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

Answer and Explanation

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.

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Correct Answer is B

Explanation

A complete blood count (CBC) may be ordered later if further infection or sepsis is suspected, but it is not the first diagnostic test.
B. Urinalysis is the most appropriate initial test to diagnose a urinary tract infection (UTI), which is common in children with symptoms such as dysuria and irritability.
C. An abdominal ultrasound is more appropriate if there are concerns about abdominal pathology, which is not suggested by the symptoms.
D. A bladder scan is not the first diagnostic step and would be used to assess post-void residual urine if necessary.

A. Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management B. Restriction of weight-bearing activities to prevent further damage C. Prescription of crutches for mobility assistance D. Application of ice packs to reduce inflammation E. Immediate referral to an orthopedic specialist for evaluation F. Application of a heat pack to relieve muscle tension

Correct Answer is ["B","C","E"]

Explanation

A. NSAIDs may help with pain management, but they are not the primary treatment for SCFE.
B. Restricting weight-bearing activities is crucial to prevent further damage and complications to the affected hip joint.
C. Crutches may be prescribed to assist with mobility and prevent weight-bearing on the affected hip.
D. Ice packs may reduce inflammation but are secondary to more important interventions like weight restriction and orthopedic referral.
E. Immediate referral to an orthopedic specialist is necessary for appropriate diagnosis and management, including possible surgery.
F. Heat packs are not recommended for SCFE because they could increase blood flow and swelling in the affected area.

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A nurse is caring for a child who is having a tonic-clonic seizure. What is the nurse's priority action during the seizure?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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