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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.
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When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction?
- A. Driving is allowed after 2 weeks of therapy.
- B. If seizures recur, take a double dose of the medication.
- C. Antacids can be taken with the AED to reduce gastrointestinal adverse effects.
- D. Take the drug at the same time every day.
Correct Answer: D
Rationale: Consistent dosing, taken regularly at the same time of day, at the recommended dose, and with meals to reduce the common gastrointestinal adverse effects, is the key to successful management of seizures when taking AEDs. The other options are not correct statements.
The U.S. Food and Drug Administration has issued a warning for users of antiepileptic drugs. Based on this report, the nurse will monitor for which potential problems with this class of drugs?
- A. Increased risk of suicidal thoughts and behaviors
- B. Signs of bone marrow depression
- C. Indications of drug addiction and dependency
- D. Increased risk of cardiovascular events, such as strokes
Correct Answer: A
Rationale: The U.S. Food and Drug Administration (FDA) has required black box warnings on all antiepileptic drugs regarding the risk of suicidal thoughts and behaviors. Patients being treated with antiepileptic drugs for any indication need to be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. The other options are incorrect.
A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition?
- A. Diazepam
- B. Midazolam
- C. Valproic acid
- D. Carbamazepine
Correct Answer: A
Rationale: Diazepam and lorazepam are considered by many to be the drugs of choice for status epilepticus. Other drugs that are used are listed in Table 14-3 and do not include the drugs listed in the other options.
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.
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.