Chronic Neurologic Disorders
Which diet is used to control seizures in some patients? Multiple choice question A diet with low fats and low carbohydrates A diet with low fats and high carbohydrates A diet with high fats and low carbohydrates A diet with high fats and high carbohydrates
A diet with high fats and low carbohydrates The ketogenic diet is used to control seizures in some patients with epilepsy. It contains high fats and low carbohydrates. A diet with low fats and low carbohydrates is not considered a ketogenic diet. A ketogenic diet also does not contain low fats and high carbohydrates. Similarly, a diet with high fats and high carbohydrates is not a ketogenic diet.
A patient with a history of epilepsy experienced gingival enlargement. Which drug may be causing it? Multiple choice question Phenytoin Gabapentin Clonazepam Valproic acid
Phenytoin Phenytoin, gabapentin, clonazepam, valproic acid, and carbamazepine are the drugs used in treating epilepsy. Gingival enlargement is a common side effect of phenytoin; therefore, a patient with epilepsy who is using phenytoin may experience gingival enlargement. Gabapentin, clonazepam, and valproic acid do not cause gingival enlargement.
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. Multiple selection question Hirsutism Neuropathy Weight gain Memory loss Gingival hyperplasia
Hirsutism Gingival hyperplasia Gingival hyperplasia and hirsutism are the most common side effects of phenytoin. Good dental hygiene, including regular tooth brushing and flossing, can limit gingival hyperplasia. The drug is not associated with neuropathy, memory loss, or weight gain.
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. Multiple selection question "Seizures can be caused by a decrease in oxygen levels." "Seizures can be caused by an increase in pH of the blood." "Seizures can be caused by a decrease in pH of the blood." "Seizures can be caused by a decrease in blood glucose levels." "Seizures can be caused by an increase in blood glucose levels."
"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." Seizures are caused by metabolic disturbances such as acidosis and can occur due to a decrease in the blood pH. Hypoxia means that oxygen levels are decreased. Hypoxia is also a metabolic disturbance; therefore, hypoxia can lead to seizures. A decrease in blood glucose levels is known as hypoglycemia. Therefore acidosis, hypoxia, and hypoglycemia are the metabolic disturbances that cause seizures. Alkalosis, in which there is an increase in pH, is not associated with seizures. Hyperglycemia, which is an increase in blood glucose levels, is also not associated with seizures.
A patient's caregiver asks the nurse how the patient could have developed a tonic-clonic seizure, having no prior history of epilepsy. What would be the nurse's best responses about the precipitating intracranial causes of the tonic-clonic seizure? Select all that apply. Multiple selection question "Stroke is an intracranial cause of tonic-clonic seizure." "Septicemia is an intracranial cause of tonic-clonic seizure." "Brain tumor is an intracranial cause of tonic-clonic seizure." "Hypertensive crisis is an intracranial cause of tonic-clonic seizure." "Systemic lupus erythematosus is an intracranial cause of tonic-clonic seizure."
"Stroke is an intracranial cause of tonic-clonic seizure." "Brain tumor is an intracranial cause of tonic-clonic seizure." "Hypertensive crisis is an intracranial cause of tonic-clonic seizure." Strokes, brain tumors, and hypertensive crises are considered intracranial events that may precipitate tonic-clonic seizures. Septicemia is an infectious process that can precipitate a tonic-clonic seizure. Systemic lupus erythematosus is a metabolic disorder that can precipitate a tonic-clonic seizure.
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? Multiple choice question "New treatments come out every year, so don't give up." "Tell me about what you would like to do and how the seizures affect you." "You are young and can still heal from the injury. It has only been a few months." "With medications and your health care provider's assistance, I am sure you will be able to achieve your life goals."
"Tell me about what you would like to do and how the seizures affect you." Asking the patient what he or she would like to do and how seizures affect him or her is correct because it addresses the patient's concerns. Telling the patient he or she will achieve his or her life goals, that the patient will still heal because he or she is young, and that new treatments are available are not correct statements to make because they do not address the patient's concern over losing control of his or her life.
A patient with epilepsy who has been taking oral gabapentin was admitted to the emergency department in an unconscious state. The patient is experiencing seizures that are reoccurring in rapid succession. Which treatment option would be beneficial in alleviating the symptoms of the patient? Multiple choice question Administer saline intravenously Administer dextrose intravenously Administer diazepam intravenously Administer gabapentin intravenously
Administer diazepam intravenously Seizures that reoccur in rapid succession without the patient regaining consciousness are a characteristic feature of status epilepticus. It is a serious complication of epilepsy and occurs with any type of seizure. The most commonly used drug to treat status epilepticus is diazepam. Saline is administered to patients with severe dehydration and electrolyte imbalance. Dextrose is given if the patient has seizures due to hypoglycemia. Gabapentin is given to treat generalized seizures.
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? Multiple choice question Clonic seizure Atonic seizure Focal seizure Absence seizure
Clonic seizure Losing consciousness and falling to the ground, followed by jerky movements of the left leg, indicate a clonic seizure. An atonic seizure is characterized by tonic episode or a paroxysmal loss of muscle tone and begins suddenly with the person falling to the ground. Consciousness usually returns by the time the person hits the ground, and normal activity can be resumed immediately. In focal seizures, the person may or may not lose consciousness and experience unusual feelings and sensations. An absence seizure is characterized by brief staring spells.
A bipolar patient is experiencing a major depressive episode. What factors may be contributing to the depressive episode? Select all that apply. Multiple selection question Low-fat diet Darkened room Physical activity Chronic disease Ineffective coping Antiseizure medications
Darkened room Chronic disease Ineffective coping 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.
The nurse is reviewing the data of a pediatric patient who is admitted in the hospital. Which findings indicate that the patient is suffering from typical absence seizures? Select all that apply. Birth injury Daydreaming Hyperventilation Loss of consciousness Electroencephalogram (EEG) results
Daydreaming Hyperventilation Electroencephalogram (EEG) results Daydreaming is seen in patients with typical absence seizures. Hyperventilation is a precipitating factor for a typical absence seizure. Electroencephalogram (EEG) results demonstrate a 3-Hz spike-and-wave pattern and are the characteristic feature of a typical absence seizure. Tonic-clonic seizures occur in children in whom birth injury is one of the primary causes of seizures. Loss of consciousness is seen in typical and atypical absence seizures with different durations.
What does the nurse recognize is the highest priority intervention for a patient experiencing status epilepticus? Multiple choice question Diazepam IV Phenytoin IV Vecuronium IV Lactated Ringer's IV
Diazepam IV Diazepam given in an IV push is one of the drugs of choice for a patient experiencing status epilepticus. It is a rapid-acting benzodiazepine, but its action is of short duration and so the drug must be followed with a longer-acting anticonvulsant medication. Vecuronium is a paralyzing agent and is not used to treat status epilepticus. Phenytoin is a long-acting anticonvulsant medication commonly administered after a rapid-acting benzodiazepine (such as diazepam) to help stop a seizure and prevent further seizures. A patient experiencing extended episodes of status epilepticus may be at risk for dehydration, but Lactated Ringer's IV fluids are not considered an immediate intervention.
A client has been receiving scheduled doses of topiramate and is now difficult to arouse. What signs of topiramate toxicity should the nurse report immediately? Multiple choice question Palpitations Hypotension Seizure activity Difficult to arouse
Difficult to arouse Decreased alertness is a sign of topiramate toxicity. The nurse should check for other signs of toxicity, which include neurologic changes such as diplopia, ataxia, confusion, dizziness, and slurred speech. A suboptimal level of topiramate, not a toxic level, would result in seizure activity. Hypotension and palpitations are not assessment findings indicative of antiepileptic medication toxicity.
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? Multiple choice question Notify the health care provider about unusual hair growth. Practice good dental hygiene to control gingival hyperplasia. Maintain a healthy lifestyle with regular exercise and nutritious diet. Do not stop the drug abruptly without consulting the health care provider.
Do not stop the drug abruptly without consulting the health care provider. Phenytoin is an antiseizure drug. Abrupt withdrawal of the drug after long-term use may precipitate seizures; therefore, the patient should not stop the drug without consulting the health care provider. Unusual hair growth and gingival hyperplasia are side effects of antiseizure drugs and are not relevant in preventing precipitation of seizures. Maintaining a healthy lifestyle is a general measure to keep healthy and may not contribute to prevention of precipitation of seizures.
What instructions should the nurse give to a patient being treated with carbamazepine for seizures? Select all that apply. Multiple selection question Do not stop using the drug abruptly. Do not take the drug with grapefruit juice. Notify the health care provider about any vision problems. Ensure adequate fluid intake. Wear protective clothing while exposed to sunlight. Take the medicine along with food. Notify the health care provider if flu-like symptoms occur.
Do not stop using the drug abruptly. Do not take the drug with grapefruit juice. 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.
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? Multiple choice question Do not take this medication with grapefruit. This medication is given to treat absence and myloclonic seizures. Don't be concerned if any visual disturbances occur while taking this medication. The goal of this medication is to cure your condition and prevent any more seizures.
Do not take this medication with grapefruit. Grapefruit inhibits the activity of the gastrointestinal enzyme that breaks down this medication so that more of the drug is in the body, and sometimes dangerously high amounts can enter the bloodstream. Carbamazepine is given to treat generalized tonic-clonic and partial seizures. Patients are instructed to report any type of visual abnormalities. Antiseizure drugs do not cure the condition but help to prevent seizures with a minimum of side effects.
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. Multiple selection question Ease the patient to the floor. Loosen constrictive clothes. Restrain the patient to a bed. Protect the patient from any injury. Bring the patient to the hospital immediately.
Ease the patient to the floor. Loosen constrictive clothes. Protect the patient from any injury During an acute seizure, the most important thing is to ease the patient to the floor, if seated, and loosen constrictive clothing. The patient should be protected from any potential injury. The chances of injury are higher if the patient is restrained. It is not necessary to bring the patient to the hospital immediately. Once the seizures have stopped and the patient becomes stable, then the patient can be brought to the hospital.
A patient is experiencing generalized tonic-clonic seizures due to hypoxia. What should be the immediate nursing interventions provided to the patient? Select all that apply. Multiple selection question Administer dextrose Ensure patent airway Administer phenytoin Remove restrictive clothes Force the airway between clenched teeth
Ensure patent airway Remove restrictive clothes Administer phenytoin Hypoxia is a metabolic disturbance that can cause seizures. In this case, the underlying cause should be treated first to control the seizure. Hypoxia should be managed by ensuring a patent airway and removing tight clothes. Dextrose is administered in patients with hypoglycemia. Phenytoin is administered after treating the underlying cause. The nurse should never force the airway between the patient's clenched teeth.
The nurse is caring for an elderly patient with a brain tumor. The family reports symptoms of headaches, confusion, and altered level of consciousness. Which drugs would be best for this patient? Select all that apply. Multiple selection question Primidone Gabapentin Levetiracetam Oxcarbazepine Carbamazepine
Gabapentin Levetiracetam Oxcarbazepine Brain tumors can cause tonic-clonic seizures. Headaches, confusion, and altered consciousness are the clinical signs of tonic-clonic seizures. Gabapentin, levetiracetam, and oxcarbazepine are the safest drugs for older adults because these drugs have fewer effects on cognitive function when compared to other drugs. Primidone and carbamazepine have potential effects on cognitive function. Therefore these drugs are contraindicated for older adults.
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? Multiple choice question Aura seizures Postictal seizures Generalized seizures Simple partial seizures
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.
Which extracranial disorder can cause seizures? Multiple choice question Migraine Meningitis Brain tumor Hypertension
Hypertension Hypertension is an extracranial disorder that can cause seizures. Migraines fall into the category of intracranial disorders that are not associated with seizures. Brain tumors and meningitis are intracranial disorders that may cause seizures.
The patient with type 1 diabetes mellitus with hypoglycemia is having a seizure. Which medication should the nurse anticipate administering to stop the seizure? Multiple choice question IV diazepam IV phenytoin Oral carbamazepine Intravenous (IV) dextrose solution
Intravenous (IV) dextrose solution This patient's seizure is caused by low blood glucose, so IV dextrose solution should be given first to stop the seizure. IV diazepam, IV phenytoin, and oral carbamazepine would be used to treat seizures from other causes, such as head trauma, drugs, and infections.
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? Multiple choice question Pregnancy Liver failure Hypertension Iron deficiency
Liver failure The nurse should include information about the conditions that cause restless legs syndrome (RLS), and liver failure is not associated with it. The conditions associated with RLS include pregnancy, hypertension, and iron deficiency. Pregnancy and anemia (iron deficiency) can worsen the symptoms.
A patient has been receiving scheduled doses of phenytoin and begins to experience diplopia. For what should the nurse immediately assess the patient? Multiple choice question An aura or focal seizure Nystagmus or confusion Abdominal pain or cramping Irregular pulse or palpitations
Nystagmus or confusion Diplopia is a sign of phenytoin toxicity. The nurse should assess for other signs of toxicity, which include neurologic changes, such as nystagmus, ataxia, confusion, dizziness, or slurred speech. An aura, focal seizure, abdominal pain or cramping, irregular pulse, and palpitations are not associated with phenytoin toxicity.
A patient with restless legs syndrome (RLS) failed to respond to gabapentin, which was prescribed earlier. What would be the drug of choice? Multiple choice question Carbidopa Oxycodone Pramipexole Phenobarbital
Oxycodone A patient with restless legs syndrome (RLS) may have severe symptoms that are not relieved by gabapentin. In such cases, low doses of opioids like oxycodone are prescribed. Carbidopa, a dopamine precursor, is used to increase the amount of dopamine in the brain. This drug may not relieve the severe symptoms of RLS. Pramipexole, a dopamine agonist, is also used to increase the dopamine amount. Like carbidopa, this drug also may not relieve the severe symptoms of RLS. Phenobarbital is not used to treat RLS.
Two patients with seizures arrive at the hospital. Their clinical data are given below. Both were having similar symptoms, but they were given different treatments. What could be the reason for this? Multiple choice question Patient A has elevated liver enzymes. Patient B has elevated liver enzymes. Patient A has elevated blood urea nitrogen. Patient B has elevated blood urea nitrogen.
Patient A has elevated liver enzymes Elevated liver enzymes may decrease the liver's ability to metabolize drugs. Phenytoin, a widely used antiseizure drug, is metabolized by the liver. It is not safe for patient A, who has decreased liver function. Therefore Patient A was prescribed lamotrigine, which may be safer than phenytoin. Patient B was prescribed phenytoin. Hence, patient B would not have elevated liver enzymes. Blood urea nitrogen will not affect the drug metabolism. Therefore patient A and patient B can use any antiseizure drug.
Which patient will be at greater risk of sustaining a head injury according to the data given below? Multiple choice question Patient A - Excessive Jerk/Increased Muscle Tone Patient B Limb Jerkin/Sudden Loss of Muscle Tone Patient C Absent Jerks/Sudden Loss of Muscle Tone Patient D Absent/ Increased Muscle Tone
Patient C Absent Jerks/Sudden Loss of Muscle Tone Patient C, who sustains no jerking and a sudden loss of muscle tone, may have atonic seizures. Because its onset is sudden, patients with atonic seizures are at a greater risk of head injury. Patient A, who experiences excessive jerking of the extremities and increased muscle tone, may have myoclonic seizures. Clonic seizures may be seen in patient B, who experiences a sudden loss of muscle tone, followed by limb jerking. Patient D, who has increased muscle tone and no jerks, may have tonic seizures.
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? Multiple choice question Tiagabine Pregabalin Topiramate Levetiracetam
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.
What is the nursing action of highest priority to be taken with a patient who experiences a generalized tonic-clonic seizure? Multiple choice question Restraining the arms and legs Controlling head movements Protecting the head and extremities Inserting a tongue blade between the teeth
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.
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. Multiple selection question The drug should be changed immediately. Regular tooth brushing can limit hyperplasia. Gingival hyperplasia is not related to phenytoin. Surgical repair of gingival tissue will be required. Regular flossing can control gingival tissue growth.
Regular tooth brushing can limit hyperplasia. Regular flossing can control gingival tissue growth. Gingival hyperplasia is a common side effect of phenytoin. The nurse should instruct the patient to maintain good dental hygiene with regular tooth brushing and flossing. Regular flossing not only helps in maintaining good dental hygiene but also helps control gingival tissue growth. Similarly, regular brushing, besides being generally good for dental health, also helps limit gingival hyperplasia. Mild gingival hyperplasia does not require the drug to be replaced. Surgical intervention would be required only if the gingival hyperplasia were extensive, which is not the case with this patient.
A patient with hypertension reports paresthesia, tingling, and a pins and needles sensation. The patient was prescribed gabapentin. What is the possible diagnosis? Multiple choice question Stroke Epilepsy Status epilepticus Restless legs syndrome (RLS)
Restless legs syndrome (RLS) Hypertension is the etiologic factor of restless legs syndrome (RLS). Paresthesia, tingling, and a pins and needles sensation are clinical signs of RLS. Gabapentin can be used in all the neurologic disorders listed. A patient who sustains a stroke will present with one-sided weakness. This is not a symptom of RLS. Paresthesias, tingling, and a pins and needles sensation are not seen in epilepsy and status epilepticus. A patient with epilepsy may have jerking movements and muscle rigidity. A patient with status epilepticus can experience hypoxia and arrhythmias.
Which characteristic feature is exclusively seen in a complex focal seizure? Multiple choice question Jerking of the limbs Smacking of the lips Loss of consciousness Increased muscle tone
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
Which type of seizure lasts longer than five minutes and occurs in rapid succession without return to consciousness between seizures? Multiple choice question Epilepsy Tonic seizure Absence seizure Status epilepticus
Status epilepticus Status epilepticus is a state of continuous seizure activity or a condition in which seizures reoccur in rapid succession without return to consciousness between seizures. Epilepsy is marked by a continuing predisposition to seizures with neurobiologic, cognitive, psychologic, and social consequences. An absence seizure is characterized by a brief staring spell lasting less than 10 seconds. A tonic seizure involves a sudden increase in tone of the exterior muscles that contribute to sudden stiff movements lasting 20 seconds or less.
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? Multiple choice question Atonic seizure Myoclonic seizure Subclinical seizure Tonic-clonic seizure
Subclinical seizure In subclinical seizures, the sedated patient experiences seizures, but external signs are not visible due to the sedative medication. In atonic seizures, the external signs like paroxysmal loss of muscle tone are visible. In myoclonic seizures, sudden and excessive jerks in the body are observed. In tonic-clonic seizures, the skin feels warm and cyanosis is visible.
Which characteristic of a patient's recent seizure is consistent with a focal seizure? Multiple choice question The patient lost consciousness during the seizure. The seizure involved lip smacking and repetitive movements. The patient fell to the ground and became stiff for 20 seconds. The etiology of the seizure involved both sides of the patient's brain.
The seizure involved lip smacking and repetitive movements. The most common complex focal seizure involves lip smacking and automatisms (repetitive movements that may not be appropriate). Loss of consciousness, bilateral brain involvement, and a tonic phase are associated with generalized seizure activity.
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. Multiple selection question A seizure is associated with loss of postural tone. The child will usually seem confused after a seizure. The seizures are characterized by brief staring spells. The seizures are usually precipitated by flashing lights. The occurrence of seizures usually subsides during adolescence.
The seizures are characterized by brief staring spells. The seizures are usually precipitated by flashing lights. 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 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? Multiple choice question Focal seizure Tonic-clonic seizure Psychogenic seizure Typical absence seizure
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.
