Ethosuximide is used mainly to treat which type of seizure?
Absence seizures
✓
Tonic-clonic seizures
Focal seizures with impaired awareness
Status epilepticus
Correct Answer
Absence seizures
Ethosuximide blocks T-type calcium channels in the thalamus, the circuit that drives absence seizures, so it is a standard drug for them. Tonic-clonic seizures do not respond to ethosuximide. Focal seizures with impaired awareness are treated with drugs such as carbamazepine or lamotrigine. Status epilepticus needs an IV benzodiazepine, not an oral drug.
Category: Other Anticonvulsants
Question 2
When giving IV phenytoin, the nurse dilutes the drug and flushes the line only with which solution?
5% dextrose in water
0.9% sodium chloride
✓
Lactated Ringer's solution
10% dextrose in water
Correct Answer
0.9% sodium chloride
Phenytoin precipitates in dextrose-containing solutions, so it is mixed with and flushed with normal saline, 0.9% sodium chloride. 5% dextrose in water causes precipitation. Lactated Ringer's solution is not the compatible diluent. 10% dextrose in water contains dextrose and also causes precipitation.
Category: Hydantoins and Barbiturates
Question 3
During IV phenytoin administration, the nurse monitors the patient continuously for which adverse effects?
Bronchospasm and wheezing
Hyperkalemia and muscle weakness
Hypotension and cardiac dysrhythmias
✓
Hypertension and tachycardia
Correct Answer
Hypotension and cardiac dysrhythmias
Rapid IV phenytoin can depress the heart, causing hypotension, bradycardia and dysrhythmias, so ECG and blood pressure are monitored throughout the infusion. Bronchospasm and wheezing are not typical effects of phenytoin. Hyperkalemia and muscle weakness are not caused by phenytoin. Hypertension and tachycardia are the opposite of the expected cardiovascular effects.
Category: Hydantoins and Barbiturates
Question 4
Phenobarbital lowers the blood levels of many other drugs because it has which effect?
Inhibits hepatic cytochrome P450 enzymes
Blocks renal tubular secretion
Displaces drugs from plasma albumin
Induces hepatic cytochrome P450 enzymes
✓
Correct Answer
Induces hepatic cytochrome P450 enzymes
Phenobarbital is a strong inducer of liver CYP enzymes, so drugs such as warfarin, corticosteroids and hormonal contraceptives are metabolized faster and may lose effect. Inhibits hepatic cytochrome P450 enzymes would raise drug levels instead. Blocks renal tubular secretion would also tend to raise levels. Displaces drugs from plasma albumin is not the mechanism of this interaction.
Category: Hydantoins and Barbiturates
Question 5
Before carbamazepine is started in a patient of Asian ancestry, testing for which genetic marker is recommended?
HLA-B*1502
✓
CYP2C9*3
BRCA1
Factor V Leiden
Correct Answer
HLA-B*1502
Patients who carry HLA-B*1502, found mainly in people of Asian ancestry, have a much higher risk of Stevens-Johnson syndrome and toxic epidermal necrolysis with carbamazepine. CYP2C9*3 matters for drugs such as warfarin and siponimod. BRCA1 is a breast and ovarian cancer gene. Factor V Leiden is an inherited clotting disorder.
Category: Other Anticonvulsants
Question 6
A patient taking carbamazepine becomes confused and reports headache and nausea. The nurse checks which laboratory result first?
Serum potassium
Serum sodium
✓
Serum calcium
Serum glucose
Correct Answer
Serum sodium
Carbamazepine can cause hyponatremia through inappropriate antidiuretic hormone secretion, and low sodium produces headache, nausea and confusion. Serum potassium is not typically disturbed by carbamazepine. Serum calcium does not explain this picture. Serum glucose is not a recognized carbamazepine problem.
Category: Other Anticonvulsants
Question 7
Lamotrigine is started more slowly in a patient who also takes valproic acid. What is the reason?
Valproic acid lowers lamotrigine levels and seizure control
The two drugs cause additive gingival overgrowth
Valproic acid raises lamotrigine levels and the rash risk
✓
Valproic acid blocks lamotrigine absorption in the gut
Correct Answer
Valproic acid raises lamotrigine levels and the rash risk
Valproic acid inhibits the metabolism of lamotrigine, raising its levels, and high or rapidly increased levels raise the risk of serious rashes such as Stevens-Johnson syndrome. Valproic acid lowers lamotrigine levels and seizure control is the opposite of the real effect. The two drugs cause additive gingival overgrowth is wrong; gum overgrowth is a phenytoin effect. Valproic acid blocks lamotrigine absorption in the gut is not the mechanism.
Category: Other Anticonvulsants
Question 8
Levetiracetam requires dose adjustment in which condition?
Hypothyroidism
Asthma
Gout
Renal impairment
✓
Correct Answer
Renal impairment
Levetiracetam is eliminated mainly unchanged by the kidneys, so its dose is reduced when kidney function is impaired. Hypothyroidism does not change levetiracetam dosing. Asthma is not a reason to adjust it. Gout is unrelated to its elimination.
Category: Other Anticonvulsants
Question 9
A patient starting topiramate is taught to drink plenty of fluids to help prevent which adverse effect?
Kidney stones
✓
Gingival overgrowth
Hair loss
Hyperkalemia
Correct Answer
Kidney stones
Topiramate weakly inhibits carbonic anhydrase, which makes urine less acidic and favors kidney stone formation; good hydration lowers the risk. Gingival overgrowth is a phenytoin effect and is prevented with oral hygiene. Hair loss is linked to valproic acid and is not prevented by fluids. Hyperkalemia is not a topiramate effect.
Category: Other Anticonvulsants
Question 10
A patient is in status epilepticus. Which drug does the nurse expect to give first?
Oral carbamazepine
An IV benzodiazepine
✓
IV mannitol
Oral ethosuximide
Correct Answer
An IV benzodiazepine
An IV benzodiazepine such as lorazepam is the first-line treatment for status epilepticus because it rapidly enhances GABA inhibition; a longer-acting drug such as fosphenytoin or levetiracetam follows. Oral carbamazepine acts too slowly and cannot be swallowed safely during a seizure. IV mannitol lowers intracranial pressure but does not stop seizures. Oral ethosuximide treats absence seizures, not status epilepticus.
Category: Benzodiazepines and Status Epilepticus
Question 11
Taking lorazepam together with an opioid carries a boxed warning for which outcome?
Malignant hyperthermia
Hypertensive crisis
Profound respiratory depression
✓
Severe hyperglycemia
Correct Answer
Profound respiratory depression
Benzodiazepines and opioids both depress the central nervous system, and together they can cause profound sedation, respiratory depression, coma and death. Malignant hyperthermia is triggered by certain anesthetic gases and succinylcholine. Hypertensive crisis is linked to MAO inhibitor interactions. Severe hyperglycemia is not an effect of this combination.
Category: Benzodiazepines and Status Epilepticus
Question 12
A patient who has been seizure-free for 3 months on levetiracetam says they want to stop taking it. What should the nurse explain?
The drug can be stopped once seizures end
Taking it every other day is equally effective
Skipped doses can be doubled the next day
Stopping suddenly can bring on seizures
✓
Correct Answer
Stopping suddenly can bring on seizures
Abruptly stopping an anticonvulsant can trigger rebound seizures, even status epilepticus, so any change is made gradually under the provider's direction. The drug can be stopped once seizures end is unsafe; seizure control depends on continued therapy. Taking it every other day is equally effective is false and lowers drug levels. Skipped doses can be doubled the next day is not safe general advice.
Category: Anticonvulsant Nursing Care
Question 13
A patient taking sertraline is prescribed sumatriptan. The nurse teaches the patient to report symptoms of which condition?
Serotonin syndrome
✓
Neuroleptic malignant syndrome
Lactic acidosis
Adrenal crisis
Correct Answer
Serotonin syndrome
Triptans are serotonin agonists, and combining them with SSRIs or SNRIs can cause serotonin syndrome, with agitation, tremor, fever, sweating and fast heart rate. Neuroleptic malignant syndrome is linked to dopamine-blocking antipsychotics. Lactic acidosis is linked to metformin. Adrenal crisis follows abrupt withdrawal of long-term corticosteroids.
Category: Migraine Drugs
Question 14
When should a patient take sumatriptan for a migraine?
Every day to prevent migraine attacks
At the first sign of migraine pain
✓
Only after the pain has peaked
Every 4 hours around the clock
Correct Answer
At the first sign of migraine pain
Triptans are abortive drugs and work best when taken early in an attack, at the first sign of headache pain. Every day to prevent migraine attacks describes preventive therapy, which is not the role of triptans. Only after the pain has peaked makes the drug less effective. Every 4 hours around the clock is not how triptans are used and risks overuse.
Category: Migraine Drugs
Question 15
For a patient whose migraines bring on vomiting early in the attack, which form of sumatriptan avoids the problem of keeping a tablet down?
Extended-release tablet
Chewable tablet
Subcutaneous injection
✓
Oral solution
Correct Answer
Subcutaneous injection
Sumatriptan can be given by subcutaneous injection, which bypasses the gut and acts quickly; a nasal spray is another non-oral option. Extended-release tablet must still be swallowed. Chewable tablet is swallowed too. Oral solution would also be vomited.
Category: Migraine Drugs
Question 16
Ergotamine carries a boxed warning against use with potent CYP3A4 inhibitors such as clarithromycin because of which risk?
Severe hypoglycemia
Aplastic anemia
Permanent hearing loss
Serious vasospasm and limb ischemia
✓
Correct Answer
Serious vasospasm and limb ischemia
Potent CYP3A4 inhibitors raise ergotamine levels, which can cause intense vasoconstriction with ischemia of the limbs or brain. Severe hypoglycemia is not part of this interaction. Aplastic anemia is a carbamazepine concern. Permanent hearing loss is linked to drugs such as aminoglycosides.
Category: Migraine Drugs
Question 17
Rimegepant relieves migraine by blocking which target?
Calcitonin gene-related peptide receptors
✓
Serotonin 5-HT3 receptors
Beta-adrenergic receptors
Histamine H1 receptors
Correct Answer
Calcitonin gene-related peptide receptors
Rimegepant is a gepant, a calcitonin gene-related peptide receptor antagonist; this peptide is released during migraine and dilates vessels and drives pain signaling. Serotonin 5-HT3 receptors are blocked by antiemetics such as ondansetron. Beta-adrenergic receptors are blocked by beta blockers such as propranolol. Histamine H1 receptors are blocked by antihistamines.
Category: Migraine Drugs
Question 18
Mannitol is contraindicated in a patient with which condition?
Cerebral edema
Anuria
✓
Increased intraocular pressure
Increased intracranial pressure
Correct Answer
Anuria
Mannitol must be excreted by the kidneys to work; in anuria it stays in the blood and expands the vascular volume, risking heart failure and pulmonary edema. Cerebral edema is an indication for mannitol. Increased intraocular pressure is also an indication. Increased intracranial pressure is a key indication for mannitol in neurologic emergencies.
Category: Intracranial Pressure Drugs
Question 19
A patient receiving mannitol for increased intracranial pressure develops which finding that the nurse should report at once as a sign of worsening pressure?
An increase in urine output
A mild increase in thirst
A pupil that no longer reacts to light
✓
A decrease in headache pain
Correct Answer
A pupil that no longer reacts to light
A pupil that stops reacting to light can signal rising pressure and possible herniation, which is an emergency. An increase in urine output is the expected diuretic effect of mannitol. A mild increase in thirst is an expected result of fluid loss, though intake and output are still tracked. A decrease in headache pain suggests that pressure is improving.
Category: Intracranial Pressure Drugs
Question 20
Before lacosamide is started, the nurse reviews the patient's ECG because the drug can have which effect?
Shorten the QT interval
Cause ST-segment elevation
Cause peaked T waves
Prolong the PR interval
✓
Correct Answer
Prolong the PR interval
Lacosamide slows conduction through the AV node and can prolong the PR interval, so it is avoided in second- or third-degree AV block. Shorten the QT interval is not a lacosamide effect. Cause ST-segment elevation suggests myocardial injury, not this drug. Cause peaked T waves is a sign of hyperkalemia.
Category: Other Anticonvulsants