N316B Neurology Pharm Exam 2025

Which adverse effect would the nurse continually assess for in a client receiving valproic acid? A. yellow sclerae B. motor restlessness C. ringing in the ears D. torsion of the neck - Correct Ans-A. yellow sclerae Yellow sclerae are a sign of jaundice; pancreatitis and hepatic failure are life-threatening adverse effects of valproic acid. The client must have frequent liver function tests. Motor restlessness (akathisia) is associated with antipsychotic medications. Ringing or buzzing in the ears (tinnitus) is associated with aspirin. Torsion of the neck (torticollis) because of contracted cervical muscles is associated with antipsychotic medications. The nurse understands which antiepileptic medication would be used as the first-line treatment for absence seizures? A. Phenytoin B. Diazepam C. Valproic acid D. Acetazolamide - Correct Ans-C. Valproic acid Valproic acid is used as the first-line treatment for absence seizures. Phenytoin is used to treat partial, secondary, and generalized tonic-clonic seizures. Diazepam is used to treat status epilepticus. Acetazolamide is used as an adjunct medication for the treatment of absence seizures. A client is diagnosed with trigeminal neuralgia. Which non-analgesic can decrease the client's pain? A. Echinacea B. Leucovorin C. Allopurinol D. Carbamazepine - Correct Ans-D. Carbamazepine Carbamazepine is an anticonvulsant that can be used to control neurological pain such as trigeminal neuralgia. Echinacea is an herbal medication used by some to treat respiratory infections, but not neuralgic pain. Leucovorin is used as rescue medication with methotrexate to prevent cellular damage; it does not relieve neurological pain. Allopurinol is used in the treatment of gout but does not relieve pain. Which effect would the nurse monitor to evaluate the effectiveness of carbamazepine in the management of a client's trigeminal neuralgia? A. Pain intensity N316B N316B B. Gait C. Range of motion D. Seizure activity - Correct Ans-A. Pain intensity Carbamazepine is administered to control pain by reducing transmission of nerve impulses in clients with trigeminal neuralgia. This neurological condition isn't manifested by problems associated with gait or range of motion. Carbamazepine is not administered to clients with trigeminal neuralgia (tic douloureux) for its anticonvulsant properties because seizures are not present with this disorder. A school-age child with a seizure disorder has been on long-term carbamazepine therapy. Which intervention would the nurse incorporate into the plan of care? A. Assessing the mouth for gingivitis B. Checking the pupillary reaction to light C. Keeping an accurate intake and output record D. Monitoring the child's complete blood cell counts - Correct Ans-D. Monitoring the child's complete blood cell count. The side effects of carbamazepine include blood dyscrasias (e.g., thrombocytopenia, aplastic anemia, leukopenia, agranulocytosis). A side effect of long-term phenytoin, not carbamazepine, therapy is hyperplasia of the gingiva. Carbamazepine does not influence pupillary response directly. Keeping an accurate intake and output is unnecessary. The nurse teaches the client about effects of carbamazepine that would be reported to the primary health care provider. Which effects would the nurse include? Select all that apply. One, some, or all responses may be correct. A. Nausea B. Dizziness C. Unusual bleeding or bruising D. Sensitivity to bright light or sun E. Breast enlargement - Correct Ans-A. Nausea C. Unusual bleeding or bruising Nausea may be a side effect or it may signal toxicity. The client should be evaluated by the primary health care provider. Carbamazepine can cause severe bone marrow depression; the client should have weekly complete blood counts for the first 4 weeks of therapy and every 3 to 6 months thereafter. Dizziness is a common side effect of carbamazepine that does not require primary health care provider notification. The client should be cautioned not to engage in hazardous activities such as driving a car. Sensitivity to bright light or sun is not a side effect of carbamazepine. Breast enlargement is not associated with carbamazepine. The nurse is educating a client with seizure disorder about newly prescribed phenytoin. Which statement should the nurse include in the teaching? A. Blood work will be required if you have a seizure while taking this medication N316B N316B B. You will need to have routine visits with a dentist when taking this medication C. It is normal to have a change in your gait when you first start this medication D. Avoid grapefruit juice when taking this medication - Correct Ans-B. You will need to have routine visits with a dentist when taking this medication Phenytoin is the first-line medication for the treatment of seizures. Clients should be instructed that they will need routine lab work to ensure that they are at a therapeutic level with the medication, even if they have been seizure-free. This medication can cause gingival hyperplasia, which will require routine dental visits. The client does not need to avoid grapefruit juice with this medication. Difficulty with hand and gait coordination could indicate toxicity and should be reported to the healthcare provider. A nurse is teaching parents of a child recently prescribed the medication phenytoin for seizure control. Which side effect will the nurse include? A. Hypertension B. Insomnia C. Gingival hyperplasia D. Increased appetite - Correct Ans-C. Gingival hyperplasia Gingival hyperplasia (overgrowth of the gums) is a common side effect of phenytoin. Other common side effects include ataxia, central nervous system depression, drowsiness, headache, hypotension, mental confusion, nausea, vomiting, rash and nystagmus. The nurse is caring for a child diagnosed with seizures. While teaching the family and the child about the medication phenytoin, which concept should the nurse emphasize? A. Omit the medication if the child is seizure-free B. Serve a diet that is high in iron C. A rash is normal with this medication D. Maintain good oral hygiene and dental care - Correct Ans-D. Maintain good oral hygiene and dental care Gingival hyperplasia may occur with this medication. It is important that good oral hygiene is maintained. The medication should never be stopped, even if the child is seizure-free. A sudden discontinuation could result in status epilepticus. A diet high in iron interferes with phenytoin absorption and will reduce the effectiveness. A blister-like rash is not normal with this medication and could indicate medication-related Stevens Johnson syndrome, which is a serious disorder of the skin and mucous membranes. The nurse teaches the parents of a child prescribed long-term phenytoin therapy about care. Which statement indicates the teaching has been effective? A. 'We give the medication between meals.' B. 'We'll call the clinic if her urine turns pink.' C. 'She's eating high-calorie foods, and we encourage fluids, too.' D. 'We'll have her massage her gums and floss her teeth frequently.' - Correct Ans-D. 'We'll have her massage her gums and floss her teeth frequently.' N316B N316B A common side effect of phenytoin is gingival hyperplasia. Meticulous oral hygiene may reduce the risk of this side effect. Phenytoin is strongly alkaline and should be administered with meals to help prevent gastric irritation. Pink urine may be observed during medication excretion; it is expected and does not require treatment. Avoidance of overeating and overhydration may result in better seizure control. A client with a seizure disorder will begin taking phenytoin. Which instructions will the nurse give to the client? A. 'Take the medication on an empty stomach.' B. 'Provide meticulous oral hygiene.' C. 'Taper off the medication if seizures are controlled for 3 months.' D. 'Stop taking the medication if you become pregnant.' - Correct Ans-B. 'Provide meticulous oral hygiene.' Phenytoin can cause gingival overgrowth that increases the risk for periodontal disease. The medication should be taken with food or milk to decrease gastrointestinal side effects. The health care provider should oversee any dosage adjustment or discontinuation. Although it can affect the developing fetus, current evidence suggests that the effect of seizure activity on the developing fetus may cause even greater problems. Which instruction would the nurse provide to parents of a school-age child who has been on long-term phenytoin therapy to prevent side effects? A. Provide good oral hygiene. B. Administer the medication between meals. C. Watch for a reddish-brown discoloration of urine. D. Supplement the diet with high-calorie foods. - Correct Ans-A. Provide good oral hygiene. These procedures reduce the risk for gingival hyperplasia, a side effect of phenytoin. This medication is strongly alkaline and should be administered with meals to help prevent gastric irritation. Discoloration of the urine may occur during medication excretion; it does not cause physiological problems. Avoiding overeating and overhydration may result in better seizure control. A client's phenytoin level is 16 mcg/L. Which action will the nurse take? A. Hold the medication and notify the health care provider. B. Administer the next dose of the medication as prescribed. C. Hold the next dose and then resume administration as prescribed. D. Call the health care provider to obtain a prescription with an increased dose. - Correct Ans-B. Administer the next dose of the medication as prescribed. Administering the next dose of the medication as prescribed is within the therapeutic range of 10 to 20 mcg/L (40-80 mcmol/L); the nurse would administer the medication as prescribed. Holding the next dose and then resuming administration as prescribed is N316B N316B unsafe and will reduce the therapeutic blood level of the medication. Calling the health care provider to obtain a prescription with an increased