Which client goal, established by the nurse, is most important as the nurse plans care for a seizure client in the home setting?
A) The client will take the seizure medication at the same time daily.
B) The client will remain free of injury if a seizure does occur.
C) The client will verbalize an understanding of feelings that preempt seizure activity.
D) The client will post emergency numbers on the refrigerator for ease of obtaining.
B
Feedback:
All of the goals are appropriate, but the most important goal is the long-term goal to remain free of injury if a seizure occurs. Nursing interventions associated can include notifying someone of not feeling well, lowering self to a safe position, protecting head, turning on a side, etc. Also, the client may be at a risk for injury because, once a seizure begins, the client cannot implement self-protective behaviors. An established plan is important in the care of a seizure client. The other options are acceptable goals for nursing care.
You might also like to view...
Which of the following statements is a principle of Lamaze preparation?
A) Abdominal breathing allows the uterus to expand freely. B) Distraction aids pain reception in the brain cortex. C) Chest breathing prevents the diaphragm from descending. D) Labor can be made painfree.
The news reported that a train derailment 5 miles away from the clinic spilled a large amount of liquid chlorine that has been vaporized by the atmosphere. An indication that the chlorine gas is an imminent threat to the clinic would be:
a. sighting of a low-lying green cloud. b. smelling "almonds" or "burning feathers." c. sudden nausea. d. skin blistering.
A patient, admitted for injuries sustained in a motor vehicle accident, has several inflamed wounds on his legs and arms. The nurse realizes that the inflammation
1. helps to build new tissue. 2. is the first phase of the wound healing process. 3. works to create new blood vessels. 4. is a precursor to collagen formation.
MC PCA infuser pumps enable the client to control three parameters of medication delivery. Which parameter is not controlled by the client?
A. Stopping and starting the infusion. B. Administering a bolus dose. C. Titrating the hourly dose within a preset range. D. Deciding on dose parameters.