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A client with partial seizures has been prescribed a succinimide anticonvulsant. The client complains of GI upset after taking the drug. The nurse would suggest taking the drug in which manner?
- A. Daily at bedtime
- B. Immediately before eating a meal
- C. With some food or milk
- D. First thing in the morning on arising
Correct Answer: C
Rationale: If the client experiences GI upset after succinimide administration, the nurse should instruct the client to take the drug with food or milk. The nurse need not instruct the client to take the drug once only at bedtime, before meals, or immediately on arising in the morning.
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A nurse should monitor a client closely for increased CNS depressant effects when an/ColorExtension anticonvulsant is used concomitantly with which of the following? Select all that apply.
- A. Analgesics
- B. Oral contraceptives
- C. Alcohol
- D. Antibiotics
- E. Antidiabetic medications
Correct Answer: A,C
Rationale: The concomitant use of anticonvulsants and analgesics or alcohol can result in increased CNS depressant effects.
The nurse suspects that the client is developing toxicity if assessment reveals which of the following?
- A. Constipation
- B. Slurred speech
- C. Diarrhea
- D. Urinary frequency
Correct Answer: B
Rationale: The nurse should monitor the client for slurred speech, which is a sign of toxicity. Constipation, diarrhea, and urinary frequency are not signs of ethotoin toxicity.
A client comes to the clinic for a follow-up visit. The client is prescribed lamotrigine for seizure control. The nurse suspects that the client may be experiencing Stevens-Johnson syndrome based on which of the following?
- A. Complaints of muscle pain
- B. Lesions on the mucous membranes
- C. Blisters on the face and neck
- D. Recurrence of seizure activity
- E. Dizziness
Correct Answer: A,B,C
Rationale: Stevens-Johnson syndrome (SJS) is manifested by fever, cough, muscular aches and pains, headache, and lesions of the skin, mucous membranes, and eyes; the lesions appear as red wheals or blisters, often starting on the face, in the mouth, or on the lips, neck, and extremities. Recurrence of seizure activity and dizziness are not associated with this condition.
After reviewing information about anticonvulsants, a nursing student demonstrates understanding of this group of drugs, identifying which of the following as acting to elevate the seizure threshold by decreasing postsynaptic excitation? Select all that apply.
- A. Clonazepam (Klonopin)
- B. Valproic acid (Depakote)
- C. Gabapentin (Neurontin)
- D. Lorazepam (Ativan)
- E. Trimethadione (Tridione)
Correct Answer: A,D
Rationale: Benzodiazepines (clonazepam and lorazepam) exert their effect by elevating the seizure threshold by decreasing postsynaptic excitation. Valproic acid increases the levels of GABA, gabapentin is a GABA agonist, and trimethadione decreases the repetitive synaptic transmission of nerve impulses.
When describing the anticonvulsants to a group of nursing students, the instructor describes which of the following as acting to stabilize the hyperexcitability postsynaptically in the motor cortex of the brain? Select all that apply.
- A. Ethosuximide (Zarontin)
- B. Phenytoin (Dilantin)
- C. Valproic acid (Depakote)
- D. Ethotoin (Peganone)
- E. Topiramate (Topamax)
Correct Answer: B,D
Rationale: Hydantoins, like phenytoin (Dilantin) and ethotoin (Peganone), exert their effect by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain. Ethosuximide depresses the motor cortex, valproic acid increases levels of GABA to stabilize the cell membranes, and topiramate blocks seizure activity instead of raising the threshold.