A client comes in with complaints of a headache. The client states, "I always wake up with a headache in the morning, but it gets better in a couple hours. I notice that it always gets worse if I cough or sneeze." What action by the nurse is most appropriate?

Administer morphine 10 mg IV every 4 hours for the pain.

Palpate the occipital lymph nodes.

Assess the client's neurological status.

Explain that migraine headaches can last a long time.

Answer and Explanation

The Correct Answer is C

Choice A reason: Morphine treats severe pain but isn’t first-line for headaches worsened by coughing, which may signal increased intracranial pressure. Without neurological assessment, this risks masking symptoms of serious conditions like brain tumors, delaying critical diagnosis and intervention.

Choice B reason: Palpating occipital lymph nodes checks for infection or inflammation, but headaches worsened by coughing or sneezing suggest intracranial issues, not lymphatic ones. This action misses the priority of assessing brain function tied to the client’s specific symptom pattern.

Choice C reason: Neurological assessment, like checking reflexes or pupil response, is vital for morning headaches worsening with coughing, hinting at possible intracranial pressure from masses or bleeds. It’s the most direct step to rule out life-threatening causes promptly.

Choice D reason: Explaining migraines assumes a diagnosis without evidence. Morning headaches improving later, worsened by strain, don’t align with typical migraine patterns, risking misdiagnosis of serious conditions like sinus thrombosis, necessitating neurological evaluation over premature reassurance.

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Correct Answer is C

Explanation

Choice A reason: Ischemic stroke causes focal deficits like weakness, not neck flexion-induced leg pain. This vascular event lacks meningeal irritation signs, misaligning with the positive Brudzinski’s sign of knee bending and neck pain in this assessment fully here.
Choice B reason: Trigeminal neuralgia triggers facial pain, not leg or neck pain with flexion. This cranial nerve V issue doesn’t involve meningeal inflammation, excluding it from the systemic response seen in this neck maneuver entirely and accurately here.
Choice C reason: Meningitis causes meningeal irritation; neck flexion (Brudzinski’s sign) elicits leg pain and knee bending. Neck pain aligns with inflammation, making this the likely diagnosis for the client’s response to this specific neurological test comprehensively here.
Choice D reason: Bell’s palsy affects cranial nerve VII, causing facial paralysis, not leg or neck pain. This peripheral nerve issue lacks the meningeal signs triggered by neck flexion, ruling it out as the cause in this scenario fully here.

A. Thin, gray-white vaginal discharge B. Difficulty with urination C. Irregular bleeding with vaginal dryness D. Painless lumps in the vaginal area

Correct Answer is C

Explanation

Choice A reason: Thin, gray-white discharge suggests infection like bacterial vaginosis, not menopause. Menopause features dryness, not discharge, making this unrelated to hormonal decline, excluding it as a trigger for menopause education in this case fully here.
Choice B reason: Urinary difficulty may relate to aging or prolapse, not directly menopause. While estrogen loss can affect the urethra, it’s less specific than vaginal symptoms, rendering it secondary for menopause-focused education entirely and accurately here.
Choice C reason: Irregular bleeding and vaginal dryness are hallmark menopause signs, from estrogen drop. Perimenopause causes erratic periods, and dryness reflects atrophy, making this the key finding for targeted menopause education comprehensively and accurately here.
Choice D reason: Painless vaginal lumps suggest cysts or tumors, not menopause. These structural issues lack hormonal ties to estrogen decline, excluding them as menopause indicators needing education compared to bleeding and dryness fully here entirely.

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A client comes in with complaints of a headache. The client states, "I always wake up with a headache in the morning, but it gets better in a couple hours. I notice that it always gets worse if I cough or sneeze." What action by the nurse is most appropriate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse has placed her hands behind the client's head and flexed his neck forward as far as he can tolerate. During the test the client experiences leg pain and bends his knees. In addition, he complains of neck pain. This assessment finding is suggestive of what health problem?

Correct Answer is C

Explanation

A nurse is providing a subjective data assessment for an older female. The client verbalizes a list of symptoms regarding their concern. Which findings would lead the nurse to supply education about menopause?

Correct Answer is C

Explanation

A nurse is integrating health promotion education into the assessment of a client's mouth, nose and throat. What interview question is most likely to identify a risk factor for oral cancer?

The nurse's auscultation of a client's lung fields reveals the presence of a wheeze. The nurse should recognize that this adventitious sound results from what pathophysiologic process in the lungs?

A client is admitted to the emergency room with a head injury. The client denies a previous history of seizures or head injury. What would the nurse most likely find when assessing a client diagnosed with a frontal lobe contusion following a motor vehicle accident?

The nurse is performing a peripheral vascular assessment of an adult client. The nurse is palpating the client's peripheral pulses but knows that some are not palpable, even in healthy clients. What pulse is not palpable in a large proportion of healthy clients?

A health promotion teaching is focusing on hygiene and the prevention of illness. When instructing clients on how to clean their ears, what action should the nurse recommend?

A nurse is caring for a client who has presbycusis. Which of the following actions should the nurse take?

The nurse is testing for motor functioning by having the client lie down and slide the heel of the right foot down the left shin and then slide the heel of the left foot down the right shin. Which response by the patient would indicate that there may be cerebellar dysfunction?