An adult client who has been experiencing a seizure for approximately 15 minutes is brought to the emergency department by private vehicle. Which intervention should the nurse implement first?

Administer levetiracetam intravenously.

Obtain a STAT electroencephalogram.

Administer lorazepam intravenously.

Obtain a STAT 12-lead electrocardiogram.

Answer and Explanation

The Correct Answer is C

Choice A Reason:

Administering levetiracetam intravenously is not the first intervention. While levetiracetam is an antiepileptic drug used to control seizures, it is not the first-line treatment for an ongoing seizure, especially one lasting as long as 15 minutes. The priority in this situation is to stop the seizure activity immediately to prevent further complications, such as neuronal damage or status epilepticus. Levetiracetam may be used later for maintenance therapy, but it is not the initial emergency intervention.

Choice B Reason:

Obtaining a STAT electroencephalogram (EEG) is important for diagnosing and understanding the type of seizure activity, but it is not the first intervention. The immediate priority is to stop the seizure. An EEG can be performed after the seizure has been controlled to assess brain activity and guide further treatment. Delaying the administration of an anticonvulsant to perform an EEG could result in prolonged seizure activity and increased risk of complications.

Choice C Reason:

Administering lorazepam intravenously is the most appropriate first intervention. Lorazepam is a benzodiazepine that acts quickly to stop seizure activity. It is the drug of choice for treating status epilepticus and prolonged seizures because of its rapid onset and effectiveness. Administering lorazepam helps to quickly terminate the seizure, reducing the risk of complications and stabilizing the patient for further evaluation and treatment.

Choice D Reason:

Obtaining a STAT 12-lead electrocardiogram (ECG) is not the first intervention. While an ECG can provide valuable information about the patient’s cardiac status, it does not address the immediate need to stop the seizure. The priority is to administer an anticonvulsant to terminate the seizure. Once the seizure is controlled, an ECG can be performed to assess any potential cardiac issues, especially if the patient has a history of cardiac problems or if the seizure was triggered by a cardiac event.

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Correct Answer is C

Explanation

Choice A Reason: Increased Serum Albumin

Increased serum albumin is not a direct indicator of the therapeutic effect of lactulose in patients with chronic hepatitis. Albumin is a protein made by the liver, and its levels can be affected by liver function. However, lactulose primarily works by reducing ammonia levels in the blood, not by increasing albumin levels. Normal serum albumin levels range from 3.5 to 5.5 grams per deciliter (g/dL). While improved liver function might eventually lead to increased albumin levels, this is not the primary therapeutic effect of lactulose.

Choice B Reason: Decreased Serum Bilirubin

Decreased serum bilirubin is also not a direct indicator of lactulose’s therapeutic effect. Bilirubin is a byproduct of the normal breakdown of red blood cells and is processed by the liver. Elevated bilirubin levels can indicate liver dysfunction, but lactulose’s main role is to reduce ammonia levels, not bilirubin. Normal serum bilirubin levels are typically between 0.1 to 1.2 milligrams per deciliter (mg/dL). While improved liver function might reduce bilirubin levels, this is not the primary goal of lactulose therapy.

Choice C Reason: Decreased Serum Ammonia

Decreased serum ammonia is the correct indicator of the therapeutic effect of lactulose in patients with chronic hepatitis. Lactulose is used to treat hepatic encephalopathy, a condition caused by high levels of ammonia in the blood due to liver dysfunction. Lactulose works by converting ammonia into ammonium, which is then excreted from the body. Normal serum ammonia levels are less than 50 micromoles per liter (µmol/L) in adults56. A decrease in serum ammonia levels indicates that lactulose is effectively reducing the toxic levels of ammonia in the blood, thereby achieving its desired therapeutic effect.

Choice D Reason: Decreased Serum Alanine Aminotransferase (ALT)

Decreased serum alanine aminotransferase (ALT) is not a direct indicator of lactulose’s therapeutic effect. ALT is an enzyme found in the liver that helps convert proteins into energy for liver cells. Elevated ALT levels can indicate liver damage. Normal ALT levels range from 7 to 56 units per liter (U/L). While improved liver function might reduce ALT levels, lactulose’s primary role is to reduce ammonia levels, not directly affect ALT.

A. A 42-year-old man with gastroesophageal reflux disease B. A 55-year-old woman who is 50 lb (23 kg) overweight C. A 20-year-old woman who is 8 months pregnant D. A 73-year-old man with type 2 diabetes mellitus

Correct Answer is B

Explanation

Choice A Reason:

A 42-year-old man with gastroesophageal reflux disease (GERD) is not at the highest risk for obstructive sleep apnea (OSA). While GERD can be associated with OSA, it is not a primary risk factor. The main risk factors for OSA include obesity, age, and anatomical features that can obstruct the airway. Therefore, this individual is not at the greatest risk compared to others.

Choice B Reason:

A 55-year-old woman who is 50 lb (23 kg) overweight is at significant risk for developing OSA. Obesity is one of the most critical risk factors for OSA because excess weight can lead to fat deposits around the upper airway, which can obstruct breathing during sleep. Additionally, being overweight increases the likelihood of other conditions that can exacerbate OSA, such as hypertension and metabolic syndrome.

Choice C Reason:

A 20-year-old woman who is 8 months pregnant may experience temporary sleep disturbances, including snoring and mild sleep apnea, due to hormonal changes and increased abdominal pressure. However, pregnancy-related sleep apnea is usually transient and resolves after childbirth. Therefore, while she may have an increased risk during pregnancy, it is not as significant as the risk posed by obesity.

Choice D Reason:

A 73-year-old man with type 2 diabetes mellitus has an increased risk of OSA, as diabetes is associated with obesity and metabolic syndrome, which are risk factors for OSA. However, the presence of diabetes alone does not pose as high a risk as obesity. Therefore, while this individual is at risk, it is not as high as the risk associated with being significantly overweight.

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An adult client who has been experiencing a seizure for approximately 15 minutes is brought to the emergency department by private vehicle. Which intervention should the nurse implement first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client diagnosed with chronic hepatitis who is receiving the medication lactulose. Which of these laboratory results would indicate the medication is achieving the desired therapeutic effect?

Correct Answer is C

Explanation

A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for development of obstructive sleep apnea?

Correct Answer is B

Explanation

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