Chapter 61: Management of Patients With Neurologic Dysfunction

Question 1

1. A client is being admitted to the neurologic ICU following an acute head injury that has
   resulted in cerebral edema. When planning this client’s care, the nurse would expect to
   administer what priority medication?
   A. Hydrochlorothiazide
   B. Furosemide
   C. Mannitol
   D. Spironlactone

Answer 1

ANS: C
Rationale: The osmotic diuretic mannitol is given to dehydrate the brain tissue and reduce cerebral edema. This drug acts by reducing the volume of brain and extracellular fluid. Spironlactone, furosemide, and hydrochlorothiazide are diuretics that are not typically used in the treatment of increased ICP resulting from cerebral edema.

Question 2

2. The nurse is providing care for a client who is unconscious. What nursing intervention
   takes highest priority?
   A. Maintaining accurate records of intake and output
   B. Maintaining a patent airway
   C. Inserting a nasogastric (NG) tube as prescribed
   D. Providing appropriate pain contro

Answer 2

ANS: B
Rationale: Maintaining a patent airway always takes top priority, even though each of the other listed actions is necessary and appropriate.

Question 3

3. The nurse is caring for a client in the ICU who has a brain stem herniation and who is
   exhibiting an altered level of consciousness. Monitoring reveals that the client’s mean
   arterial pressure (MAP) is 60 mm Hg with an intracranial pressure (ICP) reading of 5 mm
   Hg. What is the nurse’s most appropriate action?
   A. Position the client the high Fowler position as tolerated.
   B. Administer osmotic diuretics as prescribed.
   C. Participate in interventions to increase cerebral perfusion pressure (CPP).
   D. Prepare the client for craniotomy.

Answer 3

ANS: C
Rationale: The CPP is 55 mm Hg, which is considered low. The normal CPP is 70 to 100 mm Hg. Clients with a CPP of less than 50 mm Hg experience irreversible neurologic damage. As a result, interventions are necessary. A craniotomy is not directly indicated. Diuretics and increased height of bed would exacerbate the client’s condition.

Question 4

4. The nurse is caring for a client who is postoperative following a craniotomy. When
   writing the plan of care, the nurse identifies a diagnosis of “deficient fluid volume related
   to fluid restriction and osmotic diuretic use.” What is the nurse’s most appropriate
   intervention for this diagnosis?
   A. Change the client’s position as indicated.
   B. Monitor serum electrolytes.
   C. Maintain NPO status.
   D. Monitor arterial blood gas (ABG) values.

Answer 4

ANS: B
Rationale: The postoperative fluid regimen depends on the type of neurosurgical procedure and is determined on an individual basis. The volume and composition of fluids are adjusted based on daily serum electrolyte values, along with fluid intake and output. Fluids may have to be restricted in clients with cerebral edema. Changing the client’s position, maintaining an NPO status, and monitoring ABG values do not relate to the nursing diagnosis of deficient fluid volume.

Question 5

5. A client with a documented history of seizure disorder experiences a generalized
   seizure. What nursing action is most appropriate?
   A. Restrain the client to prevent injury.
   B. Open the client’s jaws to insert an oral airway.
   C. Place client in high Fowler position.
   D. Loosen the client’s restrictive clothing.

Answer 5

ANS: D
Rationale: An appropriate nursing intervention would include loosening any restrictive clothing on the client. No attempt should be made to restrain the client during the seizure
because muscular contractions are strong and restraint can produce injury. Do not attempt to pry open jaws that are clenched in a spasm to insert anything. Broken teeth
and injury to the lips and tongue may result from such an action. If possible, place the client on one side with head flexed forward, which allows the tongue to fall forward and facilitates drainage of saliva and mucus.

Question 6

6. A client who has been on long-term phenytoin therapy is admitted to the unit. In light
   of the adverse of effects of this medication, the nurse should prioritize which of the
   following in the client’s plan of care?
   A. Monitoring of pulse oximetry
   B. Administration of a low-protein diet
   C. Administration of thorough oral hygiene
   D. Fluid restriction as prescribed

Answer 6

ANS: C
Rationale: Gingival hyperplasia (swollen and tender gums) can be associated with long-term phenytoin use. Thorough oral hygiene should be provided consistently and encouraged after discharge. Fluid and protein restriction are contraindicated and there is no particular need for constant oxygen saturation monitoring.

Question 7

7. A client exhibiting an altered level of consciousness (LOC) due to blunt force trauma to
   the head is admitted to the emergency department (ED). The nurse should first gauge
   the client’s LOC on the results of what diagnostic tool?
   A. Monro-Kellie hypothesis
   B. Glasgow Coma scale
   C. Cranial nerve function
   D. Mental status examination

Answer 7

ANS: B
Rationale: LOC, a sensitive indicator of neurologic function, is assessed based on the criteria in the Glasgow Coma scale: eye opening, verbal response, and motor response. The Monro-Kellie hypothesis states that because of the limited space for expansion within the skull, an increase in any one of the components (blood, brain tissue, cerebrospinal fluid) causes a change in the volume of the others. Cranial nerve function and the mental status examination would be part of the neurologic examination for this client, but would not be the priority in evaluating LOC. Glasgow coma scale can be done quickly and establishes a baseline of neurologic function.

Question 8

8. The nurse is caring for a client with a brain tumor and is aware that the normal
   compensation measures to keep ICP (intracranial pressure) within normal limits may no
   longer be effective. What are the normal compensation measures for the brain? Select all
   that apply.
   A. Displacing or shifting cerebral spinal fluid (CSF)
   B. Decreasing cerebral perfusion
   C. Increasing the absorption of CSF
   D. Shifting brain tissue
   E. Decreasing cerebral blood volume

Answer 8

ANS: A, C, E
Rationale: The Monro–Kellie hypothesis explains the dynamic equilibrium of cranial contents. This hypothesis states that because of the limited space for expansion within
the skull, an increase in any one of the components causes a change in the volume of the others. The brain typically compensates for these changes by displacing or shifting CSF,
increasing the absorption or diminishing the production of CSF, or decreasing cerebral blood volume. Without such changes, ICP begins to rise. A decrease in cerebral perfusion and shifting brain tissue are not normal compensatory events. An increase in ICP can occur because of a brain tumor. Increased ICP from any cause would result in a decrease in cerebral perfusion which stimulates further edema and may shift brain tissue. A shift in brain tissue results in herniation which is a dire and frequently fatal event.

Question 9

9. A client with increased intracranial pressure (ICP) has a ventriculostomy for
   monitoring ICP. The nurse’s most recent assessment reveals that the client is now
   exhibiting nuchal rigidity and photophobia. The nurse would be correct in suspecting the
   presence of what complication?
   A. Encephalitis
   B. Cerebral spinal fluid leak
   C. Meningitis
   D. Catheter occlusion

Answer 9

ANS: C
Rationale: Complications of a ventriculostomy include ventricular infectious meningitis and problems with the monitoring system. Nuchal rigidity and photophobia are clinical
manifestations of meningitis, but are not suggestive of encephalitis, a cerebral spinal fluid (CSF) leak, or an occluded catheter.

Question 10

10. The nurse is participating in the care of a client with increased ICP. What diagnostic
    test is contraindicated in this client’s treatment?
    A. Computed tomography (CT) scan
    B. Lumbar puncture
    C. Magnetic resonance imaging (MRI)
    D. Venous Doppler studies

Answer 10

ANS: B
Rationale: A lumbar puncture in a client with increased ICP may cause the brain to herniate from the withdrawal of fluid and change in pressure during the lumbar puncture. Herniation of the brain is a dire and frequently fatal event. CT, MRI, and venous Doppler are considered noninvasive procedures and they would not affect the ICP itself.

Question 11

11. The nurse is caring for a client who is in status epilepticus. What medication should
    the nurse anticipate administering to halt the seizure immediately?
    A. Intravenous phenobarbital
    B. Intravenous diazepam
    C. Oral lorazepam
    D. Oral phenytoin

Answer 11

ANS: B
Rationale: Medical management of status epilepticus includes IV diazepam and IV lorazepam given slowly in an attempt to halt seizures immediately. Other medications (phenytoin, phenobarbital) are given later to maintain a seizure-free state. Oral medications are not given during status epilepticus.

Question 12

12. The nurse has created a plan of care for a client who is at risk for increased ICP. The
    client’s care plan should specify monitoring for what early sign of increased ICP?
    A. Disorientation and restlessness
    B. Decreased pulse and respirations
    C. Projectile vomiting
    D. Loss of corneal reflex

Answer 12

ANS: A
Rationale: Early indicators of ICP include disorientation and restlessness. Later signs include decreased pulse and respirations, projectile vomiting, and loss of brain stem
reflexes, such as the corneal reflex.

Question 13

13. The neurologic ICU nurse is admitting a client with increased intracranial pressure.
    How should the nurse best position the client?
    A. Position the client supine.
    B. Maintain head of bed (HOB) elevated at 30 to 45 degrees.
    C. Position client in prone position.
    D. Maintain bed in Trendelenburg position.

Answer 13

ANS: B
Rationale: The client with increased ICP should be placed with the HOB elevated 30 to 45 degrees, with the neck in neutral alignment. Each of the other listed positions would cause a dangerous elevation in ICP.

Question 14

14. A clinic nurse is caring for a client diagnosed with migraine headaches. During the
    client teaching session, the client questions the nurse regarding alcohol consumption.
    What would the nurse be correct in telling the client about the effects of alcohol?
    A. Alcohol causes hormone fluctuations.
    B. Alcohol causes vasodilation of the blood vessels.
    C. Alcohol has an excitatory effect on the CNS.
    D. Alcohol diminishes endorphins in the brain.

Answer 14

ANS: B
Rationale: Alcohol causes vasodilation of the blood vessels and may exacerbate migraine headaches. Alcohol has a depressant effect on the CNS. Alcohol does not cause hormone fluctuations, nor does it decrease endorphins (morphine-like substances produced by the body) in the brain.

Question 15

15. A client has developed diabetes insipidus after having increased ICP following head
    trauma. What nursing assessment best addresses this complication?
    A. Vigilant monitoring of fluid balance
    B. Continuous BP monitoring
    C. Serial arterial blood gases (ABGs)
    D. Monitoring of the client’s airway for patency

Answer 15

ANS: A
Rationale: Diabetes insipidus requires fluid and electrolyte replacement, along with the administration of vasopressin, to replace and slow the urine output. Because of these alterations in fluid balance, careful monitoring is necessary. None of the other listed assessments directly addresses the major manifestations of diabetes insipidus.

Question 16

16. What should the nurse suspect when hourly assessment of urine output on a client
    post craniotomy exhibits a urine output from a catheter of 1,500 mL for two consecutive
    hours?
    A. Cushing syndrome
    B. Syndrome of inappropriate antidiuretic hormone (SIADH)
    C. Adrenal crisis
    D. Diabetes insipidus

Answer 16

ANS: D
Rationale: Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in clients after brain surgery. Cushing syndrome is excessive glucocorticoid secretion resulting in sodium and water retention. SIADH is the result of increased secretion of ADH; the client becomes volume-overloaded, urine output diminishes, and serum sodium concentration becomes dilute. Adrenal crisis is undersecretion of glucocorticoids resulting in profound hypoglycemia, hypovolemia, and hypotension.

Question 17

17. During the examination of an unconscious client, the nurse observes that the client’s
    pupils are fixed and dilated. What is the most plausible clinical significance of the nurse’s
    finding?
    A. It suggests onset of metabolic problems.
    B. It indicates paralysis on the right side of the body.
    C. It indicates paralysis of cranial nerve X (CN X).
    D. It indicates an injury at the midbrain level.

Answer 17

ANS: D
Rationale: Pupils that are fixed and dilated indicate injury at the midbrain level. This finding is not suggestive of unilateral paralysis, metabolic deficits, or damage to CN X.

Question 18

18. The nurse is providing care for a client who is withdrawing from heavy alcohol use.
    The nurse and other members of the care team are present at the bedside when the client
    has a seizure. In preparation for documenting this clinical event, the nurse should note
    which of the following?
    A. The ability of the client to follow instructions during the seizure.
    B. The success or failure of the care team to physically restrain the client.
    C. The client’s ability to explain his seizure during the postictal period.
    D. The client’s activities immediately prior to the seizure.

Answer 18

ANS: D
Rationale: Before and during a seizure, the nurse observes the circumstances before the seizure, including visual, auditory, or olfactory stimuli; tactile stimuli; emotional or psychological disturbances; sleep; and hyperventilation. Communication with the client is not possible during a seizure and physical restraint is not attempted. The client’s ability to explain the seizure may not be accurate since the client is often still confused during
the postictal period.

Question 19

19. The nurse is caring for a client whose recent health history includes an altered LOC.
    What should be the nurse’s first action when assessing this client?
    A. Assessing the client’s verbal response
    B. Assessing the client’s ability to follow complex commands
    C. Assessing the client’s judgment
    D. Assessing the client’s response to pain

Answer 19

ANS: A
Rationale: Assessment of the client with an altered LOC often starts with assessing the verbal response through determining the client’s orientation to time, person, and place. In most cases, this assessment will precede each of the other listed assessments, even though each may be indicated.

Question 20

20. The nurse caring for a client in a persistent vegetative state is regularly assessing for
    potential complications. The nurse should assess for which complications? Select all that
    apply.
    A. Contractures
    B. Hemorrhage
    C. Pressure ulcers
    D. Venous thromboembolism
    E. Pneumonia

Answer 20

ANS: A, C, D, E
Rationale: Based on the assessment data, potential complications (partially based on immobility) may include respiratory distress or failure, pneumonia, aspiration, pressure
ulcer, deep vein thrombosis (DVT), and contractures. A persistent vegetative state does not directly create a heightened risk for hemorrhage.. A persistent vegetative state condition is when the client is wakeful but devoid of conscious content, without cognitive or affective mental function

Question 21

21. The nurse is caring for a client with a brain tumor. What drug would the nurse expect
    to be prescribed to reduce the edema surrounding the tumor?
    A. Solumedrol
    B. Dextromethorphan
    C. Dexamethasone
    D. Furosemide

Answer 21

ANS: C
Rationale: If a brain tumor is the cause of the increased ICP, corticosteroids (e.g., dexamethasone) help reduce the edema surrounding the tumor. Solumedrol, a steroid, and furosemide, a loop diuretic, are not the drugs of choice in this instance. Dextromethorphan is used in cough medicines.

Question 22

22. The nurse is caring for a client who sustained a moderate head injury following a
    bicycle accident. The nurse’s most recent assessment reveals that the client’s respiratory
    effort has increased. What is the nurse’s most appropriate action?
    A. Inform the care team and assess for further signs of possible increased ICP.
    B. Administer bronchodilators as prescribed and monitor the client’s LOC.
    C. Increase the client’s bed height and reassess in 30 minutes.
    D. Administer a bolus of normal saline as prescribed.

Answer 22

ANS: A
Rationale: Increased respiratory effort can be suggestive of increasing ICP, and the care team should be promptly informed. A bolus of IV fluid will not address the problem. Repositioning the client and administering bronchodilators are insufficient responses, even though these actions may later be prescribed.

Question 23

23. A client has a poor prognosis after being involved in a motor vehicle accident resulting
    in a head injury. As the client’s ICP increases and condition worsens, the nurse knows to
    assess for indications of approaching death. These indications include which of the
    following?
    A. Hemiplegia
    B. Dry mucous membranes
    C. Signs of internal bleeding
    D. Loss of brain stem reflexes

Answer 23

ANS: D
Rationale: Loss of brain stem reflexes, including pupillary, corneal, gag, and swallowing reflexes, is an ominous sign of approaching death. Dry mucous membranes, hemiplegia,
and bleeding must be promptly addressed, but none of these is a common sign of impending death.

Question 24

24. A client has experienced a seizure in which she became rigid and then experienced
    alternating muscle relaxation and contraction. What type of seizure does the nurse
    recognize?
    A. Unclassified seizure
    B. Absence seizure
    C. Generalized seizure
    D. Focal seizure

Answer 24

ANS: C
Rationale: Generalized seizures often involve both hemispheres of the brain, causing both sides of the body to react. Intense rigidity of the entire body may occur, followed by alternating muscle relaxation and contraction (generalized tonic–clonic contraction). This pattern of rigidity does not occur in clients who experience unclassified, absence, or focal seizures.

Question 25

25. The nurse is caring for a client who has developed SIADH. What intervention is most
    appropriate?
    A. Fluid restriction
    B. Transfusion of platelets
    C. Transfusion of fresh frozen plasma (FFP)
    D. Electrolyte restriction

Answer 25

ANS: A
Rationale: The nurse also assesses for complications of increased ICP, including diabetes insipidus, and SIADH. SIADH requires fluid restriction and monitoring of serum electrolyte levels. Transfusions are unnecessary.

Question 26

26. The nurse is admitting a client to the unit who is scheduled for removal of an
    intracranial mass. What diagnostic procedures might be included in this client’s
    admission orders? Select all that apply.
    A. Transcranial Doppler flow study
    B. Cerebral angiography
    C. MRI
    D. Cranial radiography
    E. Electromyography (EMG)

Answer 26

ANS: A, B, C
Rationale: Preoperative diagnostic procedures may include a CT scan to demonstrate the lesion and show the degree of surrounding brain edema, the ventricular size, and the
displacement. An MRI scan provides information similar to that of a CT scan with improved tissue contrast, resolution, and anatomic definition. Cerebral angiography may be used to study a tumor’s blood supply or to obtain information about vascular lesions. Transcranial Doppler flow studies are used to evaluate the blood flow within intracranial blood vessels. Regular x-rays of the skull would not be diagnostic for an intracranial mass. An EMG would not be ordered prior to intracranial surgery to remove a mass.

Question 27

27. A client is recovering from intracranial surgery performed approximately 24 hours
    ago and is reporting a headache that the client rates at 8 on a 10-point pain scale. What
    nursing action is most appropriate?
    A. Administer morphine sulfate as prescribed.
    B. Reposition the client in a prone position.
    C. Apply a hot pack to the client’s scalp.
    D. Implement distraction techniques.

Answer 27

ANS: A
Rationale: The client usually has a headache after a craniotomy as a result of stretching and irritation of nerves in the scalp during surgery. Morphine sulfate may also be used in the management of postoperative pain in clients who have undergone a craniotomy. Prone positioning is contraindicated due to the consequent increase in ICP. Distraction would likely be inadequate to reduce pain and a hot pack may cause vasodilation and increased pain.

Question 28

28. A client is recovering from intracranial surgery that was performed using the
    transsphenoidal approach. The nurse should be aware that the client may have required
    surgery on what neurologic structure?
    A. Cerebellum
    B. Hypothalamus
    C. Pituitary gland
    D. Pineal gland

Answer 28

ANS: C
Rationale: The transsphenoidal approach (through the mouth and nasal sinuses) is often used to gain access to the pituitary gland. This surgical approach would not allow for access to the pineal gland, cerebellum, or hypothalamus.

Question 29

29. A client is postoperative day 1 following intracranial surgery. The nurse’s assessment
    reveals that the client’s level of consciousness (LOC) is slightly decreased compared with
    the day of surgery. What is the nurse’s best response to this assessment finding?
    A. Recognize that this may represent the peak of postsurgical cerebral edema.
    B. Alert the surgeon to the possibility of an intracranial hemorrhage.
    C. Understand that the surgery may have been unsuccessful.
    D. Recognize the need to refer the client to the palliative care team.

Answer 29

ANS: A
Rationale: Some degree of cerebral edema occurs after brain surgery; it tends to peak 24 to 36 hours after surgery, producing decreased responsiveness on the second postoperative day. As such, there is not necessarily any need to deem the surgery unsuccessful or to refer the client to palliative care. A decrease in LOC is not evidence of an intracranial hemorrhage. Any change in the client’s LOC should be reported to the healthcare provider.

Question 30

30. A school nurse is called to the playground where a 6-year-old girl has been found
    sitting unresponsive and “staring into space,” according to the playground supervisor.
    How would the nurse document the girl’s activity in her chart at school?
    A. Generalized seizure
    B. Absence seizure
    C. Focal seizure
    D. Unclassified seizure

Answer 30

ANS: B
Rationale: Staring episodes characterize an absence seizure, whereas focal seizures, generalized seizures, and unclassified seizures involve uncontrolled motor activity.

Question 31

31. A 35-year-old client with a history of traumatic brain injury has been admitted to the
    emergency department for a recent change in cognition. The client is steadily walking
    across the room, intermittently laughing loudly, and crying hysterically. What is the most
    likely condition associated with these signs?
    A. Dementia
    B. Status epilepticus
    C. Pseudobulbar affect
    D. Absence seizure

Answer 31

ANS: C
Rationale: The condition known as pseudobulbar affect involves inappropriate or exaggerated emotional expression, usually episodes of laughing or crying. It is associated with brain injury (e.g., stroke, traumatic brain injury, multiple sclerosis [MS], amyotrophic lateral sclerosis [ALS], AD, and Parkinson disease). The client’s age, gait, and new onset of symptoms make dementia an unlikely choice. Even new onset dementia typically occurs in a client over the age of 40 with a progressive /slow onset of symptoms which could impair their gait. Status epilepticus (acute prolonged seizure activity) can be defined as a seizure lasting 5 minutes or longer or serial seizures occurring without full recovery of consciousness between attacks. The client’s symptoms do not support this finding. Absence seizures usually involve staring episodes.

Question 32

32. The nurse is caring for a client who has undergone supratentorial removal of a
    pituitary mass. What medication would the nurse expect to administer prophylactically to
    prevent seizures in this client?
    A. Prednisone
    B. Dexamethasone
    C. Cafergot
    D. Phenytoin

Answer 32

ANS: D
Rationale: Anticonvulsant medication (phenytoin, levetiracetam) is often prescribed prophylactically for clients who have undergone supratentorial craniotomy because of the
high risk of seizures after this procedure. Prednisone and dexamethasone are steroids and do not prevent seizures. Cafergot is used in the treatment of migraines.

Question 33

33. A hospital client has experienced a seizure. In the immediate recovery period, what
    action best protects the client’s safety?
    A. Place the client in a side-lying position.
    B. Pad the client’s bed rails.
    C. Administer antianxiety medications as prescribed.
    D. Reassure the client and family members.

Answer 33

ANS: A
Rationale: To prevent complications, the client is placed in the side-lying position to facilitate drainage of oral secretions. Suctioning is performed, if needed, to maintain a patent airway and prevent aspiration. None of the other listed actions promotes safety during the immediate recovery period.

Question 34

34. A nurse is caring for a client who experiences debilitating cluster headaches. The
    client should be taught to take appropriate medications at what point in the course of the
    onset of a new headache?
    A. As soon as the client’s pain becomes unbearable
    B. As soon as the client senses the onset of symptoms
    C. Twenty to 30 minutes after the onset of symptoms
    D. When the client senses his or her symptoms peaking

Answer 34

ANS: B
Rationale: A migraine or a cluster headache in the early phase requires abortive medication therapy instituted as soon as possible. Delaying medication administration would lead to unnecessary pain.

Question 35

35. A 50-year-old female client reports a new onset, moderate headache after a lumbar
    puncture. What is the most likely condition that the client is experiencing?
    A. Cranial arteritis
    B. Cluster headache
    C. Paroxysmal hemicranias
    D. Secondary headache

Answer 35

ANS: D
Rationale: A secondary headache is a symptom associated with other causes, such as a brain tumor, an aneurysm, or lumbar puncture. Cranial arteritis is a cause of headache in the older population, reaching its greatest incidence in those older than 70 years of age. Inflammation of the cranial arteries is characterized by a severe headache localized in the region of the temporal arteries. A cluster headache is usually chronic and occurs more frequently in the male population. Paroxysmal hemicrania is a rare form of a primary headache that usually begins as an adult. It is usually severe, sudden, and can be linked to women with conditions like head trauma or a tumor on the pituitary gland.

Question 36

36. An adult client has sought care for the treatment of headaches that have become
    increasingly severe and frequent over the past several months. Which of the following
    questions addresses potential etiologic factors? Select all that apply.
    A. “Are you exposed to any toxins or chemicals at work?”
    B. “How would you describe your ability to cope with stress?”
    C. “What medications are you currently taking?”
    D. “When was the last time you were hospitalized?”
    E. “Does anyone else in your family struggle with headaches?”

Answer 36

ANS: A, B, C, E
Rationale: Headaches are multifactorial, and may involve medications, exposure to toxins, family history, and stress. Hospitalization is an unlikely contributor to headaches.

Question 37

37. A client with a history of epilepsy is admitted preoperatively for a surgical procedure
    and dies overnight. The health care provider suspects sudden unexpected death in
    epilepsy (SUDEP). Which condition is most likely related to SUDEP?
    A. Brain aneurysm
    B. Undiagnosed sepsis
    C. Cardiac abnormalities
    D. Seizure medication overdose

Answer 37

ANS: C
Rationale: Cardiac and respiratory abnormalities have been implicated in SUDEP deaths. SUDEP may or may not be related to a seizure event. There have been studies that suggest that clients have an irregular heart rhythm after seizure which causes the death. The client is preoperative, thus there is a low likelihood of undiagnosed sepsis. Clients with epilepsy, especially when their medications are no longer preventing seizures, are at serious risk for SUDEP. SUDEP is defined as nontraumatic, nondrowning unexpected death of a client with epilepsy. These events may be witnessed or unwitnessed and postmortem examination reveals no anatomical or toxicological cause of death.