Seizures
A prescription reads phenytoin 0.2 g orally twice daily. The medication label states that each capsule is 100 mg. The nurse prepares how many capsule(s) to administer 1 dose?
2 Capsules Rationale:You must convert 0.2 mg. After conversion from grams to milligrams, use the formula to calculate the correct dose.Desired--------- × Capsule(s) = capsule(s)/doseAvailable200 mg------ × 1 capsule = 2 capsules100 mg
True or False: A patient who is experiencing a tonic-clonic seizure is experiencing a focal (partial) seizure.
Answer FALSE: A patient who is experiencing a tonic-clonic seizure is experiencing a GENERALIZED seizure. This type of seizure affects both sides of the brain.
A nurse is caring for a patient who begins to have a generalized tonic-clonic seizure while lying in bed. Which of the following actions should the nurse take? A. Insert an oral airway B. Turn the client onto a side C. Restrict Movement of the client's limbs D. Place a pillow under the client's head
B. Turn the client onto a side The nurse should turn the client onto a side to protect from aspiration. Incorrect answers: A. The nurse should not try to insert anything into the clients mouth during a seizure because this can increase the risk of injury to the client and to the nurse. C. The nurse should not try to restrict the clients movement because this can cause injury to the client or the nurse. D. The nurse should remove pillows from the clients bed to protect the client's airway.
A nurse is teaching a client who has a new diagnosis of simple partial seizures about auras. Which of the following statements by the client indicates an understanding of the teaching? A. "An aura is a sensory warning that a seizure is imminent." B. "An aura is a continuous seizure in which seizures occur in rapid succession." C. "An aura is a period of sleepiness following the seizure." D. "An aura is a brief loss of consciousness accompanied by staring."
Correct Answer: A. "An aura is a sensory warning that a seizure is imminent." An aura is a sensory warning that a seizure is imminent. The aura can be similar to a hallucination and involve any of the senses. The client can report hearing bells, seeing lights, or smelling an odor. Incorrect Answers: B. A continuous seizure state is a medical emergency called status epilepticus and requires immediate medical support. C. A period of sleepiness or lethargy following a seizure is referred to as the postictal state. D. A brief loss of consciousness accompanied by staring is a manifestation of an absence, or petit mal, seizure. These seizures occur primarily in children.
A nurse is teaching a client about computed tomography (CT) scanning of the brain. Which of the following teaching points should the nurse include? A. "You'll have to lie very still on a long, narrow table during the test." B. "You should be able to sit up during the test if you need to have a break." C. "You'll have many tiny electrodes placed on your scalp during the test." D. "You should expect the test to take at least an hour."
Correct Answer: A. "You'll have to lie very still on a long, narrow table during the test." The nurse should inform the client that the test will require the client to lie very still on a long, narrow table. Movement during the test interferes with the quality of the films. Incorrect Answers: B. The client must remain supine for the duration of the CT scan. C. An electroencephalogram, not a CT scan, requires the placement of electrodes on the client's scalp. D. Using newer CT scanners, each set of head scans (usually 1 or 2) takes <5 minutes to create.
A nurse is providing discharge teaching to the family of a client who has a new diagnosis of a seizure disorder. The nurse should instruct the client's family to take which of the following actions first in the event of a seizure? A. Reorient the client B. Protect the client's head C. Loosen constrictive clothing D. Turn the client onto his side
Correct Answer: B. Protect the client's head The nurse should apply the safety and risk reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client. This client is at greatest risk for injury from hitting his head; therefore, the first action is to protect the client's head from injury. Incorrect Answer: A. The family should reorient the client as he regains consciousness following a seizure; therefore, another action is the priority. C. The family should loosen constrictive clothing to protect the client from injury during a seizure; however, another action is the priority. D. The family should turn the client onto his side to protect the client from injury during a seizure; however, another action is the priority.
The nurse is instituting seizure precautions for a client who is being admitted from the emergency department. Which measures should the nurse include in planning for the client's safety? Select all that apply. 1.Padding the side rails of the bed. 2.Placing an airway at the bedside. 3.Placing the bed in the high position. 4.Putting a padded tongue blade at the head of the bed. 5.Placing oxygen and suction equipment at the bedside. 6.Flushing the intravenous catheter to ensure that the site is patent.
Correct Answer: 1, 2, 5, 6 Rationale:Seizure precautions may vary from agency to agency, but they generally have some common features. Usually, an airway, oxygen, and suctioning equipment are kept available at the bedside. The side rails of the bed are padded, and the bed is kept in the lowest position. The client has an intravenous access in place to have a readily accessible route if antiseizure medications must be administered, and as part of the routine assessment the nurse should be checking patency of the catheter. The use of padded tongue blades is highly controversial, and they should not be kept at the bedside. Forcing a tongue blade into the mouth during a seizure more likely will harm the client who bites down during seizure activity. Risks include blocking the airway from improper placement, chipping the client's teeth, and subsequent risk of aspirating tooth fragments. If the client has an aura before the seizure, it may give the nurse enough time to place an oral airway before seizure activity begins.
The nurse is caring for a client who begins to experience seizure activity while in bed. Which actions should the nurse take? Select all that apply. 1.Loosening restrictive clothing. 2.Restraining the client's limbs. 3.Removing the pillow and raising padded side rails. 4.Positioning the client to the side, if possible, with the head flexed forward. 5.Keeping the curtain around the client and the room door open so when help arrives they can quickly enter to assist.
Correct Answer: 1, 3, 4 Rationale:Nursing actions during a seizure include providing for privacy, loosening restrictive clothing, removing the pillow and raising padded side rails in the bed, and placing the client on 1 side with the head flexed forward, if possible, to allow the tongue to fall forward and facilitate drainage. The limbs are never restrained because the strong muscle contractions could cause the client harm. If the client is not in bed when seizure activity begins, the nurse lowers the client to the floor, if possible; protects the head from injury; and moves furniture that may injure the client.
The nurse has given medication instructions to a client receiving phenytoin. Which statement indicates that the client has an adequate understanding of the instructions? 1."Alcohol is not contraindicated while taking this medication." 2."Good oral hygiene is needed, including brushing and flossing." 3."The medication dose may be self-adjusted, depending on side effects." 4."The morning dose of the medication should be taken before a serum medication level is drawn."
Correct Answer: 2 Rationale:Typical antiseizure medication instructions include taking the prescribed daily dosage to keep the blood level of the medication constant and having a sample drawn for serum medication level determination before taking the morning dose. The client is taught not to stop the medication abruptly, to avoid alcohol, to check with a primary health care provider before taking over-the-counter medications, to avoid activities in which alertness and coordination are required until medication effects are known, to provide good oral hygiene, and to obtain regular dental care. The client should also wear a MedicAlert bracelet.
The home health nurse visits a client who is taking phenytoin for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan? 1.Pregnancy must be avoided while taking phenytoin. 2.The client may stop the medication if it is causing severe gastrointestinal effects. 3.There is the potential of decreased effectiveness of birth control pills while taking phenytoin. 4.There is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.
Correct Answer: 3 Rationale: Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, and 4 are inappropriate instructions. Pregnancy does not need to be "avoided" while taking phenytoin; however, because phenytoin may cause some risk to the fetus (Pregnancy Category D medication), consultation with the primary health care provider should be done if pregnancy is considered. Telling a client that there is an increased risk of thrombophlebitis is incorrect and inappropriate and could cause anxiety in the client. A client should not be instructed to stop antiseizure medication.
A client is taking the prescribed dose of phenytoin to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL (140 mcmol/L). Which finding would be expected as a result of this laboratory result? 1.Hypotension 2.Tachycardia 3.Slurred speech 4.No abnormal finding
Correct Answer: 3 Rationale:The therapeutic phenytoin level is 10 to 20 mcg/mL (40 to 79 mcmol/L). At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) occur. At a level higher than 30 mcg/mL (120 mcmol/L), ataxia and slurred speech occur.
A nurse responds to a call from an assistive personnel that a client just had a seizure and is unconscious. Which of the following assessments is the nurse's priority? A. Measure the client's vital signs B. Perform a neurological examination C. Check airway patency D. Assess the client for injuries
Correct Answer: C. Check airway patency The nurse should apply the ABC priority-setting framework, which emphasizes the basic core of human functioning: having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these areas can indicate a threat to life and is the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear for oxygen exchange to occur. Breathing is the second-highest priority because adequate ventilatory effort is essential in order for oxygen exchange to occur. Circulation is the third-highest priority because the delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. The priority assessment the nurse should make is to check the client's airway patency. The nurse should establish and maintain the client's airway to prevent respiratory arrest and hypoxia. Incorrect Answers: A. The nurse should measure the client's vital signs to determine overall stability; however, the nurse should perform another assessment first. B. The nurse should perform a neurological assessment to identify the client's level of consciousness and any neurological deficits; however, the nurse should perform another assessment first. D. The nurse should check the client for injuries and intervene accordingly; however, the nurse should perform another assessment first.
A nurse is providing teaching to a client who has a history of tonic-clonic seizures and is scheduled for a standard electroencephalogram (EEG). Which of the following instructions should the nurse include in the teaching? A. Remain NPO 6 to 8 hr prior to the EEG B. Take a sedative the night prior to the EEG C. Thoroughly shampoo her hair prior to the EEG D. Sleep for at least 8 hr during the night prior to the test
Correct Answer: C. Thoroughly shampoo her hair prior to the EEG The nurse should instruct the client to thoroughly wash her hair prior to the EEG because hairsprays, oils, and other hair preparations interfere with recording results of the EEG. Incorrect Answers: A. The nurse should instruct the client to eat regularly scheduled meals prior to the EEG because a low blood glucose level resulting from NPO status can alter EEG results. B. A sedative is not administered the night before a standard EEG because a sedative depresses CNS functioning and can alter EEG results. D. The nurse should instruct the client to be sleep-deprived prior to the EEG to increase the likelihood of recording seizure activity. The nurse should instruct the client to awaken at 0200 to 0300 on the morning of the EEG.
A nurse is preparing a client for an electroencephalogram (EEG). Which of the following pieces of information should the nurse share with the client? A. "Expect the test to take about 3 hr." B. "You'll begin by lying still with your eyes closed." C. "You'll sleep for the duration of the procedure." D. "Expect some mild electrical shocks during the test."
Correct answer: (B) "You'll begin by lying still with your eyes closed." The client will have to lie still in a reclining chair or bed and keep her eyes closed for the initial recording. Incorrect answers: A. An EEG takes 45 minutes to 2 hours. C. The nurse should explain the need to lie still but should also prepare the client for other activities such as hyperventilation and photic stimulation from flashing strobe lights. D. An EEG documents brain activity. Electrical shocks are not used during this test.
You're assessing a patient who recently experienced a focal type seizure (partial seizure). As the nurse, you know that which statement by the patient indicates the patient may have experienced a focal impaired awareness (complex partial) seizure? A. "My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this." B. "I remember having vision changes, but it didn't last long." C. "I woke up on the floor with my mouth bleeding." D. "After the seizure I was very sleepy, and I had a headache for several hours."
The answer is A. The patient will experience an alternation in consciousness (hence the name focal IMPAIRED awareness) AND will perform an action without knowing they are doing it called automatism like lip-smacking, rubbing the hands together etc. With a focal onset AWARE seizure (also called partial simple seizure) the patient is aware and will remember what happens (like vision changes etc.).
A patient is taking Phenytoin for treatment of seizures. Which statement by the patient requires you to re-educate the patient about this medication? A. "Every morning I take this medication with a full glass of milk with my breakfast." B. "I know it is important to have my drug levels checked regularly." C. "I will report a skin rash immediately to my doctor." D. "This medication can lower my body's ability to clot and fight infection."
The answer is A. This medication should NOT be taken with milk products or antacids because it affects absorption. All the other options are correct.
A patient with a history of epilepsy is taking Phenytoin. The patient's morning labs are back, and the patient's Phenytoin level is 7 mcg/mL. Based on this finding, the nurse will? A. Assess the patient for a rash B. Initiate seizure precautions C. Hold the next dose of Phenytoin D. Continue to monitor the patient
The answer is B. A normal Phenytoin level is 10 to 20 mcg/mL. The patient's level is low; therefore, the patient is at risk for seizures. The nurse should initiate seizure precautions. Remember a patient being under medicated is a trigger for developing a seizure.
The nurse is ordered to administer Lorazepam to a patient experiencing status epilepticus. As a precautionary measure, the nurse will also have what reversal agent on standby? A. Narcan B. Flumazenil C. Calcium Chloride D. Idarucizumab
The answer is B. Flumazenil is the reversal agent for Lorazepam, which is a benzodiazepine.
You're educating a 25-year-old female about possible triggers for seizures. Which statement requires you to re-educate the patient about the triggers? A. "I'm at risk for seizure activity during my menstrual cycle." B. "I will limit my alcohol intake to 2 glasses of wine per day." C. "It's important I get plenty of sleep." D. "I will be sure to stay hydrated, especially during hot weather."
The answer is B. The patient should avoid all alcohol because it can lead to a seizure. Hormone shifts (menstrual cycle, ovulation, pregnancy) sleep deprivation, and dehydration can lead to a seizure.
You're developing discharge instructions to the parents of a child who experiences atonic seizures. What information below is important to include in the teaching? A. "This type of seizure is hard to detect because the child may appear like he or she is daydreaming." B. "Be sure your child wears a helmet daily." C. "It is common for the child to feel extremely tired after experiencing this type of seizure." D. "Avoid high fat and low carbohydrate diets."
The answer is B. This type of seizure leads to a sudden loss of muscle tone. The patient will go limp and fall, which when this happens the head is usually the first part of the body to hit the floor or an object nearby. It is important the child wears a helmet daily to protect their head from injury. Option A is a characteristic of an absence seizure. Option C is a characteristic of a tonic-clonic seizure during the post ictus stage. And option D is wrong because some patients benefit from this type of diet known as the ketogenic diet.
Your patient has entered the post ictus stage for seizures. The patient's seizure presented with an aura followed by body stiffening and then recurrent jerking. The patient had incontinence and bleeding in the mouth from injury to the tongue. What is an expected finding in this stage based on the type of seizure this patient experienced? A. Crying and anxiety B. Immediate return to baseline behavior C. Sleepy, headache, and soreness D. Unconsciousness
The answer is C. Based on the findings during the seizure the patient experienced a tonic-clonic seizure. In the post ictus stage (after the seizure) the patient is expected to be sleepy (very tired), have soreness, and a headache. The nurse should let the patient sleep.
Neurons in the brain are tasked with handling and transmitting information. There are different types of neurons, such as excitatory and inhibitory. Excitatory neurons release the neurotransmitter _____________, while inhibitory neurons release the neurotransmitter ________________. A. GABA, glutamate B. Norepinephrine, GABA C. Glutamate, GABA D. Dopamine, glutamate
The answer is C. Excitatory neurons release glutamate and inhibitory neurons release GABA.
An 8-year-old child, who is not responding to anti-seizure medications, is prescribed to start a ketogenic diet. This diet will include: A. High carbohydrates and high fat B. Low fat, high salt, and high carbohydrates C. High fat and low carbohydrates D. High glucose, high fat, and low carbohydrates
The answer is C. This is a type of diet used in the pediatric population with epilepsy whose seizures cannot be controlled by medication. It is a high fat and low carb diet.
Keeping the previous question in mind, the patient is now experiencing characteristics of a tonic-clonic seizure. The seizure started at 1402 and it is now 1408, and the patient is still experiencing a seizure. The nurse should? A. Continue to monitor the patient B. Suction the patient C. Initiate the emergency response system D. Restrain the patient to prevent further injury
The answer is C. Tonic-clonic seizures should last about 1-3 minutes. If the seizure lasts MORE than 5 minutes, the patient needs medical treatment FAST to stop the seizure....this is known as status epilepticus.
A 7-year-old male patient is being evaluated for seizures. While in the child's room talking with the child's parents, you notice that the child appears to be daydreaming. You time this event to be 10 seconds. After 10 seconds, the child appropriately responds and doesn't recall the event. This is known as what type of seizure? A. Focal Impaired Awareness (complex partial) B. Atonic C. Tonic-clonic D. Absence
The answer is D. This is an absence seizure and is most common in children. The hallmark of it is staring that appears to be like a daydreaming state. It is very short and the post ictus stage of this type of seizure is immediate.
A patient who is having a tonic-clonic seizure is prescribed Phenobarbital. During administration of this drug, it is important the nurse monitors for: A. Respiratory depression B. Hypertension C. Disseminated intravascular clotting D. Hypotension E. Fever
The answers are A and D. This medication stimulates the GABA receptors and helps with inhibitory neurotransmission. It can lead to respiratory depression and hypotension, therefore, it is very important the nurse monitors the patient for this.
You're assessing your patient load for the patients who are at MOST risk for seizures. Select all the patients below that are at risk: A. A 32-year-old with a blood glucose of 20 mg/dL. B. A 63-year-old whose CT scan shows an ischemic stroke. C. A 72-year-old who is post opt day 5 from open heart surgery. D. A 16-year-old with bacterial meningitis. E. A 58-year-old experiencing ETOH withdrawal.
The answers are A, B, D, and E. All the patients are at risk except option C. Remember all the risk factors: illness (especially CNS types like bacterial meningitis), fever, electrolyte/metabolic issues (low blood sugar, acidosis etc), ETOH (alcohol) withdraw, brain injury, STROKE, congenital brain defects, tumors etc.
Your patient is scheduled for an EEG (electroencephalogram). As the nurse you will: A. Keep the patient nothing by mouth. B. Hold seizure medications until after the test. C. Allow the patient to have coffee, milk, and juice only. D. Wash the patient's hair prior to the test. E. Administer a sedative prior to the test.
The answers are B and D. An EEG is a painless procedure that will assess the patient's brain activity (if a seizure occurs during the test this can allow the physician to determine what type of seizure it is). Therefore, the nurse would hold seizure medications (this can affect the test) and would NOT allow the patient to have caffeine like coffee or stimulant drugs (the patient can eat prior to the test just NO caffeine). The patient's hair should be cleaned prior to the test so the technician can apply the electrodes and get them to stick to the scalp easily. A sedative is not needed before this test.
