Which assessment question will the nurse practitioner ask a patient with a history of migraines currently prescribed oral sumatriptan (Imitrex) for treatment?

Correct Answer: A

Rationale: The correct answer is A: "Does this medication provide relief of migraine symptoms?" This question directly assesses the effectiveness of sumatriptan in treating migraines, which is crucial for evaluating the medication's efficacy. Asking about symptom relief is essential in determining if the medication is working as intended. Choices B, C, and D are incorrect because they do not directly assess the primary purpose of sumatriptan, which is to provide relief from migraine symptoms. B focuses on sleep improvement, C on anxiety reduction, and D on migraine prevention, none of which are the primary goal of sumatriptan therapy. To ensure optimal care, the focus should be on assessing the medication's effectiveness in managing the migraines.

Correct Answer: B

Rationale: The correct answer is B: Relaxation. For a patient with somatic symptom disorder, relaxation techniques can help reduce anxiety and physical symptoms associated with the disorder. Relaxation promotes a sense of calm, reduces stress, and can improve coping skills. Flooding (A) involves exposing a patient to a feared stimulus in a sudden and intense manner, which can exacerbate symptoms in somatic symptom disorder. Response prevention (C) is used in treating obsessive-compulsive disorder, not somatic symptom disorder. Systematic desensitization (D) is a technique used for phobias, not somatic symptom disorder.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Take the patient's vital signs. Delegating the task of taking vital signs to the nursing assistant is appropriate as it is a non-invasive procedure that does not require advanced medical knowledge. Vital signs are essential parameters to monitor the patient's condition post-seizure, helping to assess stability or potential complications. Option A, documenting the seizure, requires a higher level of critical thinking and understanding of medical terminology, making it inappropriate for delegation to a nursing assistant. Option B, performing neurologic checks, involves assessing complex neurological functions that require specialized training and knowledge, making it unsuitable for delegation. Option D, restraining the patient for protection, should never be delegated to a nursing assistant as it involves physical restraint, which is a high-risk intervention requiring specialized training to ensure patient safety and prevent harm. From an educational standpoint, understanding the rationale behind delegation in such situations is crucial for nurses to provide safe and effective care. Delegation is a key skill in nursing practice, but it must be done thoughtfully, considering the complexity of tasks, individual competency levels, and patient safety. Nurses must be able to differentiate between tasks that can be delegated and those that require their direct involvement to ensure the best outcomes for patients.

Correct Answer: B

Rationale: The best first action in this scenario is to select option B: Notify the physician immediately. This choice is correct because the patient with myasthenia gravis (MG) is displaying signs of a myasthenic crisis, a life-threatening condition that requires urgent medical attention. The combination of an elevated temperature, increased heart rate, elevated blood pressure, and incontinence suggests a crisis situation in a patient with MG. Notifying the physician promptly is crucial to initiate appropriate interventions and prevent further deterioration. Option A, administering an acetaminophen suppository, is incorrect as it does not address the underlying cause of the symptoms and delays necessary medical intervention. Option C, rechecking vital signs in 1 hour, is also incorrect because the patient's condition requires immediate attention due to the severity of symptoms. Option D, rescheduling the patient's physical therapy, is inappropriate and does not address the urgent medical needs of the patient in crisis. Educationally, this scenario highlights the importance of recognizing acute changes in a patient's condition and the critical role of prompt communication with healthcare providers in ensuring patient safety and optimal outcomes. Nurses must be vigilant in monitoring patients with MG for signs of myasthenic crisis and act swiftly to prevent serious complications.

Correct Answer: C

Rationale: The correct answer to the question is option C, the 46-year-old patient admitted 48 hours ago with bacterial meningitis and has an antibiotic dose due. This patient is the best choice for the RN from the medical unit because bacterial meningitis requires close monitoring, timely administration of antibiotics, and ongoing assessment for any changes in neurological status. The RN from the medical unit would likely have more experience and comfort managing infectious conditions and administering antibiotics compared to the other neurologically complex cases presented in the question. Option A, the 26-year-old patient with a basilar skull fracture and clear drainage coming out of the nose, requires specialized neurologic care due to the risk of cerebrospinal fluid leak and potential complications. Option B, the 42-year-old patient with a ruptured berry aneurysm, also needs specialized care in a neuro ICU setting for monitoring and potential interventions related to the aneurysm. Option D, the 65-year-old patient with an astrocytoma who just had a craniotomy, requires specialized neurosurgical care and monitoring postoperatively. Providing this educational context helps students understand the importance of matching the complexity and acuity of patients with the appropriate level of nursing expertise to ensure safe and effective care delivery, especially in critical care settings like the neurologic ICU.