will need to check in frequently with my health care provider to have my blood levels monitored."

C. "I will try to improve my oral hygiene so my gums don't bleed."

D. "I can take this medication whenever I have a seizure."

E. "I am going to receive this medication via a shot in my muscle."

A. "I need to avoid drinking alcohol."

B. "I will need to check in frequently with my health care provider to have my blood levels monitored."

C. "I will try to improve my oral hygiene so my gums don't bleed."

The nurse understands that phenytoin should be used with caution in patients with which comorbid conditions?

A. Hirsutism

B. Gingival hyperplasia

C. Porphyria

D. Hypothyroidism

E. Cardiac disease

C. Porphyria

D. Hypothyroidism

E. Cardiac disease

Which patient laboratory values will the nurse review before initiating therapy with phenytoin?

A. Arterial blood gases

B. Serum electrolytes

C. Liver function tests (LFTs)

D. Blood urea nitrogen (BUN) and serum creatinine

E. Complete blood count (CBC)

C. Liver function tests (LFTs)

D. Blood urea nitrogen (BUN) and serum creatinine

E. Complete blood count (CBC)

Which substances interact with phenytoin to cause increased central nervous system (CNS) depression?

A. Alcohol

B. Evening primrose

C. Cimetidine

D. Oral contraceptive drugs

E. Calcium-containing antacids

A. Alcohol

C. Cimetidine

A patient asks the nurse about ways to prevent gingival symptoms while taking phenytoin. Which activity will the nurse recommend?

A. Use a soft-bristled toothbrush.

B. Floss the teeth three times daily.

C. Brush the teeth and gums vigorously.

D. Use toothpicks to clean under the gums.

A. Use a soft-bristled toothbrush.

A patient with complex partial seizures is prescribed phenytoin to control recurrent seizures, but the patient reports being reluctant to take the drug long term because of its side effects. Which information would the nurse provide this patient?

A. “Tolerance to most phenytoin side effects will develop over time.”

B. “Ask your health care provider about reducing your phenytoin dosage to minimize side effects.”

C. “Ask your health care provider about stopping your phenytoin if the side effects become troublesome.”

D. “Ask your health care provider about the possibility of using a different class of antiseizure medication.”

D. “Ask your health care provider about the possibility of using a different class of antiseizure medication.”

The nurse is caring for a patient who is experiencing excessive drowsiness caused by phenytoin. The health care provider withholds the drug and prescribes a serum drug level test. For which length of time will the nurse monitor the patient for drowsiness?

A. 30 to 60 minutes

B. 12 hours

C. 24 to 42 hours

D. 10 days

C. 24 to 42 hours

Which condition is most likely to require lower dosing and closer monitoring to prevent drug toxicity in a patient taking phenytoin?

A. Hepatitis

B. Pneumonia

C. Anemia

D. Gastroesophageal reflux

A. Hepatitis

A patient who has a seizure disorder has begun taking phenytoin. To ensure effectiveness of the drug, which laboratory value will the nurse monitor?

A. Serum drug levels

B. Liver function tests

C. Renal function tests

D. Complete blood count (CBC)

A. Serum drug levels

The nurse is performing an admission assessment on a patient who will receive intravenous phenytoin. The patient reports a history of a “slow heart rate.” Which action by the nurse is appropriate?

A. Administer the medication as prescribed.

B. Request an electrocardiogram (ECG).

C. Count the apical pulse for 1 minute before giving the drug.

D. Request an oral form of the drug to minimize cardiovascular side effects.

B. Request an electrocardiogram (ECG).

A patient prescribed phenytoin reports using over-the-counter medications to treat acid reflux. Which response by the nurse is correct?

A. “You should take a lower dose of phenytoin while using antacids.”

B. “Use an antacid that does not contain calcium.”

C. “Stop taking the phenytoin immediately if increased acid reflux occurs.”

D. “This combination may lead to increased central nervous system depression.”

B. “Use an antacid that does not contain calcium.”

A patient who has type 2 diabetes mellitus (DM) will begin taking phenytoin to treat seizures. Which ongoing assessment will the nurse complete on this patient?

A. Close monitoring of serum glucose

B. Close monitoring for adverse central nervous system (CNS) effects

C. More frequent assessment of oxygen saturation levels

D. Monitor for subtherapeutic serum drug levels

A. Close monitoring of serum glucose

The nurse is preparing to administer a dose of intravenous phenytoin to a patient and notes that the patient’s serum phenytoin level is 25 mcg/mL. Which action would the nurse take?

A. Request a prescription for oral phenytoin.

B. Hold the dose and notify the health care provider.

C. Give the dose and observe closely for central nervous system (CNS) side effects.

D. Notify the health care provider to discuss increasing the phenytoin dose.

B. Hold the dose and notify the health care provider.

At the beginning of a shift, the nurse assesses a 65-year-old patient who is receiving intravenous (IV) phenytoin and notes that the pump is programmed to deliver 50 mg/minute. Which action would the nurse take?

Select all that apply.

A. Stop the IV.

B. Notify the health care provider.

C. Increase the rate to 60 mg/minute.

D. Request a prescription for an antihypertensive drug.

E. Assess the patient’s blood pressure and heart rate.

A. Stop the IV.

B. Notify the health care provider.

E. Assess the patient's blood pressure and heart rate.

An older adult patient who weighs 70 kg is in status epilepticus. Which dose is an appropriate loading dose of phenytoin for this patient?

A. 700 mg

B. 467 mg

C. 4900 mg

D. 1400 mg

D. 1400 mg

A patient who has been taking phenytoin for several years reports stopping the drug the day before admission to the hospital. Which condition is most important for the nurse to monitor for in this patient?

A. Fever or bruising

B. Status epilepticus

C. Ataxia and nystagmus

D. Increased serum glucose

B. Status epilepticus

A patient who is taking oral phenytoin reports experiencing heartburn and gastrointestinal (GI) upset. Which recommendation will the nurse provide to the patient?

A. Take the medication with food.

B. Take with a calcium-containing antacid.

C. Take the medication on an empty stomach.

D. Stop taking the medication and notify the health care provider.

A. Take the medication with food.

A patient calls the clinic 1 week after beginning therapy with phenytoin to report urine that is pinkish red. How would the nurse respond?

A. Have the patient come to the clinic for a dipstick urinalysis.

B. Reassure the patient that this is a harmless side effect of phenytoin.

C. Contact the health care provider and request a prescription for a blood urea nitrogen (BUN) and creatinine.

D. Tell the patient to stop the drug immediately and contact the health care provider.

B. Reassure the patient that this is a harmless side effect of phenytoin.

The nurse would teach a patient with diabetes who is taking phenytoin to monitor for which condition?

A. Hypoglycemia

B. Hyperglycemia

C. Increased drug effects

D. Decreased drug effects

B. Hyperglycemia

The nurse is teaching a patient about the administration of phenytoin and instructs the patient to perform which action in case of a rash?

A. “Contact your health care provider immediately.”

B. “Apply a topical corticosteroid to the rash.”

C. “Take diphenhydramine to minimize itching.”

D. “Contact the health care provider to discuss an antibiotic.”

A. “Contact your health care provider immediately.”

A nurse would instruct patients taking phenytoin to report which side effects?

Select all that apply.

A. Fever

B. Gastrointestinal (GI) upset

C. Dizziness

D. Bleeding gums

E. Reddish-brown urine

A. Fever

C. Dizziness

D. Bleeding gums

The nurse instructs a patient receiving phenytoin to visit the dentist regularly and perform frequent oral hygiene. What is the common adverse effect the nurse is educating for with this teaching?

A. Oral candidiasis

B. Gingival hyperplasia

C. Increased risk of tooth abscess

D. Increased incidence of dental caries

B. Gingival hyperplasia

A patient receiving phenytoin has a serum drug level drawn. Which level will the nurse note as therapeutic?

A. 8 mcg/mL

B. 30 mcg/mL

C. 12 mcg/mL

D. 6 mcg/mL

C. 12 mcg/mL

While obtaining a patient history, the nurse notes that the patient has been prescribed ethosuximide. The nurse suspects that the patient has which type of seizure?

A. Partial

B. Absence

C. Tonic-clonic

D. Generalized

B. Absence

While teaching a patient newly diagnosed with a seizure disorder, what does the nurse state as the goal of anticonvulsant pharmacologic therapy?

A. Reduce seizure occurrence to one per week.

B. Maximize drug dosages to control seizure activity.

C. Eradicate all seizure activity and discontinue prescribed medication after the patient is seizure free for 3 months.

D. Maximally reducing seizure activity while minimizing the adverse effects of medication therapy.

D. Maximally reducing seizure activity while minimizing the adverse effects of medication therapy.

The nurse is completing discharge teaching for a patient prescribed an antiepileptic drug. The nurse instructs the patient of which potential complication if the medication is stopped abruptly?

A. Confusion

B. Rebound seizure activity

C. Hypotension

D. Somnolence

B. Rebound seizure activity

The nurse is caring for a postoperative craniotomy patient. Which prescribed drug does the nurse have available to treat possible acute seizures?

A. Diazepam

B. Gabapentin

C. Ethosuximide

D. Flumazenil

A. Diazepam

When administering intravenous (IV) phenytoin, which action would the nurse perform?

A. Monitor blood pressure and pulse oximetry.

B. Obtain an infusion pump for the medication.

C. Administer through peripheral IV sites only.

D. Flush the line with normal saline before and after administration.

D. Flush the line with normal saline before and after administration.

A patient receiving valproic acid would be monitored for which adverse effects? (Select all that apply.)

A. Tremors

B. Insomnia

C. Weight gain

D. Hepatotoxicity

E. Hypoglycemia

A. Tremors

C. Weight gain

D. Hepatotoxicity

A patient in a long-term care facility has a new order for carbamazepine (Tegretol) for seizure management. The nurse is correct when recognizing autoinduction as which response?

A.Toxic levels of carbamazepine (Tegretol)

B.Lower than expected drug levels

C.Gingival hyperplasia

D.Cessation of seizure activity

B.Lower than expected drug levels

The nurse is assessing the current medication list of a newly admitted patient. The drug gabapentin (Neurontin) is listed, but the patient states that he does not have any problems with seizures. What does the nurse suspect?

A.The patient is unaware of his own disease history.

B.The patient has been taking his wife's medication by mistake.

C.The patient may be taking this drug for neuropathic pain.

The patient is reluctant to admit to having a seizure disorder.

C.The patient may be taking this drug for neuropathic pain.

Before a patient is to receive phenytoin (Dilantin), the nurse practitioner orders lab work. Which lab result is of greatest concern?

A.High white blood cell count

B.Low serum albumin levels

C.Low platelet levels

D.High hemoglobin levels

B.Low serum albumin levels

A patient with unstable epilepsy is receiving IV doses of phenytoin (Dilantin). The latest drug level is 12 mcg/mL. Which administration technique will the nurse use?

A.Administer the drug by rapid IV push.

B.Infuse slowly, not exceeding 50 mg/min.

C.Mix the medication with dextrose solution.

D.Administer via continuous infusion.

B.Infuse slowly, not exceeding 50 mg/min.

Which information will the nurse provide to the patient who is receiving antiepileptic drug therapy?

A.If you feel sleepy when taking the drug, decrease the dose by half.

B.Take the drug on an empty stomach.

C.Call your health care provider if you experience a sore throat or fever.

D.Patients with epilepsy are not able to hold a job and work, so you should apply for benefits.

C.Call your health care provider if you experience a sore throat or fever.

What drug class does Phenytoin belong to?

A. Benzodiazepine

B. Barbiturate

C. Hydantoin anticonvulsant

D. Valproate

C. Hydantoin anticonvulsant

What is the primary use of Phenytoin?

A. Treatment of status epilepticus and generalized tonic-clonic seizures

B. Migraine prevention

C. Muscle relaxation

D. Anxiety control

A. Treatment of status epilepticus and generalized tonic-clonic seizures

What is the most important safety concern when administering Phenytoin?

A. Risk of respiratory depression

B. Risk of severe cardiac arrhythmias and hypotension (especially with IV administration)

C. Risk of hepatotoxicity only

D. Risk of hyperglycemia

B. Risk of severe cardiac arrhythmias and hypotension (especially with IV administration)

Which assessment finding requires immediate intervention in a patient taking Phenytoin?

A. Mild dizziness

B. Nystagmus or ataxia

C. Hypotension and dysrhythmia after IV administration

D. Fatigue

C. Hypotension and dysrhythmia after IV administration

What drug class does Carbamazepine belong to?

A. Hydantoin

B. Iminostilbene anticonvulsant

C. Barbiturate

D. Benzodiazepine

B. Iminostilbene anticonvulsant

What is the primary use of Carbamazepine?

A. Treatment of generalized tonic-clonic and partial seizures

B. Acute migraine

C. Treatment of absence seizures

D. Muscle spasticity

A. Treatment of generalized tonic-clonic and partial seizures

What is the most important safety concern when administering Carbamazepine?

A. Risk of hepatotoxicity and severe hematologic reactions

B. Risk of respiratory depression

C. Risk of hypoglycemia

D. Risk of hypertension

A. Risk of hepatotoxicity and severe hematologic reactions

Which assessment finding requires immediate intervention in a patient taking Carbamazepine?

A. Mild dizziness

B. Fever, sore throat, or signs of infection

C. Mild fatigue

D. Nausea

B. Fever, sore throat, or signs of infection

What drug class does Levetiracetam belong to?

A. Hydantoin

B. Pyrrolidone anticonvulsant

C. Barbiturate

D. Benzodiazepine

B. Pyrrolidone anticonvulsant

What is the primary use of Levetiracetam?

A. Treatment of partial-onset (focal) seizures and generalized seizures

B. Migraine prevention

C. Anxiety

D. Treatment of tonic-clonic seizures

A. Treatment of partial-onset (focal) seizures and generalized seizures

What is the most important safety concern when administering Levetiracetam?

A. Risk of suicidal ideation and behavioral changes

B. Risk of hepatotoxicity

C. Risk of renal failure

D. Risk of cardiac arrhythmias

A. Risk of suicidal ideation and behavioral changes

Which assessment finding requires immediate intervention in a patient taking Levetiracetam?

A. Mild dizziness

B. Irritability or sudden mood changes with suicidal thoughts

C. Fatigue

D. Mild nausea

B. Irritability or sudden mood changes with suicidal thoughts

What drug class does Valproic Acid belong to?

A. Hydantoin anticonvulsant

B. Barbiturate

C. Valproate anticonvulsant

D. Benzodiazepine

C. Valproate anticonvulsant

What is the primary use of Valproic Acid?

A. Migraine prevention only

B. Treatment of generalized seizures, and bipolar disorder and controlling partial (focal) seizures

C. Muscle relaxation

D. Treatment of tonic-clonic seizures and anxiety

B. Treatment of generalized seizures, and bipolar disorder and controlling partial (focal) seizures

What is the most important safety concern when administering Valproic Acid?

A. Risk of hepatotoxicity and pancreatitis

B. Risk of respiratory depression

C. Risk of hypotension

D. Risk of bradycardia

A. Risk of hepatotoxicity and pancreatitis

Which assessment finding requires immediate intervention in a patient taking Valproic Acid?

A. Mild fatigue

B. Abdominal pain, jaundice, or vomiting (possible liver failure or pancreatitis)

C. Mild dizziness

D. Headache

B. Abdominal pain, jaundice, or vomiting (possible liver failure or pancreatitis)