Multiple Choice
A pt asks you what Epilepsy means. Which response is most accurate?
A. Epilepsy only happens after a head injury.
B. It’s a chronic condition where a person has recurrent, unprovoked seizures.
C. It means every seizure will progress into a tonic-clonic event.
D. It’s caused only by low blood sugar levels.
Correct Answer
B
Rationale: Epilepsy = recurrent, unprovoked seizures due to chronic neurological dysfunction. Causes vary; genetics, structural lesions, metabolic issues, infections, etc.
Which findings can occur during the postictal phase of a tonic-clonic seizure?
A. Confusion
B. Headache
C. Cyanosis
D. Temporary weakness (Todd’s paralysis)
E. Extreme fatigue/exhaustion
Correct Answers: A, B, D, E
A. Confusion — YES. Postictal confusion is very common after generalized seizures.
B. Headache — YES. Due to intense neuronal activity and muscle strain.
C. Cyanosis — NO. This happens during the ictal tonic phase, not postictal.
D. Temporary weakness — YES. Todd’s paralysis is classic in the postictal phase.
E. Extreme fatigue — YES. Muscle exhaustion + CNS recovery.
A focal aware seizure can include sensory changes, but the patient remains fully conscious throughout the event.
True
Focal aware seizures (simple partial) start in one hemisphere and the patient stays awake and able to recall the event. Sensory changes like tingling, smells, or visual distortions are common. The key feature is preserved awareness.
What are common seizure triggers, and why do they lower the seizure threshold?
Common triggers include sleep deprivation, stress, alcohol use, missed AED doses, flashing lights, illness/fever, electrolyte imbalances (especially hyponatremia), hypoglycemia, hormonal changes, caffeine, and certain medications.
They lower the seizure threshold by increasing neuronal excitability or decreasing inhibitory control (↓GABA, ↑glutamate), making abnormal electrical firing more likely.
A patient reports “seeing flashing lights and smelling something burning” right before their seizure. Which term best describes this?
A. Prodromal phase
B. Aura
C. Postictal phase
D. Automatism
Correct Answer:
B
Rationale
Auras are focal sensory warnings right before a seizure; visual changes, smells, tastes, fear, déjà vu, etc.
Prodromal occurs hours–days earlier
postictal is after
automatism is motor behavior.
Which nursing actions are appropriate during the ictal phase of a seizure?
A. Turn the patient onto their side
B. Insert a padded tongue blade
C. Time the duration of the seizure
D. Loosen restrictive clothing
E. Hold the patient down to prevent injury
Correct Answers: A, C, D
A. Side-lying — YES. Helps maintain airway & prevent aspiration.
B. Tongue blade — NO. Never put anything in the patient’s mouth.
C. Time the seizure — YES. Critical to identify progression to status epilepticus (>5 mins).
D. Loosen clothing — YES. Prevents obstruction and optimizes breathing.
E. Do NOT restrain — NO. This increases risk of fractures and injury.
Atonic seizures put patients at high risk for head injury because of the sudden loss of muscle tone.
True
Atonic seizures cause an abrupt loss of muscle tone, leading to sudden collapse, slumping, or falling. This puts patients at major risk for hitting their head, which is why they may need helmets or additional safety precautions.
Describe the major types of seizures and how they differ in presentation.
Focal Aware (Simple Partial): patient is awake and aware; symptoms localized (twitching, tingling, déjà vu).
Focal Impaired Awareness (Complex Partial): altered awareness, automatisms (lip-smacking, picking clothes).
Generalized Tonic-Clonic: loss of consciousness → tonic stiffening → clonic jerking; postictal confusion.
Absence: brief staring spells; no postictal confusion; common in pediatrics.
Atonic: sudden loss of muscle tone; “drop attacks,” high fall risk.
Myoclonic: quick, shock-like muscle jerks.
Which nursing action is most appropriate during a tonic-clonic seizure?
A. Insert an oral airway to protect the patient’s teeth
B. Hold the patient down to prevent limb injury
C. Turn the patient to their side and clear surrounding objects
D. Begin postictal neuro checks immediately
Correct Answer
C
Rationale
During a seizure: protect the patient, turn to side for airway, time the seizure. Do NOT restrain, do NOT put anything in the mouth. Postictal neuro checks occur after.
Which factors may trigger seizures in a patient with epilepsy?
A. Sleep deprivation
B. Alcohol use
C. Stress
D. Elevated potassium
E. Flashing lights
Correct Answers: A, B, C, E
A. Sleep deprivation — YES. Major trigger that lowers seizure threshold.
B. Alcohol — YES. Interferes with CNS regulation & AED absorption.
C. Stress — YES. Neurochemical imbalance increases excitatory activity.
D. Elevated potassium — NO. Not associated with seizure activity; hypo electrolytes are more concerning.
E. Flashing lights — YES. Especially in photosensitive epilepsy.
Non-compliance with antiepileptic medications is one of the most common triggers for status epilepticus.
TRUE
Abrupt withdrawal or inconsistent dosing of AEDs is a leading cause of status epilepticus. Even a single missed dose can lower seizure threshold in vulnerable patients.
Explain the difference between the prodromal phase, aura, ictal phase, and postictal phase of a seizure.
Prodromal: hours–days before; mood changes, anxiety, GI upset.
Aura: seconds–minutes before; sensory warning such as smell, visual flashes, or rising feeling.
Ictal: the active seizure (movement, altered awareness, jerking).
Postictal: recovery period; confusion, headache, amnesia, exhaustion, possible Todd’s paralysis.
A patient with known epilepsy has a tonic-clonic seizure that has lasted 6 minutes despite having missed two doses of levetiracetam this week. Which action is the highest priority?
A. Prepare to administer a loading dose of phenytoin
B. Begin reorientation techniques when the seizure ends
C. Administer IV lorazepam to stop the seizure
D. Draw blood levels for AED concentration
Correct Answer
C
Rationale: A seizure >5 minutes = status epilepticus, a medical emergency. FIRST PRIORITY: stop the seizure with IV benzodiazepines (lorazepam). AED levels and loading doses come after stabilization
Which interventions are appropriate for a patient with refractory epilepsy undergoing long-term management? (Select all that apply.)
A. Considering surgical options such as lobectomy or corpus callosotomy
B. Using vagus nerve stimulation (VNS)
C. Following a ketogenic diet
D. Abruptly discontinuing anti-epileptic drugs when seizures stop
E. Strict medication adherence to AEDs
Correct Answers: A, B, C, E
A. Surgery — YES. Used for refractory (drug-resistant) epilepsy.
B. VNS — YES. Reduces seizure frequency in patients who fail meds.
C. Ketogenic diet — YES. Particularly effective in pediatric epilepsy.
D. Stopping AEDs suddenly — NO. MASSIVE seizure risk → may cause status epilepticus.
E. Medication adherence — YES. Non-compliance is one of the top SE triggers.
Absence seizures typically include a post-ictal phase characterized by prolonged confusion and disorientation.
FALSE
Absence seizures resolve immediately with no post-ictal confusion. The child often resumes activity like nothing happened. Any prolonged post-ictal confusion points away from absence seizures.
Why is status epilepticus dangerous, and what is the first-line treatment?
Status epilepticus causes prolonged uncontrolled neuronal firing → cerebral hypoxia, acidosis, hyperthermia, arrhythmias, and permanent brain damage.
First-line: benzodiazepines (e.g., IV lorazepam 4 mg, may repeat in 10–15 min).
Second-line: AEDs like levetiracetam, fosphenytoin, valproate.
Refractory cases may require continuous sedative infusions (propofol, midazolam) with EEG monitoring.