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A client diagnosed with epilepsy asks the nurse why he or she will have to take a prescription. Which response should the nurse provide the client? 1. "The prescription will decrease the intensity of the seizures." 2. "You will need a prescription for a little while to cure the seizures." 3. "You will need to take a prescription on a continual basis to control the seizures." 4. "You might not need a prescription; the epilepsy may be controlled with a ketogenic diet."
Answer: 3 Explanation: 1. The prescription is intended to prevent seizure activity. 2. Epilepsy and associated seizures are not curable with medications. 3. Epilepsy is a condition for which seizures may occur on a chronic basis. Once seizures are controlled, patients will continue indefinitely on the antiseizure prescription. 4. The ketogenic diet is used when seizures cannot be controlled through pharmacotherapy or when there are unacceptable side effects to the prescriptions.
The client receiving valproic acid (Depakene) for treatment of seizures has been taking 81mg aspirin daily. For which should the nurse monitor the client? 1. Increased seizure activity 2. Stevens-Johnson syndrome 3. Migraine headaches 4. Bruising of the skin
Answer: 4 Explanation: 1. Valproic acid (Depakene) and aspirin do not increase the risk of seizure activity. 2. Stevens-Johnson syndrome is a side effect of valproic acid (Depakene); its occurrence is not increased with concomitant aspirin use. 3. Valproic acid (Depakene) and aspirin use are not associated with migraine headaches. 4. Valproic acid (Depakene) can prolong bleeding time; concomitant aspirin use can cause severe bleeding
The nurse is providing information about seizures to a client. Which statement should the nurse include in the discussion? 1. "Convulsions are a symptom of the underlying seizure disorder." 2. "Bacterial infections can cause seizures." 3. "Epilepsy is an acute disorder characterized by nonconvulsive seizures." 4. "All seizures involve convulsions."
Answer: 2 Explanation: 1. Convulsions are a type of seizure, and seizures are a symptom of an underlying disorder. 2. Seizures can be caused by bacterial infections of the nervous system. 3. Epilepsy is generally chronic and can present with convulsive seizures. 4. Not all seizures involve convulsions
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." Which information should the nurse include in a response to the parent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The episodes of jerking and thrashing are called convulsions." 2. "Seizures take many forms." 3. "Your son may have seizures, but not epilepsy." 4. "Seizures can be a sign that epilepsy is present." 5. "If there is no physical movement, epilepsy is ruled out."
Answer: 1, 2, 4 Explanation: 1. Convulsions are the involuntary, violent spasms of the large skeletal muscles of the face, neck, arms, and legs. It is important to provide this parent with correct terminology. 2. There are many types of seizures. 3. It is inappropriate to lead the parent to believe that the diagnosis is incorrect. The nurse does not have all the necessary information. 4. Epilepsy is any disorder that is characterized by recurrent seizures. 5. Many seizures do not include physical movement, yet the patient still is diagnosed with epilepsy.
The nurse is preparing to administer phenytoin (Dilantin). Which route should the nurse anticipate to administer the prescription? 1. Intramuscular 2. Central venous catheter 3. Intravenously 4. Subcutaneous
Answer: 3 Explanation: 1. Phenytoin is not administered intramuscularly. The prescription is a soft-tissue irritant that causes local tissue damage following extravasation. 2. Phenytoin should not be administered through a central venous catheter. 3. Phenytoin is administered intravenously. 4. Phenytoin is not administered subcutaneously. The prescription is a soft-tissue irritant that causes local tissue damage following extravasation.
The nurse has administered intravenous (IV) diazepam (Valium) for the client in status epilepticus. Which initial assessment should the nurse perform? 1. Respirations 2. Level of consciousness 3. Heart rate 4. Blood pressure
Answer: 1 Explanation: 1. Respiratory depression is common when diazepam is given intravenously (IV). Assessing the respirations is the most important. 2. Assessing the level of consciousness is important, but not the most important. 3. Although tachycardia is a side effect of intravenous diazepam (Valium), assessing the patient's heart rate is not the most important. 4. Although hypotension is an effect of intravenous diazepam (Valium), the blood pressure is not the most important assessment.
The nurse has provided education for a client diagnosed with epilepsy. Which statement made by the client indicates an understanding of the information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Excessive stress levels cause disruptions in how the brain receives oxygen, leading to epilepsy." 2. "Epilepsy may be caused by a head injury." 3. "Eating disorders, like anorexia nervosa, increase the risk for developing epilepsy." 4. "A stroke, or brain attack, could increase the risk for developing epilepsy." 5. "With some cases of epilepsy, the cause is never determined."
Answer: 2, 4, 5 Explanation: 1. Excessive levels of stress cannot disrupt cerebral oxygen to the extent that epilepsy would occur. 2. Head trauma is a known cause of seizures. 3. There is no known correlation with anorexia nervosa and the development of epilepsy. 4. Changes in cerebral perfusion such as hypotension; strokes or brain attacks; and shock may be causes of seizures. 5. In some cases, the exact etiology may not be identified
A client taking phenobarbital (Luminal) for seizure control asks the nurse how the prescription can control seizures. Which response should the nurse provide the client? 1. "Phenobarbital (Luminal) stops seizures by decreasing the calcium in the brain, which is responsible for the seizures." 2. "Phenobarbital (Luminal) stops seizures by increasing a chemical called glutamate that calms down the excitability in the brain." 3. "Phenobarbital (Luminal) stops seizures by decreasing the sodium in the brain, which is responsible for the seizures." 4. "Phenobarbital (Luminal) stops seizures by increasing a chemical called GABA that calms down the excitability in the brain."
Answer: 4 Explanation: 1. Succinimides, not phenobarbital (Luminal), suppress calcium influx. 2. Glutamate is the primary excitatory neurotransmitter in the brain; enhancing this neurotransmitter will increase the likelihood of seizures. 3. Hydantoins and phenytoin-like drugs, not phenobarbital (Luminal), suppress sodium influx. 4. Phenobarbital (Luminal) acts biochemically in the brain by enhancing the action of the neurotransmitter GABA, which is responsible for suppressing abnormal neuronal discharges that can cause epilepsy
An older adult is prescribed phenobarbital (Luminal) for seizure control. Which assessment should the nurse recognize is the most important? 1. Fluid intake 2. Electrolyte balance 3. Respiratory function 4. Nutritional status
Answer: 3 Explanation: 1. Fluid intake is often decreased in older adults but is not a side effect of barbiturates. 2. Barbiturates do not affect electrolyte balance. 3. Older adults are at risk for cumulative effects of barbiturates due to diminished hepatic and renal function. Central nervous system (CNS) depression can lead to suppression of respiratory function. 4. Nutritional status is important with older adult patients but is not the primary concern.
A client has been prescribed several different prescriptions for seizure control without any improvement. Which initial question should the nurse ask the client? 1. "Have you thought about taking a nontypical prescription?" 2. "Have you noticed any decrease in the amount of seizures you have?" 3. "Do you take your medication as prescribed? 4. "Do you drink alcohol?"
Answer: 3 Explanation: 1. Another drug might be indicated, but compliance should be assessed first. 2. There is no indication there is an improvement in seizure control. 3. Compliance with the prescription should be initially assessed for a patient that has not had an improvement in seizure control after taking several different prescriptions for seizure control. 4. Alcohol does not increase the risk of seizures for a patient prescribed an antileptic
A client with epilepsy prescribed Phenobarbital (Luminal) tells the nurse she is planning a pregnancy. Which statement should the nurse provide the client? 1. "Your medication dose will need to be decreased during your pregnancy." 2. "Please talk to your doctor; this drug is contraindicated in pregnancy." 3. "Your medication dose will need to be increased during your pregnancy." 4. "Please talk to your doctor; you will need a safer drug like valproic acid (Depakene)."
Answer: 2 Explanation: 1. The medication does not need to be decreased; it might need to be stopped. 2. Phenobarbital (Luminal) falls under Pregnancy Category D and is contraindicated in pregnancy. 3. The medication does not need to be increased; it might need to be stopped. 4. Valproic acid (Depakene) is also a Pregnancy Category D drug and is contraindicated during pregnancy.
The healthcare provider has prescribed intravenous phenytoin (Dilantin) IV piggyback. The client is currently receiving 5% dextrose in water (D5W) intravenously (IV). Which action should the nurse take? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use a large vein for the infusion. 2. Use an intravenous (IV) line with a filter. 3. Flush the intravenous (IV) line with saline. 4. Monitor the patient for hypertension. 5. Monitor the patient for Stevens-Johnson syndrome
Answer: 2, 3 Explanation: 1. Phenytoin (Dilantin) is a soft-tissue irritant that will cause local tissue damage if extravasation occurs, so a large vein must be used for infusion. 2. An intravenous filter will trap any precipitate that occurs. 3. Intravenous lines of 5% dextrose in water (D5W) must be flushed with saline, as traces of dextrose can cause microscopic precipitate formations that become emboli, if infused. 4. Patients receiving phenytoin (Dilantin) are at risk for hypotension, not hypertension. 5. Stevens-Johnson syndrome is a side effect of phenytoin (Dilantin), but occurs over the course of several days.
A client asks the nurse about the characteristics of absence seizures. Which explanation should the nurse provide the client? 1. "Absence seizures are basically the same kind of seizures as grand mal, but they are less frequent." 2. "This type of seizure is characterized by staring into space for a few seconds." 3. "Absence seizures are characterized by twitching of the arms and legs." 4. "This type of seizure is similar to drop attacks."
Answer: 2 Explanation: 1. Grand mal, or tonic-clonic, seizures are different from absence or petit mal seizures; they are different forms of epilepsy. 2. Absence seizures last a few seconds and are characterized by staring into space. 3. Simple partial seizures are characterized by twitching of the arms and legs. 4. Drop attacks or atonic seizures last a few seconds and are characterized by stumbling or falling for no reason
The nurse has provided the education to the parent of a young child prescribed valproic acid (Depakene) syrup. Which statement made by the parent indicates an understanding of the teaching? 1. "I should not mix this with carbonated beverages." 2. "If my child gets a headache from this, I can administer a baby aspirin." 3. "I can still give the clonazepam (Klonopin) prescribed by the psychiatrist for sleep." 4. "I can give this on a full stomach or an empty stomach."
Answer: 1 Explanation: 1. Mixing valproic acid (Depakene) syrup with carbonated beverages will trigger immediate release of the drug, which causes severe mouth and throat irritation. 2. Aspirin can increase valproic acid (Depakene) toxicity, and aspirin should not be given to children because of Reye syndrome. 3. Clonazepam (Klonopin) given with valproic acid (Depakene) can induce absence seizures. 4. Valproic acid (Depakene) is a gastrointestinal (GI) irritant and should be given with food.
For which adverse effect should the nurse monitor a client prescribed phenytoin (Dilantin)? 1. Vitamin B deficiency 2. Leg edema 3. Bleeding 4. Hypoglycemia
Answer: 3 Explanation: 1. Dilantin affects the metabolism of vitamin K, which can lead to blood dyscrasias. Hyperglycemia is more common than hypoglycemia, and leg edema is not generally experienced as an adverse effect. Vitamin B deficiency is not the most common complication. 2. Leg edema is not generally experienced as an adverse effect. 3. Dilantin affects the metabolism of vitamin K, which can lead to blood dyscrasias. 4. Hyperglycemia is more common than hypoglycemia.
A client with type I diabetes mellitus has been prescribed phenytoin (Dilantin). Based on the client's medical history, which should the nurse anticipate to be included in the treatment plan? 1. A decrease in the patient's insulin 2. An increase the patient's insulin 3. Monitor coagulation studies 4. Implement fall precautions
Answer: 2 Explanation: 1. Phenytoin (Dilantin) can increase serum glucose levels. 2. Phenytoin (Dilantin) can increase serum glucose levels resulting in the need for additional insulin. 3. All clients receiving phenytoin (Dilantin) are at risk for petechiae, epistaxis, and hematuria; this is not specific to the patient with type 1 diabetes mellitus. 4. All clients receiving phenytoin (Dilantin) are at risk for dizziness and ataxia; this is not specific to the client with type 1 diabetes mellitus
The nurse is preparing to review the records for a client with petit mal seizures. Which prescription should the nurse anticipate the client has been prescribed? 1. Diazepam (Valium) 2. Carbamazepine (Tegretol) 3. Phenytoin (Dilantin) 4. Ethosuximide (Zarontin)
Answer: 4 Explanation: 1. Diazepam can be effective for tonic-clonic seizures. 2. Carbamazepine (Tegretol) is used to treat partial and tonic-clonic seizure disorders. 3. Dilantin can be effective for tonic-clonic seizures. 4. Ethosuximide is a succinimide that is indicated for petit mal seizures.
The educator is discussing the adverse effects of prescriptions used to treat seizure disorders. Which prescription should the educator refer to when discussing the risk for extravasation? 1. Phenobarbital (Luminal) 2. Phenytoin (Dilantin) 3. Ethosuximide (Zarontin) 4. Clonazepam (Klonopin)
Answer: 2 Explanation: 1. Phenobarbital is primarily administered orally and is infrequently administered intravenously. 2. Dilantin is frequently administered intravenously due to slow and variable absorption rates when given orally. Dilantin results in serious soft tissue damage if extravasation occurs. 3. Zarontin is an oral medication. 4. Klonopin is an oral medication.
A client with epilepsy who has been seizure free and prescribed phenytoin (Dilantin) asks the nurse why he or she needs to still have blood testing. Which response should the nurse provide the client? 1. "Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose." 2. "Phenytoin (Dilantin) can cause blood-thinning in some patients." 3. "Phenytoin (Dilantin) can cause Stevens-Johnson syndrome, which can be detected through blood testing." 4. "Phenytoin (Dilantin) can deplete your system of potassium."
Answer: 1 Explanation: 1. Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose; blood levels must be monitored to ensure a therapeutic level and to prevent toxicity. 2. Phenytoin (Dilantin) is not an anticoagulant and does not cause thinning of the blood. 3. Stevens-Johnson syndrome is a severe skin reaction that can be an adverse outcome with phenytoin (Dilantin), but it is monitored by skin assessment, not blood tests. 4. There isn't any evidence to support that phenytoin (Dilantin) causes potassium depletion.
) A client that has been taking phenytoin (Dilantin) tells the nurse they want to stop taking the medication due to the side effects. Which response should the nurse provide the client? 1. "Please do not stop the prescription abruptly, as you will have withdrawal seizures." 2. "Side effects are a problem, but they are not as bad as the seizures you were having." 3. "Another prescription can be added to decrease the side effects." 4. "Your seizures have been controlled so I will let your healthcare provider know that you no longer will be taking the prescription."
Answer: 1 Explanation: 1. Seizures are likely to occur with abrupt withdrawal of antiseizure prescription. The prescription must be withdrawn over a period of 6 to 12 weeks. 2. Telling a client that prescription side effects are not as bad as seizures is an inappropriate and nontherapeutic response that does not address the patient's concerns. 3. There is no other prescription that can be added to decrease the side effects associated with phenytoin (Dilantin). 4. It is not within the nurse's scope of practice to determine if a client has been taking a medication long enough. The client must be informed of the consequences of abruptly stopping the medication
The nurse observes a client that stops talking mid-sentence and has a blank stare for 5 seconds. Which should the nurse suspect has occurred? 1. Simple partial seizure 2. Status epilepticus 3. Petit mal seizure 4. Drop attack
Answer: 3 Explanation: 1. Simple partial seizures manifest in olfactory, auditory, or visual hallucinations; intense emotions; or twitching of arms, legs, and face. 2. Status epilepticus is continuous seizure activity, which can lead to coma or death. 3. The symptoms presented indicate a general (absence) or petit mal seizure. 4. Drop attacks are manifested by falling or stumbling for no reason. These attacks typically last a few seconds
The nurse is preparing to assess a client that had a tonic-clonic seizure. Which assessment findings should the nurse anticipate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Incontinence of urine. 2. The client is in a deep sleep. 3. Confusion in relation to place and time. 4. The client reports an odd taste in the mouth. 5. The client attempts to remove their hospital gown.
Answer: 2, 3 Explanation: 1. Incontinence of bowel or bladder is common during a tonic-clonic seizure but is not indicative of a postictal state. 2. Deep sleep after the seizure is a finding associated with the postictal state. 3. Patients who are in the postictal state may be confused and disoriented. 4. An odd taste, specific odor or noise, or other sensory change known as an aura often occurs prior to a seizure. 5. During complex partial seizures, patients sometimes fumble with or attempt to remove clothing
The nurse has completed the education for the parents of a child with tonic-clonic seizures. Which statements made by the parents indicate further education is needed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Some of the times when I thought he was ignoring me may have actually been seizure activity." 2. "He just needs to focus more to prevent these attacks." 3. "I know he will outgrow these seizures with time." 4. "I hope we can help our son identify his seizure aura." 5. "We will watch for the development of status epilepticus."
Answer: 1, 2, 3 Explanation: 1. Behavior that manifests as the child ignoring outside stimuli is most likely absence seizure, which is different from tonic-clonic seizure. 2. The patient who suffers seizure disorder cannot prevent seizure occurrence by focusing harder. 3. The patient with tonic-clonic seizure disorder is less likely to outgrow them than the patient with absence seizure disorder. 4. Many patients experience an aura prior to the tonic-clonic phase. Identifying the aura can provide time for the patient to move to a safe area, notify another person of the impending seizure, and to prepare. 5. Status epilepticus is a medical emergency that may occur in the patient who suffers with tonic-clonic seizure disorder.
) A client prescribed valproic acid (Depakene) for seizure control is planning a pregnancy. Which statements should the nurse include in a discussion with the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Since your epilepsy may be exacerbated by a pregnancy, your healthcare provider will most likely prescribe a second antiepileptic prescription." 2. "Thankfully, the current generation of antiepileptic prescriptions will not interfere with you getting pregnant." 3. "Your current antiepileptic prescription should not be used when you are pregnant." 4. "Folic acid supplementation is important for you." 5. "You should consider adopting a baby instead since there are so many problems associated with epilepsy and pregnancy."
Answer: 3, 4 Explanation: 1. Due to the increased side effects of the antiepileptic prescriptions, single drug therapy is the goal for a pregnant client. 2. Women who have epilepsy have a reduced fertility rate, and some do not ovulate. 3. Valproic acid (Depakene) is Pregnancy Category D. 4. Folic acid supplementation is important for all women who are, or wish to become, pregnant. This is especially true of women who are epileptic because many antiepileptic prescriptions cause folic acid deficiency. 5. Women who are epileptic can conceive and deliver healthy babies. The nurse should not discourage this client, but should provide information to the patient and then support the client's choice.
The nurse has provided a client education on the pharmacologic management of epilepsy. Which statement made by the client indicates an understanding of the treatment? 1. "I understand that I will take an antiseizure prescription indefinitely." 2. "I will avoid foods with tyramine while taking my antiseizure prescription." 3. "I will be on a ketogenic diet combined with an antiseizure prescription." 4. "I will remain on an antiseizure prescription for 1 year after my last seizure.
Answer: 1 Explanation: 1. Once seizures have been controlled, patients are continued indefinitely on the antiseizure drug. 2. A tyramine-free diet is indicated for patients receiving monoamine oxidase inhibitor medications. 3. A ketogenic diet is indicated when seizures cannot be controlled through pharmacotherapy or when there are unacceptable side effects to the medications. 4. It is unknown how long antiseizure drugs will be necessary, but many patients require a lifetime regimen.