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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.
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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.
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.
After teaching a client and family about prescribed phenytoin therapy, the nurse determines that the teaching was successful when they identify that which of the following should be reported to the primary health care provider as possibly indicating toxicity? Select all that apply.
- A. Ataxia
- B. Nystagmus
- C. Slurred speech
- D. Lethargy
- E. Diplopia
Correct Answer: A,C,D
Rationale: Signs suggesting phenytoin toxicity that need to be reported include slurred speech, ataxia, lethargy, dizziness, nausea, and vomiting.
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 at a health care center has been asked to prepare a teaching plan for a client on oxazolidinedione therapy. Which of the following points should the nurse include?
- A. Avoiding exposure to ultraviolet light
- B. Taking the drug 2 hours after a meal
- C. Taking the drug with milk
- D. Avoiding carbonated drinks during therapy
Correct Answer: A
Rationale: The nurse should suggest avoiding exposure to ultraviolet light in the teaching plan of the client on oxazolidinedione therapy because of the risk for photosensitivity. The nurse need not include taking the drug 2 hours after a meal, taking the drug with milk, or avoiding carbonated drinks.