A nurse is caring for a school-age child who is experiencing a tonic-clonic seizure. Which of the following actions should the nurse take?

Prevent movement of the child's extremities.

Administer magnesium sulfate to the child.

Put a tongue blade between the child's teeth.

Place a folded blanket under the child's head.

Answer and Explanation

The Correct Answer is D

A. Prevent movement of the child's extremities is incorrect. Attempting to prevent movement during a tonic-clonic seizure is unsafe. The nurse should avoid restraining the child, as this can cause injury. The focus should be on ensuring safety during the seizure.

B. Administer magnesium sulfate to the child is incorrect. Magnesium sulfate is used for certain conditions, such as preeclampsia in pregnant women or seizures due to eclampsia, but it is not typically used to manage tonic-clonic seizures in children. Anticonvulsant medications or emergency interventions are more appropriate.

C. Put a tongue blade between the child's teeth is incorrect. Inserting a tongue blade or any object into the mouth during a seizure is dangerous, as it can lead to injury to the mouth, teeth, or airway. The nurse should not attempt to put anything in the child's mouth.

D. Place a folded blanket under the child's head is correct. The priority during a tonic-clonic seizure is to protect the child from injury. Placing a folded blanket or soft padding under the head helps prevent head trauma if the child falls to the ground during the seizure. The nurse should also ensure the environment is clear of sharp objects.

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Free Nursing Study Resources

Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"A,B"}}

Explanation

Finding	Acute laryngotracheobronchitis	Pneumonia
Fever	✓	✓
Stridor	✓
Type of cough	✓
Irritability	✓	✓

Fever

Acute laryngotracheobronchitis: Yes, fever is common in acute laryngotracheobronchitis, especially in the early stages as the body reacts to infection.
Pneumonia: Yes, pneumonia can also cause fever as the body responds to the infection in the lungs.

 Stridor

Acute laryngotracheobronchitis: Yes, stridor is a hallmark sign of acute laryngotracheobronchitis, particularly during inspiration. It occurs due to swelling and narrowing of the upper airway.
Pneumonia: No, stridor is not typically associated with pneumonia. Pneumonia involves lower respiratory tract infection, and the symptoms usually include cough, fever, and difficulty breathing rather than stridor.

 Type of cough

Acute laryngotracheobronchitis: Yes, a barking, non-productive cough is characteristic of acute laryngotracheobronchitis, often described as a "seal-like" cough.
Pneumonia: No, pneumonia typically presents with a productive cough, often with mucus or sputum.

 Irritability

Acute laryngotracheobronchitis: Yes, irritability is common in toddlers with acute laryngotracheobronchitis, especially when they are struggling to breathe or feel uncomfortable due to the upper airway inflammation.
Pneumonia: Yes, irritability can also be seen in children with pneumonia, as they may be feeling unwell due to fever, difficulty breathing, and chest discomfort

A. A 6-year-old child who is toilet trained and bedwetting B. An 18-month-old child who has several bruises on their shins C. An 8-month-old infant who has stranger anxiety D. A 1-year-old child who kicks and screams when their parent leaves

Correct Answer is B

Explanation

A. A 6-year-old child who is toilet trained and bedwetting is not necessarily indicative of maltreatment. Regression in behavior, such as bedwetting, may occur due to stress or developmental changes, but it can also be related to other factors like illness or changes in routine.

B. An 18-month-old child who has several bruises on their shins is concerning. While some bruises are normal in children, particularly active toddlers, multiple bruises or bruises in unusual areas (such as the torso, ears, or neck) or in various stages of healing may indicate physical abuse. A careful assessment is needed to determine if the bruises are accidental or inflicted.

C. An 8-month-old infant who has stranger anxiety is a typical developmental milestone. Stranger anxiety often occurs between 6 to 9 months of age, and it is a normal part of infant development as they begin to differentiate between familiar and unfamiliar people.

D. A 1-year-old child who kicks and screams when their parent leaves is also a normal behavior at this stage of development. Separation anxiety typically peaks between 8 to 14 months of age and is considered a normal emotional response.

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A nurse is caring for a school-age child who is experiencing a tonic-clonic seizure. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in a clinic is assisting with the care of a 3-year-old toddler. Exhibits The nurse is reviewing the collected data. For each finding, click to specify if the finding is consistent with acute laryngotracheobronchitis or pneumonia. Each finding may support more than 1 disease process.

Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"A,B"}}

Explanation

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Correct Answer is B

Explanation

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