The nurse is planning care for a client experiencing headaches. Which of the following interventions should the nurse include in the client's plan of care? Select all that apply.

Provide a quiet, dark environment.

Apply heat to area for a migraine headache.

Administer prescribed analgesics.

Offer a massage for a tension headache.

Keep the head of the client's bed flat.

Offer prescribed antiemetic medication.

Answer and Explanation

Correct Answer : A,C,D,F

A. A quiet, dark environment is often helpful for clients with headaches, especially migraines. Bright lights and loud noises can exacerbate symptoms, so minimizing environmental stimuli can help the client rest and reduce discomfort.
B. Heat is typically not recommended for migraine headaches, as it can sometimes worsen the pain. For migraines, cold compresses or ice packs on the forehead may provide more relief. Heat is generally more effective for tension headaches or muscle-related pain.
C. Analgesics such as over-the-counter pain relievers (e.g., acetaminophen, ibuprofen) or prescribed medications can help manage headache pain and are often part of the treatment plan for headaches.
D. A gentle massage can help relieve the muscle tension that often contributes to tension headaches. Massaging the neck, shoulders, and scalp may help reduce headache symptoms.
E. Keeping the head of the bed flat is not generally recommended for headache relief. In fact, elevating the head of the bed slightly may help relieve pressure and improve comfort, especially in cases of sinus headaches or headaches related to congestion.
F. Many clients with headaches, especially migraines, may experience nausea or vomiting. Administering prescribed antiemetic medications can help alleviate these symptoms and improve the client’s comfort.

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Correct Answer is C

Explanation

A. Dextrose is used to treat hypoglycemia (low blood sugar), and there is no indication from the vital signs provided that the client is hypoglycemic.
B. Acetaminophen is an antipyretic (fever reducer), but the priority is not to treat the fever immediately in this case. The client's blood pressure and heart rate need to be addressed first.
C. Propranolol is a beta-blocker that can help reduce both heart rate and blood pressure. The client has severe hypertension (200/110) and tachycardia (heart rate of 160), which may indicate a hypertensive crisis or severe adrenergic overactivity. Propranolol can help lower the heart rate and blood pressure quickly, which is crucial to avoid further cardiovascular complications.
D. Potassium iodide is used in cases of thyroid storm or exposure to radioactive iodine. It is not appropriate for this situation, as the symptoms do not indicate a thyroid emergency or radiation exposure.

A. "You will immediately start thyroid replacement therapy after radioactive iodine treatment." B. "Your partner can feed breast milk to your baby if you pump it." C. "You can try to get pregnant 2 months after the treatment." D. "You need to avoid close contact with others until you the doctor determines you are no longer emitting radiation from your body."

Correct Answer is D

Explanation

A. While many patients who receive radioactive iodine treatment (RAI) for hyperthyroidism may require thyroid replacement therapy afterward, this is not always immediate. The body’s response to the treatment varies, and thyroid function will need to be monitored. The initiation of thyroid replacement therapy depends on the individual's thyroid levels after treatment.
B. Radioactive iodine is contraindicated during breastfeeding because the iodine can pass into the breast milk, potentially exposing the infant to radiation. Mothers are usually advised to stop breastfeeding and to pump and discard milk for a period after the treatment (usually several weeks).
C. The general recommendation is that women should wait at least 6 months after receiving radioactive iodine treatment before trying to become pregnant, as the radiation could potentially affect fetal development during the first few months following the treatment.
D. After receiving radioactive iodine treatment, patients should limit contact with others (especially pregnant women and young children) for a period of time to reduce the risk of radiation exposure to others. This period varies based on the dose of radioactive iodine used, but patients are typically advised to follow specific precautions until their radiation levels have decreased to a safe level.

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The nurse is planning care for a client experiencing headaches. Which of the following interventions should the nurse include in the client's plan of care? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

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