A nurse is developing a plan of care for a client who has epilepsy and was admitted after experiencing a tonic-clonic seizure. Which of the following interventions should the nurse include in the plan?
Ensure padded wrist restraints are in the client's room.
Initiate IV access for the client.
Administer lorazepam every 4 hr to sedate the client.
Place an incontinence brief on the client
The Correct Answer is B
Choice A rationale:
Padded wrist restraints are not appropriate unless there's a clear clinical indication to prevent self-harm or injury.
Choice B rationale:
After a seizure, it's important to establish IV access for the client to administer medications, fluids, or other interventions if needed. Monitoring for possible postictal state, airway patency, and vital signs are also important components of care.
Choice C rationale:
Administering lorazepam every 4 hours is not a standard protocol for post-seizure management and could lead to excessive sedation.
Choice D rationale:
Placing an incontinence brief is not necessary unless there's a specific indication, and it doesn't directly relate to post-seizure care.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Palliative care is not limited to acute care settings and can be provided in various healthcare settings.
Choice B rationale:
While palliative care aims to improve overall well-being, it does not provide financial assistance.
Choice C rationale:
Palliative care focuses on providing relief from symptoms and improving the quality of life for individuals with serious illnesses, regardless of whether they are receiving curative treatments.
Choice D rationale:
Palliative care can be provided alongside curative treatments to address symptoms and enhance quality of life.
Correct Answer is C
Explanation
Choice A rationale:
Palliative care is not necessarily focused on prolonging the client's life, but rather on improving the quality of life and managing symptoms.
Choice B rationale:
Palliative care is not limited to individuals with a specific life expectancy, such as less than 6 months. It can be provided at any stage of a serious illness.
Choice C rationale:
Palliative care aims to address the physical, emotional, and psychosocial needs of both the client and their family.
Choice D rationale:
Palliative care involves a holistic approach that includes traditional medical treatments along with psychosocial and emotional support.
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