Chapter 14: Antiepileptic Drugs
Lilley: Pharmacology and the Nursing Process, 8th Edition
MULTIPLE CHOICE
1. The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs).
Which antiepileptic drug allows for once-a-day dosing?
a. Levetiracetam (Keppra)
b. Phenobarbital
c. Valproic acid (Depakote)
d. Gabapentin (Neurontin)
ANS: B
Phenobarbital has the longest half-life of all standard AEDs, including those listed in the other
options, so it allows for once-a-day dosing.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 224
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse has given medication instructions to a patient receiving phenytoin (Dilantin).
Which statement by the patient indicates that the patient has an adequate understanding of the
instructions?
a. “I will need to take extra care of my teeth and gums while on this medication.”
b. “I can go out for a beer while on this medication.”
c. “I can skip doses if the side effects bother me.”
d. “I will be able to stop taking this drug once the seizures stop.”
ANS: A
Scrupulous dental care is necessary to prevent gingival hypertrophy during therapy with
phenytoin. Alcohol and other central nervous system depressants may cause severe sedation.
Consistent dosing is important to maintain therapeutic drug levels. Therapy with AEDs
usually must continue for life and must not be stopped once seizures stop.
DIF: COGNITIVE LEVEL: Analyzing (Analysis)
REF: p. 225
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
3. When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home,
the nurse will include which instruction?
a. “Driving is allowed after 2 weeks of therapy.”
b. “If seizures recur, take a double dose of the medication.”
c. “Antacids can be taken with the AED to reduce gastrointestinal adverse effects.”
d. “Regular, consistent dosing is important for successful treatment.”
ANS: D
Consistent dosing, taken regularly at the same time of day, at the recommended dose, and
with meals to reduce the common gastrointestinal adverse effects, is the key to successful
management of seizures when taking AEDs. Noncompliance is the factor most likely to lead
to treatment failure.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 231
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
4. A patient has a 9-year history of a seizure disorder that has been managed well with oral
phenytoin (Dilantin) therapy. He is to be NPO (consume nothing by mouth) for surgery in the
morning. What will the nurse do about his morning dose of phenytoin?
a. Give the same dose intravenously.
b. Give the morning dose with a small sip of water.
c. Contact the prescriber for another dosage form of the medication.
d. Notify the operating room that the medication has been withheld.
ANS: C
If there are any questions about the medication order or the medication prescribed, contact the
prescriber immediately for clarification and for an order of the appropriate dose form of the
medication. Do not change the route without the prescriber’s order. There is an increased risk
of seizure activity if one or more doses of the AED are missed.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 231
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. The nurse is monitoring a patient who has been taking carbamazepine (Tegretol) for 2 months.
Which effects would indicate that autoinduction has started to occur?
a. The drug levels for carbamazepine are higher than expected.
b. The drug levels for carbamazepine are lower than expected.
c. The patient is experiencing fewer seizures.
d. The patient is experiencing toxic effects from the drug.
ANS: B
With carbamazepine, autoinduction occurs and leads to lower than expected drug
concentrations. Therefore, the dosage may have to be adjusted with time. The other options
are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 226
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action is correct when
administering this drug?
a. Give the dose as a fast intravenous (IV) bolus.
b. Mix the drug with normal saline, and give it as a slow IV push.
c. Mix the drug with dextrose (D5W), and give it as a slow IV push.
d. Mix the drug with any available solution as long as the administration rate is
correct.
ANS: B
Intravenous phenytoin is given only with normal saline solution to prevent precipitation
formation caused by incompatibilities. The IV push dose must be given slowly (not exceeding
50 mg/min in adults), and the patient must be monitored for bradycardia and decreased blood
pressure.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 226
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
7. The U.S. Food and Drug Administration has issued a warning for users of antiepileptic drugs.
Based on this report, the nurse will monitor for which potential problems with this class of
drugs?
a. Increased risk of suicidal thoughts and behaviors
b. Signs of bone marrow depression
c. Indications of drug addiction and dependency
d. Increased risk of cardiovascular events, such as strokes
ANS: A
In December 2008, the U.S. Food and Drug Administration (FDA) required black box
warnings on all antiepileptic drugs regarding the risk of suicidal thoughts and behaviors.
Patients being treated with antiepileptic drugs for any indication need to be monitored for the
emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes
in mood or behavior. The other options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 222
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
8. A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice
for the treatment of this condition?
a. Diazepam (Valium)
b. Midazolam (Versed)
c. Valproic acid (Depakote)
d. Carbamazepine (Tegretol)
ANS: A
Diazepam (Valium) is considered by many to be the drug of choice for status epilepticus.
Other drugs that are used are listed in Table 14-3 and do not include the drugs listed in the
other options.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 221
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
9. Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this
characteristic indicates which of these?
a. The safe and the toxic plasma levels of the drug are very close to each other.
b. The phenytoin has a low chance of being effective.
c. There is no difference between safe and toxic plasma levels.
d. A very small dosage can result in the desired therapeutic effect.
ANS: A
Having a “narrow therapeutic index” means that there is a small difference between safe and
toxic drug levels. These drugs require monitoring of therapeutic plasma levels. The other
options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension)
REF: p. 222
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
10. A patient has been taking an AED for several years as part of his treatment for partial seizures.
His wife has called because he ran out of medication this morning and wonders if he can go
without it for a week until she has a chance to go to the drugstore. What is the nurse’s best
response?
a. “He is taking another antiepileptic drug, so he can go without the medication for a
week.”
b. “Stopping this medication abruptly may cause withdrawal seizures. A refill is
needed right away.”
c. “He can temporarily increase the dosage of his other antiseizure medications until
you get the refill.”
d. “He can stop all medications because he has been treated for several years now.”
ANS: B
Abrupt discontinuation of antiepileptic drugs can lead to withdrawal seizures. The other
options are incorrect. The nurse cannot change the dose or stop the medication without a
prescriber’s order.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 220
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11. During a routine appointment, a patient with a history of seizures is found to have a phenytoin
(Dilantin) level of 23 mcg/mL. What concern will the nurse have, if any?
a. The patient is at risk for seizures because the drug level is not at a therapeutic
level.
b. The patient’s seizures should be under control because this is a therapeutic drug
level.
c. The patient’s seizures should be under control if she is also taking a second
antiepileptic drug.
d. The drug level is at a toxic level, and the dosage needs to be reduced.
ANS: D
Therapeutic drug levels for phenytoin are usually 10 to 20 mcg/mL (see Table 14-6). The
other options are incorrect.
DIF: COGNITIVE LEVEL: Analyzing (Analysis)
REF: p. 224
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
12. A patient is taking gabapentin (Neurontin), and the nurse notes that there is no history of
seizures on his medical record. What is the best possible rationale for this medication order?
a. The medication is used for the treatment of neuropathic pain.
b. The medication is helpful for the treatment of multiple sclerosis.
c. The medication is used to reduce the symptoms of Parkinson’s disease.
d. The medical record is missing the correct information about the patient’s history of
seizures.
ANS: A
Gabapentin (Neurontin) is commonly used to treat neuropathic pain. The other options are
incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 227
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
MULTIPLE RESPONSE
1. The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED
therapy are accurate? (Select all that apply.)
a. AED therapy can be stopped when seizures are stopped.
b. AED therapy is usually lifelong.
c. Consistent dosing is the key to controlling seizures.
d. A dose may be skipped if the patient is experiencing adverse effects.
e. Do not abruptly discontinue AEDs because doing so may cause rebound seizure
activity.
ANS: B, C, E
Patients need to know that AED therapy is usually lifelong, and compliance (with consistent
dosing) is important for effective seizure control. Abruptly stopping AED therapy may cause
withdrawal (or rebound) seizure activity.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 232
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
COMPLETION
1. A 9-year-old child will be receiving carbamazepine (Tegretol) suspension, 200 mL daily. The
medication is available in a strength of 100 mg/5 mL. Identify how many milliliters will the
nurse give to the patient for each dose. _______
ANS:
10 mL
DIF: COGNITIVE LEVEL: Applying (Application)
REF: N/A
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies