Neuro: Lewis: Nursing AND Exam Questions
and Answers
Index
Topiramate: Slides 2-6
Sumatriptan and other HA meds: Slides 7-10
Headaches: Slides 11-18
MS: Slides 19-32
Parkinson's: Slides 33-69
MG: 70-89
ALS: 90-99
Huntington's: 100-111
GBS: 112-136
TB: 137-176
Bacterial and final lung infections: 177 - ✅✅
Teaching: Topiramate (Topamax) is an anticonvulsant medication typically given orally. It blocks
neuronal excitability by increasing GABA activity and inhibiting glutamate activity. It typically takes 2-3
months to work. It can cause kidney stones, so instruct the patient to increase water intake. Teach the
patient to never stop taking the medication abruptly because it can cause seizures. Another term for
kidney stones stuck in the kidney is nephrolithiasis. This medication can also cause mild cognitive
impairment. - ✅✅Memory trick: "To Pee Rocks, mate!" (Causes kidney stones)
"A Pirate at sea for 2-3 months out on the open water." (Takes 2-3 months to work, and increase water
intake.)
"Pirate? Tom? What?" (Causes cognitive impairment.)
1. What kind of medication is topiramate?
a. Anticonvulsant
b. Analgesic
c. NSAID
,d. Antibiotic - ✅✅Anticonvulsant
2. What is topiramate better known as?
a.Topamax
b.Celebrex
c.Aleve
d.Clavamox - ✅✅a.Topamax
3. How long does Topiramate take to start working?
a. 1-2 months
b. 4-5 months
c. 8-12 weeks
c. 2 weeks - ✅✅c. 8-12 weeks (2-3 months)
A common complication when taking Topiramate is?
a. stroke
b. seizures
c. migraines
d. nephrolithiasis - ✅✅d. nephrolithiasis
Teaching: Sumatriptan (Imitrex) is a selective serotonin receptor agonist used to treat migraines. It
belongs to a class known as "Triptans." This medication can cause tremors. We cannot give Sumatriptan
to patients with cardiopulmonary issues, like CAD, because this medication narrows the blood vessels,
and the combination of vessels narrowing and excessive plague can lead to occlusion of blood to major
organs, body parts, or the brain. Patients with these conditions should avoid sumatriptan: High blood
pressure, Heart disease, High cholesterol, Bad pain in the chest, problems with the liver, Diabetes,
Stroke. - ✅✅Remember the T in Sumatriptan, it causes your blood vessels to "Trip" out: Treats
migraines but causes Tight blood vessels and Tremors.
The nurse knows that which following conditions are contraindicated for a Sumatriptan subscription?
Select all that apply.
,a. Peripheral artery disease.
b. cerebrovascular disease.
c. uncontrolled hypertension.
d. Alcoholic fatty liver disease.
d. history of transient ischemic attack and stroke - ✅✅All answers are correct.
Teaching: other medications to treat headaches or migraines include NSAIDS, Beta-blockers, and muscle
relaxers. NSAIDS should not be taken long term because they increase the risk of GI bleeding. Beta-
blockers work by causing the heart to beat slowly and with less force. Muscle relaxers like Baclofen and
Zanaflex work by relaxing the fine muscles of the head and face, thus reducing tension associated
headaches. - ✅✅
The nurse knows that which of the following medications may be prescribed to treat migraines? Select
all that apply.
a. Metoprolol
b. Aspirin
c. Zanaflex
d. Topiramate
e. Sumatriptan
f. acetaminophen - ✅✅a, b, c, d, e.
Acetaminophen doesn't have anti-inflammatory properties, so it isn't very good at treating migraines.
Teaching: Nursing management of HA. The goal is to reduce pain, identify triggers, and find coping
strategies to manage pain. We need a detailed history from the patient to identify pain and find proper
coping strategies. Relaxation teaching, meditation, yoga, massage, and moist hot packs are effective
interventions. We also need to teach the patient to identify triggers like smoking, perfumes, gasoline
fumes, and to limit environmental stimuli. - ✅✅Keep going!
1. After teaching a patient about management of migraine headaches, the nurse determines that the
teaching has been effective when the patient says,
a. "I will take the (Topamax) as soon as any headaches start."
b. "I should avoid taking aspirin and sumatriptan (Imitrex) at the same time."
, c. "I will try to lie down someplace dark and quiet when the headaches begin."
d. "A glass of wine might help me relax and prevent headaches from developing." - ✅✅ANS: C. It is
recommended that the patient with a migraine rest in a dark, quiet area. Topiramate (Topamax) is used
to prevent migraines and must be taken for several months to determine effectiveness. Aspirin or other
nonsteroidal anti-inflammatory medications can be taken with the triptans. Alcohol may precipitate
migraine headaches.
Teaching: Primary headaches are the most common type, which include migraines, tension headaches,
and cluster headaches; primary causes span a wide variety. Secondary headaches are caused by another
problem such as caffeine withdrawal, hunger, or high altitude. The most important part of diagnosis of
headaches is a full neuro exam and patient history. However, many tests may be ordered for further
evaluation. Flip the card to see the other tests. - ✅✅Palpation of the head, auscultation for bruit over
the major carotid, CBC, chem panel, urinalysis, angiography, EMG EEG, MRA, MRI, LP.
Teaching: The four major types of headaches we should know are Sinus, Cluster, Tension, and Migraine.
Sinus: pain is behind browbone and/or cheekbones. Cluster: pain is in and around one eye: can cause
pain-related insomnia, pallor, restlessness, and cheek/gum/forehead, nose pain. Tension: pain is like a
band squeezing the head: constant pain. Migraine: pain, nausea, and visual changes are typical of the
classical form: food cravings and feelings of limb movement are also associated with migraines. Flip the
card to see a link for a visual. - ✅✅https://www.medicalnewstoday.com/articles/headache-
chart#overview
2. When a patient is experiencing a cluster headache, the nurse will plan to assess for
a. nuchal rigidity.
b. projectile vomiting.
c. unilateral eyelid swelling.
d. throbbing, bilateral facial pain. - ✅✅.ANS: C. Unilateral eye edema, tearing, and ptosis are
characteristic of cluster headaches. Nuchal rigidity suggests meningeal irritation, such as occurs with
meningitis. Although nausea and vomiting may occur with migraine headaches, projectile vomiting is
more consistent with increases in intracranial pressure (ICP). Unilateral sharp, stabbing pain, rather than
throbbing pain, is characteristic of cluster headaches.
A patient reports a headache to the nurse. After reviewing the patient's history, the nurse finds that the
patient has previously had a stroke. Which drug should be excluded from the patient's treatment
regimen?
a. Fluoxetine
and Answers
Index
Topiramate: Slides 2-6
Sumatriptan and other HA meds: Slides 7-10
Headaches: Slides 11-18
MS: Slides 19-32
Parkinson's: Slides 33-69
MG: 70-89
ALS: 90-99
Huntington's: 100-111
GBS: 112-136
TB: 137-176
Bacterial and final lung infections: 177 - ✅✅
Teaching: Topiramate (Topamax) is an anticonvulsant medication typically given orally. It blocks
neuronal excitability by increasing GABA activity and inhibiting glutamate activity. It typically takes 2-3
months to work. It can cause kidney stones, so instruct the patient to increase water intake. Teach the
patient to never stop taking the medication abruptly because it can cause seizures. Another term for
kidney stones stuck in the kidney is nephrolithiasis. This medication can also cause mild cognitive
impairment. - ✅✅Memory trick: "To Pee Rocks, mate!" (Causes kidney stones)
"A Pirate at sea for 2-3 months out on the open water." (Takes 2-3 months to work, and increase water
intake.)
"Pirate? Tom? What?" (Causes cognitive impairment.)
1. What kind of medication is topiramate?
a. Anticonvulsant
b. Analgesic
c. NSAID
,d. Antibiotic - ✅✅Anticonvulsant
2. What is topiramate better known as?
a.Topamax
b.Celebrex
c.Aleve
d.Clavamox - ✅✅a.Topamax
3. How long does Topiramate take to start working?
a. 1-2 months
b. 4-5 months
c. 8-12 weeks
c. 2 weeks - ✅✅c. 8-12 weeks (2-3 months)
A common complication when taking Topiramate is?
a. stroke
b. seizures
c. migraines
d. nephrolithiasis - ✅✅d. nephrolithiasis
Teaching: Sumatriptan (Imitrex) is a selective serotonin receptor agonist used to treat migraines. It
belongs to a class known as "Triptans." This medication can cause tremors. We cannot give Sumatriptan
to patients with cardiopulmonary issues, like CAD, because this medication narrows the blood vessels,
and the combination of vessels narrowing and excessive plague can lead to occlusion of blood to major
organs, body parts, or the brain. Patients with these conditions should avoid sumatriptan: High blood
pressure, Heart disease, High cholesterol, Bad pain in the chest, problems with the liver, Diabetes,
Stroke. - ✅✅Remember the T in Sumatriptan, it causes your blood vessels to "Trip" out: Treats
migraines but causes Tight blood vessels and Tremors.
The nurse knows that which following conditions are contraindicated for a Sumatriptan subscription?
Select all that apply.
,a. Peripheral artery disease.
b. cerebrovascular disease.
c. uncontrolled hypertension.
d. Alcoholic fatty liver disease.
d. history of transient ischemic attack and stroke - ✅✅All answers are correct.
Teaching: other medications to treat headaches or migraines include NSAIDS, Beta-blockers, and muscle
relaxers. NSAIDS should not be taken long term because they increase the risk of GI bleeding. Beta-
blockers work by causing the heart to beat slowly and with less force. Muscle relaxers like Baclofen and
Zanaflex work by relaxing the fine muscles of the head and face, thus reducing tension associated
headaches. - ✅✅
The nurse knows that which of the following medications may be prescribed to treat migraines? Select
all that apply.
a. Metoprolol
b. Aspirin
c. Zanaflex
d. Topiramate
e. Sumatriptan
f. acetaminophen - ✅✅a, b, c, d, e.
Acetaminophen doesn't have anti-inflammatory properties, so it isn't very good at treating migraines.
Teaching: Nursing management of HA. The goal is to reduce pain, identify triggers, and find coping
strategies to manage pain. We need a detailed history from the patient to identify pain and find proper
coping strategies. Relaxation teaching, meditation, yoga, massage, and moist hot packs are effective
interventions. We also need to teach the patient to identify triggers like smoking, perfumes, gasoline
fumes, and to limit environmental stimuli. - ✅✅Keep going!
1. After teaching a patient about management of migraine headaches, the nurse determines that the
teaching has been effective when the patient says,
a. "I will take the (Topamax) as soon as any headaches start."
b. "I should avoid taking aspirin and sumatriptan (Imitrex) at the same time."
, c. "I will try to lie down someplace dark and quiet when the headaches begin."
d. "A glass of wine might help me relax and prevent headaches from developing." - ✅✅ANS: C. It is
recommended that the patient with a migraine rest in a dark, quiet area. Topiramate (Topamax) is used
to prevent migraines and must be taken for several months to determine effectiveness. Aspirin or other
nonsteroidal anti-inflammatory medications can be taken with the triptans. Alcohol may precipitate
migraine headaches.
Teaching: Primary headaches are the most common type, which include migraines, tension headaches,
and cluster headaches; primary causes span a wide variety. Secondary headaches are caused by another
problem such as caffeine withdrawal, hunger, or high altitude. The most important part of diagnosis of
headaches is a full neuro exam and patient history. However, many tests may be ordered for further
evaluation. Flip the card to see the other tests. - ✅✅Palpation of the head, auscultation for bruit over
the major carotid, CBC, chem panel, urinalysis, angiography, EMG EEG, MRA, MRI, LP.
Teaching: The four major types of headaches we should know are Sinus, Cluster, Tension, and Migraine.
Sinus: pain is behind browbone and/or cheekbones. Cluster: pain is in and around one eye: can cause
pain-related insomnia, pallor, restlessness, and cheek/gum/forehead, nose pain. Tension: pain is like a
band squeezing the head: constant pain. Migraine: pain, nausea, and visual changes are typical of the
classical form: food cravings and feelings of limb movement are also associated with migraines. Flip the
card to see a link for a visual. - ✅✅https://www.medicalnewstoday.com/articles/headache-
chart#overview
2. When a patient is experiencing a cluster headache, the nurse will plan to assess for
a. nuchal rigidity.
b. projectile vomiting.
c. unilateral eyelid swelling.
d. throbbing, bilateral facial pain. - ✅✅.ANS: C. Unilateral eye edema, tearing, and ptosis are
characteristic of cluster headaches. Nuchal rigidity suggests meningeal irritation, such as occurs with
meningitis. Although nausea and vomiting may occur with migraine headaches, projectile vomiting is
more consistent with increases in intracranial pressure (ICP). Unilateral sharp, stabbing pain, rather than
throbbing pain, is characteristic of cluster headaches.
A patient reports a headache to the nurse. After reviewing the patient's history, the nurse finds that the
patient has previously had a stroke. Which drug should be excluded from the patient's treatment
regimen?
a. Fluoxetine
