CH 65 Degen Neuro Disorders

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 132 pounds. How many milligrams of phenytoin should the client receive? Enter the number ONLY.

600 BECAUSE MATH

In which location are most brain angiomas located?

Cerebellum Brain angiomas occur most often in the cerebellum. Most brain angiomas do not occur in the hypothalamus, thalamus, or brainstem (midbrain, pons, medulla).

An acoustic neuroma is a benign tumor of which cranial nerve?

Eighth An acoustic neuroma is a benign tumor of the eighth cranial nerve, the cranial nerve most responsible for hearing and balance.

Which of the following is a hallmark of spinal metastases?

Pain Pain is the hallmark of spinal metastases. Nausea, fatigue, and change in LOC may occur, but these are not the hallmark of spinal metastases.

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 Pain is the hallmark of spinal metastasis. Patients with sensory root involvement may suffer excruciating pain, which requires effective pain management.

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?

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 amyotrophic lateral sclerosis (ALS) asks if the nurse has heard of a drug that will prolong the patient's life. The nurse knows that there is a medication that may prolong the life by 3 to 6 months. To which medication is the patient referring?

Riluzole Riluzole, a glutamate antagonist, has been shown to prolong survival for persons with ALS for 3 to 6 months.

A patient has been diagnosed with a brain tumor, a glioblastoma multiforme. The nurse met with the family after the diagnosis to help them understand that:

Surgery can improve survival time but the results are not guaranteed. The overall prognosis for this type of aggressive brain tumor is poor but surgery can improve survival time.

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?

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.

A patient has been diagnosed with a lipoma. The nurse explains to the patient that this tumor is located in the part of the brain known as the:

Corpus callosum. The corpus callosum is a thick collection of nerve fibers that connect both hemispheres of the brain and is responsible for transmitting information from one side of the brain to another. A lipoma only occurs in this area.

Nursing students are reviewing the various types of brain tumors. The students demonstrate understanding of the material when they identify which of the following as the most common type?

Gliomas Gliomas are the most common type of intracerebral brain tumor. Meningiomas account for approximately 15% of all primary brain tumors. Pituitary adenomas represent approximately 10% to 15% of all brain tumors. Acoustic neuromas are less common.

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 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.

A client diagnosed with Huntington's disease has developed severe depression. What would be most important for the nurse to assess for?

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.

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?

Hemorrhagic stroke Brain angiomas (masses composed largely of abnormal blood vessels) are found either in the brain or on its surface. Because the walls of the blood vessels in angiomas are thin, affected clients are at risk for hemorrhagic stroke. Pituitary adenomas that produce hormones can lead to endocrine disorders, such as thyroid disorders. In addition, they can exert pressure on the optic nerves and optic chiasm, leading to vision loss. Acoustic neuromas are associated with hearing loss.

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 A herniated intervertebral disk may compress the spinal nerve roots, causing sciatic nerve inflammation that results in pain radiating down the leg. Slight knee flexion should relieve, not precipitate, lower back pain. If nerve root compression remains untreated, weakness or paralysis of the innervated muscle group may result; lower leg atrophy may occur if muscles aren't used. Homans' sign is more typical of phlebothrombosis.

The nurse is seeing a client who has just been diagnosed with a grade I meningioma. The nurse is correct when stating what information about the client's diagnosis?

"Grade 1 is the most common type of this tumor." Grade I meningiomas are the most common of meningioma and can be cured by surgery. Grades II and III are less common and grow quickly. They can spread to the brain and spinal cord. These tumors have a poorer prognosis and usually cannot be completely resected. Despite this information, the nurse should not be making statements about prognosis as this is not within the nurse's scope. Manifestations depend on the area involved and are the result of compression rather than invasion of brain tissue.

Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem?

Amyotrophic lateral sclerosis (ALS) 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.

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 participates in activities of daily living using adaptive devices. The muscular dystrophies are a group of incurable muscle disorders characterized by progressive weakening and wasting of the skeletal or voluntary muscles. Nursing care focuses on maintaining the client at his or her optimal level of functioning and enhancing the quality of life. Therefore, the outcome of participating in activities of daily living with adaptive devices would be most appropriate. Medications are not used to treat these disorders; however, they may be necessary if the client develops a complication such as respiratory dysfunction. The disorder is incurable and progressive, not chronic. Diagnostic follow-up would provide little if any information about the course of the disorder.

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?

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.

Which nursing diagnosis takes the highest priority for a client with parkinsonian crisis?

Ineffective airway clearance In parkinsonian crisis, dopamine-related symptoms are severely exacerbated, virtually immobilizing the client. A client confined to bed during such a crisis is at risk for aspiration and pneumonia. Also, excessive drooling increases the risk of airway obstruction. Because of these concerns, the nursing diagnosis of Ineffective airway clearance takes the highest priority. Although Imbalanced nutrition: Less than body requirements, Impaired urinary elimination, and Risk for injury are also appropriate nursing diagnoses, they aren't immediately life-threatening.

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. The patient may experience an on-off syndrome in which sudden periods of near immobility ("off effect") are followed by a sudden return of effectiveness of the medication ("on effect"). Changing the drug dosing regimen or switching to other drugs may be helpful in minimizing the on-off syndrome.

The nurse is providing a health promotion session on the risk factors for various health conditions. When discussing brain tumors, the nurse should include in the session which known risk factors for brain tumors? Select all that apply.

V----Exposure to certain chemicals V----Having ionizing radiation X----Cigarette smoking X----Cell phone use X----Living close to power lines During this health promotion session, the nurse should be discussing known risk factors for brain tumors, of which there are only two; exposure to cancer-causing chemicals and ionizing radiation. The factors listed in the alternate options are undergoing further investigation and, although research is finding correlations between these factors and brain tumors, further investigation is still required.

Which medication classification should be avoided in the treatment of brain tumors?

Anticoagulants Anticoagulants usually are not prescribed because of the risk for central nervous system (CNS) hemorrhage; however, prophylactic therapy with low-molecular-weight heparin is under investigation. Osmotic diuretics, corticosteroids, and anticonvulsants are utilized in the treatment of brain tumors.

A client with suspected Parkinson disease is initially being assessed by the nurse. When is the best time to assess for the presence of a tremor?

When the client is resting The tremor is present while the client is at rest; it increases when the client is walking, concentrating, or feeling anxious. Resting tremor characteristically disappears with purposeful movement, but is evident when the extremities are motionless. Consequently, the nurse should assess for the presence of a tremor when the client is not performing deliberate actions.

A client newly diagnosed with Huntington diease asks for information concerning management of symptoms. Which action would the nurse first take to address this request?

Perform a focused assessment on the client's needs and capabilities. Nurses must look beyond the disease to focus on the patient's needs and capabilities first. While the client will benefit from the expertise of a Huntington disease multidisciplinary team, it is important to first establish their goals and individual needs. Only after a full assessment should medications be recommended by anyone on a health care team. In clients who present with rigidity, some temporary benefit may be obtained from antiparkinson medications, such as levodopa. Establishing a client's willingness to adhere to treatments is premature until the treatment plan is established. Huntington disease is characterized by a triad of symptoms that include motor dysfunction (the most prominent being chorea), impaired cognition, and behavioral features such as a blunted affect. Huntington disease is a progressive and terminal illness at this time. The focus for this client is optimizing quality of life with available medications and supportive treatments.

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?

"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.

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?

Cerebrospinal fluid leakage 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.

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?

BP = 175/45 mm Hg; HR = 42 bpm 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 nurse is caring for a client postoperatively from a spinal tumor resection. The nurse assesses that the client has partial paralysis. What anticipated problems should the nurse include in the client's care plan? Select all that apply.

V-----Risk for impaired physical mobility V-----Risk for injury V-----Risk for powerlessness X-----Risk for sexual dysfunction V-----Risk for knowledge deficit The change in the client's muscle strength will effect the client's ability to carry out activities that he or she was once used to being able to perform independently. Due to the partial paralysis, the client is now at risk for impaired physical mobility related to a decreased range of motion. The client is at risk for injury due to a possible unsteady gait. The development of partial paralysis is a loss for the client, and there is the potential for feelings of powerlessness related to inability to control situation and being dependent on others. It is not likely that the nurse has been able to accurately assess sexual dysfunction. Not all clients with partial paralysis experience sexual dysfunction because this is dependent on the extent of spinal injury or nerve compression. Given that teaching is needed, it implies that there is a knowledge deficit.

The nurse is providing education to a client who is being discharged with an outpatient treatment plan that includes taking a chemotherapeutic agent. What instructions should the nurse include? Select all that apply.

V------The client should ensure no one else handles the medication. X------If a dose is missed, the client should take double the amount at the regular time the following day. X------The client should seek emergency help if nausea or vomiting occur. V------The client should seek emergency care if he or she develops a fever. V------Hair loss should be expected when taking the medication. The client should be the only person to handle the medication. Because it is a chemotherapy agent, it is cytotoxic and can have a harmful effect on anyone who does not have a tumor. It is unsafe to take a double dose of the medication if it is missed the previous day. The client should be instructed to take the medication at the same time each day and, if a dose is missed, the client should be instructed to take it as soon as possible and then get back on the regular schedule again. Some clients taking this medication experience gastrointestinal side effects such as nausea and vomiting. Although this is not considered an emergency, the client should be instructed to discuss this side effect with the health care provider, because prolonged symptoms can lead to nutritional deficit and/or dehydration. Immunosuppression caused by the medication can lead to a white blood cell count too low to fight off an infection. A fever is a sign of infection and can be life-threatening for a person taking a chemotherapeutic agent. Care should be sought immediately in this case. A common side effect of this medication is alopecia or hair loss. The client should be made aware to anticipate that this is a possibility while taking the drug.

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?

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.

What is the most common type of brain neoplasm?

Glioma Gliomas are the most common brain neoplasms, accounting for about 45% of all brain tumors. Angiomas account for approximately 4% of brain tumors. Meningiomas account for 15% to 20% of all brain tumors. Neuromas account for 7% of all brain tumors.

During assessment of a hospitalized client who is recovering from a cervical discectomy, the client reports sudden and severe pain. Which of the following interventions is the nurse's priority?

Notify the client's surgeon. If a client recovering from cervical discectomy experiences sudden increased pain, the graft may have extruded, requiring reoperation. The nurse should report this finding promptly to the surgeon. The nurse would not change the bandage or give medicine without a surgeon's order.

A nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which finding requires immediate intervention?

Urine retention or incontinence Urine retention or incontinence may indicate cauda equina syndrome, which requires immediate surgery. An increase in back pain is more common because on the second postoperative day the long-acting local anesthetic, which may have been injected during surgery, will wear off. Although paresthesia is common after surgery, progressive weakness or paralysis may indicate spinal nerve compression. A mild fever is also common after surgery but is considered significant only if the temperature reaches 101° F (38.3° C).

The nurse educator is providing orientation to a new group of staff nurses on an oncology unit. Part of the orientation is to help nurses understand the differences between various types of brain tumors. The nurse educator correctly identifies that glioma tumors are classified based on the fact that they originate where in the brain?

Within the brain tissue Gliomas tumors are a type of intracerebral brain neoplasm. They originate within brain tissue. Tumors arising from the coverings of the brain include meningiomas. These tumors grow on the membrane covering of the brain, called the meninges. An acoustic neuroma is an example of tumors that grow out of or on cranial nerves and cause compression leading to sensory deficits. Metastasis refers to spreading of any kind of malignant primary tumor. This term is not specific to any one classification of tumor.

A client who was diagnosed with Parkinson's disease several months ago recently began treatment with levodopa-carbidopa. The client and his family are excited that he has experienced significant symptom relief. The nurse should be aware of what implication of the client's medication regimen?

Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment. The beneficial effects of levodopa therapy are most pronounced in the first year or two of treatment. Benefits begin to wane and adverse effects become more severe over time. However, a "honeymoon period" of treatment is not known.

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 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.

Excessive levels of which neurotransmitter has been implicated in amyotrophic lateral sclerosis (ALS)?

Glutamate Excessive levels of the neuro-excitatory neurotransmitter glutamate have been implicated in the neurodegenerative diseases such as ALS, Huntington's disease, and the sequelae of strokes.

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:

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 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 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 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?

They can affect vital functioning. Benign tumors are usually slow growing but can occur in a vital area, where they can grow large enough to cause serious effects. Surgical removal of a benign tumor is dependent on many factors; even if the tumor is slow growing or not growing at all, the location of the tumor in the brain factors into the decision for surgical removal. The prognosis for all brain tumors is not necessarily poor. Treatment is individualized and can have varying prognostic outcomes. Benign tumors are not metastatic, meaning they do not grow rapidly or spread into surrounding tissue, but they can still be considered life-threatening.

A client has undergone a cervical discectomy. The nurse determines which interventions are essential to teach the client? Select all that apply.

V-----Keep staples or sutures clean and dry V-----Cover incision with dry dressing V-----Call health care provider if the area is red or irritated V-----Avoid twisting or flexing the neck V-----Do not remove dressing until the next visit X-----Sit as much as possible; standing can cause pain The client needs to keep staples or sutures clean and dry and covered with a dry dressing. Symptoms of infection should be reported to the health care provider. Twisting and flexing of the neck should be avoided. The client can remove the dressing to change it. The client should not sit or stand for longer than half an hour at a time.