NUR 138 COMPREHENSIVE EXAM UPDATED QUESTIONS
AND SOLUTIONS RATED A+
✔✔Seizure - ✔✔Periods of abnormal electrical discharges in the brain that cay cause
involuntary movement or behavior and sensory alterations.
✔✔Patho of seizures - ✔✔Result of abnormal excessive concurrent electrical
discharges in the brain. These cells can be triggered by enviornmental or physiologic
stimuli.
Focal Seizure- abnormal electrical activity is contained to a limited area of the brain.
Focal aware does not affect memory or awareness. Focal imparied can effect behavior,
awareness, or memory before, during, or after episode.
Generalized seizures- abnormal electrical discharge that originates from both
hemispheres of the brain. They can manifest a blank stare, brief muscle twitches, or
muscle stiffening.
Febrile Seizures (generalized)- occur in children as a result of a rapid temp raise above
102.2 rectal. Mostly seen in kids the ages of 6 months to 5 years
✔✔Risk factors/ Prevention for seizures - ✔✔Risk factors- Prevalence of epilepsy is
more common in low income families and in older, male children. Infants who were
SGA, underlying neuro issue, brain tumor, cerebral palsy, family history, depression,
ADHD, drug abuse, stroke, infection in the brain
Prevention- Everyone has a seizure threshold, if exceeded seizures may occur.
Identifying trigger can reduce occurence. General triggers include fatigue,
hypoglycemia, fever, alcohol, hyperventilation. Maintaining good self care is also
important for the theraputic regimen.
✔✔Manifestations of Seizures - ✔✔Focal aware- no alteration of consiousness,
recurrent muscle contraction of the face or parts of the body, tingling, numbness,
hallucinations, tachycardia, flushing, fear or anger
Focal Impaired- often proceed with an aura, last 30 seconds to 2 mins, impaired
consciousness happens for several hours, lip smacking, aimless walking, picking at
clothes, amnesia
Generalized- impaired LOC, sudden cessation of all motor activity, black stare, most
common in kids, usually last 5-10 seconds, no aura, sudden loss of LOC and consists of
tonic and clonic phases
Tonic phase: sharp tonic muscle contraction force air out of lungs, loss of postural
control, muscles are rigid, urinary/ bowel incontinence, breathing ceases, cyanosis,
pupils are fixed and dilated
, Clonic phase- alternating contraction and relaxation of muscles in all limbs,
hyperventilation, eyes roll back, froth from mouth, phase subsides gradually, over 60-90
seconds
Epilepsy- continuous seizure activity, most often tonic-clonic, risk for hypoxia, acidosis,
hypoglycemia, hyperthermia, and exhaustion
✔✔Clinical therapy for seizures - ✔✔Focal aware- antiseizure medications, maintain
safety during seizure, assess exact manifestations and document them fully, gamma
knife procedure, laser ablation, vagal nerve stimulation
Focal impaired- antiseizure meds, maintain safety, vagal stimulation, resection of parts
of brain
Generalized- antiseizure meds, maintain safety, may not be able to drive, helmets, do
not restrain, pad bed rails
Clonic phase- diazepam/lorazepam/pheonobarbitol
Epilepsy- maintain airway, 50% dextrose, antiseizure and general anasthesia may be
administered
✔✔Phenytoin (Dilantin) - ✔✔This drug reduces the spread of electrical discharge to
control seizures.
Considerations- monitor VS (bp, hr,rr) monitor for CNS side effects (blurred vision,
slurred speech, confusion), gingival hyperplasia, need vitamin D rich diet, monitor
serum calcium due to bone demineralization
Ginkgo and St Johns wort decrease effectiveness of seizure medications
✔✔Nursing Process: Seizure - ✔✔Assessment: history ( description of seizures),
physical exam (LOC, hypoxia, specific seizure activity, VS, neuro check, ensure safety)
Diagnosis: ineffective breathing pattern, risk for trauma, ineffective airway clearence,
anxiety, acute confusion
Planning: goals will focus on safety, maintaining airway patency, administering meds,
provide emotional support, acute/long term management
Implementation: place nothing in patients mouth, do not restrict, protect from harm,
medical alert bracelets, side lying, discuss triggers, suction at bedside, monitor
adequate oxygenation, administer IV meds carefully, have family/patient express fears,
provide support for patient and family, keto diet
AND SOLUTIONS RATED A+
✔✔Seizure - ✔✔Periods of abnormal electrical discharges in the brain that cay cause
involuntary movement or behavior and sensory alterations.
✔✔Patho of seizures - ✔✔Result of abnormal excessive concurrent electrical
discharges in the brain. These cells can be triggered by enviornmental or physiologic
stimuli.
Focal Seizure- abnormal electrical activity is contained to a limited area of the brain.
Focal aware does not affect memory or awareness. Focal imparied can effect behavior,
awareness, or memory before, during, or after episode.
Generalized seizures- abnormal electrical discharge that originates from both
hemispheres of the brain. They can manifest a blank stare, brief muscle twitches, or
muscle stiffening.
Febrile Seizures (generalized)- occur in children as a result of a rapid temp raise above
102.2 rectal. Mostly seen in kids the ages of 6 months to 5 years
✔✔Risk factors/ Prevention for seizures - ✔✔Risk factors- Prevalence of epilepsy is
more common in low income families and in older, male children. Infants who were
SGA, underlying neuro issue, brain tumor, cerebral palsy, family history, depression,
ADHD, drug abuse, stroke, infection in the brain
Prevention- Everyone has a seizure threshold, if exceeded seizures may occur.
Identifying trigger can reduce occurence. General triggers include fatigue,
hypoglycemia, fever, alcohol, hyperventilation. Maintaining good self care is also
important for the theraputic regimen.
✔✔Manifestations of Seizures - ✔✔Focal aware- no alteration of consiousness,
recurrent muscle contraction of the face or parts of the body, tingling, numbness,
hallucinations, tachycardia, flushing, fear or anger
Focal Impaired- often proceed with an aura, last 30 seconds to 2 mins, impaired
consciousness happens for several hours, lip smacking, aimless walking, picking at
clothes, amnesia
Generalized- impaired LOC, sudden cessation of all motor activity, black stare, most
common in kids, usually last 5-10 seconds, no aura, sudden loss of LOC and consists of
tonic and clonic phases
Tonic phase: sharp tonic muscle contraction force air out of lungs, loss of postural
control, muscles are rigid, urinary/ bowel incontinence, breathing ceases, cyanosis,
pupils are fixed and dilated
, Clonic phase- alternating contraction and relaxation of muscles in all limbs,
hyperventilation, eyes roll back, froth from mouth, phase subsides gradually, over 60-90
seconds
Epilepsy- continuous seizure activity, most often tonic-clonic, risk for hypoxia, acidosis,
hypoglycemia, hyperthermia, and exhaustion
✔✔Clinical therapy for seizures - ✔✔Focal aware- antiseizure medications, maintain
safety during seizure, assess exact manifestations and document them fully, gamma
knife procedure, laser ablation, vagal nerve stimulation
Focal impaired- antiseizure meds, maintain safety, vagal stimulation, resection of parts
of brain
Generalized- antiseizure meds, maintain safety, may not be able to drive, helmets, do
not restrain, pad bed rails
Clonic phase- diazepam/lorazepam/pheonobarbitol
Epilepsy- maintain airway, 50% dextrose, antiseizure and general anasthesia may be
administered
✔✔Phenytoin (Dilantin) - ✔✔This drug reduces the spread of electrical discharge to
control seizures.
Considerations- monitor VS (bp, hr,rr) monitor for CNS side effects (blurred vision,
slurred speech, confusion), gingival hyperplasia, need vitamin D rich diet, monitor
serum calcium due to bone demineralization
Ginkgo and St Johns wort decrease effectiveness of seizure medications
✔✔Nursing Process: Seizure - ✔✔Assessment: history ( description of seizures),
physical exam (LOC, hypoxia, specific seizure activity, VS, neuro check, ensure safety)
Diagnosis: ineffective breathing pattern, risk for trauma, ineffective airway clearence,
anxiety, acute confusion
Planning: goals will focus on safety, maintaining airway patency, administering meds,
provide emotional support, acute/long term management
Implementation: place nothing in patients mouth, do not restrict, protect from harm,
medical alert bracelets, side lying, discuss triggers, suction at bedside, monitor
adequate oxygenation, administer IV meds carefully, have family/patient express fears,
provide support for patient and family, keto diet
