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A patient has been taking an AED for several years as part of his treatment for seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a few days until she has a chance to go to the drugstore. What is the nurse's best response?
- A. He is taking another antiepileptic drug, so he can go without the medication for a week.
- B. Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away.
- C. He can temporarily increase the dosage of his other antiseizure medications until you get the refill.
- D. He can stop all medications because he has been treated for several years now.
Correct Answer: B
Rationale: Abrupt discontinuation of antiepileptic drugs can lead to withdrawal seizures. The other options are incorrect. The nurse cannot change the dose or stop the medication without a prescriber's order.
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A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin therapy. He is to be NPO (consume nothing by mouth) for surgery in the morning. What will the nurse do about his morning dose of phenytoin?
- A. Give the same dose intravenously.
- B. Give the morning dose with a small sip of water.
- C. Contact the prescriber for another dosage form of the medication.
- D. Notify the operating room that the medication has been withheld.
Correct Answer: C
Rationale: If there are any questions about the medication order or the medication prescribed, contact the prescriber immediately for clarification and for an order of the appropriate dose form of the medication. Do not change the route without the prescriber's order. There is an increased risk of seizure activity if one or more doses of the AED are missed.
A patient is taking gabapentin, and the nurse notes that there is no history of seizures on his medical record. What is the best possible rationale for this medication order?
- A. The medication is used for the treatment of neuropathic pain.
- B. The medication is helpful for the treatment of multiple sclerosis.
- C. The medication is used to reduce the symptoms of Parkinson's disease.
- D. The medical record is missing the correct information about the patient's history of seizures.
Correct Answer: A
Rationale: Gabapentin is commonly used to treat neuropathic pain. The other options are incorrect.
The nurse is giving an intravenous dose of phenytoin. Which action is correct when administering this drug?
- A. Give the dose as a fast intravenous (IV) bolus.
- B. Mix the drug with normal saline, and give it as a slow IV push.
- C. Mix the drug with dextrose (D5W), and give it as a slow IV push.
- D. Mix the drug with any available solution as long as the administration rate is correct.
Correct Answer: B
Rationale: Intravenous phenytoin is given only with normal saline solution to prevent precipitation formation caused by incompatibilities. The IV push dose must be given slowly (not exceeding 50 mg/min in adults), and the patient must be monitored for bradycardia and decreased blood pressure.
During a routine appointment, a patient with a history of seizures is found to have a phenytoin level of 18 mg/mL. What concern will the nurse have, if any?
- A. The patient is at risk for seizures because the drug level is not at a therapeutic level.
- B. The patient's seizures should be under control because this is a therapeutic drug level.
- C. The patient's seizures should be under control if she is also taking a second antiepileptic drug.
- D. The drug level is at a toxic level, and the dosage needs to be reduced.
Correct Answer: B
Rationale: Therapeutic drug levels for phenytoin are usually 10 to 20 mg/mL. The other options are incorrect.
A 9-year-old child will be receiving carbamazepine suspension, 200 mg twice daily. The medication is available in a strength of 100 mg/5 mL. Identify how many milliliters the nurse will give to the patient for each dose.
Correct Answer: 10 mL
Rationale: 100 mg : 5 mL :: 200 mg : x mL; (100 * x) = (5 * 200); 100x = 1000; x = 10 mL/dose.