Chapter 65: Management of Patients with Oncologic or Degenerative Neurologic Disorders (p. 2112 - 2120, 2133 - 2134)

What is the only known risk factor for brain tumors? A. ionizing radiation B. head trauma C. use of hair dye D. cellular telephones ​

A. ionizing radiation Ionizing radiation is the only known risk factor for brain tumors. Head trauma, use of hair dyes, and the use of cellular phones are possible causes that have been investigated.

A nurse is conducting a presentation about brain cancer for a local community group. During the presentation, one of the group members asks, "What causes brain tumors?" Which response by the nurse would be most appropriate? A. "There is scientific evidence that cigarette smoking is high on the list of causes." B. "The cause of most brain tumors is still really not known." C. "It's a known fact that using cell phones increases your risk for a tumor." D. "Exposure to residential power lines is a definite cause of brain tumors."

B. "The cause of most brain tumors is still really not known." The cause of most primary brain tumors is unknown. The only known risk factors are exposure to ionizing radiation and cancer-causing chemicals. Additional possible risk factors that require further investigation include non-ionizing consumption of nitrates, cigarette smoking, cell phone use, and exposure to residential power lines. However, the cause of the vast majority of brain tumors remains elusive.

A client with a malignant glioma is scheduled for surgery. The client demonstrates a need for additional teaching about the surgery when he states which of the following? A. "There will be less cancer left that might be resistant to chemotherapy." B. "The surgeon will be able to remove all of the tumor." C. "My headache and nausea should be lessened somewhat." D. "Any tissue that was dead will be removed."

B. "The surgeon will be able to remove all of the tumor." For clients with malignant gliomas, complete removal of the tumor and cure are not possible but the rationale for resection includes relief of increased intracranial pressure, removal of any necrotic tissue, and reduction in the bulk of the tumor, which theoretically leaves behind fewer cells to become resistant to radiation or chemotherapy.

A client comes to the clinic for evaluation because of complaints of dizziness and difficulty walking. Further assessment reveals a staggering gait, marked muscle incoordination, and nystagmus. A brain tumor is suspected. Based on the client's assessment findings, the nurse would suspect that the tumor is located in which area of the brain? A. frontal lobe B. cerebellum C. motor cortex D. occipital lobe

B. cerebellum Findings such as ataxic or staggering gait, dizziness, marked muscle incoordination, and nystagmus suggest a cerebellar tumor. A frontal lobe tumor frequently produces personality, emotional, and behavioral changes. A tumor in the motor cortex produces seizure-like movements localized on one side of the body. Occipital lobe tumors produce visual manifestations.

Corticosteroids are used in the management of brain tumors to A. Prevent extension of the tumor B. Facilitate regeneration of neurons C. Reduce cerebral edema D. Identify precise location of the tumor

C. Reduce cerebral edema Corticosteroids may be used before and after treatment to reduce cerebral edema and promote a smoother, more rapid recovery. Corticosteroids do not prevent extension of the tumor or facilitate regeneration of neurons. Stereotactic procedures identify the precise location of the tumor. ​

Which term is used to describe edema of the optic nerve? A. scotoma B. lymphedema C. papilledema D. angioneurotic edema

C. papilledema Papilledema is edema of the optic nerve. Scotoma is a defect in vision in a specific area in one or both eyes. Lymphedema is the chronic swelling of an extremity due to interrupted lymphatic circulation, typically from an axillary dissection. Angioneurotic edema is a condition characterized by urticaria and diffuse swelling of the deeper layers of the skin. ​

The nurse educator is teaching nursing students about various types of brain tumors. The instructor recognizes that teaching has been effective when students correctly identify a client whose lab work indicates excessively high levels of thyroid stimulating hormone would most likely be diagnosed with which type of tumor? A. angioma B. neuroma C. pituitary adenoma D. glioblastoma

C. pituitary adenoma Pituitary adenomas can increased production of several hormones including TSH, ACTH, growth hormone and prolactin. Excessive hormone production is not characteristic of the brain tumors identified in the alternate options.

A nurse assesses a patient who has been diagnosed with having a pituitary adenoma that is pressing on the third ventricle. The nurse looks for the associated sign/symptom. What is that sign/symptom? A. disruption in sleep pattern B. unusual sensitivity to heat and cold C. visual disturbance D. increased intracranial pressure

D. increased intracranial pressure All the choices are signs and symptoms that can occur with an adenoma, depending on whether the pressure is exerted on the hypothalamus, the third ventricle, or the optic nerves, chiasm, or tracts. Increased intracranial pressure occurs when the third ventricle is affected.

The nurse is seeing a female client who has been diagnosed with a pituitary adenoma. During the clinic visit, the client tells the nurse that she has been having irregular menstrual periods despite having very regular menstrual periods all her life. The nurse knows this physiological change is likely related to which characteristic of this type of brain tumor? A. Increased prolactin levels B. Decrease in growth hormone C. Decrease in adrenocorticotropic hormone D. Increase in thyroid stimulating hormone

A. Increased prolactin levels A characteristic of functioning pituitary tumors is the overproduction of prolactin, which can lead to irregular or diminished menstrual periods in women. Functioning pituitary tumors lead to an increase in the production of several hormones including growth hormone and adrenocorticotropic hormone, not a decrease. Nonetheless, the client would not experience changes in her menstrual periods as a result of increases in these two hormones. Although functioning pituitary tumors can cause an increase in thyroid-stimulating hormone, this would not be the cause of changes in the client's normal menstrual periods.

The nursing is assessing a client who has been diagnosed with a pituitary adenoma, but has not yet started treatment. The client reports having increased heart rate, hand tremors, difficulty sleeping, weight loss and hyperthermia. The nurse anticipates the client will require blood work to assess for overproduction of which hormone? A. Thyroid-stimulating hormone B. adrenocorticotropic hormone C. prolactin D. growth hormone

A. Thyroid-stimulating hormone In clients diagnosed with pituitary tumors, increase may be seen in prolactin hormone, growth hormone, adrenocorticotropic hormone, or thyroid-stimulating hormone. In this case, the client is exhibiting symptoms related to hyperthyroidism and the blood work should include the thyroid-stimulating hormone level to determine if an overproduction of this hormone due to the presence of the tumor is the cause of the presenting symptoms.

The nurse is assessing a client who was brought to the emergency department due to a severe headache with sudden onset, lowered level of consciousness and slurred, non-sensical speech. The client completed chemotherapy and radiation treatment for a glioma-type brain tumor 6 months ago. The client has been taking low molecular weight heparin since completing treatment. The nurse should be prepared to provide care for which possible problem? A. intracerebral hemorrhage B. deep vein thrombosis C. pulmonary embolism D. spinal metastasis

A. intracerebral hemorrhage Clients receiving anticoagulant agents, such as low molecular weight heparin, must be closely monitored because of the risk of central nervous system hemorrhage, also known as an intercerebral hemorrhage. Both deep vein thrombosis and pulmonary embolism would be prevented or mitigated by the use of anticoagulant medications such as low molecular weight heparin. The nurse should always consider the risk of these latter problems, however, because the client is clearly at risk for impaired coagulation. Spinal metastasis can result in spinal cord compression, which is considered a medical emergency requiring immediate treatment. In this case, the nurse would observe reports of back pain, extremity weakness, ataxia and/or paralysis.

The nurse explains to the client with projectile vomiting and severe headache that a medication is being prescribed to reduced edema surrounding the brain and lessen these symptoms. What medication is the nurse preparing to administer? A. mannitol B. temozolomide C. bevacizumab D. everolimus

A. mannitol Mannitol is an osmotic diuretic that is administered to decrease the fluid content of the brain, which leads to a decrease in intracranial pressure. Temozolomide is a chemotherapeutic agent which is commonly used to stop or slow cell growth in certain types of brain tumors. Bevacizumab and everolimus are immunotherapy agents that reduce the vascularization of tumors, thereby inhibiting tumor growth.

The nurse educator is facilitating a class on neurological function with a group of nursing students. When discussing problems that can result from growing brain tumors, the nurse educator should include that clients can experience which neurologic deficits even after surgical resection? Select all that apply. A. paralysis B. incontinence C. aphasia D. fever E. respiratory infection

A. paralysis B. incontinence C. aphasia Although fever and respiratory infection can result from various factors that influence the hospitalized client, these are not categorized as neurologic deficits. The nurse educator is correct in stating that paralysis, incontinence and aphasia are potential neurological deficits that can result from pressure of growing tumors on surrounding brain structures. The arise from a decreased sensory motor response of the central and peripheral nervous system.

A nurse is providing care to a client recently diagnosed with a brain tumor. When planning this client's care, the nurse anticipates which therapy as providing the best outcome for the client? A. surgery B. radiation therapy C. chemotherapy D. immunotherapy

A. surgery A variety of medical treatment modalities, including chemotherapy and external-beam radiation therapy, radiosurgery, or radiotherapy are used alone or in combination with surgical resection. However, surgical intervention provides the best outcome for most brain tumor types.

Which client should the nurse assess for degenerative neurologic symptoms? A. the client with Huntington disease B. the client with Paget disease C. the client with osteomyelitis D. the client with glioma

A. the client with Huntington disease Huntington disease is a chronic, progressive, degenerative neurologic hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia. Paget disease is a musculoskeletal disorder, characterized by localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae. Osteomyelitis is an infection of the bone. Malignant glioma is the most common type of brain tumor.

The nurse is caring for a client with mid-to-late stage of an inoperable brain tumor. What teaching is important for the nurse to do with this client? A. optimizing nutrition B. managing muscle weakness C. explaining hospice care and services D. offering family support groups

C. explaining hospice care and services The nurse explains hospice care and services to clients with brain tumors that no longer are at a stage where they can be cured. Managing muscle weakness and offering family support groups are important, but explaining hospice is the best answer. Optimizing nutrition at this point is not a priority.

The nurse is providing end-of-life care to a client who was diagnosed with glioblastoma multiforme (GBM) 8 months ago. Despite a calm interaction with the client 1 hour ago, the client is now angry and yells, "Get out of my room and don't touch me anymore. I don't need your help!" How should the nurse respond? A. "I am your nurse and caring for you is my obligation. If you no longer want my care, you have to make a request to my supervisor." B. "You are not permitted to speak to me this way. I am a professional and I deserve for you to treat me with respect." C. "I can see you no longer want me as your nurse today. I will ask one of my colleagues to come in to complete the rest of my assessment." D. "I can tell now is not the right time for me to come in and check on you. Please let me know when it is a better time for me to come back."

D. "I can tell now is not the right time for me to come in and check on you. Please let me know when it is a better time for me to come back." Personality changes, mood swings and irritability can be common manifestations of both growth of the brain tumor and also the process of grief and loss, such as in the case of the client who is receiving end-of-life care. The client's anger and yelling at the nurse is indicative of ineffective coping and warrants the nurse to take a therapeutic approach when responding to the anger. Acknowledging that the client is not ready to receive care at the moment and asking the client to contact the nurse when he or she is ready enables to client to maintain control and promotes self-esteem. Telling the client to speak to the nurse's supervisor does not promote a strong nurse-patient relationship and is not a supportive way to manage end-of-life care. Telling the client that he or she is not permitted to speak to the nurse "that way" may increase the client's anger and puts limits on the client's sense of control. This response does not promote an effective nurse-patient relationship. The nurse must use extra caution when responding to a client who is experiencing emotional swings when faced with death and dying. By stating, "I can see you no longer want me as your nurse," the nurse is making an assumption that the client does not want him or her as the nurse any longer. By making this statement, the nurse is limiting opportunities for the client to verbalize feelings and emotions related to stress, grief and loss.