A nurse is preparing to conduct a fall risk screening on a client.
Which of the following variables will the nurse use to evaluate the client? (Select all that apply.)
Fall history.
Medical diagnosis.
Use of assistive devices.
Mental status.
Do-not-resuscitate status.
Correct Answer : A
Choice A rationale:
Maintaining the patency of the client's airway is the priority action. During a seizure, the client may lose consciousness and have difficulty breathing. Ensuring a clear airway is essential to prevent hypoxia and maintain oxygenation. This can be achieved by positioning the client on her side and removing any obstructions from her mouth to allow for adequate airflow.
Choice B rationale:
Identifying the poison the client ingested is important for providing appropriate medical treatment, but it is not the priority action in this scenario. Airway management takes precedence because it addresses the immediate threat to the client's life.
Choice C rationale:
Measuring the client's blood pressure is a necessary assessment, but it is not the priority during an active seizure. Airway management and seizure control are the immediate concerns. Once the seizure is controlled and the airway is secured, other assessments, including blood pressure measurement, can be performed.
Choice D rationale:
Positioning the client on her side is a correct action, but it should be done after ensuring the patency of the airway. Placing the client on her side helps prevent aspiration in case of vomiting during or after the seizure. However, it is not the priority over ensuring the client can breathe properly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Modified equivalents. This is not the correct answer. The abbreviation "mEq" stands for milliequivalents, not modified equivalents.
Choice B rationale:
Megaequivalents. This is not the correct answer. "Mega" is a prefix indicating a factor of one million. In the context of electrolytes and medications, milliequivalents (mEq) are the appropriate unit of measurement, not megaequivalents.
Choice C rationale:
Milliequivalents. This is the correct answer. Milliequivalents (mEq) are a measure of the chemical combining power of a substance. In medical contexts, mEq is often used to express the amount of electrolytes (such as potassium, sodium, calcium) in a solution or dosage form. It represents 1/1000th of an equivalent, which is the amount of a substance that can react with or replace one mole of hydrogen ions (H+) It is important for healthcare professionals to understand these units when dealing with medications and intravenous fluids, as incorrect administration can lead to serious health complications.
Choice D rationale:
Miniequivalents. This is not the correct answer. "Mini" is not a standard prefix used in the International System of Units (SI) The correct prefix for a thousandth of an equivalent is "milli," making milliequivalents the appropriate unit of measurement for substances like electrolytes.
Correct Answer is B
Explanation
Choice A rationale:
A combining vowel is a vowel (usually "o") that connects a word root to a suffix or another root. It aids in the pronunciation and flow of the word. For example, in the word "gastroenteritis," "o" is the combining vowel that connects the word root "gastr-" (stomach) to the suffix "-itis" (inflammation) Combining vowels do not provide the general meaning of the word.
Choice B rationale:
The word root provides the fundamental meaning of the word. It is the core of the medical term and gives the essential meaning. For example, in the word "cardiology," the word root "cardio-" refers to the heart. Understanding word roots is crucial in comprehending medical terminology.
Choice C rationale:
A suffix is an affix added at the end of a word to form a derivative, indicating a characteristic of a person or thing. For instance, in the word "dermatologist," the suffix "-ologist" indicates a person who studies or practices a particular kind of knowledge, in this case, dermatology (the study of the skin)
Choice D rationale:
A prefix is an affix added to the beginning of a word to modify its meaning. For example, in the term "preoperative," the prefix "pre-" means before, and it modifies the root word "operative," indicating something that occurs before an operation. Prefixes provide additional information about the word's context but do not give the general meaning of the word itself.
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