NUR242 MED SURG EXAM 5 2026 VERIFIED
QUESTIONS AND DETAILED SOLUTIONS
◉ The nurse notes that a child in a crib has a clamped jaw and is
having a tonic-clonic seizure. Which is the priority nursing
responsibility at this time? Answer: Protecting the child from self-
injury
◉ A 2-year-old child is admitted to the pediatric unit with a
diagnosis of bacterial meningitis. Which is the most important safety
measure for the nurse to institute immediately after the child has a
seizure? Answer: Placing the child in the side-lying position
◉ A child sitting on a chair starts having a tonic-clonic seizure with a
clenched jaw. Which would be the initial action by the nurse?
Answer: Placing the child on the floor
◉ A child with a seizure disorder has a generalized seizure shortly
after admission to the hospital. Which nursing actions are most
appropriate? Select all that apply. One, some, or all responses may be
correct. Answer: Assessing the seizure, turning the child on the side,
pulling the padded side rails up
◉ Status epilepticus develops in an adolescent with a seizure
disorder who is taking antiseizure medication. Which reason would
,the nurse identify as the most common reason for the development
of status epilepticus? Answer: The prescribed antiseizure
medication probably is not taken consistently.
◉ Which antiseizure medications would the nurse identify as being
used to stabilize a client's mood by suppressing mania associated
with bipolar disorder (BPD)? Select all that apply. One, some, or all
responses may be correct. Answer: Carbamazepin, Divalproex
sodium, Lamotrigine
◉ Which medication would the nurse recognize as being
contraindicated for use in clients with eating and seizure disorders?
Answer: Bupropion
◉ Which piece of equipment will the nurse remove from the bedside
of a client on seizure precautions? Answer: Padded tongue blade
◉ A child becomes cyanotic during a generalized tonic-clonic
seizure. Which is the most appropriate action by the nurse? Answer:
Continuing to observe the seizure
- the child's status and the progression of the seizure should be
monitored; the child will not breathe until the seizure is over, and
cyanosis should subside at that time.
, ◉ Which nursing intervention is the most effective in preventing a
seizure in a client with severe preeclampsia Answer: Controlling
external stimuli
◉ Which is the priority nursing action when a client admitted with
preeclampsia has a seizure? Answer: Turning the client's head to the
side
◉ When would the risk of another seizure in a client with eclampsia
decrease? Answer: 48 hours postpartum
◉ Which factor would cause a rise in temperature to 102°F (38.9°C)
after a seizure in a client with eclampsia? Answer: Irregularity in the
cerebral thermal center
◉ The client with a seizure disorder receives intravenous (IV)
phenytoin. The nurse will monitor closely for which condition?
Answer: Cardiac dysrhythmias
◉ A client with a seizure disorder will begin taking phenytoin.
Which instructions will the nurse give to the client? Answer: Provide
meticulous oral hygiene."
QUESTIONS AND DETAILED SOLUTIONS
◉ The nurse notes that a child in a crib has a clamped jaw and is
having a tonic-clonic seizure. Which is the priority nursing
responsibility at this time? Answer: Protecting the child from self-
injury
◉ A 2-year-old child is admitted to the pediatric unit with a
diagnosis of bacterial meningitis. Which is the most important safety
measure for the nurse to institute immediately after the child has a
seizure? Answer: Placing the child in the side-lying position
◉ A child sitting on a chair starts having a tonic-clonic seizure with a
clenched jaw. Which would be the initial action by the nurse?
Answer: Placing the child on the floor
◉ A child with a seizure disorder has a generalized seizure shortly
after admission to the hospital. Which nursing actions are most
appropriate? Select all that apply. One, some, or all responses may be
correct. Answer: Assessing the seizure, turning the child on the side,
pulling the padded side rails up
◉ Status epilepticus develops in an adolescent with a seizure
disorder who is taking antiseizure medication. Which reason would
,the nurse identify as the most common reason for the development
of status epilepticus? Answer: The prescribed antiseizure
medication probably is not taken consistently.
◉ Which antiseizure medications would the nurse identify as being
used to stabilize a client's mood by suppressing mania associated
with bipolar disorder (BPD)? Select all that apply. One, some, or all
responses may be correct. Answer: Carbamazepin, Divalproex
sodium, Lamotrigine
◉ Which medication would the nurse recognize as being
contraindicated for use in clients with eating and seizure disorders?
Answer: Bupropion
◉ Which piece of equipment will the nurse remove from the bedside
of a client on seizure precautions? Answer: Padded tongue blade
◉ A child becomes cyanotic during a generalized tonic-clonic
seizure. Which is the most appropriate action by the nurse? Answer:
Continuing to observe the seizure
- the child's status and the progression of the seizure should be
monitored; the child will not breathe until the seizure is over, and
cyanosis should subside at that time.
, ◉ Which nursing intervention is the most effective in preventing a
seizure in a client with severe preeclampsia Answer: Controlling
external stimuli
◉ Which is the priority nursing action when a client admitted with
preeclampsia has a seizure? Answer: Turning the client's head to the
side
◉ When would the risk of another seizure in a client with eclampsia
decrease? Answer: 48 hours postpartum
◉ Which factor would cause a rise in temperature to 102°F (38.9°C)
after a seizure in a client with eclampsia? Answer: Irregularity in the
cerebral thermal center
◉ The client with a seizure disorder receives intravenous (IV)
phenytoin. The nurse will monitor closely for which condition?
Answer: Cardiac dysrhythmias
◉ A client with a seizure disorder will begin taking phenytoin.
Which instructions will the nurse give to the client? Answer: Provide
meticulous oral hygiene."
