Review Practice Exercise 1

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Practice Exercise 1

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Total Questions : 2

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Question 1:

A patient is being evaluated for a diagnosis of epilepsy. Which of the following criteria, if present, would support this diagnosis?

A. Experiencing a single, provoked seizure due to a high fever. B. Having two unprovoked seizures more than 24 hours apart. C. Having one unprovoked seizure with an underlying brain tumor confirmed by MRI. D. A history of one seizure with an abnormal EEG showing epileptiform discharges.

Answer and Explanation

Choice A:

A single provoked seizure due to a high fever is considered acute symptomatic and not epilepsy. Febrile seizures are often isolated and do not meet epilepsy diagnostic criteria.

Choice B:

The definition of epilepsy includes the occurrence of at least two unprovoked (or reflex) seizures occurring more than 24 hours apart. This criterion supports a diagnosis of epilepsy by demonstrating a persistent predisposition to generate epileptic seizures.

Choice C:

While a brain tumor increases seizure risk, a single unprovoked seizure even with structural brain abnormality does not fulfill the standard definition unless recurrence risk is deemed high (>60%).

Choice D:

An abnormal EEG may suggest a predisposition to seizures, but a single seizure with such findings does not confirm epilepsy. EEG findings alone are not diagnostic without the appropriate clinical context.

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Question 2:

A patient is brought to the emergency department after experiencing their first-ever generalized seizure. The seizure lasted for 45 seconds and resolved spontaneously. What is the nurse's highest priority action related to the diagnosis?

A. Prepare the patient for a lumbar puncture to rule out meningitis. B. Administer a prophylactic anti-seizure medication to prevent a second seizure. C. Obtain a detailed history from the patient and any witnesses to the event. D. Explain the diagnosis of epilepsy and provide information on support groups.

Answer and Explanation

Choice A:

Lumbar puncture is only indicated if there are signs of CNS infection (e.g., fever, nuchal rigidity, altered mental status), which are not present here.

Choice B:

Prophylactic anti-seizure medication is not routinely started after a first seizure unless the risk of recurrence is high (e.g., structural lesion, abnormal EEG).

Choice C:

A detailed history is the most important step after a first seizure. Understanding the context, characteristics, duration, triggers, and recovery phase of the event is essential to differentiate epileptic seizures from other causes (e.g., syncope, psychogenic non-epileptic seizures), and to guide further evaluation and management.

Choice D:

It is premature to diagnose epilepsy or offer support group referrals after a single, unprovoked seizure, especially without further diagnostic confirmation.

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Exam Review

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Practice Exercise 1

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