A nurse is providing discharge instructions to a client who has epilepsy. Which of the following instructions should be included in the nurse's teaching?
(Select All that Apply.)
Refrain from climbing ladders.
Do not go swimming without a partner.
Refrain from driving unless seizure-free for 3 months.
Avoid using power tools.
Place client on the floor when having a seizure.
Place client on their back when they are recovering from a seizure.
Correct Answer : A,B,C,D,E,F
Choice A Reason:
Refraining from climbing ladders is appropriate. Climbing ladders involves a risk of falling, which can be particularly hazardous for individuals with epilepsy. Seizures can occur unexpectedly and may cause loss of muscle control or consciousness, increasing the risk of falls from heights such as ladders. Falling from a ladder during a seizure can result in serious injuries, including head trauma, fractures, or other injuries from impact. Advising the client to refrain from climbing ladders helps mitigate the risk of falls and associated injuries during a seizure episode, promoting their safety and well-being.
Choice B Reason:
Do not go swimming without a partner is inappropriate. Swimming alone can be dangerous for individuals with epilepsy as they may be at risk of drowning if they experience a seizure while in the water. Having a swimming partner can provide assistance and ensure safety in case of a seizure.
Choice C Reason:
Refraining from driving unless seizure-free for 3 months is appropriate. Driving restrictions are often recommended for individuals with epilepsy to minimize the risk of accidents caused by seizures. Many jurisdictions require individuals with epilepsy to be seizure-free for a certain period, typically around 3 to 6 months, before resuming driving.
Choice D Reason:
Avoiding using power tools is appropriate. Operating power tools or machinery can be hazardous if a seizure occurs, potentially leading to serious injuries. Therefore, individuals with epilepsy should avoid using power tools to reduce the risk of accidents during a seizure.
Choice E Reason:
Placing client on the floor when having a seizure is appropriate. Placing the client on the floor during a seizure helps prevent injury from falls. It is safer to have the individual lie down on a flat surface to reduce the risk of head injury or other trauma during the seizure.
Choice F Reason:
Placing client on their back when they are recovering from a seizure appropriate. Placing the client on their back after a seizure helps maintain an open airway and facilitates recovery. This position allows for proper breathing and circulation while monitoring the individual's condition.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason:
Drooling is inappropriate. Drooling, also known as sialorrhea, is a common symptom in Parkinson's disease due to impaired swallowing and reduced control of the muscles involved in saliva production. Anticholinergic medications can exacerbate dry mouth, which may contribute to drooling. However, drooling is not typically a side effect that would be specifically associated with anticholinergic use.
Choice B Reason:
Anhidrosis is appropriate. Anhidrosis refers to the inability to sweat normally. Anticholinergic medications can inhibit sweating by blocking the action of acetylcholine on sweat glands, leading to decreased sweating and potentially causing hyperthermia. Anhidrosis is a potential side effect of anticholinergic agents and should be reported to the healthcare provider due to the risk of overheating.
Choice C Reason:
Tremors is inappropriate. Tremors are a common symptom of Parkinson's disease and are typically not caused by anticholinergic medications. In fact, anticholinergic agents are often prescribed to help reduce tremors in individuals with Parkinson's disease. Tremors would not be considered an adverse effect that the client should report in the context of anticholinergic therapy.
Choice D Reason:
Rigidity is inappropriate. Rigidity, or stiffness of the muscles, is a characteristic symptom of Parkinson's disease resulting from the loss of dopamine-producing neurons in the brain. While anticholinergic medications can help alleviate some symptoms of Parkinson's disease, they are not typically associated with rigidity. Rigidity would not be considered an adverse effect that the client should report in the context of anticholinergic therapy.
Correct Answer is A
Explanation
Choice A Reason:
"You must experiment with your body to find out what stimulation is enjoyable after your injury." This statement encourages the client to explore their body and discover what types of sexual stimulation are enjoyable and pleasurable for them post-injury. It promotes self-discovery and empowerment in sexual expression, which can be important for sexual satisfaction and intimacy.
Choice B Reason:
"You will not be able to have an intimate relationship with anyone after a spinal cord injury." This statement is incorrect and defeatist. It can create unnecessary feelings of hopelessness and despair in the client. Individuals with spinal cord injuries can still have intimate relationships and engage in sexual activity with partners, albeit with potential adjustments or accommodations.
Choice C Reason:
"You should not feel undesirable after your injury. You are still nice-looking. “While it's important to address body image concerns and reassure the client about their physical appearance, this statement may not directly address sexual stimulation or intimacy. However, it can help promote self-confidence and positive self-esteem, which are important aspects of sexuality and relationships.
Choice D Reason:
"Clients who have a spinal cord injury are not aroused by touch around the groin area." This statement is inaccurate and dismissive of the individual's potential for sexual arousal and pleasure. Sensation and arousal can vary among individuals with spinal cord injuries, and touch around the groin area may still be arousing for some individuals, depending on the level and extent of injury.
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