What is an appropriate nursing action when a child is experiencing a generalized tonic-clonic seizure?
Guide the child to the floor if the child is standing, and then go for help.
Move objects out of the child’s immediate area.
Stick a padded tongue blade between the child’s teeth.
Manually restrain the child.
The Correct Answer is B
Choice A reason: Guiding a child to the floor during a seizure is unsafe, as it risks injury to both the child and nurse due to uncontrolled movements. Leaving to get help abandons the child, increasing injury risk during the seizure’s tonic-clonic phase.
Choice B reason: Moving objects away from a child during a tonic-clonic seizure prevents injury from striking hard surfaces. Generalized seizures cause uncontrolled muscle contractions, increasing the risk of trauma. Ensuring a safe environment is a priority to minimize harm during the seizure event.
Choice C reason: Inserting a tongue blade, even padded, risks dental injury or airway obstruction, as jaw clenching is common in tonic-clonic seizures. Current guidelines advise against placing objects in the mouth, as it does not prevent tongue biting and may cause harm.
Choice D reason: Restraining a child during a seizure can cause fractures or soft tissue injury due to forceful muscle contractions. It also increases stress and hypoxia risk. Allowing the seizure to occur while ensuring safety is the recommended approach to minimize complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["15"]
Explanation
Step 1 is: Find out how many times 50 mg fits into 150 mg 150 ÷ 50 = 3
Step 2 is: Multiply the volume per dose 3 × 5 = 15
Final answer = 15 mL
Correct Answer is B
Explanation
Choice A reason: Removing a medical alert bracelet is not a priority, as it does not address the fracture’s immediate needs. The bracelet provides critical information (e.g., diabetes status) for emergency care, and its removal could delay appropriate management of comorbidities.
Choice B reason: Immobilizing the fractured arm with a splint is the priority to prevent further tissue damage, reduce pain, and stabilize the fracture site. In diabetes, poor wound healing increases complication risks, making immediate immobilization critical to minimize movement and promote healing.
Choice C reason: Placing the client supine with a blanket addresses comfort but not the fracture’s urgent needs. Immobilization takes precedence to prevent bone displacement, which could complicate healing, especially in diabetes, where vascular issues impair recovery.
Choice D reason: Covering open areas with a sterile dressing is necessary for open fractures to prevent infection, but the question does not specify an open fracture. Immobilization is the first action for any fracture to ensure stability and reduce complications.
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