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  1. Most clients with seizure disorders first exhibit symptoms between the ages of two to five years.
    True
  2. Epilepsy causes cognitive impairment.
    False
  3. Anticonvulsant drugs can effectively prevent and control most epileptic seizures.
    True
  4. The terms intractable seizures and status epilepticus are used interchangeably, because they have the same meaning.
    False
  5. Barbiturates are nonspecific CNS stimulants designed to redirect impulse transmission in the cortex of the brain to decrease seizures.
    False
  6. The client collapses, falls down, and loses consciousness. Then he recovers after 20 seconds, regains consciousness, and is able to ambulate unassisted. The nurse recognizes that the client is exhibiting characteristics of what type of seizure?

    a.
    absence seizure
    b.
    myoclonic seizure
    c.
    atonic seizure
    d.
    simple partial seizure
    c. atonic seizure
  7. A client is prescribed fosphenytoin sodium. The nurse prepares to administer this by which route?

    a.
    oral
    b.
    subcutaneous
    c.
    intramuscular
    d.
    intravenous
    d. intravenous
  8. When teaching a client and his family about anticonvulsant therapy, the nurse should include which of the following?

    a.
    Clients usually respond well to these agents, leading to only short-term therapy being required.
    b.
    There are very few drug interactions between anticonvulsants and OTC medications.
    c.
    Clients need routine serum blood levels of the drug drawn.
    d.
    Clients usually have to have follow-up electroencephalograms routinely.
    c. Clients need routine serum blood levels of the drug drawn.
  9. The nurse recognizes a generalized tonic-clonic seizure by the client exhibiting what characteristics?

    a.
    rigidity with muscle jerks, temporal apnea, possible loss of bowel and bladder control.
    b.
    staring, fluttering eyes, no loss of consciousness.
    c.
    blank stare followed by random activity; automatism may be present.
    d.
    jerking of one arm, leg, or the face, with altered sense of taste and smell.
    a. rigidity with muscle jerks, temporal apnea, possible loss of bowel and bladder control
  10. A client is experiencing status epilepticus. The nurse should:

    a.
    turn the client on the back and insert a tongue blade in the mouth.
    b.
    ensure a patent airway and protect the client’s head and body from injury.
    c.
    move the client to a bed and restrain the extremities.
    d.
    raise all side rails and restrain the extremities.
    b. ensure a patent airway and protect the client’s head and body from injury.
  11. When obtaining a client history, the nurse learns that the client exercises regularly, is an avid sports fan, is currently is under a great deal of both personal and professional stress causing the client to snack frequently. Which of these factors would pose the greatest risk for decreasing the client’s seizure threshold?

    a.
    stress
    b.
    physical exercise
    c.
    increased oral intake
    d.
    insomnia
    a. stress
  12. When teaching a client prescribed phenytoin about a common adverse effect of this drug, the nurse should instruct the client to:

    a.
    avoid foods preserved in sodium.
    b.
    practice good oral hygiene.
    c.
    use hair replacement products sold OTC.
    d.
    avoid oral contraceptives
    b. practice good oral hygiene
  13. Folic acid supplements are often given when phenytoin therapy is started. The reason for this is to:

    a.
    prevent the development of anemia.
    b.
    prevent drug toxicity.
    c.
    improve the client’s overall health.
    d.
    decrease the frequency of convulsions.
    a. prevent the development of anemia.
  14. A client who is n.p.o. is prescribed IV phenytoin. When preparing the equipment to administer this dose, the nurse should:

    a.
    hang an IV bag of 5% dextrose and prime the IV tubing.
    b.
    hang an IV bag of 0.9% normal saline and prime the IV tubing.
    c.
    notify the health care provider prior to drug administration.
    d.
    prepare a volumetric infusion pump to infusion the IV fluids and phenytoin.
    b. hang an IV bag of 0.9% normal saline and prime the IV tubing.
  15. Which of the following anticonvulsants is indicated for the treatment of trigeminal neuralgia?

    a.
    acetazolamide
    b.
    phenytoin
    c.
    paramethadione
    d.
    carbamazepine
    d. carbamazepine
  16. The drowsiness experienced by some clients when beginning phenytoin therapy:

    a.
    gets worse the longer the person takes the drug.
    b.
    improves after taking the drug for a while.
    c.
    is especially severe in children.
    d.
    remains throughout therapy.
    b. improves after taking the drug for a while
  17. Clients who experience intractable seizures may require surgical intervention if:

    a.
    standard medications have effectively controlled seizure activity.
    b.
    seizures originate in diverse areas of the brain.
    c.
    seizures originate near speech, memory, or vision centers in the brain.
    d.
    seizures consistently originate in just one part of the brain.
    d. seizures consistently originate in just one part of the brain
  18. The nurse understands that this medication should be available to treat or prevent seizures during neurosurgery:

    a.
    fosphenytoin sodium.
    b.
    ethosuximide
    c.
    carbamazepine.
    d.
    valproic acid.
    a. fosphenytoin sodium.
  19. The nurse caring for a client who has been on chronic therapy with valproic acid. The nurse assesses which of the following for this client?

    a.
    renal function tests
    b.
    pulmonary function tests
    c.
    audiometric tests
    d.
    liver function tests
    d. liver function tests
  20. A child with cerebral palsy is being treated with phenobarbital as prophylaxis for seizure activity. The child’s phenobarbital level is 25 mcg/mL. The mother asks the nurse about her child’s phenobarbital level and the nurse’s appropriate response is:

    a.
    “The level is normal.”
    b.
    “The level is 25 mcg/mL which is normal.”
    c.
    “I’ll need to call doctor first, who can tell you.”
    d.
    “The level is a little low, but I’m sure the doctor will increase your child’s dose.”
    b. “The level is 25 mcg/mL which is normal.”
  21. Clients taking carbamazepine should have which test monitored routinely?

    a.
    liver function tests
    b.
    renal function tests
    c.
    complete blood count
    d.
    skin biopsy
    c. complete blood count
  22. A nurse is teaching a client taking carbamazepine about what action he should take related to his serum drug level. Which of the following would indicate client understanding of the instruction for a serum carbamazepine level of 11 mcg/L?

    a.
    “I would notify my doctor right away.”
    b.
    “I will plan to take my next dose as usual.”
    c.
    “I should expect my doctor to call the pharmacy for a higher dose of my medicine.”
    d.
    “I will double up on my next dose and then go back to my regular dose.”
    b. “I will plan to take my next dose as usual.”
  23. When preparing to administer fosphenytoin sodium to an adult, the nurse understands that too rapid intravenous administration of fosphenytoin sodium can cause:

    a.
    a respiratory rate of 10.
    b.
    a pulse rate less than 60.
    c.
    blood pressure greater than 140/90.
    d.
    a temperature greater than 99 degrees F.
    b. a pulse rate less than 60.
  24. During the client’s annual physical examination, the significant other states that the client will “just stop in the middle of a sentence and stare off into space for about 15 seconds fluttering his eyes. When he stops staring, he just continues what he was saying. I asked him what he was thinking when he was staring and he doesn’t remember anything about this episode. It has happened about a dozen times in the last couple of months.” What is happening with him? The nurse recognizes this behavior as characteristic of:

    a.
    a simple partial seizure.
    b.
    a complex partial seizure.
    c.
    an atonic seizure.
    d.
    an absence seizure.
    d. an absence seizure.
  25. When administering IV bolus phenytoin to an infant, the nurse must use:

    a.
    a scalp vein IV access.
    b.
    an antecubital IV access.
    c.
    a central venous access device.
    d.
    a brachial artery catheter.
    c. a central venous access device.
  26. The nurse is caring for an adult client receiving continuous enteral feedings who is prescribed phenytoin per nasogastric tube. The nurse should:

    a.
    collaborate with the health care provider to change the route of administration of phenytoin to IV.
    b.
    discontinue the enteral feeding 90 minutes before and after administering the phenytoin.
    c.
    stop the enteral feeding, flush the nasogastric tube with normal saline, administer phenytoin, then flush tube with normal saline, restart feeding.
    d.
    dilute the phenytoin and administer it concurrently with the enteral feeding at a decreased rate of infusion.
    b. discontinue the enteral feeding 90 minutes before and after administering the phenytoin.
  27. The nurse should monitor the client taking carbamazepine for:

    a.
    gingival dysplasia.
    b.
    hypersensitivity to benzodiazepines
    c.
    photosensitivity.
    d.
    fever and sore throat.
    d. fever and sore throat.
  28. A client prescribed carbamazepine is experiencing hyponatremia characterized by:

    a.
    increased seizure activity.
    b.
    a serum sodium level less than 135 mEq/L.
    c.
    a serum potassium level less than 3 mEq/L.
    d.
    trigenimal neuralgia.
    b. a serum sodium level less than 135 mEq/L.
  29. A client is prescribed valproic acid for seizure control. The client’s current serum level of valproic acid is 130 mcg/mL. The nurse should:

    a.
    administer a stat dose to the client now as prescribed for low level of drug.
    b.
    notify the health care provider immediately.
    c.
    plan to administer the client’s next dose.
    d.
    have the laboratory redo the blood test.
    b. notify the health care provider immediately.
  30. A client is prescribed tiagabine. The nurse understands that this drug works by:

    a.
    blocking sodium to decrease neuron excitability.
    b.
    increasing the inhibitory neurotransmitter GABA.
    c.
    decreasing the level of acetylcholine.
    d.
    increasing the passage of sodium out of the neuron.
    b.increasing the inhibitory neurotransmitter GABA
  31. A client is prescribed lamotrigine. The nurse understands that this agent is used in combination with other anticonvulsant agents to treat:

    a.
    generalized tonic-clonic seizures in children.
    b.
    absence seizures in children.
    c.
    partial seizures in adults.
    d.
    Lennox-Gastaut syndrome in adults.
    c. partial seizures in adults.
  32. Complete withdrawal from antianxiety agents after long-term abuse may take weeks to months.
    True
  33. Alcohol is the oldest psychoactive drug known
    True
  34. The predominant pharmacological effect of alcohol is to stimulate the central nervous system.
    False
  35. Delirium tremens (DTs), in a person dependent on alcohol, usually occur about 12-24 hours after alcohol is withdrawn.
    False
  36. Heroin abuse has been associated with development of a permanent Parkinson’s disease-like syndrome
    True
  37. When explaining the methadone maintenance approach to managing the heroin-dependent client, the nurse explains to the client’s family that:

    a.
    by stopping heroin use, the client will not engage in criminal activity to support a heroin habit.
    b.
    methadone maintenance will prevent withdrawal symptoms, allowing the client minimal discomfort when heroin use is stopped.
    c.
    the methadone maintenance will allow the client to slowly taper off the heroine over a period of months and then the client will have a lifestyle closer to normal.
    d.
    methadone is used because it is not addicting.
    b. methadone maintenance will prevent withdrawal symptoms, allowing the client minimal discomfort when heroin use is stopped
  38. If the client is receiving a reduced effect from the use of alcohol over time, she has developed:

    a.
    psychological dependence.
    b.
    alcohol intoxication.
    c.
    physical dependence.
    d.
    tolerance.
    d. tolerance.
  39. The client has a history of repeated use of marijuana. He tells the nurse that he feels better when using the substance than when not using it. The nurse understands this as:

    a.
    habituation.
    b.
    substance dependence.
    c.
    addiction.
    d.
    tolerance.
    a. habituation
  40. Physical dependence:

    a.
    is the improper use of drugs or other chemical substances.
    b.
    usually results from prolonged use of a substance.
    c.
    implies that a client has difficulty functioning unless under the influence of a drug.
    d.
    describes a client’s strong compulsion to obtain and use a substance or drug.
    b. usually results from prolonged use of a substance
  41. When screening a client for substance abuse, the nurse should examine:

    a.
    for piloerection.
    b.
    on the soles of the feet
    c.
    between the toes.
    d.
    for skin rash
    c. between the toes.
  42. When assessing for evidence of intravenous drug use, besides checking the antecubital space, the nurse checks:

    a.
    the chest over the heart.
    b.
    the trunk
    c.
    the nose.
    d.
    in the scrotal area.
    d. in the scrotal area.
  43. The nurse is assessing a client and notes that she is lacking eyebrow hair and lashes. The nurse suspects;

    a.
    the client was a victim of a house fire caused by cigarette smoking
    b.
    this is related to abuse of marijuana
    c.
    the client smokes crack coccaine
    d.
    this is caused by heroin injections
    • c.
    • the client smokes crack coccaine
  44. The nurse understands that which group is at risk of interactions between alcohol and prescription and nonperscription medications?

    a.
    the elderly
    b.
    pregnant women
    c.
    spouses of alcohol abusers
    d.
    20-30 year olds
    • a.
    • the elderly
  45. When working in the emergency department the nurse prepares to treat an unconscious client with injestion of an overdose of MDMA "ecstacy" with:

    a.
    stomach pump
    b.
    gastric lavage
    c.
    ipecac syrup
    d.
    intravenous chlopromazine
    • b.
    • gastric lavage
  46. If the client has taken phenycyclidine (PCP), the nurse:

    a.
    places the client in an area where the client will recieve maximal stimulation
    b.
    arouses the client periodically to avoid excessive central nervous system depression
    c.
    monitors the client for elevated temp and BP
    d.
    tells the client to drink plenty of orange juice
    c. monitors the client for elevated temp and BP
  47. A client arrives in the ER dept with tachycardia, hypertension, and excessive CNS stimulation related to intake of a lg dose of coccaine. To treat these manifestations, the nurse prepares to administer:

    a.
    IV propranolol
    b.
    diazepam by mouth
    c.
    IV lidocaine
    d.
    haloperidol IM
    a. IV propranolol
  48. A nurse suspects a coworker of drug abuse during thier current shift. The nurse should first:

    a.
    check on the status of the clients assigned to that nurse
    b.
    confront the coworker with her suspicions
    c.
    discuss her suspicions wit the nurse manager/head nurse
    d.
    immediately report the nurse to the state board of nursing
    a. check on the status of the clients assigned to that nurse
  49. The nurse is caring for a homeless client admitted three days ago for frostbite. The nurse notes in ht eclient's record that he has a history of alcohol abuse. The nurse's priority is:

    a.
    assess the client's wound dressings for drainage
    b.
    monitor the clients's vital signs every two hours
    c.
    place the client on a cardiorespiratory monitor
    d.
    prepare to protect the client from harm during delerium tremors
    d. prepare to protect the client from harm during delerium tremors
  50. Nursing intervention in working with persons newly diagnosed as addicted to drugs includes:

    a.
    excluding drugs other than those prescribed by the treating health care provider from the treatment unit.
    b.
    asking the prescriber about a prescription for sleep medication.
    c.
    encouraging a trusting relationship by allowing unsupervised trips off the nursing unit.
    d.
    allowing all client acquaintances to visit the client.
    • a.
    • excluding drugs other than those prescribed by the treating health care provider from the treatment unit.
  51. The client who uses methamphetamine is a risk for:

    a.
    esophageal cancer.
    b.
    nasal passage damage
    c.
    bone marrow damage.
    d.
    death from overdose.
    d. death from overdose
  52. The improper use of drugs or chemical substances that have been prescribed or acquired for a legitimate therapeutic or nonrecreational use is:

    a.
    habituation.
    b.
    cross-tolerance.
    c.
    substance dependence.
    d.
    substance misuse.
    d. substance misuse.
  53. The nurse anticipates a client with a blood alcohol concentration of 0.60% to:

    a.
    experience blackouts.
    b.
    be unconscious.
    c.
    die from respiratory failure.
    d.
    experience delirium tremors.
    c. die from respiratory failure.
  54. When caring for a client whose last dose of heroin was self-administered just prior to admission, the nurse anticipates the client’s withdrawal symptoms will peak in:

    a.
    6-8 hours
    b.
    12-18 hours
    c.
    36-48 hours
    d.
    5-10 days
    c. 36-48 hours
  55. A client who is dependent on opiates arrives at the ED experiencing respiratory distress. Naxolone is administered. The nurse should:

    a.
    monitor the client closely for tachypnea.
    b.
    prepare the client for rapid onset of abstinence syndrome.
    c.
    prepare to administer intravenous fentanyl citrate.
    d.
    monitor the client’s blood alcohol concentration.
    b. prepare the client for rapid onset of abstinence syndrome
  56. When caring for client experiencing treatment of substance abuse, the nurse should:

    a.
    maintain a nonjudgmental, positive attitude.
    b.
    ensure that the client does not abuse the same substance in the future.
    c.
    allow the client to take her prescribed medication on a p.r.n. basis.
    d.
    maintain the temperature of the physical environment at less than 70° F.
    a. maintain a nonjudgmental, positive attitude.
  57. Urine acidifiers such as cranberry juice and ascorbic acid may be used in the postemergency treatment of overdose with:

    a.
    LSD.
    b.
    phencyclidine (PCP).
    c.
    airplane glue.
    d.
    mescaline.
    b. phencyclidine (PCP).
  58. If evidence of substance abuse is found in a person presenting to an emergency department:

    a.
    that person should be referred to a medical outpatient clinic for a workup.
    b.
    that person should be confronted directly about abuse.
    c.
    the family should be contacted immediately to verify the abuse.
    d.
    that person should be referred to a detoxification program.
    b. that person should be confronted directly about abuse.
  59. When working with families of substance abusers, the first objective of the health care team is probably to:

    a.
    identify the family enabler.
    b.
    identify obstacles to the client’s recovery.
    c.
    restore hope to the client and family.
    d.
    have the family confront the abuser.
    c. restore hope to the client and family
  60. A client presents to an emergency department with tics, tremors, paranoia, and picking at their clothes. The nurse should:

    a.
    send a blood specimen to the lab for serum blood alcohol concentration.
    b.
    notify the health care provider that client is a barbiturate abuser.
    c.
    further assess the client for cocaine use.
    d.
    monitor the client for further evidence of track marks for heroin abuse.
    c. further assess the client for cocaine use
  61. The nurse should keep current with research being conducted on some substances. For instance, marijuana has been found to:

    a.
    produce low rates of tolerance even with regular use.
    b.
    reduce nausea experienced by clients undergoing chemotherapy.
    c.
    lead to heroin addiction and antisocial behavior.
    d.
    reduce the likelihood of myocardial infarction with regular use.
    b. reduce nausea experienced by clients undergoing chemotherapy
  62. A client admitted to the nursing unit for treatment of his heart failure has a history of alcohol abuse. The nurse should:

    a.
    collaborate with the health care provider for a prescription for scheduled doses of chlordiazepoxide.
    b.
    closely monitor the client for delirium tremors common within the first 24 hours after hospital admission.
    c.
    be sure all side rails are in the up position and that the client is properly restrained.
    d.
    have members of the client’s family take turns staying at the bedside, so the client is never left alone.
    a. collaborate with the health care provider for a prescription for scheduled doses of chlordiazepoxide
  63. The nurse understands that public education about substance abuse should begin with:

    a.
    adolescents.
    b.
    school-age children
    c.
    women anticipating getting pregnant.
    d.
    elderly clients.
    b. school-age children
  64. The nurse is teaching a client prescribed acamprosate calcium. Which of the following client comments indicates a need for further teaching?

    a.
    “It is an effective treatment of alcohol abuse.”
    b.
    “It is not habit forming.”
    c.
    “It will help me cut down on my alcohol intake.”
    d.
    “It will not eliminate my withdrawal symptoms.”
    c. “It will help me cut down on my alcohol intake.”
  65. Nicotine patches are classified as “Pregnancy D” drugs, meaning this product:

    a.
    is safe to use during late pregnancy.
    b.
    poses imminent danger to the fetus.
    c.
    has not been sufficiently researched for effect on pregnancy in humans.
    d.
    is acceptable to be used during pregnancy.
    b. poses imminent danger to the fetus.

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