CH 58 EAQ Chronic Neurologic Disorders

A patient is experiencing generalized tonic-clonic seizures due to hypoxia. What should be the immediate nursing interventions provided to the patient? Select all that apply. a. Administer dextrose b. Ensure patent airway c. Administer phenytoin d. Remove restrictive clothes e. Force the airway between clenched teeth

ANS: B D Hypoxia is a metabolic disturbance that can cause seizures. In this case, the underlying cause should be treated first to control the seizure. Hypoxia should be managed by ensuring a patent airway and removing tight clothes. Dextrose is administered in patients with hypoglycemia. Phenytoin is administered after treating the underlying cause. The nurse should never force the airway between the patient's clenched teeth.

Which is the primary drug of choice for tonic-clonic seizures? a. Phenytoin b. Gabapentin c. Clonazepam d. Ethosuximide

ANS: A Phenytoin is the primary drug of choice for tonic-clonic seizures. Gabapentin is an alternative drug for tonic-clonic, absence, and myoclonic seizures. Clonazepam is the preferred drug for absence and myoclonic seizures. Ethosuximide is the primary drug used for absence and myoclonic seizures.

What has been shown to improve mood, sleep, and function in patients with restless leg syndrome? a. Walking b. Rocking c. Yoga d. Kicking

ANS: C Yoga has been shown to improve mood, sleep, and function in patients with restless leg syndrome. Walking, rocking, and kicking can help relieve any pain at night that disrupts sleep.

An elderly patient with impaired liver function is suspected of having sustained a seizure. Which antiseizure drugs are safe for this patient? Select all that apply. a. Phenytoin b. Primidone c. Lamotrigine d. Gabapentin e. Carbamazepine

ANS: C D Age-related changes in liver enzymes decrease the ability of the liver to metabolize drugs in older adults. Lamotrigine and gabapentin are newer antiseizure medications that have fewer interactions with other drugs. Hence, these are safe in older adults. Phenytoin is metabolized in the liver, so impaired liver function may not metabolize the drug completely. Primidone and carbamazepine have significant drug interactions and should be avoided in older adults.

The parent of a child newly diagnosed with a typical absence seizure is concerned. What information should the nurse provide to the parent regarding typical absence seizures? Select all that apply. a. A seizure is associated with loss of postural tone. b. The child will usually seem confused after a seizure. c. The seizures are characterized by brief staring spells. d. The seizures are usually precipitated by flashing lights. e. The occurrence of seizures usually subsides during adolescence.

ANS: C D E The typical absence seizure usually occurs in childhood only, and the occurrences subside in adolescence. The seizures are characterized by brief staring spells that last for a few seconds only. Flashing lights tend to precipitate a seizure. The child may not have loss of postural tone and may not experience confusion after a seizure.

Which extracranial condition is associated with seizures? a. Migraine b. Meningitis c. Brain tumor d. Hypertension

ANS: D Hypertension is an extracranial condition that is associated with seizures. Migraines, brain tumors, and meningitis are all intracranial conditions that can be associated with seizures.

The nurse is teaching home care measures to the caregiver of a patient with seizures. Which action made by the patient's caregiver during an acute seizure episode indicates the need for additional teaching? a. Turning the patient to the side b. Loosening the patient's tight clothing c. Easing the patient to the floor, if seated d. Sending the patient to hospital immediately after a single seizure

ANS: D It is not necessary to send a patient immediately to the hospital after a seizure unless the seizure is prolonged or another seizure immediately follows. The caregiver should turn the patient to his or her side in order to protect the patient from injury. Loosening any restrictive clothing of the patient will ensure a patent airway. Similarly, easing the patient to the floor if he or she is seated will help to protect the patient from injuries.

The patient has a prescription for phenytoin 100 mg q8hr intravenous (IV). Available is a phenytoin injection containing 50 mg/mL. How many milliliters of solution should the nurse draw up for the dose? Fill in the blank using a whole number.

ANS: 2 mL 100 mg ÷ 50 mg/mL = 2 mL

What seizure disorder typically occurs in children and rarely continues beyond adolescence? a. Focal seizures b. Tonic-clonic seizures c. Psychogenic seizures d. Typical absence seizures

ANS: D Typical absence seizures occur typically in children, rarely continuing beyond adolescence. A psychogenic seizure may be mistaken for epilepsy. A tonic-clonic seizure is the most common generalized seizure. Focal seizures are a major class of seizures. Psychogenic, tonic-clonic, and focal seizures can occur in patients of all ages.

A patient with a history of epilepsy experienced gingival enlargement. Which drug may be causing it? a. Phenytoin b. Gabapentin c. Clonazepam d. Valproic acid

ANS: A Phenytoin, gabapentin, clonazepam, valproic acid, and carbamazepine are the drugs used in treating epilepsy. Gingival enlargement is a common side effect of phenytoin; therefore, a patient with epilepsy who is using phenytoin may experience gingival enlargement. Gabapentin, clonazepam, and valproic acid do not cause gingival enlargement.

Which characteristic of a patient's recent seizure is consistent with a focal seizure? a. The patient lost consciousness during the seizure. b. The seizure involved lip smacking and repetitive movements. c. The patient fell to the ground and became stiff for 20 seconds. d. The etiology of the seizure involved both sides of the patient's brain.

ANS: B The most common complex focal seizure involves lip smacking and automatisms (repetitive movements that may not be appropriate). Loss of consciousness, bilateral brain involvement, and a tonic phase are associated with generalized seizure activity.

The nurse should instruct the patient on phenytoin to perform which action to prevent gingival hyperplasia? a. Visit a dentist annually. b. Use a firm-bristle toothbrush. c. Brush the teeth at least twice per day. d. Rinse with an oral antifungal solution twice per day.

ANS: C To prevent gingival hyperplasia, the patient should brush twice per day with a soft-bristled toothbrush and visit the dentist twice per year. An antifungal solution is not indicated for this condition.

A patient with a suspected seizure failed to respond to drug therapy and reports unusual sensations and hallucinations. What could be the effective surgical treatment? a. Hemispherectomy b. Vagal nerve stimulation c. Sectioning of corpus callosum d. Resection of epileptogenic tissue

ANS: D Unusual sensations and hallucinations are the clinical signs of simple focal seizures. Surgery is advised when the patient does not respond to drug therapy. Resection of epileptogenic tissue is the effective surgical treatment in focal seizures. A hemispherectomy is performed in patients who have multifocal epilepsy, associated with hemiplegia. When surgery is not feasible, vagal nerve stimulation is performed. Sectioning of corpus callosum is an appropriate surgical therapy for generalized seizures.

The patient with type 1 diabetes mellitus with hypoglycemia is having a seizure. Which medication should the nurse anticipate administering to stop the seizure? a. IV diazepam b. IV phenytoin c. Oral carbamazepine d. Intravenous (IV) dextrose solution

AND: D This patient's seizure is caused by low blood glucose, so IV dextrose solution should be given first to stop the seizure. IV diazepam, IV phenytoin, and oral carbamazepine would be used to treat seizures from other causes, such as head trauma, drugs, and infections.

What does the nurse recognize is the highest priority intervention for a patient experiencing status epilepticus? a. Diazepam IV b. Phenytoin IV c. Vecuronium IV d. Lactated Ringer's IV

ANS: A Diazepam given in an IV push is one of the drugs of choice for a patient experiencing status epilepticus. It is a rapid-acting benzodiazepine, but its action is of short duration and so the drug must be followed with a longer-acting anticonvulsant medication. Vecuronium is a paralyzing agent and is not used to treat status epilepticus. Phenytoin is a long-acting anticonvulsant medication commonly administered after a rapid-acting benzodiazepine (such as diazepam) to help stop a seizure and prevent further seizures. A patient experiencing extended episodes of status epilepticus may be at risk for dehydration, but Lactated Ringer's IV fluids are not considered an immediate intervention.

Two patients with seizures arrive at the hospital. Their clinical data are given below. Both were having similar symptoms, but they were given different treatments. What could be the reason for this? Patient A: Loss of consciousness, cyanosis, warm skin, tx: lamotrigine Patient B: Loss of consciousness, cyabnosis, warm skin, tx: phenytoin a. Patient A has elevated liver enzymes. b. Patient B has elevated liver enzymes. c. Patient A has elevated blood urea nitrogen. d. Patient B has elevated blood urea nitrogen.

ANS: A Elevated liver enzymes may decrease the liver's ability to metabolize drugs. Phenytoin, a widely used antiseizure drug, is metabolized by the liver. It is not safe for patient A, who has decreased liver function. Therefore Patient A was prescribed lamotrigine, which may be safer than phenytoin. Patient B was prescribed phenytoin. Hence, patient B would not have elevated liver enzymes. Blood urea nitrogen will not affect the drug metabolism. Therefore patient A and patient B can use any antiseizure drug.

A patient is prescribed carbamazepine for a new-onset seizure disorder. The nurse is educating the patient about this drug. What teaching comment by the nurse is most accurate? a. Do not take this medication with grapefruit. b. This medication is given to treat absence and myloclonic seizures. c. Don't be concerned if any visual disturbances occur while taking this medication. d. The goal of this medication is to cure your condition and prevent any more seizures.

ANS: A Grapefruit inhibits the activity of the gastrointestinal enzyme that breaks down this medication so that more of the drug is in the body, and sometimes dangerously high amounts can enter the bloodstream. Carbamazepine is given to treat generalized tonic-clonic and partial seizures. Patients are instructed to report any type of visual abnormalities. Antiseizure drugs do not cure the condition but help to prevent seizures with a minimum of side effects.

A patient is brought to the emergency department by family members The family states that the patient suddenly fell down and became unconscious and the patient's left leg had jerky movements for a few seconds. Which type of seizure should the nurse suspect? a. Clonic seizure b. Atonic seizure c. Focal seizure d. Absence seizure

ANS: A Losing consciousness and falling to the ground, followed by jerky movements of the left leg, indicate a clonic seizure. An atonic seizure is characterized by tonic episode or a paroxysmal loss of muscle tone and begins suddenly with the person falling to the ground. Consciousness usually returns by the time the person hits the ground, and normal activity can be resumed immediately. In focal seizures, the person may or may not lose consciousness and experience unusual feelings and sensations. An absence seizure is characterized by brief staring spells.

A patient was brought to the hospital after a seizure episode. Which characteristic pattern explained by the patient's caregiver would be useful in diagnosing it as tonic-clonic seizure? a. Stiffening of the body for 20 seconds, followed by jerking of the extremities for 40 seconds b. Jerking of the extremities for 20 seconds, followed by stiffening of the body for 40 seconds c. Stiffening of the body for 30 seconds, followed by jerking of the extremities for 10 seconds d. Jerking of the extremities for 20 seconds, followed by stiffening of the body for 10 seconds

ANS: A Loss of consciousness, followed by stiffening of the body for 20 seconds (10 to 20 seconds) and jerking of the extremities for 40 seconds (30 to 40 seconds) are features of tonic-clonic seizures. Jerking of the extremities for 20 seconds, followed by stiffening of the body for 40 seconds may not be associated with tonic-clonic seizures. Stiffening of the body for 30 seconds, followed by jerking of the extremities for 10 seconds is unassociated with tonic-clonic seizures. Similarly, jerking of the extremities for 20 seconds, followed by stiffening of the body for 10 seconds is not associated with tonic-clonic seizures.

The nurse is reviewing the clinical data of four patients with seizure disorders. Which patient would be most suitable for surgery? Patient A: loss of consciousness, ineffective drug therapy, increased blood pH, Abnormal EEG Patient B: Altered consciousness, effective drug therapy, decreased blood pH, Normal EEG Patient C: Alert, effective drug therapy, normal blood pH, Normal EEG Patient D: Confused, ineffective drug therapy, normal blood pH, normal EEG

ANS: A Patient A with loss of consciousness, ineffective drug therapy, increased blood pH, and an abnormal electroencephalogram (EEG) is the most suitable candidate for surgery. Patient B may not require surgical intervention because the drug therapy is effective and the EEG is normal. Altered consciousness and decreased blood pH can be rectified by fluid therapy in patient B. Patient C also may not require any surgical intervention because the drug therapy is effective and blood pH and EEG are normal. Blood pH and EEG are normal in patient D. Because patient D reports confusion, the drug may be changed for effectiveness of the treatment.

A nurse reviews the medical history with a patient and learns that the patient was diagnosed with restless legs syndrome. Based on this fact, which question should the nurse also ask? a. "Are you able to sleep well and feel rested?" b. "Do you experience calf pain after walking a block?" c. "Do you experience episodes where you are unable to move one leg?" d. "When exposed to cold, do your legs turn pale, then blue, and become painful?"

ANS: A Restless legs syndrome is a condition in which patients experience paresthesias, including numbness, tingling, pain, and restlessness in one or both legs. The condition occurs commonly at night, interferes with the patient's ability to sleep, and contributes to daytime fatigue. Asking whether the patient sleeps well and feels rested is appropriate. Calf pain that occurs with walking is termed intermittent claudication and is a symptom of peripheral vascular disease. A temporary episode of paralysis describes a transient ischemic attack (TIA), a precursor to a stroke. Raynaud's disease occurs in persons with connective tissue conditions and involves vasospasms in response to cold. The legs become pale, then cyanotic and often reddened post vasospasm. The episodes are painful.

A patient with a seizure disorder failed to respond to drug therapy. Resection of epileptogenic tissue is performed. What could be the possible diagnosis? a. Focal seizures b. Atonic seizures c. Myoclonic seizures d. Tonic-clonic seizures

ANS: A Surgical intervention is most appropriate for patients who do not respond to drug therapy. Resection of epileptogenic tissue is advised for patients who are suspected to have focal seizures. Atonic, myoclonic, and tonic-clonic seizures are included under generalized seizures. If generalized seizures do not respond to drug therapy, sectioning of the corpus callosum is performed.

What instructions should the nurse give to a patient being treated with carbamazepine for seizures? Select all that apply. a. Do not stop using the drug abruptly. b. Do not take the drug with grapefruit juice. c. Notify the health care provider about any vision problems. d. Ensure adequate fluid intake. Wear protective clothing while exposed to sunlight. e. Take the medicine along with food. Notify the health care provider if flu-like symptoms occur.

ANS: A B C Carbamazepine is an antiseizure drug. The drug has adverse interactions with grapefruit juice. Grapefruit juice tends to potentiate the action of the drug and may cause overdose; therefore, the patient should be instructed not to consume grapefruit juice when on treatment with carbamazepine. Vision problems are one of the most common side effects of the drug, and the health care provider should be notified if they occur. The patient should be instructed to not discontinue the drug abruptly because doing so can precipitate seizures. Carbamazepine does not cause photosensitivity; therefore, there is no need to avoid sun exposure. The drug is not known to cause flu-like symptoms.

The caregivers of a patient with acute seizures ask the nurse what they should do if another episode of seizure occurs at home after discharge. What should the nurse tell them? Select all that apply. a. Ease the patient to the floor. b. Loosen constrictive clothes. c. Restrain the patient to a bed. d. Protect the patient from any injury. e. Bring the patient to the hospital immediately.

ANS: A B D During an acute seizure, the most important thing is to ease the patient to the floor, if seated, and loosen constrictive clothing. The patient should be protected from any potential injury. The chances of injury are higher if the patient is restrained. It is not necessary to bring the patient to the hospital immediately. Once the seizures have stopped and the patient becomes stable, then the patient can be brought to the hospital.

A patient's caregiver asks the nurse how the patient could have developed a tonic-clonic seizure, having no prior history of epilepsy. What would be the nurse's best responses about the precipitating intracranial causes of the tonic-clonic seizure? Select all that apply. a. "Stroke is an intracranial cause of tonic-clonic seizure." b. "Septicemia is an intracranial cause of tonic-clonic seizure." c. "Brain tumor is an intracranial cause of tonic-clonic seizure." d. "Hypertensive crisis is an intracranial cause of tonic-clonic seizure." e. "Systemic lupus erythematosus is an intracranial cause of tonic-clonic seizure."

ANS: A C D Strokes, brain tumors, and hypertensive crises are considered intracranial events that may precipitate tonic-clonic seizures. Septicemia is an infectious process that can precipitate a tonic-clonic seizure. Systemic lupus erythematosus is a metabolic disorder that can precipitate a tonic-clonic seizure.

The nurse is managing the care of a patient with a seizure disorder who was admitted for status epilepticus. Which long-acting antiseizure medications would be effective for a patient with status epilepticus? Select all that apply. a. Phenytoin b. Diazepam c. Lorazepam d. Lamotrigine e. Phenobarbital

ANS: A D E Phenytoin, lamotrigine, and phenobarbital are the drugs with a long half-life that are used in treating status epilepticus. Diazepam and lorazepam are the rapid-acting drugs used in the treatment of status epilepticus. They have a short half-life.

A patient diagnosed with seizures is advised to take phenytoin. About which common side effects of phenytoin should the nurse inform the patient? Select all that apply. a. Hirsutism b Neuropathy c. Weight gain d. Memory loss e. Gingival hyperplasia

ANS: A E Gingival hyperplasia and hirsutism are the most common side effects of phenytoin. Good dental hygiene, including regular tooth brushing and flossing, can limit gingival hyperplasia. The drug is not associated with neuropathy, memory loss, or weight gain.

A patient with head trauma is admitted to the emergency department with continuous muscle contractions and loss of consciousness. Which drugs would be effective for treating this patient? Select all that apply. a. Phenytoin b. Zonisamide c. Clonazepam d. Ethosuximide e. Carbamazepine

ANS: A E Tonic-clonic seizures are characterized by continuous muscle contractions and loss of consciousness. The primary drugs that are used to treat tonic-clonic seizures are phenytoin and carbamazepine. Zonisamide, clonazepam, and ethosuximide are the drugs used to treat absence and myoclonic seizures.

A patient with restless legs syndrome (RLS) failed to respond to gabapentin, which was prescribed earlier. What would be the drug of choice? a. Carbidopa b. Oxycodone c. Pramipexole d. Phenobarbital

ANS: B A patient with restless legs syndrome (RLS) may have severe symptoms that are not relieved by gabapentin. In such cases, low doses of opioids like oxycodone are prescribed. Carbidopa, a dopamine precursor, is used to increase the amount of dopamine in the brain. This drug may not relieve the severe symptoms of RLS. Pramipexole, a dopamine agonist, is also used to increase the dopamine amount. Like carbidopa, this drug also may not relieve the severe symptoms of RLS. Phenobarbital is not used to treat RLS.

A patient developed seizures after a head injury and informs the nurse he or she feels like there has been a loss of control over life since the seizures. Initially, what is the most appropriate response by the nurse? a. "New treatments come out every year, so don't give up." b. "Tell me about what you would like to do and how the seizures affect you." c. "You are young and can still heal from the injury. It has only been a few months." d. "With medications and your health care provider's assistance, I am sure you will be able to achieve your life goals."

ANS: B Asking the patient what he or she would like to do and how seizures affect him or her is correct because it addresses the patient's concerns. Telling the patient he or she will achieve his or her life goals, that the patient will still heal because he or she is young, and that new treatments are available are not correct statements to make because they do not address the patient's concern over losing control of his or her life.

A patient has been receiving scheduled doses of phenytoin and begins to experience diplopia. For what should the nurse immediately assess the patient? a. An aura or focal seizure b. Nystagmus or confusion c. Abdominal pain or cramping d. Irregular pulse or palpitations

ANS: B Diplopia is a sign of phenytoin toxicity. The nurse should assess for other signs of toxicity, which include neurologic changes, such as nystagmus, ataxia, confusion, dizziness, or slurred speech. An aura, focal seizure, abdominal pain or cramping, irregular pulse, and palpitations are not associated with phenytoin toxicity.

What should be the immediate nursing intervention provided to a patient with hypoglycemia who is suspected to have had a seizure? a. Intravenous administration of saline b. Intravenous administration of dextrose c. Intravenous administration of diazepam d. Intravenous administration of gabapentin

ANS: B Hypoglycemia can cause tonic-clonic seizures in some patients. In such cases, the underlying cause is treated first, followed by the administration of antiseizure drugs if necessary. Therefore dextrose should be administered immediately to reverse the hypoglycemia. Intravenous administration of saline is advised to correct fluid and electrolyte imbalance in patients who are dehydrated. IV diazepam is given to patients with status epilepticus. If the symptoms do not subside after treating the underlying cause of a seizure, oral administration of gabapentin may be necessary.

Which characteristic feature is exclusively seen in a complex focal seizure? a. Jerking of the limbs b. Smacking of the lips c. Loss of consciousness d. Increased muscle tone

ANS: B Smacking of the lips is the characteristic feature seen only in complex focal seizures. Jerking of the limbs, loss of consciousness, and increased muscle tone are seen in all other types of seizures. Sometimes focal seizures may spread across the entire brain and culminate in a generalized tonic-clonic seizure. This results in symptoms such as jerking of the limbs, loss of consciousness, increased muscle tone, and lip smacking

The nurse is managing the care of a patient with status epilepticus. Which assessment would be inappropriate, once the event has subsided? a. Oxygenation b. Apical heart rate c. Oral body temperature d. Respiratory rate and pattern

ANS: B Status epilepticus is one of the complications of all types of seizures. Tachycardia is the clinical sign of tonic-clonic seizures, so the nurse need not focus on the apical heart rate. However, the nurse may monitor the heart rate to check for any improvement of the patient's overall health. Hypoxia, hyperthermia, and ventilatory insufficiency may be caused by status epilepticus. Therefore the nurse should assess the patient's oxygenation level, oral body temperature, and respiratory rate and pattern.

A nurse is educating a group of people in a community center about restless legs syndrome (RLS). Which risk factor included in the presentation would be inappropriate? a. Pregnancy b. Liver failure c. Hypertension d. Iron deficiency

ANS: B The nurse should include information about the conditions that cause restless legs syndrome (RLS), and liver failure is not associated with it. The conditions associated with RLS include pregnancy, hypertension, and iron deficiency. Pregnancy and anemia (iron deficiency) can worsen the symptoms.

The nurse is caring for a patient who suddenly loses consciousness and then stiffens for about 15 seconds, followed by jerking of the extremities. How does the nurse document this occurrence in the medical record? a. Focal seizure b. Tonic-clonic seizure c. Psychogenic seizure d. Typical absence seizure

ANS: B Tonic-clonic seizures are the most common generalized seizures. They are characterized by a loss of consciousness, stiffening of the body for 10 to 20 seconds, and subsequent jerking of the extremities. Focal seizures are also called partial seizures. Focal seizures begin in one hemisphere of the brain in a specific region of the cortex. They produce signs and symptoms related to the function of the area of the brain involved. Psychogenic seizures are also called pseudoseizures. They are psychiatric in origin and closely resemble epileptic seizures. A patient with psychogenic seizures has a history of emotional abuse, physical neglect, or a specific traumatic episode. Typical absence seizures are also generalized seizures. They are also called petit mal seizures and usually occur in children. The clinical manifestation is a brief staring spell that lasts for a few seconds.

A patient with focal seizures is prescribed gabapentin. On a follow-up visit, the primary health care provider finds that the medication has been ineffective in controlling the symptoms. The primary health care provider prescribes another antiseizure drug and advises the patient to use it along with gabapentin. What could be the drug prescribed? a. Tiagabine b. Pregabalin c. Topiramate d. Levetiracetam

ANS: B When a single medication is ineffective in controlling the focal seizure, pregabalin is used as an add-on drug. Tiagabine, topiramate, and levetiracetam are common antiseizure drugs that can also be used to treat focal seizures.

The nurse is caring for an elderly patient with a brain tumor. The family reports symptoms of headaches, confusion, and altered level of consciousness. Which drugs would be best for this patient? Select all that apply. a. Primidone b. Gabapentin c. Levetiracetam d. Oxcarbazepine e. Carbamazepine

ANS: B C D Brain tumors can cause tonic-clonic seizures. Headaches, confusion, and altered consciousness are the clinical signs of tonic-clonic seizures. Gabapentin, levetiracetam, and oxcarbazepine are the safest drugs for older adults because these drugs have fewer effects on cognitive function when compared to other drugs. Primidone and carbamazepine have potential effects on cognitive function. Therefore these drugs are contraindicated for older adults.

A patient is displaying psychotic behavior related to Alzheimer's disease. What interventions can help the patient cope with this disorder? Select all that apply. a. Putting the patient to bed b. Providing a healthy snack c. Going for a walk in the garden d. Turning on the patient's favorite music e. Singing songs and playing musical instruments f. Redirecting the patient's focus to a different task

ANS: B C D E F Interventions to help a patient cope include redirection, a healthy snack, playing the patient's favorite music, singing, and taking a walk. Putting the patient to bed may make the behavior worse.

The nurse is reviewing the data of a pediatric patient who is admitted in the hospital. Which findings indicate that the patient is suffering from typical absence seizures? Select all that apply. Subjective data: Birth injury, loss of consciousness, daydreaming Objective data: EEG 3-hz spike and wave patter, hyperventilation a. Birth injury b. Daydreaming c. Hyperventilation d. Loss of consciousness e. Electroencephalogram (EEG) results

ANS: B C E Daydreaming is seen in patients with typical absence seizures. Hyperventilation is a precipitating factor for a typical absence seizure. Electroencephalogram (EEG) results demonstrate a 3-Hz spike-and-wave pattern and are the characteristic feature of a typical absence seizure. Tonic-clonic seizures occur in children in whom birth injury is one of the primary causes of seizures. Loss of consciousness is seen in typical and atypical absence seizures with different durations.

A bipolar patient is experiencing a major depressive episode. What factors may be contributing to the depressive episode? Select all that apply. a. Low-fat diet b. Darkened room c. Physical activity d. Chronic disease e. Ineffective coping f. Antiseizure medications

ANS: B D E F Antiseizure medications, chronic diseases, ineffective coping, and a darkened room can cause depression. A high-fat diet and lack of physical activity can cause depression.

What instructions should a nurse give to a patient who has focal seizures well controlled with phenytoin and who has mild gingival hyperplasia? Select all that apply. a. The drug should be changed immediately. b. Regular tooth brushing can limit hyperplasia. c. Gingival hyperplasia is not related to phenytoin. d. Surgical repair of gingival tissue will be required. e. Regular flossing can control gingival tissue growth.

ANS: B E Gingival hyperplasia is a common side effect of phenytoin. The nurse should instruct the patient to maintain good dental hygiene with regular tooth brushing and flossing. Regular flossing not only helps in maintaining good dental hygiene but also helps control gingival tissue growth. Similarly, regular brushing, besides being generally good for dental health, also helps limit gingival hyperplasia. Mild gingival hyperplasia does not require the drug to be replaced. Surgical intervention would be required only if the gingival hyperplasia were extensive, which is not the case with this patient.

Which type of seizure is characterized by "drop attacks"? a. Tonic seizure b. Clonic seizure c. Atonic seizure d. Myoclonic seizure

ANS: C A "drop attack" is defined as sudden fall without loss of consciousness. In atonic seizures, the patient suddenly falls down due to paroxysmal loss of muscle tone. In tonic and clonic seizures, there may be loss of consciousness and the patient may fall down. In a myoclonic seizure, the patient may fall to the ground due to excessive jerking of the extremities.

A patient with a history of epilepsy is in the postanesthesia recovery unit (PACU) after surgery under local anesthesia. The patient has a tonic-clonic seizure that lasts two minutes. Which action should the nurse take while the patient is having the seizure? a. Restrain the patient to prevent injury. b. Reorient the patient to place and time. c. Ensure the patient has a patent airway. d. Administer 50 grams of dextrose intravenously.

ANS: C During a tonic-clonic seizure, the patient becomes unconscious, has generalized stiffening (tonic phase), and then jerking (clonic phase). The most important nursing intervention is to maintain the patient's open airway. Suctioning equipment should be available. The patient should not be restrained but protected from injury. Intravenous dextrose is not indicated, because the patient is not noted to be hypoglycemic. Reorientation is not done with the patient unconscious during the seizure.

The nurse admits a young adult patient with epilepsy to the trauma unit following a motor vehicle accident. The patient asks the nurse about the incidence of the condition. What response by the nurse is most appropriate? a. Females are more likely to develop epilepsy than males. b. New cases of epilepsy are most common in Hispanic patients. c. Thirty percent of all epilepsy cases are not attributable to a specific cause. d. In younger patients, epilepsy is generally caused by some birth injury, infection, trauma, or genetic factor.

ANS: C Epilepsy in patients 20 to 30 years of age generally occurs as a result of structural lesions, such as traumas, brain tumors, or vascular disease. Thirty percent of all epilepsy cases are idiopathic, and it is likely not the cause of this patient's epilepsy, because she is a young patient who experienced trauma. New-onset epilepsy cases are more common in males and in people of African American descent.

A patient displays jerky muscle movements of the extremities and is incontinent of bowel and bladder. With what does the nurse recognize these clinical manifestations to be associated? a. Aura seizures b. Postictal seizures c. Generalized seizures d. Simple partial seizures

ANS: C In a generalized, or grand mal, seizure the patient may experience incontinence along with jerking, or tonic-clonic, movements of the entire body. An aura is an individualized, subjective auditory, visual, olfactory, or taste hallucination that may precede a seizure. Postictal is the period of recovery after a seizure; it may be characterized by confusion and sedation. A simple partial seizure may be isolated to one side of the brain and remain partial or focal in nature, or it may spread to involve the entire brain, culminating in a generalized tonic-clonic seizure. Simple partial seizures generally do not involve loss of consciousness and rarely last more than one minute.

A patient with head trauma is being sedated and is on a ventilator in the intensive care unit. What type of seizure might this patient experience? a. Atonic seizure b. Myoclonic seizure c. Subclinical seizure d. Tonic-clonic seizure

ANS: C In subclinical seizures, the sedated patient experiences seizures, but external signs are not visible due to the sedative medication. In atonic seizures, the external signs like paroxysmal loss of muscle tone are visible. In myoclonic seizures, sudden and excessive jerks in the body are observed. In tonic-clonic seizures, the skin feels warm and cyanosis is visible.

Which patient will be at greater risk of sustaining a head injury according to the data given below? Patient A: Excessive jerk of the extremities: increased tone of muscle Patient B: Limb Jerking: Sudden loss of muscle tone Patient C: Absent jerks: sudden loss of muscle tone Patient D: Absent jerks: Increased tone of muscles

ANS: C Patient C, who sustains no jerking and a sudden loss of muscle tone, may have atonic seizures. Because its onset is sudden, patients with atonic seizures are at a greater risk of head injury. Patient A, who experiences excessive jerking of the extremities and increased muscle tone, may have myoclonic seizures. Clonic seizures may be seen in patient B, who experiences a sudden loss of muscle tone, followed by limb jerking. Patient D, who has increased muscle tone and no jerks, may have tonic seizures.

A patient with epilepsy who has been taking oral gabapentin was admitted to the emergency department in an unconscious state. The patient is experiencing seizures that are reoccurring in rapid succession. Which treatment option would be beneficial in alleviating the symptoms of the patient? a. Administer saline intravenously b. Administer dextrose intravenously c. Administer diazepam intravenously d. Administer gabapentin intravenously

ANS: C Seizures that reoccur in rapid succession without the patient regaining consciousness are a characteristic feature of status epilepticus. It is a serious complication of epilepsy and occurs with any type of seizure. The most commonly used drug to treat status epilepticus is diazepam. Saline is administered to patients with severe dehydration and electrolyte imbalance. Dextrose is given if the patient has seizures due to hypoglycemia. Gabapentin is given to treat generalized seizures.

What is the nursing action of highest priority to be taken with a patient who experiences a generalized tonic-clonic seizure? a. Restraining the arms and legs b. Controlling head movements c. Protecting the head and extremities d. Inserting a tongue blade between the teeth

ANS: C Staying with the patient to provide protection of the head and extremities is the most important nursing care activity for a patient experiencing a generalized tonic/clonic seizure. Attempting to restrain or control the jerking movement of the head and extremities during a seizure may cause further injury and even fracture bones. Body parts should not be restrained or controlled. Use of a tongue blade is not acceptable in current practice because it is difficult to insert once the seizure begins and the patient may bite through the tongue blade and aspirate.

A patient with systemic lupus erythematosus presents to the emergency room with warm skin and pallor. The nurse observes that the patient is lethargic and has an altered level of consciousness. What seizure phase is this patient most likely experiencing? a. Tonic phase b. Clonic phase c. Postictal phase d. Hypertonic phase

ANS: C Systemic lupus erythematosus can lead to tonic-clonic seizures. Warm skin and pallor are the clinical signs of tonic-clonic seizures. Tonic-clonic seizures progress through several phases. Lethargy and altered level of consciousness are seen in the postictal phase, so the probable phase of this patient's stroke is the postictal phase. In the tonic phase, continuous muscle contraction is observed. Rigidity and relaxation in rapid succession are observed in the clonic phase. Extreme muscle rigidity is seen in the hypertonic phase, which lasts for 5 to 15 seconds.

Which diet is used to control seizures in some patients? a. A diet with low fats and low carbohydrates b. A diet with low fats and high carbohydrates c. A diet with high fats and low carbohydrates d. A diet with high fats and high carbohydrates

ANS: C The ketogenic diet is used to control seizures in some patients with epilepsy. It contains high fats and low carbohydrates. A diet with low fats and low carbohydrates is not considered a ketogenic diet. A ketogenic diet also does not contain low fats and high carbohydrates. Similarly, a diet with high fats and high carbohydrates is not a ketogenic diet.

A client has been receiving scheduled doses of topiramate and is now difficult to arouse. What signs of topiramate toxicity should the nurse report immediately? a. Palpitations b. Hypotension c. Seizure activity d. Difficult to arouse

ANS: D Decreased alertness is a sign of topiramate toxicity. The nurse should check for other signs of toxicity, which include neurologic changes such as diplopia, ataxia, confusion, dizziness, and slurred speech. A suboptimal level of topiramate, not a toxic level, would result in seizure activity. Hypotension and palpitations are not assessment findings indicative of antiepileptic medication toxicity.

The nurse is teaching safety measures to a patient with seizure disorder who has a history of diabetes mellitus. Which statement made by the patient shows ineffective learning? a. "I will get adequate sleep." b. "I will refrain from drinking alcohol." c. "I will wear a helmet while riding a bike." d. "I will refrain from doing physical exercises."

ANS: D Good general health habits are helpful for patients who have a seizure disorder. Patients with a seizure disorder should exercise regularly. Loss of sleep is one of the factors that may aggravate the condition of the patient with a seizure disorder. Therefore adequate sleep is very important for these patients. Alcohol consumption can cause liver damage. Patients with a seizure disorder should refrain from drinking alcohol in order to prevent aggravation of this condition. Patients with seizure disorders are more prone to accidents. Therefore wearing a helmet will reduce the risk of head injury.

A patient with hypertension reports paresthesia, tingling, and a pins and needles sensation. The patient was prescribed gabapentin. What is the possible diagnosis? a. Stroke b. Epilepsy c. Status epilepticus d. Restless legs syndrome (RLS)

ANS: D Hypertension is the etiologic factor of restless legs syndrome (RLS). Paresthesia, tingling, and a pins and needles sensation are clinical signs of RLS. Gabapentin can be used in all the neurologic disorders listed. A patient who sustains a stroke will present with one-sided weakness. This is not a symptom of RLS. Paresthesias, tingling, and a pins and needles sensation are not seen in epilepsy and status epilepticus. A patient with epilepsy may have jerking movements and muscle rigidity. A patient with status epilepticus can experience hypoxia and arrhythmias.

The nurse visits a patient who is being treated with phenytoin for seizures. Which instruction is important to prevent precipitation of seizures in this patient? a. Notify the health care provider about unusual hair growth. b. Practice good dental hygiene to control gingival hyperplasia. c. Maintain a healthy lifestyle with regular exercise and nutritious diet. d. Do not stop the drug abruptly without consulting the health care provider.

ANS: D Phenytoin is an antiseizure drug. Abrupt withdrawal of the drug after long-term use may precipitate seizures; therefore, the patient should not stop the drug without consulting the health care provider. Unusual hair growth and gingival hyperplasia are side effects of antiseizure drugs and are not relevant in preventing precipitation of seizures. Maintaining a healthy lifestyle is a general measure to keep healthy and may not contribute to prevention of precipitation of seizures.

Which type of seizure lasts longer than five minutes and occurs in rapid succession without return to consciousness between seizures? a. Epilepsy b. Tonic seizure c. Absence seizure d. Status epilepticus

ANS: D Status epilepticus is a state of continuous seizure activity or a condition in which seizures reoccur in rapid succession without return to consciousness between seizures. Epilepsy is marked by a continuing predisposition to seizures with neurobiologic, cognitive, psychologic, and social consequences. An absence seizure is characterized by a brief staring spell lasting less than 10 seconds. A tonic seizure involves a sudden increase in tone of the exterior muscles that contribute to sudden stiff movements lasting 20 seconds or less.

The nurse assesses a patient for signs of petit mal, or absence, seizures. What is the classic sign of this seizure disorder? a. Dizziness b. Intense anxiety c. Stiffening of the body d. Vacant facial expression

ANS: D The patient experiencing a petit mal or absence seizure displays a sudden vacant look and usually stares straight ahead. This type of seizure often goes unnoticed by the patient and others. Dizziness and intense anxiety are not commonly associated with petit mal seizures. Stiffening of the body is the tonic phase and is associated with a tonic-clonic seizure, not an absence seizure.

The nurse is educating a student nurse about how metabolic disturbances cause seizures. Which statements made by the student nurse indicate effective learning? Select all that apply. a. "Seizures can be caused by a decrease in oxygen levels." b. "Seizures can be caused by an increase in pH of the blood." c. "Seizures can be caused by a decrease in pH of the blood." d. "Seizures can be caused by a decrease in blood glucose levels." e. "Seizures can be caused by an increase in blood glucose levels."

ANs: A C D Seizures are caused by metabolic disturbances such as acidosis and can occur due to a decrease in the blood pH. Hypoxia means that oxygen levels are decreased. Hypoxia is also a metabolic disturbance; therefore, hypoxia can lead to seizures. A decrease in blood glucose levels is known as hypoglycemia. Therefore acidosis, hypoxia, and hypoglycemia are the metabolic disturbances that cause seizures. Alkalosis, in which there is an increase in pH, is not associated with seizures. Hyperglycemia, which is an increase in blood glucose levels, is also not associated with seizures.