Chapter 63: Seizures Flashcards
A 34-year-old woman presents to the emergency department after experiencing a sudden onset of involuntary movements, sensory phenomena, and confusion. She has a history of recurring seizures. The nurse suspects seizure disorder. What is the most accurate definition of seizure disorder (epilepsy)?
A) A seizure that results from a metabolic imbalance and resolves once the imbalance is corrected.
B) A group of neurologic diseases marked by recurring seizures with no underlying cause.
C) A sudden abnormal discharge of neurons in the brain that happens only once.
D) A disorder marked by uncontrolled seizures that only occur during sleep.
B) A group of neurologic diseases marked by recurring seizures with no underlying cause.
Rationale: Seizure disorder (epilepsy) is defined as a group of neurologic diseases characterized by recurring seizures without an apparent underlying cause. Seizures from systemic or metabolic problems are not considered seizure disorder if they stop once the underlying issue is corrected, as stated in the provided text.
A nurse is educating a patient diagnosed with seizure disorder about the frequency and causes of seizures. The nurse explains that seizures may occur with underlying disorders, but they do not qualify as seizure disorder unless certain criteria are met. Which statement by the patient indicates an understanding of this concept?
A) “I will always have seizures even if my underlying problem is treated.”
B) “Seizures from fever are always considered seizure disorder.”
C) “Seizure disorder is diagnosed after one seizure event.”
D) “Seizures related to metabolic problems do not qualify as seizure disorder if they stop after treatment.”
D) “Seizures related to metabolic problems do not qualify as seizure disorder if they stop after treatment.”
Rationale: The text specifies that seizures resulting from systemic or metabolic problems are not classified as seizure disorder if they stop when the underlying problem is corrected. This statement demonstrates a clear understanding of the difference between seizures related to conditions and true seizure disorder.
A 45-year-old male is diagnosed with seizure disorder after experiencing two unprovoked seizures more than 24 hours apart. Which of the following statements best explains the diagnosis criteria for seizure disorder?
A) Seizure disorder is diagnosed after experiencing one unprovoked seizure.
B) Seizure disorder is confirmed only if the seizures are caused by an underlying condition.
C) Seizure disorder is diagnosed after two or more seizures that occur more than 24 hours apart, with no underlying cause.
D) Seizure disorder can be diagnosed if seizures occur only during the day.
C) Seizure disorder is diagnosed after two or more seizures that occur more than 24 hours apart, with no underlying cause.
Rationale: As mentioned in the text, the diagnostic criteria for seizure disorder include having two or more seizures that are more than 24 hours apart and not attributable to an underlying cause. This distinguishes seizure disorder from other types of seizures that may result from a reversible condition.
A nurse is assessing a patient experiencing a generalized-onset seizure. The patient exhibits bilateral, synchronous neural discharges and impaired consciousness for several minutes. Which of the following best describes this type of seizure?
A) A seizure that starts in both sides of the brain and is characterized by bilateral motor or nonmotor movements.
B) A seizure originating in one hemisphere of the brain, leading to unilateral motor movements.
C) A seizure limited to nonmotor movements, such as loss of sensation or emotional disturbances.
D) A seizure that only affects the motor functions of one side of the body.
A) A seizure that starts in both sides of the brain and is characterized by bilateral motor or nonmotor movements.
Rationale: Generalized-onset seizures start over wide areas of both sides of the brain and are characterized by bilateral, synchronous neural discharges. These seizures can involve motor or nonmotor movements, and they typically cause impaired consciousness for a few seconds to several minutes. This description aligns with the provided text.
A nurse is educating a patient diagnosed with generalized-onset seizures about the nature of the condition. Which of the following statements by the patient indicates an accurate understanding of generalized-onset seizures?
A) “Generalized-onset seizures are always caused by an underlying metabolic disorder.”
B) “I will experience seizures that begin in one hemisphere of my brain and affect only one side of my body.”
C) “Generalized-onset seizures involve both sides of the brain and can cause motor or nonmotor movements.”
D) “I will only experience motor seizures that involve one side of my body during a generalized-onset seizure.”
C) “Generalized-onset seizures involve both sides of the brain and can cause motor or nonmotor movements.”
Rationale: Generalized-onset seizures begin in both sides of the brain, as the text explains, and can involve motor or nonmotor movements. The other options are incorrect as generalized seizures involve both hemispheres and may have either motor or nonmotor manifestations.
A 28-year-old patient with a history of generalized-onset seizures reports a seizure episode characterized by bilateral, jerking movements and a loss of consciousness lasting for several minutes. Based on the description, which type of seizure is most likely occurring?
A) Focal-onset seizure with impaired awareness
B) Generalized-onset nonmotor seizure
C) Generalized-onset motor seizure
D) Focal-onset seizure with retained awareness
C) Generalized-onset motor seizure
Rationale: The description of bilateral, jerking movements and impaired consciousness lasting for several minutes indicates a generalized-onset motor seizure. Generalized motor seizures involve bilateral movements, and the loss of consciousness is a hallmark feature of these types of seizures, as outlined in the text.
A nurse is assessing a patient who is recovering from a tonic-clonic seizure. The patient reports feeling extremely tired and sore after the seizure and mentions that they do not remember the event. Which phase of the seizure is the patient most likely experiencing?
A) Ictal phase
B) Postictal phase
C) Preictal phase
D) Aura phase
B) Postictal phase
Rationale: The postictal phase occurs after the seizure ends and is characterized by muscle soreness, fatigue, and sometimes confusion or a prolonged period of sleep. The patient’s lack of memory of the seizure is also a hallmark of the postictal phase. The other phases (ictal, preictal, and aura) occur before or during the seizure itself.
A nurse is educating a patient’s family members about the signs and symptoms of a tonic-clonic seizure. Which of the following should the nurse include as a common manifestation during the tonic phase?
A) Jerking movements of the extremities
B) Loss of consciousness and falling to the ground
C) Muscle stiffness lasting for 10 to 20 seconds
D) Excessive salivation and incontinence
C) Muscle stiffness lasting for 10 to 20 seconds
Rationale: During the tonic phase of a tonic-clonic seizure, the patient experiences muscle stiffness, which lasts for 10 to 20 seconds. This is followed by the clonic phase, characterized by jerking movements. The other symptoms (jerking movements, loss of consciousness, salivation, and incontinence) occur later in the seizure process.
A 40-year-old patient is admitted to the hospital following a tonic-clonic seizure. The nurse notes that the patient is cyanotic, has excessive salivation, and is unable to recall the seizure. What is the most likely explanation for the patient’s cyanosis?
A) Decreased oxygenation due to muscle stiffening and respiratory difficulty during the seizure
B) An allergic reaction to medications taken during the postictal phase
C) A side effect of the seizure medication causing respiratory depression
D) Dehydration resulting in poor circulation
A) Decreased oxygenation due to muscle stiffening and respiratory difficulty during the seizure
Rationale: Cyanosis during a tonic-clonic seizure is typically caused by decreased oxygenation, which occurs due to muscle stiffening (tonic phase) and respiratory difficulty. The body may have difficulty breathing normally during the seizure, leading to oxygen deprivation. The other options are less likely to be related to the cause of cyanosis in this context.
A nurse is caring for a patient who has just experienced a tonic-clonic seizure. Which of the following interventions should the nurse prioritize immediately following the seizure?
A) Offer the patient food and drink to prevent dehydration.
B) Ensure the patient’s airway is clear and assess for breathing.
C) Administer the prescribed antiepileptic medication.
D) Provide education about avoiding triggers for seizures.
B) Ensure the patient’s airway is clear and assess for breathing.
Rationale: After a tonic-clonic seizure, it is crucial to ensure the patient’s airway is clear and to assess for breathing, as the patient may experience respiratory difficulties during and immediately following the seizure. This is the highest priority intervention to prevent airway obstruction or other respiratory complications. The other actions (administering medications, offering food, or providing education) are important but should not take precedence over ensuring airway patency.
A 60-year-old male patient with a history of tonic-clonic seizures presents to the clinic for follow-up care. He asks the nurse about the duration of his postictal phase. Which of the following statements by the nurse is most accurate based on the text provided?
A) “You will likely feel tired and sore, but this phase usually only lasts a few minutes.”
B) “The postictal phase can last for several hours, and you may feel tired or confused for days.”
C) “The postictal phase is very brief, typically lasting less than 30 minutes.”
D) “You should not experience any symptoms after the seizure ends.”
B) “The postictal phase can last for several hours, and you may feel tired or confused for days.”
Rationale: The postictal phase can last for several hours, with the patient often feeling tired, sore, and confused. In some cases, patients do not feel normal for several days after a tonic-clonic seizure. This phase is marked by fatigue and muscle soreness, as well as a lack of memory of the seizure.
A nurse is educating a family member about the possible complications of tonic-clonic seizures. Which of the following should the nurse include as a potential complication during a tonic-clonic seizure?
A) Dehydration from excessive sweating
B) Decreased blood pressure during the clonic phase
C) Increased heart rate during the tonic phase
D) Tongue or cheek biting
D) Tongue or cheek biting
Rationale: During a tonic-clonic seizure, patients may experience tongue or cheek biting due to involuntary muscle contractions and jaw clenching. The other complications listed (dehydration, blood pressure changes, and increased heart rate) are not commonly associated with the tonic-clonic seizure phases as described in the provided text.
A 32-year-old patient is diagnosed with tonic seizures, which are described as causing sudden stiff movements in the body. Which of the following is a characteristic feature of tonic seizures?
A) The seizure usually occurs while the patient is awake and involves rhythmic limb jerking.
B) The patient remains aware during the seizure, and the seizure typically lasts less than 20 seconds.
C) The seizure causes loss of consciousness followed by clonic movements of the extremities.
D) The seizure involves a sudden loss of muscle tone and may cause the patient to fall.
B) The patient remains aware during the seizure, and the seizure typically lasts less than 20 seconds.
Rationale: Tonic seizures are characterized by sudden stiffening movements due to increased tone in the extensor muscles, and they usually last less than 20 seconds. Patients typically remain aware during the seizure, and the seizure most often occurs during sleep. The other options do not accurately describe tonic seizures as they focus on other seizure types.
A nurse is educating a family member about clonic seizures. Which of the following characteristics should the nurse include in the teaching?
A) Clonic seizures cause rhythmic limb jerking and may or may not be symmetric.
B) Clonic seizures begin with increased muscle tone and cause stiffening of the body.
C) Clonic seizures cause a sudden loss of muscle tone and typically last for several minutes.
D) Clonic seizures cause patients to remain aware and fully conscious during the episode.
A) Clonic seizures cause rhythmic limb jerking and may or may not be symmetric.
Rationale: Clonic seizures are characterized by rhythmic limb jerking that may or may not be symmetric. These seizures begin with a loss of awareness and are distinct from tonic seizures, which involve stiffening, and atonic seizures, which cause loss of tone. The other options do not accurately describe clonic seizures.
A 45-year-old patient with generalized-onset motor seizures reports experiencing episodes where they suddenly lose muscle tone and fall to the ground, but the seizures are brief and last only a few seconds. The patient is also confused for a brief time afterward. Which of the following types of seizures does this describe?
A) Tonic seizure
B) Clonic seizure
C) Atonic seizure
D) Myoclonic seizure
C) Atonic seizure
Rationale: Atonic seizures, also known as drop attacks, are characterized by a sudden and brief loss of muscle tone, which can result in the patient falling to the ground. These seizures last only a few seconds, and there is brief postictal confusion. Atonic seizures often require protective helmets due to the risk of head injury. The other seizure types do not match the characteristics described.
A nurse is caring for a patient with generalized-onset tonic seizures that occur during sleep. The nurse understands that the patient is at risk for which of the following complications due to the nature of the seizures?
A) Dehydration due to excessive sweating during seizures
B) Falling and injury if the patient is standing at the time of the seizure
C) Respiratory arrest due to tonic muscle contraction
D) Prolonged postictal confusion leading to coma
B) Falling and injury if the patient is standing at the time of the seizure
Rationale: Tonic seizures cause sudden stiffening of the body, and since they most often occur during sleep, the patient may fall if standing at the time of the seizure. The other options do not align with the characteristics of tonic seizures as described in the text.
A nurse is preparing to educate a patient diagnosed with atonic seizures about the need for safety precautions. Which of the following should the nurse include in the teaching plan?
A) “You will need to avoid high-impact activities to prevent fractures.”
B) “You will need to wear a protective helmet to minimize the risk of head injury.”
C) “You should engage in regular aerobic exercise to strengthen your muscles.”
D) “There is no need for special precautions because the seizures are brief.”
B) “You will need to wear a protective helmet to minimize the risk of head injury.”
Rationale: Atonic seizures (drop attacks) involve a sudden loss of muscle tone, which increases the risk of falling and head injury. To prevent injury, it is recommended that patients wear protective helmets. The other options are not specifically relevant to preventing injury in patients with atonic seizures.
A 6-year-old girl is brought to the clinic by her parents for evaluation of episodes of staring and unresponsiveness. The episodes last for about 10 seconds and occur multiple times a day. The child does not respond when spoken to during the episodes but recovers quickly afterward. Based on these findings, which of the following is the most likely diagnosis?
A) Tonic-clonic seizure
B) Atonic seizure
C) Absence seizure
D) Complex partial seizure
C) Absence seizure
Rationale: The child’s presentation of brief staring spells, lack of response to verbal stimuli, and quick recovery is characteristic of absence seizures, which are most common in children and last less than 20 seconds. These seizures are often unnoticed due to their brief duration. The other seizure types (tonic-clonic, atonic, and complex partial) present with different characteristics and symptoms.
A 10-year-old child is diagnosed with atypical absence seizures. The parents are concerned because they have noticed the child engaging in repetitive finger movements and eye blinking during the episodes. Which of the following is true regarding atypical absence seizures?
A) Atypical absence seizures usually last less than 10 seconds.
B) Atypical absence seizures begin and end abruptly, with no gradual changes in the seizure activity.
C) Atypical absence seizures often last up to 30 seconds and may be associated with automatisms.
D) Atypical absence seizures are not associated with cognitive problems or behavioral changes.
C) Atypical absence seizures often last up to 30 seconds and may be associated with automatism.
Rationale: Atypical absence seizures typically last longer than typical absence seizures, up to 30 seconds, and can involve automatisms such as eye blinking, jerking movements of the lips, or repetitive finger movements. These seizures may have a gradual onset and end, and if the patient has existing cognitive problems, the seizure activity may be difficult to distinguish from usual behavior.
A 7-year-old girl is experiencing absence seizures that often go unnoticed because of their brief duration and the subtle nature of the symptoms. What is the most likely reason why these seizures might not be detected?
A) The child remains conscious during the seizure.
B) The child does not show any physical signs of the seizure.
C) The seizures last for less than 10 to 20 seconds.
D) The child only experiences the seizure during sleep.
C) The seizures last for less than 10 to 20 seconds.
Rationale: Absence seizures are typically brief, lasting less than 10 to 20 seconds, and often go unnoticed because of their subtle nature. The child remains conscious but unresponsive, which makes it easy to mistake the seizure for daydreaming. The brief duration and lack of physical signs also contribute to the difficulty in detecting the seizure.
A nurse is educating the parents of a 5-year-old child diagnosed with absence seizures. Which of the following statements is most accurate regarding the potential course of absence seizures?
A) Absence seizures will always resolve by the time the child reaches adolescence.
B) Absence seizures are more common in boys and usually start between ages 10 and 12.
C) Absence seizures typically begin between the ages of 4 and 8 and may stop as the child matures.
D) Absence seizures are most likely to evolve into tonic-clonic seizures as the child grows older.
C) Absence seizures typically begin between the ages of 4 and 8 and may stop as the child matures.
Rationale: Absence seizures typically begin between ages 4 and 8 and are more common in girls. In many cases, these seizures may stop as the child matures. However, some children may experience these seizures into adulthood or may transition into another type of seizure. The other options are inaccurate based on the typical course of absence seizures.
An 8-year-old child with a history of atypical absence seizures is being evaluated for cognitive problems. The nurse should consider that the child’s cognitive difficulties may make it difficult to distinguish seizure activity from what?
A) Daydreaming or normal behavior
B) Tonic-clonic seizures
C) Sleep disturbances
D) Hyperactivity and impulsiveness
A) Daydreaming or normal behavior
Rationale: Atypical absence seizures may be difficult to differentiate from daydreaming or normal behavior, especially in children with existing cognitive problems. The child may appear to be engaging in normal activities or behavior, which can make the seizure activity go unnoticed. The other options do not fit the scenario as described.
A 12-year-old child with atypical absence seizures continues to experience episodes into adolescence. Which of the following is a characteristic of atypical absence seizures that may persist into adulthood?
A) The seizures always resolve by adolescence.
B) The seizures typically stop suddenly without warning.
C) The seizures may evolve into generalized tonic-clonic seizures.
D) The seizures often include additional symptoms like automatisms, such as lip jerking or finger movements.
D) The seizures often include additional symptoms like automatisms, such as lip jerking or finger movements.
Rationale: Atypical absence seizures often include additional symptoms such as automatisms, including lip jerking, eye blinking, or repetitive finger movements. These seizures may continue into adulthood and have a more gradual onset and end compared to typical absence seizures. The other options are not consistent with the characteristics of atypical absence seizures.
A 40-year-old patient is experiencing a focal-onset seizure characterized by sudden, unexplainable feelings of joy and seeing things that are not real. The patient remains conscious and aware throughout the episode. Which of the following terms best describes this type of seizure?
A) Focal impaired awareness seizure
B) Focal awareness seizure
C) Generalized tonic-clonic seizure
D) Atonic seizure
B) Focal awareness seizure
Rationale: A focal awareness seizure is characterized by the patient being conscious and alert but experiencing unusual feelings or sensations, such as joy or hallucinations. The patient is aware of their surroundings but may perceive things that are not real. The other options do not fit the description of the seizure type.
A patient experiences rhythmic jerking of the limbs as a result of a focal-onset seizure. The neurologist suspects the discharging focus is in the motor cortex. Which of the following types of motor focal seizures is most likely occurring?
A) Atonic seizure
B) Clonic seizure
C) Myoclonic seizure
D) Tonic seizure
B) Clonic seizure
Rationale: Clonic seizures are characterized by rhythmic jerking movements, typically in the limbs. These seizures result from discharges in the motor cortex. Atonic seizures involve loss of muscle tone, tonic seizures involve sustained stiffening, and myoclonic seizures involve rapid, irregular jerking.
A patient experiences a focal-onset seizure with a sudden loss of awareness and engages in repetitive, purposeless actions, such as lip smacking and picking at clothes. The patient’s eyes are open, but they cannot interact with others. After the seizure, they cannot recall their actions. Which of the following is the most likely type of seizure?
A) Focal impaired awareness seizure
B) Focal awareness seizure
C) Absence seizure
D) Generalized tonic-clonic seizure
A) Focal impaired awareness seizure
Rationale: Focal impaired awareness seizures are characterized by a loss of consciousness or a change in awareness, leading to a dreamlike state. The patient may engage in repetitive, purposeless actions, such as lip smacking or picking at clothes, and they will not remember these actions afterward.
A 25-year-old woman experiences focal-onset seizures involving a sensation of nausea and a feeling of sudden sadness, but she is fully conscious and alert throughout the episode. Which of the following types of seizures best describes her condition?
A) Focal awareness seizure
B) Focal impaired awareness seizure
C) Generalized tonic-clonic seizure
D) Atonic seizure
A) Focal awareness seizure
Rationale: Focal awareness seizures are characterized by unusual feelings or sensations while the patient remains conscious and alert. The patient may experience emotions like sadness or physical sensations, such as nausea, but they maintain full awareness during the episode.
A patient with a focal-onset seizure experiences brief, irregular jerking movements in their arm and leg. This type of seizure is most likely caused by abnormal electrical discharges in which area of the brain?
A) Temporal lobe
B) Occipital lobe
C) Motor cortex
D) Parietal lobe
C) Motor cortex
Rationale: Motor seizures, such as those involving rhythmic jerking or brief, irregular movements, are typically caused by abnormal electrical discharges in the motor cortex. The motor cortex controls voluntary movements of the limbs, so discharges in this area can lead to motor manifestations like jerking.
A 35-year-old patient experiences focal-onset seizures that result in emotional manifestations, including sudden feelings of anger and fear. The patient is aware during the seizure but cannot explain the intensity of the emotions. Which of the following would be the most likely underlying cause of these seizures?
A) Temporal lobe dysfunction
B) Occipital lobe dysfunction
C) Parietal lobe dysfunction
D) Frontal lobe dysfunction
A) Temporal lobe dysfunction
Rationale: The temporal lobe is often involved in seizures that cause emotional manifestations, such as sudden feelings of anger, fear, or other intense emotions. These emotional disturbances are commonly seen in focal seizures originating from the temporal lobe, especially in cases of focal awareness seizures.
A patient with focal-onset seizures exhibits strange, purposeless behavior, such as repeatedly rubbing their hands together and picking at their clothes. What is the medical term for these types of actions during a seizure?
A) Automatisms
B) Myoclonus
C) Ataxia
D) Dysphagia
A) Automatisms
Rationale: Automatisms are repetitive, purposeless actions, such as lip smacking, hand rubbing, or picking at clothes, that may occur during a focal-onset seizure. These behaviors are often associated with focal seizures, particularly those with impaired awareness.
A nurse is educating a family about the possible behaviors exhibited during a focal impaired awareness seizure. Which of the following should the nurse include in the teaching?
A) The patient remains fully aware and can interact with others.
B) The patient will be unresponsive and may lose consciousness.
C) The patient may perform purposeful activities, such as counting coins, but will have no memory of the activity afterward.
D) The patient’s body will stiffen and remain rigid throughout the seizure.
C) The patient may perform purposeful activities, such as counting coins, but will have no memory of the activity afterward.
Rationale: In focal impaired awareness seizures, the patient may appear to perform purposeful activities, like counting coins or picking up items, but they are not consciously aware of their actions. They typically do not remember the activities performed during the seizure once it ends.
