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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.
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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.
Which action will the nurse take when evaluating a patient who is taking phenytoin for adverse effects of the medication?
- A. Inspect the oral mucosa.
- B. Listen to the lung sounds.
- C. Auscultate the bowel tones.
- D. Check pupil reaction to light.
Correct Answer: A
Rationale: Phenytoin can cause gingival hyperplasia, but does not affect bowel tones, lung sounds, or pupil reaction to light.
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.
The nurse is caring for a patient with Parkinson's disease who is admitted to the hospital for treatment of an acute infection. Which of the following nursing interventions will be included in the plan of care? (Select all that apply.)
- A. Use an elevated toilet seat.
- B. Cut patient's food into small pieces.
- C. Provide high protein foods at each meal.
- D. Place an arm chair at the patient's bedside.
- E. Observe for sudden exacerbation of symptoms.
Correct Answer: A,B,D
Rationale: Since the patient with Parkinson's has difficulty chewing, food should be cut into small pieces. An armchair should be used when the patient is seated so that the patient can use the arms to assist with getting up from the chair. An elevated toilet seat will facilitate getting on and off the toilet. High protein foods will decrease the effectiveness of L-dopa. Parkinson's is a steadily progressive disease without acute exacerbations.
Which of the following information about a patient who is being treated with carbidopa/levodopa for Parkinson's disease is most important for the nurse to report to the health care provider?
- A. Shuffling gait
- B. Tremor at rest
- C. Cogwheel rigidity of limbs
- D. Uncontrolled head movement
Correct Answer: D
Rationale: Dyskinesia is an adverse effect of the carbidopa/levodopa, indicating a need for a change in medication or decrease in dose. The other findings are typical with Parkinson's disease.