Hinkle 70 Management of Patients With Oncologic or Degenerative Neurologic Disorders
Which of the following outcomes would be most appropriate to include in the plan of care for a client diagnosed with a muscular dystrophy? -Client describes the importance of diagnostic follow-up to evaluate the disorder. -Client verbalizes understanding of the chronic nature of the disorder. -Client participates in activities of daily living using adaptive devices. -Client demonstrates understanding of the need to adhere to medication therapy.
Client participates in activities of daily living using adaptive devices. pg. 2072
An acoustic neuroma is a benign tumor of which cranial nerve?
Eighth pg. 2053
A patient is admitted complaining of low back pain. What will best assist the nurse in determining if the pain is related to a herniated lumbar disc?
Have the patient lie on his back and lift his leg, keeping it straight.
Which disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive, involuntary dancelike movements and dementia?
Huntington disease pg. 2069
A nurse is providing care to a client who has been diagnosed with metastatic brain cancer. When developing the client's plan of care, which outcome would the nurse most likely identify? -Improved quality of life -Removal of all or part of the tumor -Elimination of distressing signs and symptoms -Reduced incidence of recurrence
Improved quality of life The treatment of metastatic brain cancer is palliative and involves eliminating or reducing serious symptoms. Even when palliation is the goal, distressing signs and symptoms can be relieved, thereby improving the quality of life for both client and family. Removal of all or part of the tumor is the goal of surgery. Radiation therapy attempts to decrease the incidence of recurrence of incompletely resected tumors.
Which of the following is the only known risk factor for brain tumors?
Ionizing radiation
A male client who has undergone a cervical discectomy is being discharged with a cervical collar. Which of the following would be most appropriate to include the client's discharge plan? -Removing the entire collar when shaving -Wearing the cervical collar when sleeping -Moving the neck from side to side when the collar is off -Keeping the head in a neutral position
Keeping the head in a neutral position After a cervical discectomy, the client typically wears a cervical collar. The client should be instructed to keep his head in a neutral position and wear the collar at all times unless the physician has instructed otherwise. The front part of the collar is removed for shaving and the neck should be kept still while the collar is open or off.
Bone density testing will be completed for the client with post-polio syndrome. The nurse teaches the client bone density testing is used to identify what potential complication? -Calcification of long bones -Osteoarthritis =Pathologic fractures -Low bone mass and osteoporosis
Low bone mass and osteoporosis Explanation: 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.
A client with muscle weakness and an abnormal gait is being evaluated for muscular dystrophy. Which test or finding confirms muscular dystrophy?
Muscle biopsy
A client seeks care for lower back pain of 2 weeks' duration. Which assessment finding suggests a herniated intervertebral disk?
Pain radiating down the posterior thigh pg. 2073-2074.
Which term is used to describe edema of the optic nerve? -Scotoma -Papilledema -Angioneurotic edema -Lymphedema
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 is caring for a patient with Huntington disease. What intervention is a priority for safe care? -Range-of-motion exercises -Measuring electrolytes -Assessing serum cholesterol -Protecting the client from fall
Protecting the client from falls 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.
Which of the following statements reflect nursing interventions of a patient with post-polio syndrome?
Providing care aimed at slowing the loss of strength and maintaining the physical, psychological and social well being of the patient
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? -Rapid, jerky, involuntary movements -Dementia -Slow, shuffling gait -Dysphagia and dysphonia
Rapid, jerky, involuntary movements The most prominent clinical features of the disease are chorea (rapid, jerky, involuntary, purposeless movements), impaired voluntary movement, intellectual decline, and often personality changes
A client has undergone surgery for a spinal cord tumor that was located in cervical area. The nurse would be especially alert for which of the following? -Respiratory dysfunction -Hemorrhage -Skin breakdown -Bowel incontinence
Respiratory dysfunction When a spinal tumor is located in the cervical area, respiratory compromise may occur from postoperative edema. Hemorrhage would be a concern with any surgery. Bowel incontinence and skin breakdown are possible but not specific to cervical spinal tumors.
Which of the following provides the best outcome for most tumor types?
Surgery
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? -Immunotherapy -Surgery -Chemotherapy -Radiation therapy
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.
A patient with Parkinson's disease is experiencing an on-off syndrome. What does the nurse recognize that the patient's clinical symptoms will be?
The patient will have periods of near immobility, followed by a sudden return of effectiveness of the medication. pg. 2064
A nurse is working on a surgical floor. The nurse must logroll a client following a: -hemorrhoidectomy. -thoracotomy. -cystectomy. -laminectomy.
laminectomy. The client who has had spinal surgery, such as laminectomy, must be logrolled to keep the spinal column straight when turning. The client who has had a thoracotomy or cystectomy may turn himself or may be assisted into a comfortable position. Under normal circumstances, hemorrhoidectomy is an outpatient procedure, and the client may resume normal activities immediately after surgery.
A nurse knows that a patient exhibiting seizure-like movements localized to one side of the body most likely has what type of tumor?
A motor cortex tumor
A patient is diagnosed with an aggressive, primary malignant brain tumor. The nurse is aware that the glioma:
Originated within the brain tissue.
Bone density testing in patients with post-polio syndrome has demonstrated.
low bone mass and osteoporosis.
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? -Offering family support groups -Optimizing nutrition -Explaining hospice care and services -Managing muscle weakness
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.
A client is admitted reporting low back pain. How will the nurse best determine if the pain is related to a herniated lumbar disc? -Ask if the client has had a bowel movement. -Have the client lie on the back and lift the leg, keeping it straight. -Ask the client if there is pain on ambulation. -Ask if the client can walk.
Have the client lie on the back and lift the leg, keeping it straight. 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.
Which of the following is a disease in which there is a loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem?
Amyotrophic lateral sclerosis (ALS)
A patient is diagnosed with a spinal cord tumor and has had a course of radiation and chemotherapy. Two months after the completion of the radiation, the patient complains of severe pain in the back. What is pain an indicator of in a patient with a spinal cord tumor?
Spinal metastasis pg. 2062
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? -"Any tissue that was dead will be removed." -"My headache and nausea should be lessened somwhat." -"The surgeon will be able to remove all of the tumor." -"There will be less cancer left that might be resistant to chemotherapy."
"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 theorectically leaves behind fewer cells to become resistant to radiation or chemotherapy.
A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurologic symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period? -Have the client sit up in a chair as much as possible. -Logroll the client from side to side. -Elevate the head of the bed to 90 degrees. -Discourage the client from doing any range-of-motion (ROM) exercises.
Logroll the client from side to side. Logrolling the client maintains alignment of his hips and shoulders and eliminates twisting in his operative area. The nurse should encourage ROM exercises to maintain muscle strength. Because of pressure on the operative area, having the client sit up in a chair or with the head of the bed elevated should be allowed only for short durations.
Which diagnostic is most commonly used for spinal cord compression? -Positron emission tomography (PET) -Magnetic resonance imaging (MRI) -X-ray -Computed tomography (CT)
Magnetic resonance imaging (MRI) pg. 2056
Nursing students are reviewing information about Parkinson's disease in preparation for class the next day. The students demonstrate understanding of the material when they identify which of the following as a cardinal sign of this disorder? Select all that apply.
Tremor, Ridigity, Bradykinesia,Postural instability
A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action?
Turning the client from side to side, using the logroll technique
A patient diagnosed with a tumor in the cerebellar region would expect to have changes in which of the following?
Balance and coordination
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?
"If one parent has the disorder, there is a 50% chance that you will inherit the disease." pg. 2069
Which of the following diagnostic studies provides visualization of cerebral blood vessels? -Positron emission tomography (PET) -Computer-assisted stereotactic biopsy -Cerebral angiography -Cytologic studies of cerebrospinal fluid (CSF)
Cerebral angiography Cerebral angiography provides visualization of cerebral blood vessels and can localize most cerebral trauma. A PET scan measures the brain's activity and is useful in differentiating tumor from scar tissue or radiation necrosis. Cytologic studies of the cerebral spinal fluid (CSF) may be performed to detect malignant cells because central nervous system tumors can shed cells into the CSF. Computer-assisted stereotactic biopsy is being used to diagnose deep-seated brain tumors.
The nurse identifies a nursing diagnosis of self-care deficit, bathing related to motor impairment and decreased cognitive function for a client with cerebral metastasis. Which outcome would the nurse most likely identify on this client's plan of care?
Client participates in daily hygiene activities with assitive devices.
A client with a brain tumor experiences projectile vomiting. The nurse integrates understanding of this occurrence as resulting from which of the following? -Distortion of pain-sensitive structures -Compression of surrounding structures -Irritation of the meduallary vagal centers -Edema associated with the tumor
Irritation of the meduallary vagal centers 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.
A client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by:
performing capillary glucose testing every 4 hours. pg. 1880
A client diagnosed with Huntington's disease has developed severe depression. What would be most important for the nurse to assess for? -Choreiform movements -Emotional apathy -Loss of bowel and bladder control -Suicidal ideations
Suicidal ideations Severe depression is common and can lead to suicide, so it is most important for the nurse to assess for suicidal ideations. Symptoms of Huntington's disease develop slowly and include mental apathy and emotional disturbances, choreiform movements (uncontrollable writhing and twisting of the body), grimacing, difficulty chewing and swallowing, speech difficulty, intellectual decline, and loss of bowel and bladder control. Assessing for these symptoms is appropriate, but not as important as assessing for suicidal ideations.
The nurse is caring for a client hospitalized after a motor vehicle accident. The client has a comorbidity of Parkinson's disease. Why should the nurse closely monitor the condition and the drug regimen of a client with Parkinson's disease? -Drugs administered may cause a wide variety of adverse effects. -Drugs administered may not cause the requisite therapeutic effect. -Clients generally do not adhere to the drug regimen. -Clients take an assortment of different drugs.
Drugs administered may cause a wide variety of adverse effects. Drugs administered for Parkinsonism may cause a wide variety of adverse effects, which requires careful observation of the client. Over time, clients may respond less and less to their standard drug therapy and have more frequent "off episodes" of hypomobility. As a result, the nurse should administer the drugs closely to the schedule. Generally, a single drug called levodopa is administered to clients with Parkinson's disease. It is also not true that drugs may not cause the requisite therapeutic effect or such clients do not adhere to the drug regimen.
Impaired balance and uncontrolled tremors of Parkinson's disease is correlated with which neurotransmitter? -Glutamate -Dopamine -Serotonin -Acetylcholine
Dopamine The impaired balance and uncontrolled tremors of Parkinson's disease have been linked with low levels of dopamine. The other neurotransmitters have not been implicated in Parkinson's disease in this manner.
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? -Dysphonia -Hypokinesia -Micrographia -Dysphagia
Dysphonia Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech.
A client with cerebral metastasis suddenly experiences a seizure for which phenytoin 10 mg/kg intravenously is ordered as an initial loading dose. The client weighs 165 pounds. How many milligrams of phenytoin should the client receive?
750 First, change the client's weight in pounds to kilograms by dividing the weight by 2.2 (2.2 pounds = 1 kg). The client's weight is 75 kg. Next, set up a proportion: 10/1 = x/75; cross multiply and solve for x, which is 750.
The nurse reviews the patient's drug regimen for treatment of a brain tumor. She explains to the patient why one of the following drugs would not be prescribed, even though it might have therapeutic benefits. Which drug would not be prescribed for this patient?
Coumadin pg. 2057
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? -How to facilitate tasks such as using both hands to hold a drinking glass -How to take a bath -How to exercise -How to perform household tasks
How to facilitate tasks such as using both hands to hold a drinking glass 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.
A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis? -Hypoactive bowel sounds -Weakness and atrophy of the arm muscles -Sensory deficits in one arm -Severe lower back pain
Severe lower back pain The most common finding in a client with a herniated lumbar disk is severe lower back pain, which radiates to the buttocks, legs, and feet — usually unilaterally. A herniated disk also may cause sensory and motor loss (such as footdrop) in the area innervated by the compressed spinal nerve root. During later stages, it may cause weakness and atrophy of leg muscles. The condition doesn't affect bowel sounds or the arms.
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? -Magnetic resonance imaging -Ultrasonography -Computed tomography -Core needle biopsy
Magnetic resonance imaging 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.
Which of the following is a late symptom of spinal cord compression? -Urinary retention -Fecal incontinence -Paralysis -Urinary incontinence
Paralysis Later symptoms include evidence of motor weakness and sensory deficits progressing to paralysis. Early symptoms associated with spinal cord compression include bladder and bowel dysfunction (urinary incontinence or retention; fecal incontinence or constipation).
Which of the following diseases is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain?
Parkinson's disease
In which location are most brain angiomas located? -Hypothalamus -Brainstem -Cerebellum -Thalamus
Cerebellum Brain angiomas occur most often in the cerebellum. Most brain angiomas do not occur in the hypothalamus, thalamus, or brainstem (midbrain, pons, medulla).
A client comes to the clinic for evaluation because of complaints of dizzinesss 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? -Frontal lobe -Motor cortex -Occipital lobe -Cerebellum
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 seizurelike movements localized on one side of the body. Occipital lobe tumors produce visual manifestations.
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: -Surgery, which can result in complete removal of the possible tumor, should be done as soon as possible. -The tumor will cause pressure on the eighth cranial nerve. -The tumor is malignant and aggressive. -Growth is slow and symptoms are caused by compression rather than tissue invasion.
Growth is slow and symptoms are caused by compression rather than tissue invasion. A meningioma is benign, encapsulated, and slow-growing. Sometimes the patient has no symptoms because of the slow-growing nature of the tumor.
A health care provider needs help in identifying the precise location of a brain tumor. To measure brain activity, as well as to determine structure, the nurse expects the health care provider to order which of the following tests?
Positron-emission tomography (PET)
Which of the following statements indicate appropriate nursing intervention for a patient with postpolio syndrome?
Providing care aimed at slowing the loss of strength and maintaining overall well-being.
Which statement(s) reflect nursing interventions for a client with post-polio syndrome? -The nurse plans patient activities for evening hours rather then morning hours -The nurse provides care aimed at slowing the loss of strength and maintaining the physical, psychological and social well being of the client -The nurse administers antiretroviral agents per order. -The nurse must avoid the use of heat applications in the treatment of muscle and joint pain
The nurse provides care aimed at slowing the loss of strength and maintaining the physical, psychological and social well being of the client No specific medical or surgical treatment is available for this syndrome and therefore nursing plays a pivotal role in the team approach to assisting clients and families in dealing with the symptoms of progressive loss of muscle strength and significant fatigue. Nursing interventions are aimed at slowing the loss of strength and maintaining the physical, psychological and social well being of the client. Clientss need to plan and coordinate activities to conserve energy and reduce fatigue. Important activities should be planned for the morning as fatigue often increases in the afternoon and evening. Pain in muscles and joints may be a problem. Nonpharmacologic techniques such as the application of heat and cold are most appropriate because these clients tend to have strong reactions to medications.
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? -"The strength of your arms and pelvic muscles will decrease gradually, but this should cause only slight disability." -"You may experience progressive deterioration in all voluntary muscles." -"You should ask your physician about that." -"This form of muscular dystrophy is a relatively benign disease that progresses slowly."
"You may experience progressive deterioration in all voluntary muscles." 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 patient with Parkinson's disease asks the nurse what can be done to prevent problems with bowel elimination. What would be an intervention that would assist this patient with a regular stool pattern?
Adopt a diet with moderate fiber intake pg.
A patient has recently been diagnosed with an acoustic neuroma. The nurse helps the patient understand that: -Hearing loss usually occurs. -Surgery is never needed; radiation has proven very effective. -Almost 80% of these tumors become malignant over time. -Compression of the seventh cranial nerve is a side effect.
Hearing loss usually occurs. An acoustic neuroma is a benign tumor of the eighth cranial nerve. About 50% can be treated with surgery. Hearing loss always occurs. Compression on the fifth cranial nerve can also cause facial paresthesia.
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?
Increased intracranial pressure
A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement? -Related to visual field deficits -Related to difficulty swallowing -Related to impaired balance -Related to psychomotor seizures
Related to impaired A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe — not from a cerebellar brain tumor. Difficulty swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe dysfunction.
Which patient will the nurse assess for degenerative neurologic symptoms? -The client with glioma. -The client with Huntington disease. -The client with osteomyelitis. -The client with Paget disease.
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.
