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The Client with Seizures
18. Which of the following is contraindicated for a client with seizure precautions?
1. Encouraging him to perform his own personal hygiene.
The client can perform personal hygiene.
2. Allowing him to wear his own clothing.
There is no clinical reason to discourage the client from wearing his own clothes.
3. Assessing oral temperature with a glass thermometer.
Temperatures are not assessed orally with a glass thermometer because the thermometer could break and cause injury if a seizure occurred.
4. Encouraging him to be out of bed.
As long as there are no other limitations, the client should be encouraged to be out of bed.
19. A client who is unconscious from an unknown drug overdose is having grand mal seizures. Which of the following would the nurse expect to administer? Select all that apply.
1. Dextrose 50%, 50 mL IV bolus.
Severe hypoglycemia causing irreversible brain damage can occur quickly in a client who is unconscious and experiencing a seizure. Therefore, unless a rapid blood glucose level is available to rule out hypoglycemia, the nurse would expect to administer a bolus of Dextran 50% 50 to 100 ml IV.
2. Flumazenil, 0.2 mg IV
Flumazenil is administered to reverse benzodiazepine overdose
but it should not be given with a seizure disorder.
3. Thiamine, 100 mg IV
Thiamine is administered to clients who are malnourished or abuse alcohol and would not be contraindicated in this client.
4. Naloxone, 0.45 mg IV
Naloxone is administered to clients suspected of a narcotic drug or opioid overdose to reverse comas or narcoticinduced respiratory depression and is an appropriate order for this client.
20. Which of the following will the nurse observe in the client in the ictal phase of a generalized grand mal (tonic-clonic) seizure?
1. Jerking in one extremity that spreads gradually to adjacent areas.
A partial seizure starts in one region of the cortex and may stay focused or spread
(eg, jerking in the extremity spreading to other areas of the body).
2. Vacant staring and an abrupt cessation of all activity.
A petit mal seizure usually occurs in children and involves a vacant stare
with a brief loss of consciousness that often goes unnoticed.
3. Facial grimaces, patting motions, and lip smacking.
A complex partial seizure involves facial grimacing with patting and smacking.
4. Loss of consciousness, body stiffening, and violent muscle contractions.
A grand mal seizure involves both a tonic phase and a clonic phase.
The tonic phase consists of loss of consciousness, dilated pupils, and muscular stiffening or contraction, which lasts about 20 to 30 seconds.
The clonic phase involves repetitive movements.
The grand mal seizure ends with confusion, drowsiness, and resumption of respiration.
21. It is the night before a client is to have a computed tomographic (CT) scan of the head without contrast. Which statement by the nurse would be most appropriate?
1. "You must shampoo your hair tonight to remove all oil and dirt."
There is no special preparation for a CT scan, so a shampoo the night be-fore is not required.
2. "You may drink fluids until midnight; but after that drink nothing until the scan is completed."
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.
The client may drink fluids until 4 hours before the scan is scheduled.
3. "You will have some hair shaved to attach the small electrode to your scalp."
Electrodes are not used for a CT scan, nor is the head shaved.
4. "You will need to hold your head very still during the examination."
The client will be asked to hold the head very still during the examination, which lasts about 30 to 60 minutes.
22. For breakfast on the morning a client is to have an electroencephalogram (EEG), the client is served a soft boiled egg, toast with butter and marmalade, orange juice, and coffee. Which of the following would the nurse do?
2. Remove the coffee.
Beverages containing caffeine, such as coffee, tea, and cola drinks, are withheld before an EEG because of the stimulating effects of the caffeine on the brain waves.
1.Remove all the food.
3. Remove the toast, butter, and marmalade only.
4. Substitute vegetable juice for the orange juice.
A meal should not be omitted before an EEG,
because low blood sugar could alter brain wave patterns.
23. Upon awakening from his first tonic-clonic seizure, a 20-year-old client asks the nurse, "What caused me to have a seizure? I've never had one before." Which of the following would the nurse include in the response as a primary cause of tonic-clonic seizures in adults older than 20 years?
1. Head trauma.
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.
2. Electrolyte imbalance.
3. Congenital defect.
4. Epilepsy.
24. Which of the following would 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.
Gabapentin should not be stopped abruptly because of the potential for status epilepticus; this is a medication that must be tapered off.
2. Notify the physician if vision changes occur.
Gabapentin may impair vision.
Changes in vision, concentration, or coordination should be reported to the physician.
3. Store gabapentin in the refrigerator.
Gabapentin is to be stored at room temperature and out of direct light.
4. Take gabapentin with an antacid to protect against ulcers.
It should not be taken with antacids.
25. What is the priority nursing intervention in the postictal phase of a seizure?
1. Reorient the client to time, person, and place.
The nurse should apply oxygen 'and ventilation to the client as appropriate.
Other interventions, to be completed after the airway has been established, include reorientation of the client to time, person, and place.
2. Determine the client's level of sleepiness.
Determining the client's level of sleepiness is useful, but it is not a priority.
3. Assess the client's breathing pattern.
A priority for the client in the postictal phase (after a seizure) is to assess the client's breathing pattern for effective rate, rhythm, and depth.
4. Position the client comfortably.
Positioning the client comfortably promotes rest but is of less importance than ascertaining that the airway is patent.
26. 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 (phenobarbital) 30 mg orally, three times per day.
3. Close the door to the room to minimize stimulation.
Bed rest, sedation (phenobarbital), and providing privacy do not minimize the risk of seizures.
4. Administer carbamazepine (Tegretol) 200 mg orally, twice per day.
Carbamazepine (Tegretol) is an anticonvulsant that helps prevent further seizures.
27. What nursing assessments should be documented at the beginning of the ictal phase of a seizure?
1. Heart rate, respirations, pulse oximeter, and blood pressure.
It is typically not possible to assess the client's pulse and blood pressure during a tonic-clonic seizure because the muscle contractions make assessment difficult to impossible.
2. Last dose of anticonvulsant and circumstances at the time.
The last dose of anticonvulsant medication can be evaluated later.
3. Type of visual, auditory, and olfactory aura the client experienced.
The type of aura should be assessed in the preictal phase of the seizure.
4. Movement of the head and eyes and muscle rigidity.
During a seizure, the nurse should note movement of the client's head, eyes, and muscle rigidity, especially when the seizure first begins, to obtain clues about the location of the trigger focus in the brain.
Other important assessments would include noting the progression and duration of the seizure, respiratory status, loss of consciousness, pupil size, and incontinence of urine and stool.
The nurse should focus on maintaining an open airway, preventing injury to the client, and assessing the onset and progression of the seizure to determine the type of brain activity involved.
28. Which clinical manifestation does the nurse expect in the client in the postictal phase of grand mal seizure?
1. Drowsiness.
The nurse would expect a client to experience drowsiness to somnolence in the postictal phase, because exhaustion results from the abnormal spontaneous neuron firing and tonic-clonic motor response.
2. Inability to move.
An inability to move a muscle part is not expected after a tonic-clonic or grand mal seizure, because a lack of motor function would be related to a complication such as a lesion, tumor, or cerebrovascular accident in the correlating brain tissue.
3. Paresthesia.
A change in sensation would not be expected, because this would indicate a complication such as an injury to the peripheral nerve pathway to the corresponding part from the central nervous system.
4. Hypotension.
Hypotension is not typically a problem after a seizure.
29. A client with seizures asks the nurse how phenytoin sodium (Dilantin) will help. Based on knowledge of the drug's action, what is the nurse's best response?
1. It corrects the abnormal synthesis of norepinephrine in the body.
2. Transmission of abnormal impulses in the spinal cord is depressed.
3. The responsiveness of neurons in the brain to abnormal impulses is reduced.
Exactly how phenytoin sodium helps control seizures is unclear.
The most common theory is that it reduces the responsiveness of neurons in the brain to abnormal impulses-that is, it depresses neural activity.
4. It interrupts the flow of abnormal impulses from peripheral neurons in the viscera to the brain.
Dilantin does not influence norepinephrine or transmission of impulses in the spinal cord, nor does it interrupt the flow of abnormal impulses from peripheral neurons in the viscera to the brain.
30. When preparing to teach a client about phenytoin sodium (Dilantin) therapy, the nurse would urge the client not to stop the drug suddenly because
1. physical dependency on the drug develops over time.
2. status epilepticus may develop.
Anticonvulsant drug therapy should never be stopped suddenly;
doing so can lead to the life-threatening status epilepticus.
3. a hypoglycemic reaction develops.
Phenytoin sodium does not carry a risk of physical dependency or lead to hypoglycemia.
4. heart block is likely to develop.
Phenytoin sodium has antiarrhythmic properties, and discontinuation does not cause heart block.
31. A client states that she is afraid she will not be able to drive again because of her seizures. Which response by the nurse would be best?
1. A person with a history of seizures can drive only during daytime hours.
Time of day is not a consideration when determining driving restrictions related to seizures.
2. A person with evidence that the seizures are under medical control can drive.
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.
3. A person with evidence that seizures occur no more often than every 12 months can drive.
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.
4. A person with a history of seizures can drive if he carries a medical identification card.
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.
32. A client tells the nurse that he is unclear about what an aura is. The nurse's response indicates that an aura is
1. a postictal state of amnesia.
2. an hallucination that occurs during a seizure.
3. a symptom that occurs just before a seizure.
An aura is a premonition of an impending seizure. Auras usually are of a sensory nature (ie, 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.
4. a feeling of relaxation as the seizure begins to subside.
33. Which statement by a client with a seizure disorder taking topiramate (Topamax) indicates the client has understood the nurse's instruction?
1. "I will take the medicine before going to bed."
Topamax is taken in divided doses because it produces drowsiness.
2. "I will drink 6 to 8 glasses of water a day."
Toxic effects of to pi ram ate are nephrolithiasis, and clients are encouraged to drink 6 to 8 glasses of water a day to dilute the urine and flush the renal tubules to avoid stone formation.
3. "I will eat plenty of fresh fruits."
Although eating fresh fruits is desirable from a nutritional standpoint,
this is not related to the topiramate.
4. "I will take the medicine with a meal or snack."
The drug does not have to be taken with meals.
34. Which clinical manifestation does the nurse assess as a typical reaction to long-term phenytoin sodium (Dilantin) therapy?
1. Weight gain.
2. Insomnia.
3. Excessive growth of gum tissue.
A common side 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.
4. Deteriorating eyesight.
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