A nurse is transporting a 12-year-old child in a wheelchair. The child begins to experience a tonic-clonic seizure. Which of the following actions should the nurse take?
Insert an oral airway for the child.
Apply soft restraints to the child's wrists.
Place a pillow under the child's knees.
Move the child to the floor
The Correct Answer is D
A. Insert an oral airway for the child. Inserting an oral airway during a tonic-clonic seizure is not recommended, as it could cause injury to the child or block the airway. During a seizure, the priority is ensuring safety rather than trying to insert devices.
B. Apply soft restraints to the child's wrists. Restraints are not recommended during a seizure, as they can increase the risk of injury. Instead, the focus should be on protecting the child from injury and allowing the seizure to run its course.
C. Place a pillow under the child's knees. While positioning the child is important, placing a pillow under the knees is not a recommended action. The goal is to move the child to the floor to prevent falls or injury during the seizure.
D. Move the child to the floor. If a child is in a wheelchair and begins to have a seizure, moving them to the floor is the first step to prevent injury. Once the child is on the floor, ensure they are on their side to allow for airway clearance and reduce the risk of aspiration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. "You should consider finding other hobbies to participate in instead of sports." Avoiding sports altogether is not necessary for children with asthma. Many children with well-managed asthma can safely participate in sports with proper precautions.
B. "You shouldn't feel frustrated, because you can find other options for exercise." This response dismisses the child's feelings instead of acknowledging them and providing a solution.
C. "You will be able to exercise if you use your peak expiratory flow meter twice per day." While monitoring peak expiratory flow (PEF) is important for asthma management, it does not directly enable participation in sports.
D. "You can participate in sports if you use your rescue inhaler before practice or games." Using a short-acting bronchodilator (such as albuterol) before exercise is a common strategy to prevent exercise-induced bronchoconstriction, allowing children with asthma to safely participate in sports.
Correct Answer is B
Explanation
A. Elevated temperature. An elevated temperature is a common symptom of infection, including bacterial pneumonia, but it is not a direct risk factor for aspiration. The concern for aspiration is more related to a child's ability to protect their airway.
B. Neurological deficit. A neurological deficit, such as a decreased level of consciousness or impaired swallowing reflexes, increases the risk of aspiration. A child with neurological impairment may have difficulty swallowing or protecting their airway, making them more prone to inhaling food, fluids, or other substances into the lungs, leading to aspiration pneumonia.
C. Inspiratory wheezing. Inspiratory wheezing is more likely to be associated with conditions like asthma or airway obstruction, not specifically with aspiration. It does not directly indicate a risk for aspiration.
D. Rapid respirations. Rapid respirations can be a sign of respiratory distress, common in pneumonia, but they do not directly indicate a risk for aspiration. The risk for aspiration is more closely linked to issues with swallowing and airway protection, not just the rate of respiration.
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