C HAPTER 9: T ONIC -C LONIC S EIZURES
1. What is the most appropriate nursing action when a child is in the tonic phase of
a generalized tonic-clonic seizure?
a. Guide the child to the floor if he is standing and go for help.
b. Turn the childs body on his side.
c. Place a padded tongue blade between the teeth.
d. Quickly slip soft restraints on the childs wrists.
ANS: B
Positioning the child on his side will prevent aspiration. The child should be
placed on a soft surface if he is not in bed; however, it would be inappropriate
to leave the child during the seizure. Nothing should be inserted into the
childs mouth during a seizure to prevent injury to the mouth, gums, or teeth.
Restraints could cause injury. Sharp objects and furniture should be moved
out of the way to prevent injury.
2. After a tonic-clonic seizure, it would not be unusual for a child to display which
symptom?
a. Irritability and hunger
b. Lethargy and confusion
c. Nausea and vomiting
d. Nervousness and excitability
ANS: B
In the period after a tonic-clonic seizure, the child may be confused and
lethargic. Some children may sleep for a period of time. Neither irritability
, nor hunger is typical of the period after a tonic-clonic seizure. Nausea and
vomiting are not expected reactions in the postictal period. The child will
more likely be confused and lethargic after a tonic-clonic seizure.
3. What should the nurse teach parents when the child is taking phenytoin (Dilantin)
to control seizures?
a. The child should use a soft toothbrush and floss his teeth after every meal.
b. The child will require monitoring of his liver function while taking this
medication.
c. Dilantin should be taken with food because it causes gastrointestinal
distress.
d. The medication can be stopped when the child has been seizure free for 1
month.
ANS: A
A side effect of Dilantin is gingival hyperplasia. Good oral hygiene will
minimize this adverse effect. The child receiving Depakene (valproic acid)
should have liver function studies because this anticonvulsant may cause
hepatic dysfunction. Dilantin has not been found to cause gastrointestinal
upset. The medication can be taken without food. Anticonvulsants should
never be stopped suddenly or without consulting the physician. Such action
could result in seizure activity.
4. A child is brought to the emergency department in generalized tonic -clonic status
epilepticus. Which medication should the nurse expect to be given initially in this
situation?
a. Clorazepate dipotassium (Tranxene)
b. Fosphenytoin (Cerebyx)
c. Phenobarbital
d. Lorazepam (Ativan)
1. What is the most appropriate nursing action when a child is in the tonic phase of
a generalized tonic-clonic seizure?
a. Guide the child to the floor if he is standing and go for help.
b. Turn the childs body on his side.
c. Place a padded tongue blade between the teeth.
d. Quickly slip soft restraints on the childs wrists.
ANS: B
Positioning the child on his side will prevent aspiration. The child should be
placed on a soft surface if he is not in bed; however, it would be inappropriate
to leave the child during the seizure. Nothing should be inserted into the
childs mouth during a seizure to prevent injury to the mouth, gums, or teeth.
Restraints could cause injury. Sharp objects and furniture should be moved
out of the way to prevent injury.
2. After a tonic-clonic seizure, it would not be unusual for a child to display which
symptom?
a. Irritability and hunger
b. Lethargy and confusion
c. Nausea and vomiting
d. Nervousness and excitability
ANS: B
In the period after a tonic-clonic seizure, the child may be confused and
lethargic. Some children may sleep for a period of time. Neither irritability
, nor hunger is typical of the period after a tonic-clonic seizure. Nausea and
vomiting are not expected reactions in the postictal period. The child will
more likely be confused and lethargic after a tonic-clonic seizure.
3. What should the nurse teach parents when the child is taking phenytoin (Dilantin)
to control seizures?
a. The child should use a soft toothbrush and floss his teeth after every meal.
b. The child will require monitoring of his liver function while taking this
medication.
c. Dilantin should be taken with food because it causes gastrointestinal
distress.
d. The medication can be stopped when the child has been seizure free for 1
month.
ANS: A
A side effect of Dilantin is gingival hyperplasia. Good oral hygiene will
minimize this adverse effect. The child receiving Depakene (valproic acid)
should have liver function studies because this anticonvulsant may cause
hepatic dysfunction. Dilantin has not been found to cause gastrointestinal
upset. The medication can be taken without food. Anticonvulsants should
never be stopped suddenly or without consulting the physician. Such action
could result in seizure activity.
4. A child is brought to the emergency department in generalized tonic -clonic status
epilepticus. Which medication should the nurse expect to be given initially in this
situation?
a. Clorazepate dipotassium (Tranxene)
b. Fosphenytoin (Cerebyx)
c. Phenobarbital
d. Lorazepam (Ativan)
