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The nurse is giving an intravenous dose of phenytoin. Which action is correct when administering this drug?
- A. Give the dose as a fast intravenous (IV) bolus.
- B. Mix the drug with normal saline, and give it as a slow IV push.
- C. Mix the drug with dextrose (D5W), and give it as a slow IV push.
- D. Mix the drug with any available solution as long as the administration rate is correct.
Correct Answer: B
Rationale: Intravenous phenytoin is given only with normal saline solution to prevent precipitation formation caused by incompatibilities. The IV push dose must be given slowly (not exceeding 50 mg/min in adults), and the patient must be monitored for bradycardia and decreased blood pressure.
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A 9-year-old child will be receiving carbamazepine suspension, 200 mg twice daily. The medication is available in a strength of 100 mg/5 mL. Identify how many milliliters the nurse will give to the patient for each dose.
Correct Answer: 10 mL
Rationale: 100 mg : 5 mL :: 200 mg : x mL; (100 * x) = (5 * 200); 100x = 1000; x = 10 mL/dose.
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.
The nurse is monitoring a patient who has been taking carbamazepine for 2 months. Which effects would indicate that autoinduction has started to occur?
- A. The drug levels for carbamazepine are higher than expected.
- B. The drug levels for carbamazepine are lower than expected.
- C. The patient is experiencing fewer seizures.
- D. The patient is experiencing toxic effects from the drug.
Correct Answer: B
Rationale: With carbamazepine, autoinduction occurs and leads to lower than expected drug concentrations. Therefore, the dosage may have to be adjusted with time. The other options are incorrect.
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.
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.