A 29-year-old man complains of recurrent severe headaches that usually occur in the early morning. Sometimes he is awakened by the headache "like an alarm clock." The pain comes on quickly, within 5-10 minutes, and it lasts 30 to 60 minutes. He describes the pain as excruciating and stabbing. The pain begins at his left nostril and is followed by severe retro-orbital pain. He experiences tearing and nasal stuffiness on the left side of his face. The patient thinks the headaches started when he was given a promotion at work 3 months ago and his stress levels increased. Which of the following is the best course of treatment?
Selective serotonin reuptake inhibitors
Diazepam (Valium)
Sumatriptan (Imitrex)
Naproxen (Anaprox)
The Correct Answer is C
Choice A reason: SSRIs are not indicated for cluster headaches. These medications are primarily used to treat depression and anxiety and have minimal effect on the pathophysiology of cluster headaches.
Choice B reason: Diazepam, a benzodiazepine, may help with anxiety or insomnia but is not effective in aborting or preventing cluster headaches.
Choice C reason: This is the correct answer. Cluster headaches are severe, unilateral, stabbing headaches often associated with autonomic symptoms like tearing and nasal congestion. Sumatriptan, a selective serotonin 5-HT1B/1D receptor agonist, is the treatment of choice for acute attacks due to its rapid onset and ability to alleviate pain.
Choice D reason: Naproxen, an NSAID, may be effective for tension-type headaches or migraine prophylaxis but is ineffective for acute cluster headache attacks due to the extreme severity and rapid onset of pain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Temporary tic disorder involves motor or vocal tics lasting less than 12 months. This patient’s symptoms have persisted for 6 months and include both motor and vocal tics, making a simple temporary tic diagnosis less appropriate.
Choice B reason: This is the correct answer. Tourette's disorder requires both multiple motor tics and at least one vocal tic, present for more than 1 year, starting before age 18. The boy’s presentation of motor and vocal tics over a 6-month period suggests early diagnosis of Tourette’s disorder if symptoms continue beyond a year.
Choice C reason: Persistent (chronic) vocal tic disorder involves only vocal tics for more than 1 year, not combined motor and vocal tics.
Choice D reason: Provisional tic disorder is diagnosed when tics are present for less than 1 year. Since the boy has both motor and vocal tics and duration may approach 6–12 months, this may be considered but does not fully explain the combination of tics if they persist beyond a year.
Correct Answer is B
Explanation
Choice A reason: Alprazolam is a short-acting benzodiazepine that carries high risk for dependence. Using it as monotherapy without long-term management is not recommended.
Choice B reason: This is the correct answer. SSRIs are first-line long-term treatment for generalized anxiety disorder, and low-dose benzodiazepines such as clonazepam can be used short-term for rapid symptom relief during initiation of SSRIs. This approach balances immediate relief with safe long-term management.
Choice C reason: While starting an SSRI alone is reasonable, it may not provide immediate symptom relief, which the patient is requesting. Short-term adjunctive therapy is often needed initially.
Choice D reason: Psychotherapy alone is effective but does not meet the patient’s request for rapid symptom control. Combining therapy with pharmacologic treatment is more appropriate in this scenario.
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