A child with a history of seizures arrives in the emergency ...

[fnuegbu]

A child with a history of seizures arrives in the emergency department (ED) in status epilepticus. Which is the priority nursing action?
 
  1. Take vital signs.
  2. Establish an intravenous line.
  3. Perform rapid neurologic assessment.
  4. Maintain patent airway.

Question 2

Which assessment data support the nurse's suspicion that a postpartum client has mastitis? Select all that apply.
 
  1. Pain in the nipple during breastfeeding described as shooting
  2. Late onset of nipple pain
  3. Pink, flaking, pruritic skin of the affected nipple
  4. Nipple soreness when the infant latches on
  5. Breast engorgement prior to each feeding

[dpost18]

Answer to Question 1

4
Explanation:
1. Taking vital signs is important, but airway always comes first.
2. Once the airway is secure, securing an IV is vital.
3. A rapid neurologic assessment is appropriate once the airway is secure.
4. Airway is always the priority of care.

Answer to Question 2

1, 2
Explanation:
1. The pain associated with mastitis is described as shooting pain that occurs during breastfeeding.
2. Mastitis is characterized by late-onset nipple pain.
3. The skin of the affected breast, not nipple, becomes pink, flaking, and pruritic.
4. Nipple soreness often occurs if the infant is not latching onto the breast correctly. This is not a symptom associated with mastitis.
5. Breast engorgement prior to each feeding is not a clinical manifestation associated with mastitis.