Pediatric Seizure Practice Questions

Certain antiepileptic drugs, including phenytoin, are known cytochrome P450 inducers. Option C is correct because these medications accelerate the hepatic metabolism of vitamin D into inactive metabolites, significantly increasing the risk for vitamin D deficiency and subsequent osteomalacia. Option A is incorrect because it provides false reassurance; these medications directly impact bone health. Option B is incorrect and dangerous, as abruptly stopping anticonvulsants can precipitate status epilepticus; the medication should be managed, not stopped. Option D is incorrect because the risk is hypocalcemia due to vitamin D deficiency, not calcium toxicity.

The infant is demonstrating early signs of increased intracranial pressure (bulging fontanel, high-pitched cry) that are now progressing to late signs, specifically irregular respirations (Cheyne-Stokes or ataxic breathing). This indicates severe brainstem compression and failure of the respiratory center, necessitating immediate airway protection and ventilation, making option B correct. Option A is incorrect because the infant is showing signs of herniation, not active seizure activity. Option C is incorrect because placing the infant flat impairs cerebral venous drainage and will further increase intracranial pressure; the head of the bed should be elevated 30 degrees. Option D is incorrect because rapid fluid boluses can exacerbate cerebral edema and worsen the intracranial pressure in this specific scenario.

Fostering gradual autonomy is a critical component of the transition of care for adolescents with chronic conditions. When a 13-year-old with epilepsy shows interest in self-management, the nurse should support this developmentally appropriate milestone. Option A encourages collaboration between the parent and teen to safely and incrementally shift responsibility, ensuring the teen builds competence without being overwhelmed. Option B stifles his independence and ignores his readiness to learn self-care skills. Option C is dangerous; abruptly removing parental supervision sets the teen up for failure and potential seizures due to missed doses. Option D unnecessarily delays a process that should begin in early adolescence to ensure mastery by adulthood. A structured, step-wise approach prevents burnout for both the patient and the caregiver.

The primary barrier to adherence here is a lack of reliable transportation in a rural setting. Setting up a mail-order pharmacy directly removes the logistical hurdle of traveling two hours to pick up refills. Option A might reduce the number of pills taken daily but does not solve the underlying issue of obtaining the medication. Option B is important for general safety but does not address the missed doses. Option D provides emotional support but fails to resolve the immediate physical barrier to medication access.

Typical generalized absence seizures are characterized by brief staring spells without a postictal state and are uniquely provoked by hyperventilation during EEG monitoring, showing a classic 3-Hz spike-and-wave pattern. This is a hallmark diagnostic maneuver used in the clinic to elicit the event. Focal impaired awareness seizures (Option A) typically last much longer, often include a preceding aura, and feature a distinct postictal phase of confusion or lethargy. Atypical absence seizures (Option C) have a slower onset and offset, often occur in children with cognitive impairment, and are much less likely to be provoked by hyperventilation. Focal aware seizures (Option D) maintain preserved consciousness throughout the entire event, which directly contradicts the unresponsiveness and staring seen in this patient's presentation.

This child scores a 1 for absent eye opening, a 2 for incomprehensible sounds, and a 2 for abnormal extension, resulting in a total score of 5. A Glasgow Coma Scale score of 8 or less indicates a severe traumatic brain injury and an inability to protect the airway, making endotracheal intubation the priority. Option A is incorrect because the score is 5, not 7, and simple elevation is insufficient for airway protection. Option B is incorrect because the score is not 6, though hypertonic saline might be used later for intracranial pressure management. Option D is incorrect because the score is not 4, and while EEG monitoring may eventually be indicated for seizure detection, securing the airway takes immediate precedence in severe neurological compromise.

A classic warning sign of Factitious Disorder Imposed on Another is a history of unexplained sibling death combined with a caregiver who thrives in the medical environment. Reviewing the sibling's records provides critical collateral information to assess the current infant's risk. Option A is unsafe; leaving the mother alone with the infant during monitoring provides an opportunity for her to induce a life-threatening event. Option B provides false reassurance and ignores the glaring red flags of falsified symptoms and sibling mortality. Option D is incorrect because prescribing antiepileptic medications for non-physiologic seizures exposes the infant to unnecessary medication side effects without treating the underlying abuse.

When managing a child in status epilepticus, securing the airway and ensuring adequate oxygenation are always your primary interventions before administering medications. Because this child has copious oral secretions and is hypoxic, you need to clear the airway first. Option B is correct because suctioning removes the immediate obstruction, allowing the supplemental oxygen to be effective. Option A is incorrect; while lorazepam is the first-line medication for status epilepticus, pushing it before clearing the airway risks aspiration and worsening hypoxia. Option C is incorrect because inserting an oropharyngeal airway in an actively seizing child can cause oral trauma or stimulate vomiting. Option D is incorrect because a jaw-thrust maneuver is specifically indicated for suspected cervical spine injury, which is not suggested here; simple positioning and suctioning are more appropriate for secretion management.

The aura, described as a rising stomach sensation, indicates a focal onset, and the subsequent unresponsiveness with automatisms defines a focal impaired awareness seizure, which commonly originates in the temporal lobe. The rhythmic temporal lobe discharges on the EEG confirm this localized onset. Option B lacks an aura, typically lasts only a few seconds rather than two minutes, and does not feature complex automatisms like lip-smacking or picking at clothes. Option C is incorrect because the patient loses awareness during the event, whereas a focal aware seizure would preserve consciousness. Option D does not typically present with an aura or distinct temporal lobe EEG discharges, and it usually lacks the complex, coordinated automatisms and the distinct postictal phase often associated with focal temporal lobe seizures.

Following the administration of benzodiazepines like lorazepam, patients often experience profound muscle relaxation, which can lead to upper airway obstruction caused by the tongue falling against the posterior pharynx. Option C is correct because a head-tilt chin-lift maneuver physically lifts the tongue and immediately relieves this specific type of anatomical obstruction, which is indicated by the snoring respirations. Option A is incorrect; flumazenil is contraindicated in patients treated for status epilepticus because it can trigger a return of uncontrollable seizures. Option B is incorrect because while suctioning clears fluids, it does not correct the anatomical tissue obstruction causing the snoring sound. Option D is incorrect because rapid sequence intubation is an extreme measure; simple airway repositioning should always be attempted first to resolve upper airway obstruction before moving to invasive advanced airway management.