chapter 65 management of patients with oncologic or degenerative neurologic disorders
The nurse is providing care for a client who just discussed palliative care with the primary health care provider. The client's family member was also part of the discussion and asks the nurse, "I feel like this kind of treatment means we've given up on trying." How should the nurse respond? Choose the best option.
"The goal of this type of care is to promote the best quality of life that is now possible."
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?
Tissue biopsy
A home care nurse makes a visit to a client with Parkinson's disease who is being cared for by his spouse. During the visit, the spouse says, "I'm just so tired. I have to do just about everything for him." Which response by the nurse would be most appropriate?
"You sound a bit overwhelmed. Tell me more about what's happening."
A client with Parkinson's disease is prescribed amantadine hydrochloride 100 mg twice a day. The pharmacy supplies amantadine syrup, because the client has a history of difficulty swallowing tablets. The label reads 50 mg/5 mL. How many milliliters would the nurse administer to the client for each dose? Enter the correct number ONLY.
10
The nurse responds to the call light of a client who has had a cervical discectomy earlier in the day. The client states that she is having severe pain that had a sudden onset. What is the nurse's most appropriate action?
Call the surgeon to report the client's pain.
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?
Cerebellum
An acoustic neuroma is a benign tumor of which cranial nerve?
Eighth
Excessive levels of which neurotransmitter has been implicated in amyotrophic lateral sclerosis (ALS)?
Glutamate
The nurse is providing discharge teaching to a client with a spinal cord tumor and instructs the client to avoid hot water bottles and heating blankets for what reason?
Impaired sensory perception
A patient is diagnosed with an aggressive, primary malignant brain tumor. The nurse is aware that the glioma:
Originated within the brain tissue.
Which of the following is a hallmark of spinal metastases?
Pain
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.
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?
"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?"
The nurse reviews the patient's drug regimen for treatment of a brain tumor. She explains to the patient why one of the following drugs would not be prescribed, even though it might have therapeutic benefits. Which drug would not be prescribed for this patient?
Coumadin
What is the only known risk factor for brain tumors?
Ionizing radiation
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
The nurse teaches the client that corticosteroids will be used to treat his brain tumor to
reduce cerebral edema
A 17-year-old adolescent with a history of muscular dystrophy is admitted with aspiration pneumonia. The nurse asks the parents if the client has an advance directive. Which response by the parents leads the nurse to believe that the parents don't understand the severity of the client's medical condition?
"He is only 17. He doesn't need an advance directive."
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?
"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."
A client with Parkinson's disease asks the nurse what their treatment is supposed to do since the disease is progressive. What would be the nurse's best response?
"Treatment aims at keeping you independent as long as possible."
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
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.
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
The nurse is caring for a client with metastatic brain cancer. The client will be receiving palliative treatment. The nurse should anticipate what type of medical management will be included in the client's care? Select all that apply.
Radiosurgery Craniotomy with debulking Radiation
The nurse is aware that, when assessing a patient for symptoms of a brain tumor, the symptom most frequently found is:
Simple to generalized seizure
A client is diagnosed with a tumor of the temporal lobe. When developing the clients plan of care the nurse would plan interventions to address problems with which areas of functioning? Select all that apply
Understanding language Emotions Memory
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?
Intracerebral hemorrhage
A client with cerebral metastasis suddenly experiences a seizure for which phenytoin 10 mg/kg intravenously is ordered as an initial loading dose. The client weighs 165 pounds. How many milligrams of phenytoin should the client receive? Enter the number ONLY.
750
Which of the following is a late symptom of spinal cord compression?
paralysis
The nurse identifies a nursing diagnosis of self-care deficit, bathing related to motor impairment and decreased cognitive function for a client with cerebral metastasis. Which outcome would the nurse most likely identify on this client's plan of care?
Client participates in daily hygiene activities with assistive devices
A 55-year-old female client presents at the walk-in clinic complaining of feeling like a mask is on her face. While doing the initial assessment, the nurse notes the demonstration of a pill-rolling movement in the right hand and a stooped posture. Physical examination shows bradykinesia and a shuffling gait. What would the nurse suspect is the causative factor for these symptoms?
Parkinson's disease
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 impaired balance
A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis?
Severe lower back pain
A client is admitted reporting low back pain. How will the nurse best determine if the pain is related to a herniated lumbar disc?
Have the client lie on the back and lift the leg, keeping it straight.
A client with post-polio syndrome displays fatigue and decreased muscle strength. How should the nurse best respond to the client?
"Intravenous immunoglobulin infusion may help you."
A client asks the nurse to explain the development of Parkinson disease (PD). Which response will the nurse provide the client?
"It is caused by low levels of dopamine that are not available to counteract the effects of acetylcholine.
A patient diagnosed with a tumor in the cerebellar region would expect to have changes in which of the following?
Balance and coordination
The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding?
Dysphonia
Which disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells?
Parkinson disease
Which of the following are clinical manifestations associated with increased intracranial pressure (ICP)? Select all that apply.
Seizures Nausea with or without vomiting Papilledema Headache
The nurse is caring for a patient with Parkinson's disease and is preparing to administer medication. What does the nurse administer to the patient that is considered the most effective drug currently given for the tremor of Parkinson's?
Levodopa
A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following?
Dyskinesia
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
While assessing the client at the beginning of the shift, the nurse inspects a surgical dressing covering the operative site after the clients' cervical discectomy. The nurse notes that the drainage is 75% saturated with serosanguineous discharge. What is the nurse's most appropriate action?
Inform the surgeon of the possibility of a dural leak.
A nurse begins an assessment interview of a patient with a brain tumor. The patient describes her headaches. The nurse expects to hear specific terms that describe her symptoms. Which of the following best describe the symptoms of her headache? Select all that apply.
Is unrelenting Is made worse with coughing and sudden movement May improve with vomiting Occurs most frequently in the early morning
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?
Keeping the head in a neutral position
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?
Knowledge deficit
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
A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of risk of injury. Which "relates to" phrase should the nurse add to complete the nursing diagnosis statement?
Related to impaired balance
A client diagnosed with Huntington's disease has developed severe depression. What would be most important for the nurse to assess for?
Suicidal ideations
A patient with Huntington's disease is prescribed medication to reduce the chorea. What medication will the nurse administer that is the only drug approved for the treatment of this symptom?
Tetrabenazine (Xenazine)
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
The nurse is seeing a client who is being investigated for a possible spinal tumor. The nurse knows that a tumor in this region of the body is more likely if the client reports increased pain when:
sleeping on the stomach.
The nurse is providing discharge teaching for a client who was admitted to hospital after having complex partial seizures secondary to a glioma. The client has been prescribed levetiracetam to manage the seizures. What should the nurse include in the discharge teaching for this medication?
"Driving a car should be avoided until the you know how this medication effects you."
The daughter of a patient with Huntington's disease asks the nurse what the risk is of her inheriting the disease. What is the best response by the nurse?
"If one parent has the disorder, there is a 50% chance that you will inherit the disease."
A nurse is conducting a presentation about brain cancer for a local community group. During the presentation, one of the group members asks, "What causes brain tumors?" Which response by the nurse would be most appropriate?
"The cause of most brain tumors is still really not known
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?
"You may experience progressive deterioration in all voluntary muscles."
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
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
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.
Which of the following diagnostic studies provides visualization of cerebral blood vessels?
Cerebral angiography
A nurse is providing care to a client with Parkinson's disease. The nurse understands the client's signs and symptoms are related to a depletion of which of the following?
Dopamine
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
The nursing instructor gives their students an assignment of making a plan of care for a client with Huntington's disease. What would be important for the students to include in the teaching portion of the care plan?
How to facilitate tasks such as using both hands to hold a drinking glass
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?
Mannitol
A client comes to the clinic reporting low back pain and muscle spasms. He states, "The pain seems to travel into my hip and down to my leg." A herniated lumbar disk is suspected. Which of the following would help to confirm the suspicion? Select all that apply.
Postural deformity Muscle weakness Altered tendon reflexes
The nurse cares for a client with Huntington disease. What intervention is a priority for safe care?
Protecting the client from falls
The nurse is seeing a client for follow up after chemotherapy in the outpatient clinic. The client states, "Over the last week, I've been losing handfuls of my hair in the shower. I don't want to shave my head but I don't want people to stare at me either." Based on the client's statement, what should the nurse include in the client's care plan? Choose the best answer.
Risk for disturbed body image
A client diagnosed with a malignant brain tumor is scheduled to receive chemotherapy intrathecally. When explaining this technique to the client, the nurse would describe the medication as being injected into which area?
Subarachnoid space
A patient with myasthenia gravis is in the hospital for treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide on time. The nurse gets busy and does not administer the medication until after breakfast. What outcome will the patient have related to this late dose?
The muscles will become fatigued and the patient will not be able to chew food or swallow pills.
Which statement(s) reflect nursing interventions for a client with post-polio syndrome?
The nurse provides care aimed at slowing the loss of strength and maintaining the physical, psychological and social well being of the client
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
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?
You may experience progressive deterioration in all voluntary muscles."
A nurse is working in a surgical floor. The nurse must logroll a client following a:
laminectomy
Bone density testing in clients with post-polio syndrome has demonstrated
low bone mass and osteoporosis.
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?
meningioma
