Nokea
A patient tells the nurse about using acetaminophen several times every day for recurrent bilateral headaches. Which of the following actions should the nurse take first?
- A. Discuss the need to stop taking the acetaminophen.
- B. Suggest the use of biofeedback for headache control.
- C. Teach the patient about magnetic resonance imaging (MRI).
- D. Describe the use of botulism toxin (BOTOX) for headaches.
Correct Answer: A
Rationale: The headache description suggests that the patient is experiencing medication overuse headache. The initial action will be withdrawal of the medication. The other actions may be needed if headaches persist.
You may also like to solve these questions
The nurse is caring for a patient with multiple sclerosis (MS) who has urinary retention caused by a flaccid bladder. Which of the following actions should the nurse plan to take?
- A. Teach the patient how to perform self-catheterization
- B. Decrease the patient's fluid intake in the evening
- C. Suggest the use of incontinence briefs for nighttime use only
- D. Assist the patient to the commode every 2 hours during the day.
Correct Answer: A
Rationale: Bladder control is a major problem for many patients with MS. Although anticholinergics may be beneficial for some patients to decrease spasticity, other patients may need to be taught self-catheterization. Decreasing fluid intake will not improve bladder emptying and may increase risk for urinary tract infection (UTI) and dehydration. The use of incontinence briefs and frequent toileting will not improve bladder emptying.
The nurse is caring for a patient with epilepsy. Which of the following laboratory results should the nurse expect?
- A. Increased blood glucose
- B. Decreased BUN
- C. Increased creatinine
- D. Decreased liver function tests
Correct Answer: C
Rationale: The blood work results of a patient with epilepsy would show an increased creatinine level. The other results that would be expected are a decreased blood glucose level, increased BUN, and increased liver function tests.
The nurse is caring for a patient with Parkinson's disease who has decreased tongue mobility and an inability to move the facial muscles. Which of the following nursing diagnoses is of highest priority?
- A. Activity intolerance related to immobility
- B. Toileting self-care deficit related to impaired mobility
- C. Ineffective health management related to difficulty managing complex treatment regimen
- D. Imbalanced nutrition: less than body requirements related to insufficient dietary intake
Correct Answer: D
Rationale: The data about the patient indicate that poor nutrition will be a concern because of decreased swallowing. The other diagnoses also may be appropriate for a patient with Parkinson's disease, but the data do not indicate they are current problems for this patient.
The nurse is caring for a hospitalized patient who has a moderate bilateral headache that radiates from the base of the skull. Which of the following prescribed PRN medications should the nurse administer initially?
- A. Lorazepam
- B. Acetaminophen
- C. Morphine sulphate
- D. Butalbital and Aspirin
Correct Answer: B
Rationale: The patient's symptoms are consistent with a tension headache, and initial therapy usually involves a nonopioid analgesic such as acetaminophen, sometimes combined with a sedative or muscle relaxant. Lorazepam may be used in conjunction with acetaminophen but would not be appropriate as the initial monotherapy. Morphine sulphate or butalbital and Aspirin would be more appropriate for a headache that did not respond to a nonopioid analgesic.
The partner of a patient with Parkinson's disease (PD) is upset and asks the nurse why he is no longer able to read the affectionate notes that the patient writes for him. Which of the following information is the basis for the nurse's response?
- A. Characteristic slow speech makes it difficult for the patient with PD to put his or her thoughts on paper.
- B. Cogwheel rigidity makes it hard for the patient to hold a pen.
- C. Micrographia is common in patients with PD.
- D. Depression often seen in PD leads to denying affectionate feelings.
Correct Answer: C
Rationale: The best answer is that the nurse's response will be based upon the fact that micrographia is handwriting deterioration and often occurs in patients with Parkinson's disease. PD patients have characteristic slow speech but that does not cause illegible writing. Cogwheel rigidity makes it difficult to walk and balance. Although depression is common in PD, this does not directly lead to denying affectionate feelings.