NUR 4135 PrepU Chapter 14
A client on an acute medicine unit with a diagnosis of small bowel obstruction is reporting intense, diffuse abdominal pain. Which physiologic phenomenon is most likely contributing to the client's pain? Nociceptive afferents are conducting along the cranial and spinal nerve pathways of the ANS. An overlap of nerve fiber distribution between the dermatomes is causing the pain. First-order neurons are inappropriately signaling pain to the dorsal root ganglion. The client is experiencing neuropathic pain.
Nociceptive afferents are conducting along the cranial and spinal nerve pathways of the ANS. Explanation: Visceral pain, as characterized by the client's description of her pain, is conducted by way of nociceptive afferents that use the cranial and spinal nerve pathways of the ANS. The problem is not likely rooted in the inappropriate firing of first order neurons or the substitution of conduction by C fibers. Pain that is attributable to a pathologic process apart from the neural pain network is not normally considered to be neuropathic. An overlap of nerve fiber distribution between the dermatomes occurs with cutaneous pain, not visceral pain.
How will the nurse explain to a client the changes in blood flow during exercise? "Heat dilates blood vessels and increases local blood flow to skeletal muscles." "Blood vessel size remains constant during exercise." "Blood vessels to organs dilate during exercise." "Blood vessels to skeletal muscles constrict during exercise."
"Heat dilates blood vessels and increases local blood flow to skeletal muscles." Explanation: As the client exercises, blood vessels to skeletal muscles dilate to increase blood flow. Blood vessels to the organs constrict.
A client asks if pain threshold and pain tolerance are the same. The best response by the health care provider would be: "Pain threshold is the point at which a stimulus is perceived as painful." "Pain threshold is not varied from person to person." "Pain tolerance is not affected by psychological, familial, cultural, and environmental factors." "Pain tolerance is the minimum intensity of pain a client will endure."
"Pain threshold is the point at which a stimulus is perceived as painful." Explanation: Pain threshold is closely associated with the point at which a nociceptive stimulus is perceived as painful. Pain tolerance relates more to the total pain experience; it is defined as the maximum intensity or duration of pain that a person is willing to endure before the he or she wants something done about the pain. Psychological, familial, cultural, and environmental factors significantly influence the amount of pain a person is willing to tolerate. The threshold for pain is fairly uniform from one person to another, whereas pain tolerance is extremely variable.
What will the nurse teach the client to expect during ergometry treadmill testing? "You will walk or run on a moving belt to simulate exercise." "You will have a needle inserted into your muscle." "You will breathe through a tube to measure oxygen capacity." "You will lie on a table during the testing."
"You will walk or run on a moving belt to simulate exercise." Explanation: During ergometry testing on a treadmill, the person walks or runs on a moving belt while the speed and the incline of the treadmill are altered.
Which symptom indicates the next stage of a fever after a prodrome? Prodrome A chill A flush Defervescence
A chill Explanation: The physiologic behaviors that occur during the development of fever can be divided into four successive stages: prodrome, chill, flush, and defervescence. The stages are successive.
A nurse who is testing a client's response to passive movement of the fingers with the client's eyes closed notes that the client cannot accurately identify on which side the movement occurred or in what position the finger was placed. What is an appropriate interpretation of this result? Intact thermal sensations Abnormal discrimination pathway function Normal reflex function That the sense of proprioception is intact
Abnormal discrimination pathway function Explanation: The discriminative dorsal column-medial lemniscus pathway is able to sense fine touch and discriminate between two points as close as 5 mm. This pathway also mediates sense of position. Loss of this pathway means only that the anterolateral pathway is functioning and is unable to make fine distinctions in touch proprioception and points. The test does not test reflexes or temperature.
Which intervention is an appropriate action by a nurse to take in attempting to decrease a client's temperature through conduction? Lower the room temperature Give client a warm bath Remove the client's blankets Apply cooling blanket
Apply cooling blanket Explanation: Conduction is the transfer of heat from one molecule to another. A nurse attempting to use conduction to lower a client's temperature should apply a cooling blanket, as this would conduct heat from the skin to the cool surface of the blanket.
When conducting a health assessment that focuses on the pain experienced by an older client diagnosed with early dementia, the nurse will pay particular attention to which of the following? The client's verbal perception of pain Behavioral signs of pain demonstrated by the client Cultural beliefs held by the client regarding the cause of pain The client's comfort level regarding the discussion of pain
Behavioral signs of pain demonstrated by the client Explanation: The assessment of pain in older adults can range from relatively simple in a well-informed, alert, cognitively intact person with pain from a single source and no comorbidities to extraordinarily difficult in a confused person. When possible, a person's report of pain is the gold standard, but behavioral signs of pain should also be considered. This is especially true when the client's cognitive function is impaired. While the other options should be considered, the client's nonverbal behaviors should be of particular interest to the nurse.
Nonshivering thermogenesis occurs in which of the following to help the newborn infant fight hypothermia? Adipose tissue Subcutaneous tissue Brown fat Epidermis
Brown fat Explanation: Nonshivering thermogenesis occurs in the liver, brown fat tissue, and the brain and helps the newborn infant fight hypothermia.
What can the nurse assume about a child's behavior when faced with the need to repeat a painful procedure? A child will resist any intervention that involves contact with his or her body. A child will benefit from a matter-of-fact approach on the part of the nurse. Pain causes similar responses in people regardless of their age. Children act to avoid pain based on their memory of past painful events.
Children act to avoid pain based on their memory of past painful events. Explanation: Children do feel pain and have been shown to reliably and accurately report pain. They also remember pain. This is evidenced in studies of children with cancer, whose distress during painful procedures increases over time without intervention, and in neonates in intensive care units, who demonstrate protective withdrawal responses to a heel stick after repeated episodes. The other options may not necessarily be true of most children.
What is the most common cause of drug fever? Hypersensitivity reaction to medication Serotonin syndrome Impaired peripheral heat dissipation by atropine Increased heat production from PTU
Hypersensitivity reaction to medication Explanation: The most common cause of drug fever is a hypersensitivity reaction. Drug fever can also be caused by the antithyroid medication propylthiouracil (PTU), atropine and anticholinergic medications, antipsychotic agents, tricyclic antidepressants, cocaine, and amphetamines. The agitation, hyperthermia, and hyperactivity of serotonin syndrome occur with overdose of serotonin reuptake inhibitors.
The nurse is taking the history of a client scheduled for surgery with general anesthesia. What is the best response by the nurse to the client's statement that an uncle died after receiving general anesthesia? Give emotional reassurance. Request that a chaplain visit. Document the statement. Inform the anesthesiologist.
Inform the anesthesiologist. Explanation: Malignant hyperthermia is an autosomal dominant metabolic disorder that occurs in response to particular triggers such as general anesthesia (particularly halothane, and the depolarizing muscle relaxant succinylcholine), trauma, exercise, environmental heat, and infection. If the uncle experienced this condition, the client could also carry the RYR1 gene. The anesthesiologist could select a different anesthetic agent. While the other actions are important, it is essential that the nurse take action to prevent harm to the client.
Which statement is true of migraine headaches? The majority of clients have a migraine with aura. Migraines may have a hormonal etiology in some clients. Surgical treatments for migraines are indicated if pharmacologic treatments are unsuccessful. Opioid analgesics achieve adequate pain control in most clients.
Migraines may have a hormonal etiology in some clients. Explanation: Although the pathophysiology of migraines is not well understood, it is thought that hormones may underlie their increased prevalence in women. Surgery is not a standard treatment modality, and although most clients require pharmacologic measures of some type, opioid analgesics are not among the most common drug options. The majority of clients have migraines without auras.
When testing nociceptive stimuli to elicit a withdrawal reflex in the body, what stimuli are commonly used? A damp cotton ball at skin temperature Pressure from a sharp object Weak electrical current Water heated to 5°C above skin temperature
Pressure from a sharp object Explanation: Stimuli used to elicit a withdrawal reflex include pressure from a sharp object, strong electric current to the skin, or application of heat or cold of approximately 10°C above or below normal skin temperature.
The route considered the most accurate to measure a core body temperature is: Rectal Thermodilutional (pulmonary artery) Esophageal Thermosensoral (bladder)
Rectal Explanation: The rectal temperature is used as a measure of core temperature and is least invasive of all of these options.
A client is experiencing chest pain that radiates to the left arm and neck. The nurse would interpret this pain as:
Referred Explanation: Referred pain is pain that is perceived at a site different from its point of origin but innervated by the same spinal segment. Visceral pain originates in the visceral organs and is one of the most common pains produced by disease. Cutaneous pain arises from superficial structures. Somatic pain originates in deep body structures.
The nurse is studying sensory systems. She understands that signal transduction of an impulse to the thalamus for processing is accomplished by:
Second-order neurons Explanation: Second-order neurons communicate with various reflex networks and sensory pathways in the spinal cord and travel directly to the thalamus. First-order neurons transmit sensory information from the periphery to the CNS. Third-order neurons relay information from the thalamus to the cerebral cortex.
Full localization, discrimination of intensity, and interpretation of somatosensory stimuli requires processing by which region of the brain? Thalamus Autonomic nervous system Ruffini end-organ receptors Somatosensory cortex
Somatosensory cortex
A client who is being treated for chronic low back pain is using a TENS unit for relief of pain. The nurse is aware that the use of this device is considered what type of pain relief? Biofeedback A physical agent Stimulus-induced analgesia Distraction
Stimulus-induced analgesia Explanation: Stimulus-induced analgesia is one of the oldest known methods of pain relief. Electrical stimulation methods of pain relief include TENS, electrical acupuncture, and neurostimulation. A physical agent would be the use of heat or cold. Distraction is a nonpharmacologic method of reduction of pain by distracting the client from his pain. Biofeedback is used to provide feedback to a person concerning the current status of some body function, temperature, temporal artery pulsation, blood pressure, or muscle tension.
A nurse conducting a community education program on hyperthermia determines that the participants understand the information when they identify that the heat index is which of the following? Temperature sensed by the body in hot, dry climates Temperature sensed when temperature and humidity are combined Measure of humidity Measure of core body temperature
Temperature sensed when temperature and humidity are combined Explanation: The nurse determines that the participants understand the information when they identify that the heat index is the temperature sensed by the body when humidity and temperature are combined.
A client has recently been diagnosed with chronic back pain that requires the daily use of hydromorphone, an opioid analgesic. For the first few weeks, the client achieved relief with 4 mg every 6 hours. However, the client now requires 6 mg doses to achieve the same effect. How should the nurse best interpret this phenomenon? The client's medication should be replaced with nonpharmacologic interventions The opioid should likely be replaced with a nonsteroidal anti-inflammatory drug (NSAID) The client is exhibiting the early signs of opioid addiction The client is developing opioid tolerance, which is expected
The client is developing opioid tolerance, which is expected Explanation: The client is developing a tolerance to the opioid, which is not unexpected and which is not synonymous with addiction. There may be a need to include nonpharmacologic interventions or NSAIDs, but these do not need to replace the opioid.
A 33-year-old client is brought into the emergency room with a core temperature of 39°C (102.2°F). The client is red in the face, chest, and back due to significant cutaneous vasodilation. The client is likely in which stage of fever? Fourth Third First Second
Third Explanation: The first stage of a fever is marked by headache and body aches, the second stage is marked by the chills, and the third stage is the flush state. The fourth stage is defervescence.
Children feel pain just as much as adults do. What is the major principle in pain management in the pediatric population? Always use nonpharmacologic pain management before using pharmacologic pain management. Treat on individual basis and match analgesic agent with cause and level of pain. Base treatment of pain on gender and age group. Treat pediatric pain the way the parents want it treated.
Treat on individual basis and match analgesic agent with cause and level of pain. Explanation: The overriding principle in all pediatric pain management is to treat each child's pain on an individual basis and to match the analgesic agent with the cause and the level of pain.
A client comes to the clinic for evaluation of a sharp, intermittent, severe, stabbing facial pain that she describes as "like an electric shock." The pain occurs on only one side of her face. It seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. Often it is accompanied by involuntary grimacing. What diagnosis is most likely? Trigeminal neuralgia Migraine headache Postherpetic neuralgia Complex regional pain syndrome
Trigeminal neuralgia Explanation: Her symptoms are characteristic of trigeminal neuralgia, caused by damage to cranial nerve V, which carries impulses of touch, pain, pressure, and temperature to the brain from the face and jaw. Postherpetic neuralgia is a complication of shingles. Migraine headache symptoms feel as if they occur in one or more regions of the head, not the face. Complex regional pain syndrome affects either one arm or leg.
A recovery room nurse monitoring a client for adverse effects of cold cardioplegia assesses for: Ventricular dysrhythmia Increased intercranial pressure Postoperative anxiety Postoperative migraine
Ventricular dysrhythmia Explanation: The nurse should assess for ventricular dysrhythmia, decreased cerebral blood flow, and postoperative myocardial depression.
A client is admitted to the acute care facility with severe pain in the abdomen related to inflammatory bowel disease. What type of pain will the nurse be administering medication to relieve? Visceral pain Somatic pain Cutaneous pain Referred pain
Visceral pain Explanation: Visceral pain has its origin in the visceral organs and is one of the most common pains produced by disease. While similar to somatic pain in many ways, both the neurologic mechanisms and the perception of visceral pain differ from somatic pain. One of the most important differences between surface pain and visceral pain is the type of damage that causes pain. Strong contractions, distention, or ischemia affecting the walls of the viscera can induce severe pain.
In the hospital setting, one of the best ways to lower the fever in a client with hyperthermia would be to facilitate conduction of heat from the body by: placing IV solutions into the freezer for 30 minutes prior to hanging them. providing frequent sponge baths with cool water. taking all covers/clothing off and pouring alcohol on the client's skin. placing the client on a cooling mattress that circulates a coolant solution through the mattress.
placing the client on a cooling mattress that circulates a coolant solution through the mattress.
A client who has been exercising says to the nurse, "My skin is so hot!" What is the nurse's best response? "Your body is trying to lower your temperature." "You should not exercise this rigorously!" "Your skin should be cool after exercise." "Have you been sick?"
"Your body is trying to lower your temperature." Explanation: After exercise, the body dilates blood vessels and shunts blood to the skin to help to decrease the temperature. Skin typically feels hot and sweaty. Evaporation of sweat from the skin surface contributes to loss of heat. As the heat is lost through the skin, the skin typically feels hot. The nurse should calm the client and explain that this is a normal response to exercise.
Which client(s) is showing manifestations of infection? Select all that apply. - 2-month-old client with temperature 38.3°C (100.4°F), lethargy, poor feeding, and cyanosis - 50-year-old client with temperature 36.5°C (97.7°F), heart rate 65 beats/min, fatigue - 75-year-old client with temperature 37.3°C (99.2°F), declining mental status, weakness and fatigue - 25-year-old client with temperature 40°C (104°F), sweating, shivering, states generalized pain - 5-year-old client with temperature 36.8°C (98.2°F), distracted and irritable
- 75-year-old client with temperature 37.3°C (99.2°F), declining mental status, weakness and fatigue - 25-year-old client with temperature 40°C (104°F), sweating, shivering, states generalized pain - 2-month-old client with temperature 38.3°C (100.4°F), lethargy, poor feeding, and cyanosis Explanation: An older adult client with an infection may have a minimal rise in temperature, but exhibit changes in mental status, weakness, fatigue, and weight loss. An infant younger than 3 months may have a relatively mild fever, but a serious infection. Evidence includes behavioral changes and evidence of physiologic stress such as cyanosis. An adult with a high fever will exhibit sweating and chills. Aches and pains may occur with shivering and the infectious illness. A client with a temperature within the normal range, exhibiting no other signs of change, is not considered to have the typical signs of infection. Although a low body temperature can also be found with a serious infection (sepsis), this is defined as a temperature less than 36.0°C (96.8°F). There are many reasons for a child at age 5 to be distracted and irritable. These behaviors are not evidence of infection.
For which older adult client would pain assessment likely be most challenging for the nurse? A 77-year-old client who has sustained burns on the lower part of the body An 82-year-old client who has been diagnosed with diabetes and an anxiety disorder An 87-year-old client with vascular dementia and numerous other health problems, such as heart failure A 90-year-old client who takes multiple medications for cardiac and respiratory conditions
An 87-year-old client with vascular dementia and numerous other health problems, such as heart failure Explanation: Pain in older adults has been associated with impaired appetite, increased sleep disturbances, and in some cases a decrease in cognitive functions. Anxiety, polypharmacy, and the presence of acute pain are factors that may also influence the assessment process, but these are more likely to have a bearing on pain treatment and management than on pain assessment.
The nurse on the pediatric unit is implementing distraction strategies for a child who is experiencing pain. Which strategies would be best for the nurse to implement? Select all that apply. Silence Acetaminophen Television Games Music Bubbles
Bubbles Music Television Games Explanation: Distraction helps children of any age divert their attention away from pain and onto other activities. Common diversions include bubbles, music, television, conversation, and games.
What will the nurse teach a client with trigeminal neuralgia about the condition? It is good to spend time alone every day. Carbamazepine is a first-line treatment. Surgery will relieve the condition. Avoid eating if it triggers the pain.
Carbamazepine is a first-line treatment. Explanation: Trigeminal neuralgia is a condition in which clients experience brief, severe, repetitive lightninglike or throbbing pain along the distribution of one or more of the branches of the fifth cranial nerve. Clients should be taught to avoid triggers when possible, but although eating may be a trigger, it is necessary for the client to maintain nutrition. Social isolation is a possible problem arising from the condition. Time alone does not contribute significantly to improvement of the condition. Although treatment rarely provides total relief, trigeminal neuralgia can be controlled with carbamazepine and surgical release of vessels, nerve roots, or scar tissue. If other treatments are ineffective, partial destruction of the nerve branches with heat, balloon compression, or glycerol injection may be performed. Newer therapies to be considered are botulinum toxin injection and gamma radiation with stereotactic surgery.
The loss of heat from the body through the circulation of air currents is known as:
Convection Explanation: Convection refers to heat transfer through the circulation of air currents, while radiation is the transfer of heat through air or a vacuum. Conduction is the direct transfer of heat from one molecule to another, and evaporation involves the use of body heat to convert water on the skin to water vapor.
Which risk factor presents the greatest risk for injury in an older adult who is experiencing a dysfunction in temperature regulator function? Misdiagnosis of pathology Acute renal failure Delayed initiation of appropriate treatment Acute dementia
Delayed initiation of appropriate treatment Explanation: Older adults often have a lower baseline temperature (36.4°C [97.6°F]) than younger persons, and although their temperature increases during an infection, it may fail to reach a level that is equated with significant fever. The absence of fever may delay diagnosis and initiation of antimicrobial treatment. Absence of fever does not result in misdiagnosis. While the remaining options may occur, they are not the greatest risks for injury.
An older adult's blood cultures have come back positive, despite the fact that the client's oral temperature remains within normal range. Which phenomena underlies the alterations in fever response that occur in older adults? Disturbance in the functioning of the thermoregulatory center Persistent closure of arteriovenous shunts Presence of comorbidities that are associated with lowered core temperature Increased heat loss by evaporation
Disturbance in the functioning of the thermoregulatory center Explanation: The probable mechanisms for the blunted fever response in older adults include a disturbance in sensing of temperature by the thermoregulatory center in the hypothalamus. Heat loss by evaporation tends to decrease with age, and the closure of arteriovenous shunts results in increased core temperature. The presence of comorbidities is not noted to contribute to reduced fever response in older adults.
A client's body temperature has been documented as follows: 12 noon: 37°C (98.6°F); 6 pm: 37.5°C (99.5°F); 3 am: 36°C (96.8°F). Which action should the nurse take? Document the temperature. Contact the physician. Retake the temperature. Offer client a warm blanket.
Document the temperature. Explanation: The nurse should document the temperature, as the temperature is within normal limits and a drop in temperature in the early morning hours is expected with the lowest occurring between 3:00 am and 6:00 am. Therefore, there is no need to contact the physician, retake the temperature, or offer the client a warm blanket.
Which principles should underlie the pain control strategy in the care of a child with a diagnosis of cancer?
Dosing and timing should aim for a steady serum level of the prescribed drug. Explanation: Pain control can be maximized and side effects minimized by timing the administration of analgesia so that a steady blood level is achieved and, as much as possible, pain is prevented. Opioids can be safely used in children, and analgesia should not be withheld until pain is severe. Using drugs from numerous classifications will not necessarily increase pain control.
An 8-year-old boy has fallen through the ice while skating on a frozen pond. By the time paramedics arrive, the boy has been removed from the water by his friends, but his core body temperature is 31.1°C (88.0°F). The responders would recognize that which physiologic process would have been active during the boy's accident? Heat production through increased body metabolism Production and release of cortisol as a heat generation process Stimulation of the thyroid gland in order to increase cellular activity Energy generation through the release of epinephrine and norepinephrine
Heat production through increased body metabolism Explanation: An immediate response to low temperature is a heat-generating increase in metabolism. Cortisol is not involved in heat generation, and the thyroid is only capable of a longer term effect on metabolic activity. Epinephrine and norepinephrine shift activity away from energy production and toward heat production.
The health care provider is obtaining a pain history from a client. Which information is most important to obtain? Select all that apply. Self-image Intensity Gender Self-report Localization Pain onset Quality
Localization Quality Self-report Intensity Pain onset Explanation: A comprehensive pain history should include pain onset; description, localization, radiation, intensity, quality, and pattern of the pain; anything that relieves or exacerbates it; and the individual's personal reaction to the pain. The single most reliable indicator of the existence and intensity of acute pain is probably the person's self-report. Gender and self image are not essential data.
Which intervention is usually the first line of therapy when treating moderate pain in the older adult population? Muscle relaxants like cyclobenzaprine Nonopioids such as acetaminophen Antihistamines like diphenhydramine Opioids such as codeine
Nonopioids such as acetaminophen Explanation: Nonopioids are generally the first like of therapy for mild to moderate pain in the older adult population. Opioids are used for more severe pain and palliative care. Diphenhydramine is used primarily for allergy symptoms. Muscle relaxants like cyclobenzaprine are helpful for aching muscles.
Which client is exhibiting headache symptoms that indicate a need for further evaluation? Pregnant mother with drowsiness and unrelenting headache Older adult with a headache after missing the evening meal College student with unilateral headache after eating a chocolate bar Parent with general head pain after a night caring for an ill child
Pregnant mother with drowsiness and unrelenting headache Explanation: Primary headaches such as migraine, tension headache, cluster headache, and chronic daily headache do not require additional evaluation. Clients with secondary headaches should receive further evaluation. Possible causes of secondary headaches are cerebral hemorrhage or aneurysm, meningitis, cancer, and nerve lesions. Additionally, clients requiring further evaluation include those with sudden onset or progression of headaches, someone who is immunosuppressed, or a woman who is pregnant.
A nurse instructing unlicensed assistive personnel (UAP) on temperature regulation includes as part of the teaching that core body and skin temperatures are sensed by which part of the brain? medulla hypothalamus pituitary cerebellum
hypothalamus Explanation: Core body and skin temperatures are sensed and integrated by thermoregulatory regions in the hypothalamus (particularly, the preoptic-anterior hypothalamic area) and other brain structures (i.e., thalamus and cerebral cortex).
A surgical client is at greatest risk for hypothermia during a surgical procedure related to: the instillation of warmed intravenous fluids that lower the core temperature. impaired thermoregulatory mechanisms brought on by anesthesia. negligence of the anesthesiologist in regulating the body temperature. the decreased temperature of the surgical suite caused by electrical appliances.
impaired thermoregulatory mechanisms brought on by anesthesia. Explanation: A surgical client has a higher risk of hypothermia related to impaired thermoregulatory mechanisms brought on by anesthesia and other drugs. The instillation of warmed intravenous fluids is used to increase the core temperature, not lower it. The remaining options related to room temperature and the regulation of body temperature are not relevant.
A client is experiencing a cluster headache. The client would most likely manifest: nausea with vomiting. severe pain behind the eye. sensitivity to light. symptoms aggravated by physical activity.
severe pain behind the eye. Explanation: Symptoms of cluster headache include severe, unrelenting unilateral pain located in the orbital area. The pain radiates behind the eye to the ipsilateral trigeminal nerve. The client may also experience symptoms such as restlessness or agitation, conjunctival redness, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis, and eyelid edema. The other options are associated with migraine headache.
The health care provider will likely prescribe which medication to a client who is experiencing severe nausea and vomiting with a migraine? oral ondansetron, an antiemetic sumatriptan intranasal spray dihydroergotamine, an ergotamine derivative caffeine injection
sumatriptan intranasal spray Explanation: First-line agents to treat migraine attacks include acetylsalicylic acid, nonsteroidal anti-inflammatory drugs, ergotamine derivatives, and antiemetics. Nonoral routes of administration may be preferred in people who develop severe pain rapidly or on awakening, or in those with severe nausea and vomiting. Sumatriptan has been approved for intranasal administration. The other medications may be prescribed but, if a client is vomiting, the best alternative is the intranasal sumatriptan.