The nurse will assess a 67-year-old patient who is experiencing a cluster headache for
a. nuchal rigidity.
b. unilateral ptosis.
c. projectile vomiting.
d. throbbing, bilateral facial pain.
ANS: B
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 increased intracranial pressure (ICP). Unilateral sharp, stabbing pain, rather than throbbing pain, is characteristic of cluster headaches.
You might also like to view...
A patient with a long-standing diagnosis of asthma is prescribed a beta-blocker for the treatment of angina. The nurse should consequently prioritize assessment for what health problem?
A) Bronchospasm B) Hyperglycemia C) Pleural effusion D) Pneumonia
A nurse counsels a couple who have concerns about a sex-linked disorder. Both parents are carriers of the disorder. They ask the nurse how this disorder will affect any children they might have. What is the nurse's best response?
1. "If you have a daughter, she will not be affected." 2. "If you have a son, he will not be affected." 3. "There is a 25% chance that a daughter will have the disorder." 4. "There is a 50% chance that a son will be a carrier."
The medical treatment for a hypoglycemic reaction is administration of 45 g of simple carbohydrate as soon as possible
Indicate whether the statement is true or false
A mother is concerned because the grandparents believe she is spoiling the child by her attentiveness. The nurse explains:
a. The mother should let the baby cry for a while before picking him or her up b. She cannot spoil her infant by responding to its needs c. The baby should only be given affection as a reward d. She should follow the advice of the grandparents