Safety and Infection Control Practice Question

Question

The nurse is caring for a postoperative client and is focused on seizure precautions scenario 4. Which nursing action is most appropriate?

Answer choices

  1. A. Delay assessment until the next scheduled round if the client is not calling for help.
  2. B. Delegate the clinical assessment and nursing judgment to assistive personnel.
  3. C. Pad side rails when needed, protect from injury, and maintain airway safety.
  4. D. Document the concern without notifying the appropriate provider or care team member when escalation is needed.

Correct Answer

C. Pad side rails when needed, protect from injury, and maintain airway safety.

Explanation

The priority action for seizure precautions is to pad side rails when needed, protect from injury, and maintain airway safety. NCLEX-style prioritization favors safety, assessment, appropriate delegation, timely escalation, and client-centered teaching.

Question details

  • Difficulty: medium
  • Domain: Safety and Infection Control
  • Objective: seizure precautions

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