A client is having a tonic-clonic seizure. What should the nurse do first?

Elevate the head of the bed.

Restrain the client's arms and legs.

Place a tongue blade in the client's mouth.

Take measures to prevent injury.

Answer and Explanation

The Correct Answer is D

A. Elevate the head of the bed: Elevating the head of the bed is not the priority during a seizure. The primary concern is ensuring the client's safety by preventing injury.

B. Restrain the client's arms and legs: Restraining a client during a seizure is not advised, as it can cause injury. Instead, the focus should be on protecting the client from harm.

C. Place a tongue blade in the client's mouth: Placing anything in the client’s mouth during a seizure is contraindicated, as it can lead to airway obstruction or injury.

D. Take measures to prevent injury: The priority during a seizure is to protect the client from injury by ensuring a safe environment, such as padding the head and moving any dangerous objects away.

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Correct Answer is C

Explanation

A. "Inhalants are central nervous system (CNS) depressants similar to alcohol." Inhalants are CNS depressants, but this response might not indicate full understanding of the risks and addictive nature of inhalants.

B. "The 'high' that I am getting is from hallucinogenic properties in the inhalant." This is incorrect because inhalants are not primarily hallucinogens; they depress the CNS, leading to effects similar to alcohol intoxication.

C. "Inhalants are easy to come by and highly addictive." This statement indicates the client understands the accessibility and addictive potential of inhalants, which is a critical aspect of the education provided by the nurse.

D. "When inhaling solvents, I get an instant CNS stimulation that is euphoric." While inhalants may provide a euphoric sensation, they are primarily CNS depressants, not stimulants. This response indicates a misunderstanding of their effects.

A. Most restrictive B. Least restrictive C. Nursing home D. Transitional care unit

Correct Answer is D

Explanation

A. Most restrictive: A most restrictive environment may not be necessary if the client does not require intensive supervision or care.

B. Least restrictive: A least restrictive environment is generally preferred if the client can function with less supervision and support. It supports independence while providing necessary care.

C. Nursing home: A nursing home may be appropriate for clients needing extensive care, but it is often more restrictive than needed for clients who do not require 24-hour nursing care.

D. Transitional care unit: A transitional care unit is designed to support clients transitioning from hospital to home or other settings, which may be suitable if the client needs further rehabilitation or adjustment.

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A client is having a tonic-clonic seizure. What should the nurse do first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who has has been inhaling solvents to receive a "high." After the nurse provides education on the effects of inhaling solvents, which statement from the client indicates understanding of the teaching?

Correct Answer is C

Explanation

A client has lived independently prior to being admitted to an inpatient unit. The client will be unable to return home following discharge. Which environment would be most appropriate for the client?

Correct Answer is D

Explanation

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