Audio Coursesby JellypodLesson 04 of 5
Overview
Heather Murphy: Hey everyone, welcome back to NSG3046 Adult Medical Surgical 2. I’m Heather Murphy, and today we’re talking about something you will absolutely see on the floor and on NCLEX: headaches. Not just “my head hurts,” but tension-type, migraine, and cluster headaches—and how to tell them apart fast.
Heather Murphy: Think like the exam: when you read a stem, you’re scanning for patterns. So let’s build those patterns in your brain as we go. And I’ve got Caitlin Hope with me to tag-team this.
Caitlin Hope: Hey everyone. Okay, let’s start with the one you’ll see the most: tension-type headaches. Picture that dull, aching, “band-around-the-head” feeling. It’s usually bilateral, mild to moderate, and the person can still function—maybe they’re grumpy, but they’re at work.
Caitlin Hope: NCLEX brain on: if the stem says “bilateral,” “pressing or tightening,” “mild to moderate,” and there’s no nausea, no photophobia–that’s tension, not migraine. A lot of students overthink and wanna pick migraine because it sounds fancier. Don’t.
Heather Murphy: Exactly. Migraines are a different beast. They’re typically recurrent, often unilateral but can switch sides, and it’s that throbbing or pulsating pain. You’ll see photophobia, phonophobia, maybe nausea or vomiting. Some patients have an aura—visual changes like flashing lights—or other weird sensations before the pain.
Heather Murphy: On NCLEX, words like “throbbing,” “pulsating,” “worsens with activity,” plus “photophobia,” “phonophobia,” or “aura” should scream migraine at you. If the patient has to lie in a dark room, that’s another clue.
Caitlin Hope: Cluster headaches are the dramatic ones. Less common, usually in men, and the pain is excruciating, unilateral, and around or behind one eye. Patients describe it like an ice pick in the eye—that’s not an exaggeration.
Caitlin Hope: Pattern-wise, think clusters or cycles: several attacks a day for weeks or months, then remission. On exams, pair “unilateral periorbital pain,” tearing, nasal congestion, maybe ptosis, plus words like “occurs in clusters” and you pick cluster headache, not migraine.
Heather Murphy: Now, treatment. For tension-type headaches, first-line is usually simple analgesics: NSAIDs, aspirin, or acetaminophen. Sometimes they’re combined with a sedative, muscle relaxant, or caffeine.”
Heather Murphy: Migraines: triptans are big. Timing matters. The best practice is to take the triptan at the first sign of headache—or at the start of aura, depending on the specific order. If the question says the patient waits until the pain is 9 out of 10, you know the correct answer is teaching about earlier use.
Caitlin Hope: Cluster headaches? Triptans again for acute attacks. You’ll also see high-dose verapamil as a preventive. So if NCLEX throws verapamil into a question about severe unilateral headaches in clusters, don’t default to “this is for blood pressure.” You want “prophylaxis for cluster headaches.”
Caitlin Hope: Non-pharm stuff is where a lot of “select all that apply” points hide. Relaxation training, meditation, yoga, biofeedback, Cognitive Behavior Therapy, regular sleep, avoiding known triggers—those are gold. When the stem asks how to reduce migraine frequency, look for answers that mention stress management, consistent sleep, and trigger avoidance, not “take opioids around the clock.”
Heather Murphy: And quick NCLEX pattern: if the question is about long-term management or prevention, your best options are usually non-pharmacologic lifestyle changes plus appropriate prophylactic meds. If it’s asking about an acute severe attack, that’s when you pick triptans or the ordered analgesic—not guided imagery. Matching the timing of the intervention to the phase of the headache is a very testable skill.
Heather Murphy: Alright, let’s pivot into seizures—huge NCLEX territory. Big picture: seizures are sudden, uncontrolled electrical discharges in the brain. The exam loves two big buckets: generalized-onset versus focal-onset seizures.
Heather Murphy: Generalized means both sides of the brain from the start, so consciousness is usually impaired. Focal means one area to start, and awareness may or may not be affected.
Caitlin Hope: Let’s put some buzzwords on that. Generalized tonic-clonic seizures—the classic “grand mal.” The patient loses consciousness, maybe has a cry, falls, goes into a tonic phase where they stiffen, then a clonic phase with rhythmic jerking. Afterward you get the postictal phase—confusion, fatigue, maybe headache.
Caitlin Hope: If a stem says “sudden loss of consciousness with bilateral stiffening and jerking” plus postictal confusion, your brain should go: generalized tonic-clonic.
Heather Murphy: Absence seizures are another generalized type, especially in kids. Think brief staring spells, a few seconds, no warning, no postictal confusion. Teachers might think the child is daydreaming. On NCLEX, “brief staring,” “unresponsive,” and “no memory of the event” with quick return to baseline equals absence seizure.
Heather Murphy: Focal seizures start in one hemisphere. If awareness is intact, that’s a focal awareness seizure. If awareness is impaired, it’s a focal impaired awareness seizure.
Caitlin Hope: Focal impaired awareness has great buzzwords: automatisms like lip-smacking, picking at clothes, fumbling, plus confusion afterward. If a question describes “smacking lips, wandering, and then confusion,” don’t pick absence—pick focal impaired awareness.
Heather Murphy: Now, the big emergency: status epilepticus. That’s continuous seizure activity, or repeated seizures without the person regaining consciousness in between. It’s a medical emergency because of airway and breathing compromise and brain damage risk.
Heather Murphy: NCLEX priority sequence: ABC. First, support airway and breathing—side-lying position, oxygen as ordered. Then rapid IV benzodiazepine, like lorazepam, is your first-line medication. After that, you follow with maintenance antiseizure meds to prevent recurrence.
Caitlin Hope: Most seizures, though, are self-limiting. For a typical tonic-clonic seizure, your nursing priorities are: maintain a patent airway, protect from injury, and time the seizure. Don’t put anything in the mouth, don’t restrain, and don’t try to stop the jerking.
Caitlin Hope: NCLEX loves that “which action requires intervention?” question. If you see an option like “insert a padded tongue blade” or “hold the patient’s arms down,” that’s your wrong answer. Right answers look like “ease the patient to the floor,” “pad side rails,” “loosen restrictive clothing,” "apply oxygen" and “turn head to the side.”
Heather Murphy: Medication teaching is another high-yield area. Antiseizure drugs only work if taken consistently. So teaching points: take medications at the same time every day, don’t abruptly stop them, and if you miss a dose, don’t double up—call your provider for guidance.
Heather Murphy: Also, safety and legal stuff: many patients can’t drive until seizure-free for a certain period, depending on regulations. On NCLEX, if a brand-new seizure patient says, “I’ll stop taking this once my seizures are better,” the best response is education about long-term therapy and risk of withdrawal seizures.
Caitlin Hope: Documentation is underrated but testable. You want: what the patient was doing before, where the movements started, the type of movements, whether the head or eyes deviated, how long it lasted, and what the postictal period looked like.
Heather Murphy: Let’s finish with some of the big chronic neuro conditions you’ll see on exams and in practice: multiple sclerosis, Parkinson’s disease, myasthenia gravis, ALS, and Huntington’s. We’re gonna keep this really NCLEX-focused: key features and who you see first.
Heather Murphy: Multiple sclerosis is a chronic disease where the immune system attacks myelin in the CNS. Symptoms can be motor, sensory, or emotional—weakness, numbness, vision changes, fatigue. No cure, but immunomodulator drugs can slow progression and reduce relapses.
Heather Murphy: NCLEX triggers for MS: heat, infection, stress, and overexertion can worsen symptoms. So look for nursing interventions like scheduling rest periods, avoiding extreme temperatures, and infection prevention—not pushing the patient to exercise to exhaustion.
Caitlin Hope: Parkinson’s disease—classic triad: tremor, rigidity, and bradykinesia, plus postural instability. Buzzwords: “pill-rolling tremor,” “shuffling gait,” and “masklike face.” The goal is to balance dopamine, so you see drugs like levodopa or dopamine agonists.
Caitlin Hope: On exams, think safety and swallowing. Priority interventions: fall prevention, assistance with ambulation, upright position for meals, and timing levodopa. Protein can interfere with absorption, so teaching might include taking it before meals or spacing it from high-protein foods per provider guidance.
Heather Murphy: Now, myasthenia gravis: this is fluctuating skeletal muscle weakness, worse with activity, better with rest. It often starts with ocular symptoms—ptosis, diplopia—and involves facial, chewing, and swallowing muscles. Muscle strength is usually strongest in the morning so teach the patient to take their medications in the morning instead of at night.
Heather Murphy: NCLEX red flags: sudden difficulty swallowing, speaking, or breathing—that suggests myasthenic crisis and is an emergency because of airway risk. Your priority answer should be to assess respiratory status and prepare for possible ventilatory support, not just “offer small frequent meals.”
Caitlin Hope: ALS—amyotrophic lateral sclerosis, or Lou Gehrig’s disease—is progressive muscle weakness with intact cognition. No cure, but meds like riluzole can slow progression a bit. Most patients eventually die from respiratory failure.
Caitlin Hope: So test-wise, think: maintain communication, prevent aspiration, and plan for respiratory support. If an ALS patient has new weak cough, drooling, or shallow respirations, that’s your priority patient. Airway and breathing beat everything else.
Heather Murphy: Huntington’s disease is genetic and characterized by choreiform—writhing, jerky—involuntary movements plus cognitive and psychiatric changes. No cure, so care is supportive: meds for movement and mood, safety measures, and nutrition support because they burn a ton of calories with that constant movement.
Heather Murphy: NCLEX likes to bring in family teaching and genetic counseling here, because it’s inherited. Safety—preventing falls and injury—and maintaining weight are huge priorities.
Caitlin Hope: So how do you use all this on test day? When you get a “who do you see first?” neuro question, scan for airway and breathing words: difficulty swallowing, new slurred speech, drooling, weak cough, shallow respirations. That MS patient with a low-grade fever and fatigue is important—but the myasthenia gravis patient who suddenly can’t swallow is FIRST.
Caitlin Hope: Second layer is acute change: “sudden,” “new,” “worsening.” A Parkinson’s patient who has had a shuffling gait for years is chronic; a Parkinson’s patient who just choked during breakfast and is coughing nonstop jumps higher on your list.
Heather Murphy: Exactly. Chronic neuro disorders come with a lot of baseline abnormal. NCLEX wants you to pick the patient whose change suggests loss of airway, breathing, or rapid decline. So when you’re stuck, ask yourself: “Whose airway is in trouble? Whose status just changed?” That question alone will bump your score.
Heather Murphy: Alright, that was a lot, but you all did great hanging in there. Caitlin, thanks for bringing in those clinical stories and buzzwords—those really stick.
Caitlin Hope: Anytime. And if something we said today felt confusing, that’s a good sign to go back, write a couple of your own NCLEX-style questions, and see if you can pick out the key clues.
Heather Murphy: I love that. We’ll keep building on these neuro concepts in future episodes, so stay with us, keep that NCLEX brain turned on, and don’t forget to take care of yourselves in the process.
Caitlin Hope: Alright, y’all, thanks for listening.
Heather Murphy: We’ll see you next time—bye everyone.
