Chapter 65: Management of Patients with Oncologic or Degenerative Neurologic Disorders
A patient is diagnosed with an aggressive, primary malignant brain tumor. The nurse is aware that the glioma: Metastasized from a cancer in another part of the body. Originated from the coverings of the brain. Developed on the cranial nerves. Originated within the brain tissue.
Originated within the brain tissue. The most aggressive type of malignant brain tumor is a glioma, which originates within the brain tissue.
Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem? Parkinson disease Alzheimer disease Amyotrophic lateral sclerosis Huntington disease
Amyotrophic lateral sclerosis Amyotrophic lateral sclerosis (ALS) is a disease of unknown cause in which there is a loss of motor neurons in the anterior horns of the spinal cord and the motor nuclei of the lower brain stem. Parkinson disease is a slowly progressing neurologic movement disorder that eventually leads to disability. Alzheimer disease is a chronic, progressive, and degenerative brain disorder that is accompanied by profound effects on memory, cognition and ability for self-care. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia.
An acoustic neuroma is a benign tumor of which cranial nerve? Ninth Fifth Eighth Seventh
Eighth An acoustic neuroma is a benign tumor of the eighth cranial nerve, the cranial nerve most responsible for hearing and balance.
What is the most common type of brain neoplasm? Neuroma Angioma Meningioma Glioma
Glioma Gliomas are the most common brain neoplasms, accounting for about 45% of all brain tumors. Angiomas account for approximately 4% of brain tumors. Meningiomas account for 15% to 20% of all brain tumors. Neuromas account for 7% of all brain tumors.
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 exercise How to take a bath How to perform household tasks How to facilitate tasks such as using both hands to hold a drinking glass
How to facilitate tasks such as using both hands to hold a drinking glass The nurse demonstrates how to facilitate tasks such as using both hands to hold a drinking glass, using a straw to drink, and wearing slip-on shoes. The teaching portion of the care plan would not include how to exercise, perform household tasks, or take a bath.
A client with a brain tumor experiences projectile vomiting. The nurse integrates understanding of this occurrence as resulting from which of the following? Edema associated with the tumor Compression of surrounding structures Distortion of pain-sensitive structures Irritation of the medullary vagal centers
Irritation of the medullary vagal centers Vomiting associated with a brain tumor is usually the result of irritation of the vagal centers in the medulla. Edema secondary to the tumor or distortion of the pain-sensitive structures is thought to be the cause of the headache associated with brain tumors. Compression of the surrounding structures results in the signs and symptoms of increased intracranial pressure.
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? Rapid, jerky, involuntary movements Dementia Slow, shuffling gait Dysphagia and dysphonia
Rapid, jerky, involuntary movements The most prominent clinical features of the disease are chorea (rapid, jerky, involuntary, purposeless movements), impaired voluntary movement, intellectual decline, and often personality changes (Aubeeluck & Wilson, 2008).
The nurse teaches the client that corticosteroids will be used to treat his brain tumor to identify the precise location of the tumor. reduce cerebral edema. prevent extension of the tumor. facilitate regeneration of neurons.
reduce cerebral edema. Corticosteroids may be used before and after treatment to reduce cerebral edema and to promote a smoother, more rapid recovery. Corticosteroids do not prevent extension of the tumor or facilitate regeneration of neurons. Stereotactic procedures identify the precise location of the tumor.
The nurse is caring for a client hospitalized after a motor vehicle accident. The client has a comorbidity of Parkinson's disease. Why should the nurse closely monitor the condition and the drug regimen of a client with Parkinson's disease? Drugs administered may not cause the requisite therapeutic effect. Clients generally do not adhere to the drug regimen. Clients take an assortment of different drugs. Drugs administered may cause a wide variety of adverse effects.
Drugs administered may cause a wide variety of adverse effects. Drugs administered for Parkinsonism may cause a wide variety of adverse effects, which requires careful observation of the client. Over time, clients may respond less and less to their standard drug therapy and have more frequent "off episodes" of hypomobility. As a result, the nurse should administer the drugs closely to the schedule. Generally, a single drug called levodopa is administered to clients with Parkinson's disease. It is also not true that drugs may not cause the requisite therapeutic effect or such clients do not adhere to the drug regimen.
A client with a malignant brain tumor comes to the clinic for a follow up. During the visit, the client asks the nurse, "Why am I so tired all the time?" When responding to the client, which information would the nurse include as possible causes? Select all that apply. Effects of increased intracranial pressure Stress Tumor Treatment being used Metastasis
Stress Tumor Treatment being used Fatigue is a symptom experienced by clients with both malignant and nonmalignant brain tumors. Etiology of fatigue can be multifactorial. The tumor itself, surgery, medications, chemotherapy, and radiation may all contribute to increased fatigue. Clients may report a constant feeling of exhaustion, weakness, and lack of energy. It is also important to identify underlying conditions, such as stress, anxiety, and depression, which may play a role in fatigue. Metastasis and increased intracranial pressure are not usually associated with fatigue.
Which medication classification should be avoided in the treatment of brain tumors? Corticosteroids Anticonvulsants Osmotic diuretics Anticoagulants
Anticoagulants Anticoagulants usually are not prescribed because of the risk for central nervous system (CNS) hemorrhage; however, prophylactic therapy with low-molecular-weight heparin is under investigation. Osmotic diuretics, corticosteroids, and anticonvulsants are utilized in the treatment of brain tumors.
In which location are most brain angiomas located? Cerebellum Thalamus Hypothalamus Brainstem
Cerebellum Brain angiomas occur most often in the cerebellum. Most brain angiomas do not occur in the hypothalamus, thalamus, or brainstem (midbrain, pons, medulla).
A client has recently been diagnosed with an acoustic neuroma. The nurse helps the client understand that: Almost 80% of these tumors become malignant over time. Compression of the seventh cranial nerve is a side effect. Surgery is never needed; radiation has proven very effective. Hearing loss usually occurs.
Hearing loss usually occurs. An acoustic neuroma is a benign tumor of the eighth cranial nerve. About 50% can be treated with surgery. Hearing loss always occurs. Compression on the fifth cranial nerve can also cause facial paresthesia.
Which nursing diagnosis takes the highest priority for a client with parkinsonian crisis? Ineffective airway clearance Risk for injury Imbalanced nutrition: Less than body requirements Impaired urinary elimination
Ineffective airway clearance In parkinsonian crisis, dopamine-related symptoms are severely exacerbated, virtually immobilizing the client. A client confined to bed during such a crisis is at risk for aspiration and pneumonia. Also, excessive drooling increases the risk of airway obstruction. Because of these concerns, the nursing diagnosis of Ineffective airway clearance takes the highest priority. Although Imbalanced nutrition: Less than body requirements, Impaired urinary elimination, and Risk for injury are also appropriate nursing diagnoses, they aren't immediately life-threatening.
Which of the following is a brain tumor arising from the supporting structures? Astrocytomas Meningiomas Glioblastoma multiforme Medulloblastoma
Meningiomas Brain tumors arising from the supporting structures include meningiomas, neuromas, and pituitary adenomas. Intracerebral tumors include astrocytomas, medulloblastoma, and glioblastoma multiforme.
A client is diagnosed with amyotrophic lateral sclerosis (ALS) in the early stages. Which medication would the nurse most likely expect to be prescribed as treatment? Benztropine mesylate Amantadine Riluzole Bromocriptine
Riluzole Riluzole is the only medication that is approved for use in treating ALS. It is used for its neuroprotective effect in the early stages of the disease. Benztropine amantadine and bromocriptine are used to treat Parkinson's disease.
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? Epidural space Implanted port Central vein Subarachnoid space
Subarachnoid space Chemotherapy given intrathecally is injected directly into the subarachnoid space, not a central vein, implanted port or epidural space.s
A client diagnosed with Parkinson's disease has developed slurred speech and drooling. The nurse knows that these symptoms indicate which of the following? The client is exhibiting signs of medication overdose. Medication needs to be adjusted to higher doses. The client is having an exacerbation. The disease has entered the late stages.
The disease has entered the late stages. In late stages, the disease affects the jaw, tongue, and larynx; speech is slurred; and chewing and swallowing become difficult. Rigidity can lead to contractures. Salivation increases, accompanied by drooling. In a small percentage of clients, the eyes roll upward or downward and stay there involuntarily (oculogyric crises) for several hours or even a few days. Options A, B, and C are therefore incorrect.
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 are all metastatic. The prognosis is very poor. They do not require surgical removal. They can affect vital functioning.
They can affect vital functioning. Benign tumors are usually slow growing but can occur in a vital area, where they can grow large enough to cause serious effects. Surgical removal of a benign tumor is dependent on many factors; even if the tumor is slow growing or not growing at all, the location of the tumor in the brain factors into the decision for surgical removal. The prognosis for all brain tumors is not necessarily poor. Treatment is individualized and can have varying prognostic outcomes. Benign tumors are not metastatic, meaning they do not grow rapidly or spread into surrounding tissue, but they can still be considered life-threatening.
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 Temporal lobe Brain stem Pituitary gland
Cerebellum The cerebellum is the brain structure responsible for balance, coordination and fine muscle control. The tumor is most likely located on or near this brain structure. A tumor located on or near the brain stem would more likely cause changes in autonomic functioning such as blood pressure. The temporal lobe is responsible for language comprehension, behavior, memory, hearing and emotions. A tumor effecting the pituitary gland would result in hormonal changes as this structure is responsible for hormones, growth and reproductive processes in the body.
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: Surgery, which can result in complete removal of the possible tumor, should be done as soon as possible. The tumor is malignant and aggressive. The tumor will cause pressure on the eighth cranial nerve. Growth is slow and symptoms are caused by compression rather than tissue invasion.
Growth is slow and symptoms are caused by compression rather than tissue invasion. A meningioma is benign, encapsulated, and slow-growing. Sometimes the patient has no symptoms because of the slow-growing nature of the tumor.
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? Growth hormone Adrenocorticotropic hormone Thyroid-stimulating hormone Prolactin
Thyroid-stimulating hormone In clients diagnosed with pituitary tumors, increase may be seen in prolactin hormone, growth hormone, adrenocorticotropic hormone, or thyroid-stimulating hormone. In this case, the client is exhibiting symptoms related to hyperthyroidism and the blood work should include the thyroid-stimulating hormone level to determine if an overproduction of this hormone due to the presence of the tumor is the cause of the presenting symptoms.
A nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which finding requires immediate intervention? Urine retention or incontinence Temperature of 99.2° F (37.3° C) More back pain than the first postoperative day Paresthesia in the dermatomes near the wounds
Urine retention or incontinence Urine retention or incontinence may indicate cauda equina syndrome, which requires immediate surgery. An increase in back pain is more common because on the second postoperative day the long-acting local anesthetic, which may have been injected during surgery, will wear off. Although paresthesia is common after surgery, progressive weakness or paralysis may indicate spinal nerve compression. A mild fever is also common after surgery but is considered significant only if the temperature reaches 101° F (38.3° C).
A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order: Doppler scanning. quantitative spectral phonoangiography. Doppler ultrasonography. electromyography (EMG).
electromyography (EMG). To help confirm ALS, the physician typically orders EMG, which detects abnormal electrical activity of the involved muscles. To help establish the diagnosis of ALS, EMG must show widespread anterior horn cell dysfunction with fibrillations, positive waves, fasciculations, and chronic changes in the potentials of neurogenic motor units in multiple nerve root distribution in at least three limbs and the paraspinal muscles. Normal sensory responses must accompany these findings. Doppler scanning, Doppler ultrasonography, and quantitative spectral phonoangiography are used to detect vascular disorders, not muscular or neuromuscular abnormalities.
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? Dysphagia Micrographia Dysphonia Hypokinesia
Dysphonia Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech.
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? Surgery Immunotherapy Radiation therapy Chemotherapy
Surgery A variety of medical treatment modalities, including chemotherapy and external-beam radiation therapy, radiosurgery, or radiotherapy are used alone or in combination with surgical resection. However, surgical intervention provides the best outcome for most brain tumor types.
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? "If the previous day's dose was forgotten, take two at the regular time the next day." "Suicidal ideation is a common side effect of this medication and should be reported immediately." "Driving a car should be avoided until the you know how this medication effects you." "If a corticosteroid has been prescribed, do not take it at the same time as this medication."
"Driving a car should be avoided until the you know how this medication effects you." The nurse should caution the client against driving until the client has a good understanding of how the medication affects his or her central nervous system. For some individuals, the degree of somnolence is much greater than for others and, in some cases, the somnolence is higher when the medication is first initiated and then begins to lesson with physiological adaptation. If a dose is forgotten, the client should be told to take the same dose as soon as he or she remembers. If the time is too close to the following day's dose, the client should be instructed to omit the previous day's dose and just take the current day's dose only. The client should never double up on the dose. There are no cautionary concerns about taking the medication at the same time as a glucocorticoid. There are no established drug-drug interactions between these two type of medications. Suicidal ideation is a rare side effect of levetiracetam. Although the nurse can provide education to the client about this rare side effect, the nurse must indicate this is not a common finding with this medication.
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? "I am assuming your provider was trying to explain to you that meningiomas have a high cure rate if treated with surgery, chemotherapy and radiation aggressively." "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." "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." "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."
"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." The nurse should inform the client that nurses cannot interpret what another provider meant by the statement. The nurse can provide client education regarding what is known about the type of brain tumor the client has been diagnosed with. It would be incorrect for the nurse to state that the treatment for this type of brain tumor is aggressive. The tumor is slow growing. and sometime treatment is a 'wait-and-see' approach. Thus, surgery, chemotherapy and radiation would not typically be used together or aggressively. By telling the client the provider was trying to be supportive with the statement that was made communicates to the client that the provider was not telling the truth about the nature of the diagnosis. In this case, the nurse is making an assumption and should not try to interpret for the client what the provider said. It would be countertherapeutic and serve to increase the client's anxiety if the nurse stated discussing the details of the client's diagnosis is not within the nurse's scope. The nurse can provide information about the type of brain tumor within the scope of practice.
A client with a malignant glioma is scheduled for surgery. The client demonstrates a need for additional teaching about the surgery when he states which of the following? "There will be less cancer left that might be resistant to chemotherapy." "My headache and nausea should be lessened somewhat." "Any tissue that was dead will be removed." "The surgeon will be able to remove all of the tumor."
"The surgeon will be able to remove all of the tumor." For clients with malignant gliomas, complete removal of the tumor and cure are not possible but the rationale for resection includes relief of increased intracranial pressure, removal of any necrotic tissue, and reduction in the bulk of the tumor, which theoretically leaves behind fewer cells to become resistant to radiation or chemotherapy.
An older adult patient exhibiting clinical manifestations of a brain tumor is admitted to the hospital for testing. What tumor types does the nurse know are commonly seen in the older adult? Medulloblastoma Glioblastoma Anaplastic astrocytoma Ependymoma Cerebral metastasis from other sites
Anaplastic astrocytoma Cerebral metastasis from other sites Glioblastoma The most frequent tumor types in the older adult are anaplastic astrocytoma, glioblastoma, and cerebral metastases from other sites.
The nurse educator knows which statement about pituitary adenomas is true? Most of these types of tumors are malignant. They are most prevalent in the pediatric population. Men are more likely to be diagnosed with this type of tumor. Cushing disease can result from a functioning tumor.
Cushing disease can result from a functioning tumor. Endocrine disorders can result from the existence of functioning pituitary adenomas. These tumors cause the production of hormones at the anterior pituitary and there may be an increase in various hormones, including cortisol that is responsible for the development of Cushing disease. Pituitary adenomas are rarely seen in the pediatric population. Most pituitary adenomas are benign tumors. The incidence of pituitary adenoma tumors is higher in women than men.
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. Hair loss should be expected when taking the medication. The client should ensure no one else handles the medication. The client should seek emergency care if he or she develops a fever. If a dose is missed, the client should take double the amount at the regular time the following day. The client should seek emergency help if nausea or vomiting occur.
Hair loss should be expected when taking the medication. The client should ensure no one else handles the medication. The client should seek emergency care if he or she develops a fever. The client should be the only person to handle the medication. Because it is a chemotherapy agent, it is cytotoxic and can have a harmful effect on anyone who does not have a tumor. It is unsafe to take a double dose of the medication if it is missed the previous day. The client should be instructed to take the medication at the same time each day and, if a dose is missed, the client should be instructed to take it as soon as possible and then get back on the regular schedule again. Some clients taking this medication experience gastrointestinal side effects such as nausea and vomiting. Although this is not considered an emergency, the client should be instructed to discuss this side effect with the health care provider, because prolonged symptoms can lead to nutritional deficit and/or dehydration. Immunosuppression caused by the medication can lead to a white blood cell count too low to fight off an infection. A fever is a sign of infection and can be life-threatening for a person taking a chemotherapeutic agent. Care should be sought immediately in this case. A common side effect of this medication is alopecia or hair loss. The client should be made aware to anticipate that this is a possibility while taking the drug.
A client is admitted to undergo lumbar laminectomy for treatment of a herniated disk. Which action should the nurse take first to promote comfort preoperatively? Help the client assume a more comfortable position. Administer hydrocodone (Vicodin) as ordered. Notify the physician of the client's pain. Provide teaching on nonpharmacologic measures to control pain.
Help the client assume a more comfortable position. The nurse should first help the client assume a more comfortable position. After doing so, the nurse may administer pain medication as ordered. Next, the nurse should assess the client's knowledge of nonpharmacologic measures to relieve pain and provide teaching as necessary. If the client's pain isn't relieved after taking these actions, the nurse should notify the physician of the client's pain issues.
During assessment of a hospitalized client who is recovering from a cervical discectomy, the client reports sudden and severe pain. Which of the following interventions is the nurse's priority? Change the client's bandages. Give the client something to help induce sleep. Increase the client's pain medication. Notify the client's surgeon.
Notify the client's surgeon. If a client recovering from cervical discectomy experiences sudden increased pain, the graft may have extruded, requiring reoperation. The nurse should report this finding promptly to the surgeon. The nurse would not change the bandage or give medicine without a surgeon's order.
Which of the following is a hallmark of spinal metastases? Nausea Pain Change in level of consciousness (LOC) Fatigue
Pain Pain is the hallmark of spinal metastases. Nausea, fatigue, and change in LOC may occur, but these are not the hallmark of spinal metastases.
The nurse cares for a client with Huntington disease. What intervention is a priority for safe care? Range-of-motion exercises Protecting the client from falls Measuring electrolytes Assessing serum cholesterol
Protecting the client from falls The client with Huntington disease has a risk for injury from falls and skin breakdown. Protecting the client from falls is a priority for safe care. Electrolyte and cholesterol monitoring is not a priority for this condition. Range-of-motion exercises will not protect the client from injuries.
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 Related to visual field deficits Related to difficulty swallowing Related to psychomotor seizures
Related to impaired balance A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe — not from a cerebellar brain tumor. Difficulty swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe dysfunction.
A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis? Hypoactive bowel sounds Weakness and atrophy of the arm muscles Sensory deficits in one arm Severe lower back pain
Severe lower back pain The most common finding in a client with a herniated lumbar disk is severe lower back pain, which radiates to the buttocks, legs, and feet - usually unilaterally. A herniated disk also may cause sensory and motor loss (such as foot drop) in the area innervated by the compressed spinal nerve root. During later stages, it may cause weakness and atrophy of leg muscles. The condition doesn't affect bowel sounds or the arms.
A patient has been diagnosed with a brain tumor, a glioblastoma multiforme. The nurse met with the family after the diagnosis to help them understand that: The tumor rarely spreads to other parts of the body. Surgery can improve survival time but the results are not guaranteed. Radiation is not an option because of the tumor's location near the brainstem. Chemotherapy, following surgery, has recently been shown to be a highly effective treatment.
Surgery can improve survival time but the results are not guaranteed. The overall prognosis for this type of aggressive brain tumor is poor but surgery can improve survival time.
Which client should the nurse assess for degenerative neurologic symptoms? The client with glioma. The client with Paget disease. The client with Huntington disease. The client with osteomyelitis.
The client with Huntington disease. Huntington disease is a chronic, progressive, degenerative neurologic hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia. Paget disease is a musculoskeletal disorder, characterized by localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae. Osteomyelitis is an infection of the bone. Malignant glioma is the most common type of brain tumor.
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? Weber and Rinne test An increase in prolactin Audible bruit over the skull Tissue biopsy
Tissue biopsy Glioblastoma multiforme is the most common and aggressive malignant brain tumor. In most cases, a tissue biopsy, which can be obtained at the time of surgical removal, is needed to confirm the diagnosis. A Weber and Rinne test may be useful in assessing asymmetric hearing loss associated with an acoustic neuroma, not glioblastoma multiforme. The diagnosis of an angioma is suggested by the presence of another angioma somewhere in the head or by a bruit (an abnormal sound) that is audible over the skull. Functioning pituitary adenoma can produce one or more hormones, normally by the anterior pituitary. Increase maybe seen in prolactin hormone, growth hormone, adrenocorticotropic hormone, or thyroid-stimulating hormone.
A client comes to the clinic for evaluation because of complaints of dizziness and difficulty walking. Further assessment reveals a staggering gait, marked muscle incoordination, and nystagmus. A brain tumor is suspected. Based on the client's assessment findings, the nurse would suspect that the tumor is located in which area of the brain? Frontal lobe Motor cortex Occipital lobe Cerebellum
Cerebellum Findings such as ataxic or staggering gait, dizziness, marked muscle incoordination, and nystagmus suggest a cerebellar tumor. A frontal lobe tumor frequently produces personality, emotional, and behavioral changes. A tumor in the motor cortex produces seizure-like movements localized on one side of the body. Occipital lobe tumors produce visual manifestations.
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 demonstrates positive coping strategies. Client consumes adequate calories to meet energy needs. Client participates in daily hygiene activities with assistive devices. Client expresses feelings related to self-care ability.
Client participates in daily hygiene activities with assistive devices. The client has a self-care deficit related to bathing. Therefore, an appropriate outcome would address the client's participation in daily hygiene measures. Positive coping strategies would be appropriate for a nursing diagnosis associated with anxiety or fear. Verbalizing feelings about self-care ability would be more appropriate for a nursing diagnosis involving self-esteem or role function. Consuming adequate calories would be appropriate for a nursing diagnosis involving imbalanced nutrition, less than body requirements.
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? Dysphonia Bradykinesia Micrographia Dyskinesia
Dyskinesia Most clients within 5 to 10 years of taking levodopa develop a response to the medication called dyskinesia, manifested as facial grimacing, rhythmic jerking movements of the hands, head bobbing, chewing and smacking movements, and involuntary movements of the trunk and extremities. Bradykinesia refers to an overall slowing of active movement and is a manifestation of the disorder. Micrographia refers to the development of small handwriting as dexterity declines with Parkinson's disease. Dysphonia refers to soft, slurred, low-pitched, and less audible speech that occurs as the disorder progresses.
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? Anxiety Knowledge deficit Impaired cognition Body image disturbance
Knowledge deficit Clients with extensive neurologic deficits before surgery usually do not make significant functional recovery, even after successful tumor removal. In this case, the client had already developed bilateral sensory loss in the lower extremities indicating the fairly progressed impact of the tumor on the client's functional ability. The client's statement reflects a knowledge deficit and it is a priority to provide information regarding the possibility that lower extremity sensation may not return. Although body image disturbance and anxiety may be identified and addressed. This would occur after the client demonstrates an accurate understanding of loss of functional capabilities as a result of the progressed tumor. Ensuring the client understands the extent of functional loss due to the impact of the tumor is a priority. The client does not demonstrate impaired cognition.
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 Myasthenia gravis Multiple sclerosis Huntington's disease
Parkinson's disease Early signs include stiffness, referred to as rigidity, and tremors of one or both hands, described as pill-rolling (a rhythmic motion of the thumb against the fingers). The hand tremor is obvious at rest and typically decreases when movement is voluntary, such as picking up an object. Bradykinesia, slowness in performing spontaneous movements, develops. Clients have a masklike expression, stooped posture, hypophonia (low volume of speech), and difficulty swallowing saliva. Weight loss occurs. A shuffling gait is apparent, and the client has difficulty turning or redirecting forward motion. Arms are rigid while walking. These symptoms are not indicative of MS, Myasthenia gravis, or Huntington's.
The nurse is providing discharge instructions for a client who was admitted to the oncology unit due to dehydration and anorexia after chemotherapy treatment. What information should the nurse provide to the client to promote improve the client's nutritional intake at home? Prepare the eating area with a pleasant room spray Avoid any oral care prior to eating Take prescribed pain medication prior to commencing a meal Eat uninterrupted by others to eliminate distractions
Take prescribed pain medication prior to commencing a meal The client needs to be clean, comfortable, and free of pain for meals, in an environment that is as attractive as possible. Ensuring adequate pain relief in advance of commencing a meal will make the experience more pleasant and tolerable. Pain is correlated with lack of appetite. Oral hygiene before meals helps to improve appetite. Offensive sights, sounds, and odors are eliminated. Creative strategies may be required to make food more palatable, provide enough fluids, and increase opportunities for socialization during meals.
The nurse identifies a nursing diagnosis of imbalanced nutrition, less than body requirements related to difficulty in chewing and swallowing for a client with Parkinson's disease. Which of the following would be most appropriate for the nurse to integrate into the client's plan of care? Arrange for specialized utensils for the client to use when eating. Raise the head of the client's bed about 30 degrees during meals. Encourage the client to massage the facial and neck muscles before eating. Encourage the use of liquids that are thin in consistency.
Encourage the client to massage the facial and neck muscles before eating. The client is having difficulty swallowing, which is interfering with nutritional intake. Therefore, the nurse should encourage the client to massage the facial and neck muscles before meals, sit in an upright position during meals, consume a semisolid diet with thick rather than thin liquids (which are easier to swallow), and think through the swallowing sequence. Raising the head of the bed 30 degrees is not high enough. Using specialized utensils would be more appropriate for a nursing diagnosis of self-care deficit, feeding to foster a sense of greater independence and control with eating.
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? In the cranial nerves From metastasis of a primary tumor From the coverings of the brain Within the brain tissue
Within the brain tissue Gliomas tumors are a type of intracerebral brain neoplasm. They originate within brain tissue. Tumors arising from the coverings of the brain include meningiomas. These tumors grow on the membrane covering of the brain, called the meninges. An acoustic neuroma is an example of tumors that grow out of or on cranial nerves and cause compression leading to sensory deficits. Metastasis refers to spreading of any kind of malignant primary tumor. This term is not specific to any one classification of tumor.
The nurse is providing health education to a client recently diagnosed with a brain tumor. During the appointment, the client states, "I'm really worried that I will have a seizure while I am at work or with my kids. Should I be concerned about this?" How should the nurse respond? "Seizures are genetic neurological conditions. Do you have anyone in your family with a seizure disorder? If so, this increases the likelihood you will have one." "It is not within my scope to discuss this aspect of your care with you. You should talk to your treating primary health care provider about this and discuss options." "60% of people with brain tumors have seizures. There is a strong chance you will have a seizure at some point and should keep a seizure kit close by." "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?"
"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?" In this case, the client is verbalizing a valid concern about management of the potential manifestation of the brain tumor. The nurse should engage the client by providing fact-based information about the probability of seizures caused by effects of brain tumors. The nurse should further engage in the discussion by evaluating the client's existing understanding of the seizures related to brain tumors and the associated management of this problem. The open-ended manner in which the nurse has asked the question in the correct answer option allows the client to reveal any knowledge deficits or gaps in understanding of the condition. Telling the client there is a strong chance that he or she will have a seizure is countertherapeutic and would serve to increase the client's anxiety. The nurse's aim should be to reduce the client's anxiety related to the diagnosis. Telling the client that seizures are a genetic neurological condition is out of context in this situation. The client is worried about having a seizure because he or she has a brain tumor. The nurse should address the concern in the correct context. The nurse is incorrect when stating having this discussion is not within the nurse's scope of practice. The client's verbalized concern presents an opportunity for the nurse to evaluate the client's understanding of the treatment and management of the condition. The nurse should refer the client back to the primary health care provider if there are any aspects of the client's health history that are unclear.
A client 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. Ask the client if there is pain on ambulation. Ask if the client has had a bowel movement. Ask if the client can walk.
Have the client lie on the back and lift the leg, keeping it straight. A client who can lie on the back and raise a leg in a straight position will have pain radiating into the leg if there is a herniated lumbar disc. This action stretches the sciatic nerve. The client may also have muscle weakness and decreased tendon reflexes and sensory loss. The client should still be able to walk, and have bowel movements, so this assessment will not assist the nurse to confirm the diagnosis. Pain on ambulation is also not specific to this condition.
Which disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells? Huntington disease Creutzfeldt-Jakob disease Parkinson disease Multiple sclerosis
Parkinson disease In some clients, Parkinson disease can be controlled; however, it cannot be cured. Multiple sclerosis is a chronic, degenerative, progressive disease of the central nervous system (CNS) characterized by the occurrence of small patches of demyelination in the brain and spinal cord. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia. Creutzfeldt-Jakob disease is a rare, transmissible, progressive and fatal disease of the CNS characterized by spongiform degeneration of the gray matter of the brain.
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 BP =130/80 mm Hg; HR = 55 bpm BP = 90/50 mm Hg; HR = 75 bpm BP = 150/90 mm Hg; HR = 90 bpm
BP = 175/45 mm Hg; HR = 42 bpm With a blood pressure of 175/45 mm Hg, it is evident that this client is experiencing progressively rising ICP, resulting from an advanced stage of the brain tumor. This blood pressure demonstrates a wide pulse pressure, meaning the difference between systolic and diastolic pressure is large. A heart rate of 42 bpm indicates the client is bradycardic. This finding paired with hypertensive blood pressure with a widening pulse pressure are part of the Cushing triad related to increased ICP.
Excessive levels of which neurotransmitter has been implicated in amyotrophic lateral sclerosis (ALS)? Glutamate Serotonin Epinephrine Dopamine
Glutamate Excessive levels of the neuro-excitatory neurotransmitter glutamate have been implicated in the neurodegenerative diseases such as ALS, Huntington's disease, and the sequelae of strokes.
A client diagnosed with Huntington's disease has developed severe depression. What would be most important for the nurse to assess for? Loss of bowel and bladder control Suicidal ideations Choreiform movements Emotional apathy
Suicidal ideations Severe depression is common and can lead to suicide, so it is most important for the nurse to assess for suicidal ideations. Symptoms of Huntington's disease develop slowly and include mental apathy and emotional disturbances, choreiform movements (uncontrollable writhing and twisting of the body), grimacing, difficulty chewing and swallowing, speech difficulty, intellectual decline, and loss of bowel and bladder control. Assessing for these symptoms is appropriate, but not as important as assessing for suicidal ideations.
Which anticholinergic agent is used to control tremor and rigidity in Parkinson disease? Amantadine Bromocriptine mesylate Levodopa Benztropine Mesylate
Benztropine Mesylate Benztropine Mesylate is an anticholinergic agent used to control tremor and rigidity in Parkinson disease. Bromocriptine mesylate is a dopamine agonist. Amantadine is an antiviral agent. Levodopa is a dopaminergic.
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? Visual loss Hearing loss Thyroid disorders Hemorrhagic stroke
Hemorrhagic stroke Brain angiomas (masses composed largely of abnormal blood vessels) are found either in the brain or on its surface. Because the walls of the blood vessels in angiomas are thin, affected clients are at risk for hemorrhagic stroke. Pituitary adenomas that produce hormones can lead to endocrine disorders, such as thyroid disorders. In addition, they can exert pressure on the optic nerves and optic chiasm, leading to vision loss. Acoustic neuromas are associated with hearing loss.