A nurse on a medical unit is caring for a client who requires seizure precautions. Which of the following interventions should the nurse contribute to the client's plan of care?

Keep the lights on when the client is sleeping.

Restrain the client as soon as seizure activity begins.

Have a padded tongue depressor available at the bedside.

Keep the client's bed in the lowest position.

Answer and Explanation

The Correct Answer is D

A. Keeping the lights on when the client is sleeping is not a standard intervention for seizure precautions. In fact, it's generally recommended to create a quiet and low-stimulus environment for clients with seizure disorders.

B. Restraining the client as soon as seizure activity begins is not recommended. Restraints can lead to injuries and complications during a seizure. It is essential to allow the client to move and prevent injury by removing harmful objects from the vicinity.

C. Having a padded tongue depressor available at the bedside is not a standard intervention for seizure precautions. In the event of a seizure, the priority is to keep the client safe, protect their head, and ensure a clear airway. Placing objects in the mouth is not recommended and can lead to injury.

D. Keeping the client's bed in the lowest position is a safety measure to prevent injuries during a seizure. It reduces the risk of falling from a significant height in case of a seizure episode.

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Correct Answer is C

Explanation

A. "I'm sure your wife will begin to feel better soon."

This response is somewhat reassuring but may come across as dismissive or overly optimistic. It doesn't acknowledge the partner's feelings or offer support.

B. "It must be very difficult for you to see your wife in pain."

This response acknowledges the partner's emotions and shows empathy. While it recognizes the difficulty the partner is experiencing, it doesn't directly address the partner's desire to do something to help the wife.

C. "I wish there was more that I could do to relieve your wife's pain, too."

This response directly empathizes with the partner's wish to help the wife, expressing a shared concern. It conveys a sense of teamwork between the nurse and the partner, fostering a supportive connection.

D. "We're doing everything we can to keep your wife comfortable."

This response provides information about the actions being taken by the medical team but may not directly address the partner's expressed desire to contribute or alleviate the wife's pain.

A. It is not permissible because the provider should disclose laboratory results or findings to a client. B. It is permissible because the client's sibling made the request. C. It is permissible because the sibling has paid for the service. D. It is not permissible because there is no nurse-client relationship between the sibling and nurse.

Correct Answer is D

Explanation

A. It is not permissible because the provider should disclose laboratory results or findings to a client:

While it is true that the provider should disclose laboratory results or findings to the client, the nurse, in this case, should not be accessing the information on behalf of the sibling without proper authorization.

B. It is permissible because the client's sibling made the request:

Even if the sibling made the request, accessing a client's health information without proper authorization is a violation of privacy and confidentiality.

C. It is permissible because the sibling has paid for the service:

Payment for services does not automatically grant access to health information. Protected health information (PHI) is subject to privacy laws, and access should be granted only to those authorized to receive it.

D. It is not permissible because there is no nurse-client relationship between the sibling and nurse:

This is the correct explanation. The nurse should not access a client's health information, even if it is a family member, without proper authorization. The absence of a nurse-client relationship with the sibling does not justify accessing the client's health information.

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A nurse on a medical unit is caring for a client who requires seizure precautions. Which of the following interventions should the nurse contribute to the client's plan of care?

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Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is D

Explanation

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