After placing a client who is having a seizure in the side-lying position, which intervention should the nurse implement?

Apply soft restraints to all extremities.

Remove objects that could cause injury.

Place pillows around the client's head.

Administer oxygen per nasal cannula.

Answer and Explanation

The Correct Answer is B

Choice A reason: Applying soft restraints to all extremities is not appropriate during a seizure as it can increase the risk of injury. The priority is to ensure the client's safety by preventing injury without restraining them.

Choice B reason: Removing objects that could cause injury is crucial. During a seizure, the client may move unpredictably, and any nearby objects could pose a risk of harm. Clearing the area ensures the client has a safe space to have the seizure without additional hazards.

Choice C reason: Placing pillows around the client's head can provide some protection, but it is not as immediately effective or necessary as removing potentially harmful objects from the surrounding area. Ensuring a clear and safe environment is the primary concern.

Choice D reason: Administering oxygen per nasal cannula is not the first priority during a seizure. While maintaining oxygenation is important, the immediate focus should be on ensuring the client's physical safety by removing dangerous objects. Once the seizure subsides, appropriate respiratory support can be provided if needed.

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Correct Answer is B

Explanation

Choice A reason: Fluid volume excess is not related to the therapeutic use of galantamine hydrobromide. This medication is used to improve cognitive function in clients with Alzheimer's disease, which is more closely associated with disturbed thought processes.

Choice B reason: Disturbed thought processes are directly related to the therapeutic use of galantamine hydrobromide. This medication helps enhance cognitive function by increasing the levels of acetylcholine in the brain, which is crucial for memory and thinking. Clients with Alzheimer's disease often experience cognitive decline, and this medication aims to mitigate those symptoms.

Choice C reason: Altered breathing pattern is not addressed by the therapeutic use of galantamine hydrobromide. This medication is specifically used to treat cognitive symptoms associated with Alzheimer's disease, rather than respiratory issues.

A. Start pelvic floor exercises. B. Report fever or chills. C. Increase fluid intake to help with hydration. D. Tape urinary catheter securely to the thigh.

Correct Answer is A

Explanation

Choice A reason: Starting pelvic floor exercises might be beneficial in the long term for improving urinary control after TURP. However, immediately following the surgery and while the indwelling catheter is in place, it may not be the appropriate time to begin these exercises. The nurse should clarify when and how to start pelvic floor exercises.

Choice B reason: Reporting fever or chills is crucial because these symptoms could indicate an infection, which requires prompt medical attention. This statement reflects an understanding of important post-operative care instructions and does not need clarification.

Choice C reason: Increasing fluid intake to help with hydration is important for clients with a urinary catheter. Adequate hydration helps flush the urinary system and prevent complications such as urinary tract infections. This statement does not need clarification.

Choice D reason: Taping the urinary catheter securely to the thigh helps prevent tension on the catheter and reduces the risk of accidental dislodgement or trauma. This instruction is correct and does not need clarification.

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After placing a client who is having a seizure in the side-lying position, which intervention should the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse administers galantamine hydrobromide to a client with early onset Alzheimer's disease. Which nursing problem addresses its therapeutic use?

Correct Answer is B

Explanation

The nurse is providing education to a client who is returning home with an indwelling urinary catheter after having a transurethral resection of the prostate (TURP). Which statement made by the client demonstrates a need for the nurse to clarify the instructions?

Correct Answer is A

Explanation

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