Chapter 24: Drugs for Epilepsy

Chapter 24: Drugs for Epilepsy

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. A nurse is reviewing knowledge of the various types of seizures. The nurse is correct to state that signs and symptoms of loss of consciousness, jaw clenching, contraction and relaxation of muscle groups, and periods of cyanosis are most characteristic of what type of seizure disorder?

a.	Tonic-clonic
b.	Petit mal
c.	Myoclonic
d.	Atonic

 

 

ANS:   A

Tonic-clonic seizures, or grand mal, seizures are considered generalized seizures and are manifested by a loss of consciousness, jaw clenching, muscle relaxation alternating with muscle contractions, and periods or cyanosis.

Absence seizures, or petit mal seizures, are characterized by loss of consciousness for a brief period and usually involve eye blinking and staring into space.

Myoclonic seizures consist of sudden contractions that may be limited to one limb or may involve the entire body.

Atonic seizures are characterized by sudden loss of muscle tone.

 

DIF:    Cognitive Level: Comprehension      REF:    p. 219

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

2. A nurse is providing patient education to patients and families who experience seizures. To evaluate their understanding, the nurse asks the group several questions about medications. Which statement from the group best demonstrates an understanding of antiepileptic medication therapy?

a.	All seizure medications can be monitored by drug levels present in the urine.
b.	Maintenance of a seizure frequency chart is essential.
c.	The monitoring period is 10 days for most patients.
d.	Patients can safely drive during the monitoring period.

 

 

ANS:   B

Teaching the patient and family members to maintain a seizure frequency chart is important for evaluating the therapeutic effects of antiepileptic medications.

The effectiveness of antiepileptic medications can be measured by the absence of seizures and by monitoring serum drug levels, not urine levels.

Antiepileptic medications are monitored continually, not just for 10 days.

Patients should be advised to avoid potentially hazardous activities, such as driving, until seizure control has been achieved.

 

DIF:    Cognitive Level: Application             REF:    p. 236

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

3. A nurse is caring for a patient who has been taking phenytoin (Dilantin) for 6 weeks. Upon review of the laboratory results, the nurse notes that the patient’s phenytoin level is 18 mcg/mL. What is the nurse’s best action?

a.	This drug level is subtherapeutic; the nurse should contact the prescriber for a dose increase.
b.	This drug level is in the therapeutic range, therefore no nursing action is required.
c.	The nurse should review the patient’s other medications to determine whether another drug is potentiating the effects of the phenytoin.
d.	This drug level is too high; the nurse should contact the prescriber about reducing the dose.

 

 

ANS:   B

The target serum level for phenytoin is 10 to 20 mcg/mL; this level is well within the normal therapeutic range.

The drug level is not subtherapeutic, therefore contacting the prescriber is not necessary.

There is no need to review the patient’s medications, because the serum drug level is in the therapeutic range.

The drug level is within normal limits.

 

DIF:    Cognitive Level: Application             REF:    p. 224

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. A nurse is administering medications to a patient with a history of seizures and notices that the patient exhibits nystagmus, diplopia, and a serum phenytoin level of 25 mcg/mL. Upon further assessment, the nurse would anticipate which additional clinical finding?

a.	Other signs of phenytoin toxicity
b.	Signs of an impending seizure
c.	Stevens-Johnson syndrome
d.	Gingival hyperplasia

 

 

ANS:   A

A phenytoin plasma level above 20 mcg/mL may cause the patient to manifest nystagmus and diplopia, as well as other signs of toxicity. This level is toxic; the normal level is 10 to 20 mcg/mL.

Nystagmus and diplopia are not indications of an impending seizure.

No evidence suggests that Stevens-Johnson syndrome is a factor.

Gingival hyperplasia is not a result of toxicity, but rather an expected effect in about 20% of patients given phenytoin.

 

DIF:    Cognitive Level: Application             REF:    p. 224

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies