The client is a young male who appears to be 25-30 years old. He was found unconscious on a sidewalk by a jogger who was passing. The jogger called an ambulance, and the EMT's transported the ent to the hospital. The client is arousable but unable to say what his name is or what happened to him. A STAT CT of the head in the emergency room showed no abnormalities, so the client will be admitted to the medical floor for observation and further tests.
The PN reinforces education about seizures to the client and asks him to explain what he understands about his condition.
Which statements indicate understanding?
Select all that apply
"I don't need to go to the hospital if I have another seizure unless it is a very long seizure or if I have several in a row."
"There are really no lifestyle changes that I can do that will affect my risk of having another seizure."
"I may never know why I started having seizures."
"Having a medic alert bracelet might be a good idea, but it is up to me to decide if I want it or not."
"I can stop taking the phenytoin if I go for a while and don't have a seizure."
Correct Answer : A,C,D
A. "I don't need to go to the hospital if I have another seizure unless it is a very long seizure or if I have several in a row." This statement demonstrates an understanding that certain characteristics of seizures, such as prolonged duration or multiple seizures in succession, may require medical attention and evaluation.
C. "I may never know why I started having seizures." This statement acknowledges the possibility that the underlying cause of the seizures may remain unknown. Seizure etiology can vary, and in some cases, the specific cause cannot be determined despite diagnostic tests.
D. "Having a medic alert bracelet might be a good idea, but it is up to me to decide if I want it or not." This statement recognizes the potential benefits of wearing a medic alert bracelet, which can provide crucial information about the client's condition in case of emergencies. It emphasizes the client's autonomy in making the decision, showing an understanding of the role and significance of the bracelet.
The following statement does not indicate understanding:
"There are really no lifestyle changes that I can do that will affect my risk of having another seizure." This statement is incorrect, as there are lifestyle modifications that can help reduce the risk of seizures, such as getting enough sleep, managing stress, avoiding triggers (if known), and taking prescribed medications as directed.
Regarding the statement "I can stop taking the phenytoin if I go for a while and don't have a seizure," it is not included in the given options.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Verifying the completion of all new prescriptions is crucial because it ensures that necessary medications or treatments are not delayed or missed for the clients. By reviewing the new prescriptions, the PN can ensure that any necessary medications or treatments are ordered and completed as required. This task takes priority because it directly impacts the immediate care and well-being of the clients.
While the other tasks mentioned are also important, they are not as time-sensitive or critical as verifying the completion of new prescriptions:
A. "Clean up and organize the nurses' work-station": While maintaining a clean and organized work-station is important for efficiency and safety, it can be done after the more critical tasks have been completed.
B. "Write a narrative shift summary for each client": Providing shift summaries is important for effective communication and continuity of care, but it can be done after ensuring the completion of new prescriptions, as it involves documenting and reviewing the events and assessments that occurred during the shift.
C. "Calculate and record intake and output totals": Tracking intake and output is important for assessing fluid balance, but it can also be done after verifying the completion of new prescriptions, as it involves documenting and calculating fluid volumes.
Correct Answer is B
Explanation
The most important intervention for the practical nurse (PN) to implement when applying an ice pack to a client is to secure a protective cover over the bag. This is essential to protect the client's skin from direct contact with the ice pack, which can cause tissue damage, frostbite, or discomfort.
Securing a protective cover, such as a thin cloth or towel, between the ice pack and the client's skin helps to create a barrier and prevent excessive cold exposure. It allows for the therapeutic benefits of the ice pack, such as reducing swelling and pain, while minimizing the risk of skin damage.
Incorrect:
A. While wrapping the bag in place for comfort is important, it is not the most critical intervention compared to ensuring the protection of the client's skin.
C. Giving directions to leave the pack in place is a general instruction for the client to follow the prescribed treatment, but it does not specifically address the importance of using a protective cover.
D. The type of ice used, whether crushed or cubed, may vary based on availability and preference, but it does not take precedence over the need to protect the client's skin with a cover.
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