A nurse is caring for a patient who has just experienced a tonic-clonic seizure. Which of the following actions should the nurse perform first after ensuring the patient's safety?

Document the seizure activity in the patient's medical record.

Check the patient's vital signs

Administer oral antiepileptic medication.

Place the patient in a side-lying position.

Answer and Explanation

The Correct Answer is D

A.   Documenting the seizure activity is important but should be done after addressing immediate needs.
B.   Checking the patient's vital signs is important but is secondary to positioning the patient safely to prevent aspiration.
C.   Administering oral antiepileptic medication is necessary but not the first action following a tonic- clonic seizure.
D.   Placing the patient in a side-lying position immediately after the seizure ensures that the airway remains open and reduces the risk of aspiration.

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Correct Answer is ["A","B","C","G"]

Explanation

A. Administering epinephrine intramuscularly is the first-line treatment for anaphylaxis, as it counteracts the effects of histamine and reduces swelling.
B. Starting intravenous access allows for fluid resuscitation and the administration of medications like epinephrine or corticosteroids.
C. Providing supplemental oxygen is necessary to support the patient's breathing and improve oxygenation during an anaphylactic reaction.
D. Corticosteroids may be used later to reduce inflammation, but they are not first-line treatments for anaphylaxis.
E. Placing the patient in a supine position with legs elevated may be helpful for circulation, but it is not the priority over administering epinephrine.

F. Oral antihistamines are not effective in the acute management of anaphylaxis, which requires immediate action.
G. Ensuring the patient's airway is patent is the top priority, as airway compromise can occur rapidly during anaphylaxis.
H. Encouraging oral fluid intake is not appropriate in this emergency situation, as intravenous fluids are needed.
I. Monitoring the patient's skin for rashes is important but secondary to managing the airway and circulation.

A. Secondary progressive multiple sclerosis B. Relapsing-remitting multiple sclerosis C. Primary progressive multiple sclerosis D. Clinically isolating syndrome

Correct Answer is B

Explanation

A. Secondary progressive multiple sclerosis involves a steady decline in function with or without relapses, which is different from the relapsing-remitting pattern.
B. Relapsing-remitting multiple sclerosis (RRMS) is the most common type of MS and is characterized by flare-ups of symptoms followed by periods of partial or complete recovery with no symptoms.
C. Primary progressive multiple sclerosis involves a gradual worsening of symptoms without distinct relapses or remissions. This pattern does not match the client's description of periods without symptoms.
D. Clinically isolating syndrome refers to the first episode of neurologic symptoms that lasts for at least24 hours and is indicative of MS, but this is a different stage than relapsing-remitting MS.

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A nurse is caring for a patient who has just experienced a tonic-clonic seizure. Which of the following actions should the nurse perform first after ensuring the patient's safety?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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A nurse is caring for a patient who has just experienced a tonic-clonic seizure. Which of the following actions should the nurse perform first after ensuring the patient's safety?