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PrepU Ch 53 Drug Therapy for Seizure Disorders and Spasticity

Terms in this set (36)

A client with a history of partial seizures has been taking lamotrigine for the past several days. The client calls the clinic and reports the development of a facial and torso rash to the nurse. What is the nurse's best action?
a. Recommend that the client take 50 mg diphenhydramine PO and check back tomorrow.
b. Rule out any shortness of breath and inform the client that this adverse effect will resolve with time.
c. Tell the client to take the medication with a high-fat food to minimize adverse effects.
d. Tell the client to take no further doses and come be assessed at the clinic immediately.
d
What should the nurse include as a possible adverse effect when teaching a client about phenytoin?
a. Diarrhea
b. Increased white blood cell count
c. Liver toxicity
d. Physical dependence
c
The nurse is caring for a client who is being discharged home from the rehabilitation unit. Baclofen will be discontinued, and the client will begin taking carisoprodol as an outpatient. What is the nurse's primary consideration when discontinuing the client's baclofen?
a. The client will be prescribed alternate doses of baclofen and carisoprodol over 10 days to prevent symptoms of baclofen withdrawal.
b. Carisoprodol will be administered while continuing baclofen until the carisoprodol level is established.
c. Baclofen must be tapered down over 1 to 2 weeks to prevent psychoses and hallucinations.
d. The client's dose of baclofen should be gradually withdrawn over 4 to 6 weeks to prevent rebound spasticity.
c
A client has been diagnosed with partial seizures and has been prescribed carbamazepine. When providing health education about the safe and effective use of this medication, what should the nurse teach the client?
a. "I'll explain the foods that you should avoid while you're taking this drug."
b. "It's important to take a dose as soon as possible if you feel a seizure is coming."
c. "It's safest if you avoid drinking alcohol while you're taking this drug."
d. "I'll be showing you how to safely self-inject this drug."
c
The nurse has taught a client who is receiving lamotrigine about possible adverse effects. The nurse determines that the client has understood the teaching when the client identifies a need to promptly report what adverse effect?
a. Fatigue
b. Anorexia
c. Rash
d. Signs of upper respiratory infection
c
Which instruction should the nurse specifically stress when administering drugs used for muscle spasm and cramping?
a. Stay upright for 30 minutes after taking the drugs.
b. Avoid alcohol or other CNS depressants.
c. Take the drug with 6 to 8 oz of water.
d. Take the drug with food.
b
The client is taking cyclobenzaprine for muscle spasms secondary to an injury to the lumbar spine that occurred while lifting a motor at work. The client is being seen for a follow-up visit by the health care provider. The client reports dry mouth, blurred vision, and constipation. Why is the client having these side effects from cyclobenzaprine?
a. Cyclobenzaprine has an effect at the neuromuscular junction
b. Cyclobenzaprine is structurally similar to amitriptyline
c. Cyclobenzaprine acts in the peripheral nervous system
d. Cyclobenzaprine produces an anticholinergic response
d
While taking the vital signs of a hospitalized client admitted for seizure control due to epilepsy, the nurse notices a bloody toothbrush on the client's bedside table and scattered bruising over the client's extremities. What is the nurse's best action?
a. Report the findings to the primary health care provider immediately.
b. Notify the charge nurse about reporting suspected physical abuse.
c. Document the findings and offer the client a soft-bristled toothbrush.
d. Tell the client to ask for assistance when ambulating so as to prevent bruising.
a
In a person being treated for a diagnosed seizure disorder, what is the most common cause of status epilepticus?
a. hypoxia-inducing experience
b. abusing drugs and/or alcohol
c. abruptly stopping the antiseizure medications
d. experiencing a brain injury
c
While speaking with a client, the nurse notes that the client stares off, unblinking. The nurse notes that after several prompts, the client blinks rapidly and then resumes normal conversation. This behavior is consistent with what type of seizure?
a. tonic-clonic
b. absence
c. akinetic
d. myoclonic
b
One week ago, a client began taking ethosuximide 500 mg/day PO for the treatment of absence seizures. The client reports gastrointestinal (GI) upset after taking with the drug. What health education should the nurse provide?
a. "Taking over-the-counter antacids before and after the dose helps for some clients."
b. "Contact your health care provider to see if there's an alternative drug that would work for you."
c. "Take the drug 1 hour before or 2 hours after a meal to minimize stomach upset."
d. "Try taking your pills at the same time as you eat some food."
d
The nurse is caring for a client whose current medication regimen includes baclofen 60 mg PO daily. What assessment should the nurse prioritize when assessing for therapeutic effects?
a. Bilateral assessment of muscle strength
b. Comparison of fine motor and gross motor skills
c. Assessment for seizure activity
d. Inspection for muscle spasticity and range of motion assessment
d
What is a common risk for epileptic seizures during late infancy to early childhood?
a. malnutrition
b. learning disability
c. fever
d. medication overdose
c
A client is receiving lamotrigine as treatment for partial seizures. Which assessment finding would lead the nurse to stop the drug immediately?
a. Rash
b. Anorexia
c. Somnolence
d. Confusion
a
A 43-year-old woman was diagnosed with multiple sclerosis 2 years ago and has experienced a recent exacerbation of her symptoms, including muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium). In light of this new addition to her drug regimen, what teaching point should the woman's nurse provide?
a. "We'll need to closely monitor your blood sugar levels for the next week."
b. "This will likely relieve your muscle spasms but you'll probably develop a certain amount of dependence on the drug over time."
c. "There's a small risk that you might experience some hallucinations in the first few days that you begin taking this drug."
d. "You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity."
d
A client in status epilepticus has been brought to the emergency department. The nurse should anticipate which treatment measures?
a. Administration of zonisamide (Zonegran)
b. Administration of oral or sublingual phenytoin
c. Administration of intravenous lorazepam
d. Administration of intravenous gabapentin
c
A nurse who gives care on a neurological floor is working with several clients. Which client should the nurse prioritize for further assessment and possible interventions?
a. A client receiving pregabalin who is not responsive to verbal stimuli
b. A client who will be discharged on carbamazepine and who requires education
c. A client who is anxious about undergoing electroencephalography to investigate a recent absence seizure
d. A client being treated with phenobarbital whose blood pressure is 106/69 mmHg
a
A 56-year-old woman with a diagnosis of multiple sclerosis has begun taking dantrolene. What client teaching should the nurse provide?
a. "Make sure to see your health care provider promptly if you develop yellowish skin or eyes."
b. "Take an over-the-counter laxative so that you don't get constipated."
c. "You'll have to come to the hospital daily to be administered this drug."
d. "You'll find that your muscles will get progressively stronger over the next several weeks."
a
A 29-year-old client who experienced a lower back injury has seen his range of motion decrease and his pain increase over the past several weeks. As a result, he has been prescribed cyclobenzaprine. What nursing diagnosis should the nurse prioritize in light of the client's drug regimen?
a. Risk for Injury related to CNS depression
b. Risk for Ineffective Airway Clearance related to increased secretions and decreased lung function
c. Risk for Impaired Swallowing related to adverse neuromuscular effects
d. Risk for Sexual Dysfunction related to endocrine changes
a
Lorazepam (Ativan) is the drug of choice to be administered to a client with status epilepticus, however its effects last for less than one hour. Which of the following anticonvulsants are given to a client along with lorazepam (Ativan) during status epilepticus? Select all that apply:
a. Ethotoin (Peganone)
b. Zonisamide (Zonegran)
c. Phenytoin (Dilantin)
d. Ethosuximide (Zarontin)
e. Phenobarbital (Luminal)
c, e
A client is to receive ethotoin. The nurse would expect to administer this drug by which route?
a. Oral
b. Rectal
c. Intramuscular
d. Intravenous
a
When describing the action of barbiturates and barbiturate-like agents in the control of seizures, what would the nurse include?
a. Maintenance of cerebellar function
b. Stimulation of the cerebral cortex
c. Promotion of impulse conduction
d. Depression of motor nerve output
d
A 28-year-old client has been experiencing muscle spasms in the neck from a four-wheeler accident. The client is receiving 10 mg of cyclobenzaprine PO tid. The nurse's teaching plan should include which instruction?
a. Take the medication with a small amount of water.
b. Do not drive or operate heavy machinery for the first week.
c. Stop the drug if dizziness occurs.
d. Increase the dosage if necessary.
b
A client is prescribed lamotrigine for control of partial seizures. What is the most important medication teaching information the nurse should emphasize from the plan of care?
a. Take this medication with food to prevent nausea and vomiting.
b. Contact the health care provider immediately if rash appears.
c. Seek assistance when walking if dizziness occurs.
d. A mild headache may occur while taking this medication.
b
The client has a seizure that causes rhythmic twitching of the left hand for 90 seconds with no loss of consciousness and then stops. The nurse notes this same action repeated many times throughout the day and documents this as what type of seizure?
a. simple partial seizure
b. psychomotor seizure
c. myoclonic seizure
d. Jacksonian seizure
a
An older adult resident of a long-term care facility is experiencing muscle spasticity and has just been prescribed a centrally acting skeletal muscle relaxant. The client has comorbidities of early stage Alzheimer's disease and chronic obstructive pulmonary disease (COPD). What nursing action should the nurse prioritize for adding to the client's care plan?
a. Continuous pulse oximetry
b. Seizure precautions
c. Falls prevention measures
d. Deep breathing and coughing exercises
c
A client is receiving carbamazepine therapy and the client's latest serum level of the drug is 13 mcg/mL. What action is most appropriate?
a. Call an emergency code
b. Contact the provider to request a one-time supplementary dose
c. Assess the client's renal function
d. Anticipate a reduction in dosage
d
The nurse is caring for a 15-year-old male who was involved in a motor vehicle accident and, as a result, sustained a closed head injury. The health care provider ordered phenytoin prophylactically to prevent seizures. The nurse understands that phenytoin works by what mechanism?
a. Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus
b. Decreases the calcium available to the cells responsible for electrical activity in the brain
c. Increases the chloride available to promote depolarization of the cells
d. Increases the potassium available to the cell to reduce the repolarization of the cell
a
A nurse is caring for a patient who has been prescribed miscellaneous anticonvulsants containing valproic acid. What method of drug administration should the nurse inform the patient about?
a. Do not chew but swallow the whole tablet to avoid irritation
b. Dissolve the tablet in a glass of water to take the drug
c. Take the drug in small and frequent doses
d. Take the drug orally with meals to avoid an adverse reaction
a
A client, newly diagnosed with a seizure disorder, asks the nurse why the client is receiving a specific drug. What would be the best answer by the nurse?
a. Different drugs are more effective in certain people than other drugs are.
b. Different drugs work differently in different people.
c. When prescribing an AED, the health care provider takes into account the type of seizure the client is having.
d. When prescribing an AED, the health care provider takes into account the age and gender of the client.
c
A nurse is caring for a patient with seizure disorders. The patient has been prescribed phenytoin. Which of the following ongoing assessment activities should a nurse perform during the treatment?
a. Measure regular serum plasma levels of the drug.
b. Measure the pulse rate of the patient.
c. Check for the patient's vital signs every three hours.
d. Measure the respiratory rate of the patient.
a
A client with multiple sclerosis asks the nurse to explain why deep tissue massages do not relieve spasticity. The nurse should explain that spasticity is caused by:
a. nerve damage in the brain and spinal cord, and it is a permanent condition.
b. inflammation of the muscles; therefore, NSAIDs may be effective.
c. skeletal muscle trauma and will improve in time.
d. stimulation of "association areas" in the brain; therefore, only nerve blocks will be effective.
a
A patient with cortical focal seizures has been prescribed phenobarbital. What adverse reaction should the nurse monitor for in the patient?
a. Gingival hyperplasia
b. Ataxia
c. Urticaria
d. CNS depression
d
A client with a complex health history has developed severe spasticity. What aspect of the client's status would contraindicate the safe and effective use of dantrolene ?
a. The client has a history of fatty liver disease.
b. The client has type 2 diabetes and takes oral antihyperglycemics.
c. The client has asthma and occasionally uses an inhaled corticosteroid.
d. The client requires partial assistance with activities of daily living.
a
When reviewing the medical record of a client who is to receive dantrolene, which condition would alert the nurse to the need for close monitoring?
a. The client has an infected surgical wound
b. The client has respiratory depression from opioid analgesia
c. The client is 67 years old
d. The client received a blood transfusion less than 24 hours ago
b
What is the most important teaching from the plan of care, to emphasize, when a client is prescribed a skeletal muscle relaxant?
a. Always take this medication with food to prevent nausea and vomiting.
b. Do not drive or operate machinery until individual drug effects are known.
c. Drink eight to 10 glasses of water daily to prevent constipation.
d. Report increased muscle spasm to the health care provider immediately.
b
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