Epilepsy & Seizures

A client with epilepsy has the nursing diagnosis Risk for Impaired Adjustment. Which statement by the client would indicate movement towards positive resolution of this diagnosis? a. Before activities, I should ask myself What would happen if I had a seizure? b. Do you know how to apply for food stamps since I can't work? c. I feel so sad that so many activities are off-limits for me now. d. I have decided to sell my car since I will never be able to drive again.

A ~ Activity restrictions will vary among clients, but the key question the client should ask of him/herself is What would happen if I had a seizure while doing this activity? Clients with epilepsy can and do work. There are five major types of activity restrictions to discuss with clients, and only a few things will truly be off-limits for clients with well-controlled seizures. State regulations regarding driving vary; generally no driving is allowed for 6-12 months after a seizure, but many clients are able to drive again.

A nurse is reviewing leisure time activities with a client who has epilepsy. An important self-care measure the nurse teaches the client is to avoid a. alcoholic beverages. b. driving a motor vehicle. c. hiking and camping. d. light sports.

A ~ Alcoholic beverages are contraindicated for two reasons. First, alcohol lowers the seizure threshold, and second, alcohol is detoxified by the liver. Most anticonvulsant medications are also detoxified by the liver. Although certain dangerous activities should be avoided or performed with special safeguards (e.g., swimming or horseback riding), a wide range of activities can still be enjoyed. Driving motor vehicles depends on state laws and the clients medical control of seizures, with driving restrictions ranging from 3 months to 2 years.

A client has been diagnosed with epilepsy and is going home. The client has received extensive teaching on the disease, medications, and lifestyle changes that are required. What else should the nurse include in the discharge plan? a. A referral to a support group b. Easy-to-prepare menu guide c. Psychiatry clinic information d. The city's bus schedule

A ~ Clients with epilepsy often have poor self-image, feelings of inferiority, self-consciousness, guilt, anger, depression, and other emotional problems. While any of the above options might be needed by a particular client, a referral to a self-help group or support group can best help the client learn to adapt to the new diagnosis and incorporate it into a healthy self-image.

The nurse gives diazepam to a client in status epilepticus to stop the seizure because prolonged seizure activity can cause a. brain injury. b. cardiac dysrhythmias. c. muscle and tendon damage. d. respiratory arrest.

A ~ Prolonged seizure activity exhausts the body's supply of oxygen and glucose and can result in brain injury.

An important age-related consideration the nurse should include in the care plan for an elderly client with a seizure disorder is a. a decreased serum albumin level can increase the free plasma level of medications. b. fortunately, seizure medications have very few drug-drug interactions. c. older adults have very few choices when it comes to seizure medications. d. the elderly rarely have seizure disorders, so community support for them is poor.

A ~ Protein-calorie malnutrition is common among elders and the subsequent decreased serum albumin level can lead to increased plasma levels of the drug, making them prone to drug toxicities. Many seizure medications do have multiple drug-drug interactions, but all are available for use in this population. The frequency of seizures being diagnosed in the elderly population is increasing.

A nurse is teaching a newly diagnosed epileptic client about anticonvulsant medications. The nurse should include information to a. help the client learn to control stress in his/her life. b. limit heavy exercise and aerobic activities. c. stop medications if seizures are controlled for several months. d. take an extra dose of medication if a seizure is beginning.

A ~ Seizure activity is closely related to increasing stress. Clients should not alter their medication dosages without instruction and supervision of their prescriber. Exercise and aerobic activities are part of a healthy lifestyle and should be encouraged.

A patient reports feeling numbness and tingling of the left arm before experiencing a tonic-clonic seizure. The nurse determines that this history is consistent with what type of seizure? a. Focal b. Atonic c. Absence d. Myoclonic

A ~ The initial symptoms of a focal seizure involve clinical manifestations that are localized to a particular part of the body or brain. Symptoms of an absence seizure are staring and a brief loss of consciousness. In an atonic seizure, the patient loses muscle tone and (typically) falls to the ground. Myoclonic seizures are characterized by a sudden jerk of the body or extremities.

A nurse assesses clients on a medical-surgical unit. Which clients should the nurse identify as at risk for secondary seizures? (SATA) a. A 26-year-old woman with a left temporal brain tumor b. A 38-year-old male client in an alcohol withdrawal program c. A 42-year-old football player with a traumatic brain injury d. A 66-year-old female client with multiple sclerosis e. A 72-year-old man with chronic obstructive pulmonary disease

A, B, C ~ Clients at risk for secondary seizures include those with a brain lesion from a tumor or trauma, and those who are experiencing a metabolic disorder, acute alcohol withdrawal, electrolyte disturbances, and high fever. Clients with a history of stroke, heart disease, and substance abuse are also at risk. Clients with multiple sclerosis or chronic obstructive pulmonary disease are not at risk for secondary seizures.

A nurse plans care for a client with epilepsy who is admitted to the hospital. Which interventions should the nurse include in this clients plan of care? (SATA) a. Have suction equipment at the bedside. b. Place a padded tongue blade at the bedside. c. Permit only clear oral fluids. d. Keep bed rails up at all times. e. Maintain the client on strict bedrest. f. Ensure that the client has IV access.

A, D, F ~ Oxygen and suctioning equipment with an airway must be readily available. The bed rails should be up at all times while the client is in the bed to prevent injury from a fall if the client has a seizure. If the client does not have an IV access, insert a saline lock, especially for those clients who are at significant risk for generalized tonic-clonic seizures. The saline lock provides ready access if IV drug therapy must be given to stop the seizure. Padded tongue blades may pose a danger to the client during a seizure and should not be used. Dietary restrictions and strict bedrest are not interventions associated with epilepsy. The client should be encouraged to eat a well-balanced diet and ambulate while in the hospital.

When a client suffers a tonic-clonic seizure, the nurse should (SATA) a. insert an oral airway into the clients mouth. b. move objects out of the clients way. c. observe and document characteristics of the seizure. d. place a pillow or some padding under the clients head. e. turn the client gently on one side.

B, C, D, E ~ A person having a seizure needs protection from the environment. The nurse should move objects out of the way, place some type of padding under the clients head, loosen clothing that is tight around the client's neck, turn the client to one side to facilitate draining saliva, and observe the characteristics of the seizure. Nothing should be forced into the client's mouth.

A hospitalized child is having a seizure. Which action by the nurse takes priority? A. Apply oxygen and oximeter. B. Give anti-seizure medications. C. Pad the side rails of the bed. D. Turn the child on his or her side.

D ~ All actions are appropriate when a patient has a seizure. The priority, however, is on maintaining the childs airway. Placing the child in a side-lying position decreases the risk of aspiration and airway obstruction.

The nurse institutes seizure precautions for a client with a history of epilepsy. Which action is inconsistent with seizure precautions? a. Keeping oxygen and suction equipment nearby b. Keeping the side rails up while the client is in bed c. Padding the side rails of the bed d. Taking an oral temperature when doing vital signs

D ~ Clients with a history of seizures or epilepsy should have axillary or rectal temperatures taken.

The nurse clarifies that a generalized seizure, unlike a partial seizure, involves a. areas of special senses. b. both hemispheres. c. only one hemisphere. d. the autonomic system.

B ~ A generalized seizure involves both hemispheres.

A nurse cares for a client who is experiencing status epilepticus. Which prescribed medication should the nurse prepare to administer? a. Atenolol (Tenormin) b. Lorazepam (Ativan) c. Phenytoin (Dilantin) d. Lisinopril (Prinivil)

B ~ Initially, intravenous lorazepam is administered to stop motor movements. This is followed by the administration of phenytoin. Atenolol, a beta blocker, and lisinopril, an angiotensin-converting enzyme inhibitor, are not administered for seizure activity. These medications are typically administered for hypertension and heart failure.

A client is actively experiencing status epilepticus. Which prescribed medication does the nurse prepare to administer? a. Atropine b. Lorazepam (Ativan) c. Phenytoin (Dilantin) d. Morphine sulfate

B ~ Initially, intravenous lorazepam is administered to stop motor movements. This is followed by the administration of phenytoin. Atropine and morphine are not administered for seizure activity.

The nurse is assessing a client with a history of absence seizures. Which clinical manifestation does the nurse assess for? a. Automatisms b. Intermittent rigidity c. Sudden loss of muscle tone d. Brief jerking of the extremities

A ~ Automatisms are characteristic of absence seizures. These behaviors consist of lip smacking, patting, and picking at clothing. The other manifestations do not correlate with absence seizures.

A nurse admits a child experiencing drowsiness and vomiting who has had a seizure at home. The parents state the child was healthy until 2 weeks ago when she had a viral illness. Which diagnostic testing does the nurse facilitate as a priority? A. Complete blood count B. Liver biopsy C. Lumbar puncture D. Serum glucose

B ~ This child has manifestations of Reye syndrome. The definitive diagnosis of this disease is made via a liver biopsy.

The client with epilepsy asks the nurse if he will have to take antispasmodic medication for the rest of his life. The nurses most helpful response would be a. Maybe. You might be able to stop medication if you are seizure free for 2 years. b. No. After a stable pattern is recognized, you can take it sporadically. c. Yes. Epilepsy requires compliance to a regimen of lifelong medication. d. Yes. Stopping a med after you take it a while makes seizure activity worse.

A ~ Many physicians allow their patients to stop antispasmodic medication if they have been seizure-free for 2 years. Other physicians prefer a seizure-free period of 5 years.

A 27-year-old patient who has been treated for status epilepticus in the emergency department will be transferred to the medical nursing unit. Which equipment should the nurse have available in the patients room? (SATA) a. Side-rail pads b. Tongue blade c. Oxygen mask d. Suction tubing e. Urinary catheter f. Nasogastric tube

A, C, D ~ The patient is at risk for further seizures, and oxygen and suctioning may be needed after any seizures to clear the airway and maximize oxygenation. The beds side rails should be padded to minimize the risk for patient injury during a seizure. Use of tongue blades during a seizure is contraindicated. Insertion of a nasogastric (NG) tube is not indicated because the airway problem is not caused by vomiting or abdominal distention. A urinary catheter is not required unless there is urinary retention.

The nurse is planning care for a client with epilepsy. Which precautions does the nurse implement to ensure the safety of the client while in the hospital? (SATA) a. Have suction equipment at the bedside. b. Place a padded tongue at the bedside. c. Permit only clear oral fluids. d. Keep bed rails up at all times. e. Maintain the client on strict bedrest. f. Ensure that the client has IV access.

A, D, F ~ The bed rails should be up at all times while the client is in the bed to prevent injury from a fall if the client has a seizure. Padded tongue blades may pose a danger to the client during a seizure. Be sure that oxygen and suctioning equipment with an airway are readily available. If the client does not have an IV access, insert a saline lock, especially for those clients who are at significant risk for generalized tonic-clonic seizures. The saline lock provides ready access if IV drug therapy must be given to stop the seizure.

The home health registered nurse (RN) is planning care for a patient with a seizure disorder related to a recent head injury. Which nursing action can be delegated to a licensed practical/vocational nurse (LPN/LVN)? a. Make referrals to appropriate community agencies. b. Place medications in the home medication organizer. c. Teach the patient and family how to manage seizures. d. Assess for use of medications that may precipitate seizures.

B ~ LPN/LVN education includes administration of medications. The other activities require RN education and scope of practice.

A nurse assesses a client with a history of epilepsy who experiences stiffening of the muscles of the arms and legs, followed by an immediate loss of consciousness and jerking of all extremities. How should the nurse document this activity? a. Atonic seizure b. Tonic-clonic seizure c. Myoclonic seizure d. Absence seizure

B ~ Seizure activity that begins with stiffening of the arms and legs, followed by loss of consciousness and jerking of all extremities, is characteristic of a tonic-clonic seizure. An atonic seizure presents as a sudden loss of muscle tone followed by postictal confusion. A myoclonic seizure presents with a brief jerking or stiffening of extremities that may occur singly or in groups. Absence seizures present with automatisms, and the client is unaware of his or her environment.

A high school teacher who has just been diagnosed with epilepsy after having a generalized tonic-clonic seizure tells the nurse, I cannot teach anymore, it will be too upsetting if I have a seizure at work. Which response by the nurse is best? a. You might benefit from some psychologic counseling. b. Epilepsy usually can be well controlled with medications. c. You will want to contact the Epilepsy Foundation for assistance. d. The Department of Vocational Rehabilitation can help with work retraining.

B ~ The nurse should inform the patient that most patients with seizure disorders are controlled with medication. The other information may be necessary if the seizures persist after treatment with antiseizure medications is implemented.

A nurse witnesses a client begin to experience a tonic-clonic seizure and loss of consciousness. Which action should the nurse take? a. Start fluids via a large-bore catheter. b. Turn the clients head to the side. c. Administer IV push diazepam. d. Prepare to intubate the client.

B ~ The nurse should turn the clients head to the side to prevent aspiration and allow drainage of secretions. Anticonvulsants are administered on a routine basis if a seizure is sustained. If the seizure is sustained (status epilepticus), the client must be intubated and should be administered oxygen, 0.9% sodium chloride, and IV push lorazepam or diazepam.

The nurse is caring for a client with a history of epilepsy who suddenly begins to experience a tonic-clonic seizure and loses consciousness. What is the nurses priority action? a. Restrain the clients extremities. b. Turn the clients head to the side. c. Take the clients blood pressure. d. Place an airway into the clients mouth.

B ~ The nurse should turn the clients head to the side to prevent aspiration and allow drainage of secretions. The client should not be restrained nor an airway placed in his or her mouth during the seizure because these actions increase seizure activity and can harm the client. Vital signs are measured in the postictal phase of the seizure.

A nurse assesses a client who is experiencing an absence seizure. For which clinical manifestations should the nurse assess? (Select all that apply.) a. Intermittent rigidity b. Lip smacking c. Sudden loss of muscle tone d. Brief jerking of the extremities e. Picking at clothing f. Patting of the hand on the leg

B, E, F ~ Automatisms are characteristic of absence seizures. These behaviors consist of lip smacking, picking at clothing, and patting. Rigidity of muscles is associated with the tonic phase of a seizure, and jerking of the extremities is associated with the clonic phase of a seizure. Loss of muscle tone occurs with atonic seizures.

While the nurse is transporting a patient on a stretcher to the radiology department, the patient begins having a tonic-clonic seizure. Which action should the nurse take? a. Insert an oral airway during the seizure to maintain a patent airway. b. Restrain the patients arms and legs to prevent injury during the seizure. c. Time and observe and record the details of the seizure and postictal state. d. Avoid touching the patient to prevent further nervous system stimulation.

C ~ Because the diagnosis and treatment of seizures frequently are based on the description of the seizure, recording the length and details of the seizure is important. Insertion of an oral airway and restraining the patient during the seizure are contraindicated. The nurse may need to move the patient to decrease the risk of injury during the seizure.

The nurse explains to a newly diagnosed epileptic client that the basic pathophysiology of epilepsy is related to a. a period of hypoxia from sleep apnea. b. brain waves losing amplitude. c. excitation of neurons discharging in the brain stem. d. specific metabolic disturbances.

C ~ Epilepsy occurs when neurons fire with greater frequency and amplitude, spreading to adjacent neurons that ultimately discharge in the brain stem, causing muscle contractures and possible unconsciousness.

A client is being worked up for a possible brain tumor. An important intervention the nurse would include in the nursing care plan specific to this client is a. documenting manifestations. b. preparing the client for tests. c. seizure precautions. d. supporting the client and family.

C ~ Options a, b, and d are always important interventions for the client who is being worked up for a medical condition. But the specific care this client needs is seizure precautions, because seizures are a common manifestation in clients with brain tumors.

A nurse is caring for a child with suspected epilepsy. Which diagnostic test does the nurse facilitate as the priority for this child? A. Cerebral angiogram B. Electrocardiogram (ECG) C. Electroencephalogram (EEG) D. Lumbar puncture (LP)

C ~ The EEG is the gold standard diagnostic test for a seizure disorder.

When the client experiences convulsive movement beginning in the hand and progressing to the arm and face, the nurse recognizes this as being consistent with a. clonic seizure. b. complex partial seizure. c. partial seizure with motor signs. d. temporal lobe seizure.

C ~ The observation of the jacksonian march identifies this seizure activity as a partial seizure with motor signs.

A client with new-onset status epilepticus is prescribed phenytoin (Dilantin). After teaching the client about this treatment regimen, the nurse assesses the clients understanding. Which statement indicates that the client understands the teaching? a. I must drink at least 2 liters of water daily. b. This will stop me from getting an aura before a seizure. c. I will not be able to be employed while taking this medication. d. Even when my seizures stop, I will take this drug.

D ~ Discontinuing antiepileptic drugs can lead to the recurrence of seizures or status epilepticus. The client does not need to drink more water and can continue to work while taking this medication. The medication will not stop an aura before a seizure.

After teaching a client who is diagnosed with new-onset status epilepticus and prescribed phenytoin (Dilantin), the nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching? a. To prevent complications, I will drink at least 2 liters of water daily. b. This medication will stop me from getting an aura before a seizure. c. I will not drive a motor vehicle while taking this medication. d. Even when my seizures stop, I will continue to take this drug.

D ~ Discontinuing antiepileptic drugs can lead to the recurrence of seizures or status epilepticus. The client does not need to drink more water and can drive while taking this medication. The medication will not stop an aura before a seizure.

A client with epilepsy develops stiffening of the muscles of the arms and legs, followed by an immediate loss of consciousness and jerking of all extremities. How does the nurse document this seizure activity? a. Atonic seizure b. Absence seizure c. Myoclonic seizure d. Tonic-clonic seizure

D ~ Seizure activity that begins with stiffening of the arms and legs, followed by loss of consciousness and jerking of all extremities, is characteristic of a tonic-clonic seizure. The other seizures do not manifest in this manner.

The nurse caring for a client receiving phenytoin (Dilantin) should assess for a. anorexia, numbness, and tingling of extremities. b. ataxia, nausea, and bleeding tendency. c. headache, myalgias, and arthralgias. d. unsteady gait, slurred speech, and blurred vision.

D ~ Serious adverse outcomes of antiseizure medications are unsteady gait, slurred speech, extreme fatigue, blurred vision, or feelings of suicide.

The nurse is teaching a client who is newly diagnosed with epilepsy. Which statement by the client indicates a need for further teaching concerning the drug regimen? a. I will not drink any alcoholic beverages. b. I will wear a medical alert bracelet. c. I will let my doctor know about all of my prescriptions. d. I can skip a couple of pills if they make me ill.

D ~ The nurse must emphasize that antiepileptic drugs must be taken even if seizure activity has stopped. Discontinuing the medication can predispose the client to seizure activity and status epilepticus. The client should not drink alcohol while taking seizure medications. The client should wear a medical alert bracelet and should make the doctor aware of all medications to prevent complications of polypharmacy.

After teaching a client newly diagnosed with epilepsy, the nurse assesses the clients understanding. Which statement by the client indicates a need for additional teaching? a. I will wear my medical alert bracelet at all times. b. While taking my epilepsy medications, I will not drink any alcoholic beverages. c. I will tell my doctor about my prescription and over-the-counter medications. d. If I am nauseated, I will not take my epilepsy medication.

D ~ The nurse must emphasize that antiepileptic drugs must be taken even if the client is nauseous. Discontinuing the medication can predispose the client to seizure activity and status epilepticus. The client should not drink alcohol while taking seizure medications. The client should wear a medical alert bracelet and should make the doctor aware of all medications to prevent complications of polypharmacy.

Which prescribed intervention will the nurse implement first for a patient in the emergency department who is experiencing continuous tonic-clonic seizures? a. Give phenytoin (Dilantin) 100 mg IV. b. Monitor level of consciousness (LOC). c. Obtain computed tomography (CT) scan. d. Administer lorazepam (Ativan) 4 mg IV.

D ~ To prevent ongoing seizures, the nurse should administer rapidly acting antiseizure medications such as the benzodiazepines. A CT scan is appropriate, but prevention of any seizure activity during the CT scan is necessary. Phenytoin will also be administered, but it is not rapidly acting. Patients who are experiencing tonic-clonic seizures are nonresponsive, although the nurse should assess LOC after the seizure.