A nurse is caring for a client who ingested a poison and is now experiencing a seizure. Which of the following is the priority action the nurse should take?
Check the patency of the client's airway.
Determine the poison that was ingested.
Position the client side-lying
Identify the amount of poison that was ingested.
The Correct Answer is A
A. Checking the patency of the client's airway is the priority action because maintaining a clear airway is crucial during a seizure to ensure adequate oxygenation and prevent aspiration.
B. Determining the poison is important but not the immediate priority during a seizure.
C. Positioning the client side-lying is important to prevent aspiration, but the first action should be to ensure the airway is clear.
D. Identifying the amount of poison ingested is important for treatment but not the immediate priority during a seizure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Urine output of 175 mL in the past 8 hours is significantly low and indicates potential acute kidney injury or worsening renal function, requiring immediate notification to the provider.
B. Urine output of 2,200 mL in the past 24 hours is within normal limits.
C. Strong odor in the first-voided urine in the morning is common and not necessarily indicative of a problem.
D. Cloudy urine after sitting in the urinal for several hours can occur due to crystallization or bacterial growth and is not a critical finding.
Correct Answer is D
Explanation
A. Sickle cell anemia typically presents with hemolytic crises and sickle-shaped red blood cells, not necessarily heavy menstrual bleeding.
B. Folic acid deficiency anemia can cause macrocytic anemia but is less likely to cause heavy menstrual bleeding as the primary symptom.
C. Pernicious anemia is due to vitamin B12 deficiency and typically presents with neurological symptoms along with anemia, not necessarily heavy menstrual bleeding.
D. Iron-deficiency anemia commonly presents with weakness, fatigue, and heavy menstrual bleeding due to inadequate iron for red blood cell production.
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