Nursing Diagnosis for Seizures: 5 Sample Care Plans & Interventions 

Choosing the right nursing diagnosis for seizures — and building a clean NANDA-I care plan around it — is one of the highest-yield assignments in any neuro rotation. Seizures look chaotic at the bedside, so students often freeze, but the nursing job is actually pattern-based: protect the airway, prevent injury, time the event, document precisely, and escalate when the seizure crosses the 5-minute mark.

This guide walks through six NANDA-I 2024–2026 care plans (Risk for Injury, Ineffective Airway Clearance, Risk for Aspiration, Anxiety, Deficient Knowledge, Caregiver Role Strain), the during-vs-after timeline, status epilepticus first- and second-line drugs, postictal care, antiseizure medication (ASM; formerly “antiepileptic drug” / AED) red flags, and three NCLEX-RN® practice questions with rationale. By the end you’ll know exactly what to do, what to chart, and what your test-day stem is asking for.

During a seizure: stay, safe, side, time. Stay with the patient and call for help. Keep them safe — clear the area, protect the head, never restrain, never put anything in the mouth. Turn them side-lying when motor activity allows. Time the seizure. Activate the emergency / status epilepticus protocol at the 5-minute mark or for repeated seizures without recovery between them.

Table of contents

• Seizure pathophysiology
• Nursing assessment for seizure patients
• Nursing diagnosis for seizures — 6 sample NANDA-I care plans
• Nursing interventions during a seizure
• Seizure precautions
• Status epilepticus — recognition and emergency management
• Postictal care
• Antiseizure medications and nursing considerations
• Patient and family education
• NCLEX-style review questions
• Related resources
• Frequently asked questions
• References

Seizure pathophysiology

A seizure is a transient occurrence of signs or symptoms caused by abnormal, excessive, or synchronous neuronal activity in the brain. The International League Against Epilepsy (ILAE) updated its operational seizure classification in 2025, building on the 2017 framework still used in many textbooks and nursing programs. For bedside nursing, the most useful top-level classes are:

• Focal — abnormal activity begins in one area of one hemisphere. Subclassified by level of consciousness during the seizure (rather than the older “awareness” label) and by observable motor / non-motor features.
• Generalized — activity engages networks in both hemispheres from the start. Includes tonic-clonic, absence, myoclonic, atonic, tonic, and clonic types.
• Unknown whether focal or generalized — used when the onset is unwitnessed or features don’t yet point clearly to one class.
• Unclassified — seizures that don’t fit the categories above, often pending further data (EEG, video, history).

Nurses should document what was observed chronologically — for example: aura, impaired consciousness, head or eye deviation, tonic stiffening, clonic movements, automatisms, cyanosis, incontinence, and postictal recovery. The 2025 update emphasizes this observable / chronological description over older static-label thinking.

Note on terminology. Many nursing programs and NCLEX-RN® question banks still use 2017 vocabulary (e.g., “focal aware” / “focal impaired-awareness,” “focal onset” / “generalized onset”). This guide uses familiar 2017 terms where helpful while noting that current ILAE language emphasizes consciousness and observed seizure features.

Common seizure types you’ll see in clinicals

Risk factors and triggers

The most common ED-precipitating cause in known epilepsy is non-adherence to antiseizure medications. Other risk factors and triggers:

• Sleep deprivation
• Alcohol intoxication or withdrawal
• Illicit drug use or withdrawal
• Acute illness with fever (especially in pediatric patients)
• Metabolic disturbances — hyponatremia, hypoglycemia, hypocalcemia, hypomagnesemia, uremia
• Hypoxia or anoxic brain injury
• Stroke, head trauma, brain tumor, encephalitis, meningitis
• Photosensitive triggers (flashing lights) in patients with photosensitive generalized epilepsies

Epilepsy vs. a single seizure: epilepsy is a disease defined by ≥2 unprovoked seizures more than 24 hours apart, OR one unprovoked seizure with a high recurrence risk over the next 10 years. A single provoked seizure (e.g., during hypoglycemia) is not epilepsy.

Nursing assessment for seizure patients

Every nursing diagnosis for seizures is only as good as the assessment data underneath it. Build the assessment in three blocks: what happened before, what’s happening now, and what the workup shows.

History to gather

• Prior seizure activity — frequency, type, duration, last episode
• Aura — patients with focal seizures often describe a warning (déjà vu, rising stomach feeling, odd smell, visual changes)
• ASM regimen and adherence — when was the last dose, last serum level
• Recent illness, fever, head trauma
• Alcohol, illicit drug use, withdrawal status
• Sleep, stress, missed meals
• Pregnancy status (ASM teratogenicity changes the plan)

Physical assessment during the seizure

• ABCs first
• Note start time and duration — time the seizure; this single data point drives the status-epilepticus decision later
• Motor pattern — generalized vs. focal, head/eye deviation, automatisms
• Skin — cyanosis (perioral first)
• Incontinence
• Injuries — tongue laceration, head strike, shoulder dislocation from forceful contraction

Postictal assessment

• Level of consciousness and orientation
• Motor strength bilaterally — any new focal deficit must be treated as a potential stroke until evaluated. Document onset, perform serial neuro checks, notify the provider or rapid-response team per protocol, and anticipate imaging or EEG as ordered. Todd’s paresis/paralysis is a recognized post-seizure phenomenon (transient focal weakness lasting minutes to hours, occasionally longer) — but it is a diagnosis of exclusion after stroke and other causes are ruled out, not a bedside assumption.
• Vital signs and SpO₂
• Pupils
• Tongue, oral mucosa, head/limb injuries
• Bowel/bladder incontinence

Diagnostic workup the team will likely order

• Point-of-care glucose (rule out hypoglycemia first — fast and reversible)
• BMP, magnesium, calcium, lactate
• Serum ASM levels if the patient is on a known regimen
• Toxicology screen
• CT head (acute change, trauma) or MRI brain (non-emergent workup)
• EEG (gold standard for classification and for non-convulsive status if mentation doesn’t return)
• Lumbar puncture if febrile and meningitis is on the differential

Nursing diagnosis for seizures — 6 sample NANDA-I care plans

Below are six nursing diagnoses for seizures based on NANDA-I International’s Nursing Diagnoses: Definitions and Classification, 2024–2026 (13th ed.). Each plan follows the standard care-plan structure: assessment data → SMART goals → numbered interventions with rationales → evaluation criteria.

NANDA-I verification reminder. Diagnosis labels and related/risk factors below follow educational nursing care-plan conventions; verify exact spelling and capitalization against the licensed NANDA-I 2024–2026 (13th ed.) text before documentation.

1. Risk for Injury

Diagnostic statement: Risk for Injury related to tonic-clonic motor activity and loss of consciousness during seizure.

Assessment data supporting: known seizure disorder, recent or active seizure activity, altered LOC, prior seizure-related injuries.

Goals / expected outcomes:

• Patient will remain free of physical injury (no falls, lacerations, fractures, tongue trauma) during seizure activity for the duration of hospitalization.
• Patient will identify two personal seizure triggers before discharge.

Interventions and rationale:

1. Place the bed in lowest position with brakes locked and side rails up per facility policy — minimizes fall height and prevents bed exit during the ictal phase.
2. Pad side rails if institutional protocol allows — reduces extremity trauma from rhythmic motor activity.
3. Keep oxygen, suction, and an oral airway at the head of the bed — allows immediate ABC management without leaving the bedside.
4. Stay with the patient during the seizure — do not restrain — restraining can cause shoulder dislocations and long-bone fractures.
5. Move sharp or hard objects away and gently guide the patient to a side-lying position when motor activity allows — protects the airway and prevents aspiration without forcing positioning during tonic stiffness.
6. Document the time the seizure started — required for status epilepticus decision-making at the 5-minute mark.

Evaluation: Patient remains injury-free; bedside seizure setup verified each shift.

2. Ineffective Airway Clearance

Diagnostic statement: Ineffective Airway Clearance related to neuromuscular dysfunction during the ictal phase, as evidenced by cyanosis, copious oral secretions, and snoring or absent respirations.

Assessment data supporting: observed cyanosis, oral secretions, low SpO₂ during or immediately after the seizure.

Goals / expected outcomes:

• Patient will maintain SpO₂ at baseline or the provider-ordered target after seizure activity resolves; if no individualized target exists (e.g., COPD, chronic hypoxemia, pediatrics, pregnancy), maintain SpO₂ ≥ 94%.
• Patient will demonstrate clear, audible breath sounds in all lung fields within 30 minutes postictal.

Interventions and rationale:

1. Turn the patient to a side-lying (recovery) position as soon as motor activity allows — gravity drains oral secretions and reduces the tongue-falling-back risk.
2. Apply oxygen via nasal cannula or non-rebreather based on SpO₂ — supports oxygenation while neuromuscular control returns.
3. Suction oropharynx with a Yankauer when needed — do not blindly suction during active tonic-clonic movement; wait for clonic phase to end.
4. Monitor respiratory rate, depth, and SpO₂ every 5 minutes during the postictal period — early respiratory compromise is the most common immediate complication.
5. Never insert anything in the patient’s mouth during a seizure — the airway is protected by positioning, not by force; objects cause oral trauma, broken teeth, and aspiration.
6. Notify the provider for prolonged respiratory depression or apnea — may indicate post-seizure pulmonary aspiration or ASM over-sedation.

Evaluation: SpO₂ at baseline or provider target, lungs clear, no signs of aspiration on chest auscultation.

3. Risk for Aspiration

Diagnostic statement: Risk for Aspiration related to depressed cough and gag reflex and altered LOC during and after seizure.

Assessment data supporting: observed altered LOC postictal, history of oral secretions or vomiting during a seizure.

Goals / expected outcomes:

• Patient will show no signs of aspiration, as evidenced by stable oxygenation, clear or baseline lung sounds, absence of new cough/choking, and no new fever or respiratory distress. Chest imaging will be reviewed if ordered.
• Patient will maintain a patent airway throughout the ictal and postictal phases.

Interventions and rationale:

1. Position laterally throughout the postictal period until LOC fully returns — uses gravity to keep oral contents out of the airway.
2. Keep NPO until fully alert with intact gag and swallow — feeding before swallow returns is the single highest aspiration risk.
3. Have suction setup and tested at the head of the bed every shift — readiness matters because aspiration risk window is short and unpredictable.
4. Monitor for signs of aspiration pneumonitis or pneumonia in the 24–72 hours following a seizure — new fever, productive cough, hypoxia, or focal infiltrate.

Evaluation: No clinical or radiographic signs of aspiration; oral intake resumed safely once gag/swallow intact.

4. Anxiety

Diagnostic statement: Anxiety related to unpredictability of seizure recurrence and social stigma, as evidenced by verbalized fear, social withdrawal, or avoidance of public situations.

Assessment data supporting: patient statements about fear of having a seizure in public, restricted activities, sleep disturbance.

Goals / expected outcomes:

• Patient will verbalize two coping strategies for seizure-related anxiety before discharge.
• Patient will report a decrease in anxiety on a self-report scale (e.g., GAD-7 or 0–10 numeric) by the end of teaching.

Interventions and rationale:

1. Provide accurate, plain-language information about seizure triggers and what to expect during and after — knowledge reduces catastrophic thinking and gives the patient a sense of control.
2. Acknowledge the patient’s fear without minimizing — invalidation increases anxiety; validation builds therapeutic trust.
3. Connect the patient to support resources (Epilepsy Foundation, local support groups, mental-health referrals) — peer support and counseling are evidence-based for chronic-illness anxiety.
4. Encourage seizure-diary use — pattern-spotting reduces uncertainty and gives the patient agency.
5. Teach a brief grounding technique (5-4-3-2-1 sensory or paced breathing) — practical in-the-moment tool for breakthrough anxiety.

Evaluation: Patient verbalizes two coping strategies, reports lower anxiety score, and identifies one support resource before discharge.

5. Deficient Knowledge

Diagnostic statement: Deficient Knowledge related to new seizure diagnosis and complex ASM regimen, as evidenced by inability to verbalize a seizure action plan or correct dosing of prescribed ASM.

Assessment data supporting: new diagnosis, recent ASM change, patient questions, no documented prior teaching.

Goals / expected outcomes:

• Patient will state when to call 911 vs. when to use a rescue medication before discharge.
• Patient will demonstrate or teach-back correct ASM dosing schedule before discharge.
• Patient will identify three personal triggers and one mitigation strategy for each.

Interventions and rationale:

1. Provide a written seizure action plan and a printed ASM schedule — written instructions outperform verbal teaching for retention.
2. Teach: never stop ASMs abruptly — rebound or breakthrough seizures, including status epilepticus, are well-documented after sudden discontinuation.
3. Review the 5-minute rule for calling 911 (continuous seizure ≥5 min, or back-to-back seizures without recovery) — aligns the patient with the current operational definition of status epilepticus.
4. Discuss driving restrictions — they vary by state; refer the patient to their state DMV and prescribing clinician for current rules.
5. For patients who could become pregnant, discuss ASM-related fetal risk (especially valproate, which should generally be avoided when clinically feasible per the 2024 AAN/AES/SMFM guideline) and folic-acid supplementation before pregnancy — pregnancy planning changes the ASM regimen.
6. Use teach-back at the end — confirms understanding and identifies gaps to re-teach.

Evaluation: Patient correctly verbalizes 911 criteria, ASM dosing, and trigger management on teach-back.

6. Caregiver Role Strain

Diagnostic statement: Caregiver Role Strain related to round-the-clock seizure monitoring and unpredictable seizure recurrence, as evidenced by caregiver-reported exhaustion, social isolation, or hesitancy to leave the patient unattended.

Assessment data supporting: primary caregiver statements about fatigue or fear, neglected self-care, reduced social activity.

Goals / expected outcomes:

• Caregiver will identify two community respite options and one stress-management strategy within one week of teaching.
• Caregiver will demonstrate correct administration of the patient’s rescue medication (e.g., intranasal midazolam) before discharge.

Interventions and rationale:

1. Assess the caregiver’s physical and emotional well-being directly — caregivers often hide strain until they crash.
2. Teach rescue-medication administration with return demonstration — competence reduces panic during the next event.
3. Connect to caregiver-specific resources (Epilepsy Foundation caregiver toolkit, respite care, local support groups) — peer connection and structured respite reduce burnout.
4. Encourage the caregiver to maintain their own appointments, sleep, and nutrition — caregiver health predicts patient outcomes.
5. Discuss when to call EMS vs. when to manage at home — clear escalation rules reduce decision fatigue at 3 a.m.

Evaluation: Caregiver verbalizes a respite plan, demonstrates rescue-med technique correctly, and reports lower strain score on follow-up.

Nursing interventions during a seizure

Walk through the seizure on a timeline: before, during, and immediately after. Most NCLEX-RN® stems test the during phase, but real-bedside priorities live across all three.

Before — seizure precautions setup

See the next section for the full inpatient setup checklist. Briefly: bed low and locked, padded rails (per policy), suction + O₂ at the head of the bed, working call light, IV access established, bedside Yankauer.

During the ictal phase

1. Stay with the patient and call for help — never leave a seizing patient alone.
2. Note the start time — this is the single most important data point you’ll chart.
3. Protect the head — slide a pillow, folded blanket, or your hands underneath; do not place fingers in the mouth.
4. Ease the patient to the floor if they’re standing or sitting unsupported — controlled descent prevents head-strike injury.
5. Turn to side-lying as soon as motor activity allows — protects the airway from secretions and the tongue.
6. Loosen tight clothing around the neck.
7. Move objects out of the way; do not restrain.
8. Time the seizure continuously — when the clock crosses 5 minutes, activate status-epilepticus protocol.
9. Observe and chart: motor pattern (focal vs. generalized), eye deviation, automatisms, incontinence, cyanosis.
10. Apply oxygen via NC or NRB once the airway is accessible and SpO₂ < 94%.

Never. Put anything in the patient’s mouth (no spoons, tongue blades, fingers, bite blocks during active seizure). Restrain the patient. Give oral fluids or medications.

Immediately after (postictal)

Covered in detail in the postictal section. Highlights: side-lying, neuro check, vitals, document everything.

Seizure precautions

Inpatient setup checklist for any patient on seizure precautions:

• Bed in lowest position; brakes locked
• Side rails raised or padded per facility policy — side rails are a fall/injury barrier on seizure precautions, not a restraint, and policies vary on which rails are raised, when, and how padding is applied
• Suction setup with Yankauer at the head of the bed; tested each shift
• Oxygen with nasal cannula AND non-rebreather mask available
• Working call light within reach
• IV access established (peripheral, ≥20-gauge if possible)
• Bedside oral airway (do not insert during active seizure)
• Bedside helmet if drop-attack history
• Shower instead of tub bath; never leave the patient unattended in water
• No restraints — they cause more injury than they prevent

Activity / lifestyle precautions for ambulatory patients:

• Avoid heights, swimming alone, unsupervised cooking with open flame
• Take medications on schedule — set phone alarms
• Keep a current ASM list and seizure action plan in wallet/phone
• Wear medical-alert ID
• Driving restrictions vary by state — refer the patient to their state DMV and prescribing clinician for current rules; many states require a documented seizure-free period before resuming driving and have separate reporting requirements

Status epilepticus — recognition and emergency management

Status epilepticus is the part of the seizure topic that makes students nervous — fast-moving, drug-heavy, life-threatening. Let’s make it simple: the trigger is the clock. When a tonic-clonic seizure crosses the 5-minute mark, the priority shifts from observation to pharmacologic termination.

Operational definition (ILAE 2015): a continuous seizure ≥ 5 minutes, OR two or more seizures without recovery of consciousness between them. The older 30-minute definition is obsolete for clinical action.

High-yield flag. If a tonic-clonic seizure crosses the 5-minute mark, activate the status epilepticus protocol — don’t wait.

Immediate nursing actions

1. Call rapid response or follow facility code-stroke / code-seizure pathway
2. ABCs — position, suction, apply oxygen, consider BVM if respirations are inadequate
3. Establish two large-bore IVs if not already present
4. Point-of-care glucose — hypoglycemia mimics and triggers seizures
5. Draw stat labs: ASM levels, BMP, magnesium, calcium, lactate, toxicology
6. Place on continuous cardiac, SpO₂, and ETCO₂ monitoring
7. Prepare first-line benzodiazepine per facility order

First-line: benzodiazepines (give early, give enough)

Second-line: ASM loading dose (after benzo failure)

The 2019 NEJM ESETT trial and the 2024 ACEP clinical policy support that levetiracetam, fosphenytoin, and valproate are roughly equivalent as second-line agents. Facility protocol dictates which is on the order set.

Refractory and super-refractory status epilepticus

• Refractory status epilepticus — continues after first- and second-line therapy. Treat with continuous-infusion anesthetic (midazolam, propofol, or pentobarbital), intubate, transfer to ICU.
• Super-refractory status epilepticus — continues or recurs ≥24 hours after anesthetic start. Long ICU course; high mortality.

Even with first-line benzos given correctly, mortality of generalized convulsive status epilepticus remains 10–20% — early recognition is the nurse’s most important contribution.

Postictal care

The seizure has stopped. The next 30–60 minutes are where the nursing job continues.

Position and airway:

• Keep the patient laterally until LOC fully returns
• Suction secretions as needed
• Apply oxygen per SpO₂; titrate to ≥ 94% unless an individualized target applies

Monitoring cadence:

• Vital signs and SpO₂ every 5–15 minutes until stable
• Neurologic recheck (orientation, motor strength bilaterally, pupils, speech) every 15 minutes for the first hour, then per provider order
• Continuous cardiac monitoring if status was prolonged

Watch for:

• Todd’s paresis/paralysis — transient post-seizure focal weakness that can last minutes to hours, sometimes longer. Treat any new focal neurologic deficit as a potential stroke until evaluated — document onset and resolution, perform focused neuro checks, notify the provider or rapid-response team per protocol, and anticipate imaging (CT/MRI) or EEG as ordered. Todd’s is a diagnosis of exclusion.
• Tongue or lip lacerations
• Bowel or bladder incontinence
• Head, shoulder, or limb injuries from the fall or motor activity
• New fever (could indicate meningitis or aspiration)
• Prolonged altered mental status (concern for non-convulsive status epilepticus — escalate for EEG)

Documentation requirements (every chart, every seizure):

• Exact start time and end time
• Motor pattern (focal vs. generalized; right vs. left; head/eye deviation)
• Automatisms, aura, incontinence, cyanosis
• Interventions given (oxygen, positioning, medication with dose/route/time)
• Vital signs and SpO₂ trend
• Time to return of baseline LOC
• Any injuries identified
• Provider notification time

Escalate immediately if: patient does not return to baseline LOC within 30 minutes; focal deficit not resolving; new fever, headache, or stiff neck; new injury suspected on exam (head strike, shoulder pain, tongue laceration with bleeding).

Antiseizure medications and nursing considerations

A high-yield ASM summary for NCLEX-RN® and clinical handoff. Group meds by what you’d reach for: rescue / emergency (benzodiazepines) → acute IV loading (second-line) → maintenance (chronic outpatient ASMs).

Rescue / emergency (benzodiazepines)

• Lorazepam (Ativan) — IV first-line for inpatient status; watch respiratory depression and hypotension.
• Midazolam (Versed) — IM/intranasal/buccal for community or pre-hospital rescue.
• Diazepam (Diastat) — rectal gel for community pediatric rescue.

Across the class: monitor airway and respirations. Flumazenil is not routine seizure care and may precipitate seizures in benzodiazepine-dependent patients — use only when specifically ordered and clinically appropriate (typically for accidental benzodiazepine overdose in a non-dependent patient).

Maintenance ASMs — high-yield red flags

Across-the-class counseling pearls

• Never stop abruptly — rebound seizures, including status epilepticus, are well-documented after sudden discontinuation.
• ASM-ASM interactions are common; check whenever a new med is added.
• Enzyme-inducing ASMs (phenytoin, carbamazepine, phenobarbital, topiramate at higher doses) reduce hormonal contraceptive effectiveness — counsel on backup or non-hormonal methods.
• Patients who could become pregnant: discuss pregnancy planning before conception. Valproate should generally be avoided when clinically feasible because of fetal risk (major congenital malformations and neural tube defects); when clinically appropriate, options such as lamotrigine, levetiracetam, or oxcarbazepine are often considered per the 2024 AAN/AES/SMFM guideline. Folic acid is recommended before and during pregnancy — at least 0.4 mg/day, with higher doses individualized by the prescriber.
• Therapeutic drug monitoring is standard for phenytoin, carbamazepine, valproate, and phenobarbital; trough levels for most.

Patient and family education

The most important non-pharmacologic intervention you’ll deliver. Build the plan around these blocks:

• Medication adherence — never miss doses; what to do if a dose is missed; never stop abruptly.
• Seizure action plan — written, printable, in wallet and on phone. The Epilepsy Foundation has free templates.
• Seizure diary — date, time, duration, trigger, ASM dose. Patterns surface fast.
• When to call 911 — seizure lasting ≥5 minutes, repeated seizures without recovery, first seizure ever, seizure during pregnancy, seizure with diabetes (rule out hypoglycemia), injury during the event.
• Driving — restrictions vary by state. Refer the patient to their state DMV and prescribing clinician for the current rules and any reporting requirements.
• Pregnancy planning — discuss before conception; valproate carries the highest known teratogenic risk among common ASMs.
• Home safety — shower instead of bath, never swim alone, avoid heights, medical-alert ID.
• Trigger avoidance — sleep, alcohol, stress, missed meals, ASM missed doses; photosensitivity only in the small subset with photosensitive epilepsies.

NCLEX-style review questions

NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc. (NCSBN). This content is not endorsed by or affiliated with NCSBN.

Question 1

A client is actively having a generalized tonic-clonic seizure. Which nursing intervention is the priority?

• A) Promote the client’s self-esteem.
• B) Keep the client safe.
• C) Hold the client down to stop the movements.
• D) Provide information to the client about the disease process.

Answer: B. Keep the client safe.

Rationale: The priority during active seizure activity is patient safety — protect the head, position laterally when motor activity allows, time the seizure, and never restrain or insert anything in the mouth. Self-esteem and disease teaching are appropriate after the postictal phase resolves.

Question 2

The nurse is caring for a client whose generalized tonic-clonic seizure has continued for six minutes despite an initial dose of IV lorazepam 4 mg. Which medication should the nurse anticipate administering next?

• A) Diazepam 10 mg PO
• B) Levetiracetam 60 mg/kg IV
• C) Phenytoin 100 mg IM
• D) Acetaminophen 650 mg PO

Answer: B. Levetiracetam 60 mg/kg IV.

Rationale: After first-line benzodiazepine failure in status epilepticus, the next step is a second-line ASM loading dose — levetiracetam, fosphenytoin, or valproate (roughly equivalent per the 2019 ESETT trial and the 2024 ACEP clinical policy). Oral and PO routes are not appropriate during active seizure (no swallow). Phenytoin is never given IM — it causes tissue necrosis; fosphenytoin is the IM/IV-friendly prodrug.

Question 3

A client returns from a focal-to-bilateral tonic-clonic seizure with documented left-sided arm weakness. The provider has been notified and the patient is en route to imaging. Which finding would the nurse most likely identify on follow-up assessment if stroke is ruled out and the weakness resolves over the next several hours?

• A) Acute ischemic stroke requiring emergent IV thrombolysis
• B) Todd’s paresis/paralysis
• C) New-onset cerebral palsy
• D) ASM toxicity

Answer: B. Todd’s paresis/paralysis.

Rationale: Todd’s paresis/paralysis is a transient post-seizure focal weakness, classically seen after focal seizures and after focal-to-bilateral tonic-clonic events. It can last minutes to hours, occasionally longer. Crucially, it is a diagnosis of exclusion — any new focal deficit must be evaluated for acute stroke first (the question stem specifies stroke has been ruled out). A nurse who notes new focal weakness should treat it as potential stroke until imaging and clinical evaluation clear it, then document the resolving deficit as likely Todd’s.

Want more seizure NCLEX-style practice? Try our neurological drugs NCLEX review and our NCLEX practice question hub.

Related resources

The five canonical care-plan references — bookmark these alongside this guide:

• Nursing Diagnosis
• Nursing Interventions
• Nursing Care Plan Template
• Nursing Process
• ADPIE

Sibling care plans:

• Ineffective Airway Clearance
• Decreased Cardiac Output
• Acute Pain
• Decorticate vs Decerebrate (mnemonic)
• 12 Cranial Nerves

Frequently asked questions

What is the priority nursing intervention during a seizure?

Keep the patient safe. Protect the head, side-lying position when motor activity allows, time the seizure, never restrain, never insert anything in the mouth. Apply oxygen and suction once the airway is accessible.

What are the most common NANDA-I nursing diagnoses for a patient with seizures?

The high-yield nursing diagnosis for seizures set is Risk for Injury, Ineffective Airway Clearance, Risk for Aspiration, Anxiety, Deficient Knowledge, and Caregiver Role Strain. Pick the two or three that match your patient’s actual data — care plans are not one-size-fits-all.

What is status epilepticus and how is it treated?

Status epilepticus is a seizure lasting ≥5 minutes or back-to-back seizures without recovery of consciousness. First-line treatment is an IV benzodiazepine (lorazepam 4 mg, or IM midazolam 10 mg if no IV). If the seizure continues, second-line options include levetiracetam, fosphenytoin, or valproate — these are roughly equivalent per the 2019 ESETT trial and the 2024 ACEP clinical policy.

Should you put anything in a seizing patient’s mouth?

No. Never. Inserting fingers, spoons, tongue blades, or bite blocks causes broken teeth, oral trauma, and aspiration. The airway is protected by side-lying positioning, not by force.

How long should a seizure last before calling 911?

Five minutes for tonic-clonic activity, or any time the patient has back-to-back seizures without recovering consciousness between them. Also call for: first seizure ever, seizure during pregnancy, seizure in a patient with diabetes, or seizure with significant injury.

What is the difference between focal and generalized seizures?

Focal seizures start in one area of one hemisphere; the patient may stay aware (focal aware) or have altered awareness (focal impaired-awareness). Generalized seizures engage both hemispheres from the start and include tonic-clonic, absence, myoclonic, atonic, tonic, and clonic types.

What is the difference between a seizure and epilepsy?

A seizure is a single event. Epilepsy is the disease — diagnosed after ≥2 unprovoked seizures more than 24 hours apart, or after one unprovoked seizure with a high recurrence risk.

What is Todd’s paresis/paralysis?

Transient post-seizure focal weakness, classically after focal seizures and after focal-to-bilateral tonic-clonic events. It can last minutes to hours, sometimes longer. Treat any new focal deficit as a potential stroke until evaluated — document onset, perform serial neuro checks, notify the provider, and anticipate imaging or EEG as ordered. Todd’s is a diagnosis of exclusion after stroke and other causes are ruled out.

Building a nursing diagnosis for seizures gets faster the second and third time you do it. Once you recognize the pattern — protect, position, time, document, escalate at 5 minutes — the nursing job becomes repeatable. Practice with a few NCLEX-style stems, walk through the during-vs-after timeline out loud, and the next time a seizure shows up on a stem or in a clinical rotation, you’ll know exactly where to start.

References

1. International League Against Epilepsy. Updated classification of epileptic seizures (2025). ILAE position paper. ilae.org
2. Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy. Epilepsia. 2017;58(4):522-530.
3. Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475-482.
4. Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus — report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015;56(10):1515-1523.
5. Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults. Epilepsy Currents. 2016;16(1):48-61.
6. Kapur J, Elm J, Chamberlain JM, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus (ESETT). New England Journal of Medicine. 2019;381(22):2103-2113.
7. American College of Emergency Physicians. ACEP Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Seizures. 2024. acep.org
8. Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocritical Care. 2012;17(1):3-23.
9. Herdman TH, Kamitsuru S, Lopes CT, eds. NANDA International Nursing Diagnoses: Definitions & Classification, 2024–2026. 13th ed. Thieme; 2024. (Maintained by INKA, formerly NANDA International.)
10. Hinkle JL, Cheever KH, Overbaugh KJ. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 15th ed. Wolters Kluwer / Lippincott; 2022.
11. Burchum JR, Rosenthal LD. Lehne’s Pharmacology for Nursing Care. 11th ed. Elsevier; 2022.
12. American Academy of Neurology / American Epilepsy Society / Society for Maternal-Fetal Medicine. Practice Guideline Update: Antiseizure Medications in People with Epilepsy and Pregnancy. Neurology. 2024.
13. Centers for Disease Control and Prevention. First Aid for Seizures. cdc.gov/epilepsy/first-aid-for-seizures/
14. Epilepsy Foundation. Seizure first aid and seizure action plans. epilepsy.com

Source notes. NANDA-I labels and related/risk factors should be verified against the licensed 2024–2026 (13th ed.) text before clinical documentation. Status-epilepticus dosing and pregnancy/ASM guidance follow current guideline editions (AES 2016, ESETT 2019, ACEP 2024, AAN/AES/SMFM 2024). Educational content for nursing students — not a substitute for clinical training, facility protocol, or licensed provider judgment.