NCLEX-PN › Identifying Neural Conditions
A three year old patient presents for a seizure that occurred at home. To her father's knowledge, she has never had a seizure in the past. She was not ill at the time of the seizure, and she is not on any type of medication. There was no head trauma before the incident. Her father states that her older brother was diagnosed with epilepsy at age seven, and that his grandmother was also epileptic. Is it safe to assume that this child is also epileptic?
No, a diagnosis of epilepsy requires two or more seizures without a clear provocation.
Yes, she has a positive family history for epilepsy, and has had a seizure with no clear provocation.
No, epilepsy is not hereditary, and must present with a history of at least two seizure episodes before diagnosis.
Yes, epilepsy is defined as seizures in the absence of fever, head trauma, or medication.
While epilepsy may certainly be hereditary, the diagnosis of epilepsy requires the occurrence of at least two seizures during two separate incidents, regardless of positive family history. These must occur in the absence of provocative factors such as fever, head trauma, or medication.
A 62-year-old male client is admitted to the hospital with acute pancreatitis. The client has a well-established history of alcohol abuse. The nurse caring for this client is aware he may exhibit withdrawal symptoms during the inpatient course.
The nurse's plan of care for this client should include assessment for all the following symptoms of alcohol withdrawal except?
Hypersomnolence
Seizure within the first 24 hours
Hypertension
Tremors
Visual hallucinations
The symptoms of alcohol withdrawal may include confusion, disorientation, and anxiety. Hypersomnolence or excessive sleep is not associated with this condition. Additional symptoms may include agitation, hypervigilance, tremor, rapid and irregular heart beat, hypertension, seizure, and hallucinations (mostly visual).
You are the nurse in a psychiatrist's office taking care of a patient who presents with three years of pulling at her hair in a compulsive manner. The patient states that she has a strong urge to pull her hair out, especially in times of stress, and that removing hairs helps to relieve tension. She is bald on two-thirds of her scalp, and feels very distressed and socially impaired. Which of the following best describes this patient's illness?
Trichotillomania
Arachnophobia
Agoraphobia
Social phobia
Walking-corpse syndrome
The correct answer is "trichotillomania." This is the correct answer, as this term describes the obsessive-compulsive condition in which patients have an uncontrollable urge to remove their hair, which causes baldness, and social/emotional distress and impairment. Patients typically pull hair from the scalp, eyebrows, lashes, and extremities. Treatment includes a variable combination of psychotherapy and/or medications.
On the other hand, the other choices are incorrect. Walking-corpse syndrome is a psychiatric condition in which a patient thinks that they are dead, while in reality, they are indeed alive. Arachnophobia is a fear of spiders. Agoraphobia is a fear of being in public places. Last, social phobia is a fear of social situations.
Which of the following symptoms describes the typical "aura" experienced during a complex-partial seizure?
All of these are correct
Visual disturbances such as sparks, color fluctuations, or blurry vision
Odd taste in the mouth
Olfactory disturbances: unusual smells, smelling things that are not present
A sense of déjà-vu or a feeling that everything is strangely unfamiliar (jamais-vu).
The "aura" experienced before a seizure, while frequently thought-of as a primarily visual experience, can include disturbances in taste or smell, bodily sensations such as stomach ache or tingling, anxiety, or a sense that everything is oddly familiar (déjà vu) or unfamiliar (jamais vu).
What condition is described by the following: A defect of copper excretion, leading to copper overload and feedback inhibition of ceruloplasmin synthesis?
Wilson's disease
Huntington disease
Hereditary hemochromatosis
Aceruloplasminemia
Wilson's disease is characterized by a defect of copper excretion, leading to copper overload and feedback inhibition of ceruloplasmin synthesis. This results in copper accumulation, primarily in the liver and the brain. Signs and symptoms include liver failure, cognitive deterioration, clumsiness, and changes in behavior. Symptoms often start in adolescence, but can start any time between 6-20 years old. Aceruloplasminemia is a rare condition of iron accumulation in the basal ganglia, retina, and liver. Hereditary hemochromatosis is also a disorder of iron accumulation, often caused by mutations in the HFE gene. Huntington disease is a genetic neurodegenerative disease unrelated to any mineral storage disorders.
Which of the following is not a type of seizure?
All of these are seizure types
Absence
Myoclonic
Simple partial
Currently there are over 40 distinct types of seizures recognized by the medical community. Some of the most common seizure types are generalized tonic-clonic, absence, myoclonic, clonic, tonic, febrile, and atonic. Some other less common types include refractory seizures, gelastic seizures, and dacrystic seizures.
What is the most common type of seizure in adults?
Tonic clonic
Myoclonic
Simple partial
Nonepileptic
The most common type of seizure in adults is the tonic clonic seizure, also known as grand-mal. These seizures have two stages: a tonic stage, characterized by muscle stiffening and rigidity, followed by a clonic phase, characterized by jerking and twitching of the muscles and the face. Some individuals may have a tendency to have more tonic symptoms or more clonic symptoms, or may go in a tonic-clonic-tonic pattern of alternating rigidity and jerking motions. Individuals in a tonic clonic seizure experience loss of consciousness and may experience headache, lethargy, confusion, or may want to go to sleep on recovery of consciousness.
A young woman presents to a clinic complaining of unilateral headaches that she describes as throbbing, "like a hammer was hitting my head." She experiences these headaches 5-10 times per month, and an episode can last up to 24 hours. During the headache she is sensitive to light, sound, and smell. On a few occasions the pain has been severe enough to induce vomiting. She feels better with coffee, and by lying down alone in a dark room. Her headache is most likely which of the following types?
Migraine
Caffeine withdrawal
Tension
Sinus
The symptoms this individual describes are most likely due to migraine headache (migraine without aura, also known as common migraine). Migraines are diagnosed by the following criteria:
What is the most common cause of meningitis?
Viral infection
Bacterial infection
Fungal infection
Aseptic inflammation
All of the answers given are possible causes of meningitis, but the most common (and least severe) etiology is viral. There is no vaccine for viral meningitis, but there are vaccines for three different organisms that cause bacterial meningitis:
Approximately 80% of strokes are of what type?
Ischemic
Hemorrhagic
Transient ischemic attack
None of these
Approximately 80% of strokes are ischemic, either caused by thrombus or emboli. Hemorrhagic strokes only account for approximately 15% of all strokes, but are significantly more lethal and account for 30% of all stroke deaths. They involve the rupturing of a weakened blood vessel in the brain and subsequent bleeding in the surrounding areas. Transient ischemic attacks are not considered true strokes, and are often referred to as "mini strokes."