A patient tells the nurse that he has a migraine headache which started about an hour ago. The nurse should administer the prescribed analgesic and
suggest the visitors stay a bit longer to provide support and distraction.
suggest the patient ambulates in the hallway to become fatigued, so they can rest.
turn the lights and television off except for a night light.
turn on the television to be used as a distractor for the patient.
The Correct Answer is C
A. Suggest the visitors stay a bit longer to provide support and distraction. – Noise and stimulation can worsen migraines.
B. Suggest the patient ambulates in the hallway to become fatigued, so they can rest. – Movement may increase pain.
C. Turn the lights and television off except for a night light. – Correct Answer. Migraines are worsened by light and noise, so a dark and quiet environment is best.
D. Turn on the television to be used as a distractor for the patient. – Bright lights and sound can aggravate symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Give the patient access to a video about diabetes. – Incorrect. Educational materials are helpful but should be provided after assessing the patient's current knowledge level.
B. Determine what the patient knows about managing diabetes. – Correct Answer. The first step in teaching is to assess the patient's baseline knowledge to tailor the education to their needs.
C. Establish short-term, realistic goals for the patient. – Incorrect. Goal-setting is important but should come after assessing the patient’s knowledge and readiness to learn.
D. Evaluate the effectiveness of the patient's admission teaching plan. – Incorrect. The nurse should first determine what new information needs to be taught before evaluating previous teaching.
Correct Answer is A
Explanation
A. Reflect on how she's feeling, and encourage her to express other fears that she has about his injury – Acknowledging emotions and encouraging open expression helps the mother process her grief and begin adjusting to the reality of the injury.
B. Explain that you aren't sure, but you will ask the physician to talk to her right away – Deferring to the physician misses an opportunity for emotional support.
C. Advise her that it isn’t in his best interest for her to be so upset, and explain the importance of moral support – This dismisses her emotions rather than addressing them.
D. Reassure her that given time and motivation he will return to normal function – Providing false reassurance is inappropriate, as a C5 spinal cord injury results in permanent loss of function.
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