Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders

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." "The surgeon will be able to remove all of the tumor." "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." Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Surgical Management, p. 2096.

A client with an incurable brain tumor is experiencing nausea and vomiting and has little interest in eating. His family states, "We don't know how to help him." Which of the following would be appropriate for the nurse to suggest to help improve the client's nutritional intake? Select all that apply. Ensure that the client is free of pain for meals. Place the client near the sounds and smells of meals being prepared. Plan meals for times when the client is rested. Provide the client with foods that he likes. Prepare the client for the insertion of a feeding tube.

Ensure that the client is free of pain for meals. Plan meals for times when the client is rested. Provide the client with foods that he likes. Explanation: Suggestions to improve nutrition include making sure that the client is comfortable, free of pain, and rested. This may require family members to adjust meal times. Additionally, they should eliminate offensive sights, sounds, and odors. Therefore, placing the client near sites of meal preparation may be too overwhelming. If the client has difficulty with or shows disinterest in usual foods, the family should offer foods that the client prefers, rather than attempting to get the client to eat as previously. If the client shows marked deterioration, then some other form of nutritional support such as a feeding tube or parenteral nutrition may be indicated, but only if this measure is consistent with the client's choices for care. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Improving Nutrition, p. 2098.

Excessive levels of which neurotransmitter has been implicated in amyotrophic lateral sclerosis (ALS)? Epinephrine Dopamine Serotonin Glutamate

Glutamate Explanation: 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. Reference: Hinkle, J. L., Cheever, K. H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing , 14th ed Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, p. 2109

A new ancillary staff member is assisting the nurse with a client diagnosed with Parkinson's disease. The client needs assistance with eating but doesn't require thickened liquids to aid swallowing. Which instruction should the nurse give the ancillary staff member about eating assistance? Make sure the client is sitting with the head of bed elevated to 90 degrees. Assist the client into a comfortable position and stay alert for coughing, which signifies aspiration. Clients with Parkinson's disease shouldn't have liquids; remove them from the dinner tray before serving food to the client. There are no special precautions for the client with Parkinson's disease.

Make sure the client is sitting with the head of bed elevated to 90 degrees. Explanation: Clients with Parkinson's disease are at risk for aspiration; therefore, the nurse should instruct the ancillary staff member to make sure the head of the client's bed is elevated to 90 degrees before assisting the client with eating. A client doesn't always cough when he aspirates. A client with Parkinson's disease needs fluids to maintain fluid balance. Aspiration is a great concern with Parkinson's disease; therefore; the staff should take precautions to prevent this complication. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Enhancing Swallowing, p. 2106.

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. Chemotherapy, following surgery, has recently been shown to be a highly effective treatment. Radiation is not an option because of the tumor's location near the brainstem. Surgery can improve survival time but the results are not guaranteed.

Surgery can improve survival time but the results are not guaranteed. Explanation: The overall prognosis for this type of aggressive brain tumor is poor but surgery can improve survival time. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Gliomas, p. 2092.

Bone density testing in clients with post-polio syndrome has demonstrated osteoarthritis. calcification of long bones. no significant findings. low bone mass and osteoporosis.

low bone mass and osteoporosis. Explanation: Bone density testing in clients with post-polio syndrome has demonstrated low bone mass and osteoporosis. Thus, the importance of identifying risks, preventing falls, and treating osteoporosis must be discussed with clients and their families. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2119

Bone density testing will be completed for the client with post-polio syndrome. The nurse teaches the client bone density testing is used to identify what potential complication? Osteoarthritis Calcification of long bones Pathologic fractures Low bone mass and osteoporosis

Low bone mass and osteoporosis Explanation: Bone density testing in clients with post-polio syndrome has demonstrated low bone mass and osteoporosis. Thus, the importance of identifying risks, preventing falls, and treating osteoporosis must be discussed with clients and their families. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2119

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 Dysphonia Hypokinesia Micrographia

Dysphonia Explanation: Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Other Manifestations, p. 2103.

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

Improved quality of life Explanation: The treatment of metastatic brain cancer is palliative and involves eliminating or reducing serious symptoms. Even when palliation is the goal, distressing signs and symptoms can be relieved, thereby improving the quality of life for both client and family. Removal of all or part of the tumor is the goal of surgery. Radiation therapy attempts to decrease the incidence of recurrence of incompletely resected tumors.

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 a corticosteroid has been prescribed, do not take it at the same time as 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."

"Driving a car should be avoided until the you know how this medication effects you." Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Seizures, p. 2094.

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? Riluzole Benztropine mesylate Amantadine Bromocriptine

Riluzole Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Management, p. 2111.

The nurse is aware that, when assessing a patient for symptoms of a brain tumor, the symptom most frequently found is: Sharp, unrelenting headaches. Simple to generalized seizures. Vertigo and fainting. Unilateral loss of motor coordination.

Simple to generalized seizures. Explanation: Seizures are usually the first symptom of a brain tumor. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Seizures, p. 2094.

A nurse is working on a surgical floor. The nurse must logroll a client following a: laminectomy. thoracotomy. hemorrhoidectomy. cystectomy.

laminectomy. Explanation: The client who has had spinal surgery, such as laminectomy, must be logrolled to keep the spinal column straight when turning. The client who has had a thoracotomy or cystectomy may turn himself or may be assisted into a comfortable position. Under normal circumstances, hemorrhoidectomy is an outpatient procedure, and the client may resume normal activities immediately after surgery. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Nursing Management, p. 2118.

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

reduce cerebral edema. Explanation: Corticosteroids may be used before and after treatment to reduce cerebral edema and 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. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2096

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

Protecting the client from falls Explanation: 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. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2110

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 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 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." Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Meningiomas, p. 2092.

The nurse reviews the patient's drug regimen for treatment of a brain tumor. She explains to the patient why one of the following drugs would not be prescribed, even though it might have therapeutic benefits. Which drug would not be prescribed for this patient? Paclitaxel Coumadin Decadron Dilantin

Coumadin Explanation: Although deep vein thrombosis and pulmonary embolism occur in about 15% of patients and cause significant morbidity, anticoagulants are not prescribed due to the risk for CNS hemorrhage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Pharmacologic Therapy, p. 2096.

A nurse is reading a journal article about spinal cord tumors and metastasis from other primary sites. The nurse demonstrates understanding of the article when identifying which primary sites as commonly metastasizing to the spinal cord? Select all that apply. Lung Breast Gastrointestinal tract Prostate Bladder

Lung Breast Gastrointestinal tract Explanation: Cancer can spread to the spinal cord from any primary site. However, the three most common cancers that metastasize to the spinal cord are lung, breast, and those of the gastrointestinal tract.

Which of the following is a hallmark of spinal metastases? Pain Nausea Fatigue Change in level of consciousness (LOC)

Pain Explanation: Pain is the hallmark of spinal metastases. Nausea, fatigue, and change in LOC may occur, but these are not the hallmark of spinal metastases. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Medical Management, p. 2097.

Which of the following is a late symptom of spinal cord compression? Paralysis Urinary incontinence Fecal incontinence Urinary retention TAKE ANOTHER QUIZ

Paralysis Explanation: Later symptoms include evidence of motor weakness and sensory deficits progressing to paralysis. Early symptoms associated with spinal cord compression include bladder and bowel dysfunction (urinary incontinence or retention; fecal incontinence or constipation). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Monitoring and Managing Potential Complications, p. 2116.

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 Radiation therapy Chemotherapy Immunotherapy

Surgery Explanation: 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.

A patient with Huntington's disease is prescribed medication to reduce the chorea. What medication will the nurse administer that is the only drug approved for the treatment of this symptom? Tetrabenazine (Xenazine) Carbamazepine (Tegretol) phenobarbital Diazepam (Valium)

Tetrabenazine (Xenazine) Explanation: Tetrabenazine (Xenazine) is the only approved drug for the treatment of the chorea, although thiothixene hydrochloride (Navane) and haloperidol decanoate (Haldol), which predominantly block dopamine receptors, have been used in the past. Benzodiazepines and neuroleptic drugs have also been reported to control chorea. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Medical Management, p. 2109.

A client has just returned from surgery after undergoing a lumbar laminectomy. Which of the following would be most important to do when positioning the client in bed? Using a logrolling motion to change positions Keeping the knees flat with the head on a pillow Maintaining full knee flexion when lying on the side Allowing the client to sit up at the edge of the bed

Using a logrolling motion to change positions Explanation: After a laminectomy, logrolling is used to change the client's position. When in bed, a pillow is placed under the client's head and the knee rest is elevated slightly to relax the back muscles. When lying on his or her side, extreme knee flexion is avoided. Sitting is discouraged except for defecation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Nursing Management, p. 2118.

The nurse is caring for a client who underwent surgery to remove a spinal cord tumor. When conducting the postoperative assessment, the nurse notes the presence of a bulge at the surgical site. The nurse suspects the client is experiencing what complication from the surgery? Cerebrospinal fluid leakage Infection at the surgical site Growth of a secondary tumor Impaired tissue healing

Cerebrospinal fluid leakage Explanation: Bulging at the incision may indicate a contained cerebrospinal fluid (CSF) leak. The site should be monitored for increasing bulging, known as pseudomeningocele, which may require surgical repair. Infection at the surgical site should be suspected if the surgical dressing is stained. The bulge does not indicate growth of secondary tumor, this can only be identified using diagnostic imaging. Impaired tissue healing would be indicated if the nurse assessed redness, swelling and warmth at the surgical site during a dressing change. The bulge at the site warrants further assessment of a postsurgical leak of CSF. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Monitoring and Managing Potential Complications, p. 2101.

What is the most common type of brain neoplasm? Glioma Angioma Meningioma Neuroma

Glioma Explanation: 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. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2092 Add a Note

Nursing students are reviewing information about Parkinson's disease in preparation for class the next day. The students demonstrate understanding of the material when they identify which of the following as a cardinal sign of this disorder? Select all that apply. Tremor Rigidity Bradykinesia Postural instability Intellectual decline

Tremor Rigidity Bradykinesia Postural instability Explanation: Cardinal signs of Parkinson's disease are tremor, rigidity, bradykinesia, and postural instability. Although mental status changes can occur over the course of the disease, intellect is usually not affected. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Clinical Manifestations, p. 2102.

Which statement describes the pathophysiology of post-polio syndrome? The exact cause is unknown, but aging or muscle overuse is suspected. The exact cause is unknown, but latent poliovirus is suspected. Post-polio syndrome is caused by an autoimmune response. Post-polio syndrome is caused by long-term intake of a low-protein, high-fat diet in polio survivors.

The exact cause is unknown, but aging or muscle overuse is suspected. Explanation: The exact cause of post-polio syndrome is not known but researchers suspect that with aging or muscle overuse the neurons that were not destroyed originally by the poliovirus are unable to continue generating axon sprouts. The exact cause of post-polio syndrome is not known. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2119

When caring for a client diagnosed with a brain tumor of the parietal lobe, the nurse expects to find: short-term memory impairment. tactile agnosia. loss of motor function. contralateral homonymous hemianopia.

tactile agnosia. Explanation: The nurse should expect to find tactile agnosia (inability to identify objects by touch), a sign of a parietal lobe tumor. Short-term memory impairment occurs with a frontal lobe tumor. Contralateral homonymous hemianopia suggests an occipital lobe tumor. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Localized Symptoms, p. 2094.

A patient with myasthenia gravis is in the hospital for treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide on time. The nurse gets busy and does not administer the medication until after breakfast. What outcome will the patient have related to this late dose? The muscles will become fatigued and the patient will not be able to chew food or swallow pills. There should not be a problem, since the medication was only delayed by about 2 hours. The patient will go into cardiac arrest. The patient will require a double dose prior to lunch.

The muscles will become fatigued and the patient will not be able to chew food or swallow pills. Explanation: Maintenance of stable blood levels of anticholinesterase medications, such as pyridostigmine, is imperative to stabilize muscle strength. Therefore, the anticholinesterase medications must be administered on time. Any delay in administration of medications may exacerbate muscle weakness and make it impossible for the patient to take medications orally. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Pharmacologic Therapy, p. 2080.

A male client who has undergone a cervical discectomy is being discharged with a cervical collar. Which of the following would be most appropriate to include the client's discharge plan? Keeping the head in a neutral position Wearing the cervical collar when sleeping Removing the entire collar when shaving Moving the neck from side to side when the collar is off

Keeping the head in a neutral position Explanation: After a cervical discectomy, the client typically wears a cervical collar. The client should be instructed to keep his head in a neutral position and wear the collar at all times unless the physician has instructed otherwise. The front part of the collar is removed for shaving and the neck should be kept still while the collar is open or off. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Medical Management, p. 2114.

The nurse is caring for a client with mid-to-late stage of an inoperable brain tumor. What teaching is important for the nurse to do with this client? Optimizing nutrition Managing muscle weakness Explaining hospice care and services Offering family support groups

Explaining hospice care and services Explanation: The nurse explains hospice care and services to clients with brain tumors that no longer are at a stage where they can be cured. Managing muscle weakness and offering family support groups are important, but explaining hospice is the best answer. Optimizing nutrition at this point is not a priority. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Nursing Management, p. 2096.

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 Amyotrophic lateral sclerosis Alzheimer disease Huntington disease

Amyotrophic lateral sclerosis Explanation: 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. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2109

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: 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. Surgery, which can result in complete removal of the possible tumor, should be done as soon as possible.

Growth is slow and symptoms are caused by compression rather than tissue invasion. Explanation: A meningioma is benign, encapsulated, and slow-growing. Sometimes the patient has no symptoms because of the slow-growing nature of the tumor. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Meningiomas, p. 2092.

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? Body image disturbance Anxiety Impaired cognition Knowledge deficit

Knowledge deficit Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Medical Management, p. 2100.

The nurse is providing end-of-life care to a client who was diagnosed with glioblastoma multiforme (GBM) 8 months ago. Despite a calm interaction with the client 1 hour ago, the client is now angry and yells, "Get out of my room and don't touch me anymore. I don't need your help!" How should the nurse respond? "I am your nurse and caring for you is my obligation. If you no longer want my care, you have to make a request to my supervisor." "You are not permitted to speak to me this way. I am a professional and I deserve for you to treat me with respect." "I can see you no longer want me as your nurse today. I will ask one of my colleagues to come in to complete the rest of my assessment." "I can tell now is not the right time for me to come in and check on you. Please let me know when it is a better time for me to come back."

"I can tell now is not the right time for me to come in and check on you. Please let me know when it is a better time for me to come back." Explanation: Personality changes, mood swings and irritability can be common manifestations of both growth of the brain tumor and also the process of grief and loss, such as in the case of the client who is receiving end-of-life care. The client's anger and yelling at the nurse is indicative of ineffective coping and warrants the nurse to take a therapeutic approach when responding to the anger. Acknowledging that the client is not ready to receive care at the moment and asking the client to contact the nurse when he or she is ready enables to client to maintain control and promotes self-esteem. Telling the client to speak to the nurse's supervisor does not promote a strong nurse-patient relationship and is not a supportive way to manage end-of-life care. Telling the client that he or she is not permitted to speak to the nurse "that way" may increase the client's anger and puts limits on the client's sense of control. This response does not promote an effective nurse-patient relationship. The nurse must use extra caution when responding to a client who is experiencing emotional swings when faced with death and dying. By stating, "I can see you no longer want me as your nurse," the nurse is making an assumption that the client does not want him or her as the nurse any longer. By making this statement, the nurse is limiting opportunities for the client to verbalize feelings and emotions related to stress, grief and loss. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Relieving Anxiety, p. 2098.

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

Spinal cord compression Explanation: With spinal tumors, there is the risk of compression from the tumor on structures and organs surrounding the spinal cord. Urinary incontinence indicates decreased spinal cord function due to spinal cord injury related to compression from the tumor. Although the nurse may include further assessment for urinary tract infection, knowledge deficit and impaired skin integrity, these would not be the priority assessment. Spinal chord compression is considered a medical emergency and requires immediate treatment to prevent permanent neurologic damage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Monitoring and Managing Potential Complications, p. 2101.

A nurse assesses a patient who has been diagnosed with having a pituitary adenoma that is pressing on the third ventricle. The nurse looks for the associated sign/symptom. What is that sign/symptom? Disruption in sleep patterns Unusual sensitivity to heat and cold Visual disturbances Increased intracranial pressure

Increased intracranial pressure Explanation: All the choices are signs and symptoms that can occur with an adenoma, depending on whether the pressure is exerted on the hypothalamus, the third ventricle, or the optic nerves, chiasm, or tracts. Increased intracranial pressure occurs when the third ventricle is affected. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Pressure Effects of Pituitary Adenomas, p. 2093.

The nurse teaches the client with which disorder that the disease is due to decreased levels of dopamine in the basal ganglia of the brain? Multiple sclerosis Parkinson disease Huntington disease Creutzfeldt-Jakob disease TAKE ANOTHER QUIZ

Parkinson disease Explanation: In some patients, 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. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2101

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? Raise the head of the client's bed about 30 degrees during meals. Encourage the use of liquids that are thin in consistency. Arrange for specialized utensils for the client to use when eating. Encourage the client to massage the facial and neck muscles before eating.

Encourage the client to massage the facial and neck muscles before eating. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Improving Nutrition, p. 2106.

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

Ionizing radiation Explanation: Ionizing radiation is the only known risk factor for brain tumors. Head trauma, use of hair dyes, and the use of cellular phones are possible causes that have been investigated. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, p. 2092.

The daughter of a patient with Huntington's disease asks the nurse what the risk is of her inheriting the disease. What is the best response by the nurse? "The disease is not hereditary and therefore there is no risk to you." "If one parent has the disorder, there is an 75% chance that you will inherit the disease." "If one parent has the disorder, there is a 50% chance that you will inherit the disease." "The disease is inherited and all offspring of a parent will develop the disease."

"If one parent has the disorder, there is a 50% chance that you will inherit the disease." Explanation: Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia. The disease affects approximately 1 in 10,000 men or women of all races at midlife. It is transmitted as an autosomal dominant genetic disorder; therefore, each child of a parent with Huntington disease has a 50% risk of inheriting the disorder (Ha & Fung, 2012). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Huntington Disease, p. 2108.

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

"Intravenous immunoglobulin infusion may help you." Explanation: There is no specific treatment for post-polio syndrome; however, the infusion of IV immunoglobulin has been shown to help with the physical pain and weakness. Sleeping and relaxation may not assist the client with post-polio syndrome. The syndrome is very common and is most likely related to the past diagnosis of polio. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2119

A client asks the nurse to explain the development of Parkinson disease (PD). Which response will the nurse provide the client? "It is a genetic disorder that has a strong corralation to women who began menopause earlier than age 45." "While there is no average age of onset, studies suggest neurologic aging deficits put clients at risk after age 70." "It has been linked by untreated or poorly managed bacterial or viral infections in early adolescence." "It is caused by low levels of dopamine that are not available to counteract the effects of acetylcholine."

"It is caused by low levels of dopamine that are not available to counteract the effects of acetylcholine." Explanation: Parkinson disease (PD) is a slowly progressing neurologic movement disorder that eventually leads to disability. It is associated with decreased levels of dopamine resulting from degeneration of dopamine storage cells in the substantia nigra in the basal ganglia region of the brain. The loss of dopamine stores in the area of the brain that control motor movements results in more excitatory neurotransmitters than inhibitory neurotransmitters, leading to an imbalance that affects voluntary movement. PD symptoms usually appear in the fifth decade of life and affect men more often than women. There is a definite reason for the development of PD. It is not precipitated by untreated or poorly treated bacterial or viral infections.

A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond? "You should ask your physician about that." "The strength of your arms and pelvic muscles will decrease gradually, but this should cause only slight disability." "You may experience progressive deterioration in all voluntary muscles." "This form of muscular dystrophy is a relatively benign disease that progresses slowly."

"You may experience progressive deterioration in all voluntary muscles." Explanation: The nurse should tell the client that muscular dystrophy causes progressive, symmetrical wasting of skeletal muscles, without neural or sensory defects. The mixed form of the disease typically strikes between ages 30 and 50 and progresses rapidly, causing deterioration of all voluntary muscles. Because the client asked the nurse this question directly, the nurse should answer and not simply refer the client to the physician. Limb-girdle muscular dystrophy causes a gradual decrease in arm and pelvic muscle strength, resulting in slight disability. Facioscapulohumeral muscular dystrophy is a slowly progressive, relatively benign form of muscular dystrophy; it usually arises before age 10. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Promoting Home, Community-Based, and Transitional Care, p. 2112.

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 Brain stem Temporal lobe Pituitary gland

Cerebellum Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Assessment and Diagnostic Findings, p. 2095.

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

Chorea Explanation: The most prominent clinical features of Huntington disease include chorea, intellectual decline, and often emotional disturbance. As the disease progresses, speech becomes slurred, gait becomes disorganized, and cognitive function is altered with dementia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Clinical Manifestations, p. 2108.

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 participates in daily hygiene activities with assistive devices. Client expresses feelings related to self-care ability. Client consumes adequate calories to meet energy needs.

Client participates in daily hygiene activities with assistive devices. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Diagnosis, p. 2098.

A patient has been diagnosed with a lipoma. The nurse explains to the patient that this tumor is located in the part of the brain known as the: Optic chiasm. Brainstem. Corpus callosum. Cerebrum.

Corpus callosum. Explanation: The corpus callosum is a thick collection of nerve fibers that connect both hemispheres of the brain and is responsible for transmitting information from one side of the brain to another. A lipoma only occurs in this area. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Figure 70-1, p. 2094.

The nurse educator knows which statement about pituitary adenomas is true? They are most prevalent in the pediatric population. Most of these types of tumors are malignant. Cushing disease can result from a functioning tumor. Men are more likely to be diagnosed with this type of tumor.

Cushing disease can result from a functioning tumor. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Pituitary Adenomas, p. 2093.

An acoustic neuroma is a benign tumor of which cranial nerve? Eighth Fifth Seventh Ninth

Eighth Explanation: An acoustic neuroma is a benign tumor of the eighth cranial nerve, the cranial nerve most responsible for hearing and balance. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Acoustic Neuromas, p. 2092.

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

Glasgow coma scale (GCS) Mini mental status examination (MMSE) Explanation: Included within the neurological examination to determine deficits, the nurse should use the GCS, an assessment tool that can help identify the severity of brain injury for clients who have had surgery to remove a brain tumor. The MMSE can assist in evaluating the client's orientation to person, place and time. This tool can also assist the nurse is identifying changes to the client's cognitive functioning that may result from brain injury. A urinalysis would not provide any information on the client's neurological status. This test can provide information about the appearance, concentration and content of urine, but this is non-specific to issues related to neurological status. Chest auscultation is useful when conducting a respiratory assessment. The BDI is used to quantify an assessment of a client's mood and the severity of depression. This tool can be helpful when screening for mood disorders, but it does not provide any useful information about neurological status. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Assessment and Diagnostic Findings, p. 2095.

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. Provide teaching on nonpharmacologic measures to control pain. Notify the physician of the client's pain.

Help the client assume a more comfortable position. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Planning and Goals, p. 2115.

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? Hemorrhagic stroke Thyroid disorders Hearing loss Visual loss

Hemorrhagic stroke Explanation: 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.

he 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 perform household tasks How to take a bath 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 Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Promoting Home, Community-Based, and Transitional Care, p. 2109.

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

Huntington disease Explanation: Because it is transmitted as an autosomal dominant genetic disorder, each child of a parent with Huntington disease has a 50% risk of inheriting the illness. 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. Parkinson disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain. 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. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2108

The nurse is providing discharge teaching to a client with a spinal cord tumor and instructs the client to avoid hot water bottles and heating blankets for what reason? Impaired sensory perception Motor weakness Medication side effects Cognitive impairment

Impaired sensory perception Explanation: Clients with residual sensory involvement are cautioned about the dangers of extremes in temperature. They should be educated about the dangers of heating devices (e.g., hot water bottles, heating pads, space heaters) as their sensory integration may be impaired, causing them to lose the ability to detect dangerous stimulations and to react appropriately. Discharge teaching for motor weakness involves learning different ways to manage activities of daily living and possible teaching regarding the use of assistive devices such as a cane. Medications used in the treatment of spinal tumors would not predispose the client to diminished sensory integration; this problem arises from brain structure and spinal cord compression. Although cognitive impairment may be sequelae resulting from the growth and treatment of brain and spinal tumors, the primary reason clients are instructed not to use excessive temperatures is because they may have lost of ability to sense extremes of hot and cold. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Educating Patients About Self-Care, p. 2101.

A patient with a brain tumor is complaining of headaches that are worse in the morning. What does the nurse know could be the reason for the morning headaches? Increased intracranial pressure Dehydration Migraines The tumor is shrinking.

Increased intracranial pressure Explanation: Headache, although not always present, is most common in the early morning and is made worse by coughing, straining, or sudden movement. It is thought to be caused by the tumor invading, compressing, or distorting the pain-sensitive structures or by edema that accompanies the tumor, leading to increased intracranial pressure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Increased Intracranial Pressure, p. 2093.

The nurse is seeing a female client who has been diagnosed with a pituitary adenoma. During the clinic visit, the client tells the nurse that she has been having irregular menstrual periods despite having very regular menstrual periods all her life. The nurse knows this physiological change is likely related to which characteristic of this type of brain tumor? Increased prolactin levels Decrease in growth hormone Decrease in adrenocorticotropic hormone Increase in thyroid-stimulating hormone

Increased prolactin levels Explanation: A characteristic of functioning pituitary tumors is the overproduction of prolactin, which can lead to irregular or diminished menstrual periods in women. Functioning pituitary tumors lead to an increase in the production of several hormones including growth hormone and adrenocorticotropic hormone, not a decrease. Nonetheless, the client would not experience changes in her menstrual periods as a result of increases in these two hormones. Although functioning pituitary tumors can cause an increase in thyroid-stimulating hormone, this would not be the cause of changes in the client's normal menstrual periods. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Pituitary Adenomas, p. 2093.

Which nursing diagnosis takes the highest priority for a client with parkinsonian crisis? Imbalanced nutrition: Less than body requirements Ineffective airway clearance Impaired urinary elimination Risk for injury

Ineffective airway clearance Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Other Manifestations, p. 2103.

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

Irregular respirations Explanation: Impaired brain stem function caused by the rise in ICP causes irregular and depressed respirations. This clinical sign is part of the Cushing triad, which indicates late signs of increased ICP. With increased ICP, late signs include hypertension with a large, widening pulse pressure and bradycardia. These clinical manifestations are also part of the Cushing triad. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Increased Intracranial Pressure, p. 2093.

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 Irritation of the medullary vagal centers Compression of surrounding structures Distortion of pain-sensitive structures

Irritation of the medullary vagal centers Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Vomiting, p. 2093.

The nurse explains to the client with projectile vomiting and severe headache that a medication is being prescribed to reduced edema surrounding the brain and lessen these symptoms. What medication is the nurse preparing to administer? Mannitol Temozolomide Bevacizumab Everolimus

Mannitol Explanation: Mannitol is an osmotic diuretic that is administered to decrease the fluid content of the brain, which leads to a decrease in intracranial pressure. Temozolomide is a chemotherapeutic agent which is commonly used to stop or slow cell growth in certain types of brain tumors. Bevacizumab and everolimus are immunotherapy agents that reduce the vascularization of tumors, thereby inhibiting tumor growth. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Chemotherapy, p. 2096.

The community health nurse is preparing to conduct a home visit to a client in the community who was recently discharged from hospital after treatment of a metastatic brain lesion. What should the community health nurse plan to include within the time allotted for the home visit? Select all that apply. Mental status examination Skin integrity Mobility Use of pain medication Cranial nerve functioning

Mental status examination Skin integrity Mobility Use of pain medication Explanation: The community health nurse should ensure a comprehensive assessment is conducted to note any new deficits that may have developed since the client was discharged from the hospital. The mental status examination would uncover any neurological deficits that have developed. Assessment of skin integrity would uncover any possible impairments that could become portals for infection. This is especially important for clients who have bowel and/or bladder dysfunction. Changes in mobility could be related to pain management or new neurological deficits caused by compression of brain structures. It is always important to conduct a pain assessment to ensure client has adequate pain relief to engage in activities of daily living, rehabilitative activities and, overall, for the client's quality of life. Reports of increased pain and in different regions can be indicative of progression of the metastatic lesion. Cranial nerve function should be assessed during a clinic visit as the nurse may be limited in the community care setting (the client's home) with regards to the extent of a cranial nerve assessment that can be conducted. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Promoting Home, Community-Based, and Transitional Care, p. 2101.

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

Most tumors produce too much of one or more hormones. Explanation: The majority of these tumors are benign. In rare cases, they may be malignant. Functioning tumors produce hormones, frequently in excessive amounts, resulting in conditions such as hyperthyroidism, Cushing's syndrome, and gigantism or acromegaly. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Pituitary Adenomas, p. 2093.

A patient is diagnosed with an aggressive, primary malignant brain tumor. The nurse is aware that the glioma: Originated within the brain tissue. Originated from the coverings of the brain. Developed on the cranial nerves. Metastasized from a cancer in another part of the body.

Originated within the brain tissue. Explanation: The most aggressive type of malignant brain tumor is a glioma, which originates within the brain tissue. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Types of Primary Brain Tumors, p. 2092.

A client seeks care for lower back pain of 2 weeks' duration. Which assessment finding suggests a herniated intervertebral disk? Pain radiating down the posterior thigh Back pain when the knees are flexed Atrophy of the lower leg muscles Homans' sign

Pain radiating down the posterior thigh Explanation: A herniated intervertebral disk may compress the spinal nerve roots, causing sciatic nerve inflammation that results in pain radiating down the leg. Slight knee flexion should relieve, not precipitate, lower back pain. If nerve root compression remains untreated, weakness or paralysis of the innervated muscle group may result; lower leg atrophy may occur if muscles aren't used. Homans' sign is more typical of phlebothrombosis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Clinical Manifestations, p. 2117.

Which disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells? Multiple sclerosis Parkinson disease Huntington disease Creutzfeldt-Jakob disease

Parkinson disease Explanation: 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. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2101

A client newly diagnosed with Huntington diease asks for information concerning management of symptoms. Which action would the nurse first take to address this request? Recommend the immediate use of levodopa by the client. Provide a referral for the client to a Huntington disease multidisciplnary team. Perform a focused assessment on the client's needs and capabilities. Establish the client's willingness to adhere to prescribed treatments.

Perform a focused assessment on the client's needs and capabilities. Explanation: Nurses must look beyond the disease to focus on the patient's needs and capabilities first. While the client will benefit from the expertise of a Huntington disease multidisciplinary team, it is important to first establish their goals and individual needs. Only after a full assessment should medications be recommended by anyone on a health care team. In clients who present with rigidity, some temporary benefit may be obtained from antiparkinson medications, such as levodopa. Establishing a client's willingness to adhere to treatments is premature until the treatment plan is established. Huntington disease is characterized by a triad of symptoms that include motor dysfunction (the most prominent being chorea), impaired cognition, and behavioral features such as a blunted affect. Huntington disease is a progressive and terminal illness at this time. The focus for this client is optimizing quality of life with available medications and supportive treatments.

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

Provide care aimed at slowing the loss of strength and maintaining overall well-being. Explanation: No specific medical or surgical treatment is available for this syndrome and therefore nursing plays a pivotal role in the team approach to assisting clients and families in dealing with the symptoms of progressive loss of muscle strength and significant fatigue. Nursing interventions are aimed at slowing the loss of strength and maintaining the physical, psychological and social well-being of the client. Clients need to plan and coordinate activities to conserve energy and reduce fatigue. Important activities should be planned for the morning as fatigue often increases in the afternoon and evening. Pain in muscles and joints may be a problem. Nonpharmacologic techniques, such as the application of heat and cold, are most appropriate because these clients tend to have strong reactions to medications. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2119

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 Slow, shuffling gait Dysphagia and dysphonia Dementia

Rapid, jerky, involuntary movements Explanation: 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). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Clinical Manifestations, p. 2108.

A client has undergone surgery for a spinal cord tumor that was located in the cervical area. The nurse would be especially alert for which of the following? Hemorrhage Bowel incontinence Respiratory dysfunction Skin breakdown

Respiratory dysfunction Explanation: When a spinal tumor is located in the cervical area, respiratory compromise may occur from postoperative edema. Hemorrhage would be a concern with any surgery. Bowel incontinence and skin breakdown are possible but not specific to cervical spinal tumors. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Monitoring and Managing Potential Complications, p. 2101.

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

Spinal metastasis Explanation: Pain is the hallmark of spinal metastasis. Patients with sensory root involvement may suffer excruciating pain, which requires effective pain management. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Medical Management, p. 2097.

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? Take prescribed pain medication prior to commencing a meal Avoid any oral care prior to eating Eat uninterrupted by others to eliminate distractions Prepare the eating area with a pleasant room spray

Take prescribed pain medication prior to commencing a meal Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Improving Nutrition, p. 2098.

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 having an exacerbation. Medication needs to be adjusted to higher doses. The client is exhibiting signs of medication overdose. The disease has entered the late stages.

The disease has entered the late stages. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Other Manifestations, p. 2103.

The nurse is seeing the mother of a client who states, "I'm so relieved because my son's doctor told me his brain tumor is benign." The nurse knows what is true about benign brain tumors? They can affect vital functioning. They do not require surgical removal. The prognosis is very poor. They are all metastatic.

They can affect vital functioning. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Brain Tumors, p. 2092.

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? Thyroid-stimulating hormone Adrenocorticotropic hormone Prolactin Growth hormone

Thyroid-stimulating hormone Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Pituitary Adenomas, p. 2093.

The nurse is seeing a client who is suspected of having a glioblastoma multiforme tumor. The nurse anticipates the client will require which diagnostic test to confirm the client has this form of brain tumor? Tissue biopsy Weber and Rinne test Audible bruit over the skull An increase in prolactin

Tissue biopsy Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Types of Primary Brain Tumors, p. 2092.

The nurse is providing discharge teaching to a client who has had surgery for partial removal of a spinal tumor to decompress the spinal cord. Preoperatively, the client had lost sensation to the lower legs. When instructing the client regarding pain management strategies, the nurse should include which information? Use heat to decrease back pain Sleep in the recumbent position Perform moderate exercise Use assistive devices

Use assistive devices Explanation: To prevent falls and pain due to fatigue and overuse, the client should be encouraged to use assistive devices such as canes, walkers and/or wheelchairs when ambulating. When the nurse is providing discharge teaching to a client after spinal surgery, the nurse should ensure that, for a client with residual sensory involvement, the client is aware that extreme temperatures should not be applied to the skin. The client should be alerted to the dangers of heating devices (e.g., hot water bottles, heating pads, space heaters). Sleeping in the recumbent position (three quarters prone) can increase pain. Thus, the client should be encouraged to sleep flat with the head of the bed slightly elevated or closely follow instructions for sleep position provided by the surgeon. Although maintaining muscle strength is important in promoting ability to carry out activities of daily living, moderate exercise may not be possible. The client should follow the rehabilitation plan prescribed by the allied health professional responsible for this aspect of the client's care (e.g., the physiotherapist). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Managing Pain, p. 2100.

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: electromyography (EMG). Doppler scanning. Doppler ultrasonography. quantitative spectral phonoangiography.

electromyography (EMG). Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Assessment and Diagnostic Findings, p. 2111.

The nurse is seeing a client who has just been diagnosed with a grade I meningioma. The nurse is correct when stating what information about the client's diagnosis? "Surgical intervention is not very effective for this type of tumor." "This type of tumor has a poor prognosis." "This type of tumor invades brain tissue quickly." "Grade 1 is the most common type of this tumor."

"Grade 1 is the most common type of this tumor." Explanation: Grade I meningiomas are the most common of meningioma and can be cured by surgery. Grades II and III are less common and grow quickly. They can spread to the brain and spinal cord. These tumors have a poorer prognosis and usually cannot be completely resected. Despite this information, the nurse should not be making statements about prognosis as this is not within the nurse's scope. Manifestations depend on the area involved and are the result of compression rather than invasion of brain tissue. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Meningiomas, p. 2092.

A 17-year-old adolescent with a history of muscular dystrophy is admitted with aspiration pneumonia. The nurse asks the parents if the client has an advance directive. Which response by the parents leads the nurse to believe that the parents don't understand the severity of the client's medical condition? "He has pneumonia; I shouldn't have let him go to that party last week." "This is the third time he's had pneumonia in the past 6 months. I'm afraid he needs a feeding tube." "Yes, he has an advance directive." "He is only 17. He doesn't need an advance directive."

"He is only 17. He doesn't need an advance directive." Explanation: The parents stating that their son is too young for an advanced directive suggests that the parents don't fully understand the seriousness of their son's medical condition. Advance directives can be used for any client who has an irreversible condition. Stating that they shouldn't have allowed their son to go to a party shows a lack of knowledge about acquiring aspiration pneumonia. Being concerned about the need for a feeding tube and having an advance directive show an understanding of their son's condition. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Nursing Management, p. 2112.

The nurse is providing health education to a client recently diagnosed with a brain tumor. During the appointment, the client states, "I'm really worried that I will have a seizure while I am at work or with my kids. Should I be concerned about this?" How should the nurse respond? "There is a risk for seizures in people who have this diagnosis. What have you already discussed with your primary health care provider regarding management of seizures?" "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." "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."

"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?" Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Relieving Anxiety, p. 2098.

Which medication classification should be avoided in the treatment of brain tumors? Anticoagulants Osmotic diuretics Corticosteroids Anticonvulsants

Anticoagulants Explanation: 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. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2096 Add a Note

The nurse teaches the client diagnosed with Huntington disease that it is transmitted as which type of genetic disorder? X-linked Autosomal recessive Autosomal dominant Non -repeated HTT gene

Autosomal dominant Explanation: Huntington disease is transmitted as an autosomal dominant genetic disorder. It is a genetic mutation , caused by the presences of a repeat of the ( Huntington gene) HTT gene. This disease is a chronic, progressive, hereditary disorder of the nervous system and results in progressive involuntary choreiform movements and dementia. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2108

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 = 90/50 mm Hg; HR = 75 bpm BP =130/80 mm Hg; HR = 55 bpm BP = 150/90 mm Hg; HR = 90 bpm BP = 175/45 mm Hg; HR = 42 bpm

BP = 175/45 mm Hg; HR = 42 bpm Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Increased Intracranial Pressure, p. 2093.

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 take an assortment of different drugs. Clients generally do not adhere to the drug regimen. Drugs administered may cause a wide variety of adverse effects.

Drugs administered may cause a wide variety of adverse effects. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Pharmacologic Therapy, p. 2103.

A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following? Dyskinesia Bradykinesia Micrographia Dysphonia

Dyskinesia Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Other Manifestations, p. 2103.

A client is admitted reporting low back pain. How will the nurse best determine if the pain is related to a herniated lumbar disc? Ask the client if there is pain on ambulation. Ask if the client can walk. Have the client lie on the back and lift the leg, keeping it straight. Ask if the client has had a bowel movement.

Have the client lie on the back and lift the leg, keeping it straight. Explanation: 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. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2117

A client has undergone a cervical discectomy. The nurse determines which interventions are essential to teach the client? Select all that apply. Keep staples or sutures clean and dry Cover incision with dry dressing Call health care provider if the area is red or irritated Avoid twisting or flexing the neck Do not remove dressing until the next visit Sit as much as possible; standing can cause pain

Keep staples or sutures clean and dry Cover incision with dry dressing Call health care provider if the area is red or irritated Avoid twisting or flexing the neck Do not remove dressing until the next visit Explanation: The client needs to keep staples or sutures clean and dry and covered with a dry dressing. Symptoms of infection should be reported to the health care provider. Twisting and flexing of the neck should be avoided. The client can remove the dressing to change it. The client should not sit or stand for longer than half an hour at a time. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, p. 2115.

A patient with amyotrophic lateral sclerosis (ALS) asks if the nurse has heard of a drug that will prolong the patient's life. The nurse knows that there is a medication that may prolong the life by 3 to 6 months. To which medication is the patient referring? Baclofen Riluzole Dantrolene sodium Diazepam

Riluzole Explanation: Riluzole, a glutamate antagonist, has been shown to prolong survival for persons with ALS for 3 to 6 months. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Management, p. 2111.

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 Severe lower back pain Sensory deficits in one arm Weakness and atrophy of the arm muscles

Severe lower back pain Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Herniation of a Lumbar Disc, p. 2117.

The nurse in the oncology outpatient clinic receives a phone call from a family member of a client who was diagnosed with a metastatic spinal cord tumor. The family member informs the nurse that the client has been reporting increased back pain in the region of the tumor and dizziness. How should the nurse respond? Provide education regarding adequate pain medication throughout the day Share information about expected symptoms related to growing tumors Instruct the family member to encourage the client to avoid lying in a prone position Tell the family member to get the client to hospital for emergency assessment

Tell the family member to get the client to hospital for emergency assessment Explanation: The client's reported symptoms are indicative of spinal cord compression, a complication of spinal cord tumors that can lead to permanent paralysis and several other irreversible sensory impairments. Signs and symptoms of spinal cord compression warrant an urgent assessment, because it is an emergency. Providing education regarding pain management, sharing information about expected symptoms and encouraging the client to lie in the prone position are all ineffective and unsafe nursing actions, because the presenting complaints warrant emergency assessment and intervention. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Medical Management, p. 2100.

A nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which finding requires immediate intervention? More back pain than the first postoperative day Paresthesia in the dermatomes near the wounds Urine retention or incontinence Temperature of 99.2° F (37.3° C)

Urine retention or incontinence Explanation: 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). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Monitoring and Managing Potential Complications, p. 2101.

A patient is diagnosed with amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig's disease. The nurse understands that the symptoms of the disease will begin in what way? Ascending paralysis Numbness and tingling in the lower extremities Weakness starting in the muscles supplied by the cranial nerves Jerky, uncontrolled movements in the extremities

Weakness starting in the muscles supplied by the cranial nerves Explanation: The chief symptoms are fatigue, progressive muscle weakness, cramps, fasciculations (twitching), and incoordination. In about 25% of patients, weakness starts in the muscles supplied by the cranial nerves, and difficulty in talking, swallowing, and ultimately breathing occurs. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Clinical Manifestations, p. 2110.