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 ["A","B","D"]
Explanation
A. Constipation is a common adverse effect of opioid medications, including hydrocodone.
Opioids can slow down bowel motility, leading to constipation.
B. Lightheadedness is a common side effect of opioids, particularly when a patient first starts
taking them or when the dose is increased. It can be due to the central nervous system depressant effects of the medication.
C. Pain relief is the therapeutic effect of acetaminophen/hydrocodone, not an adverse effect.
D. Urinary retention can occur with opioid use due to their effects on the urinary sphincters and bladder muscle tone. Patients may experience difficulty urinating or incomplete emptying of the bladder.
E. Diarrhea is not a common adverse effect of acetaminophen/hydrocodone. In fact, opioids more commonly cause constipation rather than diarrhea.
Correct Answer is C
Explanation
A. CT of the brain can proceed regardless of atropine administration, as it does not directly affect the assessment of brain stem reflexes.
B. Electroencephalogram (EEG) can also proceed regardless of atropine administration, as it evaluates brain electrical activity rather than brain stem reflexes.
C. Assessment of brain stem reflexes should be postponed until all atropine is excreted and no
longer exerting its effects. Atropine can mask or alter the pupillary response and other brain stem reflexes, such as gag reflex and cough reflex, which are important indicators of neurological function.
D. Pupil response assessment should be postponed until atropine effects have dissipated, as
atropine can cause pupillary dilation, which may interfere with accurate assessment of pupil size and reactivity
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