Nokea
The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing?
- A. Levetiracetam
- B. Phenobarbital
- C. Valproic acid
- D. Gabapentin
Correct Answer: B
Rationale: Phenobarbital has the longest half-life of all standard AEDs, including those listed in the other options; therefore, it allows for once-a-day dosing.
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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.
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.
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.
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.
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.