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An elementary teacher who has just been diagnosed with epilepsy after having a generalized tonic-clonic seizure tells the nurse, 'I cannot teach anymore, it will be too upsetting if I have a seizure at work.' Which of the following responses by the nurse is best?
- A. You may want to contact the Epilepsy Foundation for assistance.
- B. You might benefit from some psychological counseling at this time.
- C. The Department of Vocational Rehabilitation can help with work retraining.
- D. Half of all patients with epilepsy are well controlled with antiseizure drugs.
Correct Answer: D
Rationale: The nurse should inform the patient that about 50% patients with seizure disorders are controlled with medication and another 30% have a decrease in the intensity and frequency of seizures. The other information may be necessary if the patient seizures persist after treatment with antiseizure drugs is implemented.
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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 health care provider is considering the use of sumatriptan for a patient with migraine headaches. Which of the following information obtained by the nurse is most important to report to the health care provider?
- A. The patient has at least 1-2 cups of coffee daily.
- B. The patient has had migraine headaches for 30 years.
- C. The patient has a history of a recent acute myocardial infarction.
- D. The patient has been taking topiramate for 2 months.
Correct Answer: C
Rationale: The triptans cause coronary artery vasoconstriction and should be avoided in patients with coronary artery disease. The other information will be reported to the health care provider, but none of it is an indication that sumatriptan would be an inappropriate treatment.
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.
A female patient who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which of the following responses by the nurse is accurate?
- A. MS symptoms may be worse after the pregnancy.
- B. Women with MS frequently have premature labour.
- C. Symptoms of MS are likely to become worse during pregnancy.
- D. MS is associated with a slightly increased risk for congenital defects.
Correct Answer: A
Rationale: During the postpartum period, women with MS are at greater risk for exacerbation of symptoms. There is no increased risk for congenital defects in infants born of mothers with MS. Symptoms of MS may improve during pregnancy. Onset of labour is not affected by MS.
The nurse is teaching a patient about management of migraine headaches. Which of the following patient statements indicates that the teaching has been effective?
- A. I will take the topiramate as soon as any headaches start.
- B. I should avoid taking Aspirin and sumatriptan at the same time.
- C. I will try to lie down in a dark and quiet area when the headaches begin.
- D. A glass of wine might help me relax and prevent headaches from developing.
Correct Answer: C
Rationale: It is recommended that the patient with a migraine rest in a dark, quiet area. Topiramate is used to prevent migraines and must be taken for several months to determine effectiveness. Aspirin or other nonsteroidal anti-inflammatory medications can be taken with the triptans. Alcohol may precipitate migraine headaches.