lewis: hedache seizures Flashcards
- The nurse determines that teaching about management of migraine headaches has been effective when the patient says which of the following?
a.
“I can take the (Topamax) as soon as a headache starts.”
b.
“A glass of wine might help me relax and prevent a headache.”
c.
“I will lie down someplace dark and quiet when the headaches begin.”
d.
“I should avoid taking aspirin and sumatriptan (Imitrex) at the same time.”
ANS: C
It is recommended that the patient with a migraine rest in a dark, quiet area. Topiramate (Topamax) is used to prevent migraines and must be taken for several months to determine effectiveness. Aspirin or other nonsteroidal antiinflammatory medications can be taken with the triptans. Alcohol may precipitate migraine headaches.
- The nurse will assess a 67-year-old patient who is experiencing a cluster headache for
a.
nuchal rigidity.
b.
unilateral ptosis.
c.
projectile vomiting.
d.
throbbing, bilateral facial pain.
ANS: B
Unilateral eye edema, tearing, and ptosis are characteristic of cluster headaches. Nuchal rigidity suggests meningeal irritation, such as occurs with meningitis. Although nausea and vomiting may occur with migraine headaches, projectile vomiting is more consistent with increased intracranial pressure (ICP). Unilateral sharp, stabbing pain, rather than throbbing pain, is characteristic of cluster headaches.
- While the nurse is transporting a patient on a stretcher to the radiology department, the patient begins having a tonic-clonic seizure. Which action 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.
Time and observe and record the details of the seizure and postictal state.
d.
Avoid touching the patient to prevent further nervous system stimulation.
ANS: C
Because the 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.
- A high school teacher who has just been diagnosed with epilepsy after having a generalized tonic-clonic seizure tells the nurse, “I cannot teach anymore, it will be too upsetting if I have a seizure at work.” Which response by the nurse is best?
a.
“You might benefit from some psychologic counseling.”
b.
“Epilepsy usually can be well controlled with medications.”
c.
“You will want to contact the Epilepsy Foundation for assistance.”
d.
“The Department of Vocational Rehabilitation can help with work retraining.”
ANS: B
The nurse should inform the patient that most patients with seizure disorders are controlled with medication. The other information may be necessary if the seizures persist after treatment with antiseizure medications is implemented.
- A patient has been taking phenytoin (Dilantin) for 2 years. Which action will the nurse take when evaluating 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.
ANS: A
Phenytoin can cause gingival hyperplasia, but does not affect bowel tones, lung sounds, or pupil reaction to light.
. A patient reports feeling numbness and tingling of the left arm before experiencing a tonic-clonic seizure. The nurse determines that this history is consistent with what type of seizure?
a.
Focal
b.
Atonic
c.
Absence
d.
Myoclonic
ANS: A
The initial symptoms of a focal seizure involve clinical manifestations that are localized to a particular part of the body or brain. Symptoms of an absence seizure are staring and a brief loss of consciousness. In an atonic seizure, the patient loses muscle tone and (typically) falls to the ground. Myoclonic seizures are characterized by a sudden jerk of the body or extremities.
- A 73-year-old patient with Parkinson’s disease has a nursing diagnosis of impaired physical mobility related to bradykinesia. Which action will the nurse include in the plan of care?
a.
Instruct the patient in activities that can be done while lying or sitting.
b.
Suggest that the patient rock from side to side to initiate leg movement.
c.
Have the patient take small steps in a straight line directly in front of the feet.
d.
Teach the patient to keep the feet in contact with the floor and slide them forward.
ANS: B
Rocking the body from side to side stimulates balance and improves mobility. The patient will be encouraged to continue exercising because this will maintain functional abilities. Maintaining a wide base of support will help with balance. The patient should lift the feet and avoid a shuffling gait.
- A 62-year-old patient who has Parkinson’s disease is taking bromocriptine (Parlodel). Which information obtained by the nurse may indicate a need for a decrease in the dose?
a.
The patient has a chronic 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 92/52 mm Hg.
ANS: D
Hypotension is an adverse effect of bromocriptine, 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 use.
- The nurse advises a patient with myasthenia gravis (MG) to
a.
perform physically demanding activities early in the day.
b.
anticipate the need for weekly plasmapheresis treatments.
c.
do frequent weight-bearing exercise to prevent muscle atrophy.
d.
protect the extremities from injury due to poor sensory perception.
ANS: A
Muscles are generally strongest in the morning, and activities involving muscle activity should be scheduled then. Plasmapheresis is not routinely scheduled, but is used for myasthenia crisis or for situations in which corticosteroid therapy must be avoided. There is no decrease in sensation with MG, and muscle atrophy does not occur because although there is muscle weakness, they are still used.
- When a 74-year-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rolling–type tremor, the nurse will anticipate teaching the patient about
a.
oral corticosteroids.
b.
antiparkinsonian drugs.
c.
magnetic resonance imaging (MRI).
d.
electroencephalogram (EEG) testing.
ANS: B
The diagnosis of Parkinson’s is made when two of the three characteristic manifestations 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.
- A 22-year-old patient seen at the health clinic with a severe migraine headache tells the nurse about having other similar headaches recently. Which initial action should the nurse take?
a.
Teach about the use of triptan drugs.
b.
Refer the patient for stress counseling.
c.
Ask the patient to keep a headache diary.
d.
Suggest the use of muscle-relaxation techniques.
ANS: C
The initial nursing action should be further assessment of the precipitating causes of the headaches, quality, and location of pain, etc. Stress reduction, muscle relaxation, and the triptan drugs may be helpful, but more assessment is needed first.
- A hospitalized patient complains of a bilateral headache, 4/10 on the pain scale, that radiates from the base of the skull. Which prescribed PRN medications should the nurse administer initially?
a.
Lorazepam (Ativan)
b.
Acetaminophen (Tylenol)
c.
Morphine sulfate (Roxanol)
d.
Butalbital and aspirin (Fiorinal)
ANS: B
The patient’s symptoms are consistent with a tension headache, and initial therapy usually involves a nonopioid analgesic such as acetaminophen, which is sometimes combined with a sedative or muscle relaxant. Lorazepam may be used in conjunction with acetaminophen but would not be appropriate as the initial monotherapy. Morphine sulfate and butalbital and aspirin would be more appropriate for a headache that did not respond to a nonopioid analgesic.
A 46-year-old patient tells the nurse about using acetaminophen (Tylenol) several times every day for recurrent bilateral headaches. Which action will the nurse plan to take first?
a.
Discuss the need to stop taking the acetaminophen.
b.
Suggest the use of biofeedback for headache control.
c.
Describe the use of botulism toxin (Botox) for headaches.
d.
Teach the patient about magnetic resonance imaging (MRI).
ANS: A
The headache description suggests that the patient is experiencing medication overuse headache. The initial action will be withdrawal of the medication. The other actions may be needed if the headaches persist.
- The health care provider is considering the use of sumatriptan (Imitrex) for a 54-year-old male patient with migraine headaches. Which information obtained by the nurse is most important to report to the health care provider?
a.
The patient drinks 1 to 2 cups of coffee daily.
b.
The patient had a recent acute myocardial infarction.
c.
The patient has had migraine headaches for 30 years.
d.
The patient has taken topiramate (Topamax) for 2 months.
ANS: B
The triptans cause coronary artery vasoconstriction and should be avoided in patients with coronary artery disease. The other information will be reported to the health care provider, but none of it indicates that sumatriptan would be an inappropriate treatment.
- The nurse observes a patient ambulating in the hospital hall when the patient’s arms and legs suddenly jerk and the patient falls to the floor. The nurse will first
a.
assess the patient for a possible head injury.
b.
give the scheduled dose of divalproex (Depakote).
c.
document the timing and description of the seizure.
d.
notify the patient’s health care provider about the seizure.
ANS: A
The patient who has had a myoclonic seizure and fall is at risk for head injury and should first be evaluated and treated for this possible complication. Documentation of the seizure, notification of the seizure, and administration of antiseizure medications are also appropriate actions, but the initial action should be assessment for injury.
