NCLEX-RN
NCLEX RN Questions on Neurological Disorders Questions
Extract:
The nurse in the emergency department (ED) is caring for a 26-year-old female client.
Item 6 of 6
• History and Physical
1702: The client reports a headache that has persisted for 48 hours. She describes the pain as constant, throbbing, and behind her left eye. She states that in the past six months, these headaches have occurred two to three times a month. The client reports visual disturbances, including flashes of light and blurred vision, often precede headaches. During the headache episodes, she experiences nausea, photophobia, and phonophobia. She notes that stress, lack of sleep, and certain foods such as chocolate seem to trigger the headaches. Over-the-counter pain relievers provide minimal relief. Her spouse reports new symptoms, stating that she became confused earlier in the day, had difficulty speaking, and had right arm weakness, all of which resolved before she arrived at the ED. Medical history of generalized anxiety and panic disorder for which she takes escitalopram 20 mg p.o. daily and buspirone 15 mg p.o. daily. Family history of ischemic stroke, hypertension, and diabetes mellitus.
Physical Examination
Neurological exam: Steady gait and cranial nerves grossly intact. Phonophobia.
Pupils: 3 mm and brisk with some tearing in both eyes. Sensitive to pen light.
Head and neck examination: Denies sinus pain and full cervical range of motion.
Integumentary: Skin warm to touch and pale pink in tone.
Cardiovascular: Peripheral pulses 2+ and no peripheral edema.
Respiratory: Clear lung sounds bilaterally.
Gastrointestinal: Reports persistent nausea. Normoactive bowel sounds in all quadrants. No distention.
Psych: Anxious and in moderate distress. Cooperative.
Vital Signs: Blood pressure: 120/80 mmHg Heart rate: 72 bpm Respiratory rate: 16 Temperature: 98.6°F (37°C) Oxygen saturation: 98% on room air
• Diagnostics Test Results
Head Computed Tomography (CT) scan
1739: No acute intracranial hemorrhage, mass effect, or midline shift identified. The ventricles and sulci are within normal limits. No evidence of acute ischemic changes.
• Nurses' Notes
1741: Client placed back in room following emergent CT scan of the head. The client is alert, fully oriented, cooperative, and slightly anxious. Reports 'throbbing' headache rated 7/10 on the Numerical Rating Scale. Endorses photophobia, requesting lights to be turned off. Glasgow coma scale is 15. Clear lung sounds bilaterally. Peripheral pulses 2+. Reports persistent nausea. Full range of motion in all extremities. A 20-gauge peripheral vascular access device was started in the left antecubital space.
1850: Pain reassessed. Client reports pain 7/10 on the Numerical Rating Scale. Reports persistent nausea.
1852: Physician notified of the findings.
• Orders
1800:
• ketorolac 30 mg intravenous push x 1 dose
• 500 mL of 0.9% sodium chloride (normal saline) over one hour
1900:
• metoclopramide 10 mg intravenous push x 1 dose
• diphenhydramine 25 mg intravenous push x 1 dose
• sumatriptan 6 mg subcutaneous x1 dose
Question 1 of 5
Six hours later, the client recovers and is discharged home. The nurse is teaching the client about newly prescribed intranasal sumatriptan. Which of the following statements by the client would indicate a correct understanding of the teaching? Select all that apply.
Correct Answer: A,B,C
Rationale: Using sumatriptan at migraine onset, redosing after 2 hours (with a 40 mg daily limit for intranasal form), and avoiding use with chest pain (due to possible coronary vasospasm) are correct. Daily use is incorrect (sumatriptan is for acute treatment), tingling/flushing are common side effects, and serotonin syndrome is unlikely with sumatriptan alone.
Extract:
Question 2 of 5
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Question 3 of 5
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Question 4 of 5
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Question 5 of 5
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