Seizure Practice Questions (Test #2, Fall 2020)

It is the night before a client is to have a computed tomography (CT) scan of the head without contrast. The nurse should tell the client: 1."You must shampoo your hair tonight to remove all oil and dirt." 2."You may drink fluids until midnight, but after that drink nothing until the scan is completed." 3."You will have some hair shaved to attach the small electrode to your scalp." 4."You will need to hold your head very still during the examination."

4. The client will be asked to hold the head very still during the examination, which lasts about 30 to 60 minutes. In some instances, food and fluids may be withheld for 4 to 6 hours before the procedure if a contrast medium is used because the radiopaque substance sometimes causes nausea. There is no special preparation for a CT scan, so a shampoo the night before is not required. The client may drink fluids until 4 hours before the scan is scheduled. Electrodes are not used for a CT scan, nor is the head shaved.

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. Head injury is one of the main reasons for epilepsy that can be prevented through occupational safety precautions and highway safety programs. 2. Sedentary lifestyle is not a cause of epilepsy. 3. Dietary concerns are not a cause of epilepsy. 4. Safety glasses will help prevent eye injuries, but such injuries are not a cause of epilepsy. TEST TAKING HINT: The nurse must be aware of risk factors that cause diseases. If the test taker does not know the correct answer, thinking about which body system the question is asking about may help rule out or rule in some of the answer options. Only options "1" and "4" have anything to do with the head, and only helmets on the head are connected with the neurological system.

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 medications. 4. Have anticonvulsant medication serum levels checked regularly. 5. Do not drive alone; have someone in the car.

1. Keeping a seizure and medication chart will be helpful when keeping follow-up appointments with the health-care provider and in identifying activities that may trigger a seizure. 2. The client should take showers, rather than tub baths, to avoid drowning if a seizure occurs. The nurse should also instruct the client never to swim alone. 3. Over-the-counter medications may contain ingredients that will interact with antiseizure medications or, in some cases, as with use of stimulants, possibly cause a seizure. 4. Most of the anticonvulsant medications have therapeutic serum levels that should be maintained, and regular checks of the serum levels help to ensure the correct level. 5. A newly diagnosed client would have just been put on medication, which may cause drowsiness. Therefore, the client should avoid activities that require alertness and coordination and should not be driving at all until after the effects of the medication have been evaluated. TEST TAKING HINT: The test taker must select all interventions that are appropriate for the question. A key word is the adverb "newly."

The unlicensed assistive personnel (UAP) 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 UAP to insert the oral airway in the mouth. 2. Tell the UAP to stop trying to insert anything in the mouth. 3. Take no action because the UAP is handling the situation. 4. Notify the charge nurse of the situation immediately.

1. Once the seizure has started, no one should attempt to put anything in the client's mouth. 2. The nurse should tell the UAP to stop trying to insert anything in the mouth of the client experiencing a seizure. Broken teeth and injury to the lips and tongue may result from trying to place anything in the clenched jaws of a client having a tonic-clonic seizure. 3. The primary nurse is responsible for the action of the UAP and should stop the UAP from doing anything potentially dangerous to the client. No one should attempt to pry open the jaws that are clenched in a spasm to insert anything. 4. The primary nurse must correct the action of the UAP immediately, prior to any injury occurring to the client and before notifying the charge nurse. TEST TAKING HINT: The nurse is responsible for the actions of the unlicensed assistive personnel and must correct the behavior immediately

The client who just had a three (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 minutes. 3. Turn the client to the side and allow the client to sleep. 4. Interview the client to find out what caused the seizure

1. The client is exhausted from the seizure and should be allowed to sleep. 2. Awakening the client every 30 minutes possibly could induce another seizure as a result of sleep deprivation. 3. During the postictal (after-seizure) phase, the client is very tired and should be allowed to rest quietly; placing the client on the side will help prevent aspiration and maintain a patent airway. 4. The client must rest, and asking questions about the seizure will keep the client awake, which may induce another seizure as a result of sleep deprivation. TEST TAKING HINT: Options "1," "2," and "4" all have something to do with keeping the client awake. This might lead the test taker to choose the option that is different from the other three.

Which statement by the female client 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."

1. The client with a seizure disorder should avoid stimulants, such as caffeine. 2. The onset of menstruation can cause seizure activity in the female client. 3. Tension states, such as anxiety and frustration, induce seizures in some clients, so stress management may be helpful in preventing seizures. 4. Bright flickering lights, television viewing, and some other photic (light) stimulation may cause seizures but sunlight does not. Wearing dark glasses or covering one eye during potential seizure-stimulating activities may help prevent seizures. TEST TAKING HINT: Caffeine is a stimulant and its use is not recommended in many disease processes. Menstrual cycle changes are known to affect seizure disorders. Therefore, options "1" and "2" can be eliminated, as can option "4"

A 21-year-old female client takes clonazepam. What should the nurse ask this client about? Select all that apply. 1.Seizure activity. 2.Pregnancy status. 3.Alcohol use. 4.Cigarette smoking. 5.Intake of caffeine and sugary drinks.

1, 2, 3. The nurse should assess the number and type of seizures the client has experienced since starting clonazepam monotherapy for seizure control. The nurse should also determine if the client might be pregnant because clonazepam crosses the placental barrier. The nurse should also ask about the client's use of alcohol because alcohol potentiates the action of clonazepam. Although the nurse may want to check on the client's diet or use of cigarettes for health maintenance and promotion, such information is not specifically related to clonazepam therapy.

A 22-year-old who hit his head while playing football has a tonic-clonic seizure. Upon awakening from the seizure, the client asks the nurse, "What caused me to have a seizure? I've never had one before." Which cause should the nurse include in the response as a primary cause of tonic-clonic seizures in adults older than age 20? 1.Head trauma. 2.Electrolyte imbalance. 3.Congenital defect. 4.Epilepsy.

1. Trauma is one of the primary causes of brain damage and seizure activity in adults. Other common causes of seizure activity in adults include neoplasms, withdrawal from drugs and alcohol, and vascular disease. Given the history of head injury, electrolyte imbalance is not the cause of the seizure. There is no information to indicate that the seizure is related to a congenital defect. Epilepsy is usually diagnosed in younger clients.

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 (PD). 3. Cerebral Vascular Accident (CVA, stroke). 4. Brain atrophy due to aging.

1. Alzheimer's disease does not lead to seizures. 2. Parkinson's disease does not cause seizures. 3. A CVA (stroke) is the leading cause of seizures in the elderly; increased intracranial pressure associated with the stroke can lead to seizures. 4. Brain atrophy is not associated with seizures. TEST TAKING HINT: All four answer options are associated with the brain, neurological system, and aging. However, options "1," "2," and "4" usually occur over time, with the condition gradually getting worse, and thus can be eliminated as a cause of seizures, which are usually sudden.

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. An aura is a visual, an auditory, or an olfactory occurrence that takes place prior to a seizure and warns the client a seizure is about to occur. The aura often allows time for the client to lie down on the floor or find a safe place to have the seizure. 2. An aura is not dependent on the client being physically or psychologically exhausted. 3. This is a therapeutic response, reflecting feelings, which is not an appropriate response when answering a client's question. 4. Sleepiness after a seizure is very common, but the aura does not itself cause the sleepiness. TEST TAKING HINT: If the stem of the question has the client asking a question, then the nurse needs to give factual information, and option "3," a therapeutic response, would not be appropriate. Neither would option "2" or "4" because these options are worded in such a way as to imply incorrect information

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. Push aside any furniture. 2. Place the client on his side. 3. Assess the client's vital signs. 4. Ease the client to the floor.

1. The nurse needs to protect the client from injury. Moving furniture would help ensure that the client would not hit something accidentally, but this is not done first. 2. This is done to help keep the airway patent, but it is not the first intervention in this specific situation. 3. Assessment is important but when the client is having a seizure, the nurse should not touch him 4. The client should not remain in the chair during a seizure. He should be brought safely to the floor so that he will have room to move the extremities. TEST TAKING HINT: All of the answer options are possible interventions, so the test taker should go back to the stem of the question and note that the question asks which intervention has priority. "In the chair" is the key to this question because the nurse should always think about safety, and a

When preparing to teach a client about phenytoin sodium (Dilantin) therapy, the nurse should urge the client not to stop the drug suddenly because: 1.Physical dependency on the drug develops over time. 2.Status epilepticus may develop. 3.A hypoglycemic reaction develops. 4.Heart block is likely to develop.

2. Anticonvulsant drug therapy should never be stopped suddenly; doing so can lead to life-threatening status epilepticus. Phenytoin sodium does not carry a risk of physical dependency or lead to hypoglycemia. Phenytoin has antiarrhythmic properties, and discontinuation does not cause heart block.

The nurse sees a client walking in the hallway who begins to have a seizure. The nurse should do which of the following in priority order? 1. Maintain a patent airway. 2. Record the seizure activity observed. 3. Ease the client to the floor. 4. Obtain vital signs.

3,1,4,2 Ease the client to the floor. Maintain a patent airway. Obtain vital signs. Record the seizure activity observed. To protect the client from falling, the nurse first should ease the client to the floor. It is important to protect the head and maintain a patent airway since altered breathing and excessive salivation can occur. The assessment of the postictal period should include level of consciousness and vital signs. The nurse should record details of the seizure once the client is stable. The events preceding the seizure, timing with descriptions of each phase, body parts affected and sequence of involvement, and autonomic signs should be recorded.

Which clinical manifestation is a typical reaction to long-term phenytoin sodium (Dilantin) therapy? 1.Weight gain. 2.Insomnia. 3.Excessive growth of gum tissue. 4.Deteriorating eyesight.

3. A common adverse effect of long-term phenytoin therapy is an overgrowth of gingival tissues. Problems may be minimized with good oral hygiene, but in some cases, overgrown tissues must be removed surgically. Phenytoin does not cause weight gain, insomnia, or deteriorating eyesight.

Which intervention is most effective in minimizing the risk of seizure activity in a client who is undergoing diagnostic studies after having experienced several episodes of seizures? 1.Maintain the client on bed rest. 2.Administer butabarbital sodium 30 mg PO, three times per day. 3.Close the door to the room to minimize stimulation. 4.Administer carbamazepine 200 mg PO, twice per day.

4. Carbamazepine is an anticonvulsant that helps prevent further seizures. Bed rest, sedation (phenobarbital), and providing privacy do not minimize the risk of seizures.

The client is scheduled for an electroencephalogram (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 eight (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.

1. Antiseizure drugs, tranquilizers, stimulants, and depressants are withheld before an EEG because they may alter the brain wave patterns. 2. Meals are not withheld because altered blood glucose level can cause changes in brain wave patterns. 3. The goal is for the client to have a seizure during the EEG. Sleep deprivation, hyperventilating, or flashing lights may induce a seizure. 4. Electrodes are placed on the client's scalp, but there are no electroshocks or any type of discomfort. TEST TAKING HINT: The test taker should highlight the words "diagnose a seizure disorder" in the stem and ask which answer option would possibly cause a seizure.

The client is admitted to the intensive care unit (ICU) 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 intravenous push. 4. Prepare to administer a glucocorticosteroid orally

1. Assessment is an independent nursing action, not a collaborative one. 2. All clients in the ICD will be placed on telemetry, which does not require an order by another health-care provider or collaboration with one. 3. Administering an anticonvulsant medication by intravenous push requires the nurse to have an order or confer with another member of the health-care team. 4. A glucocorticoid is a steroid and is not used to treat seizures. TEST TAKING HINT: The keyword in the stem of this question is the adjective "collaborative." The test taker would eliminate the options "1" and "2" because these do not require collaboration with another member of the health-care team and would eliminate option "4" because it is not used to treat seizures.

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. Noticing the first thing the client does during a seizure provides information and clues as to the location of the seizure in the brain. It is important to document whether the beginning of the seizure was observed. 2. Assessment is important, but during the seizure the nurse should not attempt to restrain the head to assess the eyes; muscle contractions are strong, and restraining the client could cause injury. 3. This should be done, but it is not the first intervention when walking into a room where the client is beginning to have a seizure. 4. The client should be protected from onlookers, but the nurse should always address the client first. TEST TAKING HINT: This is a prioritizing question that asks the test taker which intervention to implement first. All four interventions would be appropriate, but only one should be implemented first. If the test taker cannot decide between two choices, always select the one that directly affects the client or the condition; privacy is important, but helping determine the origin of the seizure is priority.

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. Thorough oral hygiene after each meal, gum massage, daily flossing, and regular dental care are essential to prevent or control gingival hyperplasia, which is a common occurrence in clients taking Dilantin. 2. A serum (venipuncture) Dilantin level is checked monthly at first and then, after a therapeutic level is attained, every six (6) months. 3. Dilantin does not turn the urine orange. 4. The use of Dilantin does not ensure that the client will not have any seizures, and, in some instances, the dosage may need to be adjusted or another medication may need to be used. TEST TAKING HINT: The test taker should realize that monitoring blood glucose levels using a glucometer is about the only level that is monitored daily; therefore, option "2," which calls for daily monitoring of Dilantin levels, could be eliminated. Remember, there are very few absolutes in the health-care field; therefore, option "4" could be ruled out because "won't have any" is an absolute

A client who has had seizures asks the nurse about being able to drive because of the seizures. Which response by the nurse is best? 1.A person with a history of seizures can drive only during daytime hours. 2.A person with evidence that the seizures are under medical control can drive. 3.A person with evidence that seizures occur no more often than every 12 months can drive. 4.A person with a history of seizures can drive if he or she carries a medical identification card.

2. Specific motor vehicle regulations and restrictions for people who experience seizures vary locally. Most commonly, evidence that the seizures are under medical control is required before the person is given permission to drive. Time of day is not a consideration when determining driving restrictions related to seizures. The amount of time a person has been seizure-free is a consideration for lifting driving restrictions; however, the time frame is usually 2 years. It is recommended, not required, that a person who is subject to seizures carry a card or wear an identification bracelet describing the illness to facilitate quick identification in the event of an emergency.

Which of the following should the nurse include in the teaching plan for a client with seizures who is going home with a prescription for gabapentin (Neurontin)? 1.Take all the medication until it is gone. 2.Notify the physician if vision changes occur. 3.Store gabapentin in the refrigerator. 4.Take gabapentin with an antacid to protect against ulcers.

2. Gabapentin (Neurontin) may impair vision. Changes in vision, concentration, or coordination should be reported to the physician. Gabapentin should not be stopped abruptly because of the potential for status epilepticus; this is a medication that must be tapered off. Gabapentin is to be stored at room temperature and out of direct light. It should not be taken with antacids.

The client will have an electroencephalogram (EEG) in the morning. The nurse should instruct the client to have which of the following for breakfast? 1.No food or fluids. 2.Only coffee or tea if needed. 3.A full breakfast as desired without coffee, tea, or energy drinks. 4.A liquid breakfast of fruit juice, oatmeal, or smoothie.

3 Beverages containing caffeine, such as coffee, tea, cola, and energy drinks, are withheld before an EEG because of the stimulating effects of the caffeine on the brain waves. A meal should not be omitted before an EEG because low blood sugar could alter brain wave patterns; the client can have the entire meal except for the coffee. The client does not need to be on a liquid diet or NPO.

The nurse is teaching a client to recognize an aura. The nurse should instruct the client to note: 1.A postictal state of amnesia. 2.A hallucination that occurs during a seizure. 3.A symptom that occurs just before a seizure. 4.A feeling of relaxation as the seizure begins to subside.

3. An aura is a premonition of an impending seizure. Auras usually are of a sensory nature (eg, an olfactory, visual, gustatory, or auditory sensation); some may be of a psychic nature. Evaluating an aura may help identify the area of the brain from which the seizure originates. Auras occur before a seizure, not during or after (postictal). They are not similar to hallucinations or amnesia or related to relaxation

The client is scheduled to receive phenytoin (Dilantin) through a nasogastric tube (NGT) and has a tube-feeding supplement running continuously. The head of the bed is elevated to 30 degrees. Prior to administering the medication, the nurse should: 1.Elevate the head of the bed to 60 degrees. 2.Draw blood to determine the Dilantin level after giving the morning dose in order to determine if client has toxic blood level. 3.Stop the tube feeding 1 hour before giving Dilantin and hold tube feeding for 1 hour after giving Dilantin. 4.Flush the NGT with 150 mL of water before and after giving the Dilantin"

3. In order for Dilantin to be properly absorbed and provide maximum benefit to the client, nutritional supplements must be stopped before and after delivery. The head of the bed is elevated 30 degrees since this client has a tube feeding infusing; it is not necessary to elevate the bed any further. Blood levels are usually drawn before giving a dose of Dilantin, not after. It is not necessary to flush with such a large amount of water (150 mL) before and after Dilantin.

Which of the following is contraindicated for a client with seizure precautions? 1.Encouraging him to perform his own personal hygiene. 2.Allowing him to wear his own clothing. 3.Assessing his oral temperature with a glass thermometer. 4.Encouraging him to be out of bed.

3. Temperatures are not assessed orally with a glass thermometer because the thermometer could break and cause injury if a seizure occurred. The client can perform personal hygiene. There is no clinical reason to discourage the client from wearing his own clothes. As long as there are no other limitations, the client should be encouraged to be out of bed.