Nokea
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.
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A nurse administering valproic acid to a client should monitor the client for increased effects of valproic acid when which of the following medications are initiated? Select all that apply.
- A. Cimetidine (Tagamet)
- B. Amitriptyline (Elavil)
- C. Metformin (Glucophage)
- D. Aspirin
- E. Lisinopril (Prinivil)
Correct Answer: A,B,D
Rationale: A nurse administering valproic acid to a client should monitor the client for increased effects of valproic acid when antibiotics, antifungals, salicylates (such as aspirin), tricyclic antidepressants such as amitriptyline, and cimetidine are initiated.
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.
A client is prescribed phenytoin daily for seizures. The nurse teaches the client about the importance of adhering to the dosage schedule based on the understanding that which of the following may occur if a single dose is missed?
- A. CNS depression
- B. Hypotension
- C. Recurrence of seizures
- D. Nystagmus
Correct Answer: C
Rationale: Recurrence of seizure activity may result from abrupt discontinuation of the drug, even when the anticonvulsant is being administered in small daily doses. Abrupt discontinuation of the drug does not cause CNS depression, hypotension, or nystagmus. CNS depression, hypotension, and nystagmus are adverse reactions of phenytoin.
An older adult client is prescribed diazepam for seizure control. Which of the following would be most important for the nurse to monitor?
- A. Respiratory rate and depth
- B. Blood glucose levels
- C. Swallowing ability
- D. Speech quality
Correct Answer: A
Rationale: Apnea and cardiac arrest can occur when diazepam is administered to older adults, very ill patients, and individuals with limited pulmonary reserve. Therefore, monitoring the client's respiratory rate and depth would be most important. There is no need to monitor the client's blood glucose levels, swallowing ability, or speech quality unless these were issues before this drug therapy was initiated.
A nurse is caring for a client who is prescribed carbamazepine. When reviewing the client's medical record, the nurse would notify the health care provider for a change in the order if the client has which of the following?
- A. Bipolar disorder
- B. Renal impairment
- C. Hearing impairment
- D. Respiratory depression
Correct Answer: B
Rationale: Carbamazepine is contraindicated among clients with renal impairment. It can be prescribed to treat bipolar disorder. The drug is not contraindicated in clients with hearing impairment or respiratory depression.