A nurse is caring for a child who is having a tonic-clonic seizure. What is the nurse's priority action during the seizure?
Call for a code blue and initiate cardiopulmonary resuscitation (CPR)
Restrain the child to prevent injury
Administer a dose of lorazepam to stop the seizure
Ensure the child's safety by removing nearby objects and padding the area
The Correct Answer is D
A. CPR is not typically necessary unless the child stops breathing or the heart stops during the seizure, which is rare.
B. Restraining a child during a seizure can cause injury. The focus should be on safety and protection, not restraint.
C. Lorazepam may be given if the seizure lasts too long, but ensuring safety is the priority action.
D. The nurse’s priority during a seizure is to ensure the child’s safety by removing hazardous items from the area and ensuring the child does not get injured.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Low levels of AFP are not diagnostic of any condition, but they could indicate a potential issue, requiring further investigation.
B. A negative AFP test does not rule out genetic issues, as AFP is just one screening tool.
C. High levels of AFP may indicate a neural tube defect or other issues and warrant further testing, such as ultrasound or amniocentesis.
D. An elevated AFP level is associated with neural tube defects but does not definitively indicate the presence of one without further testing.
Correct Answer is A
Explanation
A. The nurse should encourage open communication and allow the adolescent to express their emotions about the amputation. This provides emotional support and helps the child process the upcoming surgery.
B. Encouraging immediate return to physical activities may not be realistic or helpful right after surgery.
C. Assisting the adolescent in accepting the procedure as a better alternative to chemotherapy may minimize the emotional aspects of the situation and is not an ideal approach.
D. Avoiding the topic of the procedure can increase anxiety and delay the emotional preparation needed for the surgery.
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