A client's blood concentration of carbamazepine is increased. ...

[Coya19@aol.com]

A client's blood concentration of carbamazepine is increased. When reviewing the client's medication history, which of the following would alert the nurse to a possible interaction?
 
  A) Phenobarbital
  B) Primidone
  C) Phenytoin
  D) Diltiazem

Question 2

A client who is receiving lithium comes to the clinic for an evaluation. During the visit, the client reports a fine hand tremor. Which action by the nurse would be most appropriate?
 
  A) Immediately obtain a specimen to determine the client's blood drug concentration.
  B) Suggest that the client take the medication with meals or snacks.
  C) Assist the client in minimizing exposure to stressors.
  D) Encourage the client to elevate the affected hand on a pillow.

[mrphibs]

Answer to Question 1

Ans: D
Diltiazem interacts with carbamazepine, causing increased carbamazepine concentrations. Phenobarbital, primidone, and phenytoin interact with carbamazepine, leading to decreased carbamazepine concentrations.

Answer to Question 2

Ans: C
Fine hand tremor is a side effect of lithium therapy that can worsen with anxiety and intentional movement. Therefore, the nurse would provide support and reassurance, and encourage the client to minimize his or her exposure to stressors. The nurse would notify the prescriber if the tremor interferes with the client's work and if compliance will be an issue. There is no need to obtain a drug concentration because this tremor is not an indication of toxicity. Taking the medication with meals or snacks would be helpful if the client was experiencing diarrhea, nausea, or abdominal discomfort. Elevating the hand on a pillow would have no effect on the tremor. Elevating would be appropriate for edema of the hands or feet.