The nurse is providing care for a patient in status epilepticus. What nursing intervention takes the highest priority?
Maintain a patent airway
Place an intravenous catheter (IV)
Administer diazepam, per order
Insert a nasogastric tube (NG)
The Correct Answer is A
Choice A rationale
Maintaining a patent airway is the highest priority when providing care for a patient in status epilepticus. Status epilepticus is a medical emergency characterized by prolonged or recurrent seizures. It can lead to severe complications, including respiratory distress and hypoxia.
Therefore, ensuring a patent airway is crucial to prevent hypoxia and further brain damage. This involves positioning the patient to prevent aspiration, potentially suctioning the airway, and providing supplemental oxygen as needed.
Choice B rationale
While placing an intravenous catheter (IV) is an important intervention, it is not the highest priority. An IV allows for the administration of medications and fluids, which are necessary in the management of status epilepticus. However, it is secondary to maintaining a patent airway.
Choice C rationale
Administering diazepam or other antiepileptic drugs is a key intervention in managing status epilepticus. These medications help to stop the seizures. However, medication administration should only occur after a patent airway has been established.
Choice D rationale
Inserting a nasogastric tube (NG) may be necessary in some cases to protect the airway or for administering medications or nutrition. However, this is not the highest priority intervention. The first step in managing status epilepticus is always to ensure a patent airway.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Antiviral therapy is typically used to treat viral infections. However, meningitis is most commonly caused by bacteria. Therefore, antiviral therapy would not be the most effective treatment in this case.
Choice B rationale
Antibiotic therapy is the standard treatment for bacterial meningitis. The specific antibiotic or combination of antibiotics used depends on the type of bacteria causing the infection.
Therefore, after reviewing lab results that suggest meningitis, the nurse would anticipate the provider to prescribe antibiotic therapy.
Choice C rationale
Antiemetics are medications that help prevent and treat nausea and vomiting, which can be symptoms of meningitis, but they do not treat the underlying cause of meningitis.
Choice D rationale
Analgesics are used to relieve pain. While they might be used to manage the headache often associated with meningitis, they would not treat the infection itself.
Correct Answer is ["4 "]
Explanation
The nurse is preparing to administer 40 mg of furosemide intravenously. The available furosemide is 10 mg/1 mL.
Step 1 is: Calculate the dose in mL using the formula: (Desired dose ÷ Available dose) × Volume.
Step 2 is: Substitute the given values into the formula: (40 mg ÷ 10 mg) × 1 mL = 4 mL. The nurse should administer 4 mL per dose.
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
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.