The nurse receives an order for a triptan for a patient diagnosed with a cluster headache.
What drug should be indicated for this purpose?

Choice A rationale

Myasthenia gravis is an autoimmune neuromuscular disorder characterized by weakness and fatigue of the skeletal muscles. Improvement of ptosis after administration of edrophonium (Tensilon), a short-acting acetylcholinesterase inhibitor, is a diagnostic indicator of myasthenia gravis.

Choice B rationale

Cerebral palsy is a group of permanent movement disorders that appear in early childhood. It is primarily caused by abnormal development or damage to the brain and does not exhibit rapid improvement with edrophonium.

Choice C rationale

Multiple sclerosis is a chronic illness involving the central nervous system, where the immune system attacks the protective sheath (myelin) that covers nerve fibers. It does not respond to edrophonium as myasthenia gravis does.

Choice D rationale

Muscle spasm refers to an involuntary contraction of a muscle that can be sudden and painful. This condition is not typically diagnosed or treated with edrophonium, which is specific for myasthenia gravis. .

Choice A rationale

Administering a non-steroidal anti-inflammatory drug (NSAID) is not a priority action for a patient who has received a narcotic analgesic. The priority should be to ensure the patient’s safety and prevent falls, which can occur due to the sedative effects of narcotics.

Choice B rationale

Putting side rails up and placing the bed in the lowest position is essential for patient safety. Narcotics can cause dizziness, drowsiness, and impaired coordination, increasing the risk of falls. Ensuring the bed is in the lowest position and side rails are up helps prevent injury if the patient tries to get up.

Choice C rationale

Encouraging fluids is beneficial for many patients, but it is not the priority action when a patient has received a narcotic analgesic. Hydration is important but secondary to ensuring the patient’s immediate safety.

Choice D rationale

Creating a restful, dark environment may help the patient rest, but it does not directly address the immediate safety needs of a patient who has received a narcotic analgesic. The focus should be on preventing falls and injury.