Chapter 10, Drugs for Central Nervous System Problems: Drugs for Epilepsy—Sherpath

Question 1 of 18

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Which newer antiepileptic drug is recommended use to treat partial seizure activity? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Ezogabine (Potiga)Ezogabine (Potiga)is used to treat partial seizure activity.
• • Felbamate (Felbatol)Felbamate (Felbatol) is used to treat Lennox-Gastaut syndrome and not partial seizure activity.
• Correct
  • Gabapentin (Horizant)Gabapentin (Horizant) is used to treat partial seizure activity.
• • Rufinamide (Banzel)Rufinamide (Banzel) is used to treat Lennox-Gastaut syndrome and not partial seizure activity.
• Correct
  • Zonisamide (Zonegran)Zonisamide (Zonegran) is used to treat partial seizure activity.

Question 2 of 18

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A patient has a whole-body convulsion with muscle rigidity followed by vigorous shaking lasting 30 seconds, with urinary incontinence noted postseizure activity. Which type of seizure would the nurse document as the patient’s experience?

• • Absence (petit mal)Absence (petit mal) involves brief loss of consciousness without loss of posture. An absence seizure usually lasts 10–30 seconds.
• Correct
  • Tonic-clonic (grand mal)Tonic-clonic (grand mal) a generalized seizure often preceded by an aura involving unconsciousness, loss of posture, urinary incontinence, and violent muscle contractions. A tonic-clonic seizure usually lasts less than 90 seconds.
• • MyoclonicBrief or sudden jerks (1–2 seconds) involve the contraction of one (focal) or more muscle groups (can involve the whole body).
• • Status epilepticusStatus epilepticus is a life-threatening, single seizure lasting 15–30 continuous minutes or having two or more seizures within a five-minute period in which the patient does not regain consciousness.

Question 3 of 18

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Which statement by the family member of a patient with epilepsy describes an absence seizure?

• • “She was shaking really badly, then fell to the floor.”With an absence seizure, there is no loss of posture.
• • “I remember her crying out.”A seizure often preceded by an aura or cry is found with a tonic-clonic (grand mal) seizure.
• • “I saw her lose consciousness.”Losing consciousness is found with a tonic-clonic (grand mal) seizure.
• Correct
  • “She usually stares into space for a few seconds.”An absence seizure (petit mal) involves brief loss of consciousness without loss of posture usually lasting 10–30 seconds.

Question 4 of 18

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Which antiepileptic drug has an increased risk of liver toxicity in toddlers?

• • EthosuximideEthosuximide is not found to cause liver toxicity in children.
• • LacosamideLiver toxicity is not usually found when taking lacosamide.
• • PhenobarbitalPhenobarbital does not cause liver toxicity in children.
• Correct
  • Valproic acidSerious liver toxicity may be seen in some children who are taking valproic acid, especially those younger than 2 years of age and those receiving multiple antiepileptic drugs. The risk of liver toxicity decreases as the child ages.

Question 5 of 18

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Which antiepileptic drug would the nurse question if taken by a pregnant patient? Select all that apply. One, some, or all responses may be correct.

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  • CarbamazepineCarbamazepine is a known teratogen and should be avoided in pregnancy.
• • EthosuximideEthosuximide does not cause birth defects. The nurse would not question its use in a pregnant patient.
• Correct
  • PhenytoinPhenytoin can cause birth defects and should be avoided in pregnancy.
• Correct
  • PhenobarbitalPhenobarbital can cause birth defects and should be avoided in pregnancy.
• Correct
  • Valproic acidValproic acid is a known teratogen and should be avoided in pregnancy.

Question 6 of 18

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Which newer antiepileptic drug (AED) would the nurse monitor for a potential life-threatening skin problem?

• • OxcarbazepineA life-threatening skin problem is not typically a concern when taking oxcarbazepine.
• Correct
  • LamotrigineA life-threatening skin problem can occur when taking lamotrigine. The nurse should monitor the patient’s skin closely when receiving this drug.
• • LacosamideLacosamide does not cause a life-threatening skin problem.
• • TopiramateTopiramate is not known to cause a life-threatening skin problem.

Question 7 of 18

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Which laboratory result is important to monitor for a patient who is taking oxcarbazepine?

• • PhosphorusAbnormal phosphorus levels usually do not occur when taking oxcarbazepine.
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  • SodiumThe nurse should monitor the patient’s blood sodium levels because oxcarbazepine can cause hyponatremia.
• • GlucoseOxcarbazepine does not cause an alteration in blood glucose levels.
• • PotassiumAbnormal potassium blood levels are not typically observed in patients taking oxcarbazepine.

Question 8 of 18

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Which sign or symptom of hyponatremia has been associated with patients taking oxcarbazepine? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Decreased deep tendon reflexesDecreased deep tendon reflexes are a sign of hyponatremia.
• • Excessive thirstExcessive thirst is a symptom of hypernatremia, not hyponatremia.
• • Extreme fatigueExtreme fatigue is a symptom of increased, not decreased, serum sodium levels.
• Correct
  • HeadacheHeadache is a symptom of decreased serum sodium levels.
• Correct
  • Increased muscle weaknessIncreased muscle weakness is a symptom of hyponatremia.

Question 9 of 18

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A nurse is teaching a patient who works at a grocery store about the administration of oxcarbazepine. Which statement indicates that the patient requires further teaching?

• Correct
  • “It is okay to continue driving the forklift.”The nurse should reinforce that patients should avoid driving or operating dangerous equipment to prevent injury since oxcarbazepine can cause vision disturbances.
• • “It is okay to bag items.”The patient is at low risk of injury if bagging items at the grocery store.
• • “I will continue to greet customers.”Greeting customers at the grocery store is an appropriate duty.
• • “I can operate a cash register.”Operating a cash register should not pose a threat or injury while on oxcarbazepine.

Question 10 of 18

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Which supplement may be indicated for a patient who is receiving lamotrigine?

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  • Folic acidLamotrigine interferes with the production of folic acid. It is important for the nurse to verify if the patient is a candidate for folic acid supplements.
• • IronLamotrigine does not affect the iron levels in the body.
• • Vitamin DLamotrigine does not cause too little vitamin D in the body.
• • Vitamin B12Lamotrigine does not lower than normal amounts of vitamin B12.

Question 11 of 18

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Which adverse reaction would the nurse monitor for a patient who is receiving lamotrigine?

• • VomitingVomiting is a typical side effect for patients receiving lamotrigine.
• Correct
  • Toxic epidermal necrolysisToxic epidermal necrolysis is a serious skin condition caused by an adverse reaction to the patient receiving lamotrigine.
• • Blurry visionBlurry vision is a common side effect found in patients receiving lamotrigine.
• • InsomniaInsomnia is a not neither common nor an immediate side effect or adverse reaction found with patients prescribed lamotrigine.

Question 12 of 18

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After administering the first oral dose of lamotrigine, which finding indicates to the nurse the patient is experiencing an allergic reaction?

• • DrowsinessDrowsiness is a common side effect.
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  • RashA rash is an adverse effect. Lamotrigine can cause life-threatening rashes such as Stevens-Johnson syndrome.
• • Abdominal painAbdominal pain is a common side effect.
• • Blurred visionBlurred vision is a common side effect.

Question 13 of 18

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Prior to administering lacosamide intravenously, the nurse notes the patient’s blood pressure is 99/56. Which action would the nurse take?

• • Administer the drug slowly over 60 minutes.In this situation, the drug would be withheld, and the healthcare provider would be alerted for additional instructions. Even at a slowed pace, if the nurse administers the lacosamide it could cause a dangerously low blood pressure reaction, which could prove detrimental for this patient.
• • Assist the patient with ambulation.Assisting the patient with ambulation is not the best action in this situation. A blood pressure reading of 99/56 mm Hg is low and requires withholding the drug and alerting the healthcare provider for additional instructions.
• Correct
  • Hold the drug and report vital signs to the healthcare provider.The nurse should monitor the patient’s blood pressure prior to administering the lacosamide. Since lacosamide can cause orthostatic hypotension and syncope, the nurse should hold the medication and notify the healthcare provider for further instructions.
• • Suggest that the patient change positions slowly.The nurse should suggest the patient change positions slowly to avoid dizziness and syncope; however, a blood pressure reading as low as this patient’s warrants withholding the drug and alerting the healthcare provider for additional instructions.

Question 14 of 18

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A nurse is caring for a patient prescribed lacosamide. The patient states, “Why do you need to check my vital signs so frequently?” Which response by the nurse is correct?

• • “The medication you are taking causes low, shallow breathing.”Low, shallow breathing is typically caused by medications that cause CNS depression. It is not expected to occur in patients receiving lamotrigine.
• • “The drugs you are taking may cause you to develop a fever.”Lacosamide does not cause the immune system to be altered; therefore, a fever is atypical.
• • “The medication you are taking may cause your blood pressure to rise.”While blood pressure assessments are common in patients receiving lacosamide, this is to assess for hypotension. Increases in blood pressure are not expected with lacosamide.
• Correct
  • “The drug you are taking can cause your heart rate and rhythm to change.”Patients receiving lacosamide can have a dangerous change in heart rate and rhythm. The nurse should monitor the patient’s blood pressure, heart rate, and rhythm before, during, and after administration, especially if the patient is receiving a lacosamide intravenous infusion, to identify issues quickly and early.

Question 15 of 18

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Which side effect or adverse effect is associated with lacosamide (Vimpat)? Select all that apply. One, some, or all responses may be correct.

• Correct
  • HeadacheA headache is an expected side effect associated with lacosamide (Vimpat).
• Correct
  • SyncopeSyncope is a common side effect associated with lacosamide (Vimpat).
• • TachycardiaLacosamide can cause rapid lowering of blood pressure and heart rhythm problems, especially bradycardia.
• Correct
  • EuphoriaBecause lacosamide (Vimpat) can cause a feeling of intense well-being and happiness called euphoria, it is considered an adverse reaction because it can lead to psychological dependence.
• • DelusionsLacosamide (Vimpat) does not typically cause behavioral changes such as delusions.

Question 16 of 18

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Which drug interacts with topiramate and poses a risk for developing metabolic acidosis?

• • AspirinAspirin interacts with topiramate; however, it does not cause metabolic acidosis.
• • AcetaminophenAcetaminophen interacts with topiramate; however, it does not cause metabolic acidosis.
• • Sodium bicarbonateSodium bicarbonate is usually given to patients to treat metabolic acidosis.
• Correct
  • MetforminThe patient taking metformin is at greatest risk of developing metabolic acidosis because it has a serum bicarbonate-lowering effect.

Question 17 of 18

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Which adverse effect would the nurse monitor for in a patient who is prescribed topiramate? Select all that apply. One, some, or all responses may be correct.

• • Stevens-Johnson syndromeStevens-Johnson syndrome is a potentially fatal allergic reaction that can cause skin sloughing. It is typically not a concern with topiramate.
• Correct
  • EncephalopathyThe patient is presenting with what appears to be encephalopathy. The development of lethargy, vomiting, changes in mental status, or hypothermia are associated with encephalopathy. These would be reported immediately to the healthcare provider so that prompt encephalopathy treatment can begin.
• • Metabolic acidosisThis patient has signs and symptoms of encephalopathy. Metabolic acidosis is a concern with topiramate. However, symptoms include slow heart rate, hypotension, muscle weakness, and warm, flushed skin, which the patient does not seem to have.
• • HyponatremiaLow sodium levels can cause symptoms such as headache, increased muscle weakness, and decreased deep tendon reflexes, which is not the case with the patient. Oxcarbazepine, not topiramate, can reduce sodium levels.
• Correct
  • HypothermiaThe nurse should monitor the patient for hypothermia, which is an indication of encephalopathy.

Question 18 of 18

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The nurse suspects that a patient prescribed topiramate 400 mg orally once daily has developed encephalopathy. Which observation supports this hypothesis?

• Correct
  • Elevated ammonia levelsTopiramate can elevate serum ammonia levels. An elevated ammonia level is indicative of encephalopathy, which could lead to brain death. If the nurse suspects this, the healthcare provider should be notified immediately.
• • Elevated blood urea nitrogenElevated blood urea nitrogen is indicative that the patient has renal issues.
• • Elevated creatinineElevated creatinine is an indication that the kidneys are not working well.
• • Elevated potassiumElevated potassium could cause dangerous heart rate and rhythm alterations.