Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders

Corticosteroids are used in the treatment of brain tumors for which of the following clinical manifestations? Select all that apply. - Cerebral edema - Headache - Altered level of consciousness - Seizures - Personality changes

Answer: - Cerebral edema - Headache - Altered level of consciousness

An acoustic neuroma is a benign tumor of which cranial nerve? A.) Eighth B.) Fifth C.) Seventh D.) Ninth

Answer: A.) Eighth

A client who is suspected of having a spinal cord tumor is reporting pain. Upon further assessment, the nurse would anticipate that the client would report that the pain increases when in which position? A.) Supine B.) Prone C.) Side-lying D.) Semi-Fowler's

Answer: B.) Prone Rationale: The nurse is alert for early reports of back pain, which occurs in the region of the tumor. The pain typically increases when the client is in the prone position.

A client with a cervical disc herniation in the acute phase reports of numbness and tingling in the arms. What are the priority interventions for the nurse to perform? Select all that apply. - Have the client wear a cervical collar daily - Assist the client in isometric exercises of the arms - Provide NSAID therapy - Encourage weight lifting to strengthen arms - Encourage exercises to strengthen the legs

Answer: - Have the client wear a cervical collar daily - Provide NSAID therapy Rationale: During the acute phase, the nurse should assist the client in wearing a cervical collar daily. The administration of nonsteroidal anti-inflammatory drugs (NSAIDs) will assist the client to reduce pain and tissue swelling. Isometric exercises should not be started during the acute phase, and weight lifting exercises are never appropriate. Strengthening the legs will not assist in this condition and exercise should be very limited during the acute phase of this condition.

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

Answer: A.) Mannitol

Impaired balance and uncontrolled tremors of Parkinson's disease is correlated with which neurotransmitter? A.) Glutamate B.) Acetylcholine C.) Dopamine D.) Serotonin

Answer: C.) Dopamine

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 patterns B.) Unusual sensitivity to heat and cold C.) Visual disturbances D.) Increased intracranial pressure

Answer: D.) Increased intracranial pressure

Bone density testing in clients with post-polio syndrome has demonstrated A.) osteoarthritis. B.) calcification of long bones. C.) no significant findings. D.) low bone mass and osteoporosis.

Answer: D.) low bone mass and osteoporosis. Rationale: Bone density testing in clients with post-polio syndrome has demonstrated low bone mass and osteoporosis. Thus, the importance of identifying risks, preventing falls, and treating osteoporosis must be discussed with clients and their families.

What nursing intervention will best assist the client with chorea? A.) Monitor the client on bed rest B.) Assist the client with walking hourly C.) Keep an oral airway at the bedside D.) Administer pain medications every 4 hours

Answer; A.) Monitor the client on bed rest Rationale: Chorea is a rapid, jerky, involuntary, purposeless movement of the extremities that interferes with walking, sitting, and activities of daily living. It can involve facial muscles. For safety reasons, the client should be monitored on bed rest.

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.

Answer: A.) The client with Huntington disease. Rationale; 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 assessing a client with a confirmed spinal cord tumor. The client states, "I've been too embarrassed to tell anyone but, I have been awakened at night because I've wet the bed." It would be a priority for the nurse to further assess the client for which complication? A.)Urinary tract infection B.) Spinal cord compression C.) Knowledge deficit D.) Impaired skin integrity

Answer: B.) Spinal cord compression

A 37-year-old mother of three has just been diagnosed with a grade I meningioma. As part of patient education, the nurse tells the patient that: A.) The tumor is malignant and aggressive. B.) The tumor will cause pressure on the eighth cranial nerve. C.) Growth is slow and symptoms are caused by compression rather than tissue invasion. D.) Surgery, which can result in complete removal of the possible tumor, should be done as soon as possible.

Answer: C.) Growth is slow and symptoms are caused by compression rather than tissue invasion.

The nurse teaches the client that corticosteroids will be used to treat his brain tumor to A.) prevent extension of the tumor. B.) facilitate regeneration of neurons. C.) reduce cerebral edema. D.) identify the precise location of the tumor.

Answer: C.) reduce cerebral edema.

A client with spinal cord compression from a tumor must undergo diagnostic testing. Which of the following is the most likely procedure for this client? A.) Core needle biopsy B.) Ultrasonography C.) Computed tomography D.) Magnetic resonance imaging

Answer: D.) Magnetic resonance imaging Rationale: Magnetic resonance imaging is the most commonly used diagnostic procedure. It is the most sensitive diagnostic tool that is particularly helpful in detecting epidural spinal cord compression and vertebral bone metastases.

The nurse is caring for a patient with Huntington's disease in the long-term care facility. What does the nurse recognize as the most prominent symptom of the disease that the patient exhibits? A.) Rapid, jerky, involuntary movements B.) Slow, shuffling gait C.) Dysphagia and dysphonia D.) Dementia

Answer; A.) Rapid, jerky, involuntary movements Rationale: The most prominent clinical features of the disease are chorea (rapid, jerky, involuntary, purposeless movements), impaired voluntary movement, intellectual decline, and often personality changes (Aubeeluck & Wilson, 2008).

Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem? A.) Parkinson disease B.) Amyotrophic lateral sclerosis C.) Alzheimer disease D.) Huntington disease

Answer; B.) Amyotrophic lateral sclerosis Rationale: Amyotrophic lateral sclerosis (ALS) is a disease of unknown cause in which there is a loss of motor neurons in the anterior horns of the spinal cord and the motor nuclei of the lower brain stem. Parkinson disease is a slowly progressing neurologic movement disorder that eventually leads to disability. Alzheimer disease is a chronic, progressive, and degenerative brain disorder that is accompanied by profound effects on memory, cognition and ability for self-care. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia.

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

Answer: A.) Intracerebral hemorrhage

The nurse is seeing a client in the oncology outpatient clinic. The client has recently been diagnosed with grade I meningioma. The client asks, "Is there a cure for my condition?" How should the nurse respond? A.) "For most clients, surgery is an effective treatment for this type of tumor." B.) "Radiation and chemotherapy are good treatment options for this type of tumor." C.) "You will need to speak to your doctor regarding questions about your prognosis." D.) "This type of tumor is fast growing and difficult to treat."

Answer: A.) "For most clients, surgery is an effective treatment for this type of tumor." Rationale: During this client interaction, it is important that the nurse provide the newly diagnosed client with facts about the condition and use a method of communicating that helps to reduce the client's anxiety. The nurse can accomplish this by telling the client that the type of tumor that client has been diagnosed with responds well to surgery, because this is true. Grade I meningiomas are the most common type and can be cured by surgery. Radiation and chemotherapy are not used in the treatment of grade I meningiomas. The main treatment is surgery. The nurse should communicate this to the client. To tell the client to speak to the doctor limits the therapeutic effectiveness of the nurse-client relationship. The nurse should provide accurate information about the diagnosis without being too specific. Although the nurse should encourage the client to speak to the doctor, it is important to provide as much client teaching as possible. It is incorrect to tell the client that the tumor is fast growing and difficult to treat. Grade 1 meningiomas are slow growing and respond well to surgery.

The nurse is caring for a client who underwent surgery to remove a spinal cord tumor. When conducting the postoperative assessment, the nurse notes the presence of a bulge at the surgical site. The nurse suspects the client is experiencing what complication from the surgery? A.) Cerebrospinal fluid leakage B.) Infection at the surgical site C.) Growth of a secondary tumor D.) Impaired tissue healing

Answer: A.) Cerebrospinal fluid leakage Rationale: Bulging at the incision may indicate a contained cerebrospinal fluid (CSF) leak. The site should be monitored for increasing bulging, known as pseudomeningocele, which may require surgical repair. Infection at the surgical site should be suspected if the surgical dressing is stained. The bulge does not indicate growth of secondary tumor, this can only be identified using diagnostic imaging. Impaired tissue healing would be indicated if the nurse assessed redness, swelling and warmth at the surgical site during a dressing change. The bulge at the site warrants further assessment of a postsurgical leak of CSF.

A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following? A.) Dyskinesia B.) Bradykinesia C.) Micrographia D.) Dysphonia

Answer: A.) Dyskinesia

A client is diagnosed with a brain angioma. When teaching the client about the risks associated with this type of brain tumor, the nurse would educate about signs and symptoms associated with which condition? A.) Hemorrhagic stroke B.) Thyroid disorders C.) Hearing loss D.) Visual loss

Answer: A.) Hemorrhagic stroke

A patient with a brain tumor is complaining of headaches that are worse in the morning. What does the nurse know could be the reason for the morning headaches? A.) Increased intracranial pressure B.) Dehydration C.) Migraines D.) The tumor is shrinking.

Answer: A.) Increased intracranial pressure

A patient is diagnosed with an aggressive, primary malignant brain tumor. The nurse is aware that the glioma: A.) Originated within the brain tissue. B.) Originated from the coverings of the brain. C.) Developed on the cranial nerves. D.) Metastasized from a cancer in another part of the body.

Answer: A.) Originated within the brain tissue.

The nurse cares for a client with Huntington disease. What intervention is a priority for safe care? A.) Protecting the client from falls B.) Measuring electrolytes C.) Assessing serum cholesterol D.) Range-of-motion exercises

Answer: A.) Protecting the client from falls Rationale: The client with Huntington disease has a risk for injury from falls and skin breakdown. Protecting the client from falls is a priority for safe care. Electrolyte and cholesterol monitoring is not a priority for this condition. Range-of-motion exercises will not protect the client from injuries.

A patient with myasthenia gravis is in the hospital for treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide on time. The nurse gets busy and does not administer the medication until after breakfast. What outcome will the patient have related to this late dose? A.) The muscles will become fatigued and the patient will not be able to chew food or swallow pills. B.) There should not be a problem, since the medication was only delayed by about 2 hours. C.) The patient will go into cardiac arrest. D.) The patient will require a double dose prior to lunch.

Answer: A.) The muscles will become fatigued and the patient will not be able to chew food or swallow pills.

The nurse is seeing the mother of a client who states, "I'm so relieved because my son's doctor told me his brain tumor is benign." The nurse knows what is true about benign brain tumors? A.) They can affect vital functioning. B.) They do not require surgical removal. C.) The prognosis is very poor. D.) They are all metastatic.

Answer: A.) They can affect vital functioning.

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

Answer: A.) Thyroid-stimulating hormone Rationale: 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 seeing a client who is suspected of having a glioblastoma multiforme tumor. The nurse anticipates the client will require which diagnostic test to confirm the client has this form of brain tumor? A.) Tissue biopsy B.) Weber and Rinne test C.) Audible bruit over the skull D.) An increase in prolactin

Answer: A.) Tissue biopsy

A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order: A.) electromyography (EMG). B.) Doppler scanning. C.) Doppler ultrasonography. D.) quantitative spectral phonoangiography.

Answer: A.) electromyography (EMG). Rationale; To help confirm ALS, the physician typically orders EMG, which detects abnormal electrical activity of the involved muscles. To help establish the diagnosis of ALS, EMG must show widespread anterior horn cell dysfunction with fibrillations, positive waves, fasciculations, and chronic changes in the potentials of neurogenic motor units in multiple nerve root distribution in at least three limbs and the paraspinal muscles. Normal sensory responses must accompany these findings. Doppler scanning, Doppler ultrasonography, and quantitative spectral phonoangiography are used to detect vascular disorders, not muscular or neuromuscular abnormalities.

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."

Answer: B.) "The surgeon will be able to remove all of the tumor." Rationale: 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.

The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding? A.) Dysphagia B.) Dysphonia C.) Hypokinesia D.) Micrographia

Answer: B.) Dysphonia

A client with a brain tumor experiences projectile vomiting. The nurse integrates understanding of this occurrence as resulting from which of the following? A.) Edema associated with the tumor B.) Irritation of the medullary vagal centers C.) Compression of surrounding structures D.) Distortion of pain-sensitive structures

Answer: B.) Irritation of the medullary vagal centers Rationale: Vomiting associated with a brain tumor is usually the result of irritation of the vagal centers in the medulla. Edema secondary to the tumor or distortion of the pain-sensitive structures is thought to be the cause of the headache associated with brain tumors. Compression of the surrounding structures results in the signs and symptoms of increased intracranial pressure.

The daughter of a patient with Huntington's disease asks the nurse what the risk is of her inheriting the disease. What is the best response by the nurse? A.) "The disease is not hereditary and therefore there is no risk to you." B.) "If one parent has the disorder, there is an 75% chance that you will inherit the disease." C.) "If one parent has the disorder, there is a 50% chance that you will inherit the disease." D.) "The disease is inherited and all offspring of a parent will develop the disease."

Answer: C.) "If one parent has the disorder, there is a 50% chance that you will inherit the disease."

A client with post-polio syndrome displays fatigue and decreased muscle strength. How should the nurse best respond to the client? A.) "This will pass, you need to relax." B.) "Once you sleep, you should be fine." C.) "Intravenous immunoglobulin infusion may help you." D.) "These symptoms are not related to your past diagnosis."

Answer: C.) "Intravenous immunoglobulin infusion may help you." Rationale: There is no specific treatment for post-polio syndrome; however, the infusion of IV immunoglobulin has been shown to help with the physical pain and weakness. Sleeping and relaxation may not assist the client with post-polio syndrome. The syndrome is very common and is most likely related to the past diagnosis of polio.

A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond? A.) "You should ask your physician about that." B.) "The strength of your arms and pelvic muscles will decrease gradually, but this should cause only slight disability." C.) "You may experience progressive deterioration in all voluntary muscles." D.) "This form of muscular dystrophy is a relatively benign disease that progresses slowly."

Answer: C.) "You may experience progressive deterioration in all voluntary muscles." Rationale: The nurse should tell the client that muscular dystrophy causes progressive, symmetrical wasting of skeletal muscles, without neural or sensory defects. The mixed form of the disease typically strikes between ages 30 and 50 and progresses rapidly, causing deterioration of all voluntary muscles. Because the client asked the nurse this question directly, the nurse should answer and not simply refer the client to the physician. Limb-girdle muscular dystrophy causes a gradual decrease in arm and pelvic muscle strength, resulting in slight disability. Facioscapulohumeral muscular dystrophy is a slowly progressive, relatively benign form of muscular dystrophy; it usually arises before age 10.

A client is admitted reporting low back pain. How will the nurse best determine if the pain is related to a herniated lumbar disc? A.) Ask the client if there is pain on ambulation. B.) Ask if the client can walk. C.) Have the client lie on the back and lift the leg, keeping it straight. D.) Ask if the client has had a bowel movement.

Answer: C.) Have the client lie on the back and lift the leg, keeping it straight. Rationale: A client who can lie on the back and raise a leg in a straight position will have pain radiating into the leg if there is a herniated lumbar disc. This action stretches the sciatic nerve. The client may also have muscle weakness and decreased tendon reflexes and sensory loss. The client should still be able to walk, and have bowel movements, so this assessment will not assist the nurse to confirm the diagnosis. Pain on ambulation is also not specific to this condition.

A nurse is caring for a client with a pituitary adenoma. Which laboratory test result suggests that a client has a corticotropin-secreting pituitary adenoma? A.) High corticotropin and low cortisol levels B.) Low corticotropin and high cortisol levels C.) High corticotropin and high cortisol levels D.) Low corticotropin and low cortisol levels

Answer: C.) High corticotropin and high cortisol levels Rationale: Pituitary adenomas secrete excess amounts of hormones, including adrenocortical-tropic hormone, resulting in Cushing syndrome, in which a corticotropin-secreting pituitary tumor causes high corticotropin and high cortisol levels. A high corticotropin level with a low cortisol level and a low corticotropin level with a low cortisol level are associated with hypocortisolism. A primary defect in the adrenal glands causes low corticotropin and high cortisol levels.

A 55-year-old female client presents at the walk-in clinic complaining of feeling like a mask is on her face. While doing the initial assessment, the nurse notes the demonstration of a pill-rolling movement in the right hand and a stooped posture. Physical examination shows bradykinesia and a shuffling gait. What would the nurse suspect is the causative factor for these symptoms? A.) Multiple sclerosis B.) Myasthenia gravis C.) Parkinson's disease D.) Huntington's disease

Answer: C.) Parkinson's disease

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."

Answer: 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."

The nurse is caring for a client who was diagnosed with a glioma 5 months ago. Today, the client was brought to the emergency department by his caregiver because he collapsed at home. The nurse suspects late signs of rising intracranial pressure (ICP) when which blood pressure and pulse readings are noted? A.) BP = 90/50 mm Hg; HR = 75 bpm B.) BP =130/80 mm Hg; HR = 55 bpm C.) BP = 150/90 mm Hg; HR = 90 bpm D.) BP = 175/45 mm Hg; HR = 42 bpm

Answer: D.) BP = 175/45 mm Hg; HR = 42 bpm Rationale: With a blood pressure of 175/45 mm Hg, it is evident that this client is experiencing progressively rising ICP, resulting from an advanced stage of the brain tumor. This blood pressure demonstrates a wide pulse pressure, meaning the difference between systolic and diastolic pressure is large. A heart rate of 42 bpm indicates the client is bradycardic. This finding paired with hypertensive blood pressure with a widening pulse pressure are part of the Cushing triad related to increased ICP.

The nursing instructor gives their students an assignment of making a plan of care for a client with Huntington's disease. What would be important for the students to include in the teaching portion of the care plan? A.) How to exercise B.) How to perform household tasks C.) How to take a bath D.) How to facilitate tasks such as using both hands to hold a drinking glass

Answer: D.) How to facilitate tasks such as using both hands to hold a drinking glass Rationale: The nurse demonstrates how to facilitate tasks such as using both hands to hold a drinking glass, using a straw to drink, and wearing slip-on shoes. The teaching portion of the care plan would not include how to exercise, perform household tasks, or take a bath.

The nurse is providing postoperative care for a client who just underwent surgery to remove a metastatic intramedullary tumor. On postoperative day 3, the client states, "I am really looking forward to going running again, it had become too difficult because of the loss of feeling in my feet." Which should the nurse address in the client's care plan? A.) Body image disturbance B.) Anxiety C.) Impaired cognition D.) Knowledge deficit

Answer: D.) Knowledge deficit Rationale: Clients with extensive neurologic deficits before surgery usually do not make significant functional recovery, even after successful tumor removal. In this case, the client had already developed bilateral sensory loss in the lower extremities indicating the fairly progressed impact of the tumor on the client's functional ability. The client's statement reflects a knowledge deficit and it is a priority to provide information regarding the possibility that lower extremity sensation may not return. Although body image disturbance and anxiety may be identified and addressed. This would occur after the client demonstrates an accurate understanding of loss of functional capabilities as a result of the progressed tumor. Ensuring the client understands the extent of functional loss due to the impact of the tumor is a priority. The client does not demonstrate impaired cognition.