Practice Questions: Seizures & Epilepsy

Complex Parital Seizures

May can cause loss of consciousness or black out for 1 to 3 minutes .The patient might be unaware of the environment. Involuntary behaviors may occur. Partial seizure are more likely to occur in adults and they may be unresponsive to medication. Following this type of seizure, it may be possible for the patient to experience amnesia.

Secondary Seizures

Morst often caused by: Meabolic Disorders, Acute Alcohol Withdrawl, Electrolyte imbalances, high fever, stroke, head trauma, substance abuse, and/or heart disease.

The aide is attempting to put an oral airway in the mouth of a client having a tonic-clonic seizure. Which action should the primary nurse take? 1. Help the aide to insert the oral airway in the mouth 2. Tell the aide to stop trying to insert anything in the mouth 3. Take no action because the aide is handling the situation 4. Notify the charge nurse of the situation immediately

2. Tell the aide to stop trying to insert anything in the mouth

The client is prescribed phenytoin (Dilantin), an anticonvulsant, for a seizure disorder. Which statement indicates the client understands the discharge teaching concerning this medication? 1. "I will brush my teeth after every meal" 2. "I will check my Dilantin level daily" 3. "My urine will turn orange while on Dilantin" 4. "I won't have any seizures while on this medication"

1. "I will brush my teeth after every meal"

The nurse asks the male client with epilepsy if he has auras with his seizures. The client says, "I don't know what you mean. What are auras?" Which statement by the nurse would be the best response? 1. "Some people have a warning that the seizure is about to start" 2. Auras occur when you are physically and psychologically exhausted" 3. "You're concerned that you do not have auras before your seizures?" 4. "Auras usually cause you to be sleepy after you have a seizure"

1. "Some people have a warning that the seizure is about to start"

The occupational health nurse is concerned about preventing occupation-related acquired seizures. Which intervention should the nurse implement? 1. Ensure that helmets are worn in appropriate areas 2. Implement daily exercise programs for the staff 3. Provide healthy foods in the cafeteria 4. Encourage employees to wear safety glasses

1. Ensure that helmets are worn in appropriate areas

The client has been newly diagnosed with epilepsy. Which discharge instructions should be taught to the client? Select all that apply. 1. Keep a record of seizure activity 2. Take tub baths only; do not take showers 3. Avoid over the counter meds 4. Have anticonvulsant medication serum levels checked regularly 5. Do not drive alone; have someone in the car

1. Keep a record of seizure activity 3. Avoid over the counter meds 4. Have anticonvulsant medication serum levels checked regularly

The nurse enters the room as the client is beginning to have a tonic-clonic seizure. What action should the nurse implement first? 1. Note the first thing the client does in the seizure 2. Assess the size of the client's pupils 3. Determine if the client is incontinent of urine or stool 4. Provide the client with privacy during the seizure

1. Notice the first thing the client does in the seizure

Which statement by the female indicates that the client understands factors that may precipitate seizure activity? 1. "It is all right for me to drink coffee for breakfast" 2. "My menstrual cycle will not affect my seizure disorder" 3. I am going to take a class in stress management" 4. "I should wear dark glasses when I am out in the sun"

3. "I am going to take a class in stress management"

The client is admitted to the intensive care department experiencing status epilepticus. Which collaborative intervention should the nurse anticipate? 1. Assess the client's neurological status every hour 2. Monitor the client's heart rhythm via telemetry 3. Administer an anticonvulsant medication by IV push 4. Prepare to administer a glucocorticosteroid orally

3. Administer an anticonvulsant medication by IV push

The nurse educator is presenting an in service on seizures. Which disease process is the leading cause of seizures in the elderly? 1. Alzheimer's disease 2. Parkinson's disease 3. CVA (stroke) 4. Brain atrophy due to aging

3. CVA (stroke)

The client is scheduled for an EEG to help diagnose a seizure disorder. Which preprocedure teaching should the nurse implement? 1. Tell the client to take any routine antiseizure medication prior to the EEG 2. Tell the client not to eat anything for 8 hours prior to the procedure 3. Instruct the client to stay awake for 24 hours prior to the EEG 4. Explain to the client that there will be some discomfort during the procedure

3. Instruct the client to stay awake for 24 hours prior to the EEG

The client who just had a 3 minute seizure has no apparent injuries and is oriented to name, place, and time but is very lethargic and just wants to sleep. Which intervention should the nurse implement? 1. Perform a complete neurological assessment 2. Awaken the client every 30 mins 3. Turn the client to the side and allow the client to sleep 4. Interview the client to find out what caused the seizure

3. Turn the client to the side and allow the client to sleep

The male client is sitting in the chair and his entire body is rigid with his arms and legs contracting and relaxing. The client is not aware of what is going on and is making guttural sounds. Which action should the nurse implement first? 1. Place aside any furniture 2. Place the client on his side 3. Assess the client's vital signs 4. Ease the client to the floor

4. Ease the client to the floor

Epilepsy

A condition in which a person has had two or more seizures. Epilepsy is a chronic condition. It may be caused by abnormal neurotransmitters, especially gamma aminobutyic acid (GABA) or a combination.

Status Epilepticus

A medical emergency of a prolonged seizure lasting more than 5 minutes or repeatedseizures over 30 minutes. Seizures lasting longer than 10 minutes can cause death. Causes: Sudden withdrawl from antieplileptic drugs infections acute ETHO witdrawl Head trauma Cerebral edema metabolic disturbances

Atonic Seizures

A sudden loss in muscle tone which may cause the patient to fall. The patient may expereice confusion following the seizure (posticatal)

A nurse is completing discharge teaching to a client who has seizures and received a vagal nerve stimulator to decrease seizure activity. Which of the following statements should the nurse include in the teaching?

A. "It is safe to use microwaves that are 1200 watts or less." B. "You should avoid the use of CT scans with contrast." C. "You should place a magnet over the implantable device when you feel an aura occurring." D. "It is recommended that you use ultrasound diathermy for pain management." Answer: C

A nurse is reviewing trigger factors that can cause seizures with a client who has a new diagnosis of generalized seizures. Which of the following information should the nurse include in this review? SATA

A. Avoid overwhelming fatigue B. Remove caffeinated products from the diet C. Limit looking at flashing lights D. Perform aerobic exercise E. Limit episodes of hypoventilation F. Use of aerosol hairspray is recommended Answers: ABC

A nurse is providing discharge instructions to a female client who has a prescription for phenytoin. Which of the following information should the nurse include?

A. Consider taking oral contraceptives when on this medication B. Watch for receding gums when taking this medication C. Take the medication at the same time every day D. Provide a urine sample to determine therapeutic levels of the medication Answer: C

A nurse is caring for a client who just experienced a generalized seizure. Which of the following actions should the nurse perform first?

A. Keep the client in a side-lying position B. Document the duration of the seizure. C. Reorient the client to the environment D. Provide client hygiene Answer: A

A nurse is assessing a client who has a seizure disorder. The client reports he thinks he is about to have a seizure. Which of the following actions should the nurse implement. SATA

A. Provide privacy B. Ease the client to the floor if standing C. Move furniture away from the client D. Loosen the client's clothing E. Protect the client's head with padding F. Restrain the client Answers: ABCDE

Idiopathic Seizures

AKA unlcassified seizures occur for no known reason and do not fit into a generalized or partial category.

Seizure Pathophsiology

It is a sudeen exessive uncontrolled electrical discharge of neurons with in the brain. It can affect level of consciousness (LOC), motor sensory ability and behavior.

Clonic Seizures

Last several minutes andd consisting of contraction and relaxation of muscles.

Tonic Seizures

An abrupt increase in muscle tone, loss of consciousness and autonomic changes that last 30 seconds to several mintues.

Partial Seizures

Are focal or local that begin on one side of the brain, There are classified as either complex or simple partial seizures.

A nurse is planning care for a client who is experiencing status epilepticus. What concepts should the nurse include in the plan of care? Nursing Interventions: Describe five actions the nurse should plan to take

Maintain a patent airway Perform ECG monitoring Review ABG results Establish IV access Provide oxygen Monitor pulse oximetry Administer lorazepam or diazepam Administer phenytoin or fosphenytoin

Common drugs for seizures (AED's)

Carbamazepine(Tegretol, Tegretol-XR,Carbatrol) Clonazepam(Klonopin) Diazepam (Valium, lorazepam (Avtivan) Divalproex(valproic acid) Ethosuximide(for abscence only) Gabapentin (Neurotin) Lamictal Levetirgine (keppra) Phenytoin(Dilantin)

Diagnostic Tests

EEG CT PET Labs can rule out metabolic disorders

What are the two major classifications of seizures

Generalized and partial

Idiopathic Epilepsy

Not associated with any indentifable brain lesion or other specific cause. Genetics sometimes plays a role in its development.

Nursing Interventions for Patients having a seizure

Protect the patient. Lay them on their side Do not place anything in their mouth Keep Airway clear Loosen any restrictive clothing Maintain airway and suction if needed Do not restrain movements;guide if necessary Record time and length of seizure When the seizure is over: Perform vital signs Neuro checks Keep Pt on their side Allow for Pt to rest Document

A nurse is planning care for a client who is experiencing status epilepticus. What concepts should the nurse include in the plan of care? Related Content: Define the condition

Status epilepticus is repeated seizure activity within a 30-min time frame or a single prolonged seizure lasting more than 5 minutes

A nurse is planning care for a client who is experiencing status epilepticus. What concepts should the nurse include in the plan of care? Underlying Principals: Describe four possible causes

Substance withdrawal Withdrawal form antiepileptic medication Infection Head injury Cerebral edema Metabolic disturbances

Assessment

Take a family history Physical assessment Ask about auras Ask about ALL MEDS :Prescribed, herbal, vitamins etc. Ask about other medical conditions

Simple Partial Seizures

The person remains consciousness through the event. Sometime partients report an aura before the seizure occurs and can expereince deja vu or the perception of a foul smell. autonomic changes include a change in heart rate, skin flushing, and epigastric discomforts.

Absence

The types is more common in children and commonly misdiagnosed with ADHD. It consists of staring blankly

Myocolonic Seizures

These seizures casue brief herking or stiffining of the extremeties that may occure singly or in groups. They typically last only a few seconds and can be asymmetric or symmetric.

Tonic -clonic phase

These types of seizues last 2-5 minutes and start with the tonic phase that causes stiffining and rigidity of the muscles and immediate loss of consciousness. The clonic or is the rhythmic and jerking of all extremities. The PT might bite their tounge and become incontinent.

Patient Teaching

Wear a medical alert braclet Inform of drug, dose, and times to take Inform of actions to take if side effects occur Inform them of what to do in case they miss a dose Inform them of follow up labs needed Check with PCP before taking OTC meds Teach a family member or friend about their seizures and how to help Avoid excessive alcohol Connect with specialist in the field

A 31-year-old woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate? a. "MS symptoms may be worse after the pregnancy." b. "Women with MS frequently have premature labor." c. "MS is associated with an increased risk for congenital defects." d. "Symptoms of MS are likely to become worse during pregnancy."

a. "MS symptoms may be worse after the pregnancy."

A 64-year-old patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care? a. Assist with active range of motion (ROM). b. Observe for agitation and paranoia. c. Give muscle relaxants as needed to reduce spasms. d. Use simple words and phrases to explain procedures.

a. Assist with active range of motion (ROM).

A 46-year-old patient tells the nurse about using acetaminophen (Tylenol) several times every day for recurrent bilateral headaches. Which action will the nurse plan to take first? a. Discuss the need to stop taking the acetaminophen. b. Suggest the use of biofeedback for headache control. c. Describe the use of botulism toxin (Botox) for headaches. d. Teach the patient about magnetic resonance imaging (MRI).

a. Discuss the need to stop taking the acetaminophen.

A patient reports feeling numbness and tingling of the left arm before experiencing a tonic-clonic seizure. The nurse determines that this history is consistent with what type of seizure? a. Focal b. Atonic c. Absence d. Myoclonic

a. Focal

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. Inspect the oral mucosa. b. Listen to the lung sounds. c. Auscultate the bowel tones. d. Check pupil reaction to light.

a. Inspect the oral mucosa.

After change-of-shift report, which patient should the nurse assess first? a. Patient with myasthenia gravis who is reporting increased muscle weakness b. Patient with a bilateral headache described as "like a band around my head" c. Patient with seizures who is scheduled to receive a dose of phenytoin (Dilantin) d. Patient with Parkinson's disease who has developed cogwheel rigidity of the arms

a. Patient with myasthenia gravis who is reporting increased muscle weakness

A 27-year-old 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 that apply)? a. Side-rail pads b. Tongue blade c. Oxygen mask d. Suction tubing e. Urinary catheter f. Nasogastric tube

a. Side-rail pads c. Oxygen mask d. Suction tubing

A hospitalized 31-year-old patient with a history of cluster headache awakens during the night with a severe stabbing headache. Which action should the nurse take first? a. Start the ordered PRN oxygen at 6 L/min. b. Put a moist hot pack on the patient's neck. c. Give the ordered PRN acetaminophen (Tylenol). d. Notify the patient's health care provider immediately.

a. Start the ordered PRN oxygen at 6 L/min.

A patient with Parkinson's disease is admitted to the hospital for treatment of pneumonia. Which nursing interventions will be included in the plan of care (select all that apply)? a. Use an elevated toilet seat. b. Cut patient's food into small pieces. c. Provide high-protein foods at each meal. d. Place an armchair at the patient's bedside. e. Observe for sudden exacerbation of symptoms.

a. Use an elevated toilet seat. b. Cut patient's food into small pieces. d. Place an armchair at the patient's bedside.

The nurse observes a patient ambulating in the hospital hall when the patient's arms and legs suddenly jerk and the patient falls to the floor. The nurse will first a. assess the patient for a possible head injury. b. give the scheduled dose of divalproex (Depakote). c. document the timing and description of the seizure. d. notify the patient's health care provider about the seizure.

a. assess the patient for a possible head injury.

The nurse advises a patient with myasthenia gravis (MG) to a. perform physically demanding activities early in the day. b. anticipate the need for weekly plasmapheresis treatments. c. do frequent weight-bearing exercise to prevent muscle atrophy. d. protect the extremities from injury due to poor sensory perception.

a. perform physically demanding activities early in the day.

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. "Epilepsy usually can be well controlled with medicatons."

A hospitalized patient complains of a bilateral headache, 4/10 on the pain scale, that radiates from the base of the skull. Which prescribed PRN medications should the nurse administer initially? a. Lorazepam (Ativan) b. Acetaminophen (Tylenol) c. Morphine sulfate (Roxanol) d. Butalbital and aspirin (Fiorinal)

b. Acetaminophen (Tylenol)

Following a thymectomy, a 62-year-old male patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first? a. Auscultate the patient's bowel sounds. b. Notify the patient's health care provider. c. Administer the prescribed PRN antiemetic drug. d. Give the scheduled dose of prednisone (Deltasone).

b. Notify the patient's health care provider.

The home health registered nurse (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 licensed practical/vocational nurse (LPN/LVN)? a. Make referrals to appropriate community agencies. b. Place medications in the home medication organizer. c. Teach the patient and family how to manage seizures. d. Assess for use of medications that may precipitate seizures.

b. Place medications in the home medication organizer.

Which intervention will the nurse include in the plan of care for a patient with primary restless legs syndrome (RLS) who is having difficulty sleeping? a. Teach about the use of antihistamines to improve sleep. b. Suggest that the patient exercise regularly during the day. c. Make a referral to a massage therapist for deep massage of the legs. d. Assure the patient that the problem is transient and likely to resolve.

b. Suggest that the patient exercise regularly during the day.

A 73-year-old patient with Parkinson's disease has a nursing diagnosis of impaired physical mobility related to bradykinesia. Which action will the nurse include in the plan of care? a. Instruct the patient in activities that can be done while lying or sitting. b. Suggest that the patient rock from side to side to initiate leg movement. c. Have the patient take small steps in a straight line directly in front of the feet. d. Teach the patient to keep the feet in contact with the floor and slide them forward.

b. Suggest that the patient rock from side to side to initiate leg movement.

Which action will the nurse plan to take for a 40-year-old patient with multiple sclerosis (MS) who has urinary retention caused by a flaccid bladder? a. Decrease the patient's evening fluid intake. b. Teach the patient how to use the Credé method. c. Suggest the use of adult incontinence briefs for nighttime only. d. Assist the patient to the commode every 2 hours during the day.

b. Teach the patient how to use the Credé method.

The health care provider is considering the use of sumatriptan (Imitrex) for a 54-year-old male patient with migraine headaches. Which information obtained by the nurse is most important to report to the health care provider? a. The patient drinks 1 to 2 cups of coffee daily. b. The patient had a recent acute myocardial infarction. c. The patient has had migraine headaches for 30 years. d. The patient has taken topiramate (Topamax) for 2 months.

b. The patient had a recent acute myocardial infarction.

When a 74-year-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rolling-type tremor, the nurse will anticipate teaching the patient about a. oral corticosteroids. b. antiparkinsonian drugs. c. magnetic resonance imaging (MRI). d. electroencephalogram (EEG) testing.

b. antiparkinsonian drugs.

When obtaining a health history and physical assessment for a 36-year-old female patient with possible multiple sclerosis (MS), the nurse should a. assess for the presence of chest pain. b. inquire about urinary tract problems. c. inspect the skin for rashes or discoloration. d. ask the patient about any increase in libido.

b. inquire about urinary tract problems.

The nurse will assess a 67-year-old patient who is experiencing a cluster headache for a. nuchal rigidity. b. unilateral ptosis. c. projectile vomiting. d. throbbing, bilateral facial pain.

b. unilateral ptosis.

The nurse determines that teaching about management of migraine headaches has been effective when the patient says which of the following? a. "I can take the (Topamax) as soon as a headache starts." b. "A glass of wine might help me relax and prevent a headache." c. "I will lie down someplace dark and quiet when the headaches begin." d. "I should avoid taking aspirin and sumatriptan (Imitrex) at the same time.

c. "I will lie down someplace dark and quiet when the headaches begin."

A 22-year-old patient seen at the health clinic with a severe migraine headache tells the nurse about having other similar headaches recently. Which initial action should the nurse take? a. Teach about the use of triptan drugs. b. Refer the patient for stress counseling. c. Ask the patient to keep a headache diary. d. Suggest the use of muscle-relaxation techniques.

c. Ask the patient to keep a headache diary.

A 49-year-old patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information will the nurse include in patient teaching? a. Recommendation to drink at least 4 L of fluid daily b. Need to avoid driving or operating heavy machinery c. How to draw up and administer injections of the medication d. Use of contraceptive methods other than oral contraceptives

c. How to draw up and administer injections of the medication

Which assessment is most important for the nurse to make regarding a patient with myasthenia gravis? a. Pupil size b. Grip strength c. Respiratory effort d. Level of consciousness

c. Respiratory effort

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. Time and observe and record the details of the seizure and postictal state.

A 40-year-old patient is diagnosed with early Huntington's disease (HD). When teaching the patient, spouse, and children about this disorder, the nurse will provide information about the a. use of levodopa-carbidopa (Sinemet) to help reduce HD symptoms. b. prophylactic antibiotics to decrease the risk for aspiration pneumonia. c. option of genetic testing for the patient's children to determine their own HD risks. d. lifestyle changes of improved nutrition and exercise that delay disease progression.

c. option of genetic testing for the patient's children to determine their own HD risks.

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

d. Administer lorazepam (Ativan) 4 mg IV.

Which medication taken by a patient with restless legs syndrome should the nurse discuss with the patient? a. Multivitamin (Stresstabs) b. Acetaminophen (Tylenol) c. Ibuprofen (Motrin, Advil) d. Diphenhydramine (Benadryl)

d. Diphenhydramine (Benadryl)

Which nursing diagnosis is of highest priority for a patient with Parkinson's disease who is unable to move the facial muscles? a. Activity intolerance b. Self-care deficit: toileting c. Ineffective self-health management d. Imbalanced nutrition: less than body requirements

d. Imbalanced nutrition: less than body requirements

Which information about a 72-year-old 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 generalized tonic-clonic seizures. b. Patient experiences an aura before seizures. c. Patient's most recent blood pressure is 156/92 mm Hg. d. Patient has minor elevations in the liver function tests.

d. Patient has minor elevations in the liver function tests.

Which information about a 60-year-old patient with MS indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? a. The patient has relapsing-remitting MS. b. The patient walks a mile a day for exercise. c. The patient complains of pain with neck flexion. d. The patient has an increased serum creatinine level.

d. The patient has an increased serum creatinine level.

A 62-year-old patient who has Parkinson's disease is taking bromocriptine (Parlodel). Which information obtained by the nurse may indicate a need for a decrease in the dose? a. The patient has a chronic dry cough. b. The patient has four loose stools in a day. c. The patient develops a deep vein thrombosis. d. The patient's blood pressure is 92/52 mm Hg.

d. The patient's blood pressure is 92/52 mm Hg.

A 76-year-old patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease. Which information is most important for the nurse to report to the health care provider? a. Shuffling gait b. Tremor at rest c. Cogwheel rigidity of limbs d. Uncontrolled head movement

d. Uncontrolled head movement

What is the main difference between Partial and Generalized seizures in the ways of which they effect the brain and body?

generalized seizures effect both cerebral hemispheres whereas partial seizures effect one side of the brain are are focal.