Chapter 21: Drugs for Seizures Nursing School Test Banks

Workman: Understanding Pharmacology

Chapter 21: Drugs for Seizures

Test Bank

MULTIPLE CHOICE

1. Which temporary condition is considered a brief but expected response immediately after a person has a seizure?
a. Residual muscle twitches
b. Low blood pressure
c. Unconsciousness
d. Confusion
ANS: D
During seizure activity, especially a generalized seizure, the brain is not well-oxygenated and the person is not aware of his or her surroundings and events. This results in a brief period of confusion once the seizure is over.

PTS: 0 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 376 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

2. A patient with a seizure disorder tells the nurse about training to participate in a marathon run. What is the most important factor for the nurse to teach the patient at this time?
a. Your seizure medications prohibit training for this stressful event.
b. During times of increased physical stress you are more likely to have a seizure.
c. Be sure to watch your diet because during training you will need more calories.
d. Start your exercise program slowly and gradually build up your strength.
ANS: B
A person with a seizure disorder is more likely to have a seizure during times of increased emotional or physical stress (such as training for a marathon). While watching the diet and pacing the exercise program are important, they are not related to the patients seizure disorder. Most antiseizure drugs do not require the patient to avoid exercise.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

3. A patient with a seizure disorder asks the nurse why bright spots are always seen before experiencing a seizure. What is the nurses best response?
a. Some people experience a strange sensation called an aura before each seizure.
b. This is an unusual occurrence. I will notify your prescriber right away.
c. Bright spots before a seizure could indicate pressure in your brain from a tumor.
d. After the seizure do you feel confused, lethargic, and unable to respond to people?
ANS: A
Before a seizure, some people experience an aura, which is a strange sensation. It can be an odor, sound, taste, or visual sensation such as bright spots or flashes. It is a common occurrence and not an indicator of tumors or pressure in the brain. Confusion, lethargy, and an inability to respond are common for the postictal phase of a seizure, but asking about these symptoms does not address the patients question.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

4. Which sign does the nurse expect to see when a patient has an absence seizure?
a. Rigidity of arm and leg muscles
b. Automatisms such as lip smacking
c. Blank staring as if daydreaming
d. One-sided movement of an extremity
ANS: C
Absence (petit mal) seizures are more common in children. They involve a brief (few seconds) loss of consciousness and blank staring. A child may appear to be daydreaming. After the seizure the child returns to normal immediately.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 378 TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity

5. Which two conditions are possible complications of status epilepticus?
a. Blurred vision and ringing in the ears
b. Muscle paralysis and weakness
c. Brain damage and death
d. Asthma and wheezing
ANS: C
Status epilepticus is a prolonged seizure (longer than 30 minutes) or repeated severe seizures that can result in permanent brain damage and death from lack of oxygen to the brain.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 379 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

6. Which action is most important for the nurse to perform for a patient during a simple partial seizure?
a. Administering the prescribed antiseizure drug
b. Timing the duration of the seizure
c. Inserting a padded tongue blade
d. Applying oxygen by mask
ANS: B
A simple, partial seizure does not result in loss of consciousness or respiratory problems. The patient is observed and the duration of the seizure is documented. Administering drugs at this time would not stop the seizure and the attempt could stimulate further seizure activity.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

7. What is the nurses priority intervention for a patient experiencing a tonic-clonic (grand mal) seizure?
a. Place a padded tongue blade in the patients mouth to prevent biting the tongue.
b. Start a saline lock to administer IV anti-seizure medication.
c. Attach pads to the bed side rails to protect the patient from injury.
d. Monitor for and keep the patients airway open.
ANS: D
The priorities for care of a patient experiencing a seizure include maintaining an airway and providing for safety during the seizure. Forcing a padded tongue blade into a patients mouth can damage teeth and lead to aspiration of tooth fragments. Padded side rails are controversial because it is not known if they help maintain safety; they may cause embarrassment to the patient. During a seizure is not the time to place a saline lock.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

8. A pediatric patient is prescribed valproic acid (Depacon) 340 mg intravenously. The available drug solution is 500 mg in 5 mL. How many milliliters does the nurse prepare?
a. 1.4
b. 2.4
c. 3.4
d. 4.4
ANS: C
Ratio and proportion 340 mg/X mL is equal to 500 mg/5 mL, 1700X/500 = 3.4 mL.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

9. A patient who has been prescribed phenytoin (Dilantin) reports gum swelling around the teeth. What is the nurses best action?
a. Tell the patient to document this unexpected change by taking a photograph.
b. Instruct the patient to stop the drug and notify the prescriber immediately.
c. Reassure the patient that this is a common and expected side effect.
d. Remind the patient to brush teeth gently and avoid flossing.
ANS: C
A common side effect of phenytoin is gingival hyperplasia (excessive growth of gum tissue). The change does not cause physical problems or endanger the teeth. Some patients choose to change drug therapy to avoid this effect, but this is a choice and not a requirement.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

10. A patient who has been taking carbamazepine (Tegretol) for 2 months has all of the following blood laboratory results. Which result does the nurse report to the prescriber immediately?
a. White blood cell (WBC) count 2200/mm3
b. Platelet count 300,000/mm3
c. Potassium 3.6 mEq/L
d. Sodium 132 mEq/L
ANS: A
Carbamazepine can suppress bone marrow activity and decrease the number of WBCs. This patients WBC count is much lower than normal (normal range is 5000 to 10,000/mm3), greatly increasing his or her risk for infection. The drug must be discontinued as soon as possible (but not abruptly). The blood sodium level is slightly low as well, but it is not an immediate problem.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

11. Which question is most important for the nurse to ask a patient who is prescribed phenytoin (Dilantin) before administering the first dose?
a. Do you drink coffee or other caffeinated beverages?
b. Have you ever had high blood pressure?
c. How many seizures do you have daily?
d. What other drugs do you take daily?
ANS: D
Phenytoin interacts with many other drugs and changes their activity. When patients who are prescribed phenytoin are also taking other drugs, the dosages of the other drugs may need to be altered, and additional monitoring may be needed.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

12. Which precaution is most important for the nurse to teach a patient who is prescribed any of the first-line drugs for generalized seizures?
a. Avoid drinking alcoholic beverages.
b. Take the drug with food or a snack.
c. Engage in regular exercise daily.
d. See your dentist twice a year.
ANS: A
First-line antiseizure drugs enter the brain and often cause drowsiness and dizziness. This effect is worsened by drinking alcohol, increasing the risk for injury and causing the patient to have reduced cognition. The drugs can be taken with food, but do not have to be. Having regular dental checkups is important, but the priority precaution relates to alcohol avoidance.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

13. What is the priority safety measure for the nurse to implement when a patient has been started on carbamazepine (Tegretol)?
a. Ask the patient about symptoms of nausea and vomiting.
b. Monitor for and manage seizure activity.
c. Assist the patient when getting out of bed.
d. Always give this drug with food.
ANS: C
Carbamazepine is a first-line drug for partial and generalized seizures. These drugs can cause dizziness and drowsiness. The nurse must teach the patient to call for assistance when getting out of bed and ensure that the call light is within easy reach.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

14. A female patient with a seizure disorder who is taking birth control pills is prescribed valproic acid (Depakote). What must the nurse be sure to include in this patients teaching plan?
a. Do not drive a car until you know how this drug will affect you.
b. Be sure to change positions slowly when getting out of bed.
c. Avoid consumption of grapefruit or grapefruit juice.
d. Plan to use another form of contraception.
ANS: D
Female patients of childbearing age should be taught that birth control pills may not work effectively while taking first-line antiseizure drugs. To prevent pregnancy, patients should be taught to use another form of contraception.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Health Promotion and Maintenance

15. A patient who has been prescribed ethosuximide (Zarontin) twice daily (every 12 hours) for absence seizures reports that the morning dose was missed 10 hours ago. What is the nurses best advice?
a. Skip todays second dose as well as the dose you already missed.
b. Take the missed dose now and the regularly scheduled dose in 2 hours.
c. Take the missed dose and the regularly scheduled second dose immediately.
d. Take the regularly scheduled second dose now and forget about the morning dose.
ANS: D
It is important to try to keep to the dosing schedule to maintain blood levels of antiseizure drugs and prevent seizures. However, it has now been 10 hours since the missed dose. Taking it now and also taking the regularly scheduled second dose could cause blood levels to be too high. The missed dose should not be taken at all. The second dose can be taken now or at its regularly scheduled time.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

16. A patient who has been prescribed ethosuximide (Zarontin) tells the nurse about experiencing an upset stomach after each dose of the drug. What is the nurses best action?
a. Administer a dose of an antinausea drug.
b. Instruct the patient to take the drug with a full glass of water.
c. Give the drug with meals or a snack.
d. Elevate the head of the bed to avoid aspiration.
ANS: C
Among the most common side effects of ethosuximide are GI symptoms such as nausea, vomiting, and indigestion. The nurse should give this drug with food or a snack to minimize or prevent these symptoms.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

17. What does the nurse plan to teach a patient who is prescribed ethosuximide (Zarontin) about going out of doors?
a. Move slowly to avoid dizziness.
b. Wear dark glasses when the sun is bright.
c. Be sure to wear long sleeves and a broad-brimmed hat.
d. Apply a strong sunscreen whenever you will be exposed to sunlight.
ANS: B
Ethosuximide can make the eyes more sensitive to light. Instruct patients to protect their eyes by wearing dark glasses when going out into bright light. Ethosuximide does not cause skin photosensitivity.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Safe and Effective Care Environment

18. Which second-line drug for seizures has a risk for dependence?
a. Clonazepam (Klonopin)
b. Phenobarbital (Luminal)
c. Gabapentin (Neurontin)
d. Lamotrigine (Lamictal)
ANS: B
Phenobarbital is a barbiturate drug that is a controlled substance because it can become habit forming, causing drug dependence when used for long periods of time.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 385 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

19. A patient is prescribed lamotrigine for seizure control. The drug received from the pharmacy is Lamisil. What is the nurses best action?
a. Administer the drug as prescribed.
b. Hold the dose and call the pharmacy immediately.
c. Ask the patient whether he or she recognizes the tablet.
d. Notify the prescriber that the usual brand of lamotrigine is not available.
ANS: B
Lamisil is not a brand of lamotrigine; it is an antifungal drug. This drug is easily confused with the Lamictal brand of lamotrigine. The drug should not be given. The pharmacy needs to be informed about the confusion and asked to send the correct drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

20. Which assessment question is most important for the nurse to ask a patient who is prescribed clonazepam (Klonopin) before administering the first dose?
a. Do you smoke cigarettes?
b. How many seizures do you have daily?
c. Have you ever had high blood pressure?
d. Do you currently have an open sore or signs of an infection?
ANS: A
Cigarette smoking decreases the effectiveness of clonazepam. Smoking is not a contraindication; however, higher dosages of the drug may be needed for smokers.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

21. A patient who has been prescribed primidone (Mysoline) also takes warfarin (Coumadin). Which laboratory blood test results indicate to the nurse a possible drug interaction?
a. Hematocrit 32%
b. Hemoglobin 11.2 g/dL
c. Blood urea nitrogen (BUN) 21 mg/dL
d. International normalized ratio (INR) 0.5
ANS: D
Primidone decreases the effectiveness of anticoagulants, including warfarin. Warfarin effectiveness is measured by the INR. This value should be no less than 1.5 in a patient taking warfarin. With an INR level of only 0.5 the patient is at risk for forming clots and having a stroke, heart attack, pulmonary embolism, or deep vein thrombosis.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

22. A patient who is prescribed gabapentin (Neurontin) for seizures is also taking aluminum hydroxide (Amphojel) for indigestion. What does the nurse caution the patient about taking these two drugs?
a. Take the gabapentin one hour after the aluminum hydroxide.
b. Schedule at least 2 hours between taking the gabapentin and the aluminum hydroxide.
c. Take these two drugs together for the best action of both drugs to occur.
d. You may need to take a different antacid to avoid affecting the action of gabapentin.
ANS: B
Antacids interfere with the absorption of gabapentin. At least 2 hours should be scheduled between doses of gabapentin and any antacid.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

23. A patient who is prescribed gabapentin (Neurontin) is also taking morphine sulfate for severe pain. What dosage adjustment does the nurse expect?
a. Decreased dosage of gabapentin
b. Increased dosage of gabapentin
c. Decreased dosage of morphine
d. Increased dosage of morphine
ANS: A
When a patient takes morphine at the same time as gabapentin, the blood level of gabapentin is increased. The nurse should expect that the ordered dose of gabapentin will be decreased.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

MULTIPLE RESPONSE

1. Which factors are among the most common causes of seizures in adults? (Select all that apply.)
a. Emotional distress
b. Head injury
c. Stroke
d. Tumors
e. Lack of sleep
ANS: B, C, D
The single most common cause of seizures is not known. However, for adults the most common causes of seizures include head injury, stroke, and tumors.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 376 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

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