Chapter 65: Management of Patients With Oncologic or Degenerative Neurologic Disorders NCLEX

C (Feedback: Impaired communication is an appropriate nursing diagnosis; the voice in patients with ALS assumes a nasal sound and articulation becomes so disrupted that speech is unintelligible. Intellectual function is marginally impaired in patients with late ALS. Usually, the anal and bladder sphincters are intact because the spinal nerves that control muscles of the rectum and urinary bladder are not affected.)

A patient with amyotrophic lateral sclerosis (ALS) is being visited by the home health nurse who is creating a care plan. What nursing diagnosis is most likely for a patient with this condition? A)Chronic confusion B)Impaired urinary elimination C)Impaired verbal communication D)Bowel incontinence

C (Feedback: A semisolid diet with thick liquids is easier for a patient with swallowing difficulties to consume than is a solid diet. Low-residue foods and fluid restriction are unnecessary and counterproductive to the patient's nutritional status. The patient's status does not warrant TPN.)

A patient with Parkinson's disease is undergoing a swallowing assessment because she has recently developed adventitious lung sounds. The patient's nutritional needs should be met by what method? A)Total parenteral nutrition (TPN) B)Provision of a low-residue diet C)Semisolid food with thick liquids D)Minced foods and a fluid restriction

A (Feedback: Due to the continuous involuntary movements, patients will have a ravenous appetite. Despite this ravenous appetite, patients usually become emaciated and exhausted. As the disease progresses, patients experience difficulty in swallowing and thin liquids should be avoided. Protein will not be limited with this disease. Enzyme supplements are not normally required.)

A patient with Huntington disease has just been admitted to a long-term care facility. The charge nurse is creating a care plan for this patient. Nutritional management for a patient with Huntington disease should be informed by what principle? A)The patient is likely to have an increased appetite. B)The patient is likely to required enzyme supplements. C)The patient will likely require a clear liquid diet. D)The patient will benefit from a low-protein diet.

A, B, D, E (Feedback: Home care needs and interventions focus on four major areas: palliation of symptoms and pain control, assistance in self-care, control of treatment complications, and administration of specific forms of treatment, such as parenteral nutrition. Interpretation of diagnostic tests is normally beyond the purview of the nurse.)

A patient with an inoperable brain tumor has been told that he has a short life expectancy. On what aspects of assessment and care should the home health nurse focus? Select all that apply. A)Pain control B)Management of treatment complications C)Interpretation of diagnostic tests D)Assistance with self-care E)Administration of treatments

B (Feedback: Within 5 to 10 years of taking levodopa, most patients develop a response to the medication characterized by dyskinesia (abnormal involuntary movements). Another potential complication of long-term dopaminergic medication use is neuroleptic malignant syndrome characterized by severe rigidity, stupor, and hyperthermia. Side effects of long-term Sinemet therapy are not pruritus, lactose intolerance, or diarrhea.)

The clinic nurse caring for a patient with Parkinson's disease notes that the patient has been taking levodopa and carbidopa (Sinemet) for 7 years. For what common side effect of Sinemet would the nurse assesses this patient? A)Pruritus B)Dyskinesia C)Lactose intolerance D)Diarrhea

C (Range-of-motion exercises should be performed at least twice daily. DIF: Application/Applying REF: pp. 1912-1913 OBJ: Intervention MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures/Health Alteration)

The nurse formulates the following nursing diagnosis for a client with MS: Impaired Physical Mobility related to muscle weakness. Useful interventions the nurse could plan include a.encouraging long naps or rest periods. b.encouraging strengthening exercises for affected muscles every 4 hours. c.having the client perform ROM exercises at least two times daily. d.performing all the activities of daily living (ADLs) for the client.

A (Feedback: The goals for the patient may include improving functional mobility, maintaining independence in ADLs, achieving adequate bowel elimination, attaining and maintaining acceptable nutritional status, achieving effective communication, and developing positive coping mechanisms. Constipation is more likely than diarrhea and cognition largely remains intact. Choreiform movements are related to Huntington disease.)

The nurse caring for a patient diagnosed with Parkinson's disease has prepared a plan of care that would include what goal? A)Promoting effective communication B)Controlling diarrhea C)Preventing cognitive decline D)Managing choreiform movements

C (Feedback: If the patient experiences a sudden increase in pain, extrusion of the graft may have occurred, requiring reoperation. A sudden increase in pain should be promptly reported to the surgeon. Administration of an NSAID would be an insufficient response and the dressing should not be removed without an order. Palpation could cause further damage.)

The nurse responds to the call light of a patient who has had a cervical diskectomy earlier in the day. The patient states that she is having severe pain that had a sudden onset. What is the nurse's most appropriate action? A)Palpate the surgical site. B)Remove the dressing to assess the surgical site. C)Call the surgeon to report the patient's pain. D)Administer a dose of an NSAID.

C (Clasping change tightly in the pocket, using both hands to complete tasks, and sleeping on the tremorous side will help lessen the tremor. DIF: Application/Applying REF: pp. 1905, 1906 OBJ: Intervention MSC: Physiological Integrity Physiological Adaptation-Illness Management)

To assist the client with Parkinson's disease to reduce tremor, the nurse suggests that the client a.clasp arms about self and squeeze. b.sleep on the non-tremorous side. c.tightly hold change in the pocket. d.visualize stilling the tremor.

C (Occasionally, clients with PD experience a parkinsonian crisis as a result of emotional trauma or sudden or inadvertent withdrawal of anti-parkinsonian medication. Severe exacerbation of tremor, rigidity, and bradykinesia, accompanied by acute anxiety, sweating, tachycardia, and hyperpnea occur. The client should be placed in a quiet room with subdued lighting. Medical treatment may include barbiturates in addition to anti-parkinsonian drugs. DIF: Application/Applying REF: p. 1905 OBJ: Intervention MSC: Physiological Integrity Basic Care and Comfort-Rest and Sleep)

The most helpful intervention by the nurse for a client experiencing a parkinsonian crisis would be to a.administer oxygen by nasal catheter. b.give the client IV fluids that contain potassium. c.place the client in a nonstimulating environment. d.provide the client with foods high in calcium.

D (Feedback: After a cervical diskectomy, the nurse will monitor the operative site and dressing covering this site. Serosanguineous drainage may indicate a dural leak. This constitutes a risk for meningitis, but is not a direct sign of infection. This should be reported to the surgeon, not just reinforced and observed.)

While assessing the patient at the beginning of the shift, the nurse inspects a surgical dressing covering the operative site after the patients' cervical diskectomy. The nurse notes that the drainage is 75% saturated with serosanguineous discharge. What is the nurse's most appropriate action? A)Page the physician and report this sign of infection. B)Reinforce the dressing and reassess in 1 to 2 hours. C)Reposition the patient to prevent further hemorrhage. D)Inform the surgeon of the possibility of a dural leak.

B (The two most dangerous features of GBS are respiratory muscle weakness and autonomic neuropathy involving both the sympathetic and the parasympathetic systems. DIF: Application/Applying REF: p. 1915 OBJ: Assessment MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures/Health Alteration)

When a client is admitted to the hospital with Guillain-Barré syndrome (GBS), the most important assessment the nurse should make is for a. decreasing alertness. b. respiratory difficulty. c. seizure activity. d. urinary retention.

C (A common clinical manifestation of mild AD would include indifference or apathy. Other changes in mild AD are memory disturbances, impaired judgment and problem- solving skills, confusion, taking longer to do routine tasks, inability to adapt to new situations, and becoming irritable or suspicious. The inability to use familiar objects appears in the moderate stage. Incontinence is occasional in the moderate stage and frequent in the severe stage. Using words in the wrong context is moderate AD. DIF: Application/Applying REF: p. 1895 OBJ: Assessment MSC: Physiological Integrity Physiological Adaptation-Pathophysiology)

A client is assessed as being in the mild stage of Alzheimer's disease (AD). The nurse recognizes the complaint made by the client's family that is most closely related to the diagnosis is that the client a."has difficulty using simple things, such as her toothbrush or comb." b."seems to have lost control over her bowels." c."seems indifferent about things she used to care about." d."uses words in the wrong context."

A (Feedback: Prior to discharge, the nurse should assess the patient's use and care of the cervical collar. Neck ROM exercises would be contraindicated and ABGs cannot be assessed in the home. Nerve function is not compromised by a diskectomy.)

A nurse is planning discharge education for a patient who underwent a cervical diskectomy. What strategies would the nurse assess that would aid in planning discharge teaching? A)Care of the cervical collar B)Technique for performing neck ROM exercises C)Home assessment of ABGs D)Techniques for restoring nerve function

B, C, D (Research has shown that interventions that focus on communication techniques, behavioral strategies, and environmental modifications improved the quality of life of the caregivers. Emotion-based coping styles are associated with grieving, worrying, and self-accusation and are not as effective as problem-based coping styles. DIF: Application/Applying REF: p. 1901 OBJ: Intervention MSC: Psychosocial Integrity Coping and Adaptation-Quality of Life)

Nursing interventions to support the family caring for a client with Alzheimer's disease include (Select all that apply) a. encouraging emotion-focused coping mechanisms. b. helping the family identify safety concerns and modifying the home. c. showing the family how to deal with behavioral problems. d. teaching the family alternative communication techniques.

A, D (Safety is a prime concern with ALS (and with any degenerative neurologic disorder). Muscle weakness is progressive, leading to increased risk of falls. Some interventions to prevent this include spacing activities throughout the day, conserving energy, avoiding extremes of hot and cold, and using assistive devices such as canes or wheelchairs. Clients with ALS usually do not experience incontinence and cognition remains intact for the duration of the disorder. DIF: Application/Applying REF: pp. 1918-1919 OBJ: Intervention MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention)

The nurse cautions clients with ALS and their families to be aware that (Select all that apply) a. activities should be spaced throughout the day. b. clients experience incontinence, an early cause of falling. c. cognition will usually decline late in the disease. d. muscle weakness may cause a risk for injury.

B (Feedback: Important activities for patients with postpolio syndrome should be planned for the morning, as fatigue often increases in the afternoon and evening.)

The nurse in an extended care facility is planning the daily activities of a patient with postpolio syndrome. The nurse recognizes the patient will best benefit from physical therapy when it is scheduled at what time? A)Immediately after meals B)In the morning C)Before bedtime D)In the early evening

C (Although plaques may occur anywhere in the white matter of the CNS, the areas most commonly involved are the optic nerves, cerebrum, and cervical spinal cord. DIF: Comprehension/Understanding REF: p. 1909 OBJ: Intervention MSC: Physiological Integrity Physiological Adaptation-Pathophysiology)

The nurse reminds a group of students about the major component of pathophysiology in multiple sclerosis (MS), which is a.damage occurs primarily to the dendrites and oligodendrites. b.once damaged, myelin cannot regenerate at all. c.plaques occur anywhere in the white matter of the central nervous system (CNS). d.Schwann cells are destroyed slowly but relentlessly.

C (A high-fiber diet, bulk formers, and stool softeners are useful for maintaining stool consistency. Explain that laxatives and enemas should be avoided because they lead to dependence. DIF: Application/Applying REF: pp. 1911, 1912-1913 OBJ: Evaluation MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care)

A client with MS is being taught self-care measures to prevent constipation. The nurse would realize goals for teaching had been met when the client states he/she will avoid a.a high-fiber diet. b.citrus fruits. c.laxatives. d.stool softeners.

D (Feedback: Individuals with Parkinson's disease face a significant risk for injury related to the effects of dyskinesia. Unilateral neglect is not characteristic of the disease, which affects both sides of the body. Parkinson's disease does not directly constitute a risk for infection or impaired respiration.)

A patient has just been diagnosed with Parkinson's disease and the nurse is planning the patient's subsequent care for the home setting. What nursing diagnosis should the nurse address when educating the patient's family? A)Risk for infection B)Impaired spontaneous ventilation C)Unilateral neglect D)Risk for injury

A (Feedback: Male patients with prolactinomas may present with impotence and hypogonadism. An ACTH-producing adenoma would cause acromegaly. The scenario contains insufficient information to know if the tumor is an angioma, glioma, or neuroma.)

A male patient presents at the free clinic with complaints of impotency. Upon physical examination, the nurse practitioner notes the presence of hypogonadism. What diagnosis should the nurse suspect? A)Prolactinoma B)Angioma C)Glioma D)Adrenocorticotropic hormone (ACTH)-producing adenoma

B (Feedback: Priority for the care of the child with muscular dystrophy is the need to maximize the patient's level of function. Family participation is also important, but should be guided by this goal. Adherence is not a central goal, even though it is highly beneficial, and the disease is not curable.)

The nurse is caring for a boy who has muscular dystrophy. When planning assistance with the patient's ADLs, what goal should the nurse prioritize? A)Promoting the patient's recovery from the disease B)Maximizing the patient's level of function C)Ensuring the patient's adherence to treatment D)Fostering the family's participation in care

B (Feedback: Based on all the assessment data, the potential complications of diskectomy may include hematoma at the surgical site, resulting in cord compression and neurologic deficit and recurrent or persistent pain after surgery. Renal trauma and fractures are unlikely; scoliosis is a congenital malformation of the spine.)

The nurse is caring for a patient who is scheduled for a cervical discectomy the following day. During health education, the patient should be made aware of what potential complications? A)Vertebral fracture B)Hematoma at the surgical site C)Scoliosis D)Renal trauma

A (Feedback: A cerebellar tumor causes dizziness, an ataxic or staggering gait with a tendency to fall toward the side of the lesion, and marked muscle incoordination. Because of this, the patient faces a high risk of falls. Hallucinations and unstable vital signs are not closely associated with cerebellar tumors.)

The nurse is planning the care of a patient who has been recently diagnosed with a cerebellar tumor. Due to the location of this patient's tumor, the nurse should implement measures to prevent what complication? A)Falls B)Audio hallucinations C)Respiratory depression D)Labile BP

B (Feedback: After spinal surgery, the bed is usually kept flat initially. The side-lying position is usually the most comfortable because this position imposes the least pressure on the surgical site. The Fowler's position, Trendelenberg position, and reverse Trendelenberg position are inappropriate for this patient because they would result in increased pain and complications.)

A patient has just returned to the unit from the PACU after surgery for a tumor within the spine. The patient complains of pain. When positioning the patient for comfort and to reduce injury to the surgical site, the nurse will position to patient in what position? A)In the high Fowler's position B)In a flat side-lying position C)In the Trendelenberg position D)In the reverse Trendelenberg position

C (Feedback: Vomiting is often unrelated to food intake if caused by a brain tumor. The presence or absence of blood is not related to the possible etiology and vomiting may or may not relieve the patient's nausea.)

A patient who has been experiencing numerous episodes of unexplained headaches and vomiting has subsequently been referred for testing to rule out a brain tumor. What characteristic of the patient's vomiting is most consistent with a brain tumor? A)The patient's vomiting is accompanied by epistaxis. B)The patient's vomiting does not relieve his nausea. C)The patient's vomiting is unrelated to food intake. D)The patient's emesis is blood-tinged.

C (Feedback: Cachexia is a wasting syndrome of weight loss, muscle atrophy, fatigue, weakness, and significant loss of appetite. Consequently, nutritional assessment is paramount.)

A patient with a brain tumor has begun to exhibit signs of cachexia. What subsequent assessment should the nurse prioritize? A)Assessment of peripheral nervous function B)Assessment of cranial nerve function C)Assessment of nutritional status D)Assessment of respiratory status

D (Feedback: Nursing interventions for a patient who has inadequate nutritional intake should include the following: Apply deep gentle pressure around the patient's mouth to assist with swallowing, and administer phenothiazines prior to the patient's meal as ordered. The nurse should disregard the mess of the feeding area and treat the person with dignity. Stiffness and turning away by the patient during feeding are uncontrollable choreiform movements and should not be interrupted.)

The nurse is caring for a patient with Huntington disease who has been admitted to the hospital for treatment of malnutrition. What independent nursing action should be implemented in the patient's plan of care? A)Firmly redirect the patient's head when feeding. B)Administer phenothiazines after each meal as ordered. C)Encourage the patient to keep his or her feeding area clean. D)Apply deep, gentle pressure around the patient's mouth to aid swallowing.

B (Excessive movements and falling can cause injury in the client with Huntington's disease. Interventions include padding wheelchairs and beds, providing shin guards, and using gait belts for ambulation. Communication does become difficult and alternative forms of communication are appropriate before the client becomes completely demented, but this does not take priority over safety precautions. The client does not need an exercise regimen as the client is already hyperactive, and seizures do not occur. DIF: Analysis/Analyzing REF: p. 1908 OBJ: Intervention MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention)

To prevent complications caused by a common problem of Huntington's disease, the nurse should a. institute seizure precautions. b. pad wheelchairs and beds. c. start an exercise regimen. d. teach different communication signals.

D (Feedback: The MRI scan is the most commonly used diagnostic procedure. It is the most sensitive diagnostic tool that is particularly helpful in detecting epidural spinal cord compression and vertebral bone metastases.)

A 37-year-old man is brought to the clinic by his wife because he is experiencing loss of motor function and sensation. The physician suspects the patient has a spinal cord tumor and hospitalizes him for diagnostic testing. In light of the need to diagnose spinal cord compression from a tumor, the nurse will most likely prepare the patient for what test? A) Anterior-posterior x-ray B) Ultrasound C) Lumbar puncture D) MRI

D (Clients with CJD do not need isolation although it can be transmitted person-to-person. Standard precautions are used for every client and are sufficient for clients with CJD. There is no effective treatment for this unique disease that can arise from genetic mutations or from infection with an agent that is neither bacterial nor viral. DIF: Application/Applying REF: p. 1907 OBJ: Intervention MSC: Safe, Effective Care Environment Safety and Infection Control-Standard/Transmission Based/Other Precautions)

A nurse is caring for a client diagnosed with Creutzfeldt-Jakob Disease (CJD). Appropriate nursing care includes a. administering broad-spectrum antibiotics until culture results are known. b. giving the client anti-viral medications as ordered. c. placing the client in contact and airborne isolation. d. using standard precautions when handling body fluids.

A (Feedback: In older adult patients, early signs and symptoms of intracranial tumors can be easily overlooked or incorrectly attributed to cognitive and neurologic changes associated with normal aging. Brain tumors are not normally benign and they produce focal effects in all patients. Treatment options are not dependent primarily on age.)

A gerontologic nurse is advocating for diagnostic testing of an 81-year-old patient who is experiencing personality changes. The nurse is aware of what factor that is known to affect the diagnosis and treatment of brain tumors in older adults? A)The effects of brain tumors are often attributed to the cognitive effects of aging. B)Brain tumors in older adults do not normally produce focal effects. C)Older adults typically have numerous benign brain tumors by the eighth decade of life. D)Brain tumors cannot normally be treated in patient over age 75.

B (Huntington's disease is inherited in an autosomal-dominant pattern. Genetic testing is available to families in which a member has Huntington's disease. The availability of the testing has created some ethical conflicts. DIF: Application/Applying REF: p. 1908 OBJ: Intervention MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Health Screening)

Health promotion activities the nurse could suggest to a community group for Huntington's disease include a. Eating foods high in omega-3 fatty acids. b. genetic screening for high-risk individuals. c. limiting exposure to heavy metals. d. taking 400 International Units of vitamin E daily.

A (Disease management in ALS includes topics such as tube feedings and mechanical ventilation. Planning for an acceptable level of care should begin early in the disease, before a crisis occurs. Of course, decisions should be re-evaluated occasionally as the client's wishes may changes with their experiences with the disease. ALS is not a genetically-acquired disorder. Pain control is usually not an issue in the disease, and as the disease is relentlessly progressive (rather than characterized by remissions and exacerbations), extensive rehabilitation is not utilized. DIF: Application/Applying REF: p. 1919 OBJ: Intervention MSC: Psychosocial Integrity Coping and Adaptation-End of Life Care)

Nursing activities for a client with ALS and family include helping them a. decide on an acceptable level of care early in the course of the disease. b. determine if they want to share the diagnosis to allow genetic testing. c. incorporate nonpharmacologic pain control techniques in the plan of care. d. plan for extensive rehabilitation after exacerbations.

C, D, E (Feedback: The effects of neoplasms are caused by the compression and infiltration of tissue. A variety of physiologic changes result, causing any or all of the following pathophysiologic events: increased ICP and cerebral edema, seizure activity and focal neurologic signs, hydrocephalus, and altered pituitary function.)

The nurse educator is discussing neoplasms with a group of recent graduates. The educator explains that the effects of neoplasms are caused by the compression and infiltration of normal tissue. The physiologic changes that result can cause what pathophysiologic events? Select all that apply. A)Intracranial hemorrhage B)Infection of cerebrospinal fluid C)Increased ICP D)Focal neurologic signs E)Altered pituitary function

B (Feedback: Patients with intracerebral metastases who are not treated have a steady downhill course with a limited survival time, whereas those who are treated may survive for slightly longer periods, but for most cure is not possible. Palliative care is thus necessary. This is a priority over promotion of function and the family should not normally withhold information from the patient. Adherence to medications such as analgesics is important, but palliative care is a high priority.)

A 25-year-old female patient with brain metastases is considering her life expectancy after her most recent meeting with her oncologist. Based on the fact that the patient is not receiving treatment for her brain metastases, what is the nurse's most appropriate action? A) Promoting the patient's functional status and ADLs B) Ensuring that the patient receives adequate palliative care C) Ensuring that the family does not tell the patient that her condition is terminal D) Promoting adherence to the prescribed medication regimen

D (Eating problems associated with Parkinson's disease include aspiration, choking, constipa-tion, and dysphagia. Option A is incorrect since fluid overload isn't specifically related to Parkinson's disease and, although drooling occurs with Parkinson's disease, it doesn't take priority. Anorexia (option B) and diarrhea (option C) aren't specifically associated with Par-kinson's disease.)

A 63-year-old male patient has just been diagnosed with Parkinson's disease. The nurse is teaching the patient and his family about dietary practices related to Parkinson's disease. What risk is a priority for the nurse to address? A) Fluid overload and drooling. B) Aspiration and anorexia. C) Choking and diarrhea. D) Dysphagia and constipation.

B (Drugs used to treat exacerbations in ambulatory clients include Interferon b1b, Interferon b1a (Avonex), and glatiramer acetate (Copaxone). Diazepam and lioresal could be used to treat spasticity, while steroids are used for acute relapses. DIF: Application/Applying REF: p. 1911 OBJ: Intervention MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions)

A client is being treated in the clinic for an exacerbation of multiple sclerosis. The nurse would anticipate administering which drug? a.Diazepam (Valium) b.Interferon b1b (Betaseron) c.Lioresal (Baclofen) d.Methylprednisolone (Solu-Cortef)

C (Several medications are used to retain Ach in the neurojunctions of the brain. They can have small but noticeable effects and may temporarily lead to improvements. However, no drug stops the progression of AD. Aricept does not work to block oxygen free radical action, however; some studies show that alpha-tocopherol (vitamin E) and selegiline have this action. Aricept does not work on depression; often clients with AD also need antidepressants. DIF: Application/Applying REF: p. 1897 OBJ: Intervention MSC: Physiological Integrity Physiological Adaptation-Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions)

A client is receiving donepezil (Aricept) for moderate Alzheimer's disease. The nurse would assess that teaching goals for this medication have been met when the client's spouse says a. "Aricept works by blocking oxygen free radicals in the brain." b. " Depression has been the worst part so I'm glad this pill will control it." c. "I'm anxious to see how much improvement the medications allows." d. "This medicine will prevent further deterioration in condition."

D (Early in PD the client may notice a slight slowing in the ability to perform ADLs. A general feeling of stiffness may be noticed, along with mild, diffuse muscular pain. Tremor is a common early manifestation that usually occurs in one of the upper limbs. DIF: Analysis/Analyzing REF: p. 19 MSC: Physiological Integrity Physiological Adaptation-Pathophysiology)

A client tells the nurse that he is experiencing some leg stiffness when walking and slowness when performing ADLs. Occasionally he has noted slight tremors in his hands at rest. This information leads the nurse to suspect a.amyotrophic lateral sclerosis (ALS). b.Huntington's disease. c.myasthenia gravis (MG). d.Parkinson's disease (PD).

D (Memory impairment occurs in all stages of AD and the nurse must use interventions that are designed to enhance memory. Because clients' long-term memory is retained longer than their short-term memory, allow them to reminisce about past experiences. Reminiscing is a normal activity; there is no need to assess orientation. Distracting the client not only will negatively impact memory but also may agitate the client. Recent memory is impaired, so encouraging the client to discuss recent events that he/she may not remember may also be agitating. DIF: Application/Applying REF: p. 1899 OBJ: Intervention MSC: Psychosocial Integrity Coping and Adaptation-Therapeutic Interactions)

A client with AD begins to tell the nurse about his early-married life. The nurse should (a.assess orientation to time and place. b.distract the client from this activity. c.encourage the client to talk about recent memories. d.listen to his stories

B (With myasthenic crisis, if an increase in the dosage of the anticholinesterase drug does not improve the weakness, endotracheal intubation and mechanical ventilation may be required. None of the other options is used to treat a myasthenic crisis. DIF: Comprehension/Understanding REF: p. 1917 OBJ: Intervention MSC: Physiological Integrity Physiological Adaptation-Illness Management)

A client with MG began to experience a sudden worsening of her condition with difficulty in breathing. The nurse explains that this complication of MG is usually initially treated with a. admission and administration of IV corticosteroids. b. an increased dose of anticholinesterase drugs. c. bolus doses of atropine titrated to effect. d. rest and increased sleep.

B (The course of the disease is relentlessly progressive. Cognition, as well as bowel and bladder sphincters, remains intact. The client may be malnourished because of dysphagia. Encourage small, frequent, high-nutrient feedings. The nurse should assess for aspiration and choking. A feeding tube may be considered during the course of the illness. DIF: Application/Applying REF: p. 1919 OBJ: Intervention MSC: Physiological Integrity Basic Care and Comfort-Nutrition and Oral Hydration)

A client with advanced ALS is admitted to the hospital. Because of manifestations that are common in clients with ALS, the nurse should a. attempt to institute bowel-training activities. b. provide the client with small, frequent feedings. c. obtain an order for intermittent catheterization. d. orient the client to his or her surroundings frequently.

A, B, C (Feedback: The Huntington's Disease Society of America helps patients and families by providing information, referrals, family and public education, and support for research. It does not provide individual assessments or appraisals of individual research studies.)

A family member of a patient diagnosed with Huntington disease calls you at the clinic. She is requesting help from the Huntington's Disease Society of America. What kind of help can this patient and family receive from this organization? Select all that apply. A)Information about this disease B)Referrals C)Public education D)Individual assessments E)Appraisals of research studies

D (Feedback: The nurse's first response should be to place the patient on his side to prevent him from aspirating emesis. Inserting something into the seizing patient's mouth is no longer part of a seizure protocol. Obtaining supplies to suction the patient would be a delegated task. Paging or calling the physician would only be necessary if this is the patient's first seizure.)

A male patient with a metastatic brain tumor is having a generalized seizure and begins vomiting. What should the nurse do first? A)Perform oral suctioning. B)Page the physician. C)Insert a tongue depressor into the patient's mouth. D)Turn the patient on his side.

A (Feedback: An acoustic neuroma is a tumor of the eighth cranial nerve, the cranial nerve most responsible for hearing and balance. The patient with an acoustic neuroma usually experiences loss of hearing, tinnitus, and episodes of vertigo and staggering gait. Acoustic neuromas do not cause loss of vision, increased sodium retention, or tachycardia.)

A nurse is assessing a patient with an acoustic neuroma who has been recently admitted to an oncology unit. What symptoms is the nurse likely to find during the initial assessment? A) Loss of hearing, tinnitus, and vertigo B) Loss of vision, change in mental status, and hyperthermia C) Loss of hearing, increased sodium retention, and hypertension D) Loss of vision, headache, and tachycardia

A (The primary feature of MG is increasing weakness with sustained muscle contraction. After a period of rest the muscles regain their strength. Muscle weakness is greatest after exertion or at the end of the day. Ocular manifestations are most common, with ptosis or diplopia occurring in a majority of clients. DIF: Analysis/Analyzing REF: p. 1916 OBJ: Assessment MSC: Physiological Integrity Physiological Adaptation-Pathophysiology)

A nurse is performing an assessment on a client who is suspected of having MG. The complaint made by the client that reflects a manifestation commonly seen in clients with this disease is a."By the end of the day, my eyelids usually are drooping." b."I have a great deal of difficulty getting up after I rest for a while." c."I perspire more then I ever have in the past." d."When I have a cold, I usually have a strong cough with it."

B (Feedback: Functioning pituitary tumors can produce one or more hormones normally produced by the anterior pituitary and the effects of the tumor depend largely on the identity of these hormones. This variable is more significant than the patient's health status or whether the tumor is primary versus secondary. Anaerobic and aerobic respiration is not relevant.)

A patient diagnosed with a pituitary adenoma has arrived on the neurologic unit. When planning the patient's care, the nurse should be aware that the effects of the tumor will primarily depend on what variable? A)Whether the tumor utilizes aerobic or anaerobic respiration B)The specific hormones secreted by the tumor C)The patient's pre-existing health status D)Whether the tumor is primary or the result of metastasis

A (Feedback: Preoperatively, the gag reflex and ability to swallow are evaluated. In patients with diminished gag response, care includes teaching the patient to direct food and fluids toward the unaffected side, having the patient sit upright to eat, offering a semisoft diet, and having suction readily available. Deep tendon reflexes, abdominal girth, and hearing acuity are less commonly affected by brain tumors.)

A patient has been admitted to the neurologic ICU with a diagnosis of a brain tumor. The patient is scheduled to have a tumor resection/removal in the morning. Which of the following assessment parameters should the nurse include in the initial assessment? A)Gag reflex B)Deep tendon reflexes C)Abdominal girth D)Hearing acuity

B (Feedback: Patients with seizures are carefully monitored and protected from injury. Patient safety is a priority over health education, even though this is appropriate and necessary. Specific triggers may or may not be evident; identifying these is not the highest priority. A private room is preferable, but not absolutely necessary.)

A patient has been admitted to the neurologic unit for the treatment of a newly diagnosed brain tumor. The patient has just exhibited seizure activity for the first time. What is the nurse's priority response to this event? A)Identify the triggers that precipitated the seizure. B)Implement precautions to ensure the patient's safety. C)Teach the patient's family about the relationship between brain tumors and seizure activity. D)Ensure that the patient is housed in a private room.

B (Feedback: Proper positioning on a firm mattress and bed rest for 1 to 2 days may bring dramatic relief from pain. The patient may need to wear a cervical collar 24 hours a day during the acute phase of pain from a cervical disk herniation. Hot, moist compresses applied to the back of the neck will increase blood flow to the muscles and help relax the spastic muscles.)

A patient newly diagnosed with a cervical disk herniation is receiving health education from the clinic nurse. What conservative management measures should the nurse teach the patient to implement? A)Perform active ROM exercises three times daily. B)Sleep on a firm mattress. C)Apply cool compresses to the back of the neck daily. D)Wear the cervical collar for at least 2 hours at a time.

D (Feedback: The beneficial effects of levodopa therapy are most pronounced in the first year or two of treatment. Benefits begin to wane and adverse effects become more severe over time. However, a "honeymoon period" of treatment is not known.)

A patient who was diagnosed with Parkinson's disease several months ago recently began treatment with levodopa-carbidopa. The patient and his family are excited that he has experienced significant symptom relief. The nurse should be aware of what implication of the patient's medication regimen? A)The patient is in a "honeymoon period" when adverse effects of levodopa-carbidopa are not yet evident. B)Benefits of levodopa-carbidopa do not peak until 6 to 9 months after the initiation of treatment. C)The patient's temporary improvement in status is likely unrelated to levodopa-carbidopa. D)Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment.

C (Feedback: Laxatives should be avoided in patients with Parkinson's disease due to the risk of adverse effects and dependence. Herbal bowel remedies are not necessarily less risky.)

A patient with Parkinson's disease is experiencing episodes of constipation that are becoming increasingly frequent and severe. The patient states that he has been achieving relief for the past few weeks by using OTC laxatives. How should the nurse respond? A)"It's important to drink plenty of fluids while you're taking laxatives." B)"Make sure that you supplement your laxatives with a nutritious diet." C)"Let's explore other options, because laxatives can have side effects and create dependency." D)"You should ideally be using herbal remedies rather than medications to promote bowel function."

A (Feedback: Patients with ALS are encouraged to complete an advance directive or "living will" to preserve their autonomy in decision making. None of the other listed actions constitutes a legally binding statement of end-of-life care.)

A patient with a new diagnosis of amyotrophic lateral sclerosis (ALS) is overwhelmed by his diagnosis and the known complications of the disease. How can the patient best make known his wishes for care as his disease progresses? A)Prepare an advance directive. B)Designate a most responsible physician (MRP) early in the course of the disease. C)Collaborate with representatives from the Amyotrophic Lateral Sclerosis Association. D)Ensure that witnesses are present when he provides instruction.

A (Feedback: The tremor is present while the patient is at rest; it increases when the patient is walking, concentrating, or feeling anxious. Resting tremor characteristically disappears with purposeful movement, but is evident when the extremities are motionless. Consequently, the nurse should assess for the presence of a tremor when the patient is not performing deliberate actions.)

A patient with suspected Parkinson's disease is initially being assessed by the nurse. When is the best time to assess for the presence of a tremor? A)When the patient is resting B)When the patient is ambulating C)When the patient is preparing his or her meal tray to eat D)When the patient is participating in occupational therapy

C (Feedback: Huntington disease causes profound changes to personality and behavior. It is a nonmalignant disease and stroke is not a central risk. The disease is not associated with pathologic bone fractures.)

A patient, brought to the clinic by his wife and son, is diagnosed with Huntington disease. When providing anticipatory guidance, the nurse should address the future possibility of what effect of Huntington disease? A)Metastasis B)Risk for stroke C)Emotional and personality changes D)Pathologic bone fractures

D (Feedback: Neurologic signs and symptoms include headache, gait disturbances, visual impairment, personality changes, altered mentation (memory loss and confusion), focal weakness, paralysis, aphasia, and seizures. Pain, respiratory distress, and fixed pupils are not among the more common neurologic signs and symptoms of metastatic brain disease.)

A patient, diagnosed with cancer of the lung, has just been told he has metastases to the brain. What change in health status would the nurse attribute to the patient's metastatic brain disease? A)Chronic pain B)Respiratory distress C)Fixed pupils D)Personality changes

A (Feedback: Parkinson's disease is characterized by bradykinesia. It does not manifest as memory loss, increased appetite, or joint stiffness.)

An older adult has encouraged her husband to visit their primary care provider, stating that she is concerned that he may have Parkinson's disease. Which of the wife's descriptions of her husband's health and function is most suggestive of Parkinson's disease? A)"Lately he seems to move far more slowly than he ever has in the past." B)"He often complains that his joints are terribly stiff when he wakes up in the morning." C)"He's forgotten the names of some people that we've known for years." D)"He's losing weight even though he has a ravenous appetite."

A, B, D (Clients with PD need to maintain mobility and prevent contractures. Options a, b, and d are important self-help measures. The client should use a wide-based gait. If it is too hard to get on the floor to exercise, the client should do exercises in bed. DIF: Application/Applying REF: p. 1906 OBJ: Intervention MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care)

Important self-care measures a nurse can teach a client with Parkinson's disease in order to prevent contractures and improve mobility include which of the following? (Select all that apply.) a. Bend over with your head over your toes to get out of chairs. b. Exercise first thing in the morning. c. Keep a narrow-based gait. d. Look up when you walk, not down at the floor. e. Use a firm surface, like the floor, for exercising.

B (The degeneration of the caudate nucleus leads to a reduction in several neurotransmitters, including gamma-aminobutyric acid, acetylcholine, substance P, and metenkephalin, and their synthetic enzymes. This change leaves relatively higher concentrations of the other neurotransmitters, dopamine and norepinephrine. DIF: Comprehension/Understanding REF: p. 1908 OBJ: Intervention MSC: Physiological Integrity Physiological Adaptation-Pathophysiology)

The nurse explains that the pathology of Huntington's disease involves a. a decrease in the neurotransmitter norepinephrine. b. an excess of the neurotransmitter dopamine. c. destruction of white matter in the brain. d. formation of neurofibrillary tangles and plaques.

A (The neuritic plaque is a cluster of degenerating nerve terminals, both dendritic and axonal, that contains amyloid protein. DIF: Comprehension/Understanding REF: p. 1894 OBJ: Intervention MSC: Physiological Integrity Physiological Adaptation-Pathophysiology)

The nurse instructs a group of nursing students that the pathologic changes that occur in the brain of a person with dementia of Alzheimer's disease include a.abnormal accumulation of proteins. b.damage to the myelin sheath of neurons. c.destruction of neurons. d.increase in production of cerebrospinal fluid (CSF).

B (Feedback: A raised toilet seat is useful, because the patient has difficulty in moving from a standing to a sitting position. A handicapped toilet is not high enough and will not aid in improving bowel elimination. Sitting quietly on the toilet every 2 hours will not aid in getting from the sitting to standing position; neither will following the outlined bowel program.)

The nurse is caring for a patient diagnosed with Parkinson's disease. The patient is having increasing problems with rising from the sitting to the standing position. What should the nurse suggest to the patient to use that will aid in getting from the sitting to the standing position as well as aid in improving bowel elimination? A)Use of a bedpan B)Use of a raised toilet seat C)Sitting quietly on the toilet every 2 hours D)Following the outlined bowel program

C (Feedback: Primary brain tumors originate from cells and structures within the brain. Secondary brain tumors are metastatic tumors that originate somewhere else in the body. The scenario does not indicate that the patient's tumor is a pituitary tumor or a neuroma.)

The nurse is caring for a patient newly diagnosed with a primary brain tumor. The patient asks the nurse where his tumor came from. What would be the nurse's best response? A)"Your tumor originated from somewhere outside the CNS." B)"Your tumor likely started out in one of your glands." C)"Your tumor originated from cells within your brain itself." D)"Your tumor is from nerve tissue somewhere in your body."

C (Feedback: Patients need the opportunity to exercise some control over their situation. A sense of mastery can be gained as they learn to understand the disease and its treatment and how to deal with their feelings. Distraction and administering medications will not allow the patient to gain control over anxiety. Delegating planning to the family will not help the patient gain a sense of control and autonomy.)

The nurse is writing a care plan for a patient with brain metastases. The nurse decides that an appropriate nursing diagnosis is "anxiety related to lack of control over the health circumstances." In establishing this plan of care for the patient, the nurse should include what intervention? A) The patient will receive antianxiety medications every 4 hours. B) The patient's family will be instructed on planning the patient's care. C) The patient will be encouraged to verbalize concerns related to the disease and its treatment. D) The patient will begin intensive therapy with the goal of distraction.

B, C, D, E (To provide for the AD client's safety at home, the nurse could suggest several solutions: moving knickknacks to the middle of tables so the edges can be used for balance, blocking off unsafe areas, disabling stoves, removing rugs and runners, installing grab bars in the bathroom, obtaining bedside commodes and hand-held showers, and securing the environment so the client can wander safely. See the Bridge to Home Health Care feature Safety Solutions for People with Alzheimer's Disease for more ideas. DIF: Analysis/Analyzing REF: p. 1900 OBJ: Intervention MSC: Safe, Effective Care Environment Safety and Infection Control-Home Safety)

The nurse would suggest to the family of a client who is in the moderate stages of AD and is being cared for in the home to (Select all that apply) a. assess orientation hourly by hiring a sitter if necessary. b. disable the stove but find ways for the client to participate in meal preparation. c. have the client wear an identification badge. d. move knickknacks to the middle of tables. e. secure the environment with a fence so the client cannot leave the home.

D (Nursing interventions for a patient who has inadequate nutritional intake should include the following: Apply deep gentle pressure around the patient's mouth to assist with swallowing, and administer phenothiazines prior to the patient's meal as ordered. The nurse should dis-regard the mess of the feeding area and treat the person with dignity. Stiffness and turning away by the patient during feeding are uncontrollable choreiform movements and should not be interrupted.)

You are the nurse caring for a patient diagnosed with Huntington's disease who has been ad-mitted to the hospital for treatment of malnutrition. What independent nursing action should be implemented in the patient's plan of care? A) Firmly redirect the patient's head when feeding. B) Administer phenothiazines after each meal as ordered. C) Encourage the patient to keep his or her feeding area clean. D) Apply deep, gentle pressure around the patient's mouth to aid swallowing.