Correct Answer: A

Rationale: The correct answer is A: Administer antiepileptic drugs. This is the most important nursing action for a client with a history of seizures because antiepileptic drugs help prevent or reduce the frequency and severity of seizures. By ensuring the client receives their prescribed medication, the nurse can help manage the condition effectively. Placing the client on their side (
B) is important to prevent aspiration if a seizure occurs, but administering antiepileptic drugs is more crucial for long-term management. Checking the airway (
C) is important during and after a seizure but does not address the underlying cause. Monitoring for hypoglycemia (
D) is important as a potential trigger for seizures, but administering antiepileptic drugs takes precedence in managing the condition.

Correct Answer: A

Rationale: The correct answer is A: Administer oxygen. In hypovolemic shock, the body lacks adequate circulating blood volume leading to decreased tissue perfusion and oxygen delivery. Administering oxygen helps increase oxygen saturation levels and improve tissue oxygenation. This is the priority nursing action to ensure the client's vital organs receive sufficient oxygen. Administering pain relief (
B) may be necessary but is not the priority in hypovolemic shock. Administering beta blockers (
C) can further decrease blood pressure and worsen the condition. Monitoring for bleeding (
D) is important, but administering oxygen takes precedence to address the immediate oxygenation needs of the client.

Correct Answer: D

Rationale: The correct answer is D: Administer diuretics. The priority for a nurse caring for a client with pneumonia is to maintain adequate oxygenation and prevent respiratory failure. Diuretics help reduce fluid overload in the lungs, improving gas exchange and oxygenation. Administering antibiotics (choice
A) is important to treat the infection but not the top priority. Administering oxygen (choice
B) is crucial for oxygenation, but diuretics take precedence to improve lung function. Administering corticosteroids (choice
C) may be considered in certain cases to reduce inflammation, but it is not the primary priority.

Correct Answer: D

Rationale: The correct answer is D because when a client experiences an allergic reaction to a medication, the nurse should monitor for signs of infection as allergic reactions can sometimes lead to secondary infections. By closely monitoring the client for signs of infection, the nurse can promptly intervene and provide appropriate treatment.

A: Discontinuing the medication is important but not the immediate priority when dealing with an allergic reaction.
B: Notifying the healthcare provider is important, but monitoring for signs of infection takes precedence in this situation.
C: Administering antihistamines may help with allergic symptoms but does not address the potential risk of secondary infection.

Correct Answer: D

Rationale: In emergency situations, time is crucial. Emergency assessment is the most appropriate as it focuses on quickly identifying and addressing life-threatening issues. It involves a rapid but systematic evaluation of the patient's airway, breathing, circulation, and disability. Head-to-toe assessment (
A) and comprehensive assessment (
C) are too time-consuming in emergencies, whereas focused assessment (
B) may not cover all critical aspects.