FINAL Mod 6 - Seizure (PRACTICE QUESTIONS)

Which of the following are causes or triggers of seizures? Select all that apply. A) Alcohol withdrawal B) Brain tumor C) Hypocalcemia D) Infection E) Fever

A, B, C, D, E. Seizures are caused by anything that can cause brain swelling or hypoxia. The most common causes of seizures are infection, trauma, brain mass, increased intracranial pressure (ICP), fever, and alcohol and drug withdrawal. Infections due to Streptococcus agalactiae (a group B Streptococcus) and Escherichia coli are the most common causes of neonatal meningitis and cause seizures. Brain masses or tumors that metastasize, trauma, and fever add additional pressure on the brain, increasing the intracranial pressure, which results in swelling and seizures.

A client is having a grand mal seizure. Which of these interventions by the nurse will ensure safety during the seizure? A) Protect the client from injury B) Place a padded tongue blade between the teeth C) Lay the client in a supine position D) Give oxygen via facemask

A. Grand mal seizures are violent and can potentially cause injury to the client. The most important thing to remember with seizures is to maintain safety and protect the client from injury. Placing clients in the recovery position and monitoring their airway are two of the most important interventions. These interventions can help prevent aspiration and prevent injury. Other interventions include padding the side rails of the bed and placing the bed in the lowest position. It is important not to restrain a seizing client. Place suction materials at the bedside. Remember to observe the length of the seizure and afterwards to document the time it started and the time it ended and what happened during the seizure.

The nurse is assessing a client who has been on phenytoin for 10 years. Which characteristic finding is observed in clients with a long-term history of taking phenytoin sodium? A) Excess growth of gum tissue B) Enlarged tonsils C) Dry, scaly skin D) Mania

A. Phenytoin is an anti-epileptic or anticonvulsant medication used to prevent and treat certain types of seizures. It works by decreasing the impulse activity in the brain that can cause seizures. Long-term use of phenytoin can cause gingival hyperplasia (excessive growth of gum tissue). The client should be instructed to have good oral hygiene and to follow-up at least every 6 months with the dentist to have this potential complication of phenytoin monitored. Self-monitoring should be taught to the client and any change of the gums reported to the health care professional.

A client is being discharged with a new prescription of phenytoin. Which instruction by the nurse is most important to include? A) If stopped abruptly, status epilepticus may occur B) Sulfonamides will decrease phenytoin levels in the blood C) Take the medication with antacids to reduce gastric upset D) This will not affect contraceptive effectiveness

A. Phenytoin is an anti-epileptic or anticonvulsant medication used to prevent and treat certain types of seizures. It works by decreasing the impulse activity in the brain that can cause seizures. The nurse should teach a client newly prescribed phenytoin to never abruptly stop taking the medication. Abrupt withdrawal of this medication is dangerous and can cause life threatening seizure activity. The client should always plan ahead to have prescriptions filled, have extra medications available, and be systematic and consistent with taking phenytoin. Phenytoin is one of a few medications with therapeutic blood levels needed to be effective and prevent toxicity side effects. Blood levels should be monitored and maintained at 10-20 mcg/mL to prevent toxicity symptoms including CNS effects such as nystagmus, slurring speech, lethargy, coma, or death.

A client with a diagnosis of epileptic seizures is on anticonvulsant therapy, phenytoin and is at the clinic for follow-up. The client reveals signs of central nervous system (CNS) depression with complaints of increased lethargy and confusion. The nurse provides further instruction on CNS depression after the client discloses use of which of the following? A) Alcohol B) Furosemide C) Metformin D) Calcium

A. Phenytoin is an anticonvulsant medication used to control seizures. The medication works by slowing down the impulses in the brain which cause seizures. It is a CNS depressant. Phenytoin, when mixed with other CNS depressants, such as alcohol, causes additional CNS depression. Alcohol, in particular, will increase phenytoin serum levels, which may induce toxicity and CNS depression. Phenytoin toxicity signs and symptoms include CNS depression, lethargy, confusion, lack of coordination, slurred speech, double vision, and nystagmus. These symptoms should be reported immediately.

A hospital client has experienced a seizure. In the immediate recovery period, what action best protects the client's safety? A. Place the client in a side-lying position. B. Pad the client's bed rails. C. Administer anti anxiety medications as prescribed. D. Reassure the client and family members.

ANS: A Rationale: To prevent complications, the client is placed in the side-lying position to facilitate drainage of oral secretions. Suctioning is performed, if needed, to maintain a patent airway and prevent aspiration. None of the other listed actions promotes safety during the immediate recovery period.

The nurse is caring for a client who is in status epilepticus. What medication should the nurse anticipate administering to halt the seizure immediately? A. Intravenous phenobarbital B. Intravenous lorazepam C. Oral lorazepam D. Oral phenytoin

ANS: B Rationale: Medical management of status epilepticus includes IV diazepam and IV lorazepam given slowly in an attempt to halt seizures immediately. Other medications (phenytoin, phenobarbital) are given later to maintain a seizure-free state. Oral medications are not given during status epilepticus.

A school nurse is called to the playground where a 6-year-old girl has been found sitting unresponsive and staring into space, according to the playground supervisor. How would the nurse document the girl's activity in her chart at school? A. Generalized seizure B. Absence seizure C. Focal seizure D. Unclassified seizure

ANS: B Rationale: Staring episodes characterize an absence seizure, whereas focal seizures, generalized seizures, and unclassified seizures involve uncontrolled motor activity.

A client has experienced a seizure in which she became rigid and then experienced alternating muscle relaxation and contraction. What type of seizure does the nurse recognize? A. Unclassified seizure B. Absence seizure C. Generalized seizure D. Focal seizure

ANS: C Rationale: Generalized seizures often involve both hemispheres of the brain, causing both sides of the body to react. Intense rigidity of the entire body may occur, followed by alternating muscle relaxation and contraction (generalized tonic-clonic contraction). This pattern of rigidity does not occur in clients who experience unclassified, absence, or focal seizures.

A client who has been on long-term phenytoin therapy is admitted to the unit. In light of the adverse of effects of this medication, the nurse should prioritize which of the following in the client's plan of care? A. Monitoring of pulse oximetry B. Administration of a low-protein diet C. Administration of thorough oral hygiene D. Fluid restriction as prescribed

ANS: C Rationale: Gingival hyperplasia (swollen and tender gums) can be associated with long-term phenytoin use. Thorough oral hygiene should be provided consistently and encouraged after discharge. Fluid and protein restriction are contraindicated and there is no particular need for constant oxygen saturation monitoring.

A client with a documented history of seizure disorder experiences a generalized seizure. What nursing action is most appropriate? A. Restrain the client to prevent injury. B. Open the client's jaws to insert an oral airway. C. Place client in high Fowler position. D. Loosen the client's restrictive clothing.

ANS: D Rationale: An appropriate nursing intervention would include loosening any restrictive clothing on the client. No attempt should be made to restrain the client during the seizure because muscular contractions are strong and restraint can produce injury. Do not attempt to pry open jaws that are clenched in a spasm to insert anything. Broken teeth and injury to the lips and tongue may result from such an action. If possible, place the client on one side with head flexed forward, which allows the tongue to fall forward and facilitates drainage of saliva and mucus.

The nurse is providing care for a client who is withdrawing from heavy alcohol use. The nurse and other members of the care team are present at the bedside when the client has a seizure. In preparation for documenting this clinical event, the nurse should note which of the following? A. The ability of the client to follow instructions during the seizure. B. The success or failure of the care team to physically restrain the client. C. The client's ability to explain his seizure during the postictal period. D. The client's activities immediately prior to the seizure.

ANS: D Rationale: Before and during a seizure, the nurse observes the circumstances before the seizure, including visual, auditory, or olfactory stimuli; tactile stimuli; emotional or psychological disturbances; sleep; and hyperventilation. Communication with the client is not possible during a seizure and physical restraint is not attempted. The client's ability to explain the seizure may not be accurate since the client is often still confused during the postictal period.

A patient in the intensive care unit begins exhibiting seizure activity. What nursing interventions are indicated? Select all that apply. 1. Hold the patient as still as possible to prevent tissue damage. 2. Roll the patient to the side if possible. 3. Place a padded tongue blade in the patient's mouth. 4. Time the seizure from beginning to end. 5. Call the rapid response team.

Answer: 2, 4 Explanation: 1. The nurse should remove hard objects if possible and pad objects that cannot or should not be removed. This action will help prevent injury. The nurse should not attempt to hold the patient still. 2. Rolling the patient to the side will allow secretions to clear the mouth and will help prevent aspiration. 3. No attempt to place anything in the patient's mouth should be made. 4. Length of seizure is important assessment information that can be collected by the nurse. 5. The nurse working in the intensive care unit should be adequately prepared to manage a patient having a seizure. There is no need to call for a rapid response team for a simple seizure.

Following a generalized seizure in a client, which nursing assessment is a priority for detailing the event? A. Sleeping quietly after the seizure B. Seizure was 1 minute in duration including tonic-clonic activity. C. The client cried out before the seizure began. D. Seizure began at 1300 hours.

B. Describing the length and the progression of the seizure is a priority nursing responsibility. During this time, the client will experience respiratory spasms, and their skin will appear cyanotic, indicating a period of lack of tissue oxygenation. Noting when the seizure began and presence of an aura are also valuable pieces of information. Postictal behavior should be documented along with vital signs, oxygen saturation, and assessment of tongue and oral cavity.

How are seizures diagnosed? A) An EKG B) An EEG C) A CBC D) An X-ray of the brain

B. Seizures are diagnosed by an electroencephalogram or EEG. Electrodes are placed on the client's scalp with a substance like paste to record the client's brain's electrical activity. Clients may have blood drawn between 10-20 minutes past the seizure and the client's prolactin increases in the blood if the client had a generalized tonic-clonic or complex partial seizure. If an EEG does not provide enough information for the healthcare provider, a magnetic resonance imaging (MRI) may be ordered. The MRI can reveal tumors and infections. It can reveal localized areas of the client's brain where seizures begin and provide information regarding other problems neurologically. An ECG is an electrocardiogram and records information about the client's heart. A CT or x-ray of the brain is not normally used to diagnose seizures.

The patient is having a continuous seizure that has lasted over 5 minutes. What is the priority action of the nurse? A) Take the patient to MRI so that his brain can be imaged B) Complete vital signs and a full neuro assessment C) Administer prescribed lorazepam D) Ensure that the stat lab work gets completed

C. A seizure lasting longer than 5 minutes is termed status epilepticus and is an emergency. Status epilepticus affects airway and oxygenation. Seizures that last 30 minutes or longer can cause brain injury. The priority nursing interventions for a patient having a seizure is safety and stopping (aborting) the seizure. Medications such as lorazepam and diazepam may be used for seizure abortion. They work by increasing GABA and cause the brain to calm and rest.

A client with a history of tonic-clonic seizures is started on new medication. One month later the client complains of bleeding gums, increased facial hair, and double vision. Which of the following anticonvulsant medications is responsible for these symptoms? A) Diazepam B) Phenobarbital C) Phenytoin D) Valproic acid

C. Clients with a history of tonic-clonic seizures are prescribed phenytoin. Phenytoin is the first-line treatment for acute tonic-clonic seizures. Phenytoin blocks sodium channels in the brain, reducing the symptoms and frequency of seizure episodes. The adverse effects of phenytoin are bleeding enlarged gums, increased facial hair (hirsutism), and double vision (diplopia). Clients may also experience symptoms of yellow-brown skin. Phenytoin causes teratogenicity; therefore, clients must be educated to use contraception to reduce the risk of fetal abnormalities.

A client is admitted to an acute care facility after an episode of status epilepticus. After the client is stabilized, which factor is most beneficial in determining the potential cause of the episode? A. Recent weight gain and loss B. The type of anticonvulsant prescribed to manage the epileptic condition C. Compliance with the prescribed medication regimen D. Recent stress level

C. The most common cause of status epilepticus is sudden withdrawal of anticonvulsant therapy. The type of medication prescribed, the client's stress level, and weight change don't contribute to this condition.

The school nurse notes a 6-year-old running across the playground with friends. The child stops in mid-stride, freezing for a few seconds. Then the child resumes his progress across the playground. The school nurse suspects what in this child? A. A partial seizure B. A complex seizure C. A tonic-clonic seizure D. An absence seizure

D. Absence seizures, formerly referred to as petit mal seizures, are more common in children. They are characterized by a brief loss of consciousness, during which physical activity ceases. The person stares blankly; the eyelids flutter; the lips move; and slight movement of the head, arms, and legs occurs. These seizures typically last for a few seconds, and the person seldom falls to the ground. Because of their brief duration and relative lack of prominent movements, these seizures often go unnoticed. People with absence seizures can have them many times a day. Partial, or focal, seizures begin in a specific area of the cerebral cortex. A generalized seizure involves the whole brain.

The nurse assesses a client in the postictal phase (recovery phase). Which of these actions will the nurse prioritize during the postictal phase of a seizure? A) Assess level of lethargy B) Place a pillow under the head C) Reorient the client to surroundings D) Perform a respiratory assessment

D. The length of the postictal phase (recovery phase) of a seizure is dependent on the type of seizure. It can last anywhere from minutes to days. During this phase, the client may feel sore, confused, sleepy, weak, and even experience feelings of sadness. During the postictal state, it is important to keep the client safe from injury until this phase resolves. Often before this state, the client may have respiratory depression or may have aspirated. Respiratory assessment will be necessary following a seizure.

The nursing student describes the seizure observed as stiffening then jerking all over. The nurse correctly identifies this as which type of seizure? A) Clonic B) Absence C) Atonic D) Tonic-Clonic

D. There are different seizure types. Some seizures impair consciousness such as generalized seizures or complex partial seizures while others do not as in simple partial seizures. Some seizures are brief and can appear to be daydreaming, such as in absence seizures. If the tone is affected the word tonic is used. Atonic is the loss of tone, whereas, tonic is the increase of tone, meaning rigid. Clonic is jerking and may be part of the body or all of the body.