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The nurse is performing medication reconciliation for a client with Parkinson's disease. Which medication should the nurse question with the primary healthcare provider (PHCP)?
- A. Haloperidol
- B. Levodopa-carbidopa
- C. Pramipexole
- D. Ropinirole
Correct Answer: A
Rationale: Haloperidol is a typical antipsychotic that blocks dopamine receptors, which can worsen Parkinson's disease symptoms by counteracting the dopamine-enhancing effects of medications like levodopa-carbidopa, pramipexole, and ropinirole, which are used to manage Parkinson's disease.
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The nurse has administered the first dose of prescribed rivastigmine to a client with Alzheimer's disease. Which clinical data is necessary to monitor while this client takes this medication?
- A. Glucose
- B. Weight
- C. Creatinine
- D. Hemoglobin and hematocrit
Correct Answer: B
Rationale: Rivastigmine, a cholinesterase inhibitor, can cause gastrointestinal side effects such as nausea, vomiting, and weight loss. Monitoring weight is essential to assess for significant weight loss, which can impact the client's health. Glucose, creatinine, and hemoglobin/hematocrit are not typically affected by rivastigmine.
The nurse is caring for a client who sustained a cervical spinal cord injury. Which priority vital sign should the nurse obtain?
- A. Respiratory rate
- B. Blood Pressure
- C. Pulse
- D. Temperature
Correct Answer: A
Rationale: Cervical spinal cord injury can impair respiratory function, making respiratory rate the priority.
The emergency department (ED) nurse cares for a client with a suspected cerebrovascular accident (CVA). Which actions should the nurse take?
- A. Perform a Glasgow coma scale (GCS)
- B. Assess the client's capillary blood glucose (CBG)
- C. Prepare the client for an immediate computed tomography (CT) scan of the brain
- D. Insert a nasogastric tube (NGT)
- E. Determine the onset of the symptoms or the last known well (LKW)
Correct Answer: A,B,C,E
Rationale: GCS, CBG, CT scan, and determining symptom onset are critical for stroke assessment and management.
The nurse in the emergency department (ED) is caring for a 26-year-old female client.
Item 2 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
The nurse recognizes that which of the following conditions may feature photophobia? Select all that apply.
- A. Migraine headache
- B. Guillain-Barré syndrome
- C. Meningitis
- D. Delirium
- E. Alzheimer's disease
- F. Parkinson's disease
Correct Answer: A,C
Rationale: Photophobia is a common symptom in migraine headaches and meningitis due to neurological sensitivity and inflammation, respectively. Guillain-Barré syndrome, delirium, Alzheimer's, and Parkinson's do not typically cause photophobia.
The nurse is performing a follow-up assessment on a client who was prescribed carbidopa/levodopa. Which assessment finding would indicate a therapeutic finding from this medication?
- A. Decrease in tremors
- B. Improvement in the excessive drooling
- C. Reduction in seizure activity
- D. Improvement in muscle spasticity
Correct Answer: A
Rationale: Carbidopa/levodopa is used for Parkinson's disease, and a decrease in tremors indicates therapeutic efficacy.