Nokea
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.
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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.
The nurse would closely monitor a client taking which of the following anticonvulsants for pancytopenia? Select all that apply.
- A. Carbamazepine (Tegretol)
- B. Phenytoin (Dilantin)
- C. Valproic acid (Depakote)
- D. Felbamate (Felbatol)
- E. Zonisamide (Zonegran)
Correct Answer: A,D
Rationale: A client taking carbamazepine (Tegretol) or felbamate (Felbatol) should be monitored closely for pancytopenia.
When developing the teaching plan for a client receiving ethosuximide (Zarontin), the nurse would include instructions to notifypol notify the primary health care provider if which of the following occur? Select all that apply.
- A. Ataxia
- B. Blurred vision
- C. Slurred speech
- D. Joint pain
- E. Bruising
Correct Answer: B,D,E
Rationale: A nurse educating a client and family about ethosuximide (Zarontin) should tell them to notify the physician if skin rash, joint pain, unexplained fever, sore throat, unusual bleeding or bruising, drowsiness, blurred vision, or pregnancy occurs.
When reviewing the client's medical record, the nurse understands that which of the following if found would contraindicate administering phenytoin (Dilantin) to a client? Select all that apply.
- A. Pregnancy
- B. Sinus bradycardia
- C. Hepatic disease
- D. Diabetes
- E. Atrial fibrillation
Correct Answer: A,B
Rationale: The use of phenytoin is contraindicated in clients with known hypersensitivity to the drug, sinus bradycardia, sinoatrial block, Adam-Stokes syndrome, and second- and third-degree atrioventricular block and in clients who are pregnant or lactating.
A client with partial seizures has been prescribed a succinimide anticonvulsant. The client complains of GI upset after taking the drug. The nurse would suggest taking the drug in which manner?
- A. Daily at bedtime
- B. Immediately before eating a meal
- C. With some food or milk
- D. First thing in the morning on arising
Correct Answer: C
Rationale: If the client experiences GI upset after succinimide administration, the nurse should instruct the client to take the drug with food or milk. The nurse need not instruct the client to take the drug once only at bedtime, before meals, or immediately on arising in the morning.