In caring for a client who requires seizure precautions, the practical nurse (PN) should ensure the ready availability of equipment to perform which procedure?
Suction the trachea.
Insert a urinary catheter.
Apply soft restraints.
Insert a nasogastric tube.
The Correct Answer is A
- Seizure precautions are measures taken to protect a client who is at risk of having a seizure, which is a sudden and abnormal electrical activity in the brain that can cause changes in behavior, movement, sensation, or consciousness. Seizure precautions include providing a safe environment, monitoring the client's vital signs and neurological status, administering anticonvulsant medications, and documenting the onset, duration, and characteristics of any seizure activity.
- One of the potential complications of a seizure is aspiration, which is the inhalation of foreign material into the lungs, such as saliva, vomit, or food. Aspiration can cause choking, pneumonia, or respiratory distress. To prevent or treat aspiration, the practical nurse (PN) should ensure the ready availability of equipment to perform suctioning of the trachea, which is the tube that connects the mouth and nose to the lungs. Suctioning of the trachea involves inserting a catheter through the nose or mouth into the trachea and applying negative pressure to remove any secretions or debris from the airway.
- Therefore, option A is the correct answer, while options B, C, and D are incorrect.
Option B is incorrect because inserting a urinary catheter is not related to seizure precautions or aspiration prevention.
Option C is incorrect because applying soft restraints may not be necessary or appropriate for a client who requires seizure precautions, as they may interfere with the natural movements of the seizure or cause injury to the client.
Option D is incorrect because inserting a nasogastric tube is not related to seizure precautions or aspiration prevention.
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Related Questions
Correct Answer is C
Explanation
A. Saying "I'm sure your family does not want you to die" is not a therapeutic response, as it invalidates the client's feelings and imposes the nurse's assumption on the client. This option is incorrect.
B. Asking "Why would you believe such things?" is not a therapeutic response, as it sounds judgmental and confrontational, and may make the client feel defensive or ashamed. This option is incorrect.
C. Asking "How does this make you feel?" is a therapeutic response, as it encourages the client to express their emotions and shows empathy and interest from the nurse. This option is correct.
D. Saying "You should talk to your family about your feelings" is not a therapeutic response, as it implies that the client is responsible for resolving their family issues and may increase their guilt or anxiety. This option is incorrect.
Correct Answer is C
Explanation
Choice A reason:
"You should administer the medication at bedtime." This statement is incorrect option. Administering methylphenidate at bedtime is not appropriate because it is a stimulant medication, and taking it in the evening could interfere with the child's ability to fall asleep and disrupt their sleep pattern.
"Your child should avoid foods containing tyramine. “This statement is incorrect option. Tyramine is not a concern with methylphenidate. Tyramine is associated with certain antidepressant medications, such as MAO inhibitors. Methylphenidate is not a MAO inhibitor, so there is no need for the child to avoid tyramine-containing foods.
Option C: "You should administer the medication after breakfast." This is the correct option. Administering methylphenidate after breakfast is a common practice because it allows the child to benefit from the medication during school hours when improved attention and focus are needed the most.
"Your child should avoid excess sodium intake." This statement is an incorrect option. Excess sodium intake is not directly related to methylphenidate use. However, it is generally a good idea for anyone, including children, to have a balanced and healthy diet, which may include monitoring sodium intake. But it is not specifically tied to the administration of methylphenidate.
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