A nurse is contributing to the plan of care for a client who has a seizure disorder. Which of the following interventions should the nurse include in the plan? (Select all that apply.)

Provide a suction setup at the bedside.

Elevate the side rails when in bed.

Place a bite stick at the bedside.

Keep an oxygen setup at the bedside.

Furnish restraints at the bedside.

Answer and Explanation

Correct Answer : A,B,D

A. Provide a suction setup at the bedside:

This is a relevant intervention as it ensures that suction equipment is readily available in case the client experiences excessive secretions or vomiting during or after a seizure. It helps maintain a clear airway and prevent aspiration.

B. Elevate the side rails when in bed:

Elevating the side rails can help ensure the client's safety during a seizure by preventing falls from the bed. It is a preventive measure to minimize the risk of injury.

C. Place a bite stick at the bedside:

Placing a bite stick at the bedside is not a recommended intervention. Bite sticks can potentially injure the patient's teeth or mouth during a seizure and are generally not recommended in current practice.

D. Keep an oxygen setup at the bedside:

This is an appropriate intervention as it ensures that oxygen is readily available in case the client experiences respiratory distress or hypoxia during or after a seizure. Oxygen therapy may be needed to support respiratory function.

E. Furnish restraints at the bedside:

Furnishing restraints at the bedside is not a recommended intervention for managing seizures. Restraints should only be used in exceptional circumstances when the client's safety or the safety of others is at risk and should be applied according to institutional policies and legal regulations.

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Correct Answer is B

Explanation

A. A continuous seizure state in which seizures occur in rapid succession:

This describes status epilepticus, a medical emergency characterized by prolonged or continuous seizures. It is not related to the concept of an aura.

B. A sensory warning that a seizure is imminent:

This is the correct answer. An aura is a subjective sensation or symptom that acts as a warning sign that a seizure is about to occur. Auras can vary widely among individuals and may include visual, auditory, olfactory, or other sensory experiences.

C. A period of sleepiness following the seizure during which arousal is difficult:

This describes the postictal state, which occurs after a seizure. During this period, the individual may experience confusion, drowsiness, or difficulty arousing from sleep. It is not specifically related to the concept of an aura.

D. A brief loss of consciousness accompanied by staring:

This describes an absence seizure, characterized by a brief loss of awareness and a blank stare. Absence seizures typically do not have an aura preceding them.

Correct Answer is ["0.6"]

Explanation

To calculate the dose of diazepam in mL, the nurse should use the formula:

Dose (mL) = Desired dose (mg) / Available dose (mg/mL)

Plugging in the values from the question, we get:

Dose (mL) = 3 mg / 5 mg/mL

Simplifying, we get:

Dose (mL) = 0.6 mL

Therefore, the nurse should administer 0.6 mL of diazepam IM.

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A nurse is contributing to the plan of care for a client who has a seizure disorder. Which of the following interventions should the nurse include in the plan? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a seizure disorder and reports experiencing an aura. The nurse should recognize the client is experiencing which of the following conditions?

Correct Answer is B

Explanation

A nurse is preparing to administer diazepam 3 mg IM. The amount available is diazepam for injection 5 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["0.6"]

Explanation

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