A client reports having a headache. The nurse performs a specialized focused assessment and notes the following: client rates pain 10 on a scale of 1 to 10 (10 being the worst), nauseated and vomited, reporting sensitivity to noise and light. The nurse determines that the client is most likely experiencing which of the following types of headache?

Tension headache

Migraine headache

Cluster headache

Sinus headache

Answer and Explanation

The Correct Answer is B

A) Tension headache: Tension headaches are typically characterized by a dull, aching pain that feels like a tight band around the head. They are often associated with muscle tension and stress, and they generally do not involve nausea, vomiting, or sensitivity to light and sound, which are more indicative of migraines.
B) Migraine headache: The symptoms described—severe pain rated 10 out of 10, nausea, vomiting, and sensitivity to light (photophobia) and sound (phonophobia)—are classic signs of a migraine headache. Migraines are often intense and can be accompanied by these additional symptoms, making this the most likely diagnosis.
C) Cluster headache: Cluster headaches are extremely painful and typically occur in cyclical patterns or clusters. They are often unilateral (one-sided) and can cause severe pain, redness of the eye, and nasal congestion. While they can be very painful, they are less commonly associated with nausea, vomiting, and sensitivity to light and sound as described in the scenario.
D) Sinus headache: Sinus headaches are associated with sinusitis and typically involve pain and pressure in the forehead, cheeks, or nose area, often accompanied by nasal congestion. They usually do not present with the intensity of pain, nausea, vomiting, and sensitivity to light and sound seen in migraines.

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Correct Answer is C

Explanation

A) Menorrhagia: This term refers to heavy or prolonged menstrual bleeding. It does not relate to the absence of menstrual flow.
B) Dysmenorrhea: This term describes painful menstruation or menstrual cramps. It is not used to indicate the absence of menstrual flow.
C) Amenorrhea: This term is used to describe the absence of menstrual flow. It can be primary (never having had a menstrual period) or secondary (the cessation of menstruation after having had periods previously).
D) Metrorrhagia: This term refers to bleeding that occurs between menstrual periods. It does not describe the absence of menstrual flow.

A. Diabetic Neuropathy B. Chronic Arterial insufficiency C. Lymphedema D. Chronic Venous Insufficiency

Correct Answer is A

Explanation

A) Diabetic Neuropathy: Diabetic neuropathy is a common complication of diabetes that affects the nerves, particularly in the extremities. Symptoms include decreased sensation, numbness, and the development of non-healing ulcers on the feet due to loss of protective sensation and poor wound healing. This condition aligns with the patient's symptoms of decreased sensation and non-healing foot ulcers.
B) Chronic Arterial Insufficiency: Chronic arterial insufficiency typically presents with symptoms such as intermittent claudication (pain or cramping in the legs during activity), cold or pale extremities, and ulcers on the toes or feet that often have a more well-defined border. The non-healing ulcers and decreased sensation described are more characteristic of diabetic neuropathy than arterial insufficiency.
C) Lymphedema: Lymphedema is characterized by swelling due to lymph fluid accumulation, often affecting the lower extremities. While it can cause skin changes and ulcers, it is less commonly associated with decreased sensation and is more likely to present with swelling and skin changes rather than the specific combination of symptoms described.
D) Chronic Venous Insufficiency: Chronic venous insufficiency involves issues with blood return from the legs to the heart, leading to symptoms such as swelling, varicose veins, and ulcers typically around the ankles. It is usually associated with aching, heaviness, and swelling rather than the decreased sensation and non-healing ulcers seen in diabetic neuropathy.

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Naxlex Comprehensive Predictor Exams

A nurse is collecting assessment data on a new client. The client states she does not have a menses. What term will the nurse use in her documentation to describe the absence of menstrual flow?

Correct Answer is C

Explanation

A nurse is assessing a patient that presents with a chief complaint of decreased sensation in the feet and non-healing ulcers on the soles of his foot. The picture below shows the patient's foot. What is likely causing the patient's symptoms?

Correct Answer is A

Explanation

A patient came with a right ear sensorineural hearing loss. What should the nurse expect while performing the Weber test?

A nurse is developing a plan of care for a client who has COPD. The nurse should include which of the following interventions in the plan?

The nurse uses deep palpation of the abdomen to assess the client for presence of an abdominal mass. The client grimaces and grips the hand rails of the bed. Which response by the nurse is best?

Which cranial nerves are involved in eye movements? Select all that apply.

A nurse is performing a cardiac assessment. Identify where the nurse should place the stethoscope to auscultate the client's apical pulse. (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)

The nurse is planning to inspect a client's apical heart impulses. What should the nurse do to ensure an accurate assessment of this organ?

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During an abdominal examination, the nurse palpates a bulging area in the Right Lower Quadrant of a female patient. The nurse suspects that this mass could be associated with which of the following organs? (Select all that apply.)