Nokea
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.
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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.
Phenytoin has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these?
- A. The safe and the toxic plasma levels of the drug are very close to each other.
- B. The phenytoin has a low chance of being effective.
- C. There is no difference between safe and toxic plasma levels.
- D. A very small dosage can result in the desired therapeutic effect.
Correct Answer: A
Rationale: Having a narrow therapeutic index means that there is a small difference between safe and toxic drug levels. These drugs require monitoring of therapeutic plasma levels. The other options are incorrect.
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 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.
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.