Which nursing action would be appropriate to protect a patient during a seizure? (Select all that apply)
Placing a pad under the patient's head after guiding them to the floor from a standing position
Avoiding placing any objects in the mouth when the patient's teeth are clenched
Guiding the patient to the bed from the floor during a seizure
Turning the patient to one side, having a slightly forward-tilted head
Using supporting pillows for the patient who is on bed
Correct Answer : A,B,D,E
A. Placing a pad under the patient's head after guiding them to the floor from a standing position: This helps to protect the head from injury if the patient falls. However, guiding the patient to the floor should only be done if it is safe and possible to do so without causing further injury.
B. Avoiding placing any objects in the mouth when the patient's teeth are clenched: This prevents the risk of choking or damaging the patient's teeth. It is a common safety measure during seizures.
C. Guiding the patient to the bed from the floor during a seizure: This action is not appropriate during the seizure itself as it may cause injury or disrupt the patient's movement. Instead, the patient should remain in a safe position until the seizure ends.
D. Turning the patient to one side, having a slightly forward-tilted head: This helps to prevent aspiration and facilitates easier breathing during and after the seizure.
E. Using supporting pillows for the patient who is on bed: This helps to protect the patient from injury and provides support, ensuring safety during and after the seizure.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Inguinal hernia: While an inguinal hernia can cause discomfort and potential complications, it is not typically considered a significant fall risk.
B. Hyperlipidemia: This condition affects cholesterol levels and is not directly related to an increased risk of falls.
C. Multiple sclerosis: MS can lead to muscle weakness, balance issues, and coordination problems, which significantly increase the risk of falls.
D. Hyperthyroidism: Although hyperthyroidism can cause symptoms like tremors and muscle weakness, it is less directly associated with fall risk compared to multiple sclerosis.
Correct Answer is C
Explanation
A. Place the chair at a 90° angle to the bed: Incorrect. The chair should be placed at an angle to facilitate a smoother transfer, usually around 45° to the bed, allowing easier movement from the bed to the chair.
B. Place the chair on the client's left side: Incorrect. The chair should be positioned on the strong side of the client if possible, or the side the client will be transferring towards, not necessarily the left side.
C. Lock the wheels on the client's bed: Correct. Locking the wheels on the bed ensures that the bed remains stationary during the transfer, providing safety and stability for the client.
D. Raise the height of the client's bed: Incorrect. The bed should be adjusted to a height that allows the nurse to safely transfer the client without excessive bending or stretching. However, raising it too high might make it difficult for the nurse to maneuver the client safely.
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