Chapter 58.2 Chronic Neurologic Disorders

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?

"Are you able to sleep well and feel rested?"

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?

"I will refrain from doing physical exercises."

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.

"Seizures can be caused by a decrease in oxygen levels." "Seizures can be caused by a decrease in pH of the blood." "Seizures can be caused by a decrease in blood glucose levels."

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?

"Tell me about what you would like to do and how the seizures affect you."

What instructions should the nurse give to a patient being treated with carbamazepine for seizures? Select all that apply. 1 Do not stop using the drug abruptly. 2 Do not take the drug with grapefruit juice. 3 Notify the health care provider about any vision problems. 4 Ensure adequate fluid intake. Wear protective clothing while exposed to sunlight. 5 Take the medicine along with food. Notify the health care provider if flu-like symptoms occur.

1 Do not stop using the drug abruptly. 2 Do not take the drug with grapefruit juice. 3 Notify the health care provider about any vision problems. 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. STUDY TIP: A word of warning: do not expect to achieve the maximum benefits of this review tool by cramming a few days before the examination. It doesn't work! Instead, organize planned study sessions in an environment that you find relaxing, free of stress, and supportive of the learning process.

The nurse understands that generalized tonic-clonic seizures are the most common type of generalized seizure and include various phases. Arrange the phases of generalized tonic-clonic seizures in the correct order.

1. The patient loses consciousness. 2. The patient falls to the ground. 3. The body stiffens for 10 to 20 seconds. 4. The extremities jerk for 30 to 40 seconds. 5. The patient feels tired and sleepy. During a generalized tonic-clonic seizure, the patient loses consciousness and falls to the ground. This is followed by stiffening of the body for 10 to 20 seconds. There is a subsequent jerking of the extremities for another 30 to 40 seconds. The patient may then feel tired and sleep for many hours.

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? 1 Tiagabine 2 Pregabalin 3 Topiramate 4 Levetiracetam

2 Pregabalin 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 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? 1 Focal seizure 2 Tonic-clonic seizure 3 Psychogenic seizure 4 Typical absence seizure

2 Tonic-clonic seizure 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. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking and look for key words; (2) Read each answer thoroughly to see whether it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.

A bipolar patient is experiencing a major depressive episode. What factors may be contributing to the depressive episode? Select all that apply. 1 Low-fat diet 2 Darkened room 3 Physical activity 4 Chronic disease 5 Ineffective coping 6 Antiseizure medications

2 Darkened room 4 Chronic disease 5 Ineffective coping 6 Antiseizure medications 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.

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. 1 Putting the patient to bed 2 Providing a healthy snack 3 Going for a walk in the garden 4 Turning on the patient's favorite music 5 Singing songs and playing musical instruments 6 Redirecting the patient's focus to a different task

2 Providing a healthy snack 3 Going for a walk in the garden 4 Turning on the patient's favorite music 5 Singing songs and playing musical instruments 6 Redirecting the patient's focus to a different task

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. ___ mL

2 mL

What is the nursing action of highest priority to be taken with a patient who experiences a generalized tonic-clonic seizure? 1 Restraining the arms and legs 2 Controlling head movements 3 Protecting the head and extremities 4 Inserting a tongue blade between the teeth

3 Protecting the head and extremities 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.

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. 1 A seizure is associated with loss of postural tone. 2 The child will usually seem confused after a seizure. 3 The seizures are characterized by brief staring spells. 4 The seizures are usually precipitated by flashing lights. 5 The occurrence of seizures usually subsides during adolescence.

3 The seizures are characterized by brief staring spells. 4 The seizures are usually precipitated by flashing lights. 5 The occurrence of seizures usually subsides during adolescence. 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.

The nurse assesses a patient for signs of petit mal, or absence, seizures. What is the classic sign of this seizure disorder? 1 Dizziness 2 Intense anxiety 3 Stiffening of the body 4 Vacant facial expression

4 Vacant facial expression 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.

Which diet is used to control seizures in some patients?

A diet with high fats and low carbohydrates

Which type of seizure is characterized by "drop attacks"?

Atonic seizure

The nurse should instruct the patient on phenytoin to perform which action to prevent gingival hyperplasia?

Brush the teeth at least twice per day.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 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?

Clonic seizure

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?

Do not stop the drug abruptly without consulting the health care provider.

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?

Do not take this medication with grapefruit.

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.

Ease the patient to the floor. Loosen constrictive clothes Protect the patient from any injury.

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?

Ensure the patient has a patent airway.

A patient with a seizure disorder failed to respond to drug therapy. Resection of epileptogenic tissue is performed. What could be the possible diagnosis?

Focal seizures

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?

Generalized seizures 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 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.

Hirsutism Gingival hyperplasia

Which extracranial disorder can cause seizures?

Hypertension

The patient with type 1 diabetes mellitus with hypoglycemia is having a seizure. Which medication should the nurse anticipate administering to stop the seizure?

Intravenous (IV) dextrose solution

What should be the immediate nursing intervention provided to a patient with hypoglycemia who is suspected to have had a seizure?

Intravenous administration of dextrose

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?

Liver failure

A patient with restless legs syndrome (RLS) failed to respond to gabapentin, which was prescribed earlier. What would be the drug of choice?

Oxycodone

A patient with a history of epilepsy experienced gingival enlargement. Which drug may be causing it?

Phenytoin

Which is the primary drug of choice for tonic-clonic seizures?

Phenytoin

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?

Postictal phase

What is the nursing action of highest priority to be taken with a patient who experiences a generalized tonic-clonic seizure?

Protecting the head and extremities

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.

Regular tooth brushing can limit hyperplasia. Regular flossing can control gingival tissue growth.

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?

Resection of epileptogenic tissueUnusual 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.

A patient with hypertension reports paresthesia, tingling, and a pins and needles sensation. The patient was prescribed gabapentin. What is the possible diagnosis?

Restless legs syndrome (RLS)

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?

Sending the patient to hospital immediately after a single seizure

Which characteristic feature is exclusively seen in a complex focal seizure?

Smacking of the lips 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 Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

Which type of seizure lasts longer than five minutes and occurs in rapid succession without return to consciousness between seizures?

Status epilepticus

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?

Subclinical seizure

Arrange the phases of a seizure chronologically.

The phase with signs that precede a seizure The phase with a sensory warning of a seizure The phase with a full seizure The phase with recovery period after a seizure

Which characteristic of a patient's recent seizure is consistent with a focal seizure?

The seizure involved lip smacking and repetitive movements.

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?

Thirty percent of all epilepsy cases are not attributable to a specific cause

What seizure disorder typically occurs in children and rarely continues beyond adolescence?

Typical absence seizures

The nurse assesses a patient for signs of petit mal, or absence, seizures. What is the classic sign of this seizure disorder?

Vacant facial expression

Arrange the steps of vagal nerve stimulation chronologically.

Vagal nerve stimulation is used when surgery is not feasible to treat seizures. In this process, an electrode is implanted in the neck. A magnet can activate this electrode, which delivers the electrical impulse and prevents the seizure from occurring.

The patient with epilepsy is due for a dose of carbamazepine. The serum carbamazepine level today is 18 mcg/mL. What is the priority nursing action?

Withhold the dose and telephone the health care provider with the result.

What has been shown to improve mood, sleep, and function in patients with restless leg syndrome?

Yoga 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. p. 1382