The nurse is caring for a patient who suffered a spinal cord injury (SCI) who has had halo traction placed for spinal immobilization. What emergency equipment should the nurse have at the bedside? (SELECT ALL THAT APPLY)
Padded tongue blades to prevent injury in the event of seizure
Soft wrist restraints to prevent injury
Ambu bag and oxygen connection for respiratory distress
Wrenches for emergency removal of traction equipment
Oral suction tube (Yankaur) for secretion removal
Correct Answer : C,D,E
A. Padded tongue blades are not appropriate for seizure management and are not necessary in this context.
B. Soft wrist restraints are not required in this scenario unless otherwise indicated.
C. An Ambu bag and oxygen are crucial for respiratory support, especially if the patient has compromised breathing due to spinal cord injury.
D. Wrenches should be readily available to quickly remove halo traction in case of an emergency, such as if the patient's airway needs to be accessed.
E. An oral suction tube (Yankauer) is important for managing oral secretions, which can be challenging for patients with limited mobility.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Soft restraints are not recommended during a seizure and can cause harm to the patient.
B. Placing anything in the mouth during a seizure can lead to injury or airway obstruction and is contraindicated.
C. Turning the patient on their side helps to maintain an open airway and prevent aspiration; staying with the patient ensures ongoing monitoring.
D. Leaving the patient alone to seek help is unsafe, as it leaves the patient unmonitored during the seizure.
Correct Answer is C
Explanation
A. Discussing over-the-counter drugs with the healthcare provider is essential, as they can interact with antiepileptic medications.
B. Discontinuing antiepileptic medications abruptly can lead to rebound seizures and is unsafe, so this statement is correct.
C. Doubling up on doses can lead to toxicity and adverse effects; missed doses should not be made up by doubling the next dose. This response indicates the need for further teaching.
D. Taking medications exactly as prescribed is necessary to maintain therapeutic levels and manage seizure control effectively.
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