Nokea
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.
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A nurse is developing a plan of care for a client receiving anticonvulsant therapy and identifies a nursing diagnosis of Risk for Injury. Which assessment findings would support this nursing diagnosis? Select all that apply.
- A. Epistaxis
- B. Reports of blurred vision
- C. Complaints of dizziness
- D. Photosensitivity
- E. Scaling red rash
Correct Answer: B,C,D
Rationale: A client would be at risk for injury if the client was experiencing blurred vision, dizziness, and photosensitivity. Epistaxis would support a nursing diagnosis of a possible Risk for Injury related to a reduction in platelets from hematologic adverse reactions. A scaling red rash would support a nursing diagnosis of Impaired Skin Integrity.
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.
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.
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 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.