A nurse is caring for a school-age child who is having a tonic-clonic seizure. Which of the following actions should the nurse take?

Administer chlorothiazide.

Hold the child down.

Place the child in a prone position.

Time the episode.

Answer and Explanation

The Correct Answer is D

Rationale:

A. Chlorothiazide is a diuretic and is not indicated during a seizure.

B. Holding the child down during a seizure can lead to injury and is not recommended. It's essential to ensure the child's safety by protecting the head from injury and removing any objects that could cause harm.

C. Placing the child in a prone position during a seizure can compromise their ability to breathe and is not recommended. Instead, the child should be placed in a safe position on their side to prevent aspiration.

D. Timing the duration of the seizure is crucial for medical management and documentation purposes. This action allows healthcare providers to assess the

severity of the seizure and determine the need for intervention or medication administration.

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Correct Answer is A

Explanation

Rationale:

A. Assessing the risk of self-harm or suicide is the top priority when caring for a patient with major depressive disorder. It allows the nurse to intervene immediately if there's a risk of harm.

B. While group therapy can be beneficial for individuals with depression, it's not the first priority when assessing for safety concerns.

C. Administering antidepressants may be part of the treatment plan, but it's essential to assess the immediate risk of self-harm before proceeding with medication administration.

D. Assisting with activities of daily living is important, but it's not the first action to take when assessing for safety in a patient with major depressive disorder.

A. While osteomyelitis is a serious condition requiring treatment, receiving an IV bolus of nafcillin is not an urgent procedure compared to a neurological symptom like slurred speech. B. Pain management is important, but a pain level of 7, while significant, does not indicate an immediate life-threatening situation. C. Slurred speech in an adolescent with sickle cell anemia could indicate a neurological complication or a stroke, which requires immediate assessment and intervention. D. Although the toddler with a partial-thickness burn needs care, it is not as urgent as assessing a potential neurological issue like slurred speech.

Correct Answer is C

Explanation

View Question and Answer

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A nurse is caring for a school-age child who is having a tonic-clonic seizure. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for an adolescent who has major depressive disorder. Which of the following actions should the nurse take first?

Correct Answer is A

Explanation

A nurse is prioritizing care for four clients. Which of the following clients should the nurse assess first?

Correct Answer is C

Explanation

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