During a routine appointment, a patient with a history of seizures is found to have a phenytoin level of 23 mcg/mL. What concern will the nurse have, if any?
The drug level is at a toxic level, and the dosage needs to be reduced.
The patient's seizures should be under control if she is also taking a second antiepileptic drug.
The patient is at risk for seizures because the drug level is not at a therapeutic level.
The patient's seizures should be under control because this is a therapeutic drug level.
The Correct Answer is A
A. The drug level is at a toxic level, and the dosage needs to be reduced. Phenytoin has a narrow therapeutic range, and levels above 20 mcg/mL are considered to be in the toxic range.
Symptoms of phenytoin toxicity can include nystagmus, ataxia, slurred speech, and confusion. Therefore, if a patient's phenytoin level is 23 mcg/mL, the nurse should be concerned about potential toxicity and consult with the healthcare provider to adjust the dosage.
B. The patient's seizures should be under control if she is also taking a second antiepileptic drug.
While combination therapy with multiple antiepileptic drugs can help control seizures, a phenytoin level of 23 mcg/mL is still concerning for toxicity and requires intervention.
C. The patient is at risk for seizures because the drug level is not at a therapeutic level. A phenytoin level of 23 mcg/mL is actually above the therapeutic range and is more indicative of toxicity rather than subtherapeutic levels.
D. The patient's seizures should be under control because this is a therapeutic drug level. A phenytoin level of 23 mcg/mL is not within the therapeutic range but rather in the toxic range, so the patient may experience symptoms of toxicity rather than having adequate seizure control.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Acetaminophen is generally considered safe for patients with a history of peptic ulcer disease.
It does not irritate the gastrointestinal mucosa like nonsteroidal anti-inflammatory drugs (NSAIDs).
B. Patients with a history of liver disease should not receive acetaminophen or should use it with caution and under close supervision, as acetaminophen is metabolized in the liver. Liver
impairment can lead to decreased metabolism of acetaminophen, potentially resulting in drug accumulation and hepatotoxicity.
C. Acetaminophen is commonly used to relieve mild to moderate headaches. However, the appropriateness of acetaminophen use in this scenario depends on the patient's overall health status and any contraindications specific to the individual.
D. Acetaminophen is often used to reduce fever. A fever of 101°F (38.3°C) alone does not necessarily contraindicate acetaminophen use, but caution should be exercised in patients with liver disease.
Correct Answer is B
Explanation
A. Myoclonic seizures are characterized by sudden, brief muscle jerks or twitches. These
movements are usually more pronounced and may involve multiple muscle groups compared to the described behavior, which involves a brief pause in activity without muscle jerks.
B. Absence seizures are characterized by brief episodes of staring or blanking out, often lasting for a few seconds. During an absence seizure, the child may appear to be staring into space, unaware of their surroundings. After the seizure, the child typically resumes their previous
activity without any memory of the event.
C. Status epilepticus refers to a prolonged seizure or a series of seizures without full recovery of consciousness between seizures. This condition is a medical emergency and presents with continuous or recurrent seizures without regaining consciousness.
D. Tonic-clonic seizures involve a sequence of tonic (stiffening) and clonic (jerking) phases, often accompanied by loss of consciousness and sometimes preceded by an aura. The described behavior does not fit the pattern of a tonic-clonic seizure, which typically involves more noticeable motor activity and loss of consciousness.
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