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Chapter 61: Nursing Management: Chronic Neurological ProblemsLewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. The nurse is teaching a client about management of migraine headaches. Which of the
following client statements indicates that the teaching has been effective?
a. “I will take the topiramate as soon as any headaches start.”
b. “I should avoid taking Aspirin and sumatriptan at the same time.”
c. “I will try to lie down someplace dark and quiet when the headaches begin.”
d. “A glass of wine might help me relax and prevent headaches from developing.”
ANS: C
It is recommended that the client with a migraine rest in a dark, quiet area. Topiramate is
used to prevent migraines and must be taken for several months to determine effectiveness.
Aspirin or other nonsteroidal anti-inflammatory medications can be taken with the triptans.
Alcohol may precipitate migraine headaches.
DIF: Cognitive Level: Application TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
2. Which of the following parameters should the nurse assess when caring for a client who is
experiencing a cluster headache?
a. Nuchal rigidity
b. Projectile vomiting
c. Unilateral eyelid swelling
d. Throbbing, bilateral facial pain
ANS: C
Unilateral eye edema, tearing, and ptosis are characteristic of cluster headaches. Nuchal
rigidity suggests meningeal irritation, such as occurs with meningitis. Although nausea
and vomiting may occur with migraine headaches, projectile vomiting is more consistent
with increases in intracranial pressure (ICP). Unilateral sharp, stabbing pain, rather than
throbbing pain, is characteristic of cluster headaches.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
3. A client has a tonic–clonic seizure while the nurse is in the client’s room. Which of the
following actions should the nurse take?
a. Insert an oral airway during the seizure to maintain a patent airway.
b. Restrain the client’s arms and legs to prevent injury during the seizure.
c. Avoid touching the client to prevent further nervous system stimulation.
d. Time and observe and record the details of the seizure and postictal state.
ANS: D
Because diagnosis and treatment of seizures frequently are based on the description of the
seizure, recording the length and details of the seizure is important. Insertion of an oral
airway and restraining the client during the seizure are contraindicated. The nurse may
need to move the client to decrease the risk of injury during the seizure.
, DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
4. An elementary teacher who has just been diagnosed with epilepsy after having a
generalized tonic–clonic seizure tells the nurse, “I cannot teach anymore, it will be too
upsetting if I have a seizure at work.” Which of the following responses by the nurse is
best?
a. “You may want to contact the Epilepsy Foundation for assistance.”
b. “You might benefit from some psychological counselling at this time.”
c. “The Department of Vocational Rehabilitation can help with work retraining.”
d. “Half of all clients with epilepsy are well controlled with antiseizure drugs.”
ANS: D
The nurse should inform the client that about 50% clients with seizure disorders are
controlled with medication and another 30% have a decrease in the intensity and
frequency of seizures. The other information may be necessary if the client seizures persist
after treatment with antiseizure drugs is implemented.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity
5. Which action will the nurse take when evaluating a client who is taking phenytoin for
adverse effects of the medication?
a. Inspect the oral mucosa.
b. Listen to the lung sounds.
c. Auscultate the bowel tones.
d. Check pupil reaction to light.
ANS: A
Phenytoin can cause gingival hyperplasia, but does not affect bowel tones, lung sounds, or
pupil reaction to light.
DIF: Cognitive Level: Application TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
6. A client found in a tonic–clonic seizure reports afterward that the seizure was preceded by
numbness and tingling of the arm. Which of the following types of seizures should the
nurse document based upon this finding?
a. Atonic
b. Partial
c. Absence
d. Myoclonic
ANS: B
The initial symptoms of a partial seizure involve clinical manifestations that are localized
to a particular part of the body or brain. Symptoms of an absence seizure are staring and a
brief loss of consciousness. In an atonic seizure, the client loses muscle tone and (typically)
falls to the ground. Myoclonic seizures are characterized by a sudden jerk of the body or
extremities.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment
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