Exhibits

A nurse is caring for a client who has a seizure disorder. (Select all that apply.)

Administer supplemental oxygen to the client.

Restrain the client.

Time the duration of the seizure.

Place a tongue depressor in the client's mouth.

Turn the client to the side

Answer and Explanation

Correct Answer : A,C,E

A.   The client is experiencing apnea and has decreased oxygen saturation, indicating a need for supplemental oxygen.
B.   Restraining a client during a seizure is dangerous and can cause injury.
C.   This information is crucial for determining the type of seizure and guiding treatment.
D.   Placing a tongue depressor in the client's mouth can cause trauma to the teeth and mouth and should never be done.
E.   Turning the client to the side helps prevent aspiration of saliva or vomit, protecting the airway.

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Correct Answer is C

Explanation

A. Pacemaker spikes with each T wave indicates a malfunctioning pacemaker.
B. Pacemaker spikes before each P wave would indicate atrial pacing, not ventricular pacing.
C. A ventricular pacemaker stimulates the ventricles to contract, so the pacing spike should precede the QRS complex.
D. Pacemaker spikes after each QRS complex would indicate a malfunctioning pacemaker.

A. Fluid overload- B. Hypovolemia C. Left ventricular failure D. Intracardiac shunt

Correct Answer is B

Explanation

A. A high CVP, not a low CVP, is typically associated with fluid overload.
B. A low CVP indicates decreased fluid volume, which is characteristic of hypovolemia. This is particularly relevant to a patient with multiple traumas who may have significant blood loss.
C. While left ventricular failure can contribute to hemodynamic instability, it's not directly correlated with a low CVP.
D. This would affect the oxygenation status of the blood, rather than the overall blood volume and CVP.

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Exhibits A nurse is caring for a client who has a seizure disorder. (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client with a ventricular pacemaker who is on ECG monitoring. The nurse understands that the pacemaker is functioning properly when which of the following appears on the monitor strip?

Correct Answer is C

Explanation

A nurse is evaluating the central venous pressure (CVP) of a client who has sustained multiple traumas. Which of the following interpretations of a low CVP pressure should the nurse make?

Correct Answer is B

Explanation

A nurse is caring for a client who has a suspected diagnosis of myasthenia gravis. The provider prescribes a Tensilon test. Which of the following findings indicates a positive test?

A nurse is providing care for a group of clients in the emergency department. Which of the following clients is at risk for developing neurogenic shock?

A nurse is caring for a client who has heart failure and a prescription for digoxin 125 mcg PO daily. Available is digoxin PO 0.25 mg/tablet. How many tablets should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

A nurse is assessing a client who has disseminated intravascular coagulation (DIC). Which of the following findings should the nurse expect?

A client arrives to the emergency department by ambulance. The client has a possible traumatic brain injury after a fall from a roof. Which of the following assessment findings will the triage nurse report to the provider immediately?

Exhibits A nurse is providing discharge teaching. Which of the following client statements indicate an understanding of the teaching? Client Statements

A nurse is assessing a client in the emergency department when it is noted the left pupil is enlarged and fixed while the right pupil constricts to 2mm when exposed to light. Which of the following is a possible cause of unequal pupil sizing?

A nurse is caring for a client who is experiencing anaphylactic shock in response to the administration of penicillin. Which of the following medications should the nurse administer first?

Exhibits

A nurse is caring for a client who has a seizure disorder. (Select all that apply.)