What is the most appropriate nursing action when a child is in the tonic phase of a generalized tonic-clonic seizure?
a. Guide the child to the floor if he is standing and go for help.
b. Turn the child's body on his side.
c. Place a padded tongue blade between the teeth.
d. Quickly slip soft restraints on the child's wrists.
B
Positioning the child on his side will prevent aspiration. The child should be placed on a soft surface if he is not in bed; however, it would be inappropriate to leave the child during the seizure. Nothing should be inserted into the child's mouth during a seizure to prevent injury to the mouth, gums, or teeth. Restraints could cause injury. Sharp objects and furniture should be moved out of the way to prevent injury.
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Positive end-expiratory pressure (PEEP) is a mode of ventilatory assistance that produces the following condition:
a. Each time the patient initiates a breath, the ventilator delivers a full preset tidal volume. b. For each spontaneous breath taken by the patient, the tidal volume is determined by the patient's ability to generate negative pressure. c. The patient must have a respiratory drive, or no breaths will be delivered. d. There is pressure remaining in the lungs at the end of expiration that is measured in cm H2O.
The caregiver tells the nurse that her child eats things such as laundry starch, clay, paper, and paint. What does the child's behavior indicate to the nurse?
A) Pica B) Invagination C) Steatorrhea D) Polyuria
A client exhibits dependency on staff and peers and expresses fear of abandonment. Using Mahler's theory of object relations, which should the nurse expect to note in this client's childhood?
A. Lack of fulfillment of basic needs by parental figures B. Absence of the client's maternal figure during symbiosis C. Difficulty establishing trust with the maternal figure D. Inconsistency by the maternal figure during individuation
What usually causes primary bradycardia in newborns?
A) Decreased vagal tone B) Hypothermia C) Structural heart disease D) Hypothyroidism