The nurse is caring for a client who is having an active seizure. Which of the following actions should the nurse take? Select all that apply.

Place the client in the recovery position if possible.

Document the start and stop time of the seizure

Hold arms at the client's side to prevent thrashing or injury.

Remove any dangerous objects near the client.

Assist the client to the floor.

Answer and Explanation

Correct Answer : A,B,D,E

A. Place the client in the recovery position if possible. If the client is not actively seizing, placing them in the recovery position (on their side) can help prevent aspiration and allow for better airway management after the seizure ends. However, during the seizure, ensure their safety first.
B. Document the start and stop time of the seizure. It is important to document the timing of the seizure to help assess its duration and determine the appropriate interventions. This also helps guide treatment decisions post-seizure.
C. Hold arms at the client's side to prevent thrashing or injury. The nurse should not restrain the client during a seizure. Trying to hold the client’s arms or restrict their movements can cause injury. The goal is to ensure safety and prevent injury, but not to restrain them.
D. Remove any dangerous objects near the client. Clearing the area of any hard or sharp objects can prevent injury to the client during the seizure.
E. Assist the client to the floor. If the client is standing or sitting during the onset of the seizure, assist them to the floor gently to prevent injury from falling. Ensure that the area is clear of hazards.

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Free Nursing Study Resources

Correct Answer is ["35"]

Explanation

Insulin syringes are commonly marked in units rather than milliliters (mL). If it's a U-100 insulin syringe, each marking represents 1 unit. The plunger in the image above is at 35 indicating 35 units of insulin.

A. Methimazole (Tapazole) 15 mg, PO, now and every 4 hours B. Apply humidified oxygen as needed. C. Aspirin (ASA) 1,000 mg PO now. D. Apply hypothermia mattress now.

Correct Answer is C

Explanation

A. Methimazole (Tapazole) 15 mg, PO, now and every 4 hours is an appropriate treatment for thyroid storm. Methimazole is an antithyroid medication that inhibits the synthesis of thyroid hormones and helps control the symptoms of thyroid storm.
B. Applying humidified oxygen as needed is appropriate because clients in thyroid storm can develop respiratory distress due to high metabolic demands. Providing humidified oxygen can help maintain adequate oxygenation.
C. Aspirin is contraindicated in thyroid storm. It can increase the release of thyroid hormones from the thyroid gland and may also increase the risk of severe complications like bleeding. Furthermore, aspirin can interfere with the binding of thyroid hormones to proteins, exacerbating the condition. Instead, acetaminophen (Tylenol) should be used to reduce fever in thyroid storm.
D. This is an appropriate intervention to manage hyperthermia, which is a common symptom of thyroid storm. A hypothermia mattress can help reduce the client's elevated body temperature in a controlled manner

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The nurse is caring for a client who is having an active seizure. Which of the following actions should the nurse take? Select all that apply.

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Naxlex Comprehensive Predictor Exams

How many units is the arrow pointing to on the syringe below? Enter numeric value only

Correct Answer is ["35"]

Explanation

The health care team is caring for a client in thyroid storm. Which of the following prescriptions should the nurse question?

Correct Answer is C

Explanation

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