The nurse observes a novice nurse caring for a client experiencing status epilepticus. It will require immediate intervention if the novice nurse does which of the following?
Activates the rapid response team (RRT).
Loosens any restrictive clothing.
Places the client in a lateral position.
Prepares to administer intravenous valproate acid.
The Correct Answer is D
Choice A rationale: Activates the rapid response team (RRT) - Status epilepticus is a medical emergency requiring immediate intervention. Activating the rapid response team would ensure a prompt response to the situation.
Choice B rationale: Loosens any restrictive clothing - It is important for patient safety and comfort.
Choice C rationale: Places the client in a lateral position - This is a recommended positioning to prevent aspiration during a seizure.
Choice D rationale: Prepares to administer intravenous valproate acid - Valproic acid is not the first drug during epilepsy hence this action would necessitate immediate intervention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale: Plantar fasciitis typically presents with severe pain in the arch of the foot, especially during the first steps in the morning or after prolonged periods of rest.
Choice B rationale: Multiple toe deformities are not typically associated with plantar fasciitis.
Choice C rationale: Redness and severe swelling are not typical findings in plantar fasciitis.
Choice D rationale: Numbness and paresthesia are not common findings in plantar fasciitis.
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Correct Answer is B
Explanation
Choice A rationale: Cerebral motor cortex primarily controls voluntary movements, not autonomic functions like respiration, heart rate, and blood pressure.
Choice B rationale: The brain stem controls vital functions like respiration, heart rate, and blood pressure, so damage to this area can lead to difficulties in these functions.
Choice C rationale: Broca's area is responsible for speech production and is not directly involved in autonomic functions.
Choice D rationale: The occipital lobe is primarily associated with visual processing and perception, not autonomic functions like respiration or heart rate.
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