NUR 330 Exam 4 NCLEX Questions and Correct Answers
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Course
NUR 330
Institution
NUR 330
The male client is sitting in the chair and his entire body is rigid with his arms and legs contracting and relaxing. The client is not aware of what is going on and is making guttural sounds. Which action should the nurse implement first? 1. Push aside any furniture. 2. Place the client on his sid...
NUR 330 Exam 4 NCLEX Questions and
Correct Answers
The male client is sitting in the chair and his entire body is rigid with his arms and
legs contracting and relaxing. The client is not aware of what is going on and is
making guttural sounds. Which action should the nurse implement first?
1. Push aside any furniture.
2. Place the client on his side.
3. Assess the client's vital signs.
4. Ease the client to the floor.
Company. Kindle Edition. ✅4. The client should not remain in the
chair during a seizure. He should be
brought safely to the floor so that he
will have room to move the extremities.
The occupational health nurse is concerned about preventing occupation-related
acquired seizures. Which intervention should the nurse implement?
1. Ensure that helmets are worn in appropriate areas.
2. Implement daily exercise programs for the staff.
3. Provide healthy foods in the cafeteria.
4. Encourage employees to wear safety glasses. ✅1. Head injury is one of the main
reasons
for epilepsy that can be prevented
through occupational safety
precautions and highway safety
programs.
The client is scheduled for an electroencephalogram (EEG) to help diagnose a
seizure disorder. Which preprocedure teaching should the nurse implement?
1. Tell the client to take any routine antiseizure medication prior to the EEG.
2. Tell the client not to eat anything for eight (8) hours prior to the procedure.
3. Instruct the client to stay awake for 24 hours prior to the EEG.
4. Explain to the client that there will be some discomfort during the procedure. ✅3.
The goal is for the client to have a
seizure during the EEG. Sleep deprivation, hyperventilating, or flashing lights
may induce a seizure.
The nurse enters the room as the client is beginning to have a tonic-clonic seizure.
What action should the nurse implement first?
1. Note the first thing the client does in the seizure.
2. Assess the size of the client's pupils.
3. Determine if the client is incontinent of urine or stool.
,4. Provide the client with privacy during the seizure. ✅1. Noticing the first thing the
client does
during a seizure provides information
and clues as to the location of the
seizure in the brain. It is important to
document whether the beginning of
the seizure was observed.
The client who just had a three (3)-minute seizure has no apparent injuries and is
oriented to name, place, and time but is very lethargic and just wants to sleep. Which
intervention should the nurse implement?
1. Perform a complete neurological assessment.
2. Awaken the client every 30 minutes.
3. Turn the client to the side and allow the client to sleep.
4. Interview the client to find out what caused the seizure. ✅3. During the postictal
(after-seizure)
phase, the client is very tired and
should be allowed to rest quietly;
placing the client on the side will help
prevent aspiration and maintain a
patent airway.
The unlicensed assistive personnel (UAP) is attempting to put an oral airway in the
mouth of a client having a tonic-clonic seizure. Which action should the primary
nurse take?
1. Help the UAP to insert the oral airway in the mouth.
2. Tell the UAP to stop trying to insert anything in the mouth.
3. Take no action because the UAP is handling the situation.
4. Notify the charge nurse of the situation immediately. ✅2. The nurse should tell the
UAP to
stop trying to insert anything in the
mouth of the client experiencing a
seizure. Broken teeth and injury to the lips and tongue may result from
trying to place anything in the
clenched jaws of a client having a
tonic-clonic seizure.
The client is prescribed phenytoin (Dilantin), an anticonvulsant, for a seizure
disorder. Which statement indicates the client understands the discharge teaching
concerning this medication?
1. "I will brush my teeth after every meal."
2. "I will check my Dilantin level daily."
3. "My urine will turn orange while on Dilantin."
4. "I won't have any seizures while on this medication." ✅1. Thorough oral hygiene
after each
meal, gum massage, daily flossing,
, and regular dental care are essential
to prevent or control gingival
hyperplasia, which is a common
occurrence in clients taking
Dilantin.
The client is admitted to the intensive care department (ICD) experiencing status
epilepticus. Which collaborative intervention should the nurse anticipate?
1. Assess the client's neurological status every hour.
2. Monitor the client's heart rhythm via telemetry.
3. Administer an anticonvulsant medication by intravenous push.
4. Prepare to administer a glucocorticosteroid orally. ✅3. Administering an
anticonvulsant
medication by intravenous push
requires the nurse to have an order or
confer with another member of the
health-care team.
The client has been newly diagnosed with epilepsy. Which discharge instructions
should be taught to the client? Select all that apply.
1. Keep a record of seizure activity.
2. Take tub baths only; do not take showers.
3. Avoid over-the-counter medications.
4. Have anticonvulsant medication serum levels checked regularly.
5. Do not drive alone; have someone in the car. ✅1. Keeping a seizure and medication
chart
will be helpful when keeping follow-up
appointments with the health-care
provider and in identifying activities
that may trigger a seizure.
3. Over-the-counter medications may
contain ingredients that will interact
with antiseizure medications or, in
some cases, as with use of stimulants,
possibly cause a seizure.
4. Most of the anticonvulsant medications
have therapeutic serum levels that
should be maintained, and regular
checks of the serum levels help to
ensure the correct level.
Which statement by the female client indicates that the client understands factors
that may precipitate seizure activity?
1. "It is all right for me to drink coffee for breakfast."
2. "My menstrual cycle will not affect my seizure disorder."
3. "I am going to take a class in stress management."
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