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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.
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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.
The nurse has given medication instructions to a patient receiving phenytoin. Which statement by the patient indicates that the patient has an adequate understanding of the instructions?
- A. I will need to take extra care of my teeth and gums while on this medication.
- B. I can go out for a beer while on this medication.
- C. I can skip doses if the side effects bother me.
- D. I will be able to stop taking this drug once the seizures stop.
Correct Answer: A
Rationale: Good dental care is necessary to prevent gingival hypertrophy during therapy with phenytoin. Alcohol and other central nervous system depressants may cause severe sedation. Consistent dosing is important to maintain therapeutic drug levels. Therapy with AEDs usually must continue for life and must not be stopped once seizures stop.
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 reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate?
- A. AED therapy can be stopped when seizures are stopped.
- B. AED therapy is usually lifelong.
- C. Consistent dosing is the key to controlling seizures.
- D. A dose may be skipped if the patient is experiencing adverse effects.
- E. Abruptly stopping AEDs may cause rebound seizure activity.
Correct Answer: B,C,E
Rationale: Patients need to know that AED therapy is usually lifelong, and compliance (with consistent dosing) is important for effective seizure control. Abruptly stopping AED therapy may cause withdrawal (or rebound) seizure activity.