The nurse has reviewed the Provider Prescriptions at 1030, the Nurses' Notes at 1045 and 1100, and the Vital Signs at 1100.

Exhibits

Which of the following actions should the nurse take? Select all that apply.

Roll adolescent onto their side.

Do not restrain the adolescent.

Begin chest compressions.

Prepare to give phenytoin PO stat.

Suction the oral cavity.

Insert bite block.

Answer and Explanation

Correct Answer : A,B,E

A. Rolling the adolescent onto their side is appropriate during seizure activity or altered consciousness to maintain an open airway and allow secretions or emesis to drain, reducing the risk of aspiration. This is part of standard seizure precaution care.

B. Not restraining the adolescent prevents musculoskeletal injury and does not interfere with involuntary seizure movements. Restraints can cause fractures, dislocations, or soft tissue injury and should be avoided during seizure activity.

C. Beginning chest compressions is not indicated, as the adolescent still has vital signs, a pulse, and spontaneous respirations. CPR would only be initiated if there was a confirmed absence of breathing and pulse.

D. Preparing to give phenytoin PO stat is not appropriate because the adolescent is NPO and at risk for aspiration. If anticonvulsants are required, the IV route would be used instead of oral administration.

E. Suctioning the oral cavity is appropriate to maintain airway patency and clear secretions that may accumulate during seizure activity or when the client is drowsy and unable to handle secretions effectively.

F. Inserting a bite block is unsafe during seizures, as it can break teeth, injure the mouth, or obstruct the airway. Nothing should be placed in the mouth once a seizure has started.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is A

Explanation

A. "Share a bedroom with your infant for the first 6 months.": Room-sharing without bed-sharing is recommended to reduce the risk of SUID. Having the infant sleep in the same room as the parents allows for closer monitoring and easier access for feeding and comforting.

B. "Cover your infant with a nonflammable blanket at bedtime.": Loose bedding, including blankets, increases the risk of suffocation and SUID. Instead, sleep sacks or wearable blankets are safer options to keep the infant warm without creating hazards.

C. "Use bumper pads around the interior of your infant's crib.": Bumper pads are not recommended because they can lead to suffocation, strangulation, or entrapment. A firm mattress with a fitted sheet and no additional items in the crib is safest.

D. "Place your infant on a soft crib mattress after they are 4 months old.": Infants should always sleep on a firm, flat surface, regardless of age. Soft mattresses increase the risk of airway obstruction and SUID, making them unsafe for infant sleep.

A. Initiate airborne precautions. B. Maintain strict I&0. C. Monitor for constipation. D. Encourage bed rest.

Correct Answer is B

Explanation

A. Initiate airborne precautions: Airborne precautions are not required for a child receiving gentamicin, as this antibiotic is not used for airborne infections such as tuberculosis or measles. Standard precautions are sufficient.

B. Maintain strict I&O: Gentamicin is nephrotoxic, and monitoring intake and output is essential to detect early signs of kidney impairment. Strict fluid balance assessment helps ensure prompt recognition of adverse renal effects.

C. Monitor for constipation: Constipation is not a typical adverse effect of gentamicin therapy. More concerning effects are nephrotoxicity and ototoxicity, which require close monitoring during treatment.

D. Encourage bed rest: Bed rest is not necessary during gentamicin therapy. Activity restrictions are not required unless dictated by the child’s underlying illness or other clinical factors.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Body system	Findings
Respiratory	Respiratory rate 26/min
Cardiovascular	Heart rate 112/min Capillary refill 4 seconds
Gastrointestinal	Hyperactive bowel sounds
Integumentary	Diaper area reddened Extremities cool Reports no tears
Neurologic	Lethargic

The nurse has reviewed the Provider Prescriptions at 1030, the Nurses' Notes at 1045 and 1100, and the Vital Signs at 1100. Exhibits Which of the following actions should the nurse take? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing teaching to a parent about sudden unexpected infant death (SUID). Which of the following statements should the nurse Include?

Correct Answer is A

Explanation

A nurse is caring for a child who is to receive the first dose of IV gentamicin. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

A nurse is providing teaching to the parent of a school-age child who has diabetes mellitus about managing diabetes during illness. Which of the following statements by the parent indicates an understanding of the teaching?

A nurse is teaching the parent of an infant about car seat safety. Which of the following instructions should the nurse include?

A nurse is providing teaching about infant nutrition to a group of parents and guardians. Which of the following statements should the nurse include?

A nurse is providing teaching to an adolescent who has vulvovaginitis. Which of the following statements should the nurse include in the teaching?

A nurse is providing discharge teaching to the parents of an infant who is at risk for sudden unexpected infant death syndrome (SUIDS). Which of the following statements by the parents indicates an understanding of the teaching?

A nurse is preparing to insert a peripheral intravenous (IV) catheter for a preschooler. Which of the following actions should the nurse take?

A nurse is caring for a toddler who had a cleft lip and palate repair and is trying to touch the incision site. Which of the following provider prescriptions is recommended for the toddler?

The nurse has reviewed the Provider Prescriptions at 1030, the Nurses' Notes at 1045 and 1100, and the Vital Signs at 1100.

Exhibits

Which of the following actions should the nurse take? Select all that apply.