A nurse is caring for a patient who has been taking gabapentin (Neurontin) for neuropathic pain. The patient says, "I don't think this drug is working. I still have pain and now I feel dizzy and tired all the time." How should the nurse respond?
"You should stop taking the drug and ask your doctor for something else."
"You should increase your dose until you get relief from your pain."
"You should continue taking the drug as prescribed and avoid driving or operating machinery."
"You should report these symptoms to your doctor as they may indicate toxicity."
The Correct Answer is D
The nurse should respond by saying, "You should report these symptoms to your doctor as they may indicate toxicity." This is the correct answer because dizziness and tiredness are common side effects of gabapentin, but they may also be signs of toxicity if they are severe or persistent¹². The nurse should also ask the patient about their dose and frequency of gabapentin, and check their blood levels if possible³. The nurse should advise the patient not to stop or change their dose of gabapentin without consulting their doctor, as this can cause withdrawal symptoms or seizures¹².
The other statements by the nurse are incorrect and indicate a need for further education.
- Saying, "You should stop taking the drug and ask your doctor for something else." is wrong because the nurse should not advise the patient to stop taking gabapentin abruptly, as this can cause withdrawal symptoms or seizures. The nurse should also not suggest alternative drugs without knowing the patient's medical history, allergies, or other medications¹².
- Saying, "You should increase your dose until you get relief from your pain." is wrong because the nurse should not advise the patient to increase their dose of gabapentin without consulting their doctor, as this can cause toxicity or adverse effects. The nurse should also not imply that gabapentin is ineffective for neuropathic pain, as it is one of the first-line drugs for this condition⁴.
- Saying, "You should continue taking the drug as prescribed and avoid driving or operating machinery." is partially correct, but not the best response. The nurse should advise the patient to continue taking gabapentin as prescribed and avoid driving or operating machinery until they know how the drug affects them, but they should also report their symptoms to their doctor as they may indicate toxicity¹².
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","E"]
Explanation
- Choice A is correct because warfarin (Coumadin) may interact with carbamazepine and require dosage adjustments. Carbamazepine can increase the metabolism of warfarin and decrease its anticoagulant effect, which can increase the risk of blood clots or stroke¹⁴. The nurse should monitor the patient's international normalized ratio (INR) and prothrombin time (PT) and adjust the warfarin dose accordingly¹⁵.
- Choice B is correct because erythromycin (Erythrocin) may interact with carbamazepine and require dosage adjustments. Erythromycin can inhibit the metabolism of carbamazepine and increase its blood levels, which can increase the risk of toxicity or adverse effects, such as drowsiness, dizziness, nausea, or rash¹⁴. The nurse should monitor the patient's carbamazepine levels and signs of toxicity and adjust the carbamazepine dose accordingly¹⁵.
- Choice E is correct because metformin (Glucophage) may interact with carbamazepine and require dosage adjustments. Carbamazepine can decrease the absorption of metformin and reduce its blood glucose-lowering effect, which can increase the risk of hyperglycemia or diabetes complications¹⁴. The nurse should monitor the patient's blood glucose levels and adjust the metformin dose accordingly¹⁵.
- Choice C is wrong because ibuprofen (Advil) does not interact with carbamazepine and does not require dosage adjustments. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that does not affect the metabolism or blood levels of carbamazepine or be affected by it²³. The nurse should advise the patient to use ibuprofen as needed for pain or inflammation, but to avoid taking it with other NSAIDs or aspirin to prevent bleeding or stomach ulcers²³.
- Choice D is wrong because levothyroxine (Synthroid) does not interact with carbamazepine and does not require dosage adjustments. Levothyroxine is a thyroid hormone replacement that does not affect the metabolism or blood levels of carbamazepine or be affected by it²³. The nurse should advise the patient to take levothyroxine on an empty stomach, at least 30 minutes before or 4 hours after any other medications, to ensure optimal absorption²³.
Correct Answer is C
Explanation
This statement is incorrect because grapefruit juice does not interact with phenytoin and has no effect on its metabolism or blood levels¹. The patient does not need to avoid grapefruit juice while taking phenytoin, unless they are also taking another drug that is affected by grapefruit juice, such as some statins, calcium channel blockers, or cyclosporine²³.
The other statements by the patient are correct and indicate an understanding of the teaching.
- Choice A is correct because the patient should brush their teeth gently with a soft toothbrush to prevent gingival hyperplasia, which is an overgrowth of the gums that can occur with phenytoin use. The patient should also floss regularly and visit a dentist every 3 to 4 months.
- Choice B is correct because the patient should wear a medical alert bracelet that says they have epilepsy and are taking phenytoin. This can help emergency personnel to provide appropriate care and avoid drug interactions if the patient has a seizure or another medical problem.
- Choice C is correct because the patient should check their blood pressure regularly while taking phenytoin, as this drug can cause hypotension, especially when given intravenously or in high doses. The patient should also monitor their heart rate and rhythm, as phenytoin can cause bradycardia or arrhythmias.
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