Charter College, Anchorage - NURSING NU1005

Chapter 25: Drug Therapy for Seizures

Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition

MULTIPLE CHOICE

BASIC CONCEPTS

1)Which type of seizure has a sudden loss of muscle tone for a few seconds followed by confusion?

1. 1. Partial seizures
   2. Atonic seizures
   3. Myoclonic seizures
   4. Tonic-clonic seizures

2. What is another term for seizure disorder?
   1. Epilepsy
   2. Enkephalin
   3. Narcolepsy
   4. Neuropathy

3. Which health problem is the most serious possible side effect for status epilepticus?
   1. Ruptured spinal disks
   2. Brain tumor
   3. Broken bones
   4. Brain damage

4. Which first-line antiseizure drug can only be given by the oral route?
   1. Gatifloxacin (Tequin)
   2. Phenytoin (Dilantin)
   3. Carbamazepine (Tegretol)
   4. Valproic acid (Depakote)

5. Which organs can be badly damaged by valproic acid (Depakote)?
   1. Eyes and ears
   2. Skeletal muscles
   3. Liver and pancreas
   4. Brain and spinal cord

6. Which side effect of phenytoin (Dilantin) commonly occurs among children taking the drug?
   1. Delayed bone growth
   2. Darkening of the eyes
   3. Thickening of the eyelashes
   4. Thickening of the gum tissues

7. Which side effect is most common among people taking first-line drugs for absence seizures?
   1. Weight loss
   2. Weight gain
   3. Low blood pressure
   4. High blood pressure

8. Which second-line drug for seizure control has a potential for physical dependence?
   1. Terbinafine (Lamisil)
   2. Primidone (Mysoline)
   3. Lamotrigine (Lamictal)
   4. Phenobarbital (Luminal)

9. Which two conditions are possible complications of status epilepticus?
   1. Blurred vision and ringing in the ears
   2. Muscle paralysis and weakness
   3. Brain damage and death
   4. Asthma and wheezing

10. Which antiseizure drug increases the availability of the neurotransmitter gamma-aminobutyric acid (GABA)?
    1. Phenobarbital (Luminal)
    2. Carbamazepine (Tegretol)
    3. Valproic acid (Depakote)
    4. Phenytoin (Dilantin)

ADVANCED CONCEPTS

11. Which temporary condition is considered a brief but expected response immediately after an individual has a seizure?
    1. Residual muscle twitches
    2. Low blood pressure
    3. Unconsciousness
    4. Confusion

12. A patient with a seizure disorder tells you about training to participate in a marathon run. What is the most important factor to teach the patient at this time?
    1. “Your seizure medications prohibit training for this stressful event.”
    2. “During times of increased physical stress you are more likely to have a seizure.”
    3. “Be sure to watch your diet because during training you will need more calories.”
    4. “Start your exercise program slowly and gradually build up your strength.”

13. A patient with a seizure disorder asks why bright spots are always seen before experiencing a seizure. What is your best response?
    1. “Some people experience a strange sensation called an aura before each seizure.”
    2. “This is an unusual occurrence. I will notify your prescriber right away.”
    3. “Bright spots before a seizure could indicate pressure in your brain from a tumor.”
    4. “After the seizure do you feel confused, lethargic, and unable to respond to people?”

14. Which sign should you expect to see when a patient has an absence seizure?
    1. Rigidity of arm and leg muscles
    2. Automatisms such as lip smacking
    3. Blank staring as if daydreaming
    4. One-sided movement of an extremity

15. Which action is most important to perform for a patient during a simple partial seizure?
    1. Administering the prescribed antiseizure drug
    2. Record timing the duration of the seizure
    3. Inserting a padded tongue blade
    4. Applying oxygen by mask

16. What is the priority intervention for a patient experiencing a tonic-clonic (grand mal) seizure?
    1. Place a padded tongue blade in the patient’s mouth to prevent biting the tongue.

1. 2. Start a saline lock to administer IV antiseizure medication.
   3. Attach pads to the bedside rails to protect the patient from injury.
   4. Monitor for and keep the patient’s airway open.

17. A pediatric patient is prescribed valproic acid (Depacon) 340 mg intravenously. The available drug solution is 500 mg in 5 mL. How many milliliters should you give?

a.   1.4

b.   2.4

c.   3.4

d.   4.4

18. A patient who has been prescribed phenytoin (Dilantin) reports gum swelling around the teeth. What is your best action?
    1. Tell the patient to document this unexpected change by taking a photograph.
    2. Instruct the patient to stop the drug and notify the prescriber immediately.
    3. Teach the patient to visit the dentist regularly and brush and flow carefully.
    4. Remind the patient to clean teeth gently with dental swabs and avoid flossing.

19. A patient who has been taking carbamazepine (Tegretol) for 2 months has all of the following blood laboratory results. Which result should you report to the prescriber immediately?
    1. White blood cell (WBC) count 2200/mm³
    2. Platelet count 300,000/mm³
    3. Potassium 3.6 mEq/L
    4. Sodium 132 mEq/L

20. Which question is most important to ask a patient who is prescribed phenytoin (Dilantin) before?
    1. “Do you drink coffee or other caffeinated beverages?”
    2. “Have you ever had high blood pressure?”
    3. “How many seizures do you have daily?”
    4. “What other drugs do you take daily?”

21. Which precaution is most important to teach a patient who is prescribed any of the first-line drugs for generalized seizures?
    1. “Avoid drinking alcoholic beverages.”
    2. “Take the drug with food or a snack.”
    3. “Engage in regular exercise daily.”
    4. “See your dentist twice a year.”

22. What is the priority safety measure to implement when a patient has been started on carbamazepine (Tegretol)?
    1. Ask the patient about symptoms of nausea/vomiting.
    2. Monitor for and manage seizure activity.
    3. Assist the patient when getting out of bed.
    4. Always give this drug with food.

23. A patient is prescribed clonazepam (Klonopin). Which adverse effect will you monitor for after giving this drug?
    1. Respiratory depression
    2. Stevens-Johnson syndrome
    3. Angioedema
    4. Epidermal necrolysis

24. What is an important teaching point for an older patient prescribed primidone (Mysoline)?
    1. This drug may cause very high fevers.
    2. You may develop a severe rash with this drug.
    3. Your ankles are likely to swell while you are taking this drug.
    4. Primidone can cause development of unusual restlessness and excitement.

25. A female patient with a seizure disorder who is prescribed valproic acid (Depakote) tells you she wants to have a child. What must be included when teaching this patient?
    1. “This drug is safe to use while breastfeeding.”
    2. “Valproic acid should be used to prevent seizures during pregnancy.”
    3. “This drug may interfere with the ability to become pregnant.”
    4. “This drug should be avoided during pregnancy.”

26. 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 your best advice?
    1. “Skip today’s second dose as well as the dose you already missed.”
    2. “Take the missed dose now and the regularly scheduled dose in 2 hours.”
    3. “Take the missed dose and the regularly scheduled second dose immediately.”
    4. “Take the regularly scheduled second dose now and forget about the morning dose.”

27. A patient who has been prescribed ethosuximide (Zarontin) tells you about experiencing an upset stomach after each dose of the drug. What is your best action?
    1. Administer a dose of an antinausea drug.
    2. Instruct the patient to take the drug with a full glass of water.
    3. Give the drug with meals or a snack.
    4. Elevate the head of the bed to avoid aspiration.

28. What should you teach a patient who is prescribed ethosuximide (Zarontin) about spending time outdoors?
    1. Move slowly to avoid dizziness.
    2. Wear dark glasses when the sun is bright.
    3. Be sure to wear long sleeves and a broad-brimmed hat.
    4. Apply a strong sunscreen whenever you will be exposed to sunlight.

29. A patient is prescribed lamotrigine for seizure control. The drug received from the pharmacy is Lamisil. What is your best action?
    1. Administer the drug as prescribed.
    2. Hold the dose and call the pharmacy immediately.
    3. Ask the patient whether he or she recognizes the tablet.
    4. Notify the prescriber that the usual brand of lamotrigine is not available.

30. Which assessment question is most important to ask a patient who is prescribed clonazepam (Klonopin) before administering the first dose?
    1. “Do you smoke cigarettes?”
    2. “How many seizures do you have daily?”
    3. “Have you ever had high blood pressure?”
    4. “Do you currently have an open sore or signs of an infection?”

31. A patient who has been prescribed primidone (Mysoline) also takes warfarin (Coumadin). Which laboratory blood test results indicate a possible drug interaction?
    1. Hematocrit 32%
    2. Hemoglobin 11.2 g/dL
    3. Blood urea nitrogen (BUN) 21 mg/dL
    4. International normalized ratio (INR) 0.5

32. A patient who is prescribed gabapentin (Neurontin) for seizures is also taking aluminum hydroxide (Amphojel) for indigestion. What should you caution the patient about taking these two drugs?
    1. “Take the gabapentin 1 hour after the aluminum hydroxide.”
    2. “Schedule at least 2 hours between taking the gabapentin and the aluminum hydroxide.”
    3. “Take these two drugs together for the best action of both drugs to occur.”
    4. “You may need to take a different antacid to avoid affecting the action of gabapentin.”

33. A patient who is prescribed gabapentin (Neurontin) is also taking morphine sulfate for severe pain. What dosage adjustment should you expect?
    1. Decreased dosage of gabapentin
    2. Increased dosage of gabapentin
    3. Decreased dosage of morphine
    4. Increased dosage of morphine

34. A patient is having a prolonged seizure lasting more than 30 minutes. Which drug should you be prepared to administer?
    1. Diazepam (Valium) 5 to 10 mg slow IV push

1. 2. Carbamazepine (Tegretol) 1600 orally as a loading dose
   3. Phenytoin (Dilantin) 15 mg/kg orally as a loading dose
   4. Valproic acid (Depacon IV) 25 mg/kg slow IV push

35. A patient prescribed an antiseizure drug tells you that his favorite morning drink is grapefruit juice. What is your best action?
    1. Call the diet kitchen to order grapefruit juice with the patient’s breakfast tray.
    2. Ask the patient if he would like to have grapefruit juice added to his dinner tray.
    3. Instruct the patient to drink at least 8 ounces of water with each glass of grapefruit juice.
    4. Teach the patient to avoid grapefruit juice because it can increase the effects of these drugs.

36. You are removing an IV catheter from a patient prescribed carbamazepine (Tegretol). What safety technique will you apply while completing this procedure?
    1. Place a 2 by 2 dressing over the site with extra tape.
    2. Hold pressure on the IV site for at least a minute or until the bleeding stops.
    3. Ask the patient to hold pressure over the IV site for at least 30 seconds.
    4. Put a Band-Aid over the site after to catheter is removed to prevent infection.

37. A newly admitted patient with a seizure disorder is prescribed phenytoin (Dilantin) 100 mg orally every 8 hours and phenobarbital (Luminal) 300 mg orally daily. What is your best action?
    1. Remind the prescriber that these two drugs are both types of antiseizure medication.
    2. Ensure that the phenobarbital is given as early as possible in the morning.
    3. Separate the administration of the two drugs by at least 6 hours.
    4. Administer the drugs as prescribed.

38. A 13-year-old boy who has a seizure disorder has grown 6 inches and gained 30 lb in the past 8 months. How do you expect these physical changes to affect his antiseizure drug therapy?
    1. No change will be needed.
    2. The dosage of the antiseizure drugs will probably need to be decreased.
    3. The dosage of the antiseizure drugs will probably need to be increased.
    4. The antiseizure drugs can be discontinued because it is likely he has outgrown the disorder.

39. Which supplement is needed when a pregnant woman with a seizure disorder is prescribed to take lamotrigine (Lamictal)?
    1. Ascorbic acid
    2. Folic acid
    3. Citric acid
    4. Nicotinic acid

40. What is the most important action or assessment to perform after giving a patient the first dose of any antiseizure drug?
    1. Check for gingival hyperplasia.
    2. Assess any IV sites and skin areas for bleeding.
    3. Check the patient’s level of consciousness.
    4. Assess the patient’s deep tendon reflexes.

41. How does carbamazepine (Tegretol) work to decrease seizure activity?
    1. Increasing the amount of the neurotransmitter gamma-aminobutyric acid (GABA) present in the brain
    2. Decreasing the amount of the neurotransmitter gamma-aminobutyric acid (GABA) present in the brain
    3. Slowing electrical impulse conduction in the brain by altering sodium channels
    4. Slowing electrical impulse conduction in the brain by altering calcium channels

42. Which precaution should you teach patients prescribed carbamazepine (Tegretol)?
    1. Avoid crowds and people who are ill.
    2. Take this drug with an antacid to prevent ulcers.
    3. Restrict your fluid intake to less than 1.5 L daily.
    4. Keep the bottle containing the drug in the refrigerator.

43. A patient who has a seizure disorder and is prescribed valproic acid (Depakote) calls to report that she has been vomiting for 24 hours. What should you advise?
    1. Take the next dose of Depakote with an antacid.
    2. Go to the nearest emergency department to receive the Depakote parenterally.
    3. Take any missed doses and the regularly scheduled doses as soon as the vomiting subsides.
    4. Rather than swallowing the next drug dose, place the tablet under the tongue and let it dissolve.

MULTIPLE RESPONSE

ADVANCED CONCEPTS

1. Which factors are among the most common causes of seizures in adults? (select all that apply)