nur 116 - Davis Advantage / Edge - Seizures
The nurse is teaching a patient about seizure management. Which statement by the patient about this image demonstrates understanding? "I should wear this all of the time." "If I don't have it on, I can tell people I have a seizure disorder." "I only need to wear this when I leave the house." "This will help me if I get pulled over when driving."
"I should wear this all of the time." Rationale: Wearing a medic alert bracelet is important for a patient with seizures because it facilitates prompting necessary interventions in the event of a seizure. Test Taking Tips: Safety is the priority.
The nurse is providing client teaching regarding the use of phenytoin and is aware the client requires further teaching when the client makes which statement? "I know that I must follow my medication regimen." "If I feel ill, it is okay for me to stop taking this medication." "I should refill my prescription before it runs out." "I should have regular dental checkups."
"If I feel ill, it is okay for me to stop taking this medication."
The charge nurse asks the student nurse to gather supplies to set up suction for a seizure client who is going to be admitted to the nursing unit. The student nurse asks why this equipment is needed. How should the charge nurse respond? "The client may not be able to protect the airway after the seizure and suctioning may be required." "The healthcare provider ordered it, so we are required to do it." "It will be available if the client wishes to use the equipment." "The client may have aspirated before coming to the hospital and the nursing staff may need to suction out the aspirate."
"The client may not be able to protect the airway after the seizure and suctioning may be required."
The nurse is caring for a patient who is prescribed carbamazepine for complex partial seizures. Which is the most appropriate information for the nurse to teach the patient? "The medication must be chewed." "The medication may cause blurred vision." "Weight gain is a side effect of the medication." "The medication may cause sedation."
"The medication may cause blurred vision." Rationale: The patient should be monitored for visual changes because the medication may cause blurred vision. Test Taking Tips: Differentiate medications and their side effects.
Which statements would the nurse include in the client and family teaching about the postictal phase of seizures? Select all that apply. -The postictal phase occurs after the seizure. -The client in the postictal phase may exhibit automatisms such as lip smacking, rhythmic muscle movements, or chewing. -The client may exhibit confusion and disorientation during the postictal phase. -The postictal phase can last from 5-30 minutes. -The postictal phase client may state seeing visualizations, hallucinations, or smell odors that are not present.
-The postictal phase occurs after the seizure. -The client may exhibit confusion and disorientation during the postictal phase. -The postictal phase can last from 5-30 minutes.
James is a young man in his 20s whose been diagnosed with a seizure disorder. He had a tonic-clonic seizure when at a pizza restaurant with some college friends a couple of weeks ago. The seizure has been followed on an outpatient basis, but today he had another seizure at home and is brought to the emergency department. When James arrives, the nurse realizes he is in the postictal phase when observing which symptoms? Select all that apply. Confusion Alertness Disorientation Drowsiness Hunger
Confusion Disorientation Drowsiness CORRECT. During the postictal phase, which lasts between 5 and 30 minutes, the client is in an altered state of consciousness. He may exhibit drowsiness, confusion, disorientation, nausea, hypoxia, and headache or migraine symptoms.
In which state of a seizure is a patient most likely to have compromised airway and decreased level of consciousness? After a seizure episode During the preictal state During the postictal state Between seizure episodes
During the postictal state Rationale: A patient may have a compromised airway secondary to a decreased level of consciousness either during the seizure or in the postictal state. Test Taking Tips: Different stages of seizures.
The client's mother is asking what foods could be included in a ketogenic diet for her school-aged child. The nurse would explain a dietitian would work with the family, but which of the following types of foods would be included on the diet? High carbohydrate and low protein Low carbohydrate and high protein Low fat, high carbohydrate, and low protein High fat, low carbohydrate, and low protein
High fat, low carbohydrate, and low protein
The nurse would expect to place the client who just had a seizure in which position? Right-lying (lateral) Left-lying (lateral) Supine Supine with head elevated 15 degrees
Left-lying (lateral)
Which is a first-line medication used in the immediate treatment of seizures and status epilepticus? Select all that apply. Propofol Phenytoin Lorazepam Midazolam Levetiracetam
Lorazepam Midazolam Rationale: Lorazepam is a benzodiazepine that is used as a first-line medication in the treatment of seizures and status epilepticus. Rationale: Midazolam is a benzodiazepine that is used as a first-line medication in the treatment of seizures and status epilepticus. Test Taking Tips: Benzodiazepines are first line.
Which patient is most likely to experience atonic seizures? Patient A Patient B Patient C Patient D
Patient B Rationale: Patient B, who is 4 years old and unconscious with a sudden loss of motor tone and head drop due to fall, may have atonic seizures. Test Taking Tips: Differentiate seizure types.
The nurse is caring for a patient with tonic-clonic seizures. Which action of the nurse is most likely to benefit the patient? Encouraging the patient to eat finger foods Placing the patient in a left recumbent position Placing a clock and calendar in the patient's room Encouraging the patient to participate in self-care activities
Placing the patient in a left recumbent position Rationale: Encouraging the patient with tonic-clonic seizures to turn to the left side reduces the risk of aspiration. Test Taking Tips: Safety is the priority.
The nurse observes a patient experiencing a partial seizure. Which behavior does the nurse document as automatism? Unilateral, rhythmic muscle movements Rhythmic jerkiness of all extremities Repetitive unconscious movements Visualizations or hallucinations
Repetitive unconscious movements Rationale: Automatism involves repetitive unconscious movements such as lip smacking, chewing, or swallowing. Test Taking Tips: Define terms.
The nurse would expect to carry out which actions while caring for a newly admitted seizure client? Select all that apply. Setting up suction equipment at the client's bedside Having oxygen available at the client's bedside Positioning the client on the right side to prevent aspiration Placing a nasogastric (NG) tube Placing the client on a ventilator
Setting up suction equipment at the client's bedside Having oxygen available at the client's bedside
Which intervention should the nurse implement for a patient who experienced a seizure? Restrain the patient's movements. Assist the patient to a supine position. Suction the oral airway. Encourage the patient to drink water.
Suction the oral airway. Rationale: The patient may have a compromised airway after seizure activity secondary to decreased level of consciousness. The nurse should assist in maintaining the patency of the airway with oral suctioning. Test Taking Tips: Remember airway, breathing, circulation (ABCs).
The client's mother has heard a certain type of diet can improve seizure control. Although usually used with children, the doctor believes a ketogenic diet may be effective for James. When asked by the mother to explain a ketogenic diet, what information would you provide? "A ketogenic diet is high in protein, but low in carbohydrates and fats." "A ketogenic diet is high in carbohydrates and fats, but low in protein." "A ketogenic diet is high in fat and low in carbohydrates and protein." "A ketogenic diet is a balanced diet with equal values of fat, carbohydrates, and protein."
"A ketogenic diet is high in fat and low in carbohydrates and protein." CORRECT. A ketogenic diet can help improve metabolic seizure control, primarily in children. The diet is high in fat (80%-90%) and low in carbohydrates and protein. The parents should work with a dietitian to formulate meal plans when helping a child implement this diet.
James has been prescribed phenytoin (Dilantin). The nurse is providing client teaching regarding this medication. Which statement demonstrates understanding? "I understand the medication will turn my urine orange." "It is important for me to have regular dental checkups." "I will not have to have any blood work to check the level of medicine in my blood with this medicine." "If I run out of medicine, it is OK not to take it for a couple of days until I can get my prescription filled."
"It is important for me to have regular dental checkups." CORRECT. The client teaching has been noted as effective when James states it is important to have regular dental checkups. A side effect of phenytoin is gingival hyperplasia, enlargement of the gum tissue in the mouth. This condition can lead to gum and tooth issues and should be monitored by a dentist. James should also understand that he cannot stop taking the medication for any reason. He should have plans in advance to have the prescription refilled before running out. He will have regularly scheduled lab work ordered to check phenytoin levels.
The nurse caring for a client who is post status epilepticus is aware that status epilepticus can be caused by which conditions? Select all that apply. Anaphylactic reaction to medication Abrupt withdrawal of anticonvulsive medications Myocardial infarction Acute drug withdrawal Head trauma
Abrupt withdrawal of anticonvulsive medications Acute drug withdrawal Head trauma
The nurse asked a family member of a client with seizures if the client exhibited automatisms with the most recent seizure. The family member asked for clarification on what the term automatisms meant. How should the nurse respond? Automatisms are odors, visualizations, and/or hallucinations that occur just prior to the beginning of the seizure. Automatisms are symptoms such as drowsiness, confusion, and disorientation that occur immediately after the seizure. Automatisms are repetitive unconscious movements such as chewing or lip smacking. Automatisms are the tonic/clonic movement seen in some types of seizures.
Automatisms are repetitive unconscious movements such as chewing or lip smacking.
Which characteristic should the nurse monitor for in case James has another tonic-clonic seizure? Twitching with a brief loss of consciousness Twitching with no loss of consciousness Phases of rhythmic jerking of extremities and loss of consciousness Twitching where the client may or may not lose consciousness
Phases of rhythmic jerking of extremities and loss of consciousness CORRECT. A tonic-clonic seizure exhibits phases of rhythmic jerking of extremities and loss of consciousness. An absence seizure is defined as a generalized seizure with brief loss of consciousness. A myoclonic seizure is defined as a generalized seizure with no loss of consciousness. An atonic seizure is a seizure where the client may or may not lose consciousness.
The adult who has had his first complex partial seizure is asking the nurse when he can drive again. What is the best response to the client regarding this question? "The doctor usually lets clients drive upon discharge." "You will need to notify the Department of Motor Vehicles about your condition. Each state has different rules and regulations." "You will need to notify the national Department of Motor Vehicles about your condition. The rules are the same for every state." "I doubt you will ever drive again, but there are public transportation options that you can explore."
"You will need to notify the Department of Motor Vehicles about your condition. Each state has different rules and regulations."
James's seizure stops after 7 minutes. He is not intubated but is placed on a ventilator and transferred to the intensive care unit. Which medications may the nurse request from the provider in case he has additional seizures? Select all that apply. Lorazepam (Ativan) Midazolam (Versed) Phenytoin (Dilantin) Levetiracetam (Keppra) Propofol (Diprivan)
Lorazepam (Ativan) Midazolam (Versed) Phenytoin (Dilantin) Levetiracetam (Keppra) Propofol (Diprivan) CORRECT. Benzodiazepines including lorazepam and midazolam are first-line medications for seizures. At times a loading dose of anticonvulsants is used. If the client does not respond, high doses of propofol may be used or a pentobarbital coma may be induced.
The nurse enters the room and finds James is having a seizure. The episode has lasted more than 5 minutes. What is the nurse's priority action? Observe the length and sequence of the seizure. Maintain the airway and prepare for intubation. Deliver the evening dose of oral phenytoin early. Confirm that the wall suction is functioning properly.
Maintain the airway and prepare for intubation. CORRECT. Status epilepticus is seizure activity lasting greater than 5 minutes or two or more seizures without full recovery of consciousness. Airway, breathing, circulation (ABC) interventions must be initiated immediately. Clients are intubated and arterial blood gases are monitored.
The provider plans to implant a vagal nerve stimulator (VNS) to better control James's seizures. The family asks for more information. Which statement by the nurse is correct? The generator continuously stimulates the vague nerve, providing electrical shock. The generator is activated and programmed immediately in the operating room. The generator is implanted into a small pouch in the left chest below the clavicle. Access to the vagal nerve is then established via an incision in the armpit.
The generator is implanted into a small pouch in the left chest below the clavicle. CORRECT. The generator of the VNS is implanted into a small pouch in the left chest below the clavicle. Access to the vagus nerve is established via an incision in the neck. Either postoperatively or within a 2-week period, the generator is activated and programmed specifically to the patient. The generator is either continuously stimulating the vagus nerve, or the patient carries a small handheld magnet with which he can activate the program with the presence of an aura; thus, a seizure can be minimized and extinguished.
The nurse documents that a patient had an atonic seizure. What did the nurse observe? The patient experienced a brief contracture of muscles or muscle groups. The patient developed shallow breathing and periods of apnea. The patient had rhythmic jerking of all extremities. The patient experienced a severe fall to the ground with loss of consciousness.
The patient experienced a severe fall to the ground with loss of consciousness. Rationale: The patient experiencing an atonic seizure has sudden momentary loss of motor tone. This patient is at high risk of injury. The patient may have a head drop or a severe fall to the ground accompanied by a brief loss of consciousness. Test Taking Tips: Differentiate seizure types.
The nurse is caring for a client who is considering the implantation of a vagal nerve stimulator (VNS) to treat and control seizures. The nurse knows the client understands the purpose of the VNS when she makes which statement? "Electrodes are placed in deep brain structures and programmed to activate when the seizure activity is sensed." "I will be admitted to the hospital for at least a week to have the VNS implanted." "The VNS will either fire continuously or I may have to carry a magnet to activate the stimulator when I feel the presence of an aura." "The connection between the right and left hemisphere of the brain will be severed."
"The VNS will either fire continuously or I may have to carry a magnet to activate the stimulator when I feel the presence of an aura."
After a conversation with a provider, a patient asks what a psychogenic nonepileptic attack disorder (PNES) is. How should the nurse explain it? It does not involve abnormal electrical discharges. It is provoked by other disorders and conditions. It is a chronic disorder. It is an uncontrolled, sudden, excessive discharge of electrical activity.
It does not involve abnormal electrical discharges. Rationale: The client with PNES appears to be having an epileptic seizure, but there are no abnormal electrical discharges. Psychogenic nonepileptic attack disorder (PNES) is classified as a conversion disorder by the American Psychiatric Association. Test Taking Tips: Understand terminology.
Which teaching points should the nurse include when educating James's parents about caring for a client with seizures? Select all that apply. If possible, turn the client on the left side during or immediately after a seizure to reduce the risk of aspiration. Attempt to restrain the client to reduce the risk of injury during the seizure. Do not force any object into the mouth during the seizure. Offer the client a drink of water immediately following the seizure. Document specifics of the seizure activity to report to the client's healthcare provider.
If possible, turn the client on the left side during or immediately after a seizure to reduce the risk of aspiration. Do not force any object into the mouth during the seizure. Document specifics of the seizure activity to report to the client's healthcare provider. CORRECT. The person should be turned on his left side during or immediately after the seizure to reduce the risk of aspiration. The person should be protected from harm without being restrained, and should not be offered any drink or food immediately after the seizure. Parents should document specifics of the seizure, including date, time, duration of the seizure, description of the seizure, and sequence of the seizure progression. The parent should also document any observations during the preictal and postictal phases and share these observations with the healthcare provider.
