Correct Answer: A

Rationale: Absence seizures are brief, sudden lapses of consciousness that usually last a few seconds. They are more common in children than in adults.
Choice B is wrong because absence seizures typically last less than 15 seconds, not 30 to 60 seconds.
Choice C is wrong because absence seizures have a sudden onset, not a gradual one.
Choice D is wrong because absence seizures do not have an aura prior to onset. An aura is a warning sign that some people experience before a seizure, such as a strange feeling, smell, or vision.

Correct Answer: C

Rationale: Discussing with the client his inappropriate behavior prior to seclusion is important, but it's not the most appropriate action. The priority is to ensure the safety of the client and others, which can be achieved by documenting the client's behavior prior to seclusion. Offering fluids every 2 hours is a good practice to keep the client hydrated, especially if they are agitated or physically active. However, this is not the most appropriate action in this context. Documenting the client's behavior prior to being placed in seclusion is the most appropriate action. This documentation is crucial for legal and ethical reasons, and it helps in evaluating the effectiveness of the intervention. Assessing the client's behavior once every hour is important to monitor the client's condition and response to seclusion. However, this is not the most appropriate action in this context.

Correct Answer: A

Rationale: An elevated antinuclear antibody (AN
A) titer is a hallmark finding in systemic lupus erythematosus, present in over 95% of clients, indicating autoimmune activity.
Choice B is incorrect because the erythrocyte sedimentation rate (ESR) is typically elevated in SLE due to inflammation, not decreased.
Choice C is incorrect because complement levels (C3, C4) are often decreased in SLE due to immune complex formation, not normal.
Choice D is incorrect because rheumatoid factor may be positive in some SLE clients, but it is not specific to SLE and is more associated with rheumatoid arthritis.

Correct Answer: B

Rationale: Hypocalcemia is a potential complication after thyroidectomy due to accidental removal or damage to the parathyroid glands, which regulate calcium; symptoms like tetany or numbness should be monitored.
Choice A is incorrect because tachycardia is not a primary postoperative complication; it may occur with pain or hyperthyroidism but is less specific.
Choice C is incorrect because a fever of 37.5°C is not significant and may be a normal postoperative response, not a complication unless persistent.
Choice D is incorrect because increased appetite is not a typical postoperative complication; hypothyroidism may cause decreased appetite.

Correct Answer: A

Rationale: Maintaining the head of the bed at a 30-degree angle promotes venous drainage from the brain, reducing intracranial pressure in clients with traumatic brain injury.
Choice B is incorrect because suctioning the endotracheal tube every 2 hours is not routine; it should be done only as needed to avoid hypoxia and ICP spikes.
Choice C is incorrect because, while mannitol is used to reduce ICP, its administration is a medical order, not a nursing action, and requires monitoring for side effects.
Choice D is incorrect because hyperventilation is no longer recommended, as it can cause cerebral vasoconstriction, reducing blood flow and worsening brain injury.