Which of the following are characteristics of generalized tonic-clonic seizures?
Post-ictal confusion.
Sudden loss of consciousness.
Rhythmic twitching of one extremity while remaining awake and aware.
Urinary incontinence.
Rhythmic muscle twitching.
Correct Answer : A,B,D,E
Choice A rationale
Post-ictal confusion, characterized by a period of disorientation, drowsiness, and potential headache, is a universal feature of the post-seizure state following a generalized tonic-clonic event. This transient neurological deficit reflects the exhaustion and metabolic changes within the cerebral cortex after widespread neuronal depolarization.
Choice B rationale
Sudden loss of consciousness occurs at the onset of a generalized tonic-clonic seizure due to the abrupt, widespread, and bilateral electrical discharge throughout the cortex. This loss of awareness defines the generalized nature of the seizure, distinguishing it from focal seizures where consciousness may be preserved.
Choice C rationale
Rhythmic twitching of one extremity while remaining awake and aware describes a focal motor seizure (simple partial), which involves abnormal electrical activity localized to a specific area of one cerebral hemisphere. A generalized tonic-clonic seizure involves both hemispheres and global loss of consciousness.
Choice D rationale
Urinary incontinence is common during the tonic phase of the seizure due to the intense, generalized muscular contraction, including the pelvic floor muscles. The massive autonomic surge and muscular rigidity overwhelm the sphincter control, leading to involuntary voiding.
Choice E rationale
Rhythmic muscle twitching, known as the clonic phase, consists of alternating periods of muscular contraction and relaxation. This phase follows the rigid, sustained contraction of the tonic phase and is a defining characteristic of a generalized tonic-clonic seizure.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Administering half the dose is inappropriate and lacks a scientific basis unless ordered by the provider, as it would likely be sub-therapeutic and fail to achieve the desired effect of improving myocardial contractility and reducing heart rate. Digoxin administration should be all or none based on parameters.
Choice B rationale
The acceptable apical pulse rate for administering digoxin to an infant is typically above 90-110 beats per minute (bpm). An apical pulse of 88 bpm falls below this generally accepted cutoff, indicating potential drug toxicity or the therapeutic effect lowering the rate too much, necessitating withholding the dose.
Choice C rationale
Administering double the dose is a dangerous, unscientific action that would significantly increase the risk of digoxin toxicity, which can cause severe cardiac arrhythmias, gastrointestinal symptoms, and potential cardiac arrest, particularly in infants who are highly susceptible to small dose changes.
Choice D rationale
The normal heart rate for an infant is significantly higher than 88 bpm. Holding the dose and notifying the provider is the required action. Bradycardia in an infant receiving digoxin is the cardinal sign of potential toxicity or an excessively deep therapeutic effect, and the provider must assess the situation before further dosing.
Correct Answer is B
Explanation
Choice A rationale
While dehydration can cause irritability and poor feeding, it typically manifests with depressed fontanels, not a bulging fontanel, which is a hallmark sign of increased intracranial pressure. Dehydration would also likely present with dry mucous membranes and decreased urine output, differentiating it from shunt issues.
Choice B rationale
The combination of irritability, vomiting, and a bulging fontanel are classic clinical indicators of increased intracranial pressure (ICP) in an infant. This constellation of signs strongly suggests that the ventricular shunt is obstructed or malfunctioning, preventing adequate cerebrospinal fluid drainage.
Choice C rationale
Normal shunt function maintains cerebrospinal fluid (CSF) flow, keeping the intracranial pressure within the normal range, preventing the pathological signs of obstruction. A normally functioning shunt would result in the resolution of or prevention of symptoms like a bulging fontanel, irritability, and vomiting.
Choice D rationale
Gastroenteritis, or infectious diarrhea, primarily presents with diarrhea, vomiting, and often fever. Although vomiting and irritability can occur, a bulging fontanel is highly specific to elevated intracranial pressure and is not a symptom typically associated with routine infectious gastroenteritis.
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