A client with a history of migraines comes to a clinic with a throbbing headache. What Questions should the nurse include in the assessment?

“Have you experienced any nausea or vomiting with your headache?”

“Are the lights in here bothering you?”

“Have you noticed any confusion or clouded thinking?”

“Have you smelled anything unusual or are you currently smelling anything strange?”

“Did you feel weak before the headache started or are you feeling weak now?”

Answer and Explanation

The Correct Answer is A

Choice A rationale
Nausea and vomiting are common symptoms associated with migraines. Asking about these symptoms can help confirm a diagnosis of a migraine.
Choice B rationale
Sensitivity to light, also known as photophobia, is a common symptom of migraines. However, the question “Are the lights in here bothering you?” is less specific to migraines as it could be indicative of several other conditions as well.
Choice C rationale
While confusion or clouded thinking can occur with migraines, it is not as common as other symptoms such as nausea, vomiting, and sensitivity to light.
Choice D rationale
Unusual smells, known as olfactory hallucinations, are not typically associated with migraines. They are more commonly associated with conditions such as epilepsy.
Choice E rationale
Weakness before the headache started or currently feeling weak now is not a typical symptom of migraines. It could be indicative of a more serious condition, such as a stroke.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is A

Explanation

Choice A rationale
Rebleeding of the injury is a significant factor related to a high mortality rate for a client who has a subarachnoid hemorrhage (SAH). SAH is a devastating event with substantial mortality and high morbidity among survivors. The most common primary causes of death or neurological devastation leading to withdrawal of support are direct effects of the primary hemorrhage (55%) and aneurysm rebleeding (17%)2. Therefore, rebleeding of the injury is a critical concern in the management of SAH.
Choice B rationale
Decreased cerebrospinal fluid is not directly linked to a high mortality rate in SAH. While changes in cerebrospinal fluid dynamics can occur after SAH, it’s not typically a primary factor contributing to mortality.
Choice C rationale
The use of nimodipine is actually part of the treatment protocol for SAH. Nimodipine is a calcium channel blocker that is used to prevent cerebral vasospasm, a complication of SAH. It does not contribute to a higher mortality rate.
Choice D rationale
Poor functional ability could be a result of SAH due to neurological damage, but it is not a direct cause of high mortality. The severity of the initial hemorrhage and subsequent

complications like rebleeding or medical complications are more directly tied to mortality rates.

A. Reduce the temperature in the room. B. Hyperventilate the patient. C. Lower blood pressure. D. Decrease sedation.

Correct Answer is B

Explanation

Choice A rationale
Reducing the temperature in the room is not typically a treatment for brain herniation. While it’s important to maintain a comfortable environment for the patient, there’s no evidence to suggest that room temperature has a direct impact on the progression or treatment of brain herniation.
Choice B rationale

Hyperventilating the patient is a possible treatment for brain herniation. Hyperventilation causes vasoconstriction, which can decrease cerebral blood flow and intracranial pressure, potentially relieving the pressure caused by the herniation.
Choice C rationale
Lowering blood pressure is not typically a treatment for brain herniation. While maintaining a stable blood pressure is important in all patients, aggressively lowering blood pressure could potentially decrease cerebral perfusion and worsen the patient’s condition.
Choice D rationale
Decreasing sedation is not typically a treatment for brain herniation. In fact, sedatives might be used to reduce metabolic demands and control agitation in a patient with brain herniation.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A client with a history of migraines comes to a clinic with a throbbing headache. What Questions should the nurse include in the assessment?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is assisting with planning care for a client who has a subarachnoid hemorrhage (SAH). Which of the following relates to a high mortality rate for a client who has an SAH?

Correct Answer is A

Explanation

A nurse is teaching a group of nursing students about brain herniation. Which of the following interventions should the nurse include as a possible treatment for brain herniation?

Correct Answer is B

Explanation

A nurse is caring for a patient experiencing acute pain following a knee injury. The nurse is educating the patient about pain management strategies to use at home.Which of the following non-pharmacological methods of pain relief should the nurse include in their teaching?

A nurse is caring for a client who has a subarachnoid hemorrhage and asks why they are having a CT angiography. Which of the following should the nurse understand about CT angiography?

A nurse is caring for a client who has a traumatic brain injury (TBI). Which of the following should the nurse understand is a possible consequence of a TBI?

A nurse is educating a group of high school students about the damage caused by penetrating traumatic brain injuries. Which statement should the nurse include in the teaching?

A nurse is caring for a client who has increased intracranial pressure. Which of the following interventions should the nurse plan to include in the plan of care?

A nurse is caring for a patient who was involved in a motor vehicle accident.The patient is alert and oriented and reports a loss of consciousness immediately after the accident. Which of the following additional symptoms should the nurse assess the patient for? (Select All that Apply.)

A nurse is caring for a client who has degenerative disc disease. Which of the following assessment findings should the nurse understand might develop with this condition? (Select All that Apply)

A nurse is attending to a client with multiple sclerosis who reports a sensation of tightness around their torso. What condition should the nurse identify this symptom as indicating?