A home health nurse is providing teaching about post seizure management to the parents of a school-age child who has epilepsy and experiences tonic-clonic seizures. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)
Hyperextend your child's head for 5 minutes following a seizure."
"Immediately following a seizure, give your child 6 ounces of water."
"Following a seizure, record the length and characteristics of your child's seizure."
"Administer rectal diazepam to your child following a seizure."
"Call for emergency medical services if the size of your child's pupils are unequal after a seizure."
Correct Answer : C,D,E
A. "Hyperextend your child's head for 5 minutes following a seizure."
Hyperextension can obstruct the airway. Instead, place the child in a side-lying position to maintain an open airway.
B. "Immediately following a seizure, give your child 6 ounces of water."
Do not give anything orally until the child is fully awake and the gag reflex has returned to avoid aspiration.
C. "Following a seizure, record the length and characteristics of your child's seizure."
Important for tracking seizure activity and evaluating treatment effectiveness.
D. "Administer rectal diazepam to your child following a seizure."
Rectal diazepam may be prescribed for prolonged or clustered seizures, especially at home.
E. "Call for emergency medical services if the size of your child's pupils are unequal after a seizure."
Unequal pupils post-seizure may indicate increased intracranial pressure or brain injury and warrant immediate medical attention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. New heart murmur:
A new or changing heart murmur is a common clinical manifestation of infective endocarditis due to valve damage.
B. Weight gain:
Weight loss, not weight gain, is more typical due to decreased appetite and systemic illness.
C. Bradycardia:
Tachycardia (increased heart rate) is more commonly associated with infection, not bradycardia.
D. Decreased body temperature:
Fever (elevated body temperature), not hypothermia, is expected in infective endocarditis.
Correct Answer is B
Explanation
A. "Expect the medication to cause constipation for the first few days of therapy."
Metformin more commonly causes diarrhea, nausea, and abdominal discomfort, not constipation.
B. "Take the medication at the same time each day."
Consistent dosing helps maintain stable blood glucose levels. Metformin is usually taken once or twice daily with meals.
C. "This medication is used for short-term therapy until your symptoms improve."
Type 2 diabetes is a chronic condition. Metformin is often used as a long-term maintenance therapy.
D. "Take this medication 1 hour before meals."
Metformin should be taken with meals to reduce gastrointestinal side effects, not on an empty stomach.
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