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Nursing Care for Clients on Anticonvulsant Medications, Exams of Nursing

A comprehensive guide on the nursing care for clients who are on anticonvulsant medications, specifically focusing on phenytoin (dilantin), carbamazepine (tegretol), and other related drugs. It covers medication administration, side effects, adverse reactions, and appropriate interventions for various conditions such as seizures, myasthenia gravis, and trigeminal neuralgia. The document also includes instructions for clients and their families, as well as assessments and precautions to be taken.

Typology: Exams

2023/2024

Available from 05/03/2024

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NCLEX RN PHARMACOLOGY -
N
EUROLOGICAL MEDICATIONS
Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease.
The nurse monitors the client for side/adverse effects to the medication. Which
finding indicates that the client is experiencing an adverse effect?
1. Pruritus
2. Tachycardia
3. Hypertension
4. Impaired voluntary movements
4. Impaired voluntary movements
The nurse is caring for a client in the emergency department who has been
diagnosed with Bell's palsy. The client has been taking acetaminophen (Tylenol),
and acetaminophen overdose is suspected. Which antidote should the nurse
anticipate to be prescribed?
1. Pentostatin (Nipent)
2. Auranofin (Ridaura)
The home health nurse visits a client who is taking phenytoin (Dilantin) for control
of seizures. During the assessment, the nurse notes that the client is taking birth
control pills. Which information should the nurse include in the teaching plan?
1. Pregnancy should be avoided while taking phenytoin.
2. The client may stop the medication if it is causing severe gastrointestinal effects.
3. There is the potential of decreased effectiveness of birth control pills
while taking phenytoin.
4. There is the increased risk of thrombophlebitis while taking phenytoin and
birth control pills together.
3. There is the potential of decreased effectiveness of birth control pills while
taking phenytoin.
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NCLEX RN PHARMACOLOGY -

NEUROLOGICAL MEDICATIONS

Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease. The nurse monitors the client for side/adverse effects to the medication. Which finding indicates that the client is experiencing an adverse effect?

  1. Pruritus
  2. Tachycardia
  3. Hypertension
  4. Impaired voluntary movements
  5. Impaired voluntary movements The nurse is caring for a client in the emergency department who has been diagnosed with Bell's palsy. The client has been taking acetaminophen (Tylenol), and acetaminophen overdose is suspected. Which antidote should the nurse anticipate to be prescribed?
  6. Pentostatin (Nipent)
  7. Auranofin (Ridaura) The home health nurse visits a client who is taking phenytoin (Dilantin) for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan?
  8. Pregnancy should be avoided while taking phenytoin.
  9. The client may stop the medication if it is causing severe gastrointestinal effects.
  10. There is the potential of decreased effectiveness of birth control pills while taking phenytoin.
  11. There is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.
  12. There is the potential of decreased effectiveness of birth control pills while taking phenytoin.
  1. Fludarabine (Fludara)
  2. Acetylcysteine (Mucomyst)
  3. Acetylcysteine (Mucomyst) Meperidine hydrochloride (Demerol) has been prescribed for a client to treat pain. Which are side/adverse effects of this medication? Select all that apply.
  4. Diarrhea
  5. Tremors
  6. Drowsiness
  7. Hypotension
  8. Urinary frequency
  9. Increased respiratory rate
  10. Tremors
  11. Drowsiness
  12. Hypotension A client is taking the prescribed dose of phenytoin (Dilantin) to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL. Which finding would be expected as a result of this laboratory result?
  13. Hypotension
  14. Tachycardia
  15. Slurred speech
  16. No abnormal finding
  17. Slurred speech The client arrives at the emergency department complaining of back spasms. The client states, "I have been taking two to three aspirin every 4 hours for the last week, and it hasn't helped my back." Since aspirin intoxication is suspected, the nurse should assess the client for which manifestation?
  18. Tinnitus

level is drawn."

  1. "Good oral hygiene is needed, including brushing and flossing." A client with myasthenia gravis has become increasingly weaker. The health care provider prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or an increasing severity of the disease (myasthenic crisis). An injection of edrophonium is administered. Which finding would indicate that the client is in cholinergic crisis?
  2. No change in the condition
  3. Complaints of muscle spasms
  4. An improvement of the weakness
  5. A temporary worsening of the condition
  6. A temporary worsening of the condition A client with trigeminal neuralgia tells the nurse that acetaminophen (Tylenol) is taken daily for the relief of generalized discomfort. Which laboratory value would indicate toxicity associated with the medication?
  7. Sodium level of 140 mEq/L
  8. Prothrombin time of 11. seconds 3. Direct bilirubin level of 2 mg/dL
  9. Platelet count of 400,000 cells/mm
  10. Direct bilirubin level of 2 mg/dL The nurse is caring for a client receiving mannitol (Osmitrol) via intravenous (IV) infusion. A vial is sent from the pharmacy, and in preparing the medication the nurse notes that the vial contains crystals. What is the most appropriate nursing action?
  11. Discard the vial.
  12. Place the vial in warm water.
  13. Send the vial back to the pharmacy.
  14. Shake the vial to dissolve the crystals.
  15. Place the vial in warm water.

not

"something stronger." In formulating a response, the nurse incorporates which information about codeine sulfate?

  1. Is one of the strongest opioid analgesics available
  2. Cannot lead to physical or psychological dependence
  3. Does not alter respirations or mask neurological signs as do other opioids
  4. Does not cause gastrointestinal (GI) upset or constipation as do other opioids
  5. Does not alter respirations or mask neurological signs as do other opioids The nurse is administering medications to a client with trigeminal neuralgia. The nurse expects that which medication will be prescribed for pain relief?
  6. Oxycodone plus aspirin (Percodan)
  7. Acetaminophen (Tylenol) and codeine sulfate
  8. Carbamazepine (Tegretol) and gabapentin (Neurontin)
  9. Meperidine hydrochloride (Demerol) and hydroxyzine (Vistaril)
  10. Carbamazepine (Tegretol) and gabapentin (Neurontin) The nurse is caring for a client with an exacerbation of multiple sclerosis. Which medication(s) will the nurse expect to be prescribed to hasten recovery from the exacerbation?
  11. Methylprednisolone (Solu-Medrol) intravenously
  12. Carbamazepine (Tegretol) and phenytoin (Dilantin) by mouth
  13. Phenytoin (Dilantin) intravenously, then tapered to oral route
  14. Lioresal (Baclofen) by mouth and diazepam (Valium) intravenously
  15. Methylprednisolone (Solu-Medrol) intravenously The nurse is observing a new nursing graduate who is preparing an intermittent intravenous (IV) infusion of phenytoin (Dilantin) for a client with a diagnosis of seizures. Which solution used by the nursing graduate should indicate to the nurse an understanding of proper preparation of this medication?
  16. 5% dextrose in water
  17. Lactated Ringer's solution
  1. Increased diuresis
  2. Reduced intracranial pressure
  3. Increased osmotic pressure of glomerular filtrate
  4. Reduced tubular reabsorption of water and solutes The nurse has a prescription to give dexamethasone (Decadron) by the intravenous (IV) route to a client with cerebral edema. How should the nurse prepare this medication?
  5. Diluting the medication in 500 mL of 5% dextrose
  6. Preparing an undiluted direct injection of the medication
  7. Diluting the medication in 1 mL of lactated Ringer's solution for direct injection
  8. Diluting the medication in 10% dextrose in water and administering it as a direct injection
  9. Preparing an undiluted direct injection of the medication The nurse who is caring for a client with myasthenia gravis has a prescription to perform an Enlon (Tensilon) test. After obtaining edrophonium (Enlon), the nurse should be certain that which also is available at the bedside?
  10. Atropine sulfate
  11. Protamine sulfate
  12. Calcium gluconate
  13. Magnesium sulfate
  14. Atropine sulfate After review of the client's laboratory values, the nurse notes that a phenytoin (Dilantin) level for a client receiving phenytoin (Dilantin) is 7 mcg/mL. The nurse makes which interpretation regarding this laboratory result?
  15. The level is within the expected therapeutic range.
  16. The level indicates the medication should be stopped.
  17. The level is lower than the expected therapeutic range.
  1. The level is higher than the expected therapeutic range.
  1. Dizziness
  2. Drowsiness
  3. Abdominal pain
  4. Lightheadedness
  5. Abdominal pain The nurse notes that a client taking ergotamine tartrate (Cafergot) is having the intended effects of therapy if the client states relief from which symptom?
  6. Cough
  7. Diarrhea
  8. Backache
  9. Headaches
  10. Headaches A client who has been taking phenytoin (Dilantin) for seizure control has a serum phenytoin drug level of 8 mcg/mL. The nurse should make which interpretation about this value?
  11. A toxic level
  12. An inadequate drug level
  13. The low end of therapeutic range
  14. The high end of therapeutic range
  15. An inadequate drug level A client has a medication prescription for phenytoin (Dilantin) to be administered by the intravenous route. After drawing up the medication, the nurse notes the presence of precipitate in the syringe. Which action should the nurse take?
  16. Discard the syringe and begin again.
  17. Add sterile water to dissolve the precipitate.
  18. Draw up an additional 1 mL of normal saline into the syringe.
  19. Chart the medication as "not given," and write a note in the medical record.
  1. Discard the syringe and begin again. A client with a diagnosis of Parkinson's disease began taking amantadine (Symmetrel) approximately 2 weeks ago. The client reports to the clinic for a follow-up evaluation. The nurse determines that the client is experiencing an adverse effect related to the use of this medication if which is noted?
  2. Decreased rigidity
  3. Decreased akinesia
  4. A blood pressure of 118/74 mm Hg
  5. Client complaints of urinary retention
  6. Client complaints of urinary retention A client with insomnia has been started on zolpidem (Ambien). After instructing the client in how to obtain the maximal effect of zolpidem, the nurse determines that the client demonstrates understanding of correct administration of the medication by which statement?
  7. "I take the medication just after my evening meal."
  8. "I need to take the medication with a full glass of water."
  9. "I wait until bedtime and take the medication with a snack."
  10. "I take the medication with milk or an antacid to avoid stomach upset."
  11. "I need to take the medication with a full glass of water." A client with Parkinson's disease is taking benztropine mesylate (Cogentin) orally daily. In monitoring this client for medication side effects, the nurse should plan to focus the assessment on which item?
  12. Pupil response
  13. Voiding pattern
  14. Prothrombin time
  15. Respiratory status
  16. Voiding pattern

and provides instructions regarding the medication. Which statement, if made by the client, would indicate an understanding of the instructions?

  1. "I will use a soft toothbrush to brush my teeth."
  2. "It's okay to break the capsules to make it easier for me to swallow them."
  3. "If I forget to take my medication, I can wait until the next dose and eliminate that dose."
  4. "If my throat becomes sore, it's a normal effect of the medication, and it's nothing to be concerned about."
  5. "I will use a soft toothbrush to brush my teeth." Dexamethasone (Decadron) intravenously is prescribed for the client with cerebral edema. The nurse prepares the medication for administration and plans to perform which action?
  6. Mix the medication in 1000 mL of 5% dextrose.
  7. Prepare an undiluted direct injection of the medication.
  8. Mix the medication in 100 mL of lactated Ringer's solution.
  9. Dilute the medication in lactated Ringer's solution and administer as a direct injection.
  10. Prepare an undiluted direct injection of the medication. The nurse has the following prescription for a postcraniotomy client, "dexamethasone (Decadron) 4 mg by the intravenous (IV) route now." How does the nurse administer the medication?
  11. IV push over 1 minute
  12. IV push over 4 minutes
  13. IV piggyback in 50 mL of normal saline over 10 minutes
  14. IV piggyback in 50 mL of normal saline over 30 minutes
  15. IV push over 1 minute A client is experiencing impotence after taking guanfacine (Tenex). The client states, "I would sooner have a stroke than keep living with the effects of this medication." What is the most appropriate response by the nurse?
  1. "I can understand completely."
  2. "You wouldn't really want to have a stroke."
  3. "You are concerned about the effects of your medication."
  4. "The health care provider should change your prescription."
  5. "You are concerned about the effects of your medication." A client with Parkinson's disease has been prescribed benztropine (Cogentin). The nurse should assess for which gastrointestinal (GI) problems as a side effect of this medication?
  6. Diarrhea
  7. Dry mouth
  8. Increased appetite
  9. Hyperactive bowel sounds
  10. Dry mouth A client has been prescribed cyclobenzaprine (Flexeril) for the treatment of painful muscle spasms accompanying a herniated intervertebral disk. The nurse should withhold the medication and question the prescription if the client has a concurrent prescription for which medication?
  11. Furosemide (Lasix)
  12. Ibuprofen (Motrin IB)
  13. Valproic acid (Depakene)
  14. Tranylcypromine (Parnate)
  15. Tranylcypromine (Parnate) The nurse has a prescription to administer diazepam (Valium) 5 mg by the intravenous (IV) route to a client. The nurse should administer the medication over a period of at least how long?
  16. 15 seconds
  17. 30 seconds
  18. 1 minute
  1. Institute seizure precautions. The nurse has a prescription to administer phenytoin (Dilantin) 100 mg by the intravenous (IV) route to a client. The nurse administers the medication after preparing it in which solution?
  2. Lactated Ringer's solution
  3. 5% dextrose in 0.45% normal saline
  4. 0.9% normal saline with an in-line filter
  5. 5% dextrose in water with an in-line filter
  6. 0.9% normal saline with an in-line filter The nurse in the health care provider's office is reviewing the results of a client's phenytoin (Dilantin) level determination performed that morning. The nurse identifies that a therapeutic drug level has been achieved if which result is noted?
  7. 3 mcg/mL
  8. 8 mcg/mL
  9. 15 mcg/mL
  10. 24 mcg/mL
  11. 15 mcg/mL A client with a history of simple partial seizures is taking clorazepate (Tranxene). The client asks the nurse if there is a risk of addiction with this medication. The nurse's response is based on which information about this medication?
  12. Is not habit forming either physically or psychologically
  13. Leads to physical tolerance, but only after 10 or more years of therapy
  14. Leads to physical and psychological dependence with prolonged high- dose therapy
  15. Can result in psychological dependence only because of the nature of the medication
  16. Leads to physical and psychological dependence with prolonged high-dose therapy

A client has a prescription for valproic acid (Depakene) 250 mg once daily. To maximize the client's safety, the nurse should plan to schedule the medication at what time?

  1. At bedtime
  2. With lunch
  3. After breakfast
  4. Before breakfast
  5. At bedtime A client taking carbamazepine (Tegretol) asks the nurse what to do if a dose is inadvertently missed. The nurse responds that which action should be taken?
  6. Withhold until the next scheduled dose.
  7. Withhold and call the health care provider (HCP).
  8. Take the dose as long as it is not close to the time for the next dose.
  9. Withhold until the next scheduled dose, which should then be doubled.
  10. Take the dose as long as it is not close to the time for the next dose. The nurse has given medication instructions to a client beginning anticonvulsant therapy with carbamazepine (Tegretol). The nurse determines that the client understands the use of the medication if he or she makes which statement?
  11. Use sunscreen when outdoors.
  12. Drive a car as long as it is not at night.
  13. Keep tissues handy because of excess salivation.
  14. Discontinue the medication if fever or sore throat occurs.
  15. Use sunscreen when outdoors. A client with vascular headaches is taking ergotamine (Cafergot). The home health nurse should periodically assess him or her for which finding?
  16. Hypotension
  17. Constipation