A nurse is caring for a client who is in bed and begins experiencing a tonic-clonic seizure.
Which of the following actions should the nurse take?
- Lower the side rails of the bed when the seizure begins.
- Measure the duration of the seizure.
- Restrain the client's arms and legs to prevent injury.
Insert an oral airway into the client's mouth.
Lower the side rails of the bed when the seizure begins.
Measure the duration of the seizure.
Restrain the client's arms and legs to prevent injury.
Insert an oral airway into the client's mouth.
The Correct Answer is B
Lowering the side rails of the bed could lead to the client falling from the bed. Instead raise the side rails and place padding on them.
Measuring the seizure duration is a crucial step for medical evaluation afterwards necessary for determining intervention.
Inserting an oral airway into the client's mouth is not indicated during a tonic-clonic seizure. It is generally not recommended to place any objects or devices into the mouth of a person having a seizure, as it can potentially cause injury to the person or damage to the airway.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Levothyroxine is a medication used to treat hypothyroidism, and monitoring the TSH levels helps determine the effectiveness of the medication.
Blood urea nitrogen (BUN) is a test used to assess kidney function and is not specifically related to thyroid function or levothyroxine therapy.
Prothrombin time (PT) is a test used to evaluate the clotting ability of the blood and is not directly related to thyroid function or levothyroxine therapy.
Arterial blood gases (ABGs) are used to assess oxygen and carbon dioxide levels in the blood and evaluate acid-base balance. ABGs are not specifically related to thyroid function or levothyroxine therapy.
Correct Answer is A
Explanation
Explanation
A, Nervousness
Levothyroxine is a medication used to treat hypothyroidism, a condition in which the thyroid gland does not produce enough thyroid hormones. Thyrotoxicosis, on the other hand, is a condition characterized by an excess of thyroid hormones in the body, which can occur as a side effect of levothyroxine or other thyroid medications.
Nervousness is a common symptom of thyrotoxicosis. Excess thyroid hormones can lead to increased sympathetic nervous system activity, causing symptoms like nervousness, restlessness, anxiety, and palpitations.
Pruritus (itching) in (option B) is not correct because it is not a typical manifestation of thyrotoxicosis. Itching is not directly related to thyroid hormone levels and is more likely to be associated with other conditions or medication side effects.
Cough In (option C) is not correct because it is not a typical manifestation of thyrotoxicosis. Coughing is not a symptom directly related to thyroid hormone levels and is more likely to be associated with respiratory or other conditions.
Polyuria (increased urination) in (option D) is not correct because it is not a typical manifestation of thyrotoxicosis. Polyuria is not a symptom directly related to thyroid hormone levels and is more likely to be associated with other conditions, such as diabetes or kidney problems.
If the client experiences symptoms of thyrotoxicosis, such as nervousness, palpitations, or any other concerning signs, it is essential to notify the healthcare provider promptly. The provider may need to adjust the dosage of levothyroxine or consider other treatment options to address the excess thyroid hormone levels and ensure the client's well-been
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