Chapter 65: Management of Patients With Oncologic or Degenerative Neurologic Disorders
28. Because cachexia is common in patients with metastases what is the nurse sure to assess on this patient? A) Sensory function B) Cranial nerves C) Nutritional status D) Motor function
Ans: C Chapter: 65 Client Needs: D-1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 1982, Cerebral Metastases Feedback: Nutritional status is assessed, because cachexia (weak and emaciated condition) is common in patients with metastases.
15. A male patient with a metastatic brain tumor has a generalized seizure. He is vomiting. The family calls for the nurse. What should the nurse do first? A) Obtain supplies to suction. B) Page or call the physician. C) Insert a wooden tongue blade into his mouth. D) Turn him on his side.
Ans: D Chapter: 65 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 1981, Primary Brain Tumors Feedback: The nurse's first response should be to place the patient on his side to prevent him from aspirating emesis. Inserting something into the seizing patient's mouth is no longer part of a seizure protocol. Obtaining supplies to suction the patient would be a delegated task. Paging or calling the physician would only be necessary if this is the patient's first seizure.
14. A patient diagnosed with a pituitary adenoma has arrived on your unit. Based upon your initial assessment, the patient is most likely to exhibit what clinical manifestations? A) Decreased intracranial pressure B) Headache C) Hyperthalamic disorders D) Restlessness
Ans: B Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 1977, Primary Brain Tumors Feedback: Pressures from pituitary adenomas may cause headaches, visual dysfunction, and hypothalamic disorders. Restlessness is not a typical manifestation of pituitary adenomas. Pressure from pituitary adenomas would increase ICP and they would not cause hyperthalmic disorders.
37. A patient with amyotrophic lateral sclerosis has been hospitalized on your unit. The patient asks you where he can find some practical information about the disease that is killing him. What resource could you suggest? A) The ALS Association Quarterly Newsletter B) The Amyotrophic Lateral Sclerosis Association C) The National Association of Amyotrophic Lateral Sclerosis D) The International Association Quarterly Newsletter of ALS
Ans: A Chapter: 65 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 6 Page and Header: 1995, Amyotrophic Lateral Sclerosis Feedback: The ALS Association Quarterly Newsletter is a source of practical information.
38. You are caring for a patient scheduled for a cervical discectomy tomorrow. You are presenting pre-operative teaching to the patient. Your teaching includes what potential complications? A) Damage to the vocal cords B) Hematoma at the surgical site C) Airway edema D) Hemorrhage
Ans: B Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 7 Page and Header: 1999, Herniation of a Cervical Intervertebral Disk Feedback: Based on all the assessment data, the potential complications may include hematoma at the surgical site, resulting in cord compression and neurologic deficit; and recurrent or persistent pain after surgery.
8. A patient with Parkinson's disease is undergoing a swallow study because she is experiencing difficulties when swallowing. What consistency is most appropriate for this patient to reduce the risk of aspiration? A) Solid food with thin liquids B) Pureed food with water C) Semisolid food with thick liquids D) Thin liquids only
Ans: C Chapter: 65 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 1990, Parkinson's Disease Feedback: A semisolid diet with thick liquids is easier to swallow for a patient with swallowing difficulties than a solid diet. Thin liquids should be avoided. Pureed foods with water are not indicated for this patient.
39. You are covering patients for a nurse who is at dinner. One of those patients had a cervical diskectomy earlier today. The patient calls you to her room and tells you she is having severe pain and that it came on suddenly. What would you do? A) Call for an entubation tray B) Take the bandage off C) Call the surgeon D) Increase their pain medicine
Ans: C Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 7 Page and Header: 1999, Herniation of a Cervical Intervertebral Disk Feedback: If the patient experiences a sudden increase in pain, extrusion of the graft may have occurred, requiring reoperation. A sudden increase in pain should be promptly reported to the surgeon. You would not call for an entubation tray; if the procedure was an anterior cervical diskectomy the entubation tray should already be in the room. Taking the bandage off is only done at the surgeon's order, as is increasing the pain medicine.
32. Researchers are working on finding out just what the process is that initiates neurodegeration in diseases like Huntington's disease and multiple sclerosis. The current thought is that neurodegeneration is the result of what? A) Oxidative stress on the substantia nigra B) Protein aggregation on Lewy bodies C) Protein aggregation on the substantia nigra D) Oxidative stress on Lewy bodies
Ans: D Chapter: 65 Client Needs: A-1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 1992, Huntington Disease Feedback: Researchers are working on uncovering the exact mechanism of neurodegeneration; current theories suggest that it results from oxidative stress in a portion of the neuron known as Lewy bodies, protein aggregation, or a combination of the two mechanisms
40. A nurse is planning discharge teaching for a patient who underwent a cervical diskectomy. Part of the discharge process is for the nurse to assess the patient's understanding of certain management strategies. What strategies would the nurse assess that would aid her in planning discharge teaching? A) Care of the cervical collar B) Regimen for rest C) Signs and symptoms that need to be reported to the home health nurse D) How to assess vital signs
Ans: D Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Page and Header: 2000, Herniation of a Cervical Intervertebral Disk Feedback: The nurse assesses the patient's understanding of these management strategies, limitations, and recommendations: strategies for pain management; signs and symptoms that may indicate complications that should be reported to the physician; use and care of the cervical collar; and to alternate tasks that involve minimal body movement (eg, reading) with tasks that require greater body movement. The assessment of vital signs, regimen for rest, and signs and symptoms to report to the home health nurse would not need to be assessed to aid the nurse in planning discharge teaching.
10. A patient, diagnosed with cancer of the lung, has just been told he has metastases to the brain. The family should be aware that the neurologic signs and symptoms of metastatic brain disease are what? A) Bradycardia B) Temperature greater than 100.5°F C) Increase in diastolic blood pressure D) Personality changes
Ans: D Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 1977, Primary Brain Tumors Feedback: Neurologic signs and symptoms include headache, gait disturbances, visual impairment, personality changes, altered mentation (memory loss and confusion), focal weakness, paralysis, aphasia, and seizures. These problems can be devastating to both patient and family. Bradycardia, elevated temperature, and an increase in diastolic blood pressure are not neurologic signs and symptoms of metastatic brain disease.
4. A patient with suspected Parkinson's disease is being initially assessed by the nurse. The nurse would expect the patient to have a tremor. When is the best time to assess for the tremor? A) During a period of time when the patient is resting B) During a period of time when the patient is brushing the teeth C) During a period of time when the patient is preparing his or her meal tray to eat D) During a period of time when the patient is participating in occupational therapy
Ans: A Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 1986, Parkinson's Disease Feedback: The tremor is present while the patient is at rest; it increases when the patient is walking, concentrating, or feeling anxious. Resting tremor characteristically disappears with purposeful movement but is evident when the extremities are motionless. Therefore options B, C, and D are incorrect.
6. The parents of a child with muscular dystrophy have the desire to gain additional information regarding services available to children and families affected by this condition. They call the clinic nurse and ask for advice. The nurse's best response is to provide information to the parents related to what? A) Spiritual counseling B) The Muscular Dystrophy Association C) Programs offered by the local school district D) The American Academy of Pediatrics
Ans: B Chapter: 65 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing Process Objective: 6 Page and Header: 1996, Muscular Dystrophies Feedback: While all options will serve to provide a varying level of support to the child and the family, the Muscular Dystrophy Association will provide information specific to programs of patient services and clinical care, research initiatives, and professional and public education.
18. A patient has just returned to the unit from the PACU after surgery for a tumor within the spine. The patient complains of pain. When positioning the patient for comfort and to reduce injury to the surgical site, the nurse will position to patient in what position? A) In the lithotomy position B) In a flat side-lying position C) In the Trendelenberg position D) In the reverse Trendelenberg position
Ans: B Chapter: 65 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 1985, Spinal Cord Tumors Feedback: After spinal surgery, the bed is usually kept flat initially. The side-lying position is usually the most comfortable because this position imposes the least pressure on the surgical site. The lithotomy position, Trendelenberg position, and reverse Trendelenberg position are inappropriate for this patient.
23. A nurse on the oncology unit is caring for a patient with an astrocytoma. The patient has just been told that the tumor is growing very fast. The patient asks the nurse how these tumors grow. What would be the nurse's best response? A) "Astrocytomas infiltrate the surrounding neural connective tissue." B) "Astrocytomas grow by invading the surrounding gray matter." C) "Astrocytomas grow by invading the surrounding white matter." D) "Astrocytomas spread down the spinal cord." al structures. Astrocytomas invade both the gray and white matter indiscriminately, and will grow down the spinal cord if they spread far enough. These answers are not the most correct.
Ans: A Chapter: 65 Client Needs: D-3 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 1976, Primary Brain Tumors Feedback: Usually, astrocytomas spread by infiltrating into the surrounding neural connective tissue, and therefore cannot be totally removed without causing considerable damage to vital structures. Astrocytomas invade both the gray and white matter indiscriminately, and will grow down the spinal cord if they spread far enough. These answers are not the most correct.
25. A 16-year-old male patient presents at the free clinic with complaints of impotency. Upon physical examination the physician finds hypogonadism. What would the nurse know is the suspected diagnosis? A) Prolactinoma B) Angioma C) Glioma D) Adrenocorticotropic hormone (ACTH)-producing adenoma
Ans: A Chapter: 65 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 1977, Primary Brain Tumors Feedback: Male patients with prolactinomas may present with impotence and hypogonadism. An adrenocorticotropic hormone (ACTH)-producing adenoma would cause acromegaly. There is not enough information in the scenario to know if the tumor is an angioma, glioma, or neuroma.
27. A patient has been admitted to the Neuro ICU with a diagnosis of a brain tumor. The patient is scheduled to have a tumor resection/removal in the morning. What is an important part of the initial assessment on this patient? A) The gag reflex B) Ability to chew C) Sensory perception D) Corneal reflex
Ans: A Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 1980, Primary Brain Tumors Feedback: Preoperatively, the gag reflex and ability to swallow are evaluated. In patients with diminished gag response, care includes teaching the patient to direct food and fluids toward the unaffected side, having the patient sit upright to eat, offering a semisoft diet, and having suction readily available. The ability to chew and the corneal reflex would be assessed and so would sensory perception on the face, but none of them are more important than the gag reflex.
21. The pathophysiology instructor is discussing neoplasms with the pre-nursing students. The instructor explains that the effects of neoplasms are caused by the compression and infiltration of normal tissue. The physiologic changes that result cause what pathophysiologic events? (Mark all that apply.) A) Fatigue B) Slurred speech C) Increased ICP D) Focal neurologic signs E) Altered pituitary function
Ans: C, D, E Chapter: 65 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 1976, Primary Brain Tumors Feedback: The effects of neoplasms are caused by the compression and infiltration of tissue. A variety of physiologic changes result, causing any or all of the following pathophysiologic events: increased intracranial pressure (ICP) and cerebral edema, seizure activity and focal neurologic signs, hydrocephalus, and altered pituitary function.
11. A 63-year-old male patient has just been diagnosed with Parkinson's disease. The nurse is teaching the patient and his family about dietary practices related to Parkinson's disease. What risk is a priority for the nurse to address? A) Fluid overload and drooling. B) Aspiration and anorexia. C) Choking and diarrhea. D) Dysphagia and constipation.
Ans: D Chapter: 65 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 1990, Parkinson's Disease Feedback: Eating problems associated with Parkinson's disease include aspiration, choking, constipation, and dysphagia. Option A is incorrect since fluid overload isn't specifically related to Parkinson's disease and, although drooling occurs with Parkinson's disease, it doesn't take priority. Anorexia (option B) and diarrhea (option C) aren't specifically associated with Parkinson's disease.
9. While assessing the patient at the beginning of the shift the nurse inspects a surgical dressing covering the operative site after the patients' cervical discectomy. The nurse notes the drainage is serosanguineous. The nurse recognizes that the characteristic of this drainage may indicate what? A) Abnormal finding B) Postnasal drainage C) Hemorrhage D) A dural leak
Ans: D Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Page and Header: 1999, Herniation of a Cervical Intervertebral Disk Feedback: After a cervical discectomy, the nurse will monitor the operative site and dressing covering this site. Serosanguineous drainage may indicate a dural leak. This is not an abnormal finding, postnasal drip, or an indication of hemorrhage.
1. A nurse is assessing a patient with an acoustic neuroma who has been recently admitted to an oncology unit. What symptoms is the nurse likely to find during the assessment? A) Loss of hearing, tinnitus, and vertigo B) Loss of vision, change in mental status, and hyperthermia C) Loss of hearing, increased sodium retention, and hypertension D) Loss of vision, headache, and tachycardia
Ans: A Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 1977, Primary Brain Tumors Feedback: An acoustic neuroma is a tumor of the eighth cranial nerve, the cranial nerve most responsible for hearing and balance. The patient with an acoustic neuroma usually experiences loss of hearing, tinnitus, and episodes of vertigo and staggering gait. Acoustic neuromas do not cause loss of vision, increased sodium retention, or tachycardia.
19. A patient with Hungtington's disease has just been admitted to a long-term care facility. The charge nurse is creating a care plan for this patient. Nutritional management for a patient with Huntington's disease often focuses on which of the following characteristics? A) The patient will have an increased appetite. B) The patient will have a decreased appetite. C) The patient will require a clear liquid diet. D) The patient will require a diet limited in protein.
Ans: A Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 1993, Huntington Disease Feedback: Due to the continuous involuntary movements, patients will have a ravenous appetite. Despite this ravenous appetite, patients usually become emaciated and exhausted. As the disease progresses, patients experience difficulty in swallowing and thin liquids should be avoided. Protein will not be limited with this disease.
33. The nurse caring for a patient diagnosed with Parkinson's disease has prepared a plan of care that would include what goals? A) Developing positive coping mechanisms B) Controlling diarrhea C) Decreasing hyperactivity D) Alteration in nutrition
Ans: A Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 1990, Parkinson's Disease Feedback: The goals for the patient may include improving functional mobility, maintaining independence in ADLs, achieving adequate bowel elimination, attaining and maintaining acceptable nutritional status, achieving effective communication, and developing positive coping mechanisms. Option E is incorrect; it is a nursing diagnosis, not a goal. Parkinson's patients are constipated, so option B is incorrect. Mobility is a problem, not hyperactivity.
16. The nurse in an extended care facility is planning the daily activities of a patient with postpolio syndrome. The nurse recognizes the patient will best benefit from physical therapy when it is scheduled at what time? A) Immediately after lunch B) In the morning C) Two times a day D) Immediately prior to dinner
Ans: B Chapter: 65 Client Needs: D-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 2003, Postpolio Syndrome Feedback: Important activities for patients with postpolio syndrome should be planned for the morning, as fatigue often increases in the afternoon and evening. Therefore options A, C, and D are incorrect.
17. A patient newly diagnosed with a cervical disk herniation is involved in patient teaching with the clinic nurse. What conservative management measures will the nurse teach the patient to implement? A) Increase daily activity B) Sleep on a firm mattress C) Apply cool compresses to the back of the neck daily D) Wear the cervical collar when the pain begins to resolve
Ans: B Chapter: 65 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Page and Header: 2001, Herniation of a Cervical Intervertebral Disk Feedback: Proper positioning on a firm mattress and bed rest for 1 to 2 days may bring dramatic relief from pain. The patient may need to wear a cervical collar 24 hours a day during the acute phase of pain from a cervical disk herniation. Hot, moist compresses applied to the back of the neck will increase blood flow to the muscles and help relax the spastic muscles.
13. A 13-year-old patient is admitted to the adolescent unit with a suspected brain tumor. The patient asks the nurse which diagnostic test is the most helpful in the diagnosis of brain tumors. What is the nurse's best response? A) Computed tomography (CT) scan B) Magnetic resonance imaging (MRI) C) Brain biopsy D) Blood work with (ACTH) levels
Ans: B Chapter: 65 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 1979, Primary Brain Tumors Feedback: An MRI is the most helpful in the diagnosis of brain tumors. Its use has resulted in the detection of smaller lesions; it is particularly helpful in detecting tumors in the brainstem and pituitary regions, where bone interferes with CT. A brain biopsy and blood work with ACTH levels do not diagnose brain tumors.
2. A 25-year-old female with brain metastases asks the nurse about the length of time she has to live. Based upon the fact that the patient is not receiving treatment for the brain metastases, the nurse's best response is that patients with this condition generally have a mean survival time of what? A) 2 weeks B) 1 month C) 6 months D) 1 year
Ans: B Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 1 Page and Header: 1981, Cerebral Metastases Feedback: The median survival time for patients with no treatment for brain metastases is 1 month; with corticosteroid treatment alone it is 2 months; radiation therapy extends the median survival to 3 to 6 months. Therefore, options A, C, and D are incorrect.
34. You are caring for a patient diagnosed with Parkinson's disease. Your patient is having increasing problems with rising from the sitting to the standing position. What would you suggest to the patient to use that will aid in getting from the sitting to the standing position as well as aid in improving bowel elimination? A) A handicapped toilet B) A raised toilet seat C) Sit quietly on the toilet every 2 hours D) Follow the outlined bowel program
Ans: B Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 1990, Parkinson's Disease Feedback: A raised toilet seat is useful, because the patient has difficulty in moving from a standing to a sitting position. A handicapped toilet is not high enough and will not aid in improving bowel elimination. Sitting quietly on the toilet every 2 hours will not aid in getting from the sitting to standing position; neither will following the outlined bowel program.
20. A patient with amyotrophic lateral sclerosis (ALS) is being visited by the Home Health Nurse. The nurse is creating a care plan for this patient. What nursing diagnosis is appropriate for a patient with this condition? A) Chronic confusion B) Impaired urinary elimination C) Impaired verbal communication D) Bowel incontinence
Ans: B Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 1995, Amyotrophic Lateral Sclerosis Feedback: Impaired communication is an appropriate nursing diagnosis, as the voice in patients with ALS assumes a nasal sound, and articulation becomes so disrupted that speech is unintelligible. Intellectual function is not impaired in patients with ALS. Usually, the anal and bladder sphincters are intact because the spinal nerves that control muscles of the rectum and urinary bladder are not affected.
22. The nurse is caring for a patient newly diagnosed with a primary brain tumor. The patient asks the nurse where his tumor came from. What would be the nurse's best response? A) Your tumor originated from somewhere outside the CNS. B) Your tumor is pituitary in origin. C) Your tumor originated from cells and structures within the brain. D) Your tumor is from nerve tissue somewhere in your body.
Ans: C Chapter: 65 Client Needs: A-1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 1976, Primary Brain Tumors Feedback: Primary brain tumors originate from cells and structures within the brain. Secondary brain tumors are metastatic tumors that originate somewhere else in the body. The scenario does not indicate that the patient's tumor is a pituitary tumor or a neuroma; therefore options B and D are incorrect.
24. The nursing instructor is talking with the junior nursing class about glial cell tumors. The instructor tells the students that the most common type of glioma is an astrocytoma and that astrocytomas are graded from I to IV, indicating the degree of malignancy. What would the instructor tell the students the grade is based on? A) Cellular density, number of cells, and appearance B) Size of cells, number of cells, and appearance C) Cellular density, cell mitosis, and appearance D) Cell mitosis, size of cells, and appearance
Ans: C Chapter: 65 Client Needs: A-1 Cognitive Level: Application Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2 Page and Header: 1976, Primary Brain Tumors Feedback: Astrocytomas are the most common type of glioma and are graded from I to IV, indicating the degree of malignancy. The grade is based on cellular density, cell mitosis, and appearance. Usually, these tumors spread by infiltrating into the surrounding neural connective tissue and therefore cannot be totally removed without causing considerable damage to vital structures. The grading of the tumor is not based on the size of the cells or the number of cells.
26. The oncology staff educator is precepting a graduate nurse. They are admitting a 77-year-old female patient with a diagnosis of stage IV astrocytoma. The graduate nurse asks how long the lady has known she has cancer. What would be the staff educator's best response? A) "She hasn't known very long because she is pretty good at hiding things that change from her family." B) "She hasn't known very long because an early sign is personality change and elderly people don't know that their personality has changed." C) "She hasn't known very long because early signs and symptoms of intracranial tumors can be overlooked in the elderly because people think they are the result of normal aging." D) "She hasn't known very long because elderly people have a tendency not to go to the doctor when early signs and symptoms appear."
Ans: C Chapter: 65 Client Needs: B Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2 Page and Header: 1977, Primary Brain Tumors Feedback: In elderly patients, early signs and symptoms of intracranial tumors can be easily overlooked or incorrectly attributed to cognitive and neurologic changes associated with normal aging.
3. The nurse is writing a care plan for a patient with brain metastases. The nurse decides that an appropriate nursing diagnoses is "Anxiety related to lack of control over the health care needs and situation." In establishing this plan of care for the patient, the nurse will identify which measure as appropriate for the care of this patient? A) The patient will receive anti-anxiety medications every 4 hours. B) The patient's family will be instructed on measures to implement when providing care for the patient. C) The patient will be encouraged to verbalize concerns related to the disease and its treatment. D) The patient will begin a busy schedule of therapy, so that he or she will forget about the anxiety.
Ans: C Chapter: 65 Client Needs: C Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 1983, Cerebral Metastases Feedback: Patients need the opportunity to exercise some control over their situation. A sense of mastery can be gained as they learn to understand the disease and its treatment and how to deal with their feelings. Distraction, assuming care responsibilities, and administering medications will not allow the patient to gain some control over their situation or discuss their feelings.
31. A patient, brought to the clinic by his son, is diagnosed with Huntington's disease. The son asks what causes his father to do the things he does. What would be the nurse's best response? A) "Your father's brain is slowly rebuilding the area called the striatum." B) "Your father's brain is trying to rebuild the area of the brain that controls movement." C) "Your father's brain is dying in the area of the brain that controls movement." D) "Your father's brain is dying and there is nothing we can do about it."
Ans: C Chapter: 65 Client Needs: D-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 1992, Huntington Disease Feedback: The basic pathology involves premature death of cells in the striatum (caudate and putamen) of the basal ganglia, the region deep within the brain that is involved in the control of movement.
35. A patient, newly diagnosed with Parkinson's disease, is expecting to be discharged home in the morning. When interacting with the patient during discharge teaching, the patient asks for direction to resources she and her family can access. What is resource you would give her? A) International Association of Degenerative Diseases B) American Association of Degenerative Diseases C) American Parkinson's Disease Association D) International Parkinson's Foundation, Inc.
Ans: C Chapter: 65 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 6 Page and Header: 1991, Parkinson's Disease Feedback: Information booklets and a newsletter for patient education are published by the National Parkinson's Foundation, Inc., and the American Parkinson's Disease Association. That makes options A, B, and D incorrect.
29. A patient with an inoperable brain tumor has been told he is terminal. A referral is made to Home Health. The Home Health Nurse is making a care plan for this patient. What do home care needs and interventions focus on in the terminal patient? A) Assessing cognitive status B) Improving nutritional status C) Promoting mobility D) Assistance in self-care
Ans: D Chapter: 65 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 1983, Cerebral Metastases Feedback: Home care needs and interventions focus on four major areas: palliation of symptoms and pain control, assistance in self-care, control of treatment complications, and administration of specific forms of treatment, such as parenteral nutrition. Assessing cognitive status is not a focus of home care, although it is documented at each visit. Improving nutritional status is a focus with cancer patients who are not terminal. Promoting mobility is not a focus of home care for this patient.
36. A family member of a patient diagnosed with Huntington's disease calls you at the clinic. She is requesting help from the Huntington's Disease Foundation of America. What kind of help can this patient and family receive from this organization? (Mark all that apply.) A) Information B) Referrals C) Public education D) Individual assessments E) Exclusion from research studies
Ans: A, B, C Chapter: 65 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 6 Page and Header: 1993, Huntington Disease Feedback: The Huntington's Disease Foundation of America helps patients and families by providing information, referrals, family and public education, and support for research. It does not provide individual assessments or exclusion from research studies.
30. You are giving an educational presentation at the local senior center on Parkinson's disease. What would you tell the attendees Parkinson's disease is associated with? A) Decreased levels of dopamine B) Decreased levels of hydrocortisol C) Increased levels of hydrocortisone D) Decreased levels of ACTH
Ans: A Chapter: 65 Client Needs: D-2 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 4 Page and Header: 1986, Parkinson's Disease Feedback: Parkinson's disease is associated with decreased levels of dopamine resulting from destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia region of the brain.
5. The clinic nurse caring for a patient with Parkinson's disease notes that the patient has been taking levodopa and carbidopa (Sinemet) for 7 years. What common side effects of Sinemet would the nurse assesses this patient for? A) Pruritus B) Dyskinesia C) Lactose intolerance D) Diarrhea
Ans: B Chapter: 65 Client Needs: D-2 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 1988, Parkinson's Disease Feedback: Within 5 to 10 years of taking levodopa, most patients develop a response to the medication characterized by dyskinesia (abnormal involuntary movements). Another potential complication of long-term dopaminergic medication use is neuroleptic malignant syndrome characterized by severe rigidity, stupor, and hyperthermia. Side effects of long-term Sinemet therapy are not pruritus, lactose intolerance, or diarrhea.
12. You are the nurse caring for a patient diagnosed with Huntington's disease who has been admitted to the hospital for treatment of malnutrition. What independent nursing action should be implemented in the patient's plan of care? A) Firmly redirect the patient's head when feeding. B) Administer phenothiazines with the patient's meal. C) Have the patient keep his or her feeding area clean. D) Apply deep gentle pressure around the patient's mouth to assist with swallowing.
Ans: D Chapter: 64 Client Needs: D-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 1991, Parkinson's Disease Feedback: Nursing interventions for a patient who has inadequate nutritional intake should include the following: Apply deep gentle pressure around the patient's mouth to assist with swallowing, and administer phenothiazines prior to the patient's meal as ordered. The nurse should disregard the mess of the feeding area and treat the person with dignity. Stiffness and turning away by the patient during feeding are uncontrollable choreiform movements and should not be interrupted.
7. A 37-year-old male is brought to the clinic by his wife because the patient is experiencing loss of motor function and sensation. The physician suspects the patient has a spinal cord tumor and hospitalizes him for diagnostic testing. In preparation for diagnostic studies, the nurse will inform the patient that the most commonly used study to diagnose spinal cord compression from a tumor is what? A) An x-ray B) An ultrasound C) A CT scan D) An MRI scan
Ans: D Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 1984, Spinal Cord Tumors Feedback: The MRI scan 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. Therefore options A, B, and C are incorrect.
