Chapter 22: Anticonvulsants Nursing School Test Banks

Kee: Pharmacology, 7th Edition

Chapter 22: Anticonvulsants

Test Bank

MULTIPLE CHOICE

1. A client is ordered to receive phenytoin (Dilantin). The clients serum phenytoin level is noted to be 15 mcg/mL. How does the nurse interpret this level?

a.

5 to 10 mcg/mL is subnormal.

b.

8 to 15 mcg/mL is above normal.

c.

10 to 20 mcg/mL is therapeutic.

d.

15 to 30 mcg/mL is toxic.

ANS: C

15 mcg/mL is an appropriate therapeutic level for this medication.

DIF: Cognitive Level: Application REF: p. 317

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A client taking phenytoin (Dilantin) is admitted to the emergency department with a level of 30 mcg/mL. The nurse would evaluate for the severe side effect of:

a.

gingival hyperplasia.

b.

abdominal distention.

c.

abdominal cramps.

d.

hypertension.

ANS: A

Gingival hyperplasia is a common side effect of high phenytoin levels.

DIF: Cognitive Level: Application REF: p. 310

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A client taking anticonvulsants for epilepsy should receive which instruction from the nurse?

a.

The medication is usually taken for a lifetime.

b.

The medication is taken until you are seizure-free.

c.

Seizures are unpredictable, and therefore so is the drug regimen.

d.

Seizure disorders may be cured with anticonvulsants.

ANS: A

Epilepsy usually requires a lifelong regimen of anticonvulsant medications.

DIF: Cognitive Level: Application REF: p. 309

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A nurse is teaching a client about her health plan when taking phenytoin (Dilantin). Which instruction would not be included in the teaching plan?

a.

Avoid use of oral contraceptives.

b.

Assess output daily.

c.

Drink alcoholic beverages sparingly.

d.

Obtain a Medic Alert bracelet.

ANS: A

Female clients using oral contraceptives should switch to a different contraceptive method.

DIF: Cognitive Level: Application REF: pp. 312-313

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A client has been taking phenytoin (Dilantin) for 10 years. This client should be evaluated for:

a.

hypoglycemia.

b.

hyperglycemia.

c.

hypertension.

d.

status epilepticus.

ANS: B

Long-term use of this medication can impair glucose tolerance.

DIF: Cognitive Level: Application REF: pp. 312-313

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A child enters the emergency department. The paramedics report that the child has been having a seizure that has lasted for 45 minutes. In addition to securing and maintaining an airway, what is a priority intervention on the part of the nurse?

a.

Phenobarbital (Luminal)

b.

Diazepam (Valium)

c.

Phenytoin (Dilantin)

d.

Valproic acid (Depakene)

ANS: B

Diazepam IV is the drug of choice with status epilepticus.

DIF: Cognitive Level: Application REF: pp. 314-316

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The client with ________ would not be a candidate for treatment with valproic acid (Depakene).

a.

a liver disorder

b.

cardiac dysfunction

c.

a gastrointestinal tract disorder

d.

a thyroid dysfunction

ANS: A

Valproic acid is known to be hepatotoxic.

DIF: Cognitive Level: Application REF: p. 312

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

8. Gastric irritation may occur when taking ethosuximide (Zarontin). The nurse suggests taking the drug:

a.

before meals.

b.

2 hours after meals.

c.

at bedtime.

d.

at mealtime or immediately after the meal.

ANS: D

Taking the medication with food may decrease gastric irritation.

DIF: Cognitive Level: Application REF: pp. 314-316

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A child is brought to the healthcare providers office. The child has been receiving phenytoin (Dilantin) for seizure activity. The family reports that despite the childs previously reported controlled seizures, the child has been seizing two or three times a day. The nurse would anticipate that the:

a.

childs medication will be changed.

b.

child will be admitted to the hospital.

c.

child will be placed on nasogastric medications.

d.

childs phenytoin level will be drawn.

ANS: D

This is the appropriate action. The case does not give any information to indicate the other three options.

DIF: Cognitive Level: Analysis REF: p. 310

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

10. Which of the following dietary restrictions is indicated with carbamazepine (Tegretol)?

a.

Limit foods high in vitamin K.

b.

Restrict acid-ash foods.

c.

Maintain a high-fiber diet.

d.

Do not drink grapefruit juice.

ANS: D

Grapefruit juice may lead to toxicity with this medication.

DIF: Cognitive Level: Analysis REF: p. 312

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A client with a known seizure disorder is treated with several anticonvulsant medications. The client confides in the nurse, stating that he also has a strong belief in complementary medicine and takes several herbal supplements. Which is an appropriate response by the nurse?

a.

Check with your healthcare provider to ensure that there are no harmful drug interactions.

b.

Most herbal supplements are safe medications with anticonvulsants.

c.

No herbal supplements should be taken with prescription medications.

d.

You need to check the herbal labels to make sure that this is okay.

ANS: A

This is the correct recommendation because several herbs interact with anticonvulsant medications.

DIF: Cognitive Level: Application REF: p. 311

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A client with a new seizure disorder is ordered to receive phenobarbital (Luminal) for seizures. The nurse would expect:

a.

a high body temperature.

b.

hypertension.

c.

lethargy.

d.

decreased urine output.

ANS: C

As a barbiturate, this medication is known for its sedative effect.

DIF: Cognitive Level: Application REF: pp. 311-312

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

13. A client with a known seizure disorder enters the emergency department. The nurse notes that his gums are swollen and bleeding. What is a priority nursing intervention?

a.

Draw a bleeding time.

b.

Assess the clients dental hygiene.

c.

Assess for mucositis.

d.

Draw a phenytoin level.

ANS: D

Swollen and bleeding gums may indicate gingival hyperplasia, a symptom of phenytoin toxicity.

DIF: Cognitive Level: Application REF: p. 311

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

14. A client is ordered to receive an anticonvulsant for seizure activity. Which side effects are most prevalent with clients who take drugs in this class?

a.

Drowsiness and lethargy

b.

Nausea and vomiting

c.

Weight loss and anorexia

d.

Hypertension and tachycardia

ANS: A

As a barbiturate, this medication is known for its sedative effect.

DIF: Cognitive Level: Application REF: p. 311

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

15. A client enters the emergency department in status epilepticus. The nurse anticipates the administration of:

a.

phenobarbital (Luminal).

b.

phenytoin (Dilantin).

c.

valproic acid (Depakene).

d.

diazepam (Valium).

ANS: D

Diazepam (Valium) is the drug of choice for emergent, unrelenting seizures.

DIF: Cognitive Level: Application REF: pp. 314-316

TOP: Nursing Process: Intervention

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

16. A client with a known seizure disorder is being treated with phenytoin (Dilantin). The client becomes pregnant. Which recommendation would be appropriate for the nurse to make?

a.

Contact your healthcare provider right away; you should not take Dilantin while pregnant.

b.

Make certain that your healthcare provider is aware that you are taking Dilantin through the first trimester.

c.

Antiepileptic agents need to be taken during pregnancy to avoid the effect of seizure activity on the fetus.

d.

Dilantin is safe during pregnancy as long as you maintain adequate hydration.

ANS: A

Dilantin is a known teratogen.

DIF: Cognitive Level: Application REF: p. 310

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

17. A client has been receiving phenytoin (Dilantin) for 15 years. The nurse implements which diagnostic test to assess for a common adverse reaction to long-term medication use?

a.

Fasting blood glucose level

b.

Chest x-ray

c.

Voiding cystourethrogram

d.

BUN and creatinine

ANS: A

Hyperglycemia is a known adverse reaction to long-term Dilantin use that may be assessed via a fasting blood glucose measurement.

DIF: Cognitive Level: Application REF: p. 311

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

18. A nurse is providing teaching for a client taking phenytoin (Dilantin). Which client statement indicates a good understanding of the teaching?

a.

Concentrated urine means a life-threatening disorder.

b.

Alcohol is contraindicated with Dilantin.

c.

Dilantin should be taken on an empty stomach.

d.

Dilantin may be discontinued because seizure rebound is uncommon.

ANS: B

Phenytoin should not be ingested with alcohol. The other three options are false statements.

DIF: Cognitive Level: Application REF: p. 311

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

19. The client has been started on phenytoin. He reports experiencing reddish-colored urine. What is the nurses highest priority intervention?

a.

Report this symptom to the physician; this is an adverse reaction.

b.

Instruct the client to stop the medication; this is a life-threatening reaction.

c.

Report this symptom to the physician; this indicates toxicity of the medication.

d.

Instruct the client that this is an expected side effect of the medication.

ANS: D

Phenytoin will cause reddish-brown colored urine.

DIF: Cognitive Level: Application REF: p. 310

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

20. The client has been started on valproic acid. Her level of the medication is drawn and is found to be 60 mcg/mL. The nurse notes that this is a(n) _____ level.

a.

toxic

b.

therapeutic

c.

subnormal

d.

above-normal

ANS: B

60 mcg/mL is a therapeutic level of valproic acid.

DIF: Cognitive Level: Application REF: p. 317

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

21. The client has been started on phenytoin and reports to the nurse that he also takes ginkgo. What is the most accurate response from the nurse?

a.

Ginkgo can decrease the effectiveness of phenytoin.

b.

Ginkgo can increase the effectiveness of phenytoin.

c.

Ginkgo can cause an anaphylactic reaction to phenytoin.

d.

Ginkgo can cause phenytoin to reach a toxic level.

ANS: A

Ginkgo can cause phenytoin to be less effective than normal.

DIF: Cognitive Level: Application REF: p. 311

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

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