Nokea
The nurse is assessing a patient at the health clinic who has a severe migraine headache and tells the nurse about having four similar headaches in the last 3 months. Which of the following actions should the nurse take initially?
- A. Refer the patient for stress counselling.
- B. Ask the patient to keep a headache diary.
- C. Suggest the use of muscle-relaxation techniques.
- D. Teach about the effectiveness of the triptan drugs.
Correct Answer: B
Rationale: The initial nursing action should be further assessment of the precipitating causes of the headaches, quality, and location of pain, etc. Stress reduction, muscle relaxation, and the triptan drugs may be helpful, but more assessment is needed first.
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A patient has a new prescription for bromocriptine mesylate to control symptoms of Parkinson's disease. Which of the following information obtained by the nurse may indicate a need for a decrease in the dose?
- A. The patient has a persistent dry cough.
- B. The patient has four loose stools in a day.
- C. The patient develops a deep vein thrombosis.
- D. The patient's blood pressure is 90/46 mm Hg.
Correct Answer: D
Rationale: Hypotension is an adverse effect of bromocriptine mesylate, and the nurse should check with the health care provider before giving the medication. Diarrhea, cough, and deep vein thrombosis are not associated with bromocriptine mesylate use.
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.
The nurse is caring for a patient with a history of cluster headache who awakens during the night with a severe stabbing headache. Which of the following actions should the nurse take first?
- A. Start the prescribed PRN oxygen at 8 L/minute.
- B. Put a moist hot pack on the patient's neck.
- C. Give the prescribed PRN acetaminophen.
- D. Notify the patient's health care provider immediately.
Correct Answer: A
Rationale: Acute treatment for cluster headache is administration of 100% oxygen at 8-12 L/min for 15 minutes. If the patient obtains relief with the oxygen, there is no immediate need to notify the health care provider. Cluster headaches last only 60-90 minutes, so oral pain medications have minimal effect. Hot packs are helpful for tension headaches but are not as likely to reduce pain associated with a cluster headache.
The nurse assesses a patient in the health clinic who has symptoms of a stooped posture, shuffling gait, and pill rolling-type tremor. Which of the following prescriptions would the nurse anticipate?
- A. Oral corticosteroids
- B. Antiparkinsonian drugs
- C. Electroencephalogram (EEG) testing
- D. Magnetic resonance imaging (MRI)
Correct Answer: B
Rationale: The diagnosis of Parkinson's is made when two of the three characteristic signs of tremor, rigidity, and bradykinesia are present. The confirmation of the diagnosis is made on the basis of improvement when antiparkinsonian drugs are administered. This patient has symptoms of tremor and bradykinesia; the next anticipated step will be treatment with medications. MRI and EEG are not useful in diagnosing Parkinson's disease, and corticosteroid therapy is not used to treat it.
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.