A client who has a history of migraines reports to a clinic with a throbbing headache. Which of the following questions should the nurse include in the assessment?
(Select All that Apply.)

"Have you had any nausea and vomiting with your headache?"

"Are you bothered by the lights in here?"

"Have you noticed any confused or cloudy thinking?"

"Have you experienced or are you experiencing any strange smells?"

"Did you feel weak before the headache started or do you feel weak now?"

Answer and Explanation

Correct Answer : A,B,D

Choice A Reason:

"Have you had any nausea and vomiting with your headache?": This question is appropriate. Nausea and vomiting are common symptoms associated with migraines. Asking about these symptoms can help confirm the diagnosis of a migraine headache.

Choice B Reason:

"Are you bothered by the lights in here?" This question is appropriate. Sensitivity to light, known as photophobia, is a classic symptom of migraines. Inquiring about light sensitivity can provide additional evidence for the diagnosis.

Choice C Reason:

"Have you noticed any confused or cloudy thinking?". This question is inappropriate. Confusion or cognitive symptoms are not typical of migraines. However, some individuals may experience difficulty concentrating or cognitive symptoms during a migraine aura. This question may help assess for aura symptoms.

Choice D Reason
Have you experienced or are you experiencing any strange smells?" This question is appropriate. Some individuals may experience olfactory hallucinations or sensitivity to odors during a migraine aura. Asking about strange smells can help identify possible aura symptoms.

Choice E Reason:

"Did you feel weak before the headache started or do you feel weak now?" This question is inappropriate. While weakness is not a typical symptom of migraines, some individuals may experience fatigue or muscle weakness during a migraine attack. This question may help assess the overall impact of the headache on the client.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

Choice A Reason:

Pregabalin is incorrect. Pregabalin is a medication used to treat neuropathic pain, seizures, and generalized anxiety disorder. It is not associated with an increased risk of PML.

Choice B Reason:

Natalizumab is correct.: Natalizumab is a monoclonal antibody used to treat relapsing forms of MS. It is associated with an increased risk of developing PML, particularly in individuals who are JC virus antibody positive. Regular monitoring of JC virus antibody status and clinical vigilance is required when using natalizumab to reduce the risk of PML.

Choice C Reason:

Furosemide: Furosemide is a loop diuretic used to treat edema and hypertension. It is not associated with an increased risk of PML.

Choice D Reason:

Metoprolol is incorrect .Metoprolol is a beta-blocker used to treat hypertension, angina, and heart failure. It is not associated with an increased risk of PML.

A. Keep lights turned to medium level in the evening. B. Maintain the head of the bed between 30 and 45°. C. Administer hypotonic intravenous solutions. D. Reposition the client every shift.

Correct Answer is B

Explanation

Choice A Reason:

Keeping lights turned to medium level in the evening is incorrect. This intervention is aimed at reducing environmental stimuli, which may be appropriate for some patients with neurological conditions to minimize sensory overload and promote rest. However, it is not a specific intervention for preventing cerebral aneurysm rupture.

Choice B Reason:

Maintaining the head of the bed between 30 and 45° is correct. Keeping the head of the bed elevated can help reduce intracranial pressure and decrease the risk of cerebral aneurysm rupture or rebleeding in patients with aneurysmal subarachnoid hemorrhage. This position promotes venous drainage from the brain and helps prevent increases in intracranial pressure.

Choice C Reason:

Administering hypotonic intravenous solutions is incorrect. Hypotonic intravenous solutions have a lower osmolarity than blood plasma and can lead to cerebral edema, which may exacerbate intracranial pressure and increase the risk of cerebral aneurysm rupture. Isotonic solutions, such as normal saline (0.9% NaCl) or lactated Ringer's solution, are typically preferred for fluid resuscitation and maintenance in patients at risk of cerebral aneurysm rupture.

Choice D Reason:

Reposition the client every shift is incorrect. Repositioning the client every shift helps prevent complications associated with immobility, such as pressure ulcers, pneumonia, and venous thromboembolism. While important for overall patient care, repositioning alone does not directly address the risk of cerebral aneurysm rupture.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A client who has a history of migraines reports to a clinic with a throbbing headache. Which of the following questions should the nurse include in the assessment? (Select All that Apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has multiple sclerosis and is experiencing progressive multifocal leukoencephalopathy (PML). Which of the following medications should the nurse recognize is associated with the development of PML?

Correct Answer is B

Explanation

A nurse is providing care for a client who is at risk of cerebral aneurysm rupture. Which of the following interventions should the nurse include in the care plan?

Correct Answer is B

Explanation

A nurse is reviewing discharge medications with a client who has Parkinson's disease. The nurse should include teaching about the client's anticholinergic agent. Which of the following side effects should the nurse advise the client to report?

A nurse is discussing factors that can lead to obstructive sleep apnea with a group of older adults. Which of the following factors should the nurse include in the teaching? Select all that apply.Loss

A nurse is caring for a client who has multiple sclerosis. Which of the following factors should the nurse anticipate have been identified as contributing to the development of multiple sclerosis? (Select All that Apply.)

A nurse is teaching a group of student nurses about populations at higher risk for multiple sclerosis. Which of the following demographics should be included in the teaching? (Select All that Apply.)

A nurse is caring for a client with asthma. Which of the following happens physiologically when bronchospasm occurs?

A nurse is teaching a group of nursing students about spinal cord injuries in clients who are aged 65 years and older. Which of the following should the nurse identify as the most common cause of spinal cord injuries for this age group?

A nurse is caring for a client who has a spinal cord injury at the first thoracic level. Which of the following should the nurse recognize can trigger autonomic dysreflexia? (Select All that Apply.)

A nurse is assessing a client who has multiple sclerosis. The client reports that, since the onset of the disease, there are times when their symptoms are active and then followed by a period with no symptoms. Which of the following types of multiple sclerosis does this pattern indicate?

A client who has a history of migraines reports to a clinic with a throbbing headache. Which of the following questions should the nurse include in the assessment?
(Select All that Apply.)