The client tells the nurse, "I am about to have a seizure." Which of the actions should the nurse implement? (Select all that apply)

Loosen the patient's clothing

Ease the patient to the floor if standing

Restrain the patient

Protect the patient's mouth with a padded tongue blade

Provide privacy

Answer and Explanation

Correct Answer : A,B,E

Choice A rationale:
Loosening the patient's clothing around the neck and chest promotes easier breathing during the seizure. It also prevents potential injury from constrictive clothing that could restrict movement or circulation.
Choice B rationale:
Easing the patient to the floor if they are standing helps to prevent falls and injuries that could occur due to loss of consciousness and muscle control during the seizure. It's crucial to guide the patient gently to the floor to avoid abrupt movements that could trigger or worsen the seizure.
Choice C rationale:
Restraining the patient during a seizure is not recommended as it can cause harm. Attempting to restrain a patient's movements during a seizure can lead to muscle strains, joint injuries, or even fractures. It can also increase anxiety and agitation, potentially prolonging the seizure.
Choice D rationale:
Protecting the patient's mouth with a padded tongue blade is not necessary and can even be dangerous. It was once a common practice, but it's now discouraged as it can cause oral injuries, obstruct the airway, or induce vomiting.

Choice E rationale:
Providing privacy helps to protect the patient's dignity and reduce any potential embarrassment during the seizure. It also creates a calmer and less stimulating environment, which can be beneficial in managing the seizure.

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Correct Answer is C

Explanation

Choice A rationale:
A high-purine diet is actually contraindicated in gout because purines are metabolized into uric acid, which can accumulate in the joints and trigger gout attacks. Therefore, a low-purine diet is recommended.

Choice B rationale:
Aspirin is not typically recommended for gout because it can interfere with the excretion of uric acid and potentially worsen the condition. While low-dose aspirin might be used for specific cardiovascular benefits in some gout patients, it's not a general treatment for gout itself.

Choice C rationale:Alcohol intake is a common trigger for gout attacks because it can increase uric acid levels in the blood. Therefore, limiting alcohol intake is an important part of managing gout.

Choice D rationale:
Fluid intake should be increased, not limited, in gout patients. This is because adequate hydration helps to flush uric acid out of the body and reduce the risk of gout attacks.

A. A program of regular mild to moderate exercise B. Daily meditation and guided imagery C. Referral to physical therapy for an assistive device D. NSAID medications on a regular schedule

Correct Answer is A

Explanation

Choice A:
Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties. Activity intolerance is a common symptom, resulting in patients experiencing increased fatigue, pain, and decreased function with exertion.
A program of regular mild to moderate exercise is considered the cornerstone of management for fibromyalgia. Exercise improves physical fitness, reduces pain intensity, and enhances sleep quality. It also decreases fatigue and depression, and improves overall well-being and quality of life. The key is to start with low-impact activities, gradually increase intensity and duration over time, and listen to the body's signals to avoid overexertion.
Here's how exercise benefits patients with fibromyalgia:
Pain reduction: Exercise releases endorphins, natural pain-relieving chemicals in the brain. It also strengthens muscles and improves joint flexibility, leading to decreased pain intensity and frequency.
Improved physical fitness: Regular exercise increases cardiovascular health, muscle strength, and endurance, allowing patients to tolerate activity better and perform daily tasks with less fatigue.
Enhanced sleep quality: Exercise can regulate sleep patterns, promoting deeper sleep and reducing nighttime pain, leading to improved energy levels and mood throughout the day.
Reduced fatigue and depression: Exercise triggers the release of mood-boosting neurotransmitters, like serotonin and dopamine, which can help alleviate symptoms of depression and fatigue commonly associated with fibromyalgia.
Improved overall well-being: Regular physical activity enhances self-efficacy, reduces stress, and promotes social interaction, contributing to a better quality of life for patients with fibromyalgia.
Therefore, a program of regular mild to moderate exercise is the most effective recommendation for patients with fibromyalgia to address activity intolerance and improve their overall well-being.
Rationale for other choices:

Choice B: While daily meditation and guided imagery can be helpful for managing stress and improving sleep in fibromyalgia, they are not as effective as exercise in directly addressing activity intolerance and improving physical fitness and function.

Choice C: Referral to physical therapy for an assistive device may be necessary in some cases with severe limitations, but it is not the first-line intervention for addressing activity intolerance in most patients with fibromyalgia. Exercise should be the initial focus, with assistive devices considered later if needed.

Choice D: NSAID medications can offer temporary pain relief, but they do not address the underlying cause of activity intolerance in fibromyalgia and can have side effects like gastritis and kidney problems. NSAIDs should be used cautiously and only as a complementary therapy alongside exercise in managing fibromyalgia symptoms.
Remember, a tailored exercise program, starting with low-impact activities and gradually increasing intensity, is the key to managing activity intolerance and improving function in patients with fibromyalgia.

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The client tells the nurse, "I am about to have a seizure." Which of the actions should the nurse implement? (Select all that apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is completing discharge instructions with a client following an acute onset of gout. Which of the following client statements indicates an understanding of the treatment regimen?

Correct Answer is C

Explanation

When planning care for a patient diagnosed with fibromyalgia, the nurse addresses the potential problem of activity intolerance. What should the nurse recommend to the patient to most effectively address this problem?

Correct Answer is A

Explanation

A nurse is in a client's room when the client begins having a tonic-clonic seizure. Which of the following actions should the nurse take first?

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