A nurse is caring for a school-age child who is experiencing a tonic-clonic seizure. Which of the following actions should the nurse take?
Place a folded blanket under the child's head.
Put a tongue blade between the child's teeth.
Administer magnesium sulfate IM to the child.
Prevent movement of the child's extremities.
The Correct Answer is A
A. Placing a folded blanket or any soft object under the child's head helps to protect the head from injury during the seizure. Ensuring safety is a priority during a seizure.
B. Putting a tongue blade or any object between the child's teeth can cause injury to the child. It is no longer recommended to place anything in the mouth during a seizure.
C. Magnesium sulfate is not indicated for treating tonic-clonic seizures. The focus should be on maintaining safety and monitoring the seizure.
D. Preventing movement of the child's extremities can cause injury. Instead, the nurse should protect the child from harm and ensure the environment is safe.
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Related Questions
Correct Answer is D
Explanation
A. IV fluid therapy may be necessary if the child cannot tolerate oral fluids, but oral rehydration therapy is the first line of treatment for mild to moderate dehydration.
B. Administering a regular diet is important for recovery but is not the priority action when addressing acute dehydration.
C. IV antibiotics are not typically necessary for acute diarrhea unless there is a confirmed bacterial infection.
D. Initiating oral rehydration therapy is the priority to address dehydration and replace lost fluids and electrolytes effectively.
Correct Answer is A
Explanation
A. Checking the color and temperature of the toes helps assess for adequate circulation and potential complications like compartment syndrome.
B. Applying cushioning to the cast edges is important for comfort but is not the immediate priority.
C. Using a fan can help the cast dry faster but is not the priority action.
D. Repositioning the toddler is important to prevent pressure sores, but ensuring proper circulation takes precedence.
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