Nokea
The nurse is performing a medication reconciliation for a client taking prescribed phenytoin. Which medication should the nurse question with the physician while the client is taking phenytoin?
- A. Thiamine
- B. Prazosin
- C. Warfarin
- D. Acyclovir
Correct Answer: C
Rationale: Phenytoin induces liver enzymes, which can decrease warfarin's effectiveness, increasing the risk of clotting. Thiamine, prazosin, and acyclovir have no significant interactions with phenytoin.
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The nurse in the emergency department (ED) is caring for a 26-year-old female client.
Item 6 of 6
• History and Physical
1702: The client reports a headache that has persisted for 48 hours. She describes the pain as constant, throbbing, and behind her left eye. She states that in the past six months, these headaches have occurred two to three times a month. The client reports visual disturbances, including flashes of light and blurred vision, often precede headaches. During the headache episodes, she experiences nausea, photophobia, and phonophobia. She notes that stress, lack of sleep, and certain foods such as chocolate seem to trigger the headaches. Over-the-counter pain relievers provide minimal relief. Her spouse reports new symptoms, stating that she became confused earlier in the day, had difficulty speaking, and had right arm weakness, all of which resolved before she arrived at the ED. Medical history of generalized anxiety and panic disorder for which she takes escitalopram 20 mg p.o. daily and buspirone 15 mg p.o. daily. Family history of ischemic stroke, hypertension, and diabetes mellitus.
Physical Examination
Neurological exam: Steady gait and cranial nerves grossly intact. Phonophobia.
Pupils: 3 mm and brisk with some tearing in both eyes. Sensitive to pen light.
Head and neck examination: Denies sinus pain and full cervical range of motion.
Integumentary: Skin warm to touch and pale pink in tone.
Cardiovascular: Peripheral pulses 2+ and no peripheral edema.
Respiratory: Clear lung sounds bilaterally.
Gastrointestinal: Reports persistent nausea. Normoactive bowel sounds in all quadrants. No distention.
Psych: Anxious and in moderate distress. Cooperative.
Vital Signs: Blood pressure: 120/80 mmHg Heart rate: 72 bpm Respiratory rate: 16 Temperature: 98.6°F (37°C) Oxygen saturation: 98% on room air
• Diagnostics Test Results
Head Computed Tomography (CT) scan
1739: No acute intracranial hemorrhage, mass effect, or midline shift identified. The ventricles and sulci are within normal limits. No evidence of acute ischemic changes.
• Nurses' Notes
1741: Client placed back in room following emergent CT scan of the head. The client is alert, fully oriented, cooperative, and slightly anxious. Reports 'throbbing' headache rated 7/10 on the Numerical Rating Scale. Endorses photophobia, requesting lights to be turned off. Glasgow coma scale is 15. Clear lung sounds bilaterally. Peripheral pulses 2+. Reports persistent nausea. Full range of motion in all extremities. A 20-gauge peripheral vascular access device was started in the left antecubital space.
1850: Pain reassessed. Client reports pain 7/10 on the Numerical Rating Scale. Reports persistent nausea.
1852: Physician notified of the findings.
• Orders
1800:
• ketorolac 30 mg intravenous push x 1 dose
• 500 mL of 0.9% sodium chloride (normal saline) over one hour
1900:
• metoclopramide 10 mg intravenous push x 1 dose
• diphenhydramine 25 mg intravenous push x 1 dose
• sumatriptan 6 mg subcutaneous x1 dose
Six hours later, the client recovers and is discharged home. The nurse is teaching the client about newly prescribed intranasal sumatriptan. Which of the following statements by the client would indicate a correct understanding of the teaching? Select all that apply.
- A. I should use this medication as soon as I notice migraine symptoms beginning.
- B. If my migraine does not improve after two hours, I can take a second dose, but no more than 40 mg in 24 hours.
- C. I should avoid using this medication if I experience chest pain or pressure after taking it.
- D. I can use this medication daily to prevent migraines from occurring.
- E. If I experience tingling or flushing after taking this medication, I should go to the emergency room.
- F. I should watch for signs of serotonin syndrome, such as confusion and muscle stiffness.
Correct Answer: A,B,C
Rationale: Using sumatriptan at migraine onset, redosing after 2 hours (with a 40 mg daily limit for intranasal form), and avoiding use with chest pain (due to possible coronary vasospasm) are correct. Daily use is incorrect (sumatriptan is for acute treatment), tingling/flushing are common side effects, and serotonin syndrome is unlikely with sumatriptan alone.
The nurse is caring for a client diagnosed with Multiple Sclerosis (MS). The nurse should anticipate a prescription for which medication?
- A. Topiramate
- B. Risperidone
- C. Prazosin
- D. Baclofen
Correct Answer: D
Rationale: Baclofen is a muscle relaxant commonly prescribed for spasticity in Multiple Sclerosis. Topiramate is used for seizures or migraines, risperidone for psychiatric conditions, and prazosin for hypertension, none of which are primary treatments for MS.
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 primary healthcare provider (PHCP) is preparing to intubate a client. The PHCP prescribes succinylcholine. The nurse understands that this medication is intended to
- A. Sedate the client during the procedure
- B. Decrease oral and airway secretions
- C. Increase heart rate in case of a vagal response
- D. Cause skeletal muscle paralysis
Correct Answer: D
Rationale: Succinylcholine is a depolarizing neuromuscular blocker used to cause skeletal muscle paralysis, facilitating intubation. It does not sedate, reduce secretions, or increase heart rate.
The nurse is caring for a client with a spinal cord injury. Which actions should the nurse take if the client develops autonomic dysreflexia?
- A. Notify the rapid response team.
- B. Assess the client's bladder for distention.
- C. Place the client in a modified Trendelenburg position.
- D. Prepare the client for an emergency lumbar puncture (LP).
- E. Obtain and monitor the client's blood pressure.
- F. Obtain a prescription for a vasopressor.
Correct Answer: A,B,E
Rationale: Notifying RRT, assessing bladder distention, and monitoring blood pressure address autonomic dysreflexia.