Nokea
A nurse administering valproic acid to a client should monitor the client for increased effects of valproic acid when which of the following medications are initiated? Select all that apply.
- A. Cimetidine (Tagamet)
- B. Amitriptyline (Elavil)
- C. Metformin (Glucophage)
- D. Aspirin
- E. Lisinopril (Prinivil)
Correct Answer: A,B,D
Rationale: A nurse administering valproic acid to a client should monitor the client for increased effects of valproic acid when antibiotics, antifungals, salicylates (such as aspirin), tricyclic antidepressants such as amitriptyline, and cimetidine are initiated.
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A nurse is caring for a client with seizure disorders who is admitted to the health care facility. The client is prescribed phenytoin. During therapy, which of the following would be most important for the nurse to include in the ongoing assessment?
- A. Check the client's temperature every 3 to 4 hours
- B. Obtain serum plasma drug levels regularly
- C. Assess the client's respiratory rate
- D. Evaluate the client's pulse rate and rhythm
Correct Answer: B
Rationale: Although vital signs such as temperature, pulse rate and rhythm, and respiratory rate are commonly assessed routinely, it would be most important for the nurse to obtain serum plasma drug levels to evaluate the effectiveness of the therapy and also to prevent possible toxicity. Unless the client's vital signs are not within normal parameters, the nurse would monitor them based on the facility's policy.
A nurse understands that lorazepam (Ativan) is the drug of choice for treating status epilepticus but that its effects last for less than 1 hour. The nurse would expect which of the following to be prescribed along with lorazepam (Ativan) during status epilepticus? Select all that apply.
- A. Ethosuximide (Zarontin)
- B. Phenytoin (Dilantin)
- C. Ethotoin (Peganone)
- D. Zonisamide (Zonegran)
Correct Answer: B
Rationale: Due to the short effects of lorazepam (Ativan), a longer-acting anticonvulsant, such as phenytoin (Dilantin), is given to continue control of seizure activity.
The nurse is assessing a client for gingival hyperplasia based on the understanding that this adverse reaction is commonly associated with long-term administration of which of the following? Select all that apply.
- A. Carbamazepine (Tegretol)
- B. Phenytoin (Dilantin)
- C. Valproic acid (Depakote)
- D. Felbamate (Felbatol)
- E. Ethotoin (Peganone)
Correct Answer: B,E
Rationale: Gingival hyperplasia, although it can occur with any anticonvulsant, is commonly associated with long-term hydantoin therapy such as with phenytoin or ethotoin.
A client is prescribed phenytoin daily for seizures. The nurse teaches the client about the importance of adhering to the dosage schedule based on the understanding that which of the following may occur if a single dose is missed?
- A. CNS depression
- B. Hypotension
- C. Recurrence of seizures
- D. Nystagmus
Correct Answer: C
Rationale: Recurrence of seizure activity may result from abrupt discontinuation of the drug, even when the anticonvulsant is being administered in small daily doses. Abrupt discontinuation of the drug does not cause CNS depression, hypotension, or nystagmus. CNS depression, hypotension, and nystagmus are adverse reactions of phenytoin.
A nurse is caring for a client who is prescribed carbamazepine. When reviewing the client's medical record, the nurse would notify the health care provider for a change in the order if the client has which of the following?
- A. Bipolar disorder
- B. Renal impairment
- C. Hearing impairment
- D. Respiratory depression
Correct Answer: B
Rationale: Carbamazepine is contraindicated among clients with renal impairment. It can be prescribed to treat bipolar disorder. The drug is not contraindicated in clients with hearing impairment or respiratory depression.