A nurse is caring for a client who has been prescribed phenobarbital (Luminal) for status epilepticus. The nurse should monitor the client for which adverse effect of this drug?¹

Respiratory depression

Hyperglycemia

Hypertension

Insomnia

Answer and Explanation

The Correct Answer is A

This is because phenobarbital, a medication used to treat seizures, can cause serious side effects on the respiratory system, such as weak or shallow breathing, apnea, respiratory arrest, and death². Respiratory depression is more likely to occur in patients who are elderly, debilitated, or have underlying lung disease². The nurse should monitor the patient's respiratory rate, oxygen saturation, and level of consciousness, and be prepared to administer oxygen or mechanical ventilation if needed³.

Choice B is wrong because hyperglycemia is not a common or serious adverse effect of phenobarbital. Phenobarbital does not affect blood glucose levels directly, but it may interfere with the metabolism of some oral antidiabetic drugs, such as sulfonylureas. Therefore, patients who take both phenobarbital and antidiabetic drugs may need to adjust their doses or monitor their blood glucose more frequently.

Choice C is wrong because hypertension is not a common or serious adverse effect of phenobarbital. Phenobarbital may cause hypotension or orthostatic hypotension in some patients, especially when given intravenously or in high doses². The nurse should monitor the patient's blood pressure and heart rate, and avoid sudden changes in position³.

Choice D is wrong because insomnia is not a common or serious adverse effect of phenobarbital. Phenobarbital is a barbiturate that has sedative and hypnotic properties. It may cause drowsiness, dizziness, lethargy, and impaired cognition in some patients². The nurse should advise the patient to avoid driving or operating machinery while taking phenobarbital, and to avoid alcohol and other CNS depressants³.

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Correct Answer is D

Explanation

This action takes priority because the patient's head is at risk of hitting the bed, the side rails, or other objects during a seizure, which can cause trauma, bleeding, or brain damage . The nurse should place a soft pad or pillow under the patient's head and move any sharp or hard objects away from the bed. The other choices are incorrect for the following reasons:

- A. "Loosening restrictive clothing". This action is helpful but not urgent because restrictive clothing can interfere with breathing or circulation during a seizure, but it is not a life-threatening issue . The nurse can loosen the patient's clothing after protecting their head and ensuring their airway is clear.

- B. "Restraining the client's limbs". This action is harmful and contraindicated because restraining the patient's limbs can cause injury, pain, or fractures during a seizure, as well as increase their anxiety and agitation . The nurse should never restrain a patient who is having a seizure, but rather let them move freely and safely.

- C. "Removing pillows and raising side rails". This action is unnecessary and potentially dangerous because removing pillows can expose the patient's head to injury, and raising side rails can trap the patient's limbs or body between them during a seizure . The nurse should keep pillows under the patient's head and lower the side rails if possible.

A. Take the medication with food. B. Avoid driving until the medication level is therapeutic. C. Drink at least 3 L of fluid per day. D. Report any bruising or bleeding to the provider.

Correct Answer is A

Explanation

This instruction is important because valproic acid can cause nausea, vomiting, stomach pain, and diarrhea as common side effects³⁴. Taking the medication with food can help reduce these gastrointestinal symptoms and improve the patient's tolerance and adherence to the treatment. The other choices are incorrect for the following reasons:

- B. "Avoid driving until the medication level is therapeutic". This instruction is unnecessary because valproic acid does not impair driving performance or increase the risk of accidents¹. The patient can drive safely as long as they do not experience drowsiness, dizziness, or blurred vision from the medication.

- C. "Drink at least 3 L of fluid per day". This instruction is excessive because valproic acid does not cause dehydration or fluid loss¹. The patient should drink enough fluids to stay hydrated, but not more than their normal intake.

- D. "Report any bruising or bleeding to the provider". This instruction is irrelevant because valproic acid does not affect blood clotting or increase the risk of bleeding¹. The patient should report any bruising or bleeding to the provider only if they have other conditions or medications that may cause these problems.

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A nurse is caring for a client who has been prescribed phenobarbital (Luminal) for status epilepticus. The nurse should monitor the client for which adverse effect of this drug?¹

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a patient who experiences seizure activity while in bed. What action by the nurse takes priority?

Correct Answer is D

Explanation

A nurse is providing discharge teaching to a client who has a new prescription for valproic acid to treat seizures. Which of the following instructions should the nurse include in the teaching?¹

Correct Answer is A

Explanation

The nurse is caring for a patient who has been receiving intravenous phenytoin (Dilantin). The patient complains of pain and burning at the IV site, and the nurse notes redness and swelling at the site. What will the nurse do?

A nurse is preparing to administer intravenous phenytoin (Dilantin) to a patient who has status epilepticus. Which of the following actions should the nurse take?

The nurse is preparing to give medications to a client who has been receiving long-term therapy with phenytoin (Dilantin). The nurse notes that the client has coarse facial features, hirsutism, and acne. What is the most appropriate nursing diagnosis for this client?

A nurse is caring for a client who has been prescribed phenobarbital (Luminal) for status epilepticus. The nurse should monitor the client for which adverse effect of this drug?¹

A patient who has been taking phenytoin for several years comes to the clinic for a follow-up visit and tells the nurse that he has been experiencing gum tenderness and bleeding when he brushes his teeth. The nurse will perform which action?

A client is prescribed ethosuximide (Zarontin) for absence seizures. The nurse should instruct the client to report which adverse effect?¹

The nurse is caring for a client who has been taking phenytoin (Dilantin) for several years to control tonic-clonic seizures. The client tells the nurse that he wants to stop taking the medication because it makes his gums swell and bleed. What is the most appropriate response by the nurse?

A nurse is reviewing discharge instructions with a patient who has epilepsy and has been prescribed lamotrigine (Lamictal). Which of the following statements by the patient indicates a need for further teaching?