Seizures

Which type of seizure may be difficult to detect? A. Generalized B. Simple partial C. Complex partial D. Absence

D. Absence seizures may go unrecognized because little change occurs in the child's behavior during the seizure. Generalized, simple partial, & complex partial seizures all have clinical manifestations that are observable.

A patient has been taking phenytoin (Dilantin) for 2 years. Which action will the nurse take when evaluating for adverse effects of the medication? A. Listen to lung sounds B. Auscultate the bowel sounds C. Check pupil reaction to light D. Inspect the oral mucosa

D. Phenytoin can cause gingival hyperplasia, but does not affect bowel sounds, lung sounds, or pupil reaction to light

Which type of seizure involves both hemispheres of the brain? A. Generalized B. Focal C. Acquired D. Parital

A. Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres. Focal seizures may arise from any area of the cerebral cortex, but the frontal, temporal, & parietal lobes are most commonly affected. Acquired seizures are a result of a brain injury. Partial seizures are caused by abnormal electrical discharges from epileptogenic foci limited to a circumscribed region of the cerebral cortex.

The nurse observes a patient ambulating in the hospital hall when the patient's arm & legs suddenly jerk & the patient falls to the floor. The nurse will FIRST? A. Assess the patient for a possible injury B. Give the scheduled divalproex (Depakote) C. Document the timing & description of the seizure D. Notify the patient's health care provider about the seizure

A. The patient who has had a myoclonic seizure & fall is at risk for head injury & should first be evaluated & treated for this possible complication. Documentation of the seizuren, notification of the health care provider, & administration of antiseizure medications are also important but initial action is assess for injury.

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

A. 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.

A child has been seizure free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. The nurse includes which intervention in the response? A. Medications can be discontinued at this time B. A stepwise approach will be used to reduce the dosage gradually C. The child will need to take the drugs for 5 years after the last seizure D. Seizure disorders are a lifelong problem. Medications cannot be discontinued

B. A predesigned protocol is used to wean a child gradually off antiseizure medications, usually when the child is seizure free for 2 years & has a normal electroencephalogram. Medications must be gradually reduced to minimize the recurrence of seizures.

The initial clinical manifestation of generalized seizures is? A. Being confused B. Losing consciousness C. Seeing flashing lights D. Feeling frightened

B. Loss of consciousness is a frequent occurrence in generalized seizures & is the initial clinical manifestation. Being confused, feeling frightened, & seeing flashing lights are clinical manifestations of a complex partial seizure.

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.

An important nursing intervention when caring for a child who is experiencing a seizure is to? A. Restrain the child when seizure occurs to prevent bodily harm B. Describe & record the seizure activity observed C. Place a tongue blade between the teeth if they become clenched D. Suction the child during a seizure to prevent aspiration

B. When a child is having a seizure, the priority nursing care is observation of the child & seizure. The nurse then describes & records the seizure activity. The child should not be restrained, & nothing placed in mouth. To prevent aspiration, if possible, the child should be placed on his or her side, facilitating drainage.

A patient reports feeling numbness & tingling of the left arm before experiencing a seizure. The nurse determines that this history is consistent with what type of seizure? A. Atonic B. Focal C. Absence D. Myoclonic

B. The initial symptoms of a focal seizure involve clinical manifestations that are localized to a particular part of the body or brain. In an atonic seizure, the patient loses muscle tone & typically falls to the ground. Myoclonic seizures are characterized by a sudden jerk of the body or extremities.

The home health 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 LPN/LVN? A. Make referrals to appropriate community agencies B. Teach the patient & family how to manage seizures C. Place medications in the home medication organizer D. Assess for use of medications that may precipitate seizures

C. LPN/LVN education includes administration of medications. The other activities require RN education & scope of practice

A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is? A. "Epilepsy is easily treated" B. "Very few children have actual epilepsy" C. "The seizure may or may not mean that your child has epilepsy" D. "Your child has had only one convulsion; it probably won't happen again"

C. Seizures are the indispensable characteristic of epilepsy; however, not every seizure is epileptic. Epilepsy is a chronic seizure disorder with recurrent & unprovoked 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 patient's 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. The diagnosis & treatment of seizures frequently are based on the description of the seizure, recording the length & details of the seizures is important. Insertion of an oral airway & 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.

Which information about a patient who has a new prescription for phenytoin (Dilantin) indicates that the nurse should consult with the health care provider before administration of the medication? A. Patient has tonic-clonic seizures B. Patient experiences an aura before seizures C. Patient has minor elevations in the liver function tests D. Patient's most recent blood pressure is 156/92 mm Hg

C. Many older patients (especially with compromised liver function) may not be able to metabolize phenytoin. The health care provider may need to choose another anti seizure medication.

A 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 patient's assigned room? (Select all) A. Tongue blade B. Side rail pads C. Suction tubing D. Oxygen mask E. Urinary catheter F. Nasogastric tube

The patient is at risk for further seizures, and O2, & suctioning may be needed after any seizures to clear the airway & maximize oxygenation. The bed's side rails should be padded to minimize the risk for patient injury during seizure. Use of tongue blades during a seizure is contraindicated. NG tube is not indicated because airway problem is not caused by vomiting or abdominal distention. Urinary catheter not required unless there is urinary retention. Answers: B, C, D