The nurse can use seizure scales or questionnaires to measure the impact and burden of seizures on the patient and the caregiver. Seizure scales or questionnaires are tools that assess the frequency, duration, severity, and type of seizures, as well as the quality of life, mood, cognition, and functioning of the patient and the caregiver¹². Some examples of seizure scales or questionnaires are the National Hospital Seizure Severity Scale, the Liverpool Seizure Severity Scale, the Quality of Life in Epilepsy Inventory, and the Epilepsy and Learning Disabilities Quality of Life Scale¹².

Choice B is wrong because EEG is not a tool to measure the impact and burden of seizures on the patient and the caregiver. EEG is a diagnostic test that records the electrical activity of the brain and can detect abnormal patterns that indicate seizures or epilepsy³. EEG can help confirm the diagnosis, classify the type of seizures, identify the seizure focus, and guide the treatment of epilepsy³. However, EEG cannot measure the subjective aspects of seizure burden, such as quality of life, mood, cognition, or functioning.

Choice C is wrong because serum drug levels are not a tool to measure the impact and burden of seizures on the patient and the caregiver. Serum drug levels are laboratory tests that measure the concentration of anticonvulsant drugs in the blood and can help monitor the effectiveness and toxicity of these drugs. Serum drug levels can help adjust the dose, avoid drug interactions, and prevent breakthrough seizures or adverse effects. However, serum drug levels cannot measure the subjective aspects of seizure burden, such as quality of life, mood, cognition, or functioning.

Choice D is wrong because the quality of life scales or questionnaires is not a tool to measure the impact and burden of seizures on the patient and the caregiver. Quality of life scales or questionnaires are tools that assess the physical, psychological, social, and spiritual aspects of well-being and satisfaction with life. Quality of life scales or questionnaires can help evaluate the outcomes and effectiveness of epilepsy treatment. However, quality-of-life scales or questionnaires cannot measure the objective aspects of seizure burden, such as frequency, duration, severity, or type of seizures.

- Choice A is correct because the patient should report any rash, fever, or swollen lymph nodes to the prescriber immediately. These can be signs of a serious allergic reaction or a rare but life-threatening skin condition called Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN)¹². The patient should stop taking the drug and seek medical attention immediately if they develop these symptoms²³.

- Choice C is correct because the patient should use a reliable form of contraception while taking this medication. Lamotrigine can reduce the effectiveness of oral contraceptives and increase the risk of pregnancy¹². Lamotrigine can also cause birth defects or fetal harm if taken during pregnancy¹². The patient should consult their prescriber about the best method of contraception for them and inform them if they become pregnant or plan to become pregnant while taking lamotrigine²³.

- Choice D is correct because the patient should avoid exposure to sunlight and use sunscreen and protective clothing. Lamotrigine can increase the sensitivity of the skin to sunlight and cause sunburn or rash¹². The patient should limit their time in the sun and protect their skin from sun damage²³.

- Choice B is wrong because the patient does not need to take the medication with food to prevent gastrointestinal upset. Lamotrigine can be taken with or without food, depending on the patient's preference¹². Taking the medication with food may delay its absorption, but does not affect its bioavailability or efficacy⁴. The patient may experience some mild gastrointestinal side effects, such as nausea, vomiting, or diarrhea, but these usually go away with time or dose adjustment¹².

- Choice E is wrong because the patient does not need to avoid drinking alcohol or using illicit drugs while taking this medication. Lamotrigine does not have a significant interaction with alcohol or illicit drugs and does not affect the central nervous system as much as other anticonvulsants. However, the patient should still drink alcohol moderately and avoid using illicit drugs for their general health and well-being.

This is an appropriate action because absence seizures involve brief, sudden lapses of consciousness that last for a few seconds¹²³. The patient may stare blankly into space, stop talking, or stop moving during the seizure¹²³. The nurse should protect the patient from injury by guiding them to a safe place, such as a chair or a bed, and staying with them until they regain awareness¹²³. The nurse should also observe and document the time, duration, and type of seizure¹²³.

The other actions by the nurse are incorrect and indicate a need for further education.

- Choice A is wrong because calling for help and preparing to administer rescue medication is not necessary for absence seizures. Absence seizures are usually harmless and do not cause physical injury or complications¹²³. They do not require emergency treatment or rescue medication, unless they occur in clusters or last longer than 15 seconds¹²³.

- Choice C is wrong because shaking the patient and asking them if they are okay is not helpful for absence seizures. Shaking the patient may startle them or cause injury, and asking them questions may confuse them or increase their anxiety¹²³. The patient is not aware of their surroundings or able to respond during the seizure¹²³. The nurse should avoid touching or talking to the patient unnecessarily during the seizure¹²³.

- Choice D is wrong because documenting the time, duration, and type of seizure in the patient's chart is not the best action. Documenting the seizure is important, but it should not be done before ensuring the patient's safety and comfort¹²³. The nurse should document the seizure after it ends and after checking the patient's vital signs and level of consciousness¹²³.

large muscle mass. This is the correct action because phenytoin (Dilantin) is a poorly soluble drug that can cause tissue irritation, necrosis, and abscess formation when given intramuscularly¹³. The nurse should use a large-bore needle (at least 21 gauge) and inject the drug slowly into a large muscle mass, such as the gluteus maximus or the vastus lateralis, to minimize these complications¹³. The nurse should also avoid injecting more than 5 mL of solution per site and rotate the injection sites¹³.

The other actions by the nurse are incorrect and indicate a need for further education.

- Choice B is wrong because the nurse should not use a small-bore needle and inject the drug rapidly into a small muscle mass. This can increase the risk of tissue damage, pain, and infection due to the high pH and low solubility of phenytoin¹³. The nurse should use a large-bore needle and inject the drug slowly into a large muscle mass to reduce these risks¹³.

- Choice C is wrong because the nurse should not mix the drug with lidocaine or procaine to reduce pain and tissue irritation. These are local anesthetics that can interfere with the absorption and efficacy of phenytoin¹². The nurse should not mix phenytoin with any other drugs or solutions, as it is incompatible with many of them and can cause precipitation or crystallization¹².

- Choice D is wrong because the nurse should not massage the injection site after administration to enhance absorption. This can cause tissue damage, pain, and infection due to the high pH and low solubility of phenytoin¹³. The nurse should avoid touching or rubbing the injection site after administration to prevent these complications¹³.

This statement indicates that the patient understands that carbamazepine can cause a serious skin reaction called Stevens-Johnson syndrome, which requires immediate medical attention. The other statements are incorrect for the following reasons:

- A. "I will need to have my blood levels checked every week". This statement is incorrect because carbamazepine levels do not need to be checked every week, but rather every few months or as directed by the doctor.

- B. "I will drink grapefruit juice every morning with my medication". This statement is incorrect because grapefruit juice can increase the blood levels of carbamazepine and cause toxicity. The patient should avoid drinking grapefruit juice while taking this medication.

- D. "I will take my medication with food or milk". This statement is incorrect because carbamazepine should be taken on an empty stomach, at least one hour before or two hours after meals, to ensure optimal absorption. Taking it with food or milk can reduce its effectiveness.