1|Pag e
NU 578 CONTROLLED SUBSTANCES EXAM||
ACTUA EXAM PREP VERSION 1-4 ALL
QUESTIONS ANSD CORRECT ANSWERS
ALREADY GRADED A+|| LATEST AND COMPLETE
UPDATE 2024 WITH VERIFIED SOLUTIONS||
ASSURED PASS!!!
A patient who has been taking phenobarbital for epilepsy begins taking valproic
acid [Depakote] as adjunct therapy. The nurse notes that the patient is very drowsy.
What will the nurse do?
a. Explain to the patient that tolerance to sedation eventually will develop.
b. Notify the prescriber, and request an order to reduce the dose of phenobarbital.
c. Notify the prescriber of the need to increase the dose of valproic acid.
d. Request an order for liver function tests to monitor for hepatotoxicity
ANS: B
Valproic acid competes with phenobarbital for drug-metabolizing enzymes and can
increase plasma levels of phenobarbital by approximately 40%. When this
combination is used, the dose of phenobarbital should be reduced.
Increasing the dose of valproic acid would compound the problem.
Patients taking phenobarbital alone experience sedation, which diminishes as
tolerance develops.
Liver toxicity is a rare adverse effect of valproic acid and is marked by symptoms
of nausea, vomiting, and malaise, not drowsiness
,2|Pag e
A nurse is providing teaching to a patient newly diagnosed with partial seizures
who will begin taking oxcarbazepine [Trileptal]. The patient also takes furosemide
[Lasix] and digoxin [Lanoxin]. Which statement by the patient indicates
understanding of the teaching?
a. "I may need to increase my dose of Trileptal while taking these medications."
b. "I may develop a rash and itching, but these are not considered serious."
c. "I should report any nausea, drowsiness, and headache to my provider."
d. "I should use salt substitutes instead of real salt while taking these drugs."
ANS: C
Oxcarbazepine can cause clinically significant hyponatremia in 2.5% of patients.
If oxcarbazepine is combined with other drugs that reduce sodium, the patient
should be monitored.
Signs of hyponatremia include nausea, drowsiness, confusion, and headache, and
patients should be taught to report these symptoms.
Increasing the dose of oxcarbazepine is not indicated.
Rashes can indicate a serious drug reaction, and providers should be notified so
that the oxcarbazepine can be withdrawn.
Salt substitutes would compound the problem of hyponatremia.
,3|Pag e
A child who receives valproic acid [Depakote] begins taking lamotrigine
[Lamictal] because of an increase in the number of seizures. The nurse will
observe this child closely for which symptom?
a. Angioedema
b. Hypohidrosis
c. Rash
d. Psychosis
ANS: C
Lamotrigine can cause life-threatening rashes, such as Stevens-Johnson syndrome
and toxic epidermal necrolysis, and this risk increases with concurrent use of
valproic acid.
Angioedema is an adverse effect associated with pregabalin.
Hypohidrosis and psychosis are associated with topiramate.
A 20-kg child has been taking valproic acid [Depakote] for 1 week to treat a
seizure disorder. The child is receiving 200 mg PO twice daily. The child's parents
report no improvement in seizure activity. The nurse will anticipate that the
provider will order which change in this child's drug regimen?
a. Adding another seizure medication to supplement the valproic acid
b. Changing to phenytoin [Dilantin] since the valproic acid is not effective
, 4|Pag e
c. Increasing the dose of valproic acid to 300 mg PO twice daily
d. Increasing the dose of valproic acid to 200 mg three times daily
ANS: C
Valproic acid is given initially at a dose of 5 to 15 mg/kg/day, administered in two
divided doses. This child is receiving 400 mg/day, which is 10 mg/kg/day. The
dosage should be increased by 5 to 10 mg/kg/day each week until optimal levels
are achieved up to a maximum dose of 60 mg/kg/day.
At this point, adding another AED or changing to another AED is not
recommended.
Increasing the dose to three times daily is not recommended
A patient has begun taking phenobarbital after experiencing several seizures and is
currently receiving 60 mg PO twice daily. After two weeks of therapy, the patient
has a serum drug level of 30 mcg/mL and reports feeling drowsy much of the day.
What will the nurse tell this patient?
a. "I will contact your provider to discuss changing your dosing to once daily to
minimize the drowsiness."
b. "The drug level is low and you may need a higher dose, but taking it three times
daily will reduce the drowsiness."
c. "This side effect is expected and should decrease over time. You should avoid
driving in the meantime."
d. "Your lab work shows a higher than normal level of the drug and your provider
will probably lower your dose."
NU 578 CONTROLLED SUBSTANCES EXAM||
ACTUA EXAM PREP VERSION 1-4 ALL
QUESTIONS ANSD CORRECT ANSWERS
ALREADY GRADED A+|| LATEST AND COMPLETE
UPDATE 2024 WITH VERIFIED SOLUTIONS||
ASSURED PASS!!!
A patient who has been taking phenobarbital for epilepsy begins taking valproic
acid [Depakote] as adjunct therapy. The nurse notes that the patient is very drowsy.
What will the nurse do?
a. Explain to the patient that tolerance to sedation eventually will develop.
b. Notify the prescriber, and request an order to reduce the dose of phenobarbital.
c. Notify the prescriber of the need to increase the dose of valproic acid.
d. Request an order for liver function tests to monitor for hepatotoxicity
ANS: B
Valproic acid competes with phenobarbital for drug-metabolizing enzymes and can
increase plasma levels of phenobarbital by approximately 40%. When this
combination is used, the dose of phenobarbital should be reduced.
Increasing the dose of valproic acid would compound the problem.
Patients taking phenobarbital alone experience sedation, which diminishes as
tolerance develops.
Liver toxicity is a rare adverse effect of valproic acid and is marked by symptoms
of nausea, vomiting, and malaise, not drowsiness
,2|Pag e
A nurse is providing teaching to a patient newly diagnosed with partial seizures
who will begin taking oxcarbazepine [Trileptal]. The patient also takes furosemide
[Lasix] and digoxin [Lanoxin]. Which statement by the patient indicates
understanding of the teaching?
a. "I may need to increase my dose of Trileptal while taking these medications."
b. "I may develop a rash and itching, but these are not considered serious."
c. "I should report any nausea, drowsiness, and headache to my provider."
d. "I should use salt substitutes instead of real salt while taking these drugs."
ANS: C
Oxcarbazepine can cause clinically significant hyponatremia in 2.5% of patients.
If oxcarbazepine is combined with other drugs that reduce sodium, the patient
should be monitored.
Signs of hyponatremia include nausea, drowsiness, confusion, and headache, and
patients should be taught to report these symptoms.
Increasing the dose of oxcarbazepine is not indicated.
Rashes can indicate a serious drug reaction, and providers should be notified so
that the oxcarbazepine can be withdrawn.
Salt substitutes would compound the problem of hyponatremia.
,3|Pag e
A child who receives valproic acid [Depakote] begins taking lamotrigine
[Lamictal] because of an increase in the number of seizures. The nurse will
observe this child closely for which symptom?
a. Angioedema
b. Hypohidrosis
c. Rash
d. Psychosis
ANS: C
Lamotrigine can cause life-threatening rashes, such as Stevens-Johnson syndrome
and toxic epidermal necrolysis, and this risk increases with concurrent use of
valproic acid.
Angioedema is an adverse effect associated with pregabalin.
Hypohidrosis and psychosis are associated with topiramate.
A 20-kg child has been taking valproic acid [Depakote] for 1 week to treat a
seizure disorder. The child is receiving 200 mg PO twice daily. The child's parents
report no improvement in seizure activity. The nurse will anticipate that the
provider will order which change in this child's drug regimen?
a. Adding another seizure medication to supplement the valproic acid
b. Changing to phenytoin [Dilantin] since the valproic acid is not effective
, 4|Pag e
c. Increasing the dose of valproic acid to 300 mg PO twice daily
d. Increasing the dose of valproic acid to 200 mg three times daily
ANS: C
Valproic acid is given initially at a dose of 5 to 15 mg/kg/day, administered in two
divided doses. This child is receiving 400 mg/day, which is 10 mg/kg/day. The
dosage should be increased by 5 to 10 mg/kg/day each week until optimal levels
are achieved up to a maximum dose of 60 mg/kg/day.
At this point, adding another AED or changing to another AED is not
recommended.
Increasing the dose to three times daily is not recommended
A patient has begun taking phenobarbital after experiencing several seizures and is
currently receiving 60 mg PO twice daily. After two weeks of therapy, the patient
has a serum drug level of 30 mcg/mL and reports feeling drowsy much of the day.
What will the nurse tell this patient?
a. "I will contact your provider to discuss changing your dosing to once daily to
minimize the drowsiness."
b. "The drug level is low and you may need a higher dose, but taking it three times
daily will reduce the drowsiness."
c. "This side effect is expected and should decrease over time. You should avoid
driving in the meantime."
d. "Your lab work shows a higher than normal level of the drug and your provider
will probably lower your dose."
