AS
N316B – Neurology Pharmacology. A+ Graded End
Term Exam with Verified Answers
Questions and Mark scheme
Version: Final 1.1
,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. - ✔✔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. - ✔✔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 unsafe and will reduce the therapeutic blood level of the medication. Calling the health
care provider to obtain a prescription with an increased dose is inappropriate because the blood level is within the
therapeutic range.
A nurse is providing care to a client who takes phenytoin for seizure prevention. The latest laboratory report shows a
phenytoin level of 32 mcg/mL. Which action does the nurse take next?
A. Examine the oral cavity
B. Percuss the abdomen
C. Check the skin turgor
,D. Assess the pupillary response - ✔✔D. Assess the pupillary response
A phenytoin level of 32 mcg/mL is not an expected response to therapy. The therapeutic range of phenytoin is 10 to 20
mcg/mL. Signs of phenytoin toxicity include nystagmus, ataxia, and confusion. The pupillary response will assess for
symmetrical movements of the eye. Examining the oral cavity, percussing the abdomen, and checking for skin turgor do
not evaluate symptoms of phenytoin toxicity.
A newly admitted client reports taking phenytoin for several months. Which assessment should the nurse include in the
admission report? Select all that apply.
A. Report of unsteady gait, rash and diplopia
B. Report of any seizure activity
C. Serum phenytoin levels
D. Report of anorexia, numbness and tingling of the extremities - ✔✔A. Report of unsteady gait, rash and diplopia
B. Report of any seizure activity
C. Serum phenytoin levels
Serious adverse outcomes of antiseizure medications such as phenytoin are unsteady gait, slurred speech, extreme
fatigue, blurred vision or feelings of suicide. Clients who are prescribed phenytoin should have their levels monitored on
a routine basis. The nurse should include any seizure activity as this may demonstrate lack of a therapeutic level.
Increased hunger (not anorexia), increased thirst or increased urination are additional serious side effects.
The client with a seizure disorder receives intravenous (IV) phenytoin. The nurse will monitor closely for which
condition?
A. Cardiac dysrhythmias
B. Hypoglycemia
C. Polycythemia
D. Paradoxical excitation - ✔✔A. Cardiac dysrhythmias
IV phenytoin was once used to treat dysrhythmias until better medications were developed. It depresses both atrial and
ventricular conduction, and so it can cause significant dysrhythmias. It can also cause hyperglycemia (not hypoglycemia)
and pancytopenia (not polycythemia). Paradoxical excitation is not a known issue; it has a depressant effect resulting in
drowsiness.
The nurse is preparing to administer newly prescribed intravenous phenytoin to a client. When reviewing the client's
medical record, which prescription should the nurse question?
A. Continuous infusion of dextrose 5% in 0.9% saline
, B. NPH insulin 40 units before meals
C. Labetalol 100 mg orally twice per day Your Answer
D. Ketorolac 15 mg IV push as needed for pain - ✔✔A. Continuous infusion of dextrose 5% in 0.9% saline
Phenytoin is not compatible with most IV fluids, especially those with dextrose. If the nurse observes a continuous
infusion of a fluid that contains dextrose, they should understand that incompatibilities are likely and should not
administer the medication as prescribed. Insulin, labetalol, and ketorolac do not have potential incompatibilities.
The nursing is preparing to administer phenytoin IV push to a client. The client has dextrose 5% in water infusing
continuously. Which action is appropriate?
A. Pinch the line above the infusion port during the administration
B. Hold the medication and collaborate with the provider prior to administration
C. Stop the infusion and flush the port with normal saline prior to administration
D. Ask the pharmacy to mix the medication into an IV piggyback (IVPB) infusion - ✔✔C. Stop the infusion and flush the
port with normal saline prior to administration
If giving phenytoin as an infusion, it cannot be administered with D5W because it will precipitate. The D5W should be
disconnected, the port flushed with normal saline solution (NSS), medication administered, and the port flushed again
with NSS before the D5W is reconnected. The provider does not need to be contacted as this is best practice and aligns
with hospital protocol. Administering the medication via IVPB does not reduce the risk for precipitation.
Warfarin is prescribed for the client who takes phenytoin for a seizure disorder. Which medication interaction
complicates seizure therapy?
A. Warfarin inhibits the metabolism of phenytoin.
B. Warfarin decreases phenytoin absorption.
C. Phenytoin competes with warfarin for receptor occupation.
D. Warfarin promotes excretion of phenytoin. - ✔✔A. Warfarin inhibits the metabolism of phenytoin.
Warfarin inhibits metabolism of phenytoin, which can result in phenytoin toxicity. Warfarin does not decrease phenytoin
absorption. Phenytoin and warfarin act on different receptors. Excretion of phenytoin is not increased.
A client who is receiving phenytoin asks why folic acid (Vitamin B) was prescribed. Which explanation would the nurse
provide?
A. Phenytoin inhibits absorption of folate from foods.
N316B – Neurology Pharmacology. A+ Graded End
Term Exam with Verified Answers
Questions and Mark scheme
Version: Final 1.1
,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. - ✔✔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. - ✔✔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 unsafe and will reduce the therapeutic blood level of the medication. Calling the health
care provider to obtain a prescription with an increased dose is inappropriate because the blood level is within the
therapeutic range.
A nurse is providing care to a client who takes phenytoin for seizure prevention. The latest laboratory report shows a
phenytoin level of 32 mcg/mL. Which action does the nurse take next?
A. Examine the oral cavity
B. Percuss the abdomen
C. Check the skin turgor
,D. Assess the pupillary response - ✔✔D. Assess the pupillary response
A phenytoin level of 32 mcg/mL is not an expected response to therapy. The therapeutic range of phenytoin is 10 to 20
mcg/mL. Signs of phenytoin toxicity include nystagmus, ataxia, and confusion. The pupillary response will assess for
symmetrical movements of the eye. Examining the oral cavity, percussing the abdomen, and checking for skin turgor do
not evaluate symptoms of phenytoin toxicity.
A newly admitted client reports taking phenytoin for several months. Which assessment should the nurse include in the
admission report? Select all that apply.
A. Report of unsteady gait, rash and diplopia
B. Report of any seizure activity
C. Serum phenytoin levels
D. Report of anorexia, numbness and tingling of the extremities - ✔✔A. Report of unsteady gait, rash and diplopia
B. Report of any seizure activity
C. Serum phenytoin levels
Serious adverse outcomes of antiseizure medications such as phenytoin are unsteady gait, slurred speech, extreme
fatigue, blurred vision or feelings of suicide. Clients who are prescribed phenytoin should have their levels monitored on
a routine basis. The nurse should include any seizure activity as this may demonstrate lack of a therapeutic level.
Increased hunger (not anorexia), increased thirst or increased urination are additional serious side effects.
The client with a seizure disorder receives intravenous (IV) phenytoin. The nurse will monitor closely for which
condition?
A. Cardiac dysrhythmias
B. Hypoglycemia
C. Polycythemia
D. Paradoxical excitation - ✔✔A. Cardiac dysrhythmias
IV phenytoin was once used to treat dysrhythmias until better medications were developed. It depresses both atrial and
ventricular conduction, and so it can cause significant dysrhythmias. It can also cause hyperglycemia (not hypoglycemia)
and pancytopenia (not polycythemia). Paradoxical excitation is not a known issue; it has a depressant effect resulting in
drowsiness.
The nurse is preparing to administer newly prescribed intravenous phenytoin to a client. When reviewing the client's
medical record, which prescription should the nurse question?
A. Continuous infusion of dextrose 5% in 0.9% saline
, B. NPH insulin 40 units before meals
C. Labetalol 100 mg orally twice per day Your Answer
D. Ketorolac 15 mg IV push as needed for pain - ✔✔A. Continuous infusion of dextrose 5% in 0.9% saline
Phenytoin is not compatible with most IV fluids, especially those with dextrose. If the nurse observes a continuous
infusion of a fluid that contains dextrose, they should understand that incompatibilities are likely and should not
administer the medication as prescribed. Insulin, labetalol, and ketorolac do not have potential incompatibilities.
The nursing is preparing to administer phenytoin IV push to a client. The client has dextrose 5% in water infusing
continuously. Which action is appropriate?
A. Pinch the line above the infusion port during the administration
B. Hold the medication and collaborate with the provider prior to administration
C. Stop the infusion and flush the port with normal saline prior to administration
D. Ask the pharmacy to mix the medication into an IV piggyback (IVPB) infusion - ✔✔C. Stop the infusion and flush the
port with normal saline prior to administration
If giving phenytoin as an infusion, it cannot be administered with D5W because it will precipitate. The D5W should be
disconnected, the port flushed with normal saline solution (NSS), medication administered, and the port flushed again
with NSS before the D5W is reconnected. The provider does not need to be contacted as this is best practice and aligns
with hospital protocol. Administering the medication via IVPB does not reduce the risk for precipitation.
Warfarin is prescribed for the client who takes phenytoin for a seizure disorder. Which medication interaction
complicates seizure therapy?
A. Warfarin inhibits the metabolism of phenytoin.
B. Warfarin decreases phenytoin absorption.
C. Phenytoin competes with warfarin for receptor occupation.
D. Warfarin promotes excretion of phenytoin. - ✔✔A. Warfarin inhibits the metabolism of phenytoin.
Warfarin inhibits metabolism of phenytoin, which can result in phenytoin toxicity. Warfarin does not decrease phenytoin
absorption. Phenytoin and warfarin act on different receptors. Excretion of phenytoin is not increased.
A client who is receiving phenytoin asks why folic acid (Vitamin B) was prescribed. Which explanation would the nurse
provide?
A. Phenytoin inhibits absorption of folate from foods.
