The nurse is preparing for the admission to the unit of a client with a diagnosis of seizures and asks the nursing student to institute full seizure precautions. Which item if noted in the client's room would need to be removed and warrants the need to review seizure precautions with the student?

1.Oxygen source

2.Suction machine

3.Padded tongue blade

4.Padding for the side rails

3.Padded tongue blade

The nurse is documenting nursing observations in the record of a client who experienced a tonic-clonic seizure. Which clinical manifestation did the nurse most likely note in the clonic phase of the seizure?

1.Body stiffening

2.Spasms of the entire body

3.Sudden loss of consciousness

4.Brief flexion of the extremities

2.Spasms of the entire body

The nurse is teaching a client hospitalized with a seizure disorder and the client's spouse about safety precautions after discharge. The nurse determines that the client needs further teaching if the client states an intention to take which action?

1.Refrain from smoking alone.

2.Take all prescribed medications on time.

3Have the spouse nearby when showering.

4.Drink alcohol in small amounts and only on weekends.

4.Drink alcohol in small amounts and only on weekends.

The nurse is assessing a client who is experiencing seizure activity. The nurse understands that it is necessary to determine information about which items as part of routine assessment of seizures? Select all that apply.

1.Postictal status

2.Duration of the seizure

3.Changes in pupil size or eye deviation

4.Seizure progression and type of movements

5.What the client ate in the 2 hours preceding seizure activity

1.Postictal status

2.Duration of the seizure

3.Changes in pupil size or eye deviation

4.Seizure progression and type of movements

A client brought to the emergency department had a seizure 1 hour ago. Family members were present during the episode and reported that the client's jaw was moving as though grinding food. In helping to determine the origin of this seizure, what would the nurse include in the client's assessment?

1.Loss of consciousness

2.Presence of diaphoresis

3.History of prior trauma

4.Rotating eye movements

3.History of prior trauma

The nurse has a prescription to administer phenytoin by intravenous (IV) push through an IV line infusing 1000 mL of 0.9% sodium chloride. Arrange the actions in the order that they would be performed. All options must be used.

1.Inject the medication.

2.Draw up the medication in a 3-mL syringe.

3.Check the client's identification (ID) bracelet.

4.Pinch off the IV tubing above the injection port.

5.Check the compatibility of phenytoin with the IV solution.

6.Document that the medication was administered.

5.Check the compatibility of phenytoin with the IV solution.

2.Draw up the medication in a 3-mL syringe.

3.Check the client's identification (ID) bracelet.

4.Pinch off the IV tubing above the injection port.

1.Inject the medication.

6.Document that the medication was administered.

The nurse is reviewing the laboratory results of a serum medication level assay for a client seen in the health care clinic who has been taking phenytoin for the control of seizures. The nurse determines that a subtherapeutic level of phenytoin is present and that additional medication is required if which level is found?

1.) 3 mcg/mL (12 mcmol/L)

2.)16 mcg/mL (63 mcmol/L)

3.)18 mcg/mL (71 mcmol/L)

4.) 24 mcg/mL (95 mcmol/L)

1.) 3 mcg/mL (12 mcmol/L)

An adult client with a history of seizure disorder is having a routine serum phenytoin level drawn. Which serum phenytoin result indicates that the client is having a therapeutic effect of the medication?

1.)6 mcg/mL (23.8 mcmol/L)

2.)16 mcg/mL (63.4 mcmol/L)

3.)28 mcg/mL (110.9 mcmol/L)

4.) 36 mcg/mL (142.6 mcmol/L)

2.)16 mcg/mL (63.4 mcmol/L)

A registered nurse (RN) asks a licensed practical nurse (LPN) to set up a hospital room for a client who is being admitted with a diagnosis of tonic-clonic seizures and asks the LPN to institute seizure precautions. The RN checks the client's room before the arrival of the client and determines that which item placed in the room by the LPN is unsafe?

1.Restraints

2.Nasal cannula

3.Suction catheter

4.Padding for side rails

1.Restraints

The home health nurse visits a client who is taking phenytoin for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information would the nurse include in the teaching plan?

1.Pregnancy must 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.

The nurse is observing a new nursing graduate who is preparing an intermittent intravenous (IV) infusion of phenytoin for a client with a diagnosis of seizures. Which solution used by the nursing graduate would indicate to the nurse an understanding of proper preparation of this medication?

1. 5% dextrose in water

2. 0.9% sodium chloride

3.Lactated Ringer's solution

4. 5% dextrose and 0.45% sodium chloride

2. 0.9% sodium chloride

After review of the client's laboratory values, the nurse notes that a phenytoin level for a client receiving phenytoin is 7 mcg/mL (27.78 mmol/L). The nurse makes which interpretation regarding this laboratory result?

1.The level is within the expected therapeutic range.

2.The level indicates the medication should be stopped.

3.The level is lower than the expected therapeutic range.

4.The level is higher than the expected therapeutic range.

3.The level is lower than the expected therapeutic range.

A client with status epilepticus has been prescribed phenytoin to be given by the intravenous (IV) route. The nurse administering the medication is careful not to exceed which recommended infusion rate?

1.)50 mg/min

2.) 60 mg/min

3.)100 mg/min

4.)750 mg/min

1.)50 mg/min

A client is scheduled to begin medication therapy with valproic acid. The nurse looks for the results of which laboratory test(s) before administering the first dose?

1.Liver function tests

2.Renal function tests

4.Pulmonary function test

5.Pancreatic enzyme studies

1.Liver function tests

A client is scheduled to begin therapy with carbamazepine. The nurse would assess the results of which test(s) before administering the first dose of this medication to the client?

1.Liver function tests

2.Renal function tests

3.Pancreatic enzyme studies

4.Complete blood cell count

4.Complete blood cell count

A client who has been taking phenytoin for seizure control has a serum phenytoin level of 8 mcg/mL (35.71 mmol/L). On the basis of this finding, which note would the nurse enter in the client's health record?

1.Client is experiencing a toxic level.

2.Client has an inadequate medication level.

3.Client's result is at the low end of therapeutic range.

4.Client's result is at the high end of therapeutic range.

2.Client has an inadequate medication level.

A client has a medication prescription for phenytoin to be administered by the intravenous route. After drawing up the medication from the vial, the nurse notes the presence of precipitate in the syringe. Which action would the nurse take?

1.Discard the syringe and obtain another vial.

2.Add sterile water to dissolve the precipitate.

3.Draw up an additional 1 mL of normal saline into the syringe.

4.Chart the medication as "not given," and write a note in the medical record.

1.Discard the syringe and obtain another vial.

Phenytoin 100 mg to be given orally 3 times daily has been prescribed to a client. The home health nurse visits the client 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."

1."I will use a soft toothbrush to brush my teeth."

The nurse has a prescription to administer diazepam 5 mg by the intravenous (IV) route to a client. The nurse would administer the medication over a period of at least how long?

1.)15 seconds

2.) 30 seconds

3.) 1 minute

5.) 5 minutes

3.) 1 minute

A client is receiving phenytoin. To monitor for side and adverse effects of this medication, the nurse assesses the results of which laboratory test?

1.Serum sodium

2.Serum potassium

3.Blood urea nitrogen

4.Complete blood count (CBC)

4.Complete blood count (CBC)

A client who was started on clonazepam tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these manifestations and asks the nurse what to do. The nurse's response is based on which understanding?

1.These symptoms probably result from interaction with another medication.

2.These symptoms usually occur when the client takes the medication with food.

3.These symptoms indicate that the client is experiencing a severe adverse reaction to the medication.

4.These symptoms are most severe during initial therapy and decrease or disappear with long-term use.

4.These symptoms are most severe during initial therapy and decrease or disappear with long-term use.

A client is having the dosage of clonazepam adjusted. The nurse would plan to perform which action?

1.Weigh the client daily.

2.Institute seizure precautions.

3.Monitor blood glucose levels.

4.Observe for areas of ecchymosis.

2.Institute seizure precautions.

The nurse has a prescription to administer phenytoin 100 mg mixed in 5% dextrose in water by the intravenous (IV) route to a client. After reading this prescription, which action would the nurse take?

1.Prepare the solution for administration.

2.Contact the agency pharmacy to obtain the medication.

3.Contact the primary health care provider (PHCP) to question the prescription.

4.Mix the medication in the prescribed solution and attach an in-line filter.

3.Contact the primary health care provider (PHCP) to question the prescription.

The nurse in the primary health care provider's office is reviewing the results of a client's phenytoin level determination performed that morning. The nurse identifies that a therapeutic medication level has been achieved if which result is noted?

1.) 3 mcg/mL (11.9 mmol/L)

2.) 8 mcg/mL (31.74 mmol/L)

3.) 15 mcg/mL (59.52 mmol/L)

4.) 24 mcg/mL (95.23 mmol/L)

3.) 15 mcg/mL (59.52 mmol/L)

A client has a prescription for valproic acid. To maximize the client's safety, the nurse would plan to monitor for which potential complications of this medication? Select all that apply.

1.Pancreatitis

2.Hypotension

3.Renal failure

4.Hepatotoxicity

5.Cardiotoxicity

1.Pancreatitis

4.Hepatotoxicity

A client taking carbamazepine asks the nurse what to do if a dose is inadvertently missed. The nurse responds that which action would be taken?

1.Withhold until the next scheduled dose.

2.Withhold and call the primary health care provider (PHCP).

3.Take the dose as long as it is not close to the time for the next dose.

4.Withhold until the next scheduled dose, which should then be doubled.

3.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 carbamazepine. The nurse determines that the client understands the use of the medication if which statement is made by the client?

1."I will use sunscreen when outdoors."

2."I can drive a car as long as it is not at night."

3."I will keep tissues handy because of excess salivation."

4."I will discontinue the medication if fever or sore throat occurs."

1."I will use sunscreen when outdoors."

The nurse has completed discharge teaching for a client prescribed carbamazepine. Which statement by the client indicates that education about the main effect of the medication was effective?

1."This medication has an anticonvulsant effect."

2."This medication interferes with DNA production."

3."The main effect is a decrease in intraocular pressure."

4."The main action of this medication is prevention of cellular division."

1."This medication has an anticonvulsant effect."

The primary health care provider (PHCP) writes a prescription for carbamazepine for a client who was admitted to the hospital. The nurse contacts the PHCP to verify the prescription if which condition is noted in the assessment data?

1.Hypertension

2.Tonic-clonic seizures

3.Trigeminal neuralgia

4.Bone marrow depression

4.Bone marrow depression

A home care nurse visits a client at home. Clonazepam has been prescribed for the client, and the nurse teaches the client about the medication. Which client statement indicates that further teaching is necessary?

1."My drowsiness will decrease over time with continued treatment."

2."I need to take my medicine with food to avoid any stomach problems."

3."I can take my medicine at bedtime if it tends to make me feel drowsy."

4."If I experience slurred speech, this problem will disappear in about 8 weeks."

4."If I experience slurred speech, this problem will disappear in about 8 weeks."

A client who is taking phenytoin for a seizure disorder is being admitted to the hospital because of an increase in seizure activity. The client reports severe vomiting for the last 24 hours and an inability to take phenytoin during that time. The nurse anticipates that the primary health care provider will most likely prescribe which medication?

1.Clonazepam

2.Phenobarbital

3.Carbamazepine

4.Fosphenytoin sodium

4.Fosphenytoin sodium

The nurse is giving medication instructions to a client who is receiving phenytoin for epilepsy. Which instruction would the nurse include to promote adherence to the medication?

1.Discuss the self-limiting nature of epilepsy.

2.Explain how nonadherence does not account for treatment failure.

3.Involve one other person only in promoting adherence to prevent confusion.

4.Monitor plasma medication levels to provide information about adherence.

4.Monitor plasma medication levels to provide information about adherence.

The nurse is preparing an intravenous (IV) infusion of phenytoin as prescribed by the primary health care provider for the client with seizures. Which solution would the nurse plan to use to dilute this medication?

1.Dextrose 5%

2.Normal saline solution

3.Lactated Ringer's solution

4.Dextrose 5% and half-normal saline (0.45%)

2.Normal saline solution

The nurse preparing to administer carbamazepine notices a number of items on the client's breakfast tray. Which item would be a cause for concern and would be removed from the tray?

1.Carton of milk

2.Scrambled eggs

3.Grapefruit juice

4.Toast with honey

3.Grapefruit juice

The nurse is told that the result of a serum carbamazepine level for a client who is receiving the medication for the control of seizures is 13 mcg/mL (55.03 mmol/L). Based on this laboratory result, the nurse anticipates that the primary health care provider (PHCP) will document which prescription?

1.Discontinuation of the medication

2.A decrease of the dosage of the medication

3.An increase of the dosage of the medication

4.Continuation of the presently prescribed dosage

2.A decrease of the dosage of the medication

The nurse is providing instructions to a client beginning medication therapy with divalproex sodium for the treatment of absence seizures. The nurse instructs the client that which represents the most frequent side or adverse effect of this medication?

1.Tinnitus

2.Irritability

3.Blue vision

4.Nausea and vomiting

4.Nausea and vomiting

The nurse is speaking with a client taking phenytoin for seizure control. The client states has started using birth control pills to prevent pregnancy. Which would be an important point for the nurse to emphasize to the client?

1.Oral contraceptives decrease the effectiveness of phenytoin.

2.Severe gastrointestinal side effects can occur when phenytoin and oral contraceptives are taken together.

3.There is an increased risk of thrombophlebitis when phenytoin and oral contraceptives are taken at the same time.

4.Phenytoin may decrease the effectiveness of birth control pills, and additional measures need to be taken to avoid pregnancy.

4.Phenytoin may decrease the effectiveness of birth control pills, and additional measures need to be taken to avoid pregnancy.

The nurse is reading the laboratory results for a client being treated with carbamazepine for prophylaxis of complex partial seizures. When evaluating the client's laboratory data, the nurse determines that which value is consistent with a side or adverse effect of this medication?

1.Sodium level, 136 mEq/L (136 mmol/L)

2.Platelet count, 350,000 mm³ (350 × 10⁹/L)

3.White blood cell count, 3200 mm³ (3.2 × 10⁹/L)

4.Blood urea nitrogen (BUN), 19 mg/dL (6.84 mmol/L)

3.White blood cell count, 3200 mm³ (3.2 × 10⁹/L)

The nurse is assisting in the care of a client being discharged on phenytoin 100 mg 3 times daily. When providing client teaching about this medication, the nurse would be sure to include which points? Select all that apply.

1.Break the capsules so that they are easier to swallow.

2.Use a soft toothbrush while taking this medication.

3.If a dose is missed, just wait until the next one is due.

4.The medication may turn the urine pink, red, or brown.

5.Alcohol needs to be avoided while taking this medication.

6.Sore throat is a common side effect of the medication and is nothing to worry about.

2.Use a soft toothbrush while taking this medication.

4.The medication may turn the urine pink, red, or brown.

5.Alcohol needs to be avoided while taking this medication.

The nurse is providing instructions to an adolescent prescribed phenytoin for the control of seizures. Which statement by the adolescent indicates a need for further teaching regarding the medication?

1."The medication may cause acne or oily skin."

2."Drinking alcohol may affect the medication."

3."If my gums become sore and swollen, I need to stop the medication."

4."Birth control pills may not be effective when I take this medication."

3."If my gums become sore and swollen, I need to stop the medication."

The nurse is caring for a client who begins to experience seizure activity while in bed. Which actions would the nurse take? Select all that apply.

1.Loosening restrictive clothing.

2.Restraining the client's limbs.

3.Removing the pillow and raising padded side rails.

4.Positioning the client to the side, if possible, with the head flexed forward.

5.Keeping the curtain around the client and the room door open so that when help arrives, they can quickly enter to assist.

1.Loosening restrictive clothing.

3.Removing the pillow and raising padded side rails.

4.Positioning the client to the side, if possible, with the head flexed forward.

The nurse is instituting seizure precautions for a client who is being admitted from the emergency department. Which measures would the nurse include in planning for the client's safety? Select all that apply.

1.Padding the side rails of the bed.

2.Placing an airway at the bedside.

3.Placing the bed in the high position.Putting a padded tongue blade at the head of the bed.

5.Placing oxygen and suction equipment at the bedside.

6.Flushing the intravenous catheter to ensure that the site is patent.

1.Padding the side rails of the bed.

2.Placing an airway at the bedside

5.Placing oxygen and suction equipment at the bedside.

6.Flushing the intravenous catheter to ensure that the site is patent.

.

The home health nurse visits a client who is taking phenytoin for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information would the nurse include in the teaching plan?

1.Pregnancy must 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.

A client is taking the prescribed dose of phenytoin 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?

1.Hypotension

2.Tachycardia

3.Slurred speech

4.No abnormal finding

3.Slurred speech

The nurse has given medication instructions to a client receiving phenytoin. Which statement indicates that the client has an adequate understanding of the instructions?

1.Alcohol is not contraindicated while taking this medication."

2."Good oral hygiene is needed, including brushing and flossing."

3."The medication dose may be self-adjusted, depending on side effects."

4."The morning dose of the medication needs to be taken before a medication level is drawn."

2"Good oral hygiene is needed, including brushing and flossing."