The nurse is creating a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? Select all that apply.
Move furniture away from the child.
Place the child in a prone position.
Restrain the child.
Time the seizure
Insert a padded tongue blade in the child's mouth.
Stay with the child
Correct Answer : A,D,F
A.Move furniture away from the child.
Explanation: Creating a safe environment is important during a seizure. Moving furniture away from the child helps prevent injury.
B.Place the child in a prone position.
Explanation: Placing the child in a prone position (face down) is not recommended. The child should be placed on their side to allow for drainage of oral secretions and to prevent aspiration.
C. Restrain the child.
Explanation: Restraint is generally not recommended during a seizure, as it may cause injury to the child or the person providing care. Allow the seizure to run its course, and focus on keeping the environment safe.
D.Time the seizure.
Explanation: Timing the duration of the seizure is important for medical evaluation and management. Note the start and end times of the seizure.
E. Insert a padded tongue blade in the child's mouth.
Explanation: Inserting any object, including a padded tongue blade, into the child's mouth during a seizure is not recommended. This can lead to oral and dental injuries. Maintaining a clear airway and protecting the child from injury are priorities.
F. Stay with the child.
Explanation: Staying with the child provides support and ensures the child's safety during the seizure. It also allows the caregiver to observe and provide information to healthcare professionals.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["90"]
Explanation
The nurse should withhold the dose if the infant's apical heart rate is less than 90 beats per minute.
Digoxin is a medication that can slow the heart rate. If an infant's heart rate is already too slow, administering digoxin can increase the risk of bradycardia, a serious heart rhythm disturbance.
It's important to monitor the apical heart rate for a full minute before administering digoxin to an infant and to withhold the dose if the heart rate is below the specified threshold.
Correct Answer is ["160ml"]
Explanation
The Parkland formula is commonly used to calculate the fluid requirements for burn resuscitation. The formula is:
Fluid requirement (in mL)=TBSA×Weight (in kg)×Fluid volume (in mL/kg)
For burn patients, the recommended fluid volume is typically 4 mL/kg for each percent of TBSA burned.
Let's calculate the fluid requirement for the given case:
Fluid requirement=40%×22 lbs×4 mL/kg
First, convert the weight from pounds to kilograms:
Weight (in kg)= Weight (in lbs)/2.2
Weight (in kg)=22 lbs/2.2≈10 kg
Now, calculate the fluid requirement:
Fluid requirement=40% x 10 kg × 4 mL/kg
Fluid requirement=160mL
Therefore, the child will require 160 mL of fluid in the first 8 hours after the time of injury.
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