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?

"I will wear sunscreen and protective clothing when I go outside"

"I will take ibuprofen if I have a headache from my medication"

"I will report any changes in my vision or mood to my doctor"

"I will not stop taking my medication abruptly"

Answer and Explanation

The Correct Answer is B

This statement is incorrect because ibuprofen may interact with lamotrigine and increase the risk of side effects such as dizziness, drowsiness, confusion, and difficulty concentrating¹². A clinical study found that common interactions between lamotrigine and ibuprofen include gait disturbance among females and insomnia among males². The patient should avoid taking ibuprofen while on lamotrigine and consult their doctor for alternative pain relief options. The other statements are correct for the following reasons:

- A. "I will wear sunscreen and protective clothing when I go outside". This statement is correct because lamotrigine can make the skin more sensitive to sunlight and increase the risk of sunburns and rashes. The patient should protect their skin from sun exposure while taking this medication.

- C. "I will report any changes in my vision or mood to my doctor". This statement is correct because lamotrigine can cause vision problems such as blurred vision, double vision, or eye irritation, as well as mood changes such as depression, anxiety, or suicidal thoughts. The patient should monitor their vision and mood and report any changes to their doctor promptly.

- D. "I will not stop taking my medication abruptly". This statement is correct because stopping lamotrigine suddenly can cause withdrawal symptoms such as seizures, headaches, nausea, or insomnia. The patient should follow their doctor's instructions on how to taper off the medication gradually if they need to stop taking it.

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Correct Answer is A

Explanation

This statement accurately describes the action of amantadine, which is a medication that has both antiviral and antiparkinsonian effects. The mechanism of action of amantadine in the treatment of parkinsonism is not fully understood, but it may involve increasing dopamine release in the brain, stimulating norepinephrine response, or activating dopaminergic receptors¹². The other choices are incorrect for the following reasons:

- B. "Dopamine in the central nervous system is decreased". This statement is incorrect because amantadine does not decrease dopamine levels, but rather enhances them. Decreasing dopamine levels would worsen the symptoms of parkinsonism, which are caused by a deficiency of dopamine in the basal ganglia.

- C. "Acetylcholine in the central nervous system is increased". This statement is incorrect because amantadine does not affect acetylcholine levels or activity. Acetylcholine is another neurotransmitter that is involved in the regulation of movement and cognition. Increasing acetylcholine levels would have anticholinergic effects, such as dry mouth, blurred vision, constipation, and confusion.

- D. "Acetylcholine in the central nervous system is decreased". This statement is incorrect because amantadine does not affect acetylcholine levels or activity. Decreasing acetylcholine levels would have cholinergic effects, such as salivation, lacrimation, urination, and diarrhea.

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 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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with mild parkinsonism is started on oral amantadine (Symmetrel). What statement accurately describes the action of this medication?

Correct Answer is A

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

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?

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