Adams4e Tif Ch15

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/EChapter 15Question 1Type: MCSA

The patient says to the nurse, "My doctor said I have epilepsy and need to take medicine for those seizures I had. Do I really need medicine?" What is the best response by the nurse?

1. "Having epilepsy is the same as having a mental illness; the medications are very similar."

2. "You will need medicine for a little while to cure the seizures."

3. "You might not need medicine; you may be controlled by a ketogenic diet."

4. "Yes, you need to take medication on a continual basis to control the seizures."

Correct Answer: 4

Rationale 1: Epilepsy is a disease where seizures occur on a chronic basis. Once seizures are controlled, patients are continued indefinitely on the antiseizure drug. Epilepsy and associated seizures are not curable with medications. The ketogenic diet is used when seizures cannot be controlled through pharmacotherapy, or when there are unacceptable side effects to the medications. Epilepsy is not a mental illness, although some of the same medications are used to control symptoms of both disorders.




Global Rationale:

Cognitive Level: Applying

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 15-1

Question 2Type: MCMA

The nurse is teaching a class for patients who have been recently diagnosed with epilepsy. The nurse determines that learning has occurred when the patients make which statements?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. "Excessive stress levels cause disruptions in how the brain receives oxygen, leading to epilepsy."

2. "Epilepsy may be caused by a head injury."

3. "Eating disorders, like anorexia nervosa, increase the risk for developing epilepsy."

4. "A stroke, or brain attack, could increase the risk for developing epilepsy."

5. "With some cases of epilepsy, the cause is never determined."

Correct Answer: 2,4,5

Rationale 1: Epilepsy is a disorder where seizures occur on a chronic basis. Head trauma is a known cause of seizures. In some cases, the exact etiology may not be identified. Changes in cerebral perfusion such as hypotension, strokes or brain attacks, and shock may be causes of seizures. There is no known correlation with anorexia nervosa and the development of epilepsy. Excessive levels of stress cannot disrupt cerebral oxygen to the extent that epilepsy would occur.

Rationale 2: Epilepsy is a disorder where seizures occur on a chronic basis. Head trauma is a known cause of seizures. In some cases, the exact etiology may not be identified. Changes in cerebral perfusion such as hypotension; strokes, or brain attacks; and shock may be causes of seizures. There is no known correlation with anorexia nervosa and the development of epilepsy. Excessive levels of stress cannot disrupt cerebral oxygen to the extent that epilepsy would occur.


Rationale 4: Epilepsy is a disorder where seizures occur on a chronic basis. Head trauma is a known cause of seizures. In some cases, the exact etiology may not be identified. Changes in cerebral perfusion such as Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

hypotension; strokes, or brain attacks; and shock may be causes of seizures. There is no known correlation with anorexia nervosa and the development of epilepsy. Excessive levels of stress cannot disrupt cerebral oxygen to the extent that epilepsy would occur.


Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 15-2

Question 3Type: MCSA

A parent says to the nurse, "The doctor prescribed ethosuximide (Zarontin) for my child, who has absence seizures. What does this mean?" What is the best response by the nurse?

1. "Absence seizures are basically the same kind of seizures as grand mal, but they are less frequent."

2. "Your daughter's seizures manifest as a staring into space for a few seconds. Ethosuximide (Zarontin) is a good medication for this type of seizure."

3. "Explaining the types of seizure activity is complicated. Have you spoken to your doctor about it?"

4. "Are you sure your doctor prescribed ethosuximide (Zarontin)? Phenobarbital (Luminal) is used much more frequently with children."

Correct Answer: 2

Rationale 1: Absence seizures, formerly known as petit mal, last a few seconds and are seen most often in children. Ethosuximide (Zarontin) is a drug of choice for this type of seizure disorder. Grand mal, or tonic-clonic, seizures are different from absence or petite mal seizures; they are different forms of epilepsy. Ethosuximide (Zarontin), not phenobarbital (Luminal), is the drug of choice for absence seizures. It is the responsibility of the RN to educate the patient, not just refer questions to the physician.

Rationale 2: Absence seizures, formerly known as petit mal, last a few seconds and are seen most often in children. Ethosuximide (Zarontin) is a drug of choice for this type of seizure disorder. Grand mal, or tonic-clonic, seizures are different from absence or petite mal seizures; they are different forms of epilepsy. Ethosuximide (Zarontin), not phenobarbital (Luminal), is the drug of choice for absence seizures. It is the responsibility of the RN to educate the patient, not just refer questions to the physician.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.



Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 15-3


The patient has epilepsy and receives phenytoin (Dilantin). The patient has been seizure-free, and asks the nurse why he still needs blood tests when he is not having seizures. What is the best response by the nurse?

1. "Because phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose."

2. "Because phenytoin (Dilantin) can cause blood-thinning in some patients."

3. "Because phenytoin (Dilantin) can cause Stevens-Johnson syndrome, which will show up in the blood tests."

4. "Because phenytoin (Dilantin) can deplete your system of potassium."

Correct Answer: 1

Rationale 1: Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose; blood levels must be monitored to ensure a therapeutic level and to prevent toxicity. There isn't any evidence to support that phenytoin (Dilantin) causes potassium depletion. Stevens-Johnson Syndrome is a severe skin reaction that can be an adverse outcome with phenytoin (Dilantin), but it is monitored by skin assessment, not blood tests. Phenytoin (Dilantin) is not an anticoagulant, and does not cause thinning of the blood.

Rationale 2: Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose; blood levels must be monitored to ensure a therapeutic level and to prevent toxicity. There isn't any evidence to support that phenytoin (Dilantin) causes potassium depletion. Stevens-Johnson Syndrome is a severe skin reaction that can be an adverse outcome with phenytoin (Dilantin), but it is monitored by skin assessment, not blood tests. Phenytoin (Dilantin) is not an anticoagulant, and does not cause thinning of the blood.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.



Global Rationale:



The nurse has been conducting medication education for a patient with epilepsy. What is the best outcome for this patient?

1. The patient will recognize that the antiseizure medication must be continued indefinitely.

2. The patient will recognize the need to be on a tyramine-free diet while on antiseizure medications.

3. The patient will recognize the need to be on a ketogenic diet in combination with antiseizure medications.

4. The patient will recognize the need to be on antiseizure medication for one year after the last seizure.

Correct Answer: 1

Rationale 1: Once seizures have been controlled, patients are continued indefinitely on the antiseizure drug. In general, withdrawal of antiseizure drugs should only be attempted after at least 3 years of being seizure free. A ketogenic diet is indicated when seizures cannot be controlled through pharmacotherapy or when there are unacceptable side effects to the medications. A tyramine-free diet is indicated for patients receiving monoamine oxidase inhibitor medications.

Rationale 2: Once seizures have been controlled, patients are continued indefinitely on the antiseizure drug. In general, withdrawal of antiseizure drugs should only be attempted after at least 3 years of being seizure free. A ketogenic diet is indicated when seizures cannot be controlled through pharmacotherapy or when there are unacceptable side effects to the medications. A tyramine-free diet is indicated for patients receiving monoamine oxidase inhibitor medications.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.



Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 15-5


The physician has ordered intravenous (IV) diazepam (Valium) for the patient in status epilepticus. During administration, which assessment by the nurse is most important?

1. Assessing respirations every 5 to 15 minutes

2. Assessing level of consciousness

3. Assessing pulse for bradycardia

4. Assessing blood pressure for hypertension

Correct Answer: 1

Rationale 1: Respiratory depression is common when diazepam is given intravenously (IV). Respiratory assessment is the priority. Although hypotension is an effect of intravenous diazepam (Valium), it is not the top priority. Although tachycardia is an effect of intravenous diazepam (Valium), it is not the top priority. Assessing respirations is a higher priority than assessing the level of consciousness.





Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 15-6


The physician has ordered intravenous (IV) phenytoin (Dilantin). The nurse does not read the drug label and administers the medication intramuscularly (IM). What is the most likely response in the patient?

1. Local tissue damage following extravasation will most likely occur.

2. A phenomenon known as purple gluteus syndrome will most likely occur.

3. A marked decrease in serum glucose levels will most likely occur.

4. Nothing adverse, the medication may be administered intravenously (IV) or intramuscularly (IM).

Correct Answer: 1

Rationale 1: Phenytoin (Dilantin) injectable is a soft-tissue irritant that causes local tissue damage following extravasation. It should not be administered intramuscularly, but should be given intravenously into a large vein or via a central catheter. There isn't any such thing as purple gluteus syndrome; purple glove syndrome occurs when phenytoin (Dilantin) is administered in a hand vein, and causes a serious local vasoconstrictive response. Phenytoin (Dilantin) causes an increase in serum glucose.





Global Rationale:



The physician has ordered intravenous phenytoin (Dilantin). The patient is also receiving 5% dextrose in water (D5W) intravenously (IV). What will the nurse plan to do before administering this medication?



1. Use a large vein for the infusion.

2. Use an intravenous (IV) line with a filter.

3. Flush the intravenous (IV) line with saline.

4. Monitor the patient for hypertension.

5. Monitor the patient for Stevens-Johnson Syndrome.


Rationale 1: Intravenous lines of 5% dextrose in water (D5W) must be flushed with saline, as traces of dextrose can cause microscopic precipitate formations that become emboli, if infused. An intravenous filter will trap any precipitate that occurs. Phenytoin (Dilantin) is a soft-tissue irritant that will cause local tissue damage if extravasation occurs, so a large vein must be used for infusion. Patients receiving phenytoin (Dilantin) are at risk


for hypotension, not hypertension. Stevens-Johnson syndrome is a side effect of phenytoin (Dilantin), but it takes days to occur.

Rationale 2: Intravenous lines of 5% dextrose in water (D5W) must be flushed with saline, as traces of dextrose can cause microscopic precipitate formations that become emboli, if infused. An intravenous filter will trap any precipitate that occurs. Phenytoin (Dilantin) is a soft-tissue irritant that will cause local tissue damage if extravasation occurs, so a large vein must be used for infusion. Patients receiving phenytoin (Dilantin) are at risk for hypotension, not hypertension. Stevens-Johnson syndrome is a side effect of phenytoin (Dilantin), but it takes days to occur.




Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 15-8


The patient is receiving valproic acid (Depakene) for treatment of seizures. The patient has also been taking a daily 81 mg aspirin tablet prophylactically for a cardiac condition. What would the nurse be most likely to observe?

1. An increase in seizure activityAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

2. Stevens-Johnson syndrome

3. Migraine headaches and generalized irritability

4. Bleeding from the gums and bruising of the skin

Correct Answer: 4

Rationale 1: Valproic acid (Depakene) can prolong bleeding time; concomitant aspirin use can cause severe bleeding. Increased seizure activity is not associated with valproic acid (Depakene) and aspirin use. Stevens-Johnson syndrome is a side effect of valproic acid (Depakene); its occurrence is not increased with concomitant aspirin use. Migraine headaches and generalized irritability do not result from valproic acid (Depakene) and aspirin use.




Global Rationale:



The patient is receiving Phenobarbital (Luminal) for control of seizures. The patient tells the nurse she plans to become pregnant. What is the best response of the nurse?

1. "Your medication dose will need to be decreased during your pregnancy."Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

2. "Please talk to your doctor; this drug is contraindicated in pregnancy."

3. "Your medication dose will need to be increased during your pregnancy."

4. "Please talk to your doctor; you will need a safer drug like valproic acid (Depakene)."

Correct Answer: 2

Rationale 1: Phenobarbital (Luminal) falls under Pregnancy Category D, and is contraindicated in pregnancy. The medication does not need to be increased; it might need to be stopped. The medication does not need to be decreased; it might need to be stopped. Valproic acid (Depakene) is also a Pregnancy Category D drug and is contraindicated during pregnancy.




Global Rationale:



The patient tells the nurse that she has been taking phenytoin (Dilantin) for 2 years now and is still having too many side effects. She wants to stop taking it. What is the best response by the nurse?

1. "Please do not stop the medication abruptly, as you will have withdrawal seizures."

2. "Side effects are a problem, but they are not as bad as the seizures you were having."

3. "This is the best medication for you; we can add another medication to decrease side effects."Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

4. "You have probably been on the medication long enough; I'll let your doctor know you are stopping it."

Correct Answer: 1

Rationale 1: Seizures are likely to occur with abrupt withdrawal of antiseizure medication. The medication must be withdrawn over a period of 6 to 12 weeks. There is no other medication that can be added to decrease the side effects associated with phenytoin (Dilantin). The nurse does not know if the patient has been on the medication long enough, and the patient must be informed of the consequences of abruptly stopping the medication. Telling a patient that medication side effects are not as bad as seizures is an inappropriate and non-therapeutic response that does not address the patient's concerns.




Global Rationale:



The physician has prescribed phenytoin (Dilantin) for a patient with type 1 diabetes mellitus. What does the nurse include in the plan of care for this patient?

1. Plan to discuss with the physician the need to decrease the patient's insulin based on serum glucose levels.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

2. Plan to discuss with the physician the need to increase the patient's insulin based on serum glucose levels.

3. Plan to assess the patient for petechiae, epistaxis, and hematuria.

4. Plan to institute safety precautions, as the patient is at risk for dizziness and ataxia.

Correct Answer: 2

Rationale 1: Phenytoin (Dilantin) can increase serum glucose levels and the patient may need additional insulin. All patients receiving phenytoin (Dilantin) are at risk for dizziness and ataxia; this is not specific to the patient with type 1 diabetes mellitus. All patients receiving phenytoin (Dilantin) are at risk for petechiae, epistaxis, and hematuria; this is not specific to the patient with type 1 diabetes mellitus. Phenytoin (Dilantin) can increase serum glucose levels, not decrease them.


Rationale 3: Phenytoin (Dilantin) can increase serum glucose levels and the patient may need additional insulin. All patients receiving phenytoin (Dilantin) are at risk for dizziness and ataxia; this is not specific to the patient with diabetes mellitus, type 1. All patients receiving phenytoin (Dilantin) are at risk for petechiae, epistaxis, and hematuria; this is not specific to the patient with type 1 diabetes mellitus. Phenytoin (Dilantin) can increase serum glucose levels, not decrease them.


Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 15-6


The young child has absence seizures. The physician has prescribed valproic acid (Depakene) syrup. The nurse has completed medication education with the child's mother and determines that learning has occurred when the mother makes which statement?


1. "I should not mix this with carbonated beverages."

2. "If my child gets a headache from this, I can administer a baby aspirin."

3. "I can still give the clonazepam (Klonopin) prescribed by the psychiatrist for sleep."

4. "I can give this on a full stomach or an empty stomach."

Correct Answer: 1

Rationale 1: Mixing valproic acid (Depakene) syrup with carbonated beverages will trigger immediate release of the drug, which causes severe mouth and throat irritation. Valproic acid (Depakene) is a gastrointestinal (GI) irritant and should be given with food. Aspirin can increase valproic acid (Depakene) toxicity, and aspirin should not be given to children because of Reye syndrome. Clonazepam (Klonopin) given with valproic acid (Depakene) can induce absence seizures.




Global Rationale:



The patient is receiving phenobarbital (Luminal) for seizure control. The patient asks the nurse how this little pill can stop his seizures. What is the best response by the nurse?Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

1. "Phenobarbital (Luminal) stops your seizures by decreasing the calcium in your brain which is responsible for the seizures."

2. "Phenobarbital (Luminal) stops your seizures by increasing a chemical called glutamate that calms down the excitability in your brain."

3. "Phenobarbital (Luminal) stops your seizures by decreasing the sodium in your brain which is responsible for the seizures."

4. "Phenobarbital (Luminal) stops your seizures by increasing a chemical called GABA that calms down the excitability in your brain."

Correct Answer: 4

Rationale 1: Phenobarbital (Luminal) acts biochemically in the brain by enhancing the action of the neurotransmitter GABA, which is responsible for suppressing abnormal neuronal discharges that can cause epilepsy. Glutamate is the primary excitatory neurotransmitter in the brain; enhancing this neurotransmitter will increase the likelihood of seizures. Hydantoins and phenytoin-like drugs, not phenobarbital (Luminal), suppress sodium influx. Succinimides, not phenobarbital (Luminal), suppress calcium influx.




Global Rationale:


Question 15


Type: MCSA

The elderly patient is taking phenobarbital (Luminal) for seizure control. What is most important for the nurse to assess in the patient?

1. Fluid intake

2. Electrolyte balance

3. Respiratory function

4. Nutritional status

Correct Answer: 3

Rationale 1: Elderly patients are at risk for cumulative effects of barbiturates due to diminished hepatic and renal function. Central nervous system (CNS) depression can lead to suppression of respiratory function. Nutritional status is important with elderly patients, but is not the primary concern. Fluid intake is often decreased in elderly patients, but is not a side effect of barbiturates. Barbiturates do not affect electrolyte balance.




Global Rationale:



Identify the correct statement regarding seizures.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

1. Convulsions are a symptom of the underlying seizure disorder.

2. Seizures can be caused by bacterial infections of the nervous system.

3. Epilepsy is an acute disorder characterized by non-convulsive seizures.

4. All seizures are convulsions, but not all convulsions are seizures.

Correct Answer: 2

Rationale 1: Several things, including bacterial infections, can cause seizures. All convulsions are seizures, but not all seizures are convulsions. Convulsions are a type of seizure, and seizures are a symptom of an underlying disorder. Epilepsy is generally chronic, and can present with convulsive seizures.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 15-1 and 15-2


A person who stops talking mid-sentence and has a blank stare for 5 seconds would most likely be experiencing

1. a partial seizure.

2. a grand mal seizure.

3. a petit mal seizure.

4. A convulsion.


Correct Answer: 3

Rationale 1: The symptoms presented indicate a general (absence) or petit mal seizure.



Rationale 4: the symptoms presented indicate a general (absence) or petit mal seizure.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 15-3


Vitamin D deficiency would most likely be seen in a patient with seizures who is being treated with which drug type?

1. Phenytoin-like agents

2. Benzodiazepines

3. Barbiturates

4. Hydantoins

Correct Answer: 3

Rationale 1: Barbiturates can cause a vitamin D deficiency.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 15-6


A low-income patient without insurance has been prescribed several different medications over several months for seizure control without any improvement. The patient indicates she has not experienced any adverse effects. At this point the nurse should

1. recommend nontypical drug use.

2. inform the patient that it might take years for the medications to work.

3. assess for medication compliance.

4. advise the patient to double the current dose.

Correct Answer: 3

Rationale 1: Due to the financial situation presented and absence of any side effects, it is possible the patient is not in compliance. The nurse should assess for this possibility at this point. Another drug might be indicated, but compliance should be assessed first. It generally doesn't take years for seizure medications to work. Changing the prescribed dose of a medication is not within the scope of practice of the nurse.




Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 15-5Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.


Which of the following adverse effects would most likely be associated with the use of phenytoin (Dilantin)?

1. Vitamin B deficiency

2. Leg edema

3. Bleeding

4. Hypoglycemia

Correct Answer: 3

Rationale 1: Dilantin affects the metabolism of vitamin K, which can lead to blood dyscrasias. Hyperglycemia is more common than hypoglycemia, and leg edema is not generally experienced as an adverse effect.




Global Rationale:

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 15-6


A drug that is used to treat petit mal seizures but not tonic-clonic seizures and works by decreasing neuronal activity in the motor cortex is

1. diazepam (Valium).

2. valproic acid (Depakote).


3. phenytoin (Dilantin).

4. ethosuximide (Zarontin).

Correct Answer: 4

Rationale 1: Succinimides like Zarontin use indicated for petit mal seizures, but not for tonic-clonic seizures. Depakote, Valium, and Dilantin can be effective for tonic-clonic seizures.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 15-7


Which of the following seizure drugs is most likely to be administered IV and result in soft tissue damage following extravasation?

1. Phenobarbital (Luminal)

2. Phenytoin (Dilantin)

3. Ethosuximide (Zarontin)

4. Clonazepam (Klonopin)

Correct Answer: 2

Rationale 1: Dilantin is frequently administered IV due to slow and variable absorption rates when given orally. If Dilantin extravasates, serious soft tissue damage can result. Zarontin and Klonopin are oral medications. Phenobarbital would be more likely to be administered orally.





Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 15-7


The health care provider has ordered 5 mg of intravenous diazepam (Valium) to treat the patient in status epilepticus. The patient's IV bag is labeled "1,000 mL D5NS with 20,000 units Heparin." What nursing interventions are necessary to safely administer this diazepam (Valium)?



1. Use a large bore needle to access the IV port.

2. Flush the intravenous (IV) line with saline.

3. Administer the diazepam (Valium) directly into a vein in the patient's hand.

4. Dilute the diazepam (Valium) with xylocaine prior to administration.

5. Observe the IV tubing for cloudiness while administering the diazepam (Valium).

Correct Answer: 2,5

Rationale 1: There is no need to use a large bore needle. Most IV administration is done using a needleless system.


Rationale 2: The IV line should be well flushed with saline to remove any residual heparin, which will precipitate with the diazepam (Valium).

Rationale 3: Direct administration of IV medication is not recommended. The patient receiving IV diazepam (Valium) should have an IV established for possible emergency use.

Rationale 4: Diazepam (Valium) precipitates with many drugs and should not be mixed for infusion.

Rationale 5: Diazepam (Valium) precipitates with many drugs. The nurse should watch the IV tubing just above the injection site for cloudiness or development of precipitate during administration and should discontinue the administration if this situation occurs.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 15-6


The nurse has completed education to the parents of a child newly diagnosed with tonic-clonic seizures. Which comments made by the parents would the nurse evaluate as indicating need for further education?



1. "Some of the times when I thought he was ignoring me may have actually been seizure activity."

2. "He just needs to focus more to prevent these attacks."

3. "I know he will outgrow these seizures with time."

4. "I hope we can help our son identify his seizure aura."

5. "We will watch for the development of status epilepticus."


Rationale 1: Behavior that manifests as the child ignoring outside stimuli is most likely absence seizure, which is different from tonic-clonic seizure.

Rationale 2: The patient who suffers seizure disorder cannot prevent seizure occurrence by focusing harder.


Rationale 3: The patient with tonic-clonic seizure disorder is less likely to outgrow them than the patient with absence seizure disorder.

Rationale 4: Many patients experience an aura prior to the tonic-clonic phase. Identifying the aura can provide time for the patient to move to a safe area, notify another person of the impending seizure, and to prepare.

Rationale 5: Status epilepticus is a medical emergency that may occur in the patient who suffers tonic-clonic seizure disorder.

Global Rationale:

Cognitive Level: EvaluatingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 15-4


The patient who is prescribed valproic acid (Depakote) for seizure control would like to have a baby. Which statements should the nurse include in a discussion with this patient?



1. "Since your epilepsy may flare up during pregnancy, your doctor will likely have you take a second antiepileptic medication."

2. "Thankfully, most modern antiepileptic medications will not interfere with you getting pregnant."

3. "Your current antiepileptic medication should not be used when you are pregnant."

4. "Folic acid supplementation is important for you."

5. "You should consider adopting a baby instead since there are so many problems associated with epilepsy and pregnancy."

Correct Answer: 3,4

Rationale 1: Since there are many side effects to antiepileptic medications, single drug therapy is the goal for pregnant patients.

Rationale 2: Women who have epilepsy have a reduced fertility rate, and some do not ovulate.

Rationale 3: Valproic acid (Depakote) is Pregnancy Category D.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 4: Folic acid supplementation is important for all women who are, or wish to become, pregnant. This is especially true of women who are epileptic because many antiepileptic medications cause folic acid deficiency.

Rationale 5: Women who are epileptic can and do conceive and deliver healthy babies. The nurse should not discourage this patient, but should provide information to the patient and then support the patient's choice.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 15-3


The nurse is planning educations sessions for a patient regarding use of a newly prescribed antiepileptic drug (AED). Which topics should be included in this session?



1. The patient should take the medication at the same time every day.

2. If the patient forgets a dose of medication, wait until the next dose is due and take both doses together.

3. The patient should take an additional dose of medication upon experiencing a seizure aura.

4. If the patient experiences side effects of the medication, the patient should skip the next dose to see if the side effects lessen.

5. The patient should avoid using dietary supplements containing kava when on this medication.

Correct Answer: 1,5

Rationale 1: Stable blood levels of medication are important in the control of seizure activity. In order to achieve this stability, the medication should be taken at the same time every day.

Rationale 2: The patient should take the dose as soon as it is remembered but should not take two doses at the same time or close together.

Rationale 3: Oral medications are not delivered rapidly to the system, so taking an additional dose of medication when an aura occurs is not effective in controlling the impending seizure.

Rationale 4: The patient should never abruptly discontinue taking these medications and should not skip doses.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 5: Kava interferes with many AEDs, often adding to their sedative effects.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 15-8


A mother phones the clinic and tells the nurse, "My 5-year-old son had a febrile seizure this morning." She adds that this is the child's first seizure experience. The nurse responds by asking the mother to bring the child in to be seen today. What other information should the nurse offer?



1. "Febrile seizures are uncommon in boys."

2. "High temperatures generally induce seizures."

3. "Five-year-olds are too old for febrile seizures."

4. "Febrile seizures occur in up to 5% of children."

5. "Seizure medications are usually not necessary for febrile seizures."

Correct Answer: 4,5

Rationale 1: Febrile seizures occur in both genders.

Rationale 2: Many children experience high temperatures without experiencing seizures.

Rationale 3: Febrile seizures are most common in the 3-month to 5-year range.

Rationale 4: Up to 5% of children experience seizure activity related to temperature elevation.

Rationale 5: The best course of action for febrile seizures is prevention by using acetaminophen to prevent onset of fever.

Global Rationale:


Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 15-5


The nurse is talking with a patient who was just prescribed zonisamide (Zonegran). Which patient statement should the nurse immediately discuss with the patient's health care provider?



1. "Did I mention that I used to take phenobarbital for my seizures?"

2. "I forgot to tell the doctor that I am allergic to sulfa drugs."

3. "I have lactose intolerance, so I can't drink milk."

4. "My husband and I plan to have a baby in a couple of years."

5. "My husband and I are leading a 20-mile bicycle tour next weekend for the company we have just started."

Correct Answer: 2,5

Rationale 1: There is no indication that previous phenobarbital use is problematic with the use of zonisamide (Zonegran).

Rationale 2: Zonisamide (Zonegran) is an oral sulfonamide.

Rationale 3: There is no indication that inability to drink milk is problematic with the use of zonisamide (Zonegran).

Rationale 4: Zonisamide (Zonegran) is Pregnancy Category C.

Rationale 5: The most common adverse effects of zonisamide (Zonegran) include dizziness, ataxia, and fatigue. These effects may be problematic for the owner of a company that promotes bicycle touring.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral Therapies


Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 15-7


Adams4e Tif Ch15

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Transcript of Adams4e Tif Ch15