A patient is brought into the emergency department by her family members who report that the patient started seizing about 10 minutes ago and has not regained consciousness. The family says that they did administer the patient's Diastat (Diazepam rectal) medication when the seizures first started.
You recognize that this patient is most likely experiencing:
Status asthmaticus.
Benzodiazepine tolerance.
Status epilepticus.
Intermittent focal seizures.
The Correct Answer is C
Choice A rationale
Status asthmaticus is a severe and persistent asthma attack that does not respond to conventional bronchodilator therapy, leading to respiratory distress. While it is a medical emergency, it involves the respiratory system and is distinct from neurological events like seizures.
Choice B rationale
Benzodiazepine tolerance refers to a decreased response to the drug over time, requiring higher doses to achieve the same effect. While the patient was given diazepam, the primary concern is the ongoing seizure activity despite medication, indicating a more severe seizure state, not merely tolerance.
Choice C rationale
Status epilepticus is defined as continuous seizure activity lasting longer than five minutes or two or more seizures occurring without a full recovery of consciousness between them. The patient's presentation of seizing for 10 minutes without regaining consciousness, despite receiving Diastat, strongly indicates status epilepticus.
Choice D rationale
Intermittent focal seizures are seizures that originate in a specific area of the brain and may cause localized symptoms. However, the prolonged nature of the current seizure and the lack of consciousness between episodes indicate a more severe and sustained seizure disorder than just intermittent focal seizures.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Positioning the patient sitting on the edge of the bed, leaning on a pillow on the bedside table, is the optimal position for a thoracentesis. This position maximizes the intercostal spaces, allowing for easier access to the pleural cavity while keeping the diaphragm in a lowered position. This widens the spaces between the ribs, facilitating needle insertion and minimizing the risk of injury to surrounding structures like the lungs or diaphragm.
Choice B rationale
Placing the patient in a prone position is contraindicated for a thoracentesis. This position would make accessing the posterior pleural space extremely difficult and unsafe, increasing the risk of accidental organ puncture. It offers no anatomical advantage for the procedure and significantly impedes proper visualization and access to the typical insertion site.
Choice C rationale
Lying supine with arms folded across the chest is not an appropriate position for a thoracentesis. This position would flatten the intercostal spaces, making needle insertion more challenging and increasing the risk of lung puncture. It does not provide optimal access to the pleural cavity for fluid drainage and limits respiratory excursion.
Choice D rationale
Stating no particular positioning is required for a thoracentesis is incorrect and potentially dangerous. Proper positioning is critical for patient safety and procedural success, as it optimizes access to the pleural space, minimizes risks, and enhances patient comfort during the procedure. Incorrect positioning can lead to complications.
Correct Answer is B
Explanation
Choice B rationale
Placing the patient in Trendelenburg position on their left side is the priority intervention for a suspected air embolism. This position traps the air in the apex of the right ventricle, preventing it from entering the pulmonary circulation and causing a pulmonary embolism, which can be fatal. The left lateral position further aids in keeping the air bubble within the right ventricle.
Choice A rationale
Ambulation would be contraindicated as it could facilitate the movement of the air embolism through the circulatory system, potentially leading to a more severe and widespread impact, including cerebral or pulmonary embolism. The goal is to isolate and prevent the air from progressing, not to mobilize it.
Choice C rationale
Reverse Trendelenburg position elevates the head of the bed, which would cause the air embolism to travel towards the brain, increasing the risk of a cerebral air embolism, a life-threatening complication. This position is actively harmful in the context of an air embolism.
Choice D rationale
McRoberts maneuver is used in obstetrics to aid in shoulder dystocia during childbirth by hyperflexing the mother's thighs toward her abdomen. This maneuver has no physiological relevance or benefit in the management of an air embolism and would not prevent or mitigate its effects.
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