Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E Chapter 15

Question 1 Type: 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 " !hat is the "est response "y the nurse 1. "#avin$ epilepsy is the same as havin$ a mental illness% the medications are very similar." 2. "&ou 'ill need medicine for a little 'hile to cure the seizures." 3. "&ou mi$ht not need medicine% you may "e controlled "y a keto$enic diet." 4. "&es, you need to take medication on a continual "asis to control the seizures." Correct Answer: ( ationa!e 1) *pilepsy is a disease 'here seizures occur on a chronic "asis. +nce seizures are controlled, patients are continued indefinitely on the antiseizure dru$. *pilepsy and associated seizures are not cura"le 'ith medications. The keto$enic diet is used 'hen seizures cannot "e controlled throu$h pharmacotherapy, or 'hen there are unaccepta"le side effects to the medications. *pilepsy is not a mental illness, althou$h some of the same medications are used to control symptoms of "oth disorders. ationa!e 2) *pilepsy is a disease 'here seizures occur on a chronic "asis. +nce seizures are controlled, patients are continued indefinitely on the antiseizure dru$. *pilepsy and associated seizures are not cura"le 'ith medications. The keto$enic diet is used 'hen seizures cannot "e controlled throu$h pharmacotherapy, or 'hen there are unaccepta"le side effects to the medications. *pilepsy is not a mental illness, althou$h some of the same medications are used to control symptoms of "oth disorders. ationa!e 3) *pilepsy is a disease 'here seizures occur on a chronic "asis. +nce seizures are controlled, patients are continued indefinitely on the antiseizure dru$. *pilepsy and associated seizures are not cura"le 'ith medications. The keto$enic diet is used 'hen seizures cannot "e controlled throu$h pharmacotherapy, or 'hen there are unaccepta"le side effects to the medications. *pilepsy is not a mental illness, althou$h some of the same medications are used to control symptoms of "oth disorders. ationa!e 4) *pilepsy is a disease 'here seizures occur on a chronic "asis. +nce seizures are controlled, patients are continued indefinitely on the antiseizure dru$. *pilepsy and associated seizures are not cura"le 'ith medications. The keto$enic diet is used 'hen seizures cannot "e controlled throu$h pharmacotherapy, or 'hen there are unaccepta"le side effects to the medications. *pilepsy is not a mental illness, althou$h some of the same medications are used to control symptoms of "oth disorders. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Implementation &earnin$ *utcome: 0230 Question 2 Type: MCMA The nurse is teachin$ a class for patients 'ho have "een recently dia$nosed 'ith epilepsy. The nurse determines that learnin$ has occurred 'hen the patients make 'hich statements 1ote) Credit 'ill "e $iven only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. "*4cessive stress levels cause disruptions in ho' the "rain receives o4y$en, leadin$ to epilepsy." 2. "*pilepsy may "e caused "y a head in5ury." 3. "*atin$ disorders, like anore4ia nervosa, increase the risk for developin$ epilepsy." 4. "A stroke, or "rain attack, could increase the risk for developin$ epilepsy." 5. "!ith some cases of epilepsy, the cause is never determined." Correct Answer: .,(,2 ationa!e 1) *pilepsy is a disorder 'here seizures occur on a chronic "asis. #ead trauma is a kno'n cause of seizures. In some cases, the e4act etiolo$y may not "e identified. Chan$es in cere"ral perfusion such as hypotension, strokes or "rain attacks, and shock may "e causes of seizures. There is no kno'n correlation 'ith anore4ia nervosa and the development of epilepsy. *4cessive levels of stress cannot disrupt cere"ral o4y$en to the e4tent that epilepsy 'ould occur. ationa!e 2) *pilepsy is a disorder 'here seizures occur on a chronic "asis. #ead trauma is a kno'n cause of seizures. In some cases, the e4act etiolo$y may not "e identified. Chan$es in cere"ral perfusion such as hypotension% strokes, or "rain attacks% and shock may "e causes of seizures. There is no kno'n correlation 'ith anore4ia nervosa and the development of epilepsy. *4cessive levels of stress cannot disrupt cere"ral o4y$en to the e4tent that epilepsy 'ould occur. ationa!e 3) *pilepsy is a disorder 'here seizures occur on a chronic "asis. #ead trauma is a kno'n cause of seizures. In some cases, the e4act etiolo$y may not "e identified. Chan$es in cere"ral perfusion such as hypotension% strokes, or "rain attacks% and shock may "e causes of seizures. There is no kno'n correlation 'ith anore4ia nervosa and the development of epilepsy. *4cessive levels of stress cannot disrupt cere"ral o4y$en to the e4tent that epilepsy 'ould occur. ationa!e 4) *pilepsy is a disorder 'here seizures occur on a chronic "asis. #ead trauma is a kno'n cause of seizures. In some cases, the e4act etiolo$y may not "e identified. Chan$es in cere"ral perfusion such as hypotension% strokes, or "rain attacks% and shock may "e causes of seizures. There is no kno'n correlation 'ith
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

anore4ia nervosa and the development of epilepsy. *4cessive levels of stress cannot disrupt cere"ral o4y$en to the e4tent that epilepsy 'ould occur. ationa!e 5) *pilepsy is a disorder 'here seizures occur on a chronic "asis. #ead trauma is a kno'n cause of seizures. In some cases, the e4act etiolo$y may not "e identified. Chan$es in cere"ral perfusion such as hypotension% strokes, or "rain attacks% and shock may "e causes of seizures. There is no kno'n correlation 'ith anore4ia nervosa and the development of epilepsy. *4cessive levels of stress cannot disrupt cere"ral o4y$en to the e4tent that epilepsy 'ould occur. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) *valuation &earnin$ *utcome: 023. Question 3 Type: MCSA A parent says to the nurse, "The doctor prescri"ed ethosu4imide 67arontin8 for my child, 'ho has a"sence seizures. !hat does this mean " !hat is the "est response "y the nurse 1. "A"sence seizures are "asically the same kind of seizures as $rand mal, "ut they are less fre9uent." 2. "&our dau$hter:s seizures manifest as a starin$ into space for a fe' seconds. *thosu4imide 67arontin8 is a $ood medication for this type of seizure." 3. "*4plainin$ the types of seizure activity is complicated. #ave you spoken to your doctor a"out it " 4. "Are you sure your doctor prescri"ed ethosu4imide 67arontin8 ,heno"ar"ital 6;uminal8 is used much more fre9uently 'ith children." Correct Answer: . ationa!e 1) A"sence seizures, formerly kno'n as petit mal, last a fe' seconds and are seen most often in children. *thosu4imide 67arontin8 is a dru$ of choice for this type of seizure disorder. <rand mal, or tonic3clonic, seizures are different from a"sence or petite mal seizures% they are different forms of epilepsy. *thosu4imide 67arontin8, not pheno"ar"ital 6;uminal8, is the dru$ of choice for a"sence seizures. It is the responsi"ility of the =1 to educate the patient, not 5ust refer 9uestions to the physician. ationa!e 2) A"sence seizures, formerly kno'n as petit mal, last a fe' seconds and are seen most often in children. *thosu4imide 67arontin8 is a dru$ of choice for this type of seizure disorder. <rand mal, or tonic3clonic, seizures are different from a"sence or petite mal seizures% they are different forms of epilepsy. *thosu4imide 67arontin8, not pheno"ar"ital 6;uminal8, is the dru$ of choice for a"sence seizures. It is the responsi"ility of the =1 to educate the patient, not 5ust refer 9uestions to the physician.
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

ationa!e 3) A"sence seizures, formerly kno'n as petit mal, last a fe' seconds and are seen most often in children. *thosu4imide 67arontin8 is a dru$ of choice for this type of seizure disorder. <rand mal, or tonic3clonic, seizures are different from a"sence or petite mal seizures% they are different forms of epilepsy. *thosu4imide 67arontin8, not pheno"ar"ital 6;uminal8, is the dru$ of choice for a"sence seizures. It is the responsi"ility of the =1 to educate the patient, not 5ust refer 9uestions to the physician. ationa!e 4) A"sence seizures, formerly kno'n as petit mal, last a fe' seconds and are seen most often in children. *thosu4imide 67arontin8 is a dru$ of choice for this type of seizure disorder. <rand mal, or tonic3clonic, seizures are different from a"sence or petite mal seizures% they are different forms of epilepsy. *thosu4imide 67arontin8, not pheno"ar"ital 6;uminal8, is the dru$ of choice for a"sence seizures. It is the responsi"ility of the =1 to educate the patient, not 5ust refer 9uestions to the physician. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Implementation &earnin$ *utcome: 023> Question 4 Type: MCSA The patient has epilepsy and receives phenytoin 6Dilantin8. The patient has "een seizure3free, and asks the nurse 'hy he still needs "lood tests 'hen he is not havin$ seizures. !hat is the "est response "y the nurse 1. "?ecause phenytoin 6Dilantin8 has a very narro' ran$e "et'een a therapeutic dose and a to4ic dose." 2. "?ecause phenytoin 6Dilantin8 can cause "lood3thinnin$ in some patients." 3. "?ecause phenytoin 6Dilantin8 can cause Stevens3@ohnson syndrome, 'hich 'ill sho' up in the "lood tests." 4. "?ecause phenytoin 6Dilantin8 can deplete your system of potassium." Correct Answer: 0 ationa!e 1) ,henytoin 6Dilantin8 has a very narro' ran$e "et'een a therapeutic dose and a to4ic dose% "lood levels must "e monitored to ensure a therapeutic level and to prevent to4icity. There isn:t any evidence to support that phenytoin 6Dilantin8 causes potassium depletion. Stevens3@ohnson Syndrome is a severe skin reaction that can "e an adverse outcome 'ith phenytoin 6Dilantin8, "ut it is monitored "y skin assessment, not "lood tests. ,henytoin 6Dilantin8 is not an anticoa$ulant, and does not cause thinnin$ of the "lood. ationa!e 2) ,henytoin 6Dilantin8 has a very narro' ran$e "et'een a therapeutic dose and a to4ic dose% "lood levels must "e monitored to ensure a therapeutic level and to prevent to4icity. There isn:t any evidence to support that phenytoin 6Dilantin8 causes potassium depletion. Stevens3@ohnson Syndrome is a severe skin reaction that can "e an adverse outcome 'ith phenytoin 6Dilantin8, "ut it is monitored "y skin assessment, not "lood tests. ,henytoin 6Dilantin8 is not an anticoa$ulant, and does not cause thinnin$ of the "lood.
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

ationa!e 3) ,henytoin 6Dilantin8 has a very narro' ran$e "et'een a therapeutic dose and a to4ic dose% "lood levels must "e monitored to ensure a therapeutic level and to prevent to4icity. There isn:t any evidence to support that phenytoin 6Dilantin8 causes potassium depletion. Stevens3@ohnson Syndrome is a severe skin reaction that can "e an adverse outcome 'ith phenytoin 6Dilantin8, "ut it is monitored "y skin assessment, not "lood tests. ,henytoin 6Dilantin8 is not an anticoa$ulant, and does not cause thinnin$ of the "lood. ationa!e 4) ,henytoin 6Dilantin8 has a very narro' ran$e "et'een a therapeutic dose and a to4ic dose% "lood levels must "e monitored to ensure a therapeutic level and to prevent to4icity. There isn:t any evidence to support that phenytoin 6Dilantin8 causes potassium depletion. Stevens3@ohnson Syndrome is a severe skin reaction that can "e an adverse outcome 'ith phenytoin 6Dilantin8, "ut it is monitored "y skin assessment, not "lood tests. ,henytoin 6Dilantin8 is not an anticoa$ulant, and does not cause thinnin$ of the "lood. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Implementation &earnin$ *utcome: 023( Question 5 Type: MCSA The nurse has "een conductin$ medication education for a patient 'ith epilepsy. !hat is the "est outcome for this patient 1. The patient 'ill reco$nize that the antiseizure medication must "e continued indefinitely. 2. The patient 'ill reco$nize the need to "e on a tyramine3free diet 'hile on antiseizure medications. 3. The patient 'ill reco$nize the need to "e on a keto$enic diet in com"ination 'ith antiseizure medications. 4. The patient 'ill reco$nize the need to "e on antiseizure medication for one year after the last seizure. Correct Answer: 0 ationa!e 1) +nce seizures have "een controlled, patients are continued indefinitely on the antiseizure dru$. In $eneral, 'ithdra'al of antiseizure dru$s should only "e attempted after at least > years of "ein$ seizure free. A keto$enic diet is indicated 'hen seizures cannot "e controlled throu$h pharmacotherapy or 'hen there are unaccepta"le side effects to the medications. A tyramine3free diet is indicated for patients receivin$ monoamine o4idase inhi"itor medications. ationa!e 2) +nce seizures have "een controlled, patients are continued indefinitely on the antiseizure dru$. In $eneral, 'ithdra'al of antiseizure dru$s should only "e attempted after at least > years of "ein$ seizure free. A keto$enic diet is indicated 'hen seizures cannot "e controlled throu$h pharmacotherapy or 'hen there are unaccepta"le side effects to the medications. A tyramine3free diet is indicated for patients receivin$ monoamine o4idase inhi"itor medications.
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

ationa!e 3) +nce seizures have "een controlled, patients are continued indefinitely on the antiseizure dru$. In $eneral, 'ithdra'al of antiseizure dru$s should only "e attempted after at least > years of "ein$ seizure free. A keto$enic diet is indicated 'hen seizures cannot "e controlled throu$h pharmacotherapy or 'hen there are unaccepta"le side effects to the medications. A tyramine3free diet is indicated for patients receivin$ monoamine o4idase inhi"itor medications. ationa!e 4) +nce seizures have "een controlled, patients are continued indefinitely on the antiseizure dru$. In $eneral, 'ithdra'al of antiseizure dru$s should only "e attempted after at least > years of "ein$ seizure free. A keto$enic diet is indicated 'hen seizures cannot "e controlled throu$h pharmacotherapy or 'hen there are unaccepta"le side effects to the medications. A tyramine3free diet is indicated for patients receivin$ monoamine o4idase inhi"itor medications. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) ,lannin$ &earnin$ *utcome: 0232 Question , Type: MCSA The physician has ordered intravenous 6IA8 diazepam 6Aalium8 for the patient in status epilepticus. Durin$ administration, 'hich assessment "y the nurse is most important 1. Assessin$ respirations every 2 to 02 minutes 2. Assessin$ level of consciousness 3. Assessin$ pulse for "radycardia 4. Assessin$ "lood pressure for hypertension Correct Answer: 0 ationa!e 1) =espiratory depression is common 'hen diazepam is $iven intravenously 6IA8. =espiratory assessment is the priority. Althou$h hypotension is an effect of intravenous diazepam 6Aalium8, it is not the top priority. Althou$h tachycardia is an effect of intravenous diazepam 6Aalium8, it is not the top priority. Assessin$ respirations is a hi$her priority than assessin$ the level of consciousness. ationa!e 2) =espiratory depression is common 'hen diazepam is $iven intravenously 6IA8. =espiratory assessment is the priority. Althou$h hypotension is an effect of intravenous diazepam 6Aalium8, it is not the top priority. Althou$h tachycardia is an effect of intravenous diazepam 6Aalium8, it is not the top priority. Assessin$ respirations is a hi$her priority than assessin$ the level of consciousness. ationa!e 3) =espiratory depression is common 'hen diazepam is $iven intravenously 6IA8. =espiratory assessment is the priority. Althou$h hypotension is an effect of intravenous diazepam 6Aalium8, it is not the top
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

priority. Althou$h tachycardia is an effect of intravenous diazepam 6Aalium8, it is not the top priority. Assessin$ respirations is a hi$her priority than assessin$ the level of consciousness. ationa!e 4) =espiratory depression is common 'hen diazepam is $iven intravenously 6IA8. =espiratory assessment is the priority. Althou$h hypotension is an effect of intravenous diazepam 6Aalium8, it is not the top priority. Althou$h tachycardia is an effect of intravenous diazepam 6Aalium8, it is not the top priority. Assessin$ respirations is a hi$her priority than assessin$ the level of consciousness. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Assessment &earnin$ *utcome: 023B Question Type: MCSA The physician has ordered intravenous 6IA8 phenytoin 6Dilantin8. The nurse does not read the dru$ la"el and administers the medication intramuscularly 6IM8. !hat is the most likely response in the patient 1. ;ocal tissue dama$e follo'in$ e4travasation 'ill most likely occur. 2. A phenomenon kno'n as purple $luteus syndrome 'ill most likely occur. 3. A marked decrease in serum $lucose levels 'ill most likely occur. 4. 1othin$ adverse, the medication may "e administered intravenously 6IA8 or intramuscularly 6IM8. Correct Answer: 0 ationa!e 1) ,henytoin 6Dilantin8 in5ecta"le is a soft3tissue irritant that causes local tissue dama$e follo'in$ e4travasation. It should not "e administered intramuscularly, "ut should "e $iven intravenously into a lar$e vein or via a central catheter. There isn:t any such thin$ as purple $luteus syndrome% purple $love syndrome occurs 'hen phenytoin 6Dilantin8 is administered in a hand vein, and causes a serious local vasoconstrictive response. ,henytoin 6Dilantin8 causes an increase in serum $lucose. ationa!e 2) ,henytoin 6Dilantin8 in5ecta"le is a soft3tissue irritant that causes local tissue dama$e follo'in$ e4travasation. It should not "e administered intramuscularly, "ut should "e $iven intravenously into a lar$e vein or via a central catheter. There isn:t any such thin$ as purple $luteus syndrome% purple $love syndrome occurs 'hen phenytoin 6Dilantin8 is administered in a hand vein, and causes a serious local vasoconstrictive response. ,henytoin 6Dilantin8 causes an increase in serum $lucose. ationa!e 3) ,henytoin 6Dilantin8 in5ecta"le is a soft3tissue irritant that causes local tissue dama$e follo'in$ e4travasation. It should not "e administered intramuscularly, "ut should "e $iven intravenously into a lar$e vein or via a central catheter. There isn:t any such thin$ as purple $luteus syndrome% purple $love syndrome occurs
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

'hen phenytoin 6Dilantin8 is administered in a hand vein, and causes a serious local vasoconstrictive response. ,henytoin 6Dilantin8 causes an increase in serum $lucose. ationa!e 4) ,henytoin 6Dilantin8 in5ecta"le is a soft3tissue irritant that causes local tissue dama$e follo'in$ e4travasation. It should not "e administered intramuscularly, "ut should "e $iven intravenously into a lar$e vein or via a central catheter. There isn:t any such thin$ as purple $luteus syndrome% purple $love syndrome occurs 'hen phenytoin 6Dilantin8 is administered in a hand vein, and causes a serious local vasoconstrictive response. ,henytoin 6Dilantin8 causes an increase in serum $lucose. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) *valuation &earnin$ *utcome: 023B Question . Type: MCMA The physician has ordered intravenous phenytoin 6Dilantin8. The patient is also receivin$ 2C de4trose in 'ater 6D2!8 intravenously 6IA8. !hat 'ill the nurse plan to do "efore administerin$ this medication Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. Dse a lar$e vein for the infusion. 2. Dse an intravenous 6IA8 line 'ith a filter. 3. Elush the intravenous 6IA8 line 'ith saline. 4. Monitor the patient for hypertension. 5. Monitor the patient for Stevens3@ohnson Syndrome. Correct Answer: 0,.,> ationa!e 1) Intravenous lines of 2C de4trose in 'ater 6D2!8 must "e flushed 'ith saline, as traces of de4trose can cause microscopic precipitate formations that "ecome em"oli, if infused. An intravenous filter 'ill trap any precipitate that occurs. ,henytoin 6Dilantin8 is a soft3tissue irritant that 'ill cause local tissue dama$e if e4travasation occurs, so a lar$e vein must "e used for infusion. ,atients receivin$ phenytoin 6Dilantin8 are at risk for hypotension, not hypertension. Stevens3@ohnson syndrome is a side effect of phenytoin 6Dilantin8, "ut it takes days to occur.

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

ationa!e 2) Intravenous lines of 2C de4trose in 'ater 6D2!8 must "e flushed 'ith saline, as traces of de4trose can cause microscopic precipitate formations that "ecome em"oli, if infused. An intravenous filter 'ill trap any precipitate that occurs. ,henytoin 6Dilantin8 is a soft3tissue irritant that 'ill cause local tissue dama$e if e4travasation occurs, so a lar$e vein must "e used for infusion. ,atients receivin$ phenytoin 6Dilantin8 are at risk for hypotension, not hypertension. Stevens3@ohnson syndrome is a side effect of phenytoin 6Dilantin8, "ut it takes days to occur. ationa!e 3) Intravenous lines of 2C de4trose in 'ater 6D2!8 must "e flushed 'ith saline, as traces of de4trose can cause microscopic precipitate formations that "ecome em"oli, if infused. An intravenous filter 'ill trap any precipitate that occurs. ,henytoin 6Dilantin8 is a soft3tissue irritant that 'ill cause local tissue dama$e if e4travasation occurs, so a lar$e vein must "e used for infusion. ,atients receivin$ phenytoin 6Dilantin8 are at risk for hypotension, not hypertension. Stevens3@ohnson syndrome is a side effect of phenytoin 6Dilantin8, "ut it takes days to occur. ationa!e 4) Intravenous lines of 2C de4trose in 'ater 6D2!8 must "e flushed 'ith saline, as traces of de4trose can cause microscopic precipitate formations that "ecome em"oli, if infused. An intravenous filter 'ill trap any precipitate that occurs. ,henytoin 6Dilantin8 is a soft3tissue irritant that 'ill cause local tissue dama$e if e4travasation occurs, so a lar$e vein must "e used for infusion. ,atients receivin$ phenytoin 6Dilantin8 are at risk for hypotension, not hypertension. Stevens3@ohnson syndrome is a side effect of phenytoin 6Dilantin8, "ut it takes days to occur. ationa!e 5) Intravenous lines of 2C de4trose in 'ater 6D2!8 must "e flushed 'ith saline, as traces of de4trose can cause microscopic precipitate formations that "ecome em"oli, if infused. An intravenous filter 'ill trap any precipitate that occurs. ,henytoin 6Dilantin8 is a soft3tissue irritant that 'ill cause local tissue dama$e if e4travasation occurs, so a lar$e vein must "e used for infusion. ,atients receivin$ phenytoin 6Dilantin8 are at risk for hypotension, not hypertension. Stevens3@ohnson syndrome is a side effect of phenytoin 6Dilantin8, "ut it takes days to occur. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) ,lannin$ &earnin$ *utcome: 023F Question / Type: MCSA The patient is receivin$ valproic acid 6Depakene8 for treatment of seizures. The patient has also "een takin$ a daily F0 m$ aspirin ta"let prophylactically for a cardiac condition. !hat 'ould the nurse "e most likely to o"serve 1. An increase in seizure activity 2. Stevens3@ohnson syndrome 3. Mi$raine headaches and $eneralized irrita"ility
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

4. ?leedin$ from the $ums and "ruisin$ of the skin Correct Answer: ( ationa!e 1) Aalproic acid 6Depakene8 can prolon$ "leedin$ time% concomitant aspirin use can cause severe "leedin$. Increased seizure activity is not associated 'ith valproic acid 6Depakene8 and aspirin use. Stevens3 @ohnson syndrome is a side effect of valproic acid 6Depakene8% its occurrence is not increased 'ith concomitant aspirin use. Mi$raine headaches and $eneralized irrita"ility do not result from valproic acid 6Depakene8 and aspirin use. ationa!e 2) Aalproic acid 6Depakene8 can prolon$ "leedin$ time% concomitant aspirin use can cause severe "leedin$. Increased seizure activity is not associated 'ith valproic acid 6Depakene8 and aspirin use. Stevens3 @ohnson syndrome is a side effect of valproic acid 6Depakene8% its occurrence is not increased 'ith concomitant aspirin use. Mi$raine headaches and $eneralized irrita"ility do not result from valproic acid 6Depakene8 and aspirin use. ationa!e 3) Aalproic acid 6Depakene8 can prolon$ "leedin$ time% concomitant aspirin use can cause severe "leedin$. Increased seizure activity is not associated 'ith valproic acid 6Depakene8 and aspirin use. Stevens3 @ohnson syndrome is a side effect of valproic acid 6Depakene8% its occurrence is not increased 'ith concomitant aspirin use. Mi$raine headaches and $eneralized irrita"ility do not result from valproic acid 6Depakene8 and aspirin use. ationa!e 4) Aalproic acid 6Depakene8 can prolon$ "leedin$ time% concomitant aspirin use can cause severe "leedin$. Increased seizure activity is not associated 'ith valproic acid 6Depakene8 and aspirin use. Stevens3 @ohnson syndrome is a side effect of valproic acid 6Depakene8% its occurrence is not increased 'ith concomitant aspirin use. Mi$raine headaches and $eneralized irrita"ility do not result from valproic acid 6Depakene8 and aspirin use. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Assessment &earnin$ *utcome: 023B Question 10 Type: MCSA The patient is receivin$ ,heno"ar"ital 6;uminal8 for control of seizures. The patient tells the nurse she plans to "ecome pre$nant. !hat is the "est response of the nurse 1. "&our medication dose 'ill need to "e decreased durin$ your pre$nancy." 2. ",lease talk to your doctor% this dru$ is contraindicated in pre$nancy." 3. "&our medication dose 'ill need to "e increased durin$ your pre$nancy."
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

4. ",lease talk to your doctor% you 'ill need a safer dru$ like valproic acid 6Depakene8." Correct Answer: . ationa!e 1) ,heno"ar"ital 6;uminal8 falls under ,re$nancy Cate$ory D, and is contraindicated in pre$nancy. The medication does not need to "e increased% it mi$ht need to "e stopped. The medication does not need to "e decreased% it mi$ht need to "e stopped. Aalproic acid 6Depakene8 is also a ,re$nancy Cate$ory D dru$ and is contraindicated durin$ pre$nancy. ationa!e 2) ,heno"ar"ital 6;uminal8 falls under ,re$nancy Cate$ory D, and is contraindicated in pre$nancy. The medication does not need to "e increased% it mi$ht need to "e stopped. The medication does not need to "e decreased% it mi$ht need to "e stopped. Aalproic acid 6Depakene8 is also a ,re$nancy Cate$ory D dru$ and is contraindicated durin$ pre$nancy. ationa!e 3) ,heno"ar"ital 6;uminal8 falls under ,re$nancy Cate$ory D, and is contraindicated in pre$nancy. The medication does not need to "e increased% it mi$ht need to "e stopped. The medication does not need to "e decreased% it mi$ht need to "e stopped. Aalproic acid 6Depakene8 is also a ,re$nancy Cate$ory D dru$ and is contraindicated durin$ pre$nancy. ationa!e 4) ,heno"ar"ital 6;uminal8 falls under ,re$nancy Cate$ory D, and is contraindicated in pre$nancy. The medication does not need to "e increased% it mi$ht need to "e stopped. The medication does not need to "e decreased% it mi$ht need to "e stopped. Aalproic acid 6Depakene8 is also a ,re$nancy Cate$ory D dru$ and is contraindicated durin$ pre$nancy. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Implementation &earnin$ *utcome: 023B Question 11 Type: MCSA The patient tells the nurse that she has "een takin$ phenytoin 6Dilantin8 for . years no' and is still havin$ too many side effects. She 'ants to stop takin$ it. !hat is the "est response "y the nurse 1. ",lease do not stop the medication a"ruptly, as you 'ill have 'ithdra'al seizures." 2. "Side effects are a pro"lem, "ut they are not as "ad as the seizures you 'ere havin$." 3. "This is the "est medication for you% 'e can add another medication to decrease side effects." 4. "&ou have pro"a"ly "een on the medication lon$ enou$h% I:ll let your doctor kno' you are stoppin$ it." Correct Answer: 0
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

ationa!e 1) Seizures are likely to occur 'ith a"rupt 'ithdra'al of antiseizure medication. The medication must "e 'ithdra'n over a period of B to 0. 'eeks. There is no other medication that can "e added to decrease the side effects associated 'ith phenytoin 6Dilantin8. The nurse does not kno' if the patient has "een on the medication lon$ enou$h, and the patient must "e informed of the conse9uences of a"ruptly stoppin$ the medication. Tellin$ a patient that medication side effects are not as "ad as seizures is an inappropriate and non3therapeutic response that does not address the patient:s concerns. ationa!e 2) Seizures are likely to occur 'ith a"rupt 'ithdra'al of antiseizure medication. The medication must "e 'ithdra'n over a period of B to 0. 'eeks. There is no other medication that can "e added to decrease the side effects associated 'ith phenytoin 6Dilantin8. The nurse does not kno' if the patient has "een on the medication lon$ enou$h, and the patient must "e informed of the conse9uences of a"ruptly stoppin$ the medication. Tellin$ a patient that medication side effects are not as "ad as seizures is an inappropriate and non3therapeutic response that does not address the patient:s concerns. ationa!e 3) Seizures are likely to occur 'ith a"rupt 'ithdra'al of antiseizure medication. The medication must "e 'ithdra'n over a period of B to 0. 'eeks. There is no other medication that can "e added to decrease the side effects associated 'ith phenytoin 6Dilantin8. The nurse does not kno' if the patient has "een on the medication lon$ enou$h, and the patient must "e informed of the conse9uences of a"ruptly stoppin$ the medication. Tellin$ a patient that medication side effects are not as "ad as seizures is an inappropriate and non3therapeutic response that does not address the patient:s concerns. ationa!e 4) Seizures are likely to occur 'ith a"rupt 'ithdra'al of antiseizure medication. The medication must "e 'ithdra'n over a period of B to 0. 'eeks. There is no other medication that can "e added to decrease the side effects associated 'ith phenytoin 6Dilantin8. The nurse does not kno' if the patient has "een on the medication lon$ enou$h, and the patient must "e informed of the conse9uences of a"ruptly stoppin$ the medication. Tellin$ a patient that medication side effects are not as "ad as seizures is an inappropriate and non3therapeutic response that does not address the patient:s concerns. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Implementation &earnin$ *utcome: 023B Question 12 Type: MCSA The physician has prescri"ed phenytoin 6Dilantin8 for a patient 'ith type 0 dia"etes mellitus. !hat does the nurse include in the plan of care for this patient 1. ,lan to discuss 'ith the physician the need to decrease the patient:s insulin "ased on serum $lucose levels. 2. ,lan to discuss 'ith the physician the need to increase the patient:s insulin "ased on serum $lucose levels. 3. ,lan to assess the patient for petechiae, epista4is, and hematuria.
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

4. ,lan to institute safety precautions, as the patient is at risk for dizziness and ata4ia. Correct Answer: . ationa!e 1) ,henytoin 6Dilantin8 can increase serum $lucose levels and the patient may need additional insulin. All patients receivin$ phenytoin 6Dilantin8 are at risk for dizziness and ata4ia% this is not specific to the patient 'ith type 0 dia"etes mellitus. All patients receivin$ phenytoin 6Dilantin8 are at risk for petechiae, epista4is, and hematuria% this is not specific to the patient 'ith type 0 dia"etes mellitus. ,henytoin 6Dilantin8 can increase serum $lucose levels, not decrease them. ationa!e 2) ,henytoin 6Dilantin8 can increase serum $lucose levels and the patient may need additional insulin. All patients receivin$ phenytoin 6Dilantin8 are at risk for dizziness and ata4ia% this is not specific to the patient 'ith type 0 dia"etes mellitus. All patients receivin$ phenytoin 6Dilantin8 are at risk for petechiae, epista4is, and hematuria% this is not specific to the patient 'ith type 0 dia"etes mellitus. ,henytoin 6Dilantin8 can increase serum $lucose levels, not decrease them. ationa!e 3) ,henytoin 6Dilantin8 can increase serum $lucose levels and the patient may need additional insulin. All patients receivin$ phenytoin 6Dilantin8 are at risk for dizziness and ata4ia% this is not specific to the patient 'ith dia"etes mellitus, type 0. All patients receivin$ phenytoin 6Dilantin8 are at risk for petechiae, epista4is, and hematuria% this is not specific to the patient 'ith type 0 dia"etes mellitus. ,henytoin 6Dilantin8 can increase serum $lucose levels, not decrease them. ationa!e 4) ,henytoin 6Dilantin8 can increase serum $lucose levels and the patient may need additional insulin. All patients receivin$ phenytoin 6Dilantin8 are at risk for dizziness and ata4ia% this is not specific to the patient 'ith type 0 dia"etes mellitus. All patients receivin$ phenytoin 6Dilantin8 are at risk for petechiae, epista4is, and hematuria% this is not specific to the patient 'ith type 0 dia"etes mellitus. ,henytoin 6Dilantin8 can increase serum $lucose levels, not decrease them. "!o#a! ationa!e: Co$niti%e &e%e!: Analyzin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) ,lannin$ &earnin$ *utcome: 023B Question 13 Type: MCSA The youn$ child has a"sence seizures. The physician has prescri"ed valproic acid 6Depakene8 syrup. The nurse has completed medication education 'ith the child:s mother and determines that learnin$ has occurred 'hen the mother makes 'hich statement 1. "I should not mi4 this 'ith car"onated "evera$es." 2. "If my child $ets a headache from this, I can administer a "a"y aspirin."
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

3. "I can still $ive the clonazepam 6Glonopin8 prescri"ed "y the psychiatrist for sleep." 4. "I can $ive this on a full stomach or an empty stomach." Correct Answer: 0 ationa!e 1) Mi4in$ valproic acid 6Depakene8 syrup 'ith car"onated "evera$es 'ill tri$$er immediate release of the dru$, 'hich causes severe mouth and throat irritation. Aalproic acid 6Depakene8 is a $astrointestinal 6<I8 irritant and should "e $iven 'ith food. Aspirin can increase valproic acid 6Depakene8 to4icity, and aspirin should not "e $iven to children "ecause of =eye syndrome. Clonazepam 6Glonopin8 $iven 'ith valproic acid 6Depakene8 can induce a"sence seizures. ationa!e 2) Mi4in$ valproic acid 6Depakene8 syrup 'ith car"onated "evera$es 'ill tri$$er immediate release of the dru$, 'hich causes severe mouth and throat irritation. Aalproic acid 6Depakene8 is a $astrointestinal 6<I8 irritant and should "e $iven 'ith food. Aspirin can increase valproic acid 6Depakene8 to4icity, and aspirin should not "e $iven to children "ecause of =eye syndrome. Clonazepam 6Glonopin8 $iven 'ith valproic acid 6Depakene8 can induce a"sence seizures. ationa!e 3) Mi4in$ valproic acid 6Depakene8 syrup 'ith car"onated "evera$es 'ill tri$$er immediate release of the dru$, 'hich causes severe mouth and throat irritation. Aalproic acid 6Depakene8 is a $astrointestinal 6<I8 irritant and should "e $iven 'ith food. Aspirin can increase valproic acid 6Depakene8 to4icity, and aspirin should not "e $iven to children "ecause of =eye syndrome. Clonazepam 6Glonopin8 $iven 'ith valproic acid 6Depakene8 can induce a"sence seizures. ationa!e 4) Mi4in$ valproic acid 6Depakene8 syrup 'ith car"onated "evera$es 'ill tri$$er immediate release of the dru$, 'hich causes severe mouth and throat irritation. Aalproic acid 6Depakene8 is a $astrointestinal 6<I8 irritant and should "e $iven 'ith food. Aspirin can increase valproic acid 6Depakene8 to4icity, and aspirin should not "e $iven to children "ecause of =eye syndrome. Clonazepam 6Glonopin8 $iven 'ith valproic acid 6Depakene8 can induce a"sence seizures. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) *valuation &earnin$ *utcome: 023B Question 14 Type: MCSA The patient is receivin$ pheno"ar"ital 6;uminal8 for seizure control. The patient asks the nurse ho' this little pill can stop his seizures. !hat is the "est response "y the nurse 1. ",heno"ar"ital 6;uminal8 stops your seizures "y decreasin$ the calcium in your "rain 'hich is responsi"le for the seizures."

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

2. ",heno"ar"ital 6;uminal8 stops your seizures "y increasin$ a chemical called $lutamate that calms do'n the e4cita"ility in your "rain." 3. ",heno"ar"ital 6;uminal8 stops your seizures "y decreasin$ the sodium in your "rain 'hich is responsi"le for the seizures." 4. ",heno"ar"ital 6;uminal8 stops your seizures "y increasin$ a chemical called <A?A that calms do'n the e4cita"ility in your "rain." Correct Answer: ( ationa!e 1) ,heno"ar"ital 6;uminal8 acts "iochemically in the "rain "y enhancin$ the action of the neurotransmitter <A?A, 'hich is responsi"le for suppressin$ a"normal neuronal dischar$es that can cause epilepsy. <lutamate is the primary e4citatory neurotransmitter in the "rain% enhancin$ this neurotransmitter 'ill increase the likelihood of seizures. #ydantoins and phenytoin3like dru$s, not pheno"ar"ital 6;uminal8, suppress sodium influ4. Succinimides, not pheno"ar"ital 6;uminal8, suppress calcium influ4. ationa!e 2) ,heno"ar"ital 6;uminal8 acts "iochemically in the "rain "y enhancin$ the action of the neurotransmitter <A?A, 'hich is responsi"le for suppressin$ a"normal neuronal dischar$es that can cause epilepsy. <lutamate is the primary e4citatory neurotransmitter in the "rain% enhancin$ this neurotransmitter 'ill increase the likelihood of seizures. #ydantoins and phenytoin3like dru$s, not pheno"ar"ital 6;uminal8, suppress sodium influ4. Succinimides, not pheno"ar"ital 6;uminal8, suppress calcium influ4. ationa!e 3) ,heno"ar"ital 6;uminal8 acts "iochemically in the "rain "y enhancin$ the action of the neurotransmitter <A?A, 'hich is responsi"le for suppressin$ a"normal neuronal dischar$es that can cause epilepsy. <lutamate is the primary e4citatory neurotransmitter in the "rain% enhancin$ this neurotransmitter 'ill increase the likelihood of seizures. #ydantoins and phenytoin3like dru$s, not pheno"ar"ital 6;uminal8, suppress sodium influ4. Succinimides, not pheno"ar"ital 6;uminal8, suppress calcium influ4. ationa!e 4) ,heno"ar"ital 6;uminal8 acts "iochemically in the "rain "y enhancin$ the action of the neurotransmitter <A?A, 'hich is responsi"le for suppressin$ a"normal neuronal dischar$es that can cause epilepsy. <lutamate is the primary e4citatory neurotransmitter in the "rain% enhancin$ this neurotransmitter 'ill increase the likelihood of seizures. #ydantoins and phenytoin3like dru$s, not pheno"ar"ital 6;uminal8, suppress sodium influ4. Succinimides, not pheno"ar"ital 6;uminal8, suppress calcium influ4. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Implementation &earnin$ *utcome: 023H Question 15 Type: MCSA The elderly patient is takin$ pheno"ar"ital 6;uminal8 for seizure control. !hat is most important for the nurse to assess in the patient
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

1. Eluid intake 2. *lectrolyte "alance 3. =espiratory function 4. 1utritional status Correct Answer: > ationa!e 1) *lderly patients are at risk for cumulative effects of "ar"iturates due to diminished hepatic and renal function. Central nervous system 6C1S8 depression can lead to suppression of respiratory function. 1utritional status is important 'ith elderly patients, "ut is not the primary concern. Eluid intake is often decreased in elderly patients, "ut is not a side effect of "ar"iturates. ?ar"iturates do not affect electrolyte "alance. ationa!e 2) *lderly patients are at risk for cumulative effects of "ar"iturates due to diminished hepatic and renal function. Central nervous system 6C1S8 depression can lead to suppression of respiratory function. 1utritional status is important 'ith elderly patients, "ut is not the primary concern. Eluid intake is often decreased in elderly patients, "ut is not a side effect of "ar"iturates. ?ar"iturates do not affect electrolyte "alance. ationa!e 3) *lderly patients are at risk for cumulative effects of "ar"iturates due to diminished hepatic and renal function. Central nervous system 6C1S8 depression can lead to suppression of respiratory function. 1utritional status is important 'ith elderly patients, "ut is not the primary concern. Eluid intake is often decreased in elderly patients, "ut is not a side effect of "ar"iturates. ?ar"iturates do not affect electrolyte "alance. ationa!e 4) *lderly patients are at risk for cumulative effects of "ar"iturates due to diminished hepatic and renal function. Central nervous system 6C1S8 depression can lead to suppression of respiratory function. 1utritional status is important 'ith elderly patients, "ut is not the primary concern. Eluid intake is often decreased in elderly patients, "ut is not a side effect of "ar"iturates. ?ar"iturates do not affect electrolyte "alance. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Assessment &earnin$ *utcome: 023B Question 1, Type: MCSA Identify the correct statement re$ardin$ seizures. 1. Convulsions are a symptom of the underlyin$ seizure disorder. 2. Seizures can "e caused "y "acterial infections of the nervous system. 3. *pilepsy is an acute disorder characterized "y non3convulsive seizures.
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

4. All seizures are convulsions, "ut not all convulsions are seizures. Correct Answer: . ationa!e 1) Several thin$s, includin$ "acterial infections, can cause seizures. All convulsions are seizures, "ut not all seizures are convulsions. Convulsions are a type of seizure, and seizures are a symptom of an underlyin$ disorder. *pilepsy is $enerally chronic, and can present 'ith convulsive seizures. ationa!e 2) Several thin$s, includin$ "acterial infections, can cause seizures. All convulsions are seizures, "ut not all seizures are convulsions. Convulsions are a type of seizure, and seizures are a symptom of an underlyin$ disorder. *pilepsy is $enerally chronic, and can present 'ith convulsive seizures. ationa!e 3) Several thin$s, includin$ "acterial infections, can cause seizures. All convulsions are seizures, "ut not all seizures are convulsions. Convulsions are a type of seizure, and seizures are a symptom of an underlyin$ disorder. *pilepsy is $enerally chronic, and can present 'ith convulsive seizures. ationa!e 4) Several thin$s, includin$ "acterial infections, can cause seizures. All convulsions are seizures, "ut not all seizures are convulsions. Convulsions are a type of seizure, and seizures are a symptom of an underlyin$ disorder. *pilepsy is $enerally chronic, and can present 'ith convulsive seizures. "!o#a! ationa!e: Co$niti%e &e%e!: =emem"erin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) *valuation &earnin$ *utcome: 0230 and 023. Question 1Type: MCSA A person 'ho stops talkin$ mid3sentence and has a "lank stare for 2 seconds 'ould most likely "e e4periencin$ 1. a partial seizure. 2. a $rand mal seizure. 3. a petit mal seizure. 4. A convulsion. Correct Answer: > ationa!e 1) The symptoms presented indicate a $eneral 6a"sence8 or petit mal seizure. ationa!e 2) The symptoms presented indicate a $eneral 6a"sence8 or petit mal seizure. ationa!e 3) The symptoms presented indicate a $eneral 6a"sence8 or petit mal seizure.
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

ationa!e 4) the symptoms presented indicate a $eneral 6a"sence8 or petit mal seizure. "!o#a! ationa!e: Co$niti%e &e%e!: =emem"erin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Assessment &earnin$ *utcome: 023> Question 1. Type: MCSA Aitamin D deficiency 'ould most likely "e seen in a patient 'ith seizures 'ho is "ein$ treated 'ith 'hich dru$ type 1. ,henytoin3like a$ents 2. ?enzodiazepines 3. ?ar"iturates 4. #ydantoins Correct Answer: > ationa!e 1) ?ar"iturates can cause a vitamin D deficiency. ationa!e 2) ?ar"iturates can cause a vitamin D deficiency. ationa!e 3) ?ar"iturates can cause a vitamin D deficiency. ationa!e 4) ?ar"iturates can cause a vitamin D deficiency. "!o#a! ationa!e: Co$niti%e &e%e!: =emem"erin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Assessment &earnin$ *utcome: 023B Question 1/ Type: MCSA

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

A lo'3income patient 'ithout insurance has "een prescri"ed several different medications over several months for seizure control 'ithout any improvement. The patient indicates she has not e4perienced any adverse effects. At this point the nurse should 1. recommend nontypical dru$ use. 2. inform the patient that it mi$ht take years for the medications to 'ork. 3. assess for medication compliance. 4. advise the patient to dou"le the current dose. Correct Answer: > ationa!e 1) Due to the financial situation presented and a"sence of any side effects, it is possi"le the patient is not in compliance. The nurse should assess for this possi"ility at this point. Another dru$ mi$ht "e indicated, "ut compliance should "e assessed first. It $enerally doesn:t take years for seizure medications to 'ork. Chan$in$ the prescri"ed dose of a medication is not 'ithin the scope of practice of the nurse. ationa!e 2) Due to the financial situation presented and a"sence of any side effects, it is possi"le the patient is not in compliance. The nurse should assess for this possi"ility at this point. Another dru$ mi$ht "e indicated, "ut compliance should "e assessed first. It $enerally doesn:t take years for seizure medications to 'ork. Chan$in$ the prescri"ed dose of a medication is not 'ithin the scope of practice of the nurse. ationa!e 3) Due to the financial situation presented and a"sence of any side effects, it is possi"le the patient is not in compliance. The nurse should assess for this possi"ility at this point. Another dru$ mi$ht "e indicated, "ut compliance should "e assessed first. It $enerally doesn:t take years for seizure medications to 'ork. Chan$in$ the prescri"ed dose of a medication is not 'ithin the scope of practice of the nurse. ationa!e 4) Due to the financial situation presented and a"sence of any side effects, it is possi"le the patient is not in compliance. The nurse should assess for this possi"ility at this point. Another dru$ mi$ht "e indicated, "ut compliance should "e assessed first. It $enerally doesn:t take years for seizure medications to 'ork. Chan$in$ the prescri"ed dose of a medication is not 'ithin the scope of practice of the nurse. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Assessment &earnin$ *utcome: 0232 Question 20 Type: MCSA !hich of the follo'in$ adverse effects 'ould most likely "e associated 'ith the use of phenytoin 6Dilantin8
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

1. Aitamin ? deficiency 2. ;e$ edema 3. ?leedin$ 4. #ypo$lycemia Correct Answer: > ationa!e 1) Dilantin affects the meta"olism of vitamin G, 'hich can lead to "lood dyscrasias. #yper$lycemia is more common than hypo$lycemia, and le$ edema is not $enerally e4perienced as an adverse effect. ationa!e 2) Dilantin affects the meta"olism of vitamin G, 'hich can lead to "lood dyscrasias. #yper$lycemia is more common than hypo$lycemia, and le$ edema is not $enerally e4perienced as an adverse effect. ationa!e 3) Dilantin affects the meta"olism of vitamin G, 'hich can lead to "lood dyscrasias. #yper$lycemia is more common than hypo$lycemia, and le$ edema is not $enerally e4perienced as an adverse effect. ationa!e 4) Dilantin affects the meta"olism of vitamin G, 'hich can lead to "lood dyscrasias. #yper$lycemia is more common than hypo$lycemia, and le$ edema is not $enerally e4perienced as an adverse effect. "!o#a! ationa!e: Co$niti%e &e%e!: Dnderstandin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Assessment &earnin$ *utcome: 023B Question 21 Type: MCSA A dru$ that is used to treat petit mal seizures "ut not tonic3clonic seizures and 'orks "y decreasin$ neuronal activity in the motor corte4 is 1. diazepam 6Aalium8. 2. valproic acid 6Depakote8. 3. phenytoin 6Dilantin8. 4. ethosu4imide 67arontin8. Correct Answer: ( ationa!e 1) Succinimides like 7arontin use indicated for petit mal seizures, "ut not for tonic3clonic seizures. Depakote, Aalium, and Dilantin can "e effective for tonic3clonic seizures.
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

ationa!e 2) Succinimides like 7arontin use indicated for petit mal seizures, "ut not for tonic3clonic seizures. Depakote, Aalium, and Dilantin can "e effective for tonic3clonic seizures. ationa!e 3) Succinimides like 7arontin use indicated for petit mal seizures, "ut not for tonic3clonic seizures. Depakote, Aalium, and Dilantin can "e effective for tonic3clonic seizures. ationa!e 4) Succinimides like 7arontin use indicated for petit mal seizures, "ut not for tonic3clonic seizures. Depakote, Aalium, and Dilantin can "e effective for tonic3clonic seizures. "!o#a! ationa!e: Co$niti%e &e%e!: =emem"erin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Assessment &earnin$ *utcome: 023H Question 22 Type: MCSA !hich of the follo'in$ seizure dru$s is most likely to "e administered IA and result in soft tissue dama$e follo'in$ e4travasation 1. ,heno"ar"ital 6;uminal8 2. ,henytoin 6Dilantin8 3. *thosu4imide 67arontin8 4. Clonazepam 6Glonopin8 Correct Answer: . ationa!e 1) Dilantin is fre9uently administered IA due to slo' and varia"le a"sorption rates 'hen $iven orally. If Dilantin e4travasates, serious soft tissue dama$e can result. 7arontin and Glonopin are oral medications. ,heno"ar"ital 'ould "e more likely to "e administered orally. ationa!e 2) Dilantin is fre9uently administered IA due to slo' and varia"le a"sorption rates 'hen $iven orally. If Dilantin e4travasates, serious soft tissue dama$e can result. 7arontin and Glonopin are oral medications. ,heno"ar"ital 'ould "e more likely to "e administered orally. ationa!e 3) Dilantin is fre9uently administered IA due to slo' and varia"le a"sorption rates 'hen $iven orally. If Dilantin e4travasates, serious soft tissue dama$e can result. 7arontin and Glonopin are oral medications. ,heno"ar"ital 'ould "e more likely to "e administered orally. ationa!e 4) Dilantin is fre9uently administered IA due to slo' and varia"le a"sorption rates 'hen $iven orally. If Dilantin e4travasates, serious soft tissue dama$e can result. 7arontin and Glonopin are oral medications. ,heno"ar"ital 'ould "e more likely to "e administered orally.
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

"!o#a! ationa!e: Co$niti%e &e%e!: =emem"erin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Implementation &earnin$ *utcome: 023H Question 23 Type: MCMA The health care provider has ordered 2 m$ of intravenous diazepam 6Aalium8 to treat the patient in status epilepticus. The patient:s IA "a$ is la"eled "0,/// m; D21S 'ith ./,/// units #eparin." !hat nursin$ interventions are necessary to safely administer this diazepam 6Aalium8 Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. Dse a lar$e "ore needle to access the IA port. 2. Elush the intravenous 6IA8 line 'ith saline. 3. Administer the diazepam 6Aalium8 directly into a vein in the patient:s hand. 4. Dilute the diazepam 6Aalium8 'ith 4ylocaine prior to administration. 5. +"serve the IA tu"in$ for cloudiness 'hile administerin$ the diazepam 6Aalium8. Correct Answer: .,2 ationa!e 1) There is no need to use a lar$e "ore needle. Most IA administration is done usin$ a needleless system. ationa!e 2) The IA line should "e 'ell flushed 'ith saline to remove any residual heparin, 'hich 'ill precipitate 'ith the diazepam 6Aalium8. ationa!e 3) Direct administration of IA medication is not recommended. The patient receivin$ IA diazepam 6Aalium8 should have an IA esta"lished for possi"le emer$ency use. ationa!e 4) Diazepam 6Aalium8 precipitates 'ith many dru$s and should not "e mi4ed for infusion. ationa!e 5) Diazepam 6Aalium8 precipitates 'ith many dru$s. The nurse should 'atch the IA tu"in$ 5ust a"ove the in5ection site for cloudiness or development of precipitate durin$ administration and should discontinue the administration if this situation occurs. "!o#a! ationa!e:
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: ,harmacolo$ical and ,arenteral Therapies 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) ,lannin$ &earnin$ *utcome: 023B Question 24 Type: MCMA The nurse has completed education to the parents of a child ne'ly dia$nosed 'ith tonic3clonic seizures. !hich comments made "y the parents 'ould the nurse evaluate as indicatin$ need for further education Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. "Some of the times 'hen I thou$ht he 'as i$norin$ me may have actually "een seizure activity." 2. "#e 5ust needs to focus more to prevent these attacks." 3. "I kno' he 'ill out$ro' these seizures 'ith time." 4. "I hope 'e can help our son identify his seizure aura." 5. "!e 'ill 'atch for the development of status epilepticus." Correct Answer: 0,.,> ationa!e 1) ?ehavior that manifests as the child i$norin$ outside stimuli is most likely a"sence seizure, 'hich is different from tonic3clonic seizure. ationa!e 2) The patient 'ho suffers seizure disorder cannot prevent seizure occurrence "y focusin$ harder. ationa!e 3) The patient 'ith tonic3clonic seizure disorder is less likely to out$ro' them than the patient 'ith a"sence seizure disorder. ationa!e 4) Many patients e4perience an aura prior to the tonic3clonic phase. Identifyin$ the aura can provide time for the patient to move to a safe area, notify another person of the impendin$ seizure, and to prepare. ationa!e 5) Status epilepticus is a medical emer$ency that may occur in the patient 'ho suffers tonic3clonic seizure disorder. "!o#a! ationa!e: Co$niti%e &e%e!: *valuatin$ C!ient 'eed: ,hysiolo$ical Inte$rity
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

C!ient 'eed (u#: ,hysiolo$ical Adaptation 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) *valuation &earnin$ *utcome: 023( Question 25 Type: MCMA The patient 'ho is prescri"ed valproic acid 6Depakote8 for seizure control 'ould like to have a "a"y. !hich statements should the nurse include in a discussion 'ith this patient Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. "Since your epilepsy may flare up durin$ pre$nancy, your doctor 'ill likely have you take a second antiepileptic medication." 2. "Thankfully, most modern antiepileptic medications 'ill not interfere 'ith you $ettin$ pre$nant." 3. "&our current antiepileptic medication should not "e used 'hen you are pre$nant." 4. "Eolic acid supplementation is important for you." 5. "&ou should consider adoptin$ a "a"y instead since there are so many pro"lems associated 'ith epilepsy and pre$nancy." Correct Answer: >,( ationa!e 1) Since there are many side effects to antiepileptic medications, sin$le dru$ therapy is the $oal for pre$nant patients. ationa!e 2) !omen 'ho have epilepsy have a reduced fertility rate, and some do not ovulate. ationa!e 3) Aalproic acid 6Depakote8 is ,re$nancy Cate$ory D. ationa!e 4) Eolic acid supplementation is important for all 'omen 'ho are, or 'ish to "ecome, pre$nant. This is especially true of 'omen 'ho are epileptic "ecause many antiepileptic medications cause folic acid deficiency. ationa!e 5) !omen 'ho are epileptic can and do conceive and deliver healthy "a"ies. The nurse should not discoura$e this patient, "ut should provide information to the patient and then support the patient:s choice. "!o#a! ationa!e: Co$niti%e &e%e!: Analyzin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: =eduction of =isk ,otential 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Implementation
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

&earnin$ *utcome: 023> Question 2, Type: MCMA The nurse is plannin$ educations sessions for a patient re$ardin$ use of a ne'ly prescri"ed antiepileptic dru$ 6A*D8. !hich topics should "e included in this session Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. The patient should take the medication at the same time every day. 2. If the patient for$ets a dose of medication, 'ait until the ne4t dose is due and take "oth doses to$ether. 3. The patient should take an additional dose of medication upon e4periencin$ a seizure aura. 4. If the patient e4periences side effects of the medication, the patient should skip the ne4t dose to see if the side effects lessen. 5. The patient should avoid usin$ dietary supplements containin$ kava 'hen on this medication. Correct Answer: 0,2 ationa!e 1) Sta"le "lood levels of medication are important in the control of seizure activity. In order to achieve this sta"ility, the medication should "e taken at the same time every day. ationa!e 2) The patient should take the dose as soon as it is remem"ered "ut should not take t'o doses at the same time or close to$ether. ationa!e 3) +ral medications are not delivered rapidly to the system, so takin$ an additional dose of medication 'hen an aura occurs is not effective in controllin$ the impendin$ seizure. ationa!e 4) The patient should never a"ruptly discontinue takin$ these medications and should not skip doses. ationa!e 5) Gava interferes 'ith many A*Ds, often addin$ to their sedative effects. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: ,harmacolo$ical and ,arenteral Therapies 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) ,lannin$ &earnin$ *utcome: 023F Question 2Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

Type: MCMA A mother phones the clinic and tells the nurse, "My 23year3old son had a fe"rile seizure this mornin$." She adds that this is the child:s first seizure e4perience. The nurse responds "y askin$ the mother to "rin$ the child in to "e seen today. !hat other information should the nurse offer Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. "Ee"rile seizures are uncommon in "oys." 2. "#i$h temperatures $enerally induce seizures." 3. "Eive3year3olds are too old for fe"rile seizures." 4. "Ee"rile seizures occur in up to 2C of children." 5. "Seizure medications are usually not necessary for fe"rile seizures." Correct Answer: (,2 ationa!e 1) Ee"rile seizures occur in "oth $enders. ationa!e 2) Many children e4perience hi$h temperatures 'ithout e4periencin$ seizures. ationa!e 3) Ee"rile seizures are most common in the >3month to 23year ran$e. ationa!e 4) Dp to 2C of children e4perience seizure activity related to temperature elevation. ationa!e 5) The "est course of action for fe"rile seizures is prevention "y usin$ acetaminophen to prevent onset of fever. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: =eduction of =isk ,otential 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Implementation &earnin$ *utcome: 0232 Question 2. Type: MCMA The nurse is talkin$ 'ith a patient 'ho 'as 5ust prescri"ed zonisamide 67one$ran8. !hich patient statement should the nurse immediately discuss 'ith the patient:s health care provider
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.

Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. "Did I mention that I used to take pheno"ar"ital for my seizures " 2. "I for$ot to tell the doctor that I am aller$ic to sulfa dru$s." 3. "I have lactose intolerance, so I can:t drink milk." 4. "My hus"and and I plan to have a "a"y in a couple of years." 5. "My hus"and and I are leadin$ a ./3mile "icycle tour ne4t 'eekend for the company 'e have 5ust started." Correct Answer: .,2 ationa!e 1) There is no indication that previous pheno"ar"ital use is pro"lematic 'ith the use of zonisamide 67one$ran8. ationa!e 2) 7onisamide 67one$ran8 is an oral sulfonamide. ationa!e 3) There is no indication that ina"ility to drink milk is pro"lematic 'ith the use of zonisamide 67one$ran8. ationa!e 4) 7onisamide 67one$ran8 is ,re$nancy Cate$ory C. ationa!e 5) The most common adverse effects of zonisamide 67one$ran8 include dizziness, ata4ia, and fati$ue. These effects may "e pro"lematic for the o'ner of a company that promotes "icycle tourin$. "!o#a! ationa!e: Co$niti%e &e%e!: Analyzin$ C!ient 'eed: ,hysiolo$ical Inte$rity C!ient 'eed (u#: ,harmacolo$ical and ,arenteral Therapies 'ursin$/)nte$rated Concepts: 1ursin$ ,rocess) Implementation &earnin$ *utcome: 023H

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, (-* Copyri$ht ./0( "y ,earson *ducation, Inc.