A patient is being admitted to the unit with suspected herpes simplex virus encephalitis. What nursing action best addresses the patient’s complaints of headache?

Administering hydromorphone as needed

Distracting the patient with activity

Dimming the lights and reducing stimulation

Initiating a patient-controlled analgesia (PCA) of morphine sulfate .

Answer and Explanation

The Correct Answer is C

Choice C rationale
Dimming the lights and reducing stimulation can be an effective nursing intervention for a patient with herpes simplex virus encephalitis who is complaining of a headache. Bright lights and excessive noise can exacerbate headaches, so creating a quiet, dimly lit environment can help to alleviate this symptom.
Choice A rationale

While administering hydromorphone as needed can help to manage the patient’s pain, it does not directly address the patient’s complaint of a headache. Moreover, opioids like hydromorphone can have side effects such as drowsiness and constipation, which may not be desirable in a patient with encephalitis.
Choice B rationale
Distracting the patient with activity may not be appropriate for a patient with herpes simplex virus encephalitis who is complaining of a headache. Rest and quiet are often more beneficial for these patients.
Choice D rationale
Initiating a patient-controlled analgesia (PCA) of morphine sulfate can provide effective pain relief for some patients, but it may not be the best first-line approach for a patient with a headache due to herpes simplex virus encephalitis. Like hydromorphone, morphine can have side effects such as drowsiness and constipation.

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Free Nursing Study Resources

Correct Answer is ["56"]

Explanation

Step 1 is to calculate the total drops per hour. This is done by multiplying the total volume of the solution by the drop factor and then dividing by the total time in minutes. So, (1000 mL × 10 gtt/mL) ÷ 180 min = 55.56 gtt/min. The final calculated answer is approximately 56 gtt/min when rounded to the nearest whole number.

A. Prothrombin level B. Brain CT or MRI C. Chest x-ray D. Lumbar puncture

Correct Answer is B

Explanation

Choice A rationale

While prothrombin level is an important test in evaluating blood clotting disorders, it is not typically used in the initial diagnostic evaluations for a cerebrovascular accident (CVA) or stroke.
Choice B rationale
Brain CT or MRI scans are commonly used in the initial diagnostic evaluations for a CVA. These imaging tests can show bleeding in the brain, an ischemic stroke, a tumor, or other conditions.
Choice C rationale
A chest x-ray is not typically used in the initial diagnostic evaluations for a CVA. It is more commonly used to diagnose conditions affecting the lungs and heart.
Choice D rationale
A lumbar puncture, or spinal tap, may be used in some cases to help diagnose a CVA, but it is not typically part of the initial diagnostic evaluations.

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A patient is being admitted to the unit with suspected herpes simplex virus encephalitis. What nursing action best addresses the patient’s complaints of headache?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient with hypotension has an order for 1000 mL of 0.9% Normal Saline over 3 hours. The tubing drop factor is 10 gtt/mL. How many gtt/min should be given? (This is a med math nd does not require options)

Correct Answer is ["56"]

Explanation

A patient arrives in the emergency department exhibiting symptoms of a cerebrovascular accident (CVA). Which diagnostic evaluations would the nurse anticipate before treatment is initiated?

Correct Answer is B

Explanation

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