CNRN Seizure Disorders and Epilepsy Management 1 — Questions and Answers
Question 1: A patient begins having generalized tonic-clonic seizure activity. The nurse's FIRST priority action is to:
- Insert an oral airway device
- Protect the patient from injury and maintain airway patency (Correct answer)
- Administer IV lorazepam immediately
- Restrain the patient's limbs to prevent injury
Correct answer: Protect the patient from injury and maintain airway patency
The first priority during a seizure is patient safety — protecting from injury and maintaining airway patency without restraining limb movements.
Question 2: Status epilepticus is defined as continuous seizure activity lasting longer than:
- 2 minutes
- 5 minutes (Correct answer)
- 15 minutes
- 30 minutes
Correct answer: 5 minutes
Status epilepticus is defined as seizure activity lasting ≥5 minutes or two or more seizures without return to baseline consciousness between them.
Question 3: Which first-line medication is recommended for initial treatment of status epilepticus in adults?
- Phenytoin IV
- Benzodiazepine (lorazepam or diazepam) (Correct answer)
- Levetiracetam IV
- Valproic acid IV
Correct answer: Benzodiazepine (lorazepam or diazepam)
Benzodiazepines (IV lorazepam preferred, or IM midazolam) are the first-line agents for terminating status epilepticus.
Question 4: A patient on phenytoin therapy has a level of 8 mcg/mL. The therapeutic range for phenytoin is:
- 5–10 mcg/mL
- 10–20 mcg/mL (Correct answer)
- 20–30 mcg/mL
- 30–40 mcg/mL
Correct answer: 10–20 mcg/mL
The therapeutic serum level for phenytoin is 10–20 mcg/mL; a level of 8 mcg/mL is subtherapeutic.
Question 5: Which seizure type is characterized by sudden loss of muscle tone, causing the patient to fall?
- Myoclonic seizure
- Atonic (drop) seizure (Correct answer)
- Absence seizure
- Tonic seizure
Correct answer: Atonic (drop) seizure
Atonic seizures (drop attacks) involve sudden loss of muscle tone leading to falls, often requiring protective headgear.
Question 6: The nurse observes a patient staring blankly for 15 seconds with lip-smacking and hand automatisms, then returning to baseline confused. This describes:
- Absence (petit mal) seizure
- Focal impaired awareness seizure (complex partial) (Correct answer)
- Generalized tonic-clonic seizure
- Simple focal seizure
Correct answer: Focal impaired awareness seizure (complex partial)
Focal impaired awareness seizures (formerly complex partial) involve altered consciousness with automatisms and postictal confusion, arising from one hemisphere.
CNRN Seizure Disorders and Epilepsy Management 1
A patient begins having generalized tonic-clonic seizure activity.
The nurse's FIRST priority action is to: