Chapter 44: PrepU - Nursing Management: Patients With Oncologic Disorders of the Brain and Spinal Cord

Corticosteroids are used in the management of brain tumors to 1- prevent extension of the tumor. 2- facilitate regeneration of neurons. 3- reduce cerebral edema. 4- identify precise location of the tumor.

3

A patient diagnosed with a tumor in the cerebellar region would expect to have changes in which of the following? 1- Balance and coordination 2- Vision 3- Hearing 4- Cognition

1

Which medication classification should be avoided in the treatment of brain tumors? 1- Anticoagulants 2- Osmotic diuretics 3- Corticosteroids 4- Anticonvulsants

1

Which of the following is a late symptom of spinal cord compression? 1- Paralysis 2- Urinary incontinence 3- Fecal incontinence 4- Urinary retention

1

A nurse suspects that a client has Huntington disease based on which assessment finding? 1- Slurred speech 2- Disorganized gait 3- Chorea 4- Dementia

3

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? 1- Disruption in sleep patterns 2- Unusual sensitivity to heat and cold 3- Visual disturbances 4- Increased intracranial pressure

4

A 66-year-old woman with a recent history of headaches and agitation has been found to have a meningioma. The neurological nurse should understand that the symptoms of this woman's tumor are attributable to what pathophysiological process? 1- Invasion of brain tissue by the tumor 2- Intracerebral hemorrhage 3- Compression of brain tissue 4- Impaired cerebrospinal fluid (CSF) synthesis

3

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

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

The nurse is assessing a client with a confirmed spinal cord tumor. The client states, "I've been too embarrassed to tell anyone but, I have been awakened at night because I've wet the bed." It would be a priority for the nurse to further assess the client for which complication? 1- Spinal cord compression 2- Urinary tract infection 3- Knowledge deficit 4- Impaired skin integrity

1

A client with a brain tumor experiences projectile vomiting. The nurse integrates understanding of this occurrence as resulting from which of the following? 1- Edema associated with the tumor 2- Irritation of the meduallary vagal centers 3- Compression of surrounding structures 4- Distortion of pain-sensitive structures

2

The spouse of a client with terminal brain cancer asks the nurse about hospice. Which statement by the nurse best describes hospice care? 1- "Hospice care uses a team approach and provides complete care." 2- "Clients and families are the focus of hospice care." 3- "The physician coordinates all the care delivered." 4- "All hospice clients die at home."

2

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? 1- Hemorrhage 2- Bowel incontinence 3- Respiratory dysfunction 4- Skin breakdown

3

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? 1- "If a corticosteroid has been prescribed, do not take it at the same time as this medication." 2- "If the previous day's dose was forgotten, take two at the regular time the next day." 3- "Suicidal ideation is a common side effect of this medication and should be reported immediately." 4- "Driving a car should be avoided until the you know how this medication effects you."

4

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? 1- How to exercise 2- How to perform household tasks 3- How to take a bath 4- How to facilitate tasks such as using both hands to hold a drinking glass

4

The nurse teaches the client that corticosteroids will be used to treat his brain tumor to 1- prevent extension of the tumor. 2- facilitate regeneration of neurons. 3- reduce cerebral edema. 4- identify the precise location of the tumor.

3

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? 1- "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." 2- "You are not permitted to speak to me this way. I am a professional and I deserve for you to treat me with respect." 3- "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." 4- "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."

4

Which statement indicates appropriate nursing intervention for a client with post-polio syndrome? 1- Administer antiretroviral agents 2- Plan activities for evening hours rather than morning hours 3- Avoid the use of heat applications in the treatment of muscle and joint pain 4- Provide care aimed at slowing the loss of strength and maintaining overall well-being.

4

After a transsphenoidal adenohypophysectomy, a client is likely to undergo hormone replacement therapy. A transsphenoidal adenohypophysectomy is performed to treat which type of cancer? 1- Esophageal carcinoma 2- Pituitary carcinoma 3- Laryngeal carcinoma 4- Colorectal carcinoma

2

The nurse and a nursing student are admitting a client with a malignant glioma brain tumor preoperatively for resection of the tumor. The nursing student asks the nurse, " I was told these types of tumors have a very poor prognosis. Why is the tumor being resected?" Which rationale for this intervention is true? 1- "Every life-saving treatment is administered when treating brain tumors." 2- "Surgical resection of the tumor will decrease intracranial pressure." 3- "Using this procedure will eliminate the need for chemotherapy." 4- "Removing bulk from the tumor will reverse the paralysis."

2

A nurse is assisting with a neurological examination of a client who reports a headache in the occipital area and shows signs of ataxia and nystagmus. Which of the following conditions is the most likely reason for the client's problems? 1- Frontal lobe abscess 2- Temporal lobe abscess 3- Cerebellar abscess 4- Wernicke's abscess

3

A nurse is reviewing a client's medical record and finds that the client has a spinal cord tumor that invovles the vertebral bodies. The nurse identifies this as which type of spinal tumor? 1- Intramedullary 2- Intradural-extramedullary 3- Extradural 4- Metastatic

3

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? 1- Paclitaxel 2- Coumadin 3- Decadron 4- Dilantin

2

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? 1- Related to visual field deficits 2- Related to difficulty swallowing 3- Related to impaired balance 4- Related to psychomotor seizures

3

A client with post-polio syndrome displays fatigue and decreased muscle strength. How should the nurse best respond to the client? 1- "This will pass, you need to relax." 2- "Once you sleep, you should be fine." 3- "Intravenous immunoglobulin infusion may help you." 4- "These symptoms are not related to your past diagnosis."

3

A client is diagnosed with a brain angioma. When teaching the client about the risks associated with this type of brain tumor, the nurse would educate about signs and symptoms associated with which condition? 1- Hemorrhagic stroke 2- Thyroid disorders 3- Hearing loss 4- Visual loss

1

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? 1- Subarachnoid space 2- Central vein 3- Implanted port 4- Epidural space

1

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? 1- Surgery 2- Radiation therapy 3- Chemotherapy 4- Immunotherapy

1

A nurse is providing care to a client who has been diagnosed with metastatic brain cancer. When developing the client's plan of care, which outcome would the nurse most likely identify? 1- Improved quality of life 2- Elimination of distressing signs and symptoms 3- Removal of all or part of the tumor 4- Reduced incidence of recurrence

1

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? 1- Tetrabenazine (Xenazine) 2- Carbamazepine (Tegretol) 3- phenobarbital 4- Diazepam (Valium)

1

A patient's recent diagnostic workup has resulted in a diagnosis of a glioma, and a treatment plan is being promptly created by the multidisciplinary care team. The patient's oncologist has recommended chemotherapy, which is to be administered by the intrathecal route. The nurse should understand that the rationale for choosing this administration route involves which of the following considerations? 1- The drug will bypass the blood-brain barrier. 2- The patient will not require IV access. 3- The drug can be administered on an outpatient basis. 4- The patient will require weekly, rather than daily, drug administration.

1

An acoustic neuroma is a benign tumor of which cranial nerve? 1- Eighth 2- Fifth 3- Seventh 4- Ninth

1

Following a transsphenoidal hypophysectomy, a nurse should assess a client for which condition? 1- Hypocortisolism 2- Hypoglycemia 3- Hyperglycemia 4- Hypercalcemia

1

In which location are most brain angiomas located? 1- Cerebellum 2- Hypothalamus 3- Thalamus 4- Brainstem

1

Nurses are performing hourly neurological assessments of a patient who is postoperative day 1 following spinal surgery that was performed to treat spinal cord compression (SCC). The nurse's most recent assessment shows a marked reduction in motor and sensory function. How should the nurse best follow-up this assessment finding? 1- Inform the care provider promptly about this sudden change. 2- Reassess the patient in 15 minutes. 3- Contact the anesthesiologist to discuss possible residual effects of anesthesia. 4- Document these findings and have a colleague confirm the assessment.

1

The nurse cares for a client with Huntington disease. What intervention is a priority for safe care? 1- Protecting the client from falls 2- Measuring electrolytes 3- Assessing serum cholesterol 4- Range-of-motion exercises

1

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? 1- Within the brain tissue 2- From the coverings of the brain 3- In the cranial nerves 4- From metastasis of a primary tumor

1

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? 1- Mannitol 2- Temozolomide 3- Bevacizumab 4- Everolimus

1

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? 1- Intracerebral hemorrhage 2- Deep vein thrombosis 3- Pulmonary embolism 4- Spinal metastasis

1

The nurse is caring for a client in the hospital emergency department who reports recent muscle weakness, sensory loss, aphasia, and visual changes accompanied by a suddent onset of complex partial seizures. The nurse anticipates which diagnostic test will be prescribed to rule out or confirm with high certainty the presence of a brain tumor? 1- Magnetic resonance imaging (MRI) 2- Computed tomography (CT) 3- Positron emission tomography (PET) 4- Cranial x-ray

1

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? 1- Cerebrospinal fluid leakage 2- Infection at the surgical site 3- Growth of a secondary tumor 4- Impaired tissue healing

1

The nurse is caring for a client with an inoperable brain tumor. What is a major threat to this client? 1- Increased intracranial pressure 2- Decreased intracranial pressure 3- Hypervolemia 4- Hypovolemia

1

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? 1- Rapid, jerky, involuntary movements 2- Slow, shuffling gait 3- Dysphagia and dysphonia 4- Dementia

1

The nurse is performing an initial assessment on a client admitted with a possible brain abscess. Which of the following would the nurse most likely find? 1- Headache that is worse in the morning 2- Ptosis that is more pronounced at the end of the day 3- Diplopia that is constant 4- Nuchal rigidity

1

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? 1- Impaired sensory perception 2- Motor weakness 3- Medication side effects 4- Cognitive impairment

1

The nurse is seeing a client who has just been diagnosed with a meningioma. The client states he is confused because the provider stated, "If you have to be diagnosed with a brain tumor, this is the least harmful." The client asks the nurse for clarification. How should the nurse respond? 1- "I am unable to interpret what your provider meant by making that statement; however, it is true that meningiomas are slow growing tumors that are not typically fatal." 2- "I am assuming your provider was trying to explain to you that meningomas have a high cure rate if treated with surgery, chemotherapy and radiation aggressively." 3- "It is likely that your provider was trying to be as supportive as possible with those positive words. You need a lot of support during this challenging time." 4- "It would have been important for you to clarify your provider's statement during your appointment. It is not within my scope to discuss the details of your diagnosis."

1

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? 1- Tissue biopsy 2- Weber and Rinne test 3- Audible bruit over the skull 4- An increase in prolactin

1

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? 1- They can affect vital functioning. 2- They do not require surgical removal. 3- The prognosis is very poor. 4- They are all metastatic.

1

The nursing is assessing a client who has been diagnosed with a pituitary adenoma, but has not yet started treatment. The client reports having increased heart rate, hand tremors, difficulty sleeping, weight loss and hyperthermia. The nurse anticipates the client will require blood work to assess for overproduction of which hormone? 1- Thyroid-stimulating hormone 2- Adrenocorticotropic hormone 3- Prolactin 4- Growth hormone

1

What is the only known risk factor for brain tumors? 1- Ionizing radiation 2- Head trauma 3- Use of hair dyes 4- Cellular telephones

1

Which diagnostic is most commonly used for spinal cord compression? 1- Magnetic resonance imaging (MRI) 2- Computed tomography (CT) 3- Positron emission tomography (PET) 4- X-ray

1

Which of the following outcomes would be most appropriate to include in the plan of care for a client diagnosed with a muscular dystrophy? 1- Client participates in activities of daily living using adaptive devices. 2- Client demonstrates understanding of the need to adhere to medication therapy. 3- Client verbalizes understanding of the chronic nature of the disorder. 4- Client describes the importance of diagnostic follow-up to evaluate the disorder.

1

Which of the following provides the best outcome for most tumor types? 1- Surgery 2- Radiation 3- Chemotherapy 4- Palliation

1

The nurse is conducting a neurological assessment with a client who has increased intracranial pressure secondary to growth of brain tumor mass. What assessment tools can the nurse use to determine the client's neurological status? Select all that apply. 1- Glascow coma scale (GCS) 2- Mini mental status examination (MMSE) 3- Urinalysis 4- Chest ascultation 5- Beck Depression Inventory (BDI)

1,2

The nurse educator is testing a group of nursing students about various types of brain tumors and their clinical manifestations. The students are correct when stating tumors located in the cerebellar region of the brain produce which symptoms? Select all that apply. 1- Staggering gait 2- Muscle incoordination 3- Abnormal eye movements 4- Visual hallucinations 5- Apathetic mental attitude

1,2,3

A client diagnosed with a brain tumor is exhibiting focal symptoms. Which assessment findings are the nurse likely to note? Select all that apply. 1- Muscle weakness 2- Sensory loss 3- Aphasia 4- Visual changes 5- Vomiting

1,2,3,4

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. 1- Ensure that the client is free of pain for meals. 2- Place the client near the sounds and smells of meals being prepared. 3- Plan meals for times when the client is rested. 4- Provide the client with foods that he likes. 5- Prepare the client for the insertion of a feeding tube.

1,3,4

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. 1- The client should ensure no one else handles the medication. 2- If a dose is missed, the client should take double the amount at the regular time the following day. 3- The client should seek emergency help if nausea or vomiting occur. 4- The client should seek emergency care if he or she develops a fever. 5- Hair loss should be expected when taking the medication.

1,4,5

A 13-year-old patient is admitted to the pediatric unit with a suspected brain tumor. The nurse should understand that which diagnostic test is the most helpful in the diagnosis of brain tumors? 1- Computed tomography (CT) scan 2- Magnetic resonance imaging (MRI) 3- Brain biopsy 4- Blood work with adrenocorticotropic hormone (ACTH) levels

2

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? 1- Frontal lobe 2- Cerebellum 3- Motor cortex 4- Occipital lobe

2

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 the patient in what position? 1- In the lithotomy position 2- In a flat side-lying position 3- In the Trendelenburg position 4- In the reverse Trendelenburg position

2

A patient has recently been diagnosed with an acoustic neuroma. The nurse helps the patient understand that: 1- Almost 80% of these tumors become malignant over time. 2- Hearing loss usually occurs. 3- Compression of the seventh cranial nerve is a side effect. 4- Surgery is never needed; radiation has proven very effective.

2

Which disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive, involuntary dancelike movements and dementia? 1- Multiple sclerosis 2- Huntington disease 3- Parkinson disease 4- Creutzfeldt-Jakob disease

2

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: 1- The tumor is malignant and aggressive. 2- The tumor will cause pressure on the eighth cranial nerve. 3- Growth is slow and symptoms are caused by compression rather than tissue invasion. 4- Surgery, which can result in complete removal of the possible tumor, should be done as soon as possible.

3

A client diagnosed with Huntington's disease has developed severe depression. What would be most important for the nurse to assess for? 1- Loss of bowel and bladder control 2- Choreiform movements 3- Suicidal ideations 4- Emotional apathy

3

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? 1- "You should ask your physician about that." 2- "The strength of your arms and pelvic muscles will decrease gradually, but this should cause only slight disability." 3- "You may experience progressive deterioration in all voluntary muscles." 4- "This form of muscular dystrophy is a relatively benign disease that progresses slowly."

3

Magnetic resonance imaging has confirmed a diagnosis of glioblastoma multiforme (GBM) in a 56-year-old male patient. The nurse who is planning this patient's care should prioritize which of the following nursing actions? 1- Liaising with community agencies to organize long-term rehabilitation 2- Teaching the patient about the importance of healthy lifestyle in recovery from GBM 3- Choosing psychosocial interventions that are relevant to the patient's poor prognosis 4- Teaching the patient about the pharmacological interventions relevant to his treatment

3

The nurse is caring for a client with an inoperable brain tumor. What teaching is important for the nurse to do with these clients? 1- Optimizing nutrition 2- Managing muscle weakness 3- Explaining hospice care and services 4- Offering family support groups

3

A 30-year-old female patient has been referred to a specialist by her primary care provider because she has recently developed fat pads at the base of her neck, an increasingly round face, and striae at various locations. The patient's signs of illness have been attributed to a brain tumor. What type of brain tumor is most likely to result in these changes to the woman's physical appearance? 1- Glioma 2- Acoustic neuroma 3- Meningioma 4- Pituitary adenoma

4

A 33-year-old man who is in healthy physical condition has been admitted to the emergency room with unilateral weakness and slurred speech. A computed tomography (CT) scan of the man's head reveals a hemorrhagic stroke despite the fact that the man is in good health with no history of hypertension, thromboembolism, or drug use. What type of brain tumor has the potential to cause this man's health problem? 1- Acoustic neuroma 2- Meningioma 3- Pituitary adenoma 4- Angioma

4

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? 1- Core needle biopsy 2- Ultrasonography 3- Computed tomography 4- Magnetic resonance imaging

4

A nurse helps a patient recently diagnosed with a pituitary adenoma understand that: 1- The cause is directly related to prior exposure to radiation. 2- Most tumors are malignant (>90%). 3- Transcranial surgery is usually necessary to remove the tumor. 4- Most tumors produce too much of one or more hormones.

4

A patient is diagnosed with a spinal cord tumor and has had a course of radiation and chemotherapy. Two months after the completion of the radiation, the patient complains of severe pain in the back. What is pain an indicator of in a patient with a spinal cord tumor? 1- Lumbar sacral strain 2- The development of a skin ulcer from the radiation 3- Hematoma formation 4- Spinal metastasis

4

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? 1- Osteoarthritis 2- Calcification of long bones 3- Pathologic fractures 4- Low bone mass and osteoporosis

4

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? 1- BP = 90/50 mm Hg; HR = 75 bpm 2- BP =130/80 mm Hg; HR = 55 bpm 3- BP = 150/90 mm Hg; HR = 90 bpm 4- BP = 175/45 mm Hg; HR = 42 bpm

4

The nurse is caring for a client with increased intracranial pressure (ICP) after surgical resection of a brain tumor. The nurse recognizes the client is demonstrating late signs of ICP when which sign is observed? 1- Hypotension 2- Low pulse pressure 3- Tachycardia 4- Irregular respirations

4