Seizure care NCLEX-RN Practice Questions

Seizure care NCLEX-RN Practice Questions help you sharpen clinical judgment around prevention, early recognition, and safe management of seizure activity in diverse settings. This topic under Reduction of Risk Potential emphasizes protecting the airway, minimizing injury, anticipating complications like status epilepticus, and monitoring for adverse effects of antiseizure medications. You’ll review priority actions during and after a seizure, essential seizure precautions, device and diagnostic considerations, and patient/family teaching that reduces harm at home and in the hospital. These 30 high-yield questions mirror NCLEX-RN style and integrate pharmacologic monitoring, maternal-neonatal considerations, electrolyte disturbances, and documentation. Work through each scenario to strengthen your decision-making and ensure safe, evidence-based care for clients at risk for seizures.

Q1. A hospitalized client begins having a generalized tonic–clonic seizure. Which initial nursing action best reduces immediate risk to the client?

• Insert an oral airway to prevent tongue obstruction
• Restrain the client’s arms to prevent injury
• Turn the client to the side and clear the surrounding area
• Attempt to deliver oxygen via face mask during convulsions

Correct Answer: Turn the client to the side and clear the surrounding area

Q2. A client with status epilepticus is in the ED. Which medication is the priority first-line therapy to stop ongoing seizure activity?

• Fosphenytoin IV loading dose
• Lorazepam IV push
• Levetiracetam IV infusion
• Phenytoin IV push at 100 mg/min

Correct Answer: Lorazepam IV push

Q3. The nurse prepares to administer IV phenytoin to a client post–status epilepticus. Which action is essential to reduce risk of serious adverse effects?

• Infuse with dextrose 5% in water to enhance stability
• Limit infusion rate to no more than 50 mg/min in adults
• Warm the solution and administer via peripheral IV
• Administer IM for faster absorption

Correct Answer: Limit infusion rate to no more than 50 mg/min in adults

Q4. A client receives continuous enteral tube feedings and is prescribed oral phenytoin. To optimize drug absorption and reduce risk of breakthrough seizures, the nurse should:

• Administer phenytoin with feeds to reduce GI irritation
• Flush with dextrose 5% before and after dosing
• Hold tube feeding 1–2 hours before and after phenytoin dosing
• Crush and mix phenytoin with enteral nutrition to improve dissolution

Correct Answer: Hold tube feeding 1–2 hours before and after phenytoin dosing

Q5. Which finding in a client taking carbamazepine requires immediate provider notification due to risk of life-threatening complications?

• Increased urinary frequency
• Rash on forearms
• WBC count of 2,200/mm³
• Mild ankle edema

Correct Answer: WBC count of 2,200/mm³

Q6. The nurse reviews labs for a client on valproic acid. Which result is most concerning and increases the risk of bleeding?

• Platelet count 85,000/mm³
• Serum sodium 133 mEq/L
• Creatinine 1.3 mg/dL
• AST 38 U/L

Correct Answer: Platelet count 85,000/mm³

Q7. A client newly started on lamotrigine reports a widespread, painful, blistering rash. What is the nurse’s priority action?

• Administer PRN diphenhydramine and monitor
• Document findings and reassess in 4 hours
• Hold the medication and notify the provider immediately
• Apply topical corticosteroid cream to affected areas

Correct Answer: Hold the medication and notify the provider immediately

Q8. Which adverse effect is most characteristic of levetiracetam and requires focused assessment?

• Gingival hyperplasia and hirsutism
• Mood changes, agitation, or depression
• Severe hyponatremia from SIADH
• Hepatic failure with elevated ammonia

Correct Answer: Mood changes, agitation, or depression

Q9. The nurse prepares a client for an EEG to evaluate seizure activity. Which instruction best reduces risk of false results and promotes test accuracy?

• Avoid all antiseizure medications for 48 hours before the test
• Refrain from caffeine for 24 hours and arrive with clean, product-free hair
• Fast for 12 hours to increase cerebral excitability
• Take a sedative the night before to improve sleep

Correct Answer: Refrain from caffeine for 24 hours and arrive with clean, product-free hair

Q10. Which equipment is most important to have at the bedside for a client on seizure precautions?

• Ambu bag and endotracheal tube
• Nasogastric tube and irrigation set
• Suction setup and oxygen delivery system
• Cardioversion pads and defibrillator

Correct Answer: Suction setup and oxygen delivery system

Q11. A client with a vagus nerve stimulator (VNS) reports an aura. Which action should the nurse teach as a risk-reducing self-management strategy?

• Swipe the magnet over the generator to activate stimulation
• Take an extra dose of daily antiseizure medication
• Call EMS immediately for all auras
• Lie flat with head midline to increase cerebral perfusion

Correct Answer: Swipe the magnet over the generator to activate stimulation

Q12. A pregnant client at 32 weeks with eclampsia has a tonic–clonic seizure. Which medication is indicated to prevent recurrent seizures in this condition?

• Magnesium sulfate IV
• Valproic acid IV
• Carbamazepine PO
• Phenytoin IV

Correct Answer: Magnesium sulfate IV

Q13. The nurse monitors a client receiving magnesium sulfate for seizure prophylaxis. Which finding indicates toxicity requiring immediate intervention?

• 2+ deep tendon reflexes and urine output 60 mL/hr
• Respiratory rate 10/min and absent patellar reflexes
• Mild flushing and warmth at infusion start
• Blood pressure 138/86 mm Hg

Correct Answer: Respiratory rate 10/min and absent patellar reflexes

Q14. A client with alcohol withdrawal is at risk for seizures. Which medication class reduces this risk most effectively?

• Atypical antipsychotics
• Benzodiazepines
• Opioid antagonists
• Barbiturate-free sedatives

Correct Answer: Benzodiazepines

Q15. Which electrolyte abnormality most increases risk for acute seizures and requires seizure precautions?

• Serum potassium 5.2 mEq/L
• Serum sodium 118 mEq/L
• Serum calcium 9.2 mg/dL
• Serum magnesium 2.0 mg/dL

Correct Answer: Serum sodium 118 mEq/L

Q16. During a tonic–clonic seizure in the community, which bystander action is safest and most appropriate?

• Place a wallet or spoon in the mouth to prevent biting the tongue
• Hold the person down to stop limb movements
• Protect the head, turn to the side, and time the seizure
• Give sips of water once movements slow

Correct Answer: Protect the head, turn to the side, and time the seizure

Q17. The nurse plans discharge teaching for a client with epilepsy. Which instruction best reduces risk of injury at home?

• Take baths instead of showers to relax muscles
• Swim only with a lifeguard or companion present
• Climb ladders carefully using support rails
• Sleep 4–5 hours to reduce daytime somnolence

Correct Answer: Swim only with a lifeguard or companion present

Q18. A parent asks when to administer the child’s prescribed rectal diazepam for breakthrough seizures. The nurse should teach to give it when:

• The seizure lasts longer than 5 minutes
• The child reports feeling tired after a seizure
• There is any brief staring spell
• The child has a mild headache

Correct Answer: The seizure lasts longer than 5 minutes

Q19. The nurse assesses a client on chronic phenytoin therapy. Which finding suggests toxicity and requires dose evaluation?

• Nystagmus and ataxia
• Bradycardia at rest
• Mild tremor of the hands
• Polyuria and polydipsia

Correct Answer: Nystagmus and ataxia

Q20. A client’s total phenytoin level is 9 mcg/mL (therapeutic 10–20). Albumin is 2.2 g/dL. Which action is most appropriate?

• Administer an additional loading dose immediately
• Request a free (unbound) phenytoin level before adjusting dose
• Stop phenytoin due to subtherapeutic level
• Switch to valproic acid to avoid protein binding

Correct Answer: Request a free (unbound) phenytoin level before adjusting dose

Q21. Which documentation element after a seizure best supports reduction of risk in ongoing care?

• Amount of time the nurse stayed in the room
• Exact start/stop time, precipitating factors, movements, and postictal status
• Visitor names present during the event
• Provider’s future plan of care

Correct Answer: Exact start/stop time, precipitating factors, movements, and postictal status

Q22. A client with new-onset seizures asks about driving. The nurse’s best response to reduce legal and safety risk is:

• You may drive as long as medications are started
• Driving is permanently prohibited
• Driving is restricted per state law until seizure-free for a specified period
• Short, local trips are permitted with a companion

Correct Answer: Driving is restricted per state law until seizure-free for a specified period

Q23. The nurse cares for a client with frequent nocturnal tonic–clonic seizures. Which intervention may reduce risk of SUDEP (sudden unexpected death in epilepsy)?

• Encourage medication holidays monthly
• Optimize adherence to antiseizure regimen and consider nocturnal monitoring device
• Switch to short-acting benzodiazepines nightly
• Recommend sleeping in prone position

Correct Answer: Optimize adherence to antiseizure regimen and consider nocturnal monitoring device

Q24. Which instruction for a client prescribed carbamazepine reduces risk of toxicity and complications?

• Increase grapefruit juice intake to improve absorption
• Report fever, sore throat, or mouth sores immediately
• Avoid all sodium in the diet
• Double doses when a dose is missed

Correct Answer: Report fever, sore throat, or mouth sores immediately

Q25. A 2-year-old with a simple febrile seizure is in the ED, now alert. Which discharge teaching reduces risk and is most appropriate?

• Daily antiseizure therapy is required long-term
• Place the child in a side-lying position and manage fever; call EMS if seizure exceeds 5 minutes
• Restrict activity for 6 months
• Begin magnesium sulfate at first fever

Correct Answer: Place the child in a side-lying position and manage fever; call EMS if seizure exceeds 5 minutes

Q26. During an active seizure, which nursing action is contraindicated and increases risk of injury?

• Loosening restrictive clothing
• Inserting a padded tongue blade
• Padding bed rails
• Removing nearby objects

Correct Answer: Inserting a padded tongue blade

Q27. Which statement about fosphenytoin reduces infusion-related risk compared with phenytoin?

• It can be infused faster with fewer cardiovascular effects
• It has no risk of dermatologic reactions
• It cannot be given IM
• It requires dextrose-only diluent

Correct Answer: It can be infused faster with fewer cardiovascular effects

Q28. A client post-seizure is drowsy with copious oral secretions. Which action best reduces aspiration risk?

• Place the client supine with head midline
• Position in lateral recovery position and suction as needed
• Administer a large bolus of oral fluids
• Insert an oral airway during clonic movements

Correct Answer: Position in lateral recovery position and suction as needed

Q29. Which change requires immediate provider notification in a pregnant client with epilepsy maintained on antiseizure medications?

• Mild nausea in the first trimester
• Breakthrough generalized seizure
• Cravings for salty foods
• Occasional leg cramps at night

Correct Answer: Breakthrough generalized seizure

Q30. A client with hyponatremia develops a seizure. After ensuring safety and airway, which provider order would the nurse anticipate to reduce cerebral edema and stop seizures?

• 0.45% normal saline at 150 mL/hr
• 3% hypertonic saline via controlled infusion
• D5W bolus followed by maintenance fluids
• Restrict all fluids for 24 hours

Correct Answer: 3% hypertonic saline via controlled infusion

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