A nurse is caring for a client who is in bed and begins experiencing a tonic-clonic seizure.
Which of the following actions should the nurse take?
- Lower the side rails of the bed when the seizure begins.
- Measure the duration of the seizure.
- Restrain the client's arms and legs to prevent injury.
Insert an oral airway into the client's mouth.
Lower the side rails of the bed when the seizure begins.
Measure the duration of the seizure.
Restrain the client's arms and legs to prevent injury.
Insert an oral airway into the client's mouth.
The Correct Answer is B
Lowering the side rails of the bed could lead to the client falling from the bed. Instead raise the side rails and place padding on them.
Measuring the seizure duration is a crucial step for medical evaluation afterwards necessary for determining intervention.
Inserting an oral airway into the client's mouth is not indicated during a tonic-clonic seizure. It is generally not recommended to place any objects or devices into the mouth of a person having a seizure, as it can potentially cause injury to the person or damage to the airway.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Explanation
D. Muscle cramps
Hyponatremia is a condition characterized by low levels of sodium in the blood. Sodium plays a crucial role in maintaining fluid balance and nerve and muscle function. When sodium levels are low, it can lead to imbalances in fluid levels and cause muscle cramps and weakness.
Constipation in (option A) is incorrect because it is more commonly associated with other conditions such as dehydration or electrolyte imbalances like hypercalcemia.
Blurred vision in (option B) is not a typical finding in hyponatremia. Visual disturbances may occur in severe cases, but they are not a consistent symptom.
Hypertension (high blood pressure) in (option C) is not typically associated with hyponatremia. In fact, hyponatremia can sometimes lead to low blood pressure (hypotension) due to the fluid imbalances it causes.
Therefore, the nurse should expect muscle cramps (option D) as a finding in a client with hyponatremia due to the disruption of fluid balance and its impact on muscle function.
Correct Answer is A
Explanation
A. I have to take this medication on an empty stomach: Pantoprazole, a proton pump inhibitor (PPI), should be taken on an empty stomach, typically 30 minutes before a meal, for optimal absorption and effectiveness in reducing stomach acid.
B. I will need to remain upright for 1 hour after taking the medication: While remaining upright after meals is recommended for individuals with GERD to prevent reflux, this is not a specific instruction related to pantoprazole. The primary concern for pantoprazole is taking it before meals.
C. I should expect to have diarrhea while taking this medication: Diarrhea is not a common side effect of pantoprazole. The most common side effects include headache, nausea, or gastrointestinal disturbances, but diarrhea is not typically expected.
D. I can take antacids at the same time as this medication: Antacids should generally not be taken at the same time as pantoprazole. Taking antacids can interfere with the absorption of pantoprazole and reduce its effectiveness. It's usually advised to space them out by at least 2 hours.
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