Chapter 28: Antiepileptics Introductory Clinical Pharmacology 12th Edition by Susan M Ford

Introductory Clinical Pharmacology 12th Edition by Susan M Ford 1. A nurse is administering lorazepam to a client with status epilepticus. The nurse will be prepared to administer which additional drug to treat the status epilepticus for the next several hours? a. Ethosuximide b. Phenytoin c. Ethotoin d. Zonisamide Answer: B Rationale: Due to the short effects of lorazepam, a longer-acting anticonvulsant, such as phenytoin, is given to continue control of seizure activity. Ethotoin is a hydantoin that is used to treat tonic–clonic seizures. Ethosuximide is a succinimide that is used to treat focal seizures. Zonisamide is a nonspecified preparation and used to treat focal seizures as well. Question format: Multiple Choice Chapter: 28 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 341, Uses 2. The nurse has completed a teaching with a client prescribed phenytoin daily for seizure activity. The nurse determines the session is successful after the client correctly chooses which potential adverse reaction that can occur if the client misses a dose of medication? a. CNS depression b. Hypotension c. Recurrence of seizures d. Nystagmus 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. Question format: Multiple Choice Chapter: 28 Learning Objective: 5 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Teaching/Learning Reference: p. 344, Promoting an Optimal Response to Therapy 3. A nurse is preparing to administer carbamazepine to a client. The nurse should question the health care provider about this order if which disorder is noted in the client's history? a. Bipolar disorder b. Renal impairment c. Hearing impairment d. Respiratory depression 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. Hearing impairment is an adverse reaction to quinidine. Barbiturates, sedatives, and hypnotics can depress the respiratory system as an adverse reaction. Question format: Multiple Choice Chapter: 28 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 342, Contraindications 4. The nurse is conducting an ongoing assessment on a client who was administered ethotoin. Which finding should the nurse prioritize? a. Constipation b. Slurred speech c. Diarrhea d. Urinary frequency Answer: B Rationale: The nurse should monitor the client for slurred speech, which is a sign of toxicity. Constipation, diarrhea, and urinary frequency are potential adverse reactions; however, these are not signs of ethotoin toxicity. Question format: Multiple Choice Chapter: 28 Learning Objective: 3 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 344, Special Considerations for Hydantoins 5. An older adult client experiencing seizures is prescribed diazepam. Which assessment should the nurse prioritize? a. Respiratory rate and depth b. Blood glucose levels c. Swallowing ability d. Speech quality Answer: A Rationale: Apnea and cardiac arrest can occur when diazepam is administered to older adults, very ill clients, and individuals with limited pulmonary reserve. Therefore, monitoring the client's respiratory rate and depth would be most important. If the client is prescribed diazepam and antidiabetic medications, there may be an increase in the blood glucose level. The nurse should test the client's swallowing ability by offering sips of water before giving the drug. If there is difficulty swallowing, hold the drug and contact the health care provider as soon as possible. Slurred speech is an adverse reaction of hydantoins. It is also a potential sign of toxicity; however, the most important would be to determine the respiratory status and if that is functioning within reasonable parameters, then address the toxicity issue, if present. Question format: Multiple Choice Chapter: 28 Learning Objective: 3 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 345, Special Considerations for Benzodiazepines 6. The nurse is preparing to administer the next dose of methsuximide to a client experiencing partial seizures. The client remarks about hoping their stomach will do better this time. Which suggestion from the nurse will best assist this client when administering this next dose?