A nurse is planning care for a client who has status epilepticus.
Which of the following interventions is the nurse's priority to include?
Administer phenytoin IV bolus to the client.
Administer diazepam intravenously to the client.
Provide the client oxygen at 6 L/min using a nasal cannula.
Turn the client to the lateral position during seizure activity.
The Correct Answer is B
The priority intervention for a nurse planning care for a client who has status epilepticus is to administer diazepam intravenously to the client.
Diazepam is a benzodiazepine medication that can help stop seizure activity and is often used as a first-line treatment for status epilepticus.
Choice A is incorrect because while phenytoin can be used to treat seizures, it is not typically used as a first-line treatment for status epilepticus.
Choice C is incorrect because while providing oxygen can be an important intervention for clients experiencing seizures, it is not the priority intervention.
Choice D is incorrect because while turning the client to the lateral position during seizure activity can help prevent aspiration, it is not the priority intervention.
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Related Questions
Correct Answer is D
Explanation
The client’s ABG results show a pH of 7.24, which is below the normal range of 7.35-7.45 and indicates acidosis.
The PaCO2 is within the normal range of 35-45 mm Hg, indicating that the acidosis is not caused by a respiratory issue.
The HCO3 level is 18 mEq/L, which is below the normal range of 22-28 mEq/L and indicates a primary metabolic cause for acidosis.
Respiratory acidosis is not indicated by the ABG results as the PaCO2 is within the normal range.
B) Metabolic alkalosis is not indicated by the ABG results as the pH and HCO3 levels are below their respective normal ranges.
C) Respiratory alkalosis is not indicated by the ABG results as the pH is below the normal range and the PaCO2 is within the normal range.
Correct Answer is A
Explanation
This statement indicates that the nurse understands the importance of limiting the exposure of family members to radiation from the sealed implant.
Choice B is incorrect because the dosimeter badge should not be given to the oncoming nurse at the end of the shift.
The dosimeter badge is used to measure an individual’s exposure to radiation and should be worn by the same person throughout their shift.
Choice C is incorrect because if the client’s implant dislodges, the nurse should not touch it with their hands, even if they are wearing gloves.
The nurse should follow the facility’s protocol for handling dislodged implants.
Choice D is incorrect because soiled linens from a client with a sealed radiation implant do not need to be removed from the room after each change.
The linens can be handled according to standard precautions.
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