Brain Tumors
A patient with a suspected brain tumor asks the nurse why a CT scan has not been ordered. Which statement, made by the nurse, would be the best response? "It is too soon for your doctor to order the CT scan. Other tests will be done first." "An MRI may a better option for diagnosing your tumor." "You will have a lumbar puncture first, then have the CT scan." "The dye from the CT scan could be harmful to you."
"It is too soon for your doctor to order the CT scan. Other tests will be done first." Telling the patient that the provider will order the test when it's appropriate is dismissing the patient's concerns, and may be perceived as rude by the patient. "An MRI may a better option for diagnosing your tumor." MRI is more appropriate for detecting small tumors. The nurse should clearly explain all procedures and treatments and their rationale. "You will have a lumbar puncture first, then have the CT scan." The patient will likely not have a lumbar puncture because of the threat of cerebral herniation. "The dye from the CT scan could be harmful to you." Unless the patient has impaired kidney function or an allergy to shellfish, CT scan dye would not be harmful.
During the admission assessment of a patient diagnosed with a brain tumor, which questions should the nurse ask to gain pertinent information about the patient's condition? Select all that apply. "Who is the current president of the United States?" "Have you been scheduled for surgery or chemotherapy?" "Do you get dizzy when you change positions from sitting to standing?" "What other chronic conditions have you been diagnosed with?" "Have you ever been diagnosed with meningitis or encephalitis?"
"Who is the current president of the United States?" A full neurologic and mental status examination should be performed. "Have you been scheduled for surgery or chemotherapy?" Information about the patient's current treatment can be obtained from the patient's health record and would not be part of the initial assessment. "Do you get dizzy when you change positions from sitting to standing?" The nurse should ask the patient about any history of syncope or near-syncopal episodes. "What other chronic conditions have you been diagnosed with?" Medical history should be obtained during the patient interview of a patient with a brain tumor. "Have you ever been diagnosed with meningitis or encephalitis?" The nurse should ask the patient with a brain tumor about a history of neurologic infections.
Match the clinical manifestation with the tumor location. 1) Temporal 2) Occipital 3) Frontal A. Dysphagia B. Diplopia C. Papilledema D. Unilateral ataxia; cognitive changes
1) A 2) B C) D
A patient with a parietal lobe tumor is disoriented and has left-sided weakness. Which interventions would the nurse implement to ensure patient safety? Select all that apply. Apply non-skid socks Raise all 4 side rails Apply behavioral wrist restraints Provide an around the clock sitter Instruct patient to ask for help before getting out of bed
Apply non-skid socks Applying non-skid socks will help prevent the patient from falling when out of bed. Raise all 4 side rails Raising all 4 side rails is considered a restraint, and should not be done in the hospital. Apply behavioral wrist restraints Behavioral restraints would not be appropriate for a patient who is disoriented and not combative. Provide an around the clock sitter Providing a sitter allows for constant supervision of the patient. Instruct patient to ask for help before getting out of bed The nurse should encourage the patient to ask for help getting out of bed to protect the patient from falling.
Which assessments are most important for the nurse to conduct when admitting a patient diagnosed with a brain tumor? Select all that apply. Pain level Primary diet Range of motion Vision screening Patient orientation NOT SURE
Pain level Pain assessment is important because patients with brain tumors may experience severe pain. Primary diet Dietary preferences are important to assess, but are not the priority for a patient with a brain tumor. Range of motion On admission, the nurse should complete a full neurological assessment, including the motor function. Range of motion is part of motor function. Vision screening On admission, the nurse should complete a full neurological assessment, including the sensory function. Vision is a part of the sensory assessment. Patient orientation On admission, the nurse should complete a full neurological assessment, including the level of consciousness.
Collaborative care of brain tumors should be focused on which factors? Select all that apply. Establishing baseline vital signs Treating the underlying infection Preventing/managing increased ICP Identifying the tumor type and location Removing and decreasing the tumor mass
Establishing baseline vital signs Establishing baseline vital signs is important, however, it is not the primary goal of collaborative therapy. Treating the underlying infection Patients with brain tumors may also have infections, but treating the infection is not the priority of collaborative care. Preventing/managing increased ICP Brain tumors can cause an increase in ICP. Collaborative care should work to maintain a normal ICP. Identifying the tumor type and location It is important to identify the type and location of the tumor so that surgical removal is most effective. Removing and decreasing the tumor mass The tumor will likely be removed, or debulked, depending on the size, location, and other affected brain structures.
Which cancers commonly metastasize to the brain? Liver Breast Lung Ovarian Pancreatic
Liver Liver cancer frequently metastasizes to the gastrointestinal tract, breast, and lung, but not the brain. Breast Breast cancer frequently metastasizes to the brain. Lung Lung cancer frequently metastasizes to the brain. Ovarian Ovarian cancer may spread to the peritoneum, but does not metastasize to the brain. Pancreatic Pancreatic cancer frequently metastasizes to the liver and the lungs, but not the brain.
When caring for a patient admitted with a temporal lobe tumor, the nurse prepares the patient for which diagnostic procedure? MRI Biopsy CT scan Lumbar puncture
MRI MRI is used to detect small tumors, not tumors that have already been detected. Biopsy Histology is performed from tissue obtained during surgery or biopsy to definitively diagnose malignancy. CT scan A CT scan helps to locate the tumor. This tumor has already been located. Lumbar puncture A Lumbar puncture is used to test the CSF for abnormalities. It is rarely used with brain tumors.
Which complication may occur if the brain tumor obstructs the ventricles? Metastases Herniation Encephalitis Hydrocephalus
Metastases Metastases, the spread of tumor cells to other body areas, does not result from obstructed ventricles. Herniation Herniation, movement of brain tissue from increased pressure, does not result from obstructed ventricles. Encephalitis Encephalitis is an inflammatory condition of the brain caused by a viral infection. It does not result from obstructed ventricles. Hydrocephalus If the ventricles are obstructed, the patient may develop hydrocephalus. This can be treated by use of a ventricular shunt.
A patient previously diagnosed with lung cancer now reports headaches, nausea and vomiting, and a new onset of muscle weakness. Which condition does the nurse suspect? Metastatic tumor Glioblastoma Meningioma Pituitary adenoma
Metastatic tumor Because the patient was previously diagnosed with lung cancer, the nurse would suspect a metastatic brain tumor. Glioblastoma The nurse would not suspect glioblastomas based on the patient's information. Meningioma The nurse would not suspect a meningioma based on the patient's information. Pituitary adenoma The nurse would not suspect pituitary adenoma based on the patient's information. Pituitary tumors are typically benign.
A patient with a parietal lobe tumor who is receiving radiation therapy complains of worsening headaches, nausea, and drowsiness. The nurse suspects increased ICP and anticipates which health care provider order? Morphine 5 mg IV push Ampicillin 2 g IVPB Dexamethasone 10 mg IV Phenergan 10 mg IV push
Morphine 5 mg IV push Morphine would alleviate the patient's pain, but will exacerbate the drowsiness. Ampicillin 2 g IVPB Ampicillin is used to treat infection. The patient's symptoms are not consistent with infection. Dexamethasone 10 mg IV Dexamethasone is a corticosteroid and is used to treat cerebral edema. Headache, nausea, and drowsiness are symptoms of cerebral edema. Phenergan 10 mg IV push Phenergan will help the patient's nausea, but will exacerbate the drowsiness.
Place the tumor types in order of malignancy from benign to highly malignant. Oligodendroglioma Astrocytoma Glioblastoma multiforme Acoustic neuroma
Oligodendroglioma. Acoustic neuroma. Astrocytoma. Glioblastoma multiforme Oligodendroglioma are benign tumors. Acoustic neuroma are usually benign, are also associated with low-grade malignancy. Astrocytoma can range from low-grade to moderate-grade malignancy, whereas glioblastoma multiforme is a highly malignant and invasive disease and one of the most devastating forms of primary brain tumor.
The nurse is caring for a patient with a ventricular shunt and notes decreased level of consciousness (LOC), a temperature of 102 °F, and vomiting. Which orders would the nurse anticipate? Select all that apply. Prepare for surgery Lay patient supine Phenergan 25 mg PO Ceftriaxone 1 g IV Morphine 15 mg IV push
Prepare for surgery Altered LOC and vomiting are signs of a shunt malfunction. The ventricular shunt may need to be adjusted or replaced. Lay patient supine Altered LOC and vomiting are signs of increased ICP; laying the patient supine would exacerbate the patient's symptoms. Phenergan 25 mg PO The patient may also have pain with an infected ventricular shunt, however 25 mg of phenergan may sedate the patient and prohibit true neurological assessment. Ceftriaxone 1 g IV Altered LOC, fever, and vomiting are signs of infection. Antibiotics would be used to treat the infection. Morphine 15 mg IV push The patient may also have pain with an infected ventricular shunt, however 15 mg of morphine may sedate the patient and prohibit true neurological assessment.
A patient with a temporal lobe tumor is having trouble communicating with the nurse. What is the appropriate nursing action? Provide an interpreter Provide the patient with a pen and paper Increase voice volume when speaking Sit directly beside the patient when speaking
Provide an interpreter An interpreter is used to bridge a language gap, not to assist a patient with a temporal lobe tumor with communicating. Provide the patient with a pen and paper Providing a pen and paper allows the patient with aphagia related to a temporal lobe tumor to communicate directly with the nurse. Communication difficulty may also indicate progression of the tumor into the parietal lobe. Increase voice volume when speaking A temporal lobe tumor does not affect the ability of the patient to hear and therefore, increasing volume will not aid in communication. Sit directly beside the patient when speaking Sitting directly beside the patient, does not necessarily promote communication with the patient.
The nurse is caring for a patient with a brain tumor in the temporal region who has developed aphagia. Which action is most important for the nurse to take? Provide verbal instructions rather than written instructions. Give the patient a four-point walker to use when ambulating. Keep a white board and markers in the patient's room at all times. Place padding on all four side rails and place patient on fall precautions.
Provide verbal instructions rather than written instructions. Tumors confined to the temporal region do not typically affect the patient's vision. It may not be necessary. Give the patient a four-point walker to use when ambulating. Tumors confined to the temporal region do not affect balance. A walker may not be necessary. Keep a white board and markers in the patient's room at all times. Tumors in the temporal region affect the patient's speech and may cause aphagia. The nurse should develop a means of communication, such as use of a white board. Place padding on all four side rails and place patient on fall precautions. Padding on the side rails and fall precautions are necessary for patients who have developed seizures related to increased ICP. The patient's symptoms do not indicate increased ICP at this time.
A patient with a large tumor in the occipital region asks the nurse about the benefits of surgery. Which information would the nurse include in the response? Select all that apply. Removal can relieve symptoms Surgery can reduce the tumor mass Removal of the tumor will decrease ICP Complete surgical removal may not be possible Recovery time after brain surgery is relatively short
Removal can relieve symptoms Tumors cause symptoms of increased ICP and also affect the brain structure they press on. Removing the tumor would alleviate those symptoms. Surgery can reduce the tumor mass Surgery may be used for debulking the tumor. Removal of the tumor will decrease ICP Brain tumors increase ICP by adding content to the cranial cavity, and pressing on other structures. Tumor removal alleviates the pressure. Complete surgical removal may not be possible The tumor is not always accessible or may involve vital parts of the brain. The nurse must include all information regarding the procedure. Recovery time after brain surgery is relatively short Recovery time will depend on the size and location of the tumor. It may not be a short process.
The nurse is educating a patient with a parietal lobe tumor regarding symptoms to report to the health care provider. Which information should be included in the teaching? Select all that apply. Sleepiness Blurred vision Slurred speech Spatial disorders Hearing problems
Sleepiness Brainstem tumors, not parietal lobe tumors, cause drowsiness. Blurred vision Blurred vision is not a symptom of parietal lobe tumors, but of occipital tumors that affect the vision center of the brain. Slurred speech Speech disturbance, including slurring, is a symptom of parietal lobe tumors. Spatial disorders Spatial disorders are a symptom of parietal lobe tumors. Hearing problems Cerebellopontine tumors, not tumors of the parietal lobe, typically cause hearing problems such as tinnitus and deafness.
A patient being treated for a brain tumor is receiving radiation therapy. Which assessment findings indicate that nursing management of this patient is effective? Sodium 156 Albumin 3.5 Glucose 120 Hemoglobin 7.6
Sodium 156 Serum sodium of 156 indicates the presence of dehydration and the need for further follow-up. Albumin 3.5 An albumin level of 3.5 indicates adequate nutritional intake. Nutritional intake should be assessed to ensure nursing management is effective. Glucose 120 Glucose of 120 is a normal finding, but is not related to radiation therapy. Hemoglobin 7.6 A hemoglobin of 7.6 indicates anemia and indicates the patient needs further treatment.
