Chapter 15 Seizures

The nurse has provided the education to the parent of a young child prescribed valproic acid (Depakene) syrup. Which statement made by the parent indicates an understanding of the teaching? 1) "I should not mix this with carbonated beverages." 2) "If my child gets a headache from this, I can administer a baby aspirin." 3) "I can still give the clonazepam (Klonopin) prescribed by the psychiatrist for sleep." 4) "I can give this on a full stomach or an empty stomach."

1) "I should not mix this with carbonated beverages." (Pg. 179 Prototype box; triggers immediate release of drug and can irritate GI)

The nurse has provided a client education on the pharmacologic management of epilepsy. Which statement made by the client indicates an understanding of the treatment? 1) "I understand that I will take an antiseizure prescription indefinitely." 2) "I will avoid foods with tyramine while taking my antiseizure prescription." 3) "I will be on a ketogenic diet combined with an antiseizure prescription." 4) "I will remain on an antiseizure prescription for 1 year after my last seizure.

1) "I understand that I will take an antiseizure prescription indefinitely." (Pg. 169)

A client with epilepsy who has been seizure free and prescribed phenytoin (Dilantin) asks the nurse why he or she needs to still have blood testing. Which response should the nurse provide the client? 1) "Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose." 2) "Phenytoin (Dilantin) can cause blood-thinning in some patients." 3) "Phenytoin (Dilantin) can cause Stevens-Johnson syndrome, which can be detected through blood testing." 4) "Phenytoin (Dilantin) can deplete your system of potassium."

1) "Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose." (Pg. 177)

A client that has been taking phenytoin (Dilantin) tells the nurse they want to stop taking the medication due to the side effects. Which response should the nurse provide the client? 1) "Please do not stop the prescription abruptly, as you will have withdrawal seizures." 2) "Side effects are a problem, but they are not as bad as the seizures you were having." 3) "Another prescription can be added to decrease the side effects." 4) "Your seizures have been controlled so I will let your healthcare provider know that you no longer will be taking the prescription.

1) "Please do not stop the prescription abruptly, as you will have withdrawal seizures." (Pg. 182; status epilepticus may occur)

The nurse has completed the education for the parents of a child with tonic-clonic seizures. Which statements made by the parents indicate further education is needed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) "Some of the times when I thought he was ignoring me may have actually been seizure activity." 2) "He just needs to focus more to prevent these attacks." 3) "I know he will outgrow these seizures with time." 4) "I hope we can help our son identify his seizure aura." 5) "We will watch for the development of status epilepticus."

1) "Some of the times when I thought he was ignoring me may have actually been seizure activity." (absence, not tonic-clonic) 2) "He just needs to focus more to prevent these attacks." 3) "I know he will outgrow these seizures with time."

A parent states, "The doctors all say that my son's problem is epilepsy, but I don't think that is correct. I have never seen him jerk or thrash." Which information should the nurse include in a response to the parent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) "The episodes of jerking and thrashing are called convulsions." 2) "Seizures take many forms." 3) "Your son may have seizures, but not epilepsy." 4) "Seizures can be a sign that epilepsy is present." 5) "If there is no physical movement, epilepsy is ruled out."

1) "The episodes of jerking and thrashing are called convulsions." 2) "Seizures take many forms." 4) "Seizures can be a sign that epilepsy is present." (Pg. 169)

The nurse is obtaining a history from a client that experienced an atonic seizure. Which information is the most important for the nurse to obtain? 1) "What method of birth control do you use?" 2) "Are your periods regular?" 3) "Do you have a history of infertility?" 4) "Have you ever been pregnant?

1) "What method of birth control do you use?" (Pg. 170; barrier birth control should be used while using AEDs)

A client has been prescribed ketogenic diet to supplement pharmacotherapy for a seizure disorder. Which food items should the nurse encourage the client to consume? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) Foods high in fat 2) Salty foods 3) Foods high in vitamin K 4) Low protein foods 5) Low carbohydrate foods

1) Foods high in fat 4) Low protein foods 5) Low carbohydrate foods (Pg. 175 CAM box)

The nurse has administered intravenous (IV) diazepam (Valium) for the client in status epilepticus. Which initial assessment should the nurse perform? 1) Respirations 2) Level of consciousness 3) Heart rate 4) Blood pressure

1) Respirations (Pg. 176 prototype box)

The nurse is preparing to educate a client on prescribed antiepileptic drug (AED). Which information should the nurse include in the teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) The prescription should be taken at the same time every day. 2) When a dose of the prescription is missed, take both doses together when the next dose is due. 3) Take an additional dose of the prescription if experiencing a seizure aura. 4) When experiencing side effects skip the next dose of the prescription. 5) Avoid the use of dietary supplements containing kava while taking the prescription.

1) The prescription should be taken at the same time every day. (Pg. 182) 5) Avoid the use of dietary supplements containing kava while taking the prescription. (Pg. 175 Prototype box...?)

The nurse is providing information about seizures to a client. Which statement should the nurse include in the discussion? 1) "Convulsions are a symptom of the underlying seizure disorder." 2) "Bacterial infections can cause seizures." 3) "Epilepsy is an acute disorder characterized by nonconvulsive seizures." 4) "All seizures involve convulsions."

2) "Bacterial infections can cause seizures." (Pg. 169... infectious diseases listed both have viral and bacterial causes, not sure why option 1 would not be correct as well)

The nurse has provided education for a client diagnosed with epilepsy. Which statement made by the client indicates an understanding of the information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) "Excessive stress levels cause disruptions in how the brain receives oxygen, leading to epilepsy." 2) "Epilepsy may be caused by a head injury." 3) "Eating disorders, like anorexia nervosa, increase the risk for developing epilepsy." 4) "A stroke, or brain attack, could increase the risk for developing epilepsy." 5) "With some cases of epilepsy, the cause is never determined."

2) "Epilepsy may be caused by a head injury." 4) "A stroke, or brain attack, could increase the risk for developing epilepsy." 5) "With some cases of epilepsy, the cause is never determined." Pg. 169-170

A client with epilepsy prescribed Phenobarbital (Luminal) tells the nurse she is planning a pregnancy. Which statement should the nurse provide the client? 1) "Your medication dose will need to be decreased during your pregnancy." 2) "Please talk to your doctor; this drug is contraindicated in pregnancy." 3) "Your medication dose will need to be increased during your pregnancy." 4) "Please talk to your doctor; you will need a safer drug like valproic acid (Depakene)."

2) "Please talk to your doctor; this drug is contraindicated in pregnancy." (Pg. 175 Prototype box; category D)

A client asks the nurse about the characteristics of absence seizures. Which explanation should the nurse provide the client? 1) "Absence seizures are basically the same kind of seizures as grand mal, but they are less frequent." 2) "This type of seizure is characterized by staring into space for a few seconds." 3) "Absence seizures are characterized by twitching of the arms and legs." 4) "This type of seizure is similar to drop attacks."

2) "This type of seizure is characterized by staring into space for a few seconds." (Pg. 171; table 15.1)

A client with type I diabetes mellitus has been prescribed phenytoin (Dilantin). Based on the client's medical history, which should the nurse anticipate to be included in the treatment plan? 1) A decrease in the patient's insulin 2) An increase the patient's insulin 3) Monitor coagulation studies 4) Implement fall precautions

2) An increase the patient's insulin (Pg. 177 Prototype box; increases serum levels of glucose)

The nurse is providing education to a parent of a 5-year-old that experienced a febrile seizure. Which information should the nurse include? 1) After a febrile seizure the child returns to consciousness slowly. 2) High temperatures rarely induce seizures in children. 3) A five-year-old is too old for febrile seizures. 4) Seizure medications are usually prescribed for febrile seizures.

2) High temperatures rarely induce seizures in children. (Pg. 169)

The educator is discussing the adverse effects of prescriptions used to treat seizure disorders. Which prescription should the educator refer to when discussing the risk for extravasation? 1) Phenobarbital (Luminal) 2) Phenytoin (Dilantin) 3) Ethosuximide (Zarontin) 4) Clonazepam (Klonopin)

2) Phenytoin (Dilantin) (Pg. 177 prototype; also true of Phenobarbital on Pg. 175)

The nurse is preparing to assess a client that had a tonic-clonic seizure. Which assessment findings should the nurse anticipate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) Incontinence of urine. 2) The client is in a deep sleep. 3) Confusion in relation to place and time. 4) The client reports an odd taste in the mouth. 5) The client attempts to remove their hospital gown.

2) The client is in a deep sleep. 3) Confusion in relation to place and time. (Pg. 171 box; incontinence is wrong b/c this occurs at the beginning of symptoms)

The healthcare provider has prescribed intravenous phenytoin (Dilantin) IV piggyback. The client is currently receiving 5% dextrose in water (D5W) intravenously (IV). Which action should the nurse take? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) Use a large vein for the infusion. 2) Use an intravenous (IV) line with a filter. 3) Flush the intravenous (IV) line with saline. 4) Monitor the patient for hypertension. 5) Monitor the patient for Stevens-Johnson syndrome.

2) Use an intravenous (IV) line with a filter. 3) Flush the intravenous (IV) line with saline. (Pg. 177 Prototype box)

A client has been prescribed several different prescriptions for seizure control without any improvement. Which initial question should the nurse ask the client? 1) "Have you thought about taking a nontypical prescription?" 2) "Have you noticed any decrease in the amount of seizures you have?" 3) "Do you take your medication as prescribed? 4) "Do you drink alcohol?"

3) "Do you take your medication as prescribed? (Pg. 182)

The nurse has provided education for a client prescribed ethosuximide (Zarontin). For which information offered by the client should the nurse notify the healthcare provider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) "Did I mention that I used to take phenobarbital for my seizures?" 2) "I forgot to tell the doctor that I am allergic to penicillin." 3) "I take ginkgo to help improve my memory." 4) "My husband and I plan to have a baby in a couple of years." 5) "My husband and I are leading a 20-mile bicycle tour next weekend for the company we have just started."

3) "I take ginkgo to help improve my memory." 5) "My husband and I are leading a 20-mile bicycle tour next weekend for the company we have just started." (Pg. 180 prototype box; may impaire mental and physical abilities, Ginko)

A client diagnosed with epilepsy asks the nurse why he or she will have to take a prescription. Which response should the nurse provide the client? 1) "The prescription will decrease the intensity of the seizures." 2) "You will need a prescription for a little while to cure the seizures." 3) "You will need to take a prescription on a continual basis to control the seizures." 4) "You might not need a prescription; the epilepsy may be controlled with a ketogenic diet."

3) "You will need to take a prescription on a continual basis to control the seizures." (Pg. 169) Keto was used firstline before meds were available

A client prescribed valproic acid (Depakene) for seizure control is planning a pregnancy. Which statements should the nurse include in a discussion with the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) "Since your epilepsy may be exacerbated by a pregnancy, your healthcare provider will most likely prescribe a second antiepileptic prescription." 2) "Thankfully, the current generation of antiepileptic prescriptions will not interfere with you getting pregnant." 3) "Your current antiepileptic prescription should not be used when you are pregnant." 4) "Folic acid supplementation is important for you." 5) "You should consider adopting a baby instead since there are so many problems associated with epilepsy and pregnancy."

3) "Your current antiepileptic prescription should not be used when you are pregnant." (Pg. 179 prototype box; category D, can produce spina bifida, which relates to folate) 4) "Folic acid supplementation is important for you." (Pg. 170)

For which adverse effect should the nurse monitor a client prescribed phenytoin (Dilantin)? 1) Vitamin B deficiency 2) Leg edema 3) Bleeding 4) Hypoglycemia

3) Bleeding (Pg. 177 prototype box; agranulocytosis and aplastic anemia) interesting that vitamin B deficiency would be wrong though: https://pubmed.ncbi.nlm.nih.gov/8520091/

The nurse is preparing to administer phenytoin (Dilantin). Which route should the nurse anticipate to administer the prescription? 1) Intramuscular 2) Central venous catheter 3) Intravenously 4) Subcutaneous

3) Intravenously (Pg. 177 prototype box, but also suggests central venous catheter...)

The nurse observes a client that stops talking mid-sentence and has a blank stare for 5 seconds. Which should the nurse suspect has occurred? 1) Simple partial seizure 2) Status epilepticus 3) Petit mal seizure 4) Drop attack

3) Petit mal seizure (table on 171; also called absence seizures)

An older adult is prescribed phenobarbital (Luminal) for seizure control. Which assessment should the nurse recognize is the most important? 1) Fluid intake 2) Electrolyte balance 3) Respiratory function 4) Nutritional status

3) Respiratory function (Pg. 175 Prototype box; severe respiratory depression)

A client taking phenobarbital (Luminal) for seizure control asks the nurse how the prescription can control seizures. Which response should the nurse provide the client? 1) "Phenobarbital (Luminal) stops seizures by decreasing the calcium in the brain, which is responsible for the seizures." 2) "Phenobarbital (Luminal) stops seizures by increasing a chemical called glutamate that calms down the excitability in the brain." 3) "Phenobarbital (Luminal) stops seizures by decreasing the sodium in the brain, which is responsible for the seizures." 4) "Phenobarbital (Luminal) stops seizures by increasing a chemical called GABA that calms down the excitability in the brain."

4) "Phenobarbital (Luminal) stops seizures by increasing a chemical called GABA that calms down the excitability in the brain." (Pg. 174)

The client receiving valproic acid (Depakene) for treatment of seizures has been taking 81mg aspirin daily. For which should the nurse monitor the client? 1) Increased seizure activity 2) Stevens-Johnson syndrome 3) Migraine headaches 4) Bruising of the skin

4) Bruising of the skin (Pg. 179 Protptype box)

The nurse is preparing to review the records for a client with petit mal seizures. Which prescription should the nurse anticipate the client has been prescribed? 1) Diazepam (Valium) 2) Carbamazepine (Tegretol) 3) Phenytoin (Dilantin) 4) Ethosuximide (Zarontin)

4) Ethosuximide (Zarontin) (Pg. 179)