A nurse is caring for a client who is experiencing a generalized tonic-clonic seizure. Which of the following actions should the nurse take?
Apply restraints to the client.
Administer an IV bolus of lorazepam.
Place the client in the prone position.
Insert a tongue blade into the client's mouth.
The Correct Answer is B
Choice A reason: Applying restraints to the client is not an appropriate action, as it can cause injury or suffocation to the client during a seizure. The nurse should protect the client from harm by removing any nearby objects and padding the side rails.
Choice B reason: Administering an IV bolus of lorazepam is an appropriate action, as lorazepam is an anticonvulsant drug that can stop or shorten the duration of a seizure by enhancing the inhibitory effects of gamma-aminobutyric acid (GABA) in the brain.
Choice C reason: Placing the client in the prone position is not an appropriate action, as it can obstruct the airway and cause respiratory distress or aspiration during a seizure. The nurse should place the client in the side-lying position to facilitate drainage of oral secretions and prevent tongue biting.
Choice D reason: Inserting a tongue blade into the client's mouth is not an appropriate action, as it can cause oral trauma or choking during a seizure. The nurse should never force anything into the client's mouth during a seizure and should allow them to breathe spontaneously.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A: This is incorrect. Vegetable shortening is high in saturated fat and trans fat, which can increase the risk of cardiovascular disease by raising the LDL (bad) cholesterol and lowering the HDL (good) cholesterol.
Choice B: This is incorrect. Lard is animal fat that is high in saturated fat and cholesterol, which can also increase the risk of cardiovascular disease by raising the LDL cholesterol and lowering the HDL cholesterol.
Choice C: This is correct. Canola oil is low in saturated fat and high in monounsaturated fat and omega-3 fatty acids, which can lower the risk of cardiovascular disease by lowering the LDL cholesterol and raising the HDL cholesterol.
Choice D: This is incorrect. Butter is dairy fat that is high in saturated fat and cholesterol, which can also increase the risk of cardiovascular disease by raising the LDL cholesterol and lowering the HDL cholesterol
Correct Answer is ["1.5"]
Explanation
The correct answer is 1.5 mL. Here is the explanation:
To calculate the amount of mL to administer, the nurse should use the following formula:
mL = (units ordered / units available) x mL available
Plugging in the values from the question, we get:
mL = (15,000 / 10,000) x 1
mL = 1.5 x 1
mL = 1.5
Therefore, the nurse should administer 1.5 mL of heparin with each dose.
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