Nokea
The nurse is caring for a client with an acute migraine headache. Which medication would the nurse anticipate a prescription for an acute migraine? Select all that apply.
- A. Ketorolac
- B. Nitroglycerin
- C. Topiramate
- D. Dexamethasone
- E. Hydromorphone
- F. Acetaminophen-caffeine
Correct Answer: A,F
Rationale: Ketorolac (an NSAID) and acetaminophen-caffeine are used for acute migraine relief. Nitroglycerin can worsen migraines, topiramate is for prevention, dexamethasone is not standard, and hydromorphone is not typically used for migraines.
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The nurse is planning staff education about cerebral infarcts. The nurse knows which of the following options is the most appropriate treatment for clients with acute cerebellar infarction presenting within 4.5 hours of symptom onset?
- A. Thrombectomy
- B. Ventriculostomy
- C. Decompressive suboccipital craniotomy
- D. Thrombolysis with recombinant tissue plasminogen activator (rtPA)
Correct Answer: D
Rationale: Thrombolysis with rtPA is the standard treatment for acute ischemic stroke within 4.5 hours.
The nurse is assessing a client who is suspected of having myasthenia gravis. Which of the following would be an expected finding?
- A. Diplopia
- B. Butterfly rash
- C. Facial muscle weakness
- D. Shuffling gait
- E. Ptosis
Correct Answer: A,C,E
Rationale: Diplopia, facial muscle weakness, and ptosis are common in myasthenia gravis due to neuromuscular junction dysfunction.
The nurse gives discharge instructions to a client who sustained a brain injury from a motor vehicle accident. His wife is concerned regarding her husband having seizures at home. Which statement from the wife indicates that she understood the nurse's teaching?
- A. I will make sure that my husband does not wet himself.'
- B. I will clear all furniture that might injure him when he has a seizure.'
- C. I will call 911 once he has a seizure lasting about 3 minutes.'
- D. I will ensure he sleeps well after a seizure.'
Correct Answer: B
Rationale: Clearing furniture prevents injury during seizures, indicating understanding of safety measures.
The nurse is caring for a client who was prescribed lamotrigine. The nurse understands that this medication is intended to treat
- A. Acute spinal shock
- B. Epilepsy
- C. Parkinson's disease
- D. Multiple sclerosis
Correct Answer: B
Rationale: Lamotrigine is an anticonvulsant primarily used to treat epilepsy. It is not indicated for spinal shock, Parkinson's disease, or multiple sclerosis.
The nurse is discussing biological clocks with another nurse. What term is used to describe a human's innate biological clock relating to daytime and nighttime wakefulness and activity?
- A. REM sleep
- B. Circadian rhythm
- C. Diurnal rhythm
- D. Nocturnal activity
Correct Answer: B
Rationale: Circadian rhythm refers to the body's 24-hour cycle regulating sleep and wakefulness.