Chap 61 - Neurological Probs

Question 1

A 20-year-old woman is seen at the health clinic with a severe migraine headache. The headaches began 3 months ago, and she has had four headaches since that time. During assessment, the patient tells the nurse she is afraid to make social plans because she never knows when she will be incapacitated with the pain. What is the most appropriate nursing intervention in response to the patient’s comments?

a. Refer the patient for counselling to assist her with conflict resolution and stress reduction.
b. Suggest that the patient keep a diary of headache episodes to identify precipitating factors.
c. Encourage the patient to learn the holistic techniques of meditation and biofeedback to minimize the pain.
d. Reassure the patient that the headaches are not serious and the pain can be controlled with a variety of drugs.

Answer 1

ANS: B
The initial nursing action should be further assessment of the precipitating causes of the headaches, quality and location of pain, and so on, which can be accomplished by the patient keeping a diary of the headache episodes.

Question 2

When teaching a patient about management of her migraine headaches, the nurse determines that teaching has been effective when the patient gives which of the following responses?

a. “I will take the topiramate as soon as any headaches start.”
b. “The sumatriptan will help increase the blood flow to my brain.”
c. “I will try to lie down someplace dark and quiet when the headaches begin.”
d. “A glass of wine might help me relax and prevent headaches from developing.”

Answer 2

ANS: C

It is recommended that the patient with a migraine rest in a dimly lit, quiet area.

Question 3

What is the most important nursing tool in diagnosing a cluster headache?

a. Magnetic resonance imaging (MRI) of the brain
b. Electromyography
c. The patient history
d. Computed tomography (CT) imaging of the brain

Answer 3

ANS: C
Diagnosis of cluster headache is made primarily on the basis of the patient’s symptoms; therefore, a thorough patient history is required.

Question 4

A patient with a headache describes it as affecting both sides of his head with a moderate intensity that becomes worse when he is physically active. The nurse knows that the patient’s clinical manifestations are characteristic of which of the following disorders?

a. Cluster headaches
b. Migraine headaches
c. Tension-type headaches
d. Headaches associated with trigeminal neuralgia

Answer 4

ANS: C
The International Headache Society (2004) classification system defines tension-type headache as involving at least two of the following characteristics: pressure or tightness sensation, mild to moderate severity, bilateral location, or worsening with physical activity.