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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.
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The nurse is caring for a patient with multiple sclerosis (MS) who has urinary retention caused by a flaccid bladder. Which of the following actions should the nurse plan to take?
- A. Teach the patient how to perform self-catheterization
- B. Decrease the patient's fluid intake in the evening
- C. Suggest the use of incontinence briefs for nighttime use only
- D. Assist the patient to the commode every 2 hours during the day.
Correct Answer: A
Rationale: Bladder control is a major problem for many patients with MS. Although anticholinergics may be beneficial for some patients to decrease spasticity, other patients may need to be taught self-catheterization. Decreasing fluid intake will not improve bladder emptying and may increase risk for urinary tract infection (UTI) and dehydration. The use of incontinence briefs and frequent toileting will not improve bladder emptying.
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.
Which of the following prescribed interventions will the nurse implement first for a hospitalized patient who is experiencing continuous tonic-clonic seizures?
- A. Give phenytoin 100 mg IV.
- B. Monitor level of consciousness.
- C. Obtain computed tomography scan.
- D. Administer lorazepam 4 mg IV.
Correct Answer: D
Rationale: To prevent ongoing seizures, the nurse should administer rapidly acting antiseizure drugs such as the benzodiazepines. A CT scan is appropriate, but prevention of any seizure activity during the CT scan is necessary. Phenytoin also will be administered, but it is not rapidly acting. Patients who are experiencing tonic-clonic seizures are nonresponsive, although the nurse should assess LOC after the seizure.
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.
A patient has a tonic-clonic seizure while the nurse is in the patient's room. Which of the following actions should the nurse take?
- A. Insert an oral airway during the seizure to maintain a patent airway.
- B. Restrain the patient's arms and legs to prevent injury during the seizure.
- C. Avoid touching the patient to prevent further nervous system stimulation.
- D. Time and observe and record the details of the seizure and postictal state.
Correct Answer: D
Rationale: Because diagnosis and treatment of seizures frequently are based on the description of the seizure, recording the length and details of the seizure is important. Insertion of an oral airway and restraining the patient during the seizure are contraindicated. The nurse may need to move the patient to decrease the risk of injury during the seizure.