Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a child who is experiencing a seizure. Which of the following actions should the nurse take?
A. Position the child laterally
Position the child laterally Explanation: When a child is experiencing a seizure, it's important to ensure their safety and prevent injury. Positioning the child laterally, also known as the recovery position, helps keep the airway clear and allows any fluids to drain from the mouth, reducing the risk of aspiration. It also helps prevent the child from choking on saliva or vomit. The other options are not appropriate actions during a seizure:
B. Use a padded tongue blade.
Using a padded tongue blade is not recommended during a seizure. Placing objects in the mouth during a seizure can lead to injury, including damage to the teeth, jaw, or airway.
C. Attempt to stop the seizure
Attempting to stop the seizure is not within the nurse's control. Seizures are caused by abnormal electrical activity in the brain and should not be interrupted forcefully. Instead, the focus should be on ensuring the child's safety and managing the situation until the seizure stops on its own.
D. Restrain the child's arms,
Restraining the child's arms is not advisable during a seizure. Restraining can cause harm and increase the risk of injury to the child or others involved. It's important to allow the seizure to run its course while protecting the child from harm.
This question is an excerpt from Nurse Dive's nursing test bank - ATI PAEDIATRICS PROCTORED EXAM - SIMMONS U BSN. Take the full exam now
Full Explanation
A. Position the child laterally
Explanation: When a child is experiencing a seizure, it's important to ensure their safety and prevent injury. Positioning the child laterally, also known as the recovery position, helps keep the airway clear and allows any fluids to drain from the mouth, reducing the risk of aspiration. It also helps prevent the child from choking on saliva or vomit.
The other options are not appropriate actions during a seizure:
B. Using a padded tongue blade is not recommended during a seizure. Placing objects in the mouth during a seizure can lead to injury, including damage to the teeth, jaw, or airway.
C. Attempting to stop the seizure is not within the nurse's control. Seizures are caused by abnormal electrical activity in the brain and should not be interrupted forcefully. Instead, the focus should be on ensuring the child's safety and managing the situation until the seizure stops on its own.
D. Restraining the child's arms is not advisable during a seizure. Restraining can cause harm and increase the risk of injury to the child or others involved. It's important to allow the seizure to run its course while protecting the child from harm.
Similar Questions
What are the priorites of our care and teaching ifor the patient with reflux? (Select All that Apply.)
A. Preventing further Urinary Tract Infections
Preventing further Urinary Tract Infections:This is a relevant priority for patients with reflux. Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder into the ureters and sometimes to the kidneys, increasing the risk of urinary tract infections (UTIs). Preventing UTIs is important because recurring infections can lead to more severe kidney problems and complications. Teaching patients and caregivers about hygiene, proper voiding techniques, and recognizing UTI symptoms is crucial to minimize the risk of infections.
B. Preventing kidney damage
Preventing kidney damage:Preventing kidney damage is a significant priority for patients with reflux. If urine refluxes back into the kidneys, it can lead to kidney damage over time. This damage can affect kidney function and potentially lead to chronic kidney disease. Monitoring kidney function, managing UTIs promptly, and considering medical or surgical interventions to correct reflux are all important strategies to prevent kidney damage.
C. The chances of needing brain surgery
The chances of needing brain surgery:The chances of needing brain surgery are not directly related to reflux. Reflux primarily involves the urinary system, specifically the flow of urine from the bladder to the kidneys. Brain surgery is not a relevant consideration in the context of reflux or its management.
D. Antibiotic usage teaching with the presence of an infection
Antibiotic usage teaching with the presence of an infection:This is an important aspect of care for patients with reflux who develop urinary tract infections. UTIs are common complications of reflux, and appropriate use of antibiotics is crucial to treat infections effectively and prevent further complications. Teaching patients and caregivers about the importance of completing prescribed antibiotic courses, recognizing signs of infection, and adhering to medical advice is essential to manage UTIs in the presence of reflux.
Full Explanation
A) Preventing further Urinary Tract Infections:
This is a relevant priority for patients with reflux. Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder into the ureters and sometimes to the kidneys, increasing the risk of urinary tract infections (UTIs). Preventing UTIs is important because recurring infections can lead to more severe kidney problems and complications. Teaching patients and caregivers about hygiene, proper voiding techniques, and recognizing UTI symptoms is crucial to minimize the risk of infections.
B) Preventing kidney damage:
Preventing kidney damage is a significant priority for patients with reflux. If urine refluxes back into the kidneys, it can lead to kidney damage over time. This damage can affect kidney function and potentially lead to chronic kidney disease. Monitoring kidney function, managing UTIs promptly, and considering medical or surgical interventions to correct reflux are all important strategies to prevent kidney damage.
C) The chances of needing brain surgery:
The chances of needing brain surgery are not directly related to reflux. Reflux primarily involves the urinary system, specifically the flow of urine from the bladder to the kidneys. Brain surgery is not a relevant consideration in the context of reflux or its management.
D) Antibiotic usage teaching with the presence of an infection:
This is an important aspect of care for patients with reflux who develop urinary tract infections. UTIs are common complications of reflux, and appropriate use of antibiotics is crucial to treat infections effectively and prevent further complications. Teaching patients and caregivers about the importance of completing prescribed antibiotic courses, recognizing signs of infection, and adhering to medical advice is essential to manage UTIs in the presence of reflux.
A nurse is preparing to administer amoxicillin 30 mg/kg/day divided equally every 12 hr to a toddler who weighs 33 lb. Available is amoxicillin 200 mg/5 mL suspension. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)
Full Explanation
To calculate the dose of amoxicillin for the toddler:
Step 1: Convert the toddler's weight from pounds to kilograms.
33 lb ÷ 2.2 (lb to kg conversion factor) = approximately 15 kg
Step 2: Calculate the total daily dose of amoxicillin.
Dose = 30 mg/kg/day × 15 kg = 450 mg/day
Step 3: Divide the total daily dose into equal doses every 12 hours.
450 mg/day ÷ 2 doses = 225 mg/dose
Step 4: Calculate the amount of amoxicillin suspension needed for each dose.
The available concentration is 200 mg/5 mL, so for 225 mg, you would use the proportion:
225 mg : 200 mg = x mL : 5 mL
Cross-multiplying: x = (225 mg × 5 mL) / 200 mg ≈ 5.625 mL
Therefore, the nurse should administer approximately 5.625 mL of amoxicillin suspension for each dose.
A nurse is caring for a client who is to receive liquid medications via a gastrostomy tube. The client is prescribed phenytoin 250 mg. The amount available is phenytoin oral solution 25 mg/5 mL. How many mL should the nurse administer per dose?
(Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
Full Explanation
To calculate the mL of phenytoin oral solution needed for a 250 mg dose, we can use the following equation:
Dose (mg) = Volume (mL) × Concentration (mg/mL)
Given:
Dose = 250 mg
Concentration = 25 mg/5 mL
We need to find the volume (mL):
Volume (mL) = Dose (mg) / Concentration (mg/mL)
Volume (mL) = 250 mg / (25 mg/5 mL)
Volume (mL) = 250 mg / (5 mg/mL)
Volume (mL) = 50 mL
So, the nurse should administer 50 mL of phenytoin oral solution per dose.