Ch. 70: Mgmt of Pts w/ Oncologic or Degenerative Neurologic Disorders

The nurse is providing health education to a client recently diagnosed with a brain tumor. During the appointment, the client states, "I'm really worried that I will have a seizure while I am at work or with my kids. Should I be concerned about this?" How should the nurse respond? "Seizures are genetic neurological conditions. Do you have anyone in your family with a seizure disorder? If so, this increases the likelihood you will have one." "There is a risk for seizures in people who have this diagnosis. What have you already discussed with your primary health care provider regarding management of seizures?" "It is not within my scope to discuss this aspect of your care with you. You should talk to your treating primary health care provider about this and discuss options." "60% of people with brain tumors have seizures. There is a strong chance you will have a seizure at some point and should keep a seizure kit close by."

Correct response: "There is a risk for seizures in people who have this diagnosis. What have you already discussed with your primary health care provider regarding management of seizures?" Explanation: In this case, the client is verbalizing a valid concern about management of the potential manifestation of the brain tumor. The nurse should engage the client by providing fact-based information about the probability of seizures caused by effects of brain tumors. The nurse should further engage in the discussion by evaluating the client's existing understanding of the seizures related to brain tumors and the associated management of this problem. The open-ended manner in which the nurse has asked the question in the correct answer option allows the client to reveal any knowledge deficits or gaps in understanding of the condition. Telling the client there is a strong chance that he or she will have a seizure is countertherapeutic and would serve to increase the client's anxiety. The nurse's aim should be to reduce the client's anxiety related to the diagnosis. Telling the client that seizures are a genetic neurological condition is out of context in this situation. The client is worried about having a seizure because he or she has a brain tumor. The nurse should address the concern in the correct context. The nurse is incorrect when stating having this discussion is not within the nurse's scope of practice. The client's verbalized concern presents an opportunity for the nurse to evaluate the client's understanding of the treatment and management of the condition. The nurse should refer the client back to the primary health care provider if there are any aspects of the client's health history that are unclear.

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." "This form of muscular dystrophy is a relatively benign disease that progresses slowly." "You may experience progressive deterioration in all voluntary muscles." "You should ask your physician about that."

Correct response: "You may experience progressive deterioration in all voluntary muscles." Explanation: 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 nurse suspects that a client has Huntington disease based on which assessment finding? Slurred speech Dementia Disorganized gait Chorea

Correct response: Chorea Explanation: The most prominent clincial features of Huntington disease include chorea, intellectual decline, and often emotional disturbance. As the disease progresses, speech becomes slurred, gait becomes disorganized, and cognitive function is altered with dementia.

Impaired balance and uncontrolled tremors of Parkinson's disease is correlated with which neurotransmitter? Glutamate Serotonin Acetylcholine Dopamine

Correct response: Dopamine Explanation: 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.

A client with an incurable brain tumor is experiencing nausea and vomiting and has little interest in eating. His family states, "We don't know how to help him." Which of the following would be appropriate for the nurse to suggest to help improve the client's nutritional intake? Select all that apply. Prepare the client for the insertion of a feeding tube. Place the client near the sounds and smells of meals being prepared. Plan meals for times when the client is rested. Ensure that the client is free of pain for meals. Provide the client with foods that he likes.

Correct response: Ensure that the client is free of pain for meals. Plan meals for times when the client is rested. Provide the client with foods that he likes. Explanation: Suggestions to improve nutrition include making sure that the client is comfortable, free of pain, and rested. This may require family members to adjust meal times. Additionally, they should eliminate offensive sights, sounds, and odors. Therefore, placing the client near sites of meal preparation may be too overwhelming. If the client has difficulty with or shows disinterest in usual foods, the family should offer foods that the client prefers, rather than attempting to get the client to eat as previously. If the client shows marked deterioration, then some other form of nutritional support such as a feeding tube or parenteral nutrition may be indicated, but only if this measure is consistent with the client's choices for care.

Which nursing diagnosis takes the highest priority for a client with parkinsonian crisis? Risk for injury Imbalanced nutrition: Less than body requirements Impaired urinary elimination Ineffective airway clearance

Correct response: Ineffective airway clearance Explanation: 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.

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? Impaired cognition Knowledge deficit Body image disturbance Anxiety

Correct response: Knowledge deficit Explanation: 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.

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? Low bone mass and osteoporosis Calcification of long bones Osteoarthritis Pathologic fractures

Correct response: 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.

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? Slow, shuffling gait Dysphagia and dysphonia Rapid, jerky, involuntary movements Dementia

Correct response: Rapid, jerky, involuntary movements Explanation: 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).

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 psychomotor seizures Related to difficulty swallowing Related to visual field deficits Related to impaired balance

Correct response: Related to impaired balance Explanation: 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.

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. The client should ensure no one else handles the medication. The client should seek emergency care if he or she develops a fever. If a dose is missed, the client should take double the amount at the regular time the following day. Hair loss should be expected when taking the medication. The client should seek emergency help if nausea or vomiting occur.

Correct response: The client should ensure no one else handles the medication. The client should seek emergency care if he or she develops a fever. Hair loss should be expected when taking the medication. Explanation: 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 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? An increase in prolactin Tissue biopsy Audible bruit over the skull Weber and Rinne test

Correct response: Tissue biopsy Explanation: Glioblastoma multiforme is the most common and aggressive malignant brain tumor. In most cases, a tissue biopsy, which can be obtained at the time of surgical removal, is needed to confirm the diagnosis. A Weber and Rinne test may be useful in assessing asymmetric hearing loss associated with an acoustic neuroma, not glioblastoma multiforme. The diagnosis of an angioma is suggested by the presence of another angioma somewhere in the head or by a bruit (an abnormal sound) that is audible over the skull. Functioning pituitary adenoma can produce one or more hormones, normally by the anterior pituitary. Increase maybe seen in prolactin hormone, growth hormone, adrenocorticotropic hormone, or thyroid-stimulating hormone.

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? Moving the neck from side to side when the collar is off Removing the entire collar when shaving Keeping the head in a neutral position Wearing the cervical collar when sleeping

Correct response: Keeping the head in a neutral position Explanation: 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.

In which location are most brain angiomas located? Brainstem Thalamus Cerebellum Hypothalamus

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

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? Pituitary adenoma Angioma Neuroma Glioblastoma

Correct response: Pituitary adenoma Explanation: 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 client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action? Keeping a pillow under the client's knees at all times Maintaining bed rest for 72 hours after the laminectomy Placing the client in semi-Fowler's position Turning the client from side to side, using the logroll technique

Correct response: Turning the client from side to side, using the logroll technique Explanation: To avoid twisting the spine or hips when turning a client onto the side, the nurse should use the logroll technique. (Twisting after a laminectomy could injure the spine.) After surgery, the nurse shouldn't put anything under the client's knees or place the client in semi-Fowler's position because these actions increase the risk of deep vein thrombosis. Typically, the client is allowed out of bed by the first or second day after a laminectomy.

An acoustic neuroma is a benign tumor of which cranial nerve? Eighth Fifth Seventh Ninth

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

The nurse educator is faciliating 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. Fever Aphasia Paralysis Incontinence Respiratory infection

Correct response: Paralysis Incontinence Aphasia Explanation: 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 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? Side-lying Prone Semi-Fowler's Supine

Correct response: Prone Explanation: 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.

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

Correct response: Protecting the client from falls Explanation: 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.

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

Correct response: reduce cerebral edema. Explanation: Corticosteroids may be used before and after treatment to reduce cerebral edema and to 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.

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 Occipital lobe Cerebellum Motor cortex

Correct response: Cerebellum Explanation: 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.

Which of the following diagnostic studies provides visualization of cerebral blood vessels? Computer-assisted stereotactic biopsy Positron emission tomography (PET) Cytologic studies of cerebrospinal fluid (CSF) Cerebral angiography

Correct response: Cerebral angiography Explanation: 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 educator knows which statement about pituitary adenomas is true? Men are more likely to be diagnosed with this type of tumor. Cushing disease can result from a functioning tumor. Most of these types of tumors are malignant. They are most prevalent in the pediatric population.

Correct response: Cushing disease can result from a functioning tumor. Explanation: Endocrine disorders can result from the existence of functioning pituitary adenomas. These tumors cause the production of hormones at the anterior pituitary and there may be an increase in various hormones, including cortisol that is responsible for the development of Cushing disease. Pituitary adenomas are rarely seen in the pediatric population. Most pituitary adenomas are benign tumors. The incidence of pituitary adenoma tumors is higher in women than men.

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? Meningiomas Pituitary adenomas Gliomas Acoustic neuromas

Correct response: Gliomas Explanation: Gliomas are the most common type of intracerebral brain tumor. Menigiomas 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 client is admitted reporting low back pain. How will the nurse best determine if the pain is related to a herniated lumbar disc? Ask the client if there is pain on ambulation. Ask if the client can walk. Ask if the client has had a bowel movement. Have the client lie on the back and lift the leg, keeping it straight.

Correct response: Have the client lie on the back and lift the leg, keeping it straight. Explanation: 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 patient has recently been diagnosed with an acoustic neuroma. The nurse helps the patient understand that: Compression of the seventh cranial nerve is a side effect. Hearing loss usually occurs. Almost 80% of these tumors become malignant over time. Surgery is never needed; radiation has proven very effective.

Correct response: Hearing loss usually occurs. Explanation: 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.

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 take a bath How to perform household tasks How to exercise How to facilitate tasks such as using both hands to hold a drinking glass

Correct response: How to facilitate tasks such as using both hands to hold a drinking glass Explanation: 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 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? Disruption in sleep patterns Unusual sensitivity to heat and cold Increased intracranial pressure Visual disturbances

Correct response: Increased intracranial pressure Explanation: 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.

Which client should the nurse assess for degenerative neurologic symptoms? The client with Huntington disease. The client with osteomyelitis. The client with Paget disease. The client with glioma.

Correct response: The client with Huntington disease. Explanation: 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.

A nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which finding requires immediate intervention? Urine retention or incontinence Paresthesia in the dermatomes near the wounds More back pain than the first postoperative day Temperature of 99.2° F (37.3° C)

Correct response: Urine retention or incontinence Explanation: 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).

Which of the following is a hallmark of spinal metastases? Nausea Fatigue Pain Change in level of consciousness (LOC)

Correct response: Pain Explanation: 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 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? Logroll the client from side to side. Have the client sit up in a chair as much as possible. Elevate the head of the bed to 90 degrees. Discourage the client from doing any range-of-motion (ROM) exercises.

Correct response: Logroll the client from side to side. Explanation: 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.

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? Bevacizumab Temozolomide Everolimus Mannitol

Correct response: Mannitol Explanation: 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.

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

Correct response: Irritation of the meduallary vagal centers Explanation: 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.

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

Correct response: Amyotrophic lateral sclerosis Explanation: 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 disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive, involuntary dancelike movements and dementia? Parkinson disease Huntington disease Creutzfeldt-Jakob disease Multiple sclerosis

Correct response: Huntington disease Explanation: Because it is transmitted as an autosomal dominant genetic disorder, each child of a parent with Huntington disease has a 50% risk of inheriting the illness. Multiple sclerosis is a chronic, degenerative, progressive disease of the central nervous system (CNS) characterized by the occurrence of small patches of demyelination in the brain and spinal cord. Parkinson disease 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. Creutzfeldt-Jakob disease is a rare, transmissible, progressive and fatal disease of the CNS characterized by spongiform degeneration of the gray matter of the brain.

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? Spinal metastasis Deep vein thrombosis Intracerebral hemorrhage Pulmonary embolism

Correct response: Intracerebral hemorrhage Explanation: 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 teaches the client diagnosed with Huntington disease that it is transmitted as which type of genetic disorder? Autosomal dominant Non -repeated HTT gene Autosomal recessive X-linked

Correct response: Autosomal dominant Explanation: Huntington disease is transmitted as an autosomal dominant genetic disorder. It is a genetic mutation , caused by the presences of a repeat of the ( Huntington gene) HTT gene. This disease is a chronic, progressive, hereditary disorder of the nervous system and results in progressive involuntary choreiform movements and dementia.

The nurse is caring for a client who has been hospitalized for investigation of a sudden change in gait due to loss of balance and coordination. A magnetic resonance imaging scan reveals the client has a brain tumor. On or close to which brain structure is the tumor most likely situated? Pituitary gland Temporal lobe Cerebellum Brain stem

Correct response: Cerebellum Explanation: The cerebellum is the brain structure responsible for balance, coordination and fine muscle control. The tumor is most likely located on or near this brain structure. A tumor located on or near the brain stem would more likely cause changes in autonomic functioning such as blood pressure. The temporal lobe is responsible for language comprehension, behavior, memory, hearing and emotions. A tumor effecting the pituitary gland would result in hormonal changes as this structure is responsible for hormones, growth and reproductive processes in the body.

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? Infection at the surgical site Cerebrospinal fluid leakage Impaired tissue healing Growth of a secondary tumor

Correct response: Cerebrospinal fluid leakage Explanation: 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 home health nurse is caring for a client with Parkinson's disease. The nurse understands that the purpose of adding selegiline with carbidopa-levodopa to the medication regime should result in which purpose? Slows the progression of the disease Replaces dopamine Relieves symptoms of dyskinesia Prevents side effects from carbidopa-levodopa

Correct response: Slows the progression of the disease Explanation: Selegiline increases dopaminergic activity and slows the progression of the disease. Carbidopa-levodopa is a dopamine replacement drug. Anticholinergic drugs are used to reduce the symptoms of dyskinesia and other side effects.

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? Managing muscle weakness Optimizing nutrition Explaining hospice care and services Offering family support groups

Correct response: Explaining hospice care and services Explanation: 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 seeks care for lower back pain of 2 weeks' duration. Which assessment finding suggests a herniated intervertebral disk? Homans' sign Back pain when the knees are flexed Atrophy of the lower leg muscles Pain radiating down the posterior thigh

Correct response: Pain radiating down the posterior thigh Explanation: 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.

What nursing intervention will best help the client with Huntington disease to increase nutrition? Select all that apply. Eliminate foods high in fat Use Relaxation techniques Take phenothiazine prior to meals Increase high carbohydrate foods Maintain a pureed diet

Correct response: Use Relaxation techniques Take phenothiazine prior to meals Explanation: Talking to the client before meals will help to promote relaxation, and phenothiazines help to calm some clients. Eliminating foods high in fat, increasing carbohydrates, and pureeing food will not assist in relaxing muscles during choreiform movements. The nurse should wait for the client to chew and swallow, which can be a slow process.

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. Clients take an assortment of different drugs. Clients generally do not adhere to the drug regimen. Drugs administered may not cause the requisite therapeutic effect.

Correct response: Drugs administered may cause a wide variety of adverse effects. Explanation: 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.

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: The tumor will cause pressure on the eighth cranial nerve. Growth is slow and symptoms are caused by compression rather than tissue invasion. The tumor is malignant and aggressive. Surgery, which can result in complete removal of the possible tumor, should be done as soon as possible.

Correct response: Growth is slow and symptoms are caused by compression rather than tissue invasion. Explanation: 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 has undergone surgery for a spinal cord tumor that was located in the cervical area. The nurse would be especially alert for which of the following? Bowel incontinence Skin breakdown Respiratory dysfunction Hemorrhage

Correct response: Respiratory dysfunction Explanation: 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.

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? Radiation therapy Immunotherapy Chemotherapy Surgery

Correct response: Surgery Explanation: 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 nurse is working on a surgical floor. The nurse must logroll a client following a: laminectomy. hemorrhoidectomy. thoracotomy. cystectomy.

Correct response: laminectomy. Explanation: 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.

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? "You are not permitted to speak to me this way. I am a professional and I deserve for you to treat me with respect." "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." "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." "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."

Correct response: "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." Explanation: 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.

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

Correct response: Originated within the brain tissue. Explanation: The most aggressive type of malignant brain tumor is a glioma, which originates within the brain tissue.

Which term is used to describe edema of the optic nerve? Angioneurotic edema Scotoma Lymphedema Papilledema

Correct response: Papilledema Explanation: 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 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? "The disease is not hereditary and therefore there is no risk to you." "If one parent has the disorder, there is an 75% chance that you will inherit the disease." "The disease is inherited and all offspring of a parent will develop the disease." "If one parent has the disorder, there is a 50% chance that you will inherit the disease."

Correct response: "If one parent has the disorder, there is a 50% chance that you will inherit the disease." Explanation: Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia. The disease affects approximately 1 in 10,000 men or women of all races at midlife. It is transmitted as an autosomal dominant genetic disorder; therefore, each child of a parent with Huntington disease has a 50% risk of inheriting the disorder (Ha & Fung, 2012).

The nurse teaches the client with which disorder that the disease is due to decreased levels of dopamine in the basal ganglia of the brain? Creutzfeldt-Jakob disease Huntington disease Parkinson disease Multiple sclerosis

Correct response: Parkinson disease Explanation: In some patients, Parkinson disease can be controlled; however, it cannot be cured. Multiple sclerosis is a chronic, degenerative, progressive disease of the central nervous system (CNS) characterized by the occurrence of small patches of demyelination in the brain and spinal cord. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia. Creutzfeldt-Jakob disease is a rare, transmissible, progressive and fatal disease of the CNS characterized by spongiform degeneration of the gray matter of the brain.

Which statement indicates appropriate nursing intervention for a client with post-polio syndrome? Avoid the use of heat applications in the treatment of muscle and joint pain Provide care aimed at slowing the loss of strength and maintaining overall well-being. Administer antiretroviral agents Plan activities for evening hours rather than morning hours

Correct response: Provide care aimed at slowing the loss of strength and maintaining overall well-being. Explanation: 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. Clients 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 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: Doppler ultrasonography. quantitative spectral phonoangiography. electromyography (EMG). Doppler scanning.

Correct response: electromyography (EMG). Explanation: 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 nurse is reviewing the medical record of a client diagnosed with a primary brain tumor. The nurse identifies the type of tumor as one that is most commonly found in adults. Which type of tumor would the nurse most likely identify? pituitary adenoma acoustic neuroma meningioma angioma

Correct response: meningioma Explanation: Although acoustic neuromas, pituitary adenomas and angiomas can occur in adults, meningiomas are the most common type of brain tumor found in adults.