Seizure (16 Questions)

1.1 Mr. Laurent, a 24-year-old patient with a history of epilepsy, is admitted for seizure monitoring. He has been stable since admission and is on prescribed medication.

His medical orders include:
Phenytoin (Dilantin) 100 mg PO bid
Lorazepam (Ativan) 2 mg IV PRN for seizure lasting more than 5 minutes

While on your evening shift, you hear the bed alarm and rush to his room. You find Mr. Laurent actively seizing in bed. He is having a tonic-clonic seizure: his body is stiff, shaking, his eyes are rolling upward, and there is drooling from his mouth. The padded side rails are already up.

Question:
What is your next priority intervention? *
1.2 The next day, Mr. Laurent, the same 24-year-old patient with epilepsy, begins to tremble and complains of a headache.

He appears confused, has difficulty with balance, and shows mild nystagmus.

Lab results indicate:
*Potassium: 3.2 mmol/L (reference range: 3.5-5 mmol/L)
*Phenytoin (Dilantin) level: 80 micromol/L (reference range: 40–80 micromol/L)

Question:
What do you suspect is happening to the patient? *
1.3 Mr. Laurent, now stabilized and seizure-free, is being prepared for discharge. He will continue phenytoin (Dilantin)therapy at home as per the neurologist’s orders. As part of your discharge teaching, you explain the importance of monitoring for long-term side effects of the medication.

During teaching, Mr. Laurent says, “I read somewhere this medication can affect my gums. Is that true?”

Question:
What is your best response regarding discharge teaching? *
2. You are the nurse caring for M. Tremblay, a 54-year-old patient admitted for investigation of syncope. While you are in the room taking vital signs, M. Tremblay suddenly loses consciousness, his body stiffens, and he begins to experience violent rhythmic muscle contractions. He is currently lying in his hospital bed.

Question:
What is your priority intervention? *
3. Mme Lefebvre, 32 years old, is brought to the ER in status epilepticus. She has been seizing for 15 minutes. You have established IV access.

Medical Order: Lorazepam (Ativan) 4 mg IV push STAT.

Question:
Which nursing consideration is most critical when administering this medication? *
4. M. Gagnon, a 65-year-old male with a history of epilepsy, has just finished a tonic-clonic seizure that lasted 2 minutes. He is now groggy, confused, and breathing deeply. His oxygen saturation is 94% on room air.

Question:
What is the most appropriate nursing action during this post-ictal phase? *
5. Mme Bouchard is hospitalized on the neurological unit. She rings the call bell and tells you, "I smell burning rubber, and I feel a very strange sense of déjà vu." She has a known history of temporal lobe epilepsy.

Question:
How do you interpret this finding and what is your immediate action? *
6. You are a triage nurse. Léo, a 3-year-old boy, is brought in by his mother. She states he had a fever of 39.5°C and then "shook all over" for about 3 minutes. Léo is now awake but irritable.

Medical Order: Acetaminophen 15mg/kg PO now.

Question:
The mother asks, "Should I put him in a cold ice bath next time to stop the fever fast?" What is your best response? *
7. M. Cloutier had a seizure in the hallway. You arrived midway through the event. The seizure has now stopped, and M. Cloutier is being transferred to his room.

Question:
Which information is most critical to include in your nursing notes regarding the event? *
8. Mme Roy is being discharged with a new prescription for Phenytoin (Dilantin) for long-term seizure control.

Question:
Which specific health teaching point must be included regarding this medication? *
9. A school nurse is observing Sophie, a 7-year-old student. The teacher reports that Sophie frequently "zones out" for 10-15 seconds, stares blankly, and sometimes smacks her lips, but immediately resumes her activity afterward without confusion.

Question:
What type of seizure activity do these symptoms suggest? *
10. M. Fortin is admitted for alcohol withdrawal. He begins having a generalized tonic-clonic seizure. You observe that his lips are becoming cyanotic.

Medical Order: Oxygen therapy PRN to keep Sat > 92%.

Question:
What is the appropriate method to deliver oxygen during the active seizure? *
11. Mme Dubois, a 22-year-old university student, is being discharged after being diagnosed with epilepsy. She asks about lifestyle changes to prevent future attacks.

Question:
Which factor should you identify as a major trigger for seizures that she should avoid? *
12. You are ambulating Mme Caron, a 58-year-old patient recovering from a stroke, down the hospital corridor. Suddenly, Mme Caron stops, grabs your arm tightly, and says, "I feel strange, I think I’m going to have an attack," referring to her history of seizures. Her knees begin to buckle.

Question:
What is your immediate intervention? *
13. You are in the dayroom with M. Lavoie, a 45-year-old patient. He is sitting in his wheelchair when he suddenly begins to experience tonic-clonic movements. He is currently secured with a waist belt, but his limbs are flailing violently.

Question:
What is the most appropriate nursing intervention? *
14. Bébé Mathis, an 8-month-old infant admitted for high fever, is being held in his mother's arms while she stands by the crib. Suddenly, Mathis' eyes roll back and he begins to twitch rhythmically. The mother screams, "He's shaking!" and clutches him tightly to her chest.

Question:
What is your priority instruction and action? *